摘要:

SummaryConventional surgical treatment of ectopic pregnancy may decrease subsequent fertility. Conservative surgery may increase the risk of another ectopic pregnancy, partly because damaged tube is saved. Because there is evidence that the mucosa close to the site of tubal implantation may be irreparably damaged, a logical approach may be to conserve as much tube as possible whilst excising the segment which contains the eccyesis. The techniques, advantages and disadvantages of the various conservative operations are discussed. The authors favour salpingotomy with excision of the involved segment, thus preserving the tube for anastomosis later if this is requested by the patient.

ISSN:1340-9654    

DOI:10.3109/01443618409075752

出版商:Taylor&Francis    

年代:1984

数据来源: WILEY

摘要:

SummaryUrinary incontinence is common. It affects about 10 per cent of the adult female population in this country (Thomaset al., 1980). Not only is it distressing to the patient but it presents a social and hygienic problem and is expensive in terms of protective garments and nursing time. It is therefore important that treatment achieves the best possible cure rate.

ISSN:1340-9654    

DOI:10.3109/01443618409075766

出版商:Taylor&Francis    

年代:1984

数据来源: WILEY

摘要:

SummaryAntimicrobial prophylaxis for abdominal hysterectomy has been widely used over the past decade. Many trials have been unsatisfactory because of the criteria employed to indicate the presence or absence of infection. In particular, febrile morbidity, for which there is no generally accepted definition, is not directly related to wound infection. Whilst some prophylactic regimens have demonstrated a decrease in the incidence of febrile morbidity without any accompanying decrease in the number of wound infections, others have produced a rise in the incidence of febrile morbidity together with a significant fall in the number of wounds infected.

ISSN:1340-9654    

DOI:10.3109/01443618409075753

出版商:Taylor&Francis    

年代:1984

数据来源: WILEY

摘要:

SummaryPostoperative infections in abdominal and pelvic wounds after abdominal hysterectomy are mostly due to more than one organism, representing the wide range of anaerobic and aerobic bacteria present in the vagina of the asymptomatic female (Kauppilaet al., 1983). Anaerobes, notably theBacteroidesspecies, may be found alone or in association with aerobes in 90 per cent of pelvic abscesses (Seligman, 1978). Researchers have been unable to demonstrate wound infections in animal models after inoculation of pureBacteroidescultures and some doubt has been cast on the pathogenicity of this species. Kelly (1980), in a series of elegant experiments, demonstrated a pathogenic synergy betweenEscherichia coliandBacteroides fragilis.When individually subinfective doses of these organisms were inoculated together into surgical wounds, severe sepsis resulted. Similarly, when peri-operative wound swabs cultured both aerobes and anaerobes the incidence of postoperative wound infection was 71 per cent compared to 13 to 22 per cent if anaerobes or aerobes were isolated singly. Infections caused by a combination of aerobic and anaerobic organisms are dependent on the presence of both and reduction of one kind of bacteria may preclude infection by the other. If either the anaerobic or aerobic population is decreased at the time of operation, there will be reduction in the rate of postoperative sepsis.

ISSN:1340-9654    

DOI:10.3109/01443618409075754

出版商:Taylor&Francis    

年代:1984

数据来源: WILEY

摘要:

SummaryThe Use of prophylactic antibiotics to reduce the incidence of postoperative infections is well established. In gynaecological surgery many authors including the Study Group (1975) and Vaughanet al.(1981) have shown metronidazole or cephradine to be useful in lowering postoperative infection rates.

ISSN:1340-9654    

DOI:10.3109/01443618409075755

出版商:Taylor&Francis    

年代:1984

数据来源: WILEY

摘要:

SummaryThe Efficacy of prophylaxis in abdominal hysterectomy has been much studied but remains controversial. Recently, there have been some detailed literature reviews on the topic (Bergeret al., 1980; Hirschmann and Inui, 1980; Polk, 1981). By evaluating studies which have been carried out scientifically as suggested by Gifford and Feinstein (1969), that is, prospective, double-blind, placebo-controlled and randomised, the authors of these reviews report a reduction in the incidence of complications resulting from infection in nearly all the studies. Particularly with respect to the in, incidence of postoperative wound infection, this reduction is statistically significant in some reports. During the period of January 1982 to March 1983, we assessed the efficacy of prophylaxis, using ampicillin plus penicillanic acid sulphone (Sulbactam sodium CP 45899, Pfizer) or ampicillin plus metronidazole, in major gynaecological surgery carried out at our hospital (Study A; Houanger al., 1984). The results obtained in patients undergoing abdominal hysterectomy will be reported here. Since November 1983, we have been studying the efficacy of piperacillin in prophylaxis for abdominal hysterectomy in comparison with the combination of ampicillin plus metronidazole (Study B). We also report the preliminary results of this study.

ISSN:1340-9654    

DOI:10.3109/01443618409075756

出版商:Taylor&Francis    

年代:1984

数据来源: WILEY

摘要:

SummaryIrritable bowel syndrome is said to affect 14 per cent of the population (Thompson and Heaton, 1978) and affects women more frequently than men. We have shown (Alun Joneset al., 1982; Hunteret al., 1984) that in two-thirds of cases presenting in East Anglia the symptoms can be controlled, both in the short and the long term, by the detection of specific food intolerances.

ISSN:1340-9654    

DOI:10.3109/01443618409075757

出版商:Taylor&Francis    

年代:1984

数据来源: WILEY

摘要:

SummaryThe indications for prophylactic antibiotics in surgery have been studied intensely over the past few years, and consensus is beginning to emerge in three main areas—the type of patient that requires prophylactic agent, the type of agent that should be given and its duration. It is now a reasonable strategy to use a prophylactic agent when a viscus harbouring micro-organisms is excised. Thus prophylactic antibiotics are indicated for abdominal hysterectomy. The type of agent selected must have an appropriate spectrum for the potential pathogens, including several anaerobes, streptococci, staphylococci and one or two other species. It is not clear whether or not it is necessary to‘cover’all the potential pathogens as the removal of some members of a mixed infection may result in the elimination of all the organisms. The antibiotics with most appropriate spectrum are metronidazole and first generation cephalosporins. More recently introduced cephalosporins have a spectrum predominantly towards Gram negative aerobes and are not indicated. The obvious contender amongst the first generation cephalosporins is cephradine, on account of its safety, price and convenience. It is a true advantage for an antibiotic to be available both parenterally and orally for two main reasons—there are fewer risks of idiosyncratic reactions to one drug compared to two, and, if cephradine is given by injection, any antibiotic reaching the small intestine in the bile should be reabsorbed with the benefit of reducing disturbance of the intestinal flora and increasing available antibiotic in the tissues. The correct timing of the antibiotic would seem to be administration with the pre-medication, with continuation for not more than 48 hours.

ISSN:1340-9654    

DOI:10.3109/01443618409075758

出版商:Taylor&Francis    

年代:1984

数据来源: WILEY

ISSN:1340-9654    

DOI:10.3109/01443618409075759

出版商:Taylor&Francis    

年代:1984

数据来源: WILEY

摘要:

SummaryAbdominal hysterectomy is often a relatively easy operation completed in half an hour, or it may make great technical demands upon the surgeon and of his time. We learn our surgical techniques from our mentors and from their writings, and from this distillate we develop a method that is suitable to our individual aptitudes and skills. With hysterectomy the gynaecologist has a standard technique which is hoped to be efficient, relatively rapid and easy to teach. At times the surgeon may be required to surrender a set routine and modify the operation for special circumstances. It is these unusual situations that I have been asked to discuss, and my views are based upon my own surgical experiences and a certain amount of consultation of Bonney's textbook, which has been on my bookshelf this past 30 years.

ISSN:1340-9654    

DOI:10.3109/01443618409075760

出版商:Taylor&Francis    

年代:1984

数据来源: WILEY