ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1996.tb00751.x

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY

摘要:

There is a general consensus that cell‐cell and cell‐matrix interactions determine. at least in part. the behaviour of colon cancer. The biological mediators responsible for these interactions are cell adhesion molecules belonging to several major receptor families called integrins, cadherins, the immunoglobulin superfamily, hyaluronate receptors and mucins. Emerging data indicate that certain patterns of adhesion receptor expression are associated with more aggressive disease. The present review examines the role of each of the receptor families in the development and progression of large bowel can

ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1996.tb00752.x

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY

摘要:

Background: Thirty years have elapsed since the commencement of open‐heart surgery in South Australia. A retrospective study was performed to evaluate mortality and complication rates and to identify factors associated with poor outcomes in all patients who underwent prosthetic aortic valve replacement during this period.Methods: Questionnaires and personal contact have been used to generate a combined database of pre‐operative and postoperative information and long‐term follow‐up on 1322 patients who underwent isolated prosthetic aortic valve replacement at the Cardio‐Thoracic Surgical Unit of the Royal Adelaide Hospital between 1963 and 1992.Results: Complete survival follow‐up data were obtained for 94% (1241) of the patients. The Bjork‐Shiley valve was used in 668 (875) of the patients, a Starr‐Edwards prosthesis in 31% (412). a St Jude prosthesis in 2% (26). and only 0.7% (9) bioprosthetic valves were inserted. The hospital mortality rate for the 30‐year period was 2.9%. Progressively older and less fit patients have undergone surgery in recent years. The long‐term survival of patients with aortic stenosis and aortic incompetence was not significantly different. Long‐term survival was significantly shorter for patients with higher New York Heart Association (NYHA) functional classifications, and for patients in pre‐operative atrial fibrillation. Pre‐operative dyspnoea was significantly improved following aortic valve replacement. The rates of postoperative haemorrhagic and embolic complications were low by comparison with other published series.Conclusions: Aortic valve replacement can be performed with low hospital mortality and complication rates, and significant symptomatic improvement can be expected. Aortic valve recipients have a favourable prognostic outcome compared with an age‐ and sex‐matched population, and risk factors that determine long‐term survival ca

ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1996.tb00753.x

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY

摘要:

Background: Thirty years have elapsed since the commencement of open‐heart surgery in South Australia. A retrospective study was performed to evaluate mortality and complication rates and to identify factors associated with poor outcomes in all patients who underwent prosthetic mitral valve replacement during this period.Methods: Questionnaires and personal contact have been used to generate a combined database of pre‐operative and postoperative information and long‐term follow‐up on 938 patients who underwent isolated prosthetic mitral valve replacement at the Cardio‐Thoracic Surgical Unit of the Royal Adelaide Hospital between 1963 and 1993.Results: Complete survival follow‐up data were obtained for 92% (865) of the patients. The Starr‐Edwards valve was used in 95% (891) of the patients, a Bjork‐Shiley prosthesis in 2.5% (23) of the patients, and only 24 (2.5%) other valves were inserted. The hospital mortality rate for the 30‐year period was 4.7%. The mean age of the patients who underwent surgery was greater in each of the three successive decades. A long‐term survival advantage was observed for patients with mitral stenosis, however, survival was significantly shorter for patients with higher New York Heart Association (NYHA) functional classifications and for patients in pre‐operative atrial fibrillation. Pre‐operative dyspnoea was significantly improved following mitral valve replacement. The rates of postoperative haemorrhagic and embolic complications were low by comparison with other published series.Conclusion: Mitral valve recipients do not regain a normalized life expectancy, but risk factors that determine long‐term survival can be identified pre‐operatively to aid ap

ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1996.tb00754.x

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY

摘要:

Background: Mortality rates from gastric cancer, apart from those derived from Japanese series, remain poor. This paper sought to determine the present outcome of gastric carcinoma in a predominantly Chinese population in Singapore. Prognostic factors useful in predicting survival were also evaluated in this population.Method: All cases of histologically confirmed gastric adenocarcinoma presenting in 1992 were entered into a prospective database. Prognostic factors related to age, sex, site of disease, depth of invasion, histological grade, nodal status and stage of disease were evaluated in patients with resectable disease to determine their utility in predicting survival.Results: Of 1310 consecutive patients with histologically proven adenocarcinomas, 37% had distant metastases at presentation predominantly in the liver (21%) and peritoneal cavity (20%). Sixty‐four per cent of patients underwent surgery and in only 51% of these patients was resection of the turnour possible. Stages 111 and IV (T4N2) locally advanced disease were present in 38% of patients. Thus the majority of patients presented with late or metastatic disease (75%, stages 111 and IV). Sixty per cent of patients were alive at I year and 40% at 2 years after resection of the tumour (Kaplan‐Meier survival plots). In contrast, no patient survived longer than a year if the tumour was not resectable (P<0.001, log‐rank test). Median survival of patients without surgery was 12 weeks. Median survival for patients with resected stage IV disease was 23 weeks, compared to 18 weeks after surgical bypass. Age, sex, site, depth of invasion and histological grade did not significantly predict survival. Patients with node‐negative disease survived longer (2 year, 70%) than those with nodal involvement (2 years, 44%;P =0.06, log‐rank test). Pathologic staging with the TNM system was useful in predicting survival (P<0.001). Sixty per cent of patients with stage I and II disease were alive at 2 years compared to 54% with stage III disease and 0% with stage IV disease.Conclusion: The prognosis of stomach cancer remains poor, due predominantly to late presentation. Pathologic TNM staging and nodal status were useful in predicting survival outcome after resection. If the tumour were resectable, survival was appreciable even in patients with advanced stage III (2 years, 54%) and stage IV (1 year, 40%) disease. Strategies to improve outcome should focus on early detection of gastric c

ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1996.tb00755.x

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY

摘要:

Background: The present study reviews the nature of upper gastrointestinal complications of hepatic arterial chemoperfusion at a tertiary referral centre for the treatment of hepatic malignancy.Methods: The patients involved in the present study all had major upper gastrointestinal (GI) haemorrhage and were undergoing hepatic arterial chemoperfusion.Results: Eight patients had major upper GI haemorrhage. Three of these patients were not referred for surgical management, and all three patients died. The five patients who were admitted or transferred to our unit and who underwent surgery all survived.Conclusions: These complications are probably caused by extravasation of 5‐fluorouracil (5‐FU) following thrombosis of the gastroduodenal artery. The resulting cavity may perforate into the hepatic artery, portal vein, duodenum or biliary tree. Surgeons and oncologists should be aware of these complications. If upper abdominal pain occurs, chemoperfusion should cease immediately and an urgent investigation, which may include catheter angiography, gastroscopy and computed tomography (CT) scanning. should be carried out to exclude an hepatic artery pseudo‐ane

ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1996.tb00756.x

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY

摘要:

Background: The optimal method of restoring intestinal continuity after rectal resection has been controversial. This study aims to compare the morbidity, mortality and survival of patients having either single‐stapled (SS) or double‐stapled (DS) colorectal anastomoses following resection of the rectum for cancer.Methods: Peri‐operative and long‐term follow‐up data were prospectively documented in all patients undergoing rectal resection for carcinoma with a stapled anastomosis at our institution over a 14‐year period. Patients were stratified by anastomotic technique (SS or DS). Peri‐operative mortality, complications potentially related to anastomotic technique and cancer‐related outcome were compared.Results: Two hundred and thirty‐five patients had SS and 65 patients had DS anastomoses. The groups were well matched for age, sex, and tumour stage. Double‐stapled anastomoses were used more frequently in the distal third of the rectum (P<0.001). The distal margin of resection was not influenced by anastomotic technique. Major anastomotic leakage in 2.9% of SS cases was not significantly different from 6.1% of DS cases, and leakage was not influenced by anastomotic technique at any given level of the rectum. Two‐year local recurrence rates were not significantly different between groups (SS 3.5%: DS 5.9%).Conclusions: These results suggest that the double‐stapling technique is as safe as the single‐stapling technique for constructing an anastomosis after excision of the rectum for cancer, in terms of the risk of leakage, the development of an anastomotic stric

ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1996.tb00757.x

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY

摘要:

Background: Pelvi‐ureteric junction obstruction has been increasingly diagnosed in infants, mostly as a consequence of antenatal ultrasound examinations.Methods: Of 55 infants below the age of 12 months who underwent dismembered pyeloplasty over a 7‐year period, we aimed to determine the patterns and outcome of associated vesico‐ureteric reflux that was present in 15 (28%) of the 53 infants in whom follow‐up was available.Results: A total of eight infants had resolution of their reflux with conservative management and the median time to resolution was 15 months. Five infants proceeded to ureteroneocystotomy.Conclusions: Given the association of vesico‐ureteric reflux and pelvi‐ureteric junction obstruction, routine cystography is recommended when the diagnosis of pelvi‐ureteric junction obstru

ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1996.tb00758.x

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY

摘要:

Background: Alternatives to cutaneous diversion have included continent urinary diversion and replacement cystoplasty. Fiveyear experience with continent diversion is reported.Methods: Between 1989 and 1994. 29 patients underwent continent urinary diversion. Of these, 24 patients underwent Indiana pouch procedures and five patients had a Mitrofanoff‐type procedure. All have now been followed up for at least 12 months.Results: The continence rate for the Indiana pouch group was 23/24 (96%) and the mean capacity was 648 mL (range 300–1400). There were nine (37.5%) early postoperative complications, only three of which (12.5%) required surgical revision. The late complication rate was 35.5% (7/22), and 18.2% (4/22) of the patients underwent re‐operation. Stomal stenosis occurred in two patients in whom the stoma was situated in the right iliac fossa, whereas all 12 stomas sited at the umbilicus had no stomal problem. Four of the five patients having Mitrofanoff procedures were continent, but these patients had higher rates of early and late complications.Conclusions: From this experience, the Indiana pouch urinary diversion appears to be superior to the Mitrofanoff procedure when continent diversion is indicated. An umbilical stoma site is op

ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1996.tb00759.x

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY

摘要:

Background: Haemorrhoidectomy is a common treatment for third degree symptomatic haemorrhoids. and day surgery has increased because of increasing pressure for hospital beds. The aim of the present study is to describe a technique of suture haemorrhoidectomy (SH), conducted as a day‐only procedure, and compare the effectiveness and outcomes of this method with the conventional Milligan‐Morgan haemorrhoidectomy (MMH).Methods: The results of 18 consecutive patients, mean age 52 years (31–73) undergoing SH between April 1994 and June 1995 were compared with a historical control group of 17 consecutive patients, mean age 45 years (29–72). who had MMH in the preceding year. Seven patients were excluded because of intercurrent anal pathology (1), thrombosed haemorrhoids (1) or loss to follow‐up (5). An interviewer followed up patients using a telephone questionnaire.Results: Mean follow‐up was 6 months in the SH group and 18 months in the MMH group. There was no significant difference in total operative time. The SH group had a significantly shorter mean time to first void of 3 h versus 11 h (P<0.005). mean time to first bowel action of 11 h versus 48 h (P<0.005) and mean in‐hospital stay of 10 h versus 77 h (P<0.005). The SH group had a significantly decreased linear analogue pain scale, a mean of 1 versus 3 (P<0.05). The complications were: two readmissions for pain relief in the SH group and urinary retention in one MMH patient. None of the study group have had recurrence of haemorrhoids.Conclusion: Suture haemorrhoidectomy as a day‐only procedure is safe, less painful and reduces in‐hospital admission time. The long‐term effectiveness and complications of the technique are

ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1996.tb00760.x

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY