ISSN:0038-4348    

出版商:OVID    

年代:1985

数据来源: OVID

摘要:

Closure of the infected sternotomy has been facilitated by the use of the pectoralis major musculocutaneous flap and has been well described. This paper describes six cases of more complex infected thoracotomies and the methods of closure. Knowledge of the dual blood supply of many of the thoracic musculocutaneous units is important in closure of these difficult thoracic wounds. The axial and segmental blood supply of the large flat muscles of the chest wall can be exploited to satisfy complex defects involving both vertical and transverse thoracotomy incisions and therefore decrease the risk of progressive infection and erosion of major vascular structures.

ISSN:0038-4348    

出版商:OVID    

年代:1985

数据来源: OVID

摘要:

A significant percentage of children who are fecally incontinent are so from improper operation or failure to recognize a surgically correctable problem. Over the past five years, we have managed ten children who had operations for anorectal problems and two with anterior anus. Seven were seen after poorly positioned pull-through procedures for imperforate anus and had anal repositioning, four successfully. Gracilis sling was successful in two of the other three. In two children overflow after a Duhamel operation for Hirschsprung's disease was corrected by division of a persistent anorectal septum. The third child with a disrupted Duhamel procedure was cured by anolevatorplasty. In two children an anterior ectopic anus was made continent by posterior anoplasty. Primary and secondary deviations from proper anatomy of the anorectal region will result in incontinence, which may be recognized by physical examination and defecograms. Proper operation usually produces acceptable continence.

ISSN:0038-4348    

出版商:OVID    

年代:1985

数据来源: OVID

摘要:

Both percutaneous and endoscopic cholangiography identify strictures, stones,and other causes of biliary obstruction. With a radiologic diagnosis, benign and malignant causes of biliary obstruction can often be differentiated, but cholangiography does not provide a pathologic diagnosis. Therefore, we recommend cytologic excamination of bile obtained during cholangiography to provide pathologic evidence of malignant causes of bile duct obstruction. We present the results of the diagnostic work-up of 17 patients with biliary obstruction to demonstrate the value of examining bile for malignant cells in all cases of biliary obstruction requiring cholangiography. If bile is cytopathologically normal, the diagnostic work-up must proceed. Abnormal findings on cytologic examination of bile in this study were confirmed with a tissue diagnosis or at operation (once) for malignant neoplasm in 100% of cases (ie, there were no false-positive results).

ISSN:0038-4348    

出版商:OVID    

年代:1985

数据来源: OVID

摘要:

Operations on the biliary tract in cirrhotic patients are reported to have a higher than normal risk of operative morbidity and mortality. We reviewed 39 cases from two university-based hospitals over a five-year period. Each patient had biliary tract surgery and biopsy-proven cirrhosis. Eight patients died (21%), and major complications were found in 12 surviving patients (35%). Local and systemic sepsis was the major contributor, accounting for all of the deaths and 17 of the 22 (77%) complications among survivors. Choledochotomy was done in ten patients; three of them died (30%) and nine major complications occurred in the remaining five. Preoperative risk factors found to be predictive of this high morbidity and mortality were ascites (50% mortality, 50% morbidity), prolonged prothrombin time (29% mortality, 38% morbidity), and a serum albumin level of<3.5 mg/dl (33% mortality, 40% morbidity). The presence of other major systemic disease was not significantly different between survivors and nonsurvivors. In 12 patients with no ascites and normal preoperative serum chemistry values, no deaths and only one minor complication occurred. We conclude that although biliary surgery in cirrhotic patients carries a high mortality, this risk can be assessed preoperatively. There appears to be a small subgroup of patients with cirrhosis and cholelithiasis who can have a favorable outcome. Operative therapy in these patients should be reserved for the complications of the biliary tract.

ISSN:0038-4348    

出版商:OVID    

年代:1985

数据来源: OVID

摘要:

Preoperative placement of a No. 9 percutaneous transhepatic drainage catheter for two to three weeks greatly improves the condition of the patient who has suffered operative damage to the hepatic bile ducts. At operation the previously placed catheter serves to identify the proximal portion of the damaged bile duct, even in dense scar tissue, and then serves to pull a Silastic tube stent in a retrograde manner into the bile duct and out through the right hepatic lobe and skin. This stent is left across the hepaticojejunostomy anastomosis for 12 months, or even permanently, in cases in which the anastomosis can be made only to scar tissue rather than biliary mucosa.

ISSN:0038-4348    

出版商:OVID    

年代:1985

数据来源: OVID

摘要:

Primary duodenal carcinoma is an uncommon tumor that tends to be diagnosed late in its course because of a symptom complex compatible with many benign diseases. We reviewed the cases of five patients with duodenal adenocarcinoma treated at Norfolk General Hospital from 1973 to 1983. Periampullary tumors were excluded. The most common symptom, nausea and vomiting, was present in four patients, all of whom had microcytic anemia; in three, tests showed blood in stool specimens. The upper gastrointestinal series was suggestive of carcinoma in all patients. One of the lesions was proximal to the ampulla, while the other four were in the third and fourth portions of the duodenum. Only three of the lesions could be seen on upper GI endoscopy, and in only one of the three was the biopsy specimen positive for malignancy. At laparotomy, two patients had resectable lesions, but only segmental resection was done. Three patients had unresectable disease because of liver metastases and/or involvement of the root of the small bowel mesentery. Because delay in diagnosis of duodenal carcinoma may prevent successful resection, greater awareness of the possibility of these uncommon lesions, along with aggressive diagnostic work-up, may result in a higher percentage of cures.

ISSN:0038-4348    

出版商:OVID    

年代:1985

数据来源: OVID

摘要:

Three cases of tetanus occurring in a community in southern West Virginia in five years prompted a survey of. the immunization status of the population of this region. An immunization history was obtained from 540 consecutive patients seen at three different health care facilities. Of these, 386 (71.5%) had received prior tetanus protection, 65 (12%) had never been immunized, and 89 (16.5%) were uncertain or had received incomplete immunization. Of the 65 nonimmunized patients, 54 (83%) were older than 50 and only 11 (17%) were younger. Compared to the total group sampled, significantly more nonimmunized patients (both male and female) were older than 50 (P<.001). Also, significantly more of these never immunized individuals lived in rural areas (P<.001). In a group of 222 patients identified as being at increased risk of having tetanus, 65 (29%) had never been immunized, 89 (40%) were of uncertain or incomplete status, and 68 (30.5%) had been immunized more than ten years previously. One hundred twenty (54%) high-risk patients were older than 50 and 103 (46%) were younger. Compared to the entire population sampled, high-risk patients included significantly more who were older than 50 (P<.001). Also, significantly more high-risk patients lived in rural areas (P<.007). When treating injured patients, it is important to recall that many older adults living in rural areas are not adequately immunized against tetanus. Such patients should receive human tetanus immunoglobulin, as well as tetanus toxoid.

ISSN:0038-4348    

出版商:OVID    

年代:1985

数据来源: OVID

摘要:

Diagnosis and management of hand infections in the elderly can be challenging. The general principles of rest, elevation; compresses, and drainage when appropriate apply. Antibiotics are important to therapy. Review of data from elderly patients and comparison with a younger population having identical infections show a number of important differences. Temperature, pulse, and white blood cell and differential counts were not elevated significantly enough to be useful. Culture data show fewer pureStaphylococcus aureusinfections (20%) and fewer pure gram-positive infections (20%) than the 34% and 56% respectively in a younger population. On the other hand, there were significantly more mixed gram-positive and gram-negative infections (60%). Significantly, the average number of organisms per infection is increased (2.4 vs 1.9 per infection). Antibiotic susceptibility is significantly worse. The cephalosporins and the penicillinase-resistant antibiotics remain good choices.

ISSN:0038-4348    

出版商:OVID    

年代:1985

数据来源: OVID

摘要:

An outbreak of four cases of type 8Streptococcus pneumoniaepneumonia occurred on an Oncology Ward during a five-day period. All four patients had underlying malignancy and were in close proximity to each other on an open ward. No other patients or hospital personnel had type 8 Spneumoniaeon throat or nasopharyngeal cultures. The implications of the outbreak with respect to transmission of this disease and role of pneumococcal vaccination are discussed.

ISSN:0038-4348    

出版商:OVID    

年代:1985

数据来源: OVID