摘要:

Intrapancreatic cysts were demonstrated by endoscopic retrograde pancreatography (E.R.P.) in nine patients with a clinical diagnosis of relapsing pancreatitis. The cysts ranged in diameter from 0.6 cm to 5 cm and were frequently associated with a prolonged elevation of the serum amylase level. The complication of intracystic haemorrhage with obstructive jaundice developed in one patient requiring early surgical decompression and drainage. In four patients laparotomy was performed because of continuing abdominal pain. One patient was treated by cystogastrostomy and another by cyst aspiration, but in two patients the cyst could not be visualized or palpated. Four patients were observed without operation for periods of four to 24 months, and all showed improvement or resolution of symptoms. E.R.P. was repeated in one patient and the cyst could not be outlined, while in another an abnormal barium meal X‐ray examination result reverted to normal. Intrapancreatic cysts can be managed non‐operatively, since complications appear infrequent and spontaneous resolution

ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1979.tb06434.x

出版商:Blackwell Publishing Ltd    

年代:1979

数据来源: WILEY

摘要:

A retrospective study of three hundred patients with colorectal cancer seen during a five‐year period at Wellington Hospital is presented. The age incidence, anatomical distribution, tumour stage and incidence of intestinal obstruction differ from those reported in most other series. There is no correlation between delay in presentation and Dukes stage. It is suggested that colorectal cancer is a more aggressive disease In New Zealand than it is elsewhere in the world. The dangers of translating disease statistics from one country to another are emphasize

ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1979.tb06435.x

出版商:Blackwell Publishing Ltd    

年代:1979

数据来源: WILEY

摘要:

The explicit criteria method for quality assurance programmes consists ol drawing up criteria for management of specific conditions, either by consensus of experts (normative criteria) or by adopting practice norms (empiric criteria). These are then applied to medical record reviews. Opinions were sought from 36 physician gastroenterologists, 12 trainee gastroenterologists and 219 N.S.W. interns regarding which investigations were considered essential for a patient admitted to hospital for surgery for colorectal cancer. A haemoglobin estimation and chest X‐ray examination were considered to be almost universally necessary by all groups; barium enema/colonoscopy necessary by 95% interns; 92% trainees, 84% surgeons and 75% physicians; liver function tests by 84% interns, 83% trainees, 52% surgeons and 72% physicians; liver scan by 57% interns 50% trainees, 16% surgeons, 53% physicians. Average percentages for the five investigations were 86% interns, 83% trainees, 77% physicians, 68% surgeons. A retrospective medical record review of 230 consecutive patients admitted to A.C.T. hospitals with colorectal cancer showed that the following investigations were recorded; preoperative haemoglobin level 92%; preoperative chest X‐ray 74%; liver function tests/liver scan 66%; barium enema/colonoscopy 58%. This study highlights the difficulties of retrospective record reviews; shows no real difference in opinion between interns and trainee gastroenterologists regarding these explicit criteria; and suggests that normative criteria set up for quality assurance programmes must be formed by involvement of all medical personnel concerned. This, in itself, could be a rewarding education proc

ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1979.tb06436.x

出版商:Blackwell Publishing Ltd    

年代:1979

数据来源: WILEY

摘要:

A personal series of 93 patients treated by low anterior resection for carcinoma (87) and benign disease (6) is reviewed to highlight the technical problems and complications of the operation. The series comprises two groups for comparison of (i) technique of anastomosis; (ii) the use of protective stoma; and (Hi) methods of drainage.

ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1979.tb06437.x

出版商:Blackwell Publishing Ltd    

年代:1979

数据来源: WILEY

摘要:

The mortality and complications of large‐bowel resection for carcinoma performed at the Princess Alexandra Hospital since the Colorectal Project commenced in 1971 are reviewed and compared with the results in other published series.There were 443 patients in this prospective study, and 375 underwent resection of their tumour. The overall operative mortality was 6.4% ‐ for colonic lesions it was 8.0% and for rectal 3.4%. The mortality for elective curative resections was 2.6%, and for emergency resections it was 10.8%. The anastomotic leak rate was 6.8%, but was higher (16.6%) when the anastomosis was done at the time of emergency resection. No patient whose anastomosis leaked but who had had a previous defunctioning proximal colostomy died. There was a wound infection rate of 15

ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1979.tb06438.x

出版商:Blackwell Publishing Ltd    

年代:1979

数据来源: WILEY

摘要:

A series of 119 patients undergoing elective resection for diverticular disease has been reviewed. The indications for resection were classified into two ma|or groups – those with severe infections (“complicated” diverticulitis), comprising 58 patients, and those with minimal infections, comprising 61 patients. The majority of the resections were limited to the sigmoid colon (101 patients). Fifteen patients underwent left hemicolectomy, whilst three had total colectomy. Thirty‐six patients (30%) had a proximal defunctioning stoma – 18 prior to resection and 19 at the time of resection. Anastomotic defects were noted in 15 patients (12.6%), but these were of clinical significance only in eight (6.7%). There were two deaths (1.7%) and 17 wound infections (14.3%). The group classified as “complicated” diverticulitis included the great majority of the patients requiring colostomy (32 out of 37), almost all those with anastomotic defects (14 out of 15), and most of the patients who had postoperative

ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1979.tb06439.x

出版商:Blackwell Publishing Ltd    

年代:1979

数据来源: WILEY

摘要:

One hundred and twenty‐seven patients with complete rectal prolapse have been reviewed. The condition occurred more commonly in females than males (105 to 22), and at an older age in females (mean age 55 years compared with 40 years for males). Although the diagnosis is usually obvious, the importance of recognizing occult prolapse is stressed, especially in association with benign rectal ulcer, localized proctitis and colitis cystica profunda. Examination of the patient in the squatting position may assist in showing occult prolapse. Associated incontinence occurred in 33 patients (26%).Since 1971 the policy of this Unit has been to perform a Ripstein repair for complete rectal prolapse wherever possible. One hundred and two Ripstein repairs have now been performed. A minimum follow‐up period of two years is available for 53 patients, of whom 50 (94%) have had their prolapse cured. Control of prolapse usually improves continence; however, seven (13%) remained incontinent despite surgery. The Ripstein. repair is strongly advocated as the most effective operation for cure of complete rectal prola

ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1979.tb06440.x

出版商:Blackwell Publishing Ltd    

年代:1979

数据来源: WILEY

摘要:

One in six patients receiving renal transplants has orthopaedic problems. Osteoporosis with accompanying fractures is common, as is avascular necrosis of the hips, knees, and other bones. Immunosuppressive therapy with steroids is implicated and its mode of action discussed. No means of prophylaxis is known. If treated conservatively, aseptic necrosis of bone is much more disabling than is commonly believed as judged by the critical assessment technique of Charnley. The authors therefore recommend that a surgical approach should be adopted whenever possible.

ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1979.tb06441.x

出版商:Blackwell Publishing Ltd    

年代:1979

数据来源: WILEY

摘要:

Non‐union of mandibular fractures is uncommon, but when it does occur it requires protracted treatment including further surgery. Nine patients with factors known to predispose to non‐union out of 150 consecutive mandibular fractures received interferential therapy (I.T.) during the fixation period; all fractures united satisfactorily. In a retrospective study of 150 consecutive mandibular fractures previously treated by the same surgeons without I. T., three fractures resulted in non‐union requiring grafting. Thus the incidence of non‐union was 0% when I. T. was used and 2% in the contro

ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1979.tb06442.x

出版商:Blackwell Publishing Ltd    

年代:1979

数据来源: WILEY

摘要:

Albright in 1944 described a syndrome of hypercalcaemia in patients immobilized following fractures through bones affected with Paget's disease. This paper reports a further two cases in which this syndrome was con‐. sidered the cause of hypercalcaemia with fatal outcome. Both patients had parathyroid adenomata. The literature is reviewed, and it is argued that no firm evidence for the existence of this syndrome has ever been put forward. The finding of hypercalcaemia in Paget's disease of bone should prompt an exhaustive search for its caus

ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1979.tb06443.x

出版商:Blackwell Publishing Ltd    

年代:1979

数据来源: WILEY