摘要:

One hundred and sixty‐eight ruptured aortic aneurysms presenting at the Princess Alexandra Hospital in an 11‐year period have been reviewed. Surgical treatment still carries a high mortality and a very high postoperative morbidity. The survival rate in the Vascular Unit of this hospital has improved during the period studied and in the last five years has risen to 61%. The operative technique is described in detail, and the operative problems and complications are discussed. It is felt that prompt surgical treatment, and accurate assessment of blood loss with adequate replacement during surgery, combined with attention to early postoperative problems, particularly those of a respiratory nature, are the most important factors in survi

ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1977.tb03934.x

出版商:Blackwell Publishing Ltd    

年代:1977

数据来源: WILEY

摘要:

The experience of acute mesenteric ischæmia at St Vincent's Hospital, Melbourne, has been reviewed over 17 years. The mortality remains appallingly high. This applies particularly to those patients who had thrombosis of the superior mesenteric artery, amongst whom the mortality in this series was 97%. The mortality was slightly less in the group suffering from embolic occlusion of the superior mesenteric artery (66%), and in those suffering from thrombosis of the superior mesenteric vein (60%). A mortality of 66% was also found in patients suffering from non‐occlusive gut ischæmia. Delay in diagnosis accounted for this high mortality. Early diagnosis is all‐important, and this depends on the performance of mesenteric angiography in any patient suspected of having mesenteric ischæmia. Appropriate surgery may then be carried out in the occlusive group and supportive treatment, including intraarterial papaverine infusion, given to those with non‐occlusive ischæmia. There is a pressing need for simple non‐invasive tests to segregate those patients suffering from acute mesenteric ischæmia from those whose acute abdomen is due to some

ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1977.tb03935.x

出版商:Blackwell Publishing Ltd    

年代:1977

数据来源: WILEY

摘要:

The term “claudication of the cauda equina” is examined. It has arisen from semantic errors, and a belief in ischæmia for which there is no scientific evidence. Its use tends to hamper rather than assist the investigation of patients with obscure pain in the lower limb. A preferable alternative term, “atypical sciatica”, is s

ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1977.tb03936.x

出版商:Blackwell Publishing Ltd    

年代:1977

数据来源: WILEY

摘要:

A survey of surgical in‐patients in Hong Kong has shown that subclinical peripheral arterial disease caused by atherosclerosis and detected by palpation is not uncommon and is similar in incidence to that reported in European populations. However, only a small proportion of affected patients had any associated symptoms. Reduced or absent ankle and ulnar pulses occurred with the same frequency in our patients as in those in Europe. Cigarette smoking does not appear to be associated with symptomatic arterial disease in the local population in Hong Kon

ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1977.tb03937.x

出版商:Blackwell Publishing Ltd    

年代:1977

数据来源: WILEY

摘要:

This is a report on the periods of survival, and the factors that influence survival, in a series of 509 patients treated for malignant melanoma in the Peter MacCallum Clinic, Melbourne. Not the least of these factors is education of the public and the medical profession in its early recognition, which has greatly improved the prognosis. In this context, it is also firmly believed that whenever possible, one clinician only should be responsible for the total surgical management of any patient suffering from this disease.

ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1977.tb03938.x

出版商:Blackwell Publishing Ltd    

年代:1977

数据来源: WILEY

摘要:

Three hundred liver scans were performed on a routine basis in patients with colorectal carcinoma, before and after operation, to detect hepatic metastases. In 98 of 106 pre‐operative and 28 of 194 postoperative scans, confirmation of the pathological condition was obtained at operation or post‐mortem examination. The overall diagnostic accuracy of the scan was 77.4%, but the false‐positive rate was high.The presence of focal defects in liver scans before operation did not influence our decision regarding abdominal exploration. After operation on patients who did not have disseminated disease and whose liver scans showed localized focal defects, selective hepatic arteriography and abdominal exploration did not reveal resectable metastatic disease. In one‐third of patients with abnormal liver scans after operation, subsequent scans returned to normal.Of the patients with true positive liver scans, three‐quarters had clinically evident hepatic metastases. Serum alkaline phosphatase estimations were as accurate in detecting liver metastases as the liver scan, and returned fewer false‐positive results. Routine liver scanning before or after operation is not recommended for patients with colorectal carcinoma and should be reserved for patients with clinical features or biochemical abnormalities suggestive of liver

ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1977.tb03939.x

出版商:Blackwell Publishing Ltd    

年代:1977

数据来源: WILEY

摘要:

An analysis of 246 cases of perforated peptic ulcer, treated at the Royal Newcastle Hospital from 1964 to 1974, is presented. The incidence has fallen considerably over that period. The rising proportion of women has reached a plateau. A perforated peptic ulcer in an Australian woman is still just as likely to be located in the stomach as In the duodenum. In men, however, 84% of perforations are pyloroduodenal. A perforated gastric ulcer is closely associated with the use of salicylate preparations. The mortality rate has remained steady at 15% over the last 30 years. It is significantly higher in women.There is a highly significant relationship between the mortality and (a) the duration of perforation; and (b) the size of the perforation, particularly if it is located in the stomach.

ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1977.tb03940.x

出版商:Blackwell Publishing Ltd    

年代:1977

数据来源: WILEY

摘要:

Para‐ileostomy hernia is an uncommon cause of bowel obstruction following ileostomy. Two cases are reported that demonstrate the difficulty in diagnosis and the high morbidity associated with this condition. Early recognition and repair of the uncomplicated and strangulated hernia are recommende

ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1977.tb03941.x

出版商:Blackwell Publishing Ltd    

年代:1977

数据来源: WILEY

摘要:

Pancreatitis is a rare disease under the age of 15 years, and especially so when associated with gallstones. A case is reported here of a young girl who had acute pancreatitis and was subsequently found to have gallstones. She made an uneventful recovery and remains symptom‐free after cholecystectom

ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1977.tb03942.x

出版商:Blackwell Publishing Ltd    

年代:1977

数据来源: WILEY

摘要:

One hundred and forty‐one patients have undergone mediastinoscopy in the Hong Kong University Surgical Unit since March 1974. Among these there were 109 cases of bronchogenic carcinoma. In approximately 50% of these patients the carcinoma had already spread to involve the mediastinal lymph nodes at the time of examination. Mediastinoscopy may be the only source of positive histological proof of the diagnosis in bronchogenic carcinoma as well as in other types of intrathoracic disease such as tuberculosis. We believe that mediastinoscopy reduces the number of unnecessary exploratory thoracotomie

ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1977.tb03943.x

出版商:Blackwell Publishing Ltd    

年代:1977

数据来源: WILEY