ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1996.tb01139.x

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY

摘要:

Background: The current diagnostic modalities used to detect breast cancer are mammography, together with clinical examination, ultrasound and fine needle aspiration biopsy (FNAB). The accuracy rates for each modality varies and a combination of the modalities is recommended to detect cancer early. Some authors have suggested that mammography should be used primarily as a screening tool because of the false negative mammography results that have been reported in the past 10 years. The records of patients at the Strathfield Breast Centre were reviewed to determine the accuracy of the practice and to compare it with the accuracy of other modalities.Methods: The records of 371 breast cancer patients treated at the Strathfield Breast Centre in the 6 years from 1989 to 1994 were reviewed to determine the accuracy of mammography, ultrasound, clinical examination and fine needle aspiration biopsy. Of the 371 women with histopathologically diagnosed breast cancer, 349 had mammography.Results: The accuracy rate of mammography in the present study was 91% with a false negative rate of 9%. It was found that there was no significant delay in the treatment of breast cancer in mammogram‐negative patients.Conclusions: Mammographically negative breast cancer was found to be more common in younger women, to be similar in size to mammogram‐positive cancer, to occur in all histological types and grades and was usually invasive rather than noninvasive. The rate of lymph node involvement was similar to the mammogram‐positive

ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1996.tb01140.x

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY

摘要:

Background: The injection of liquid paraffin wax was a form of breast augmentation practised in Hong Kong 30–40 years ago. Patients may present many years later with complications of this treatment.Methods: The records of 43 patients diagnosed with paraffinomas of the breast at a teaching hospital in Hong Kong were reviewed. These patients had received paraffin injections 3–41 years (median 17) previously.Results: Patients presented with hard masses in the breast 4–18 cm (median 17) diameter. Ulceration or infection occurred in 10 patients. Mammography revealed a honeycomb appearance in the affected breast. Treatment included biopsy only (7), excision of masses (3) and total mastectomy (30, bilateral in 27). Histology demonstrated hyalinized and densely sclerotic fibrous tissue with cystic spaces of various sizes.Conclusions: Awareness of this condition facilitates the differentiation from tuberculosis and carcinoma of the breast which often present late in this population of patients. Adequate treatment usually requires total maste

ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1996.tb01141.x

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY

摘要:

Background: An extensive programme was undertaken to trace and screen four known families in Tasmania with multiple endocrine neoplasia type 1 (MEN‐I).Methods: Written and personal contact was made with family members over the age of 20 years recommending a review by family practitioners for the purpose of recording their medical history and collecting a blood sample. Those suspected of MEN‐1 were referred to our Department for further investigation.Results: In January 1993, the total number of individuals alive and known to be affected by MEN‐I was 107, giving a prevalence of MEN‐I disease in Tasmania of 23/100 000. The estimated prevalence of the MEN‐I trait in Tasmania (including affected cases and those considered at 50% risk of possessing the trait) is 45/100 000.Conclusion: The prevalence of MEN‐I has never previously been determined accurately. The prevalence of MEN‐I in Tasmania is at the upper end of the possible range and would justify the allocation of resources for screening programmes equal to those available for the detection of several less prevalent gen

ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1996.tb01142.x

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY

摘要:

Background: Meningiomas usually grow slowly but they may cause recurrences despite surgical resection. The impact of clinical, neuroradiological and surgical characteristics on operative morbidity and mortality of patients operated on for intracranial meningioma was analysed.Methods: A series of 450 patients operated on for intracranial meningiomas at the Department of Neurosurgery, Hacettepe University Hospital during the period 1964–92 is reported. The surgical results were analysed with regard to intracranial site, extent of removal, histological type, and different time periods. Computed tomography (CT) and magnetic resonance imaging (MRI) facilitated the diagnosis and helped with the planning of treatment.Results: Two hundred and ninety‐two patients were examined with both CT and MRI. Overall mortality was 4% but showed a decline from 9% in the pre‐CT era to 3% in the post‐CT era and to 1% in the past 3 years.Conclusions: Operative mortality and recurrence rates are affected by the intracranial location of the tumour, histological type, and extent of tumour removal. Emphasis is also given to the importance of the introduction of the imaging techniques, and the microsurgical techniques with the Cavitron ultrasonic surgical aspirator (CUSA), laser, and/or bipolar coagulator which have further improved the operative mortality and recurrenc

ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1996.tb01143.x

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY

摘要:

Background: The Gamma nail has been introduced as an advance over the Ambi hip screw in intertrochanteric femoral fractures. Its efficacy in an Australasian setting has not been documented.Methods: A prospective randomized study was used to compare the Ambi hip screw and the Gamma nail for the treatment of 69 patients over the age of 50 years with intertrochanteric femoral fractures. The groups were similar with respect to age, sex, prefracture mobility and abode, anaesthetic risk grade, CT measured bone density and fracture pattern.Results: Those treated with the Gamma nail had a significantly longer image intensifier screening time (P<0.05), greater blood loss (P<0.01) and more operative complications. There was no difference in the length of hospital stay but the level of mobility recovered was significantly better in the Ambi group at 6 months follow up. Urine retention was the most frequent complication but did not correlate with the implant or method of anaesthesia. Two implants cut out, one in each group. Limb shortening was similar in both groups and was not affected by leaving the Gamma nail unlocked distally in unstable fractures. Thirteen patients died from pre‐existing medical conditions.Conclusions: The Gamma nail proved technically more demanding with higher intra‐operative complications and inferior return of mobil

ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1996.tb01144.x

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY

摘要:

Background: The use of intramedullary nails for the management of humeral shaft fractures has been controversial. Recently, the Seidel nail has become available. The purpose of this study was to review our initial experience with the Seidel nail.Methods: A retrospective clinical and radiographic review of 25 consecutive patients treated with Seidel intramedullary humeral nail was performed. The nail was used for non‐union in 10 patients, delayed union in four, acute fracture in eight and pathological fracture in three. Eighteen of the 19 survivors were clinically reviewed at an average of 15 months (range 8–25). Pain, function, satisfaction, shoulder power, range of motion and clinical outcome were graded using the UCLA shoulder score.Results: Pain was present at the shoulder in four patients and at the fracture site in nine. Average shoulder abduction was 99° and nine patients could not abduct the shoulder past 90°. Sixty‐six per cent of patients reviewed were graded as only fair or poor using the UCLA shoulder score. In three patients rotational control was not achieved with the distal locking device at the time of surgery. Complications included non‐union in 10 patients and three intra‐operative fractures.Conclusions: Non‐union was more likely to occur if rotational control was not obtained, or if the patient had the nail inserted for a previous non‐union. Use of the Seidel nail frequently leads to shoulder pain and dysfunction. The distal locking device is unreliable and predisposes to non‐union. We do not recommend the continued use o

ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1996.tb01145.x

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY

摘要:

Background: Matchett Brown hemiarthroplasty has been routinely performed at Middlemore Hospital in elderly patients following subcapital fracture of the hip. The outcome of patients undergoing Matchett Brown hemiarthroplasty was evaluated.Methods: Matchett Brown hemiarthroplasties performed at Middlemore Hospital during 1987 were retrospectively reviewed. Medical records were reviewed and where possible patients were interviewed, examined and radiographs of their hip taken.Results: The overall survival at follow up was 34%, with the greatest predictor of survival being whether the patient had been living alone prior to the accident. The majority of patients who survived the 4 year follow up had excellent mobility at the time of fracture. At follow up most patients had little or no pain from their hip, but three complained of constant pain.Conclusions: Hemiarthroplasty proved to be a satisfactory form of replacement in this group. If one were to select a patient for total hip replacement, rather than hemiarthroplasty, then age alone is not as important as other factors such as degree of mobility and independence of living.

ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1996.tb01146.x

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY

摘要:

Background: Biliary complications remain a continuing problem in liver transplantation. The goals of this study were to document the frequency of biliary complications following orthotopic liver transplantation in the Victorian programme. and to examine associations with suspected risk factors with reference to biliary stenosis.Methods: Data were collected from 129 consecutive transplants in 123 patients (106 adults, 17 children) at the Austin Hospital, Melbourne during the period 1988–94. The 2 year actuarial survival was 88%. Biliary reconstruction was by end‐to‐end anastomosis in 89 patients and Roux‐en‐Y in 40. Complications were suspected on clinical, biochemical or microbiological evidence. Biliary stenoses were considered to be radiological evidence of duct narrowing.Results: Biliary complications occurred in 19% and biliary stenosis in 8.5%. Of the stenoses, 1/35 occurred in the first 20 month period, 9/47 in the second and 1/47 in the third. There was a significant difference between the middle period and other periods (P<0.05, Chi‐square test). This change may be related to incomplete flushing of bile from the donor liver. Recurrence of the original disease was suspected for one stenosis. The length of the donor bile duct from hilum to anastomosis, cold ischaemia time and total hepatic artery flow at transplant did not relate to stenosis. Cholangitis was not diagnosed in patients without strictures. Strictures were managed by dilatation (5/11) and by operative repair (6).Conclusions: Stenoses were not related to the length of the donor bile duct, cold ischaemia time or total hepatic artery flow. Meticulous adherence to the protocol for flushing out bile at the donor operation was associated with a significant reduction in frequency of bilia

ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1996.tb01147.x

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY

摘要:

Background: A study of the incidence of polycystic liver in a transplant population and an assessment of the impact of this disease on the group was undertaken. Clinical presentation, investigation and treatment of hepatic polycystic disease are explored.Methods: The study examined the morbidity incurred by polycystic liver disease in these patients, patient and graft survival, incidence of hepatic cysts and presentation, investigation and management of morbid hepatic cystic disease. One hundred and eleven patients were studied.Results: It was found that hepatic cysts occurred in the majority of patients that underwent transplants for renal failure because of polycystic kidney disease at this institution. Symptomatic hepatic cystic disease was found to be primarily responsible for three deaths and affected between 15 and 20% of the group. Gall bladder disease was found to be associated with highly symptomatic hepatic cystic disease.Conclusion: Hepatic cystic disease is common in patients that have had kidney transplants because of polycystic kidney disease. Morbidity is likely to increase as patients survive for longer periods. Cholecystectomy should be considered in patients with significant hepatic cystic disease.

ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1996.tb01148.x

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY