ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1995.tb01692.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY

ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1995.tb01693.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY

摘要:

In spite of a number of ingenious operative and non‐operative techniques in the management of pilonidal sinus no single technique can be relied upon to prevent recurrence of this benign yet troublesome condition. Once thought to be a congenital condition it is now appreciated that pilonidal sinus is most often an acquired condition due to accumulation of tough, bristly hair penetrating the skin, or local hair growing into a skin crevice, pit or abnormal follicle. The most common site is the upper natal cleft but the condition may occur in other sites especially where there is a crevice or irregularity of skin surface with pressure or suction applied to that region. Most surgical procedures have been designed to eradicate the existing sinus and the crevice in which hair tends to accumulate. However, without the presence of hair there can be no pilonidal sinus and, in the past, little attention has been given to preventing the re‐accumulation of hair in the troublesome site; hence the risk of recurrence. Management objectives should be directed not only at eradicating the obvious lesion present but also to preventing recurrence of the aetiological factors: especially the re‐accumulation or re‐growth

ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1995.tb01694.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY

摘要:

All patients with pilonidal disease (abscess or sinus) managed surgically (‘laying open’) between 1975 and 1990 in the Colorectal Service, University Department of Surgery, Wellington School of Medicine were reviewed. A total of 323 operations (177 males, 146 females) were performed in 311 patients. Seven males and 5 females required two operations before satisfactory healing was achieved (recurrence rate 3.8%). Males were older than females (mean, 26.4vs. 21.5 years). One patient's wound bled following surgery and required immediate repacking. There were no other wound problems. One hundred and seventy‐seven patients presented acutely with pilonidal abscess and 146 patients presented with pilonidal sinus. Patients with pilonidal abscess were younger than those with pilonidal sinus (male, 25.8vs26.9 years and female, 20.8vs23.5 years). There were proportionately more Maori patients who presented acutely. ‘Laying open’ under general anaesthesia seems to be a safe and successful method for managing pilonidal disease in all but the few patients in whom multiple operations have been performed previously or in those in whom healing has failed to occur. Based on our initial experience of ‘day case’ surgery the procedure could safely be done on an out

ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1995.tb01695.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY

摘要:

Between 1967 and 1991, 130 patients underwent surgery for Crohn's disense at The Royal Newcastle Hospital, New South Wales, There were more patients in recent years, which suggested an increased incidence of the condition (2.1/100 000/per year). The clinical profile and recurrence rate were similar to other studies. However, a greater proportion of patients required surgery for chronic small bowel obstruction and fulminant colitis compared with patients in other countries.

ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1995.tb01696.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY

摘要:

This study reviewed a series of patients with Crohn's disease managed by surgeons of the Department of Colon and Rectal Surgery, St Vincent's Hospital, Melbourne, since 1978. There were 306 patients: 171 males and 135 females. The mean age at diagnosis was 33.4 years (range 11–93). The distribution of the disease was small bowel 32.3%, small bowel and colon 26.5%, colon 39.9%, and anal disease alone 1.6%. A total of 416 abdominal operations were performed on 204 patients. The commonest indications for surgery were failed medical therapy (21.9%), small bowel obstruction (15.9%), enteric tistula (10.1%), and intra‐abdominal abscess (10.1%). The most frequently performed procedures were ileocolic resection with anastomosis (28.8%), small bowel resection (9.4%), and total colectomy and ileostomy (7.0%). Postoperative complications included anastomotic leaks in 4.0%. intra‐abdominal abscess formation in 3.6%, and enterocutaneous fistulae developed in 6%. Three patients died during the review period. During follow up (mean 84.4). 30% of patients developed recurrence requiring further surgery at a mean of 72.7 months postoperatively. The most frequent site for a recurrence was the pre‐anastomotic terminal ileum (61.7%). In conclusion. the majority of patients with Crohn's disease will require resectional surgery at some stage. This can be performed with a low mortality and morbidity, and a recurrence rate of around 5% p

ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1995.tb01697.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY

摘要:

This study details the results of a retrospective analysis of 98 patients who underwent lateral subcutaneous internal sphincterotoiny for the treatment of fissure in ano. Data with particular emphasis on patient satisfaction and anorectal control were collected by postal questionnaire. Minimum follow up was 15 months with an average of 41 months. Ninety‐seven percent of patients indicated that they were moderately or very satistied with the outcome of the procedure and 90% claimed symptomatic improvement with this being sustained in 69%. Eighteen per cent of patients noted ongoing new problems with minor impairment of anorcctal control. Despite these symptoms, 90% of this group were also moderately or very pleased with the outcome and 72% had resolution of their symptoms which was sustained in more than two‐thirds of cases. It is concluded that lateral subcutaneous internal sphincterotomy is well tolerated and the majority of patients are more than moderately pleased with the outcome. There was however a significant incidence of minor impairment in anorectal control but this did not detract from the perceived success of the proced

ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1995.tb01698.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY

摘要:

Over a 16 month period seven patients underwent surgery using venous allografts either to reconstruct the portal vein, or to construct a mesocaval ‘H’ graft or a shunt between the coronary vein and the subhepatic inferior vena cava. The allografts were harvested during multiorgan procurement from the bifurcation of the inferior vena cava, the common iliac vein and the external iliac vein and kept in a preservation solution at 4°C for a mean time of 6 days (range 1–29) before use. Subsequent thrombosis was clinically evident in only two patients. The use of venous allografts appears to be a useful alternative to other venous replac

ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1995.tb01699.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY

摘要:

The complications of the Caldwell‐Luc operation were retrospectively studied in 1990. The case records were analysed and updated information from telephone interviews and posted questionnaires were available for most patients. One hundred and eighty‐five patients with 216 procedures with a mean postoperative follow‐up period of 33.5 months were studied. The commonest indication for the operation was for chronic sinusitis. There were three common complications found: facial swelling (61.9%), pain and/or numbness of the face (46.0%) and pain and/or numbness of the teeth/gums (30.9%). Rare complications are postoperative epistaxis (0.4%), oroantral fistulae (0.4%), epiphora (0.4%) and dental discoloration (0.4%). This paper discusses the pathophysiology of these complications and surgical techniques on how to avoid them. Although the use of the Caldwell‐Luc operation has declined in recent years with the development of endoscopic sinus surgery, it still has occasional indications and a set of practical guidelines on how to prevent complications would be useful. The basis for treating chronic sinusitis with functional endoscopic sinus surgery at the expense of the more traditional form of treatment is also di

ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1995.tb01700.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY

摘要:

The aims of this paper are to review the incidence and pathology of primary oral mucosal melanomas in Papua New Guinea and describe the presentation and management of five cases.

ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1995.tb01701.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY