ISSN:0007-1323    

DOI:10.1046/j.1365-2168.1997.02755.x

出版商:John Wiley&Sons, Ltd.    

年代:1997

数据来源: WILEY

ISSN:0007-1323    

DOI:10.1046/j.1365-2168.1997.02801.x

出版商:John Wiley&Sons, Ltd.    

年代:1997

数据来源: WILEY

ISSN:0007-1323    

DOI:10.1002/bjs.1800840504

出版商:John Wiley&Sons, Ltd.    

年代:1997

数据来源: WILEY

摘要:

AbstractContinuing our introduction of surgeons from overseas who have joined the Editorial Board of the Journal during 1996. We present a short synopsis of their biographical data and clinical interests.

ISSN:0007-1323    

DOI:10.1002/bjs.1800840505

出版商:John Wiley&Sons, Ltd.    

年代:1997

数据来源: WILEY

摘要:

AbstractBackgroundClosed laparoscopy, employing a Veress needle and blind insertion of the first trocar, is favoured by most laparoscopic surgeons. The potential danger of this technique is the occurrence of visceral or vascular injury. Establishment of pneumoperitoneum by an open technique using a blunt‐tipped trocar may be a safer alternative.Methodsand Results Retrospective review of the literature and the authors' experience was used to compare closed and open laparoscopy. Data on closed laparoscopy in 489 335 patients and on open laparoscopy in 12 444 patients were culled. Rates of visceral and vascular injury were respectively 0.483 and 0.075 per cent after closed laparoscopy, and 0.048 per cent and zero after open laparoscopy. Mortality rates after closed and open laparoscopy were respectively 0.003 per cent and zero. Pearsonx2analysis demonstrated a statistically significant difference in terms of visceral and vascular injury between closed and open laparoscopy (P= 0.002); there was no such difference for mortality rates.ConclusionOpen establishment of pneumoperitoneum is advocated in laparoscopic surgery because it is safer than the closed metho

ISSN:0007-1323    

DOI:10.1046/j.1365-2168.1997.d01-1355.x

出版商:John Wiley&Sons, Ltd.    

年代:1997

数据来源: WILEY

摘要:

AbstractBackgroundBlunt trauma causing injury to the vessels of the aortic arch is uncommon but may be attended by serious consequences. Most surgeons will experience only an occasional case and will need to rely on published literature for guidance.MethodsA Medline search over 1986–1995 was carried out using the following keywords: brachiocephalic trunk, common carotid artery and subclavian artery; injury was used as a subheading.Resultsand Conclusion After the aortic isthmus, the innominate is the most commonly injured artery in the chest. Whatever the site of an arterial lesion, however, angiography is the diagnostic test of choice. Some vascular lcsions are relatively benign and may be managed without operation; this form of management may also be appropriate if there is severe associated neurological injury. Otherwise, operation using an approach and technique suited to the site of the injury is advocate

ISSN:0007-1323    

DOI:10.1046/j.1365-2168.1997.02756.x

出版商:John Wiley&Sons, Ltd.    

年代:1997

数据来源: WILEY

摘要:

AbstractBackgroundRandomized controlled studies of surgical procedures are difficult, but can be done to acceptable standards. There are few published objective assessments of such trials.MethodsThe original articles that involved a randomized controlled trial including at least one laparoscopic procedure were reviewed and evaluated with special interest in their methodology. An assessment form containing 11 generic questions and three additional criteria (assessment of quality of life, cost analysis and laparoscopic experience required) was used. Forty trials were retrieved including 12 on cholecystectomy, 12 on hernia repair and 12 on appendicectomy. Each trial was scored by two assessors.ResultsThe agreement among the two independent assessors was very good. Six of the trials were well conducted but 22 had a poor score. The trials on cholecystectomy were scored the best in contrast to those on hernia repair or appendicectomy. Few trials provided an adequate prospective calculation of the sample size, an unbiased assessment of endpoints, evaluation of the quality of life and a study of the economic aspects.ConclusionReaders should be cautious when interpreting the results of some of these trials and their impact on daily surgical practice.

ISSN:0007-1323    

DOI:10.1046/j.1365-2168.1997.02753.x

出版商:John Wiley&Sons, Ltd.    

年代:1997

数据来源: WILEY

摘要:

AbstractBackgroundAutosomal dominant polycystic kidney disease (ADPKD) is a common cause of renal impairment with a number of well recognized extrarenal associations. A high incidence of abdominal wall hernia was noted in patients with ADPKD.MethodsA retrospective review of the notes of all patients with ADPKD on the South Wales renal replacement therapy database was performed. These patients were compared with age‐ and sex‐matched patients with renal failure but without ADPKD and with general surgical patients.ResultsThe prevalence of hernia in patients with ADPKD was 38 of 85 (45 per cent) compared with seven of 85 (8 per cent) for other forms of renal failure and three of 85 (4 per cent) for general surgical controls (P<0·001). There were significantly greater numbers of inguinal (P<0·001), incisional (P= 0·019) and paraumbilical (P= 0·007) hernias in patients with ADPKD compared with the other two groups.ConclusionThese results show a significantly greater incidence of hernia, which could be an additional manifestation of the underlying defect in extracellular matrix production identified in patients wit

ISSN:0007-1323    

DOI:10.1046/j.1365-2168.1997.02616.x

出版商:John Wiley&Sons, Ltd.    

年代:1997

数据来源: WILEY

摘要:

AbstractBackgroundRegional chemotherapy using hepatic artery catheters is one method of treating patients with colorectal liver metastases. A problem arises when the catheter occludes in patients who are responding to treatment. This report describes experience of replacing occluded hepatic artery catheters.MethodsSome 108 patients with colorectal liver metastases had hepatic arterial catheters surgically implanted for regional chemotherapy. The catheter occluded in 17 patients at a time when they were responding to treatment. Twelve catheters were replaced, of which seven were inserted retrogradely into the splenic artery, four were anastomosed end to side to the common hepatic artery via a saphenous vein graft and one was replaced in the patent gastroduodenal artery.ResultsThe mean duration of catheter survival when a saphenous vein graft was used was 9·6 months compared with 2·5 months following retrograde insertion into the splenic artery.ConclusionReplacement of hepatic artery catheters is possible and may be of benefit in patients whose catheters fail while they are responding to treatment. The use of a saphenous vein graft appears to be a more anatomical and therefore preferable method of replacement than retrograde splenic artery cannulatio

ISSN:0007-1323    

DOI:10.1046/j.1365-2168.1997.02639.x

出版商:John Wiley&Sons, Ltd.    

年代:1997

数据来源: WILEY

摘要:

AbstractBackgroundBiliary complications are a significant cause of morbidity and death after orthotopic liver transplantation (OLT). This study was a prospective evaluation of endoscopic retrograde cholangiography (ERC) and hepatobiliary scintigraphy (HBS), using99mTc Mebrofenin, to detect early biliary complications following OLT.MethodsOne hundred consecutive patients who had OLT with a biliary duct‐to‐duct anastomosis were studied. Of these, 67 had both ERC and HBS performed within 30 days of OLT. Sensitivity, specificity and diagnostic accuracy of HBS in identifying biliary leak or stricture was calculated.ResultsOf the 67 cholangiographies performed 45 were normal. In 22 patients there was radiological evidence of a leak (n= 14) or stricture (n= 8) which required further intervention in nine and four patients respectively. The sensitivity and specificity of scintigraphy for the detection of biliary leak after transplantation was 50 and 79 per cent and for biliary stricture 62 and 64 per cent respectively. No patient with normal scintigraphy required biliary intervention. Only six of 14 patients with biliary leaks and two of 20 with strictures suggested by scintigraphy required intervention. If both ERC and HBS reported leak or stricture, the intervention rate was tonsiderably higher at five of seven leaks and two of five strictures.ConclusionThis study suggests that scintigraphy is a useful screening test for biliary complications after OLT. ERC is only necessary if HBS is abnor

ISSN:0007-1323    

DOI:10.1046/j.1365-2168.1997.02653.x

出版商:John Wiley&Sons, Ltd.    

年代:1997

数据来源: WILEY