ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1996.tb00775.x

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY

ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1996.tb00776.x

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY

摘要:

Background: First aid is commonly required during commercial aircraft flights, especially during international flights. An intimidating and sometimes threatening array of in‐flight medical emergencies challenge the doctor, flight attendants and other passengers in such medical emergencies. Cramped conditions, difficulties of access to the victim, lack of privacy, cultural and language differences and noise and vibration all compound to increase the difficulties of the normal first aid drills which are required in the management of in‐cabin emergencies. Doctors who fly as passengers are liable to be called upon to render first aid in the air. We provide an analysis of the types of medical emergencies encountered during commercial air travel.Methods: We have reviewed all consecutive in‐flight medical incident reports for QANTAS international flights for 1993. All incidents requiring the attention of a doctor were included.Results: A total of 454 significant medical incidents occurred. These included, in rank order, syncope (35%), angina and cardiac emergencies (23%), gastrointestinal conditions (13%), respiratory tract infections and asthma (9%) and anxiety and panic reactions warranting medical intervention (5%).Conclusions: Syncope, the management of gastrointestinal symptoms and problems of angina comprise over half (58%) of the presenting symptoms which confront a fellow traveller who may coincidentally be a medical practitioner. Problems of anxiety, sleeplessness, airport bustle, immobility, barotrauma, alcohol abuse and mild hypoxia are discussed in the context of precipitating factors which may trigger an in‐flight emergency. Psychological problems are very common and challenge the first aider, whether or not he or she is medically trained. We emphasize the necessity for doctors and nurses to be trained in first aid, as a distinct profession in its own right and a series of drills and skills which are distinctive from those of surgery‐based health care. The 5% annual increase in air‐passenger traffic, predicted for the next two decades, highlights the importance of special training for ‘first ai

ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1996.tb00777.x

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY

摘要:

Background: The kidney is the most frequently injured abdominal organ in children and controversy surrounds some aspects of management. This study looks at the experience of our institution and reviews the literature towards developing an optimal strategy for managing this common childhood injury.Methods: One hundred and forty‐two cases of paediatric renal trauma are reported from a catchment population of approximately 240 000 children<14 years of age over a 12 year period. Injuries were classified into four groups: groups 1 and 2 were regarded as minor injuries (85%) and group 3 and 4 injuries were those with extravasation of urine or pedicle injury (15%). Results: The male:female ratio was 2:I with an average age of 8.5 years. Major renal injuries frequently required large amounts of resuscitation fluid. Associated injuries were present in 41% of all cases with an average of two injuries each. With one exception in each case, the development of complications and the need for early surgery were confined to major injuries. There were no long‐term complications. The renal loss rate was 2.1%.Conclusions: Renal injuries can be usefully classified into major or minor by determining whether extravasation of urine or pedicle injury is present. Minor injuries should be managed conservatively. Major injuries causing ongoing haemorrhage require urgent surgery. Other major injuries should be imaged regularly and patients with more severe urinomas benefit from early elective surgery at 2–5 days. In cases where extravasation of urine has not shown clear evidence of settling by 5 days' elective surgery probably results in less morbidity and fewer complications than protracted conservative trea

ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1996.tb00778.x

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY

摘要:

Background: With the introduction of laparoscopic cholecystectomy (LC) there has been a reduction in the use of operative cholangiography. The practice of selective cholangiography (SC), where the common bile duct (CBD) is imaged only in those patients where the surgeon believes there is a significant risk of CBD stones has contributed to this reduction. Selective cholangiography has been criticized by advocates of routine cholangiography who argue that there will be more CBD stones missed and more CBD injuries.Methods: This prospective study reports the outcome in a series of 457 patients who had LC performed between 1990 and 1992 where cholangiography was used according to a strict protocol relying on clinical history, CBD size and pre‐operative liver function tests. There were no CBD injuries. Twenty‐nine patients (6.4%) had CBD stones.Results: Follow up by structured questionnaire at 12–24 months detected 6 patients (1.3%) with CBD stones. Three of these 6 patients had cholangiograms. Of the 3 patients with missed stones and no X‐ray, 2 were protocol breaches and only I patient from 307 (0.3%) with no indication for SC was subsequently found to have a CBD stone.Conclusion: We believe that this study validates a polic

ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1996.tb00779.x

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY

摘要:

Background: Many prognostic factors of colorectal cancer are known but their actual clinical validity is still uncertain. The aim of the present study was to verify, on the basis of our experience, the prognostic validy of variables for survival by using survival regression analysis.Methods: From January 1978 to December 1986 the prognostic factors for 192 patients were analysed. These patients had undergone surgical resection for colorectal cancer. The follow up was completed in every patient by the end of December 1992. with a median follow up of 10 years (range 6–14 years). The prognostic factors considered in the statistical analysis were age. sex, size of tumour, site, grade, direct spread, node involvement and stage (according to Astler‐Coller and pTNM).Results: Of the prognostic factors, sex was the only one not to show any prognostic significance. In the survival regression analysis we have used an accelerated failure time model (equivalent to the Cox proportional hazard model); age. grade and stage were significant covariables.Conclusions: Although clinical pathological staging (pTNM) appears as a pre‐eminent prognostic factor, and as our analysis shows. it needs a further variable (grading), which has been shown to affect the prognosis in a significan

ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1996.tb00780.x

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY

摘要:

Background: Total mastectomy remains the mainstay of operative treatment for breast cancer mainly because it is preferred by surgeons. The techniques and benefits of reconstructing the amputated breast have been well documented in the medical literature but there have been very few reports on this issue in Chinese women. Immediate breast reconstruction using the transverse rectus abdominis myocutaneous (TRAM) flap in Chinese women suffering from early breast cancer who require mastectomy is summarized.Methods: Since September 1991, the option of immediate breast reconstruction was offered to all patients less than 60 years of age suffering from early cancer (Tis, T1 or T2) who were not suitable for breast‐conserving treatment or who preferred to have a mastectomy. The single‐pedicled TRAM flap was used.Results: From September 1991 to September 1994, 27 reconstructions were performed. Partial flap loss occurred in four patients (15%). fat necrosis in three patients (11%) and abdominal bulging in one patient (4%). Operations performed by two teams simultaneously reduced operating time by 1.5 h without increasing the risk of complications. Twenty‐one patients (78%) were satisfied or very satisfied with the outcome of reconstruction.Conclusions: The TRAM flap is a safisfactory method of breast reconstruction in Chinese women. A two‐team approach can be employed safely to shorten operative time. Overall patient satisfaction w

ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1996.tb00781.x

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY

摘要:

Background: Tamoxifen and toremifene have been used in patients with advanced desmoid tumours with response rates of 51%.Method: We developed an experimental model of desmoid tumour cells in tissue culture to study their effect. Four cell lines were established in tissue culture. All native and corresponding cultured tumours were oestrogen receptor negative. Tumour I was from a 22 year old with familial adenomatous polyposis (FAP) and recurrent abdominal wall desmoid turnours. She remains disease free on tamoxifen 4 years following surgery. Both her mother and sister also have shown regression of their FAP‐associated desmoid tumours at the menopause and on tamoxifen, respectively. We assessed the effect of tamoxifen on desmoid tumours in tissue culture at 780 ng/mL. The results were assessed by cell density counting.Results: Tumours 1 and 2 have responded with an approximately 50% reduction in growth to tamoxifen at 780 ng/mL.Conclusions: This apparent growth inhibitory effect of tamoxifen on two desmoid tumour cell lines appears to be independent of oestrogen and correlates with thein vivoeffect of tamoxifen on three desmoid tumours in an FAP famil

ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1996.tb00782.x

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY

摘要:

Background: Transforming growth factor alpha (TGF‐α) is a polypeptide that is structurally similar to epidermal growth factor (EGF) that binds to the epidermal growth factor receptor (EGFR) and has been implicated in the development of several types of human tumours.Methods: The expression of TGF‐α is examined in laryngeal squamous cell carcinoma (SCC) (n= 24) and non‐neoplastic polyps (n =7) using streptavidin‐biotin immunohistochemistry and a monoclonal antibody to the TGF‐α protein. These cases had been previously characterized for EGFR immunoreactivity. The carcinomas were classified as well differentiated (n = 2). moderately differentiated (n = 16) and poorly differentiated (n= 6). Tissues from metastatic tumour deposits in lymph nodes (n = 5) were also studied.Results: TGF‐α overexpression was defined as intense immunoreactivity in more than two‐thirds of tumour cells immunostained for TGF‐a and was present in the majority of the SCC cases (n= 15; 63%) and metastatic turnour deposits (n =4; 80%). In contrast, although some of the vocal cord polyps showed weak (n= 2) to moderate (n = 5) immunostaining, none had evidence of strong TGF‐a immunoreactivity. The differences in TGF‐α immunoreactivity were significant between primary laryngeal SCC and vocal cord polyps (P= 0.013; x2test with continuity correction), and between metastatic laryngeal SCC and vocal cord polyps (P =0.023;x2test with continuity correction). There was no significant difference in TGF‐α expression between the different grades of carcinomas (P= 0.92, x2test) or between non‐metastatic and metastatic carcinomas (P= 0.82; x2test with continuity correction). No significant correlation was found between TGF‐α expression and patient survival or tumour recurrence (r =0.077,r2= 0.006,P =0.75; simple regression analysis), or between TGF‐α expression and EGFR immunoreactivity (r =0.325.r'= 0.106,P =0.0851).Conclusions: In conclusion, increased TGF‐α immunoreactivity is present in most cases of laryngeal SCC with no specific relationship to tumour grade, suggesting that it may be important in the development of laryngeal carcinomas but not in its progression. No significant correlation was found between TGF‐a and EGFR expression in laryngeal tumours and TGF‐a

ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1996.tb00783.x

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY

摘要:

Background: Defects in the skull have presented difficult reconstructive problems. Recently glass‐ionomer cement and preformed implants have been used to repair bony defects in the skull base and in cranio‐facial surgery. Three patients are reported to illustrate possible applications for this new material.Methods: Ionocap cement and Ionoroc‐skull standardized implants have been used. The cement is available as a two component blister pack. When mixed and blended a gel is produced which can be worked for approximately 5 min before hardening. It can then be contoured and drilled to the required shape. The resultant material is biocompatible and biostable, is non‐toxic and permanently bonds to bone with no increase in temperature or shrinkage.Results: The material has been used to fill the temporal defect left by transplantation of the temporalis muscle for oral reconstruction, the anterior and lateral walls of the maxilla and following craniofacial resection, the posterior wall of the frontal sinus and anterior skull base.Conclusions: Three patients with different reconstructive problems have been presented to illustrate the use of an alloplastic material that has a tensile strength similar to bone* and firmly adheres to it. The material was found to be safe and easy to use. All three patients have now been followed for 12 months with no adverse

ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1996.tb00784.x

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY