ISSN:0007-1323    

DOI:10.1046/j.1365-2168.1997.02720.x

出版商:John Wiley&Sons, Ltd.    

年代:1997

数据来源: WILEY

ISSN:0007-1323    

DOI:10.1046/j.1365-2168.1997.02705.x

出版商:John Wiley&Sons, Ltd.    

年代:1997

数据来源: WILEY

摘要:

AbstractBackgroundA popliteal artery aneurysm (PAA) has been described as a ‘sinister harbinger of sudden catastrophe’. This review seeks to provide data regarding the epidemiological aspects, natural history, clinical presentation and results of treatment to help clinicians make appropriate decisions.MethodsA systematic review of data in the English language literature published since 1980.ResultsThe authors include 29 studies containing 1673 patients with 2445 PAAs. No controlled trials exist regarding the management of PAAs.Conclusion(1) At most, only four or five patients are seen each year by a major vascular centre; (2) aortic aneurysms are found in 37 per cent and bilateral PAAs in 50 per cent of patients; (3) more than 95 per cent of patients are men with a mean age of 65 years and 45 per cent have hypertension; (4) approximately one‐third of patients are asymptomatic at the time of initial diagnosis; (5) the risk of ischaemic complications after conservative follow‐up varies from 8 to 100 per cent (mean 36 per cent), depending on the selection of patients and duration of follow‐up; (6) elective surgical reconstruction is recommended for all asymptomatic aneurysms; (7) 5‐year graft patency rates after surgical repair range from 29 to 100 per cent, with 5‐year limb salvage ranging from 75 to 98 per cent; (8) patient survival rates at 5 and 10 years are 70 and 44 per cent respectively; (9) lifelong, careful patient surveillance is essential to detect and treat new aneurysms a

ISSN:0007-1323    

DOI:10.1046/j.1365-2168.1997.02731.x

出版商:John Wiley&Sons, Ltd.    

年代:1997

数据来源: WILEY

摘要:

AbstractBackgroundFaced with upward pressure on costs from ageing populations and new technologies, those responsible for funding health care are seeking innovative ways of providing that care at lower cost. A common strategy is to shift care from the inpatient to the outpatient setting. This, taken with pressure for greater accountability and improved training, is creating great challenges for those responsible for organizing outpatient care. This paper seeks to review these challenges and the various responses to them.MethodsA critical review of literature on the changing role of outpatient care, with an emphasis on the current situation in the United Kingdom.ResultsMany diverse responses have been developed to address the changing nature of outpatient care. These have certain features, including the recognition that clinicians have the ability to initiate, rather than simply react to change, and an appreciation of the value of clear and definable objectives for outpatient care. They range from discrete interventions addressing a single concern to wholesale restructuring of the system of care, such as one‐stop clinics.ConclusionThere is now considerable evidence on what can and should be done to improve the existing system of outpatient car

ISSN:0007-1323    

DOI:10.1046/j.1365-2168.1997.02732.x

出版商:John Wiley&Sons, Ltd.    

年代:1997

数据来源: WILEY

ISSN:0007-1323    

DOI:10.1046/j.1365-2168.1997.00085.x

出版商:John Wiley&Sons, Ltd.    

年代:1997

数据来源: WILEY

摘要:

AbstractBackgroundProstheses are widely used in the elective treatment of adult groin hernias. Their use for strangulated hernias remains controversial because of the potential risk of sepsis.MethodsThirty‐five patients with a strangulated groin hernia were treated by insertion of a prosthetic mesh via a midline preperitoneal approach. Nine patients needed an intestinal resection for irreversible necrosis without peritonitis, and an appendicectomy was carried out in three others.ResultsThere were two postoperative wound infections, neither in patients who had an intestinal resection. No mesh had to be removed. The recurrence rate was one of 35 after mean follow‐up of 4.2 years.ConclusionA strangulated groin hernia can be repaired safely with prosthetic mesh. When an intestinal resection is carried out with sufficient care to minimize infective complications, the use of mesh is not contraindica

ISSN:0007-1323    

DOI:10.1046/j.1365-2168.1997.02509.x

出版商:John Wiley&Sons, Ltd.    

年代:1997

数据来源: WILEY

ISSN:0007-1323    

DOI:10.1046/j.1365-2168.1997.02595.x

出版商:John Wiley&Sons, Ltd.    

年代:1997

数据来源: WILEY

ISSN:0007-1323    

DOI:10.1046/j.1365-2168.1997.02550.x

出版商:John Wiley&Sons, Ltd.    

年代:1997

数据来源: WILEY

摘要:

AbstractBackgroundThe treatment of giant symptomatic haemangioma of the liver is still controversial. This retrospective study reviewed the results of surgical treatment.MethodsTwenty‐eight patients with symptomatic giant haemangioma of the liver were treated by liver resection (n= 24) or liver transplantation (n =4). The median diameter of the haemangiomas was 11 (range 5–20) cm.ResultsComplications occurred in five of the 24 patients treated by partial liver resection, although all survived and remain alive and well more than 2 years after surgery. In six patients there was residual haemangioma in the liver remnant which did not enlarge during the 2‐year follow‐up. In four patients the haemangioma was considered irresectable and liver transplantation was performed. One died after a ‘two‐stage’ liver transplantation; the remaining three patients are alive and well, 1, 4 and 9 years after transplantation.ConclusionLiver resection is the treatment of choice for giant haemangioma of the liver where possible. In selected cases liver transplantation

ISSN:0007-1323    

DOI:10.1046/j.1365-2168.1997.02534.x

出版商:John Wiley&Sons, Ltd.    

年代:1997

数据来源: WILEY

摘要:

AbstractBackgroundLaser‐induced thermotherapy is a minimally invasive method that can be applied percutaneously or during laparotomy for the treatment of malignant liver tumours. The aim of this experimental study was to investigate whether the laparoscopic approach is suitable for laser‐induced thermotherapy. Laparoscopic ultrasonography was tested as an aid to intrahepatic positioning of the applicators as well as for online monitoring during application.MethodsA neodymium yttrium–aluminium–garnet laser was used to induce thermal lesions in the healthy liver of ten German hybrid pigs. The length of application was 840 s. Forty applications were performed with normal hepatic blood flow and 40 with hepatic blood flow interrupted by means of a laparoscopic Pringle's manoeuvre.ResultsA total of 20 simultaneous multifibre applications with 80 single applications were performed. Thermal necrosis with a total volume of 50·3 cm3was induced with high precision when hepatic blood flow was interrupted temporarily. When hepatic blood flow was normal, the total volume of thermal necrosis was only 14·6 cm3(P<0·01). Laparoscopic ultrasonography was used successfully as an aid for exact applicator positioning and for online monitoring. Method‐related complications did not occur.ConclusionThe laparoscopic approach is an attractive means of application for laser‐induced thermotherapy and it seems that clinical testin

ISSN:0007-1323    

DOI:10.1046/j.1365-2168.1997.02567.x

出版商:John Wiley&Sons, Ltd.    

年代:1997

数据来源: WILEY