ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1992.tb07528.x

出版商:Blackwell Publishing Ltd    

年代:1992

数据来源: WILEY

摘要:

A survey of current practice for deep vein thrombosis (DVT) prophylaxis was undertaken in Australia and New Zealand. The most common indications for prophylaxis were a history of thrombo‐embolism, the type and length of surgery and obesity. Prophylaxis was used in 65% of patients having hip surgery and in 39% undergoing knee surgery. In general surgery the corresponding rate was around 67% for colorectal surgery, hepatobiliary, upper gastrointestinal and major abdominal vascular surgery. Apart from open‐heart cardio‐thoracic surgery (66%), use in other specialties was less than 50%.Physical methods (anti‐embolism stockings, calf stimulation and calf compression devices) were most commonly used for prophylaxis (46%) with heparin being used by 40%. The main side effect reported with heparin was bleeding (18%). The estimated incidence of DVT and pulmonary embolus (PE) was 2.8 and 0.4% for general surgery, 2.7 and 0.7% for orthopaedic surgery and 6.6 and 1.3% for hip surgery.Intravenous heparin followed by oral anticoagulants was the most commonly used treatment for established DVT and nearly all respondents used intravenous heparin and oral anticoagulants for treatment of PE. Venography was the favoured objective test for diagnosing DVT.The principal reason for considering a change in prophylactic policy was the potential availability of an agent with increased efficacy and a reduced incidence of haemorrhagic compli

ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1992.tb07529.x

出版商:Blackwell Publishing Ltd    

年代:1992

数据来源: WILEY

摘要:

Venous thrombosis rates were compared in 200 patients undergoing total hip arthroplasty and randomized to receive either fixed mini‐dose warfarin (1 mg daily) or adjusted‐dose warfarin to maintain an international normalized prothrombin ratio (INR) of 2.0–4.0. Bilateral lower limb venography was performed between days 11 and 13 inclusive. Fixed mini‐dose warfarin was associated with a significantly higher rate of total thrombosis (P<0.05). General anaesthesia was associated with a significantly higher rate of thrombosis than spinal anaesthesia (P<0.05). Adjusted‐dose warfarin was associated with more bleeding complications than mini‐dose warfarin although these were not attributable to excessive anticoagulation. A single death from pulmonary embolus occurred in the early postoperative period in a patient receiving adjusted‐

ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1992.tb07530.x

出版商:Blackwell Publishing Ltd    

年代:1992

数据来源: WILEY

摘要:

A consecutive series of 270 non‐reversed infra‐inguinal saphenous vein bypass grafts performed by the same surgeon between January 1986 and January 1991 was reviewed. The series included 250in situand 20 translocated non‐reversed grafts. The aims were to calculate the number of duplex scans that would have been required for surveillance, to determine the value of a non‐selective prolonged scanning regimen and to identify subgroups requiring more (or less) intensive surveillance. Indications were for critical ischaemia in 194 patients, popliteal aneurysms in seven patients and incapacitating claudication in 69 patients. Patients were reviewed at 1 month and then at approximate 6 month intervals for symptoms and with resting and post‐exercise ankle pressures. Primary patency of grafts placed to a popliteal distal anastomosis for critical ischaemia was 85% (s.e.m. 9.1%) at 3 years while secondary patency was 94% (s.e.m. 8.1%) at 4 years. Primary patency of grafts placed to a tibial artery or isolated popliteal segment was 68% (s.e.m. 8.4%) at 2 years while secondary patency was 76% (s.e.m. 9.9%) at 2.5 years. The difference in secondary patency between popliteal and tibial grafts was highly significant (P= 0.003). Tibial grafts required significantly more secondary early intervention than popliteal grafts. If recommended protocols for serial duplex scan (DS) surveillance had been followed, a minimum of 960 scans would have been required. If the tibial bypass group only had been monitored, 702 of these scans would have been avoided with a maximum loss of one popliteal graft and no limbs. This study suggests that non‐selective DS surveillance in ambulant asymptomatic patients with a popliteal distal anastomosis may not be justified. Both early and intensive surveillance of tibial grafts appea

ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1992.tb07531.x

出版商:Blackwell Publishing Ltd    

年代:1992

数据来源: WILEY

摘要:

Coronary atherosclerosis is being increasingly observed in young patients. However results of surgery in such patients have so far been disappointing both in terms of operative mortality, symptomatic relief and long‐term survival. Reasons given for this include the increased prevalence of risk factors in young patients and a higher incidence of graft occlusion. In the treatment of Asian patients, a further negative factor is the belief that coronary artery disease is more often diffuse and the vessels smaller. Between January 1987 and May 1991, a total of 66 patients under the age of 45 years at the time of surgery had coronary artery bypass grafting performed. The demographic, clinical, angiographic and operative data were analysed. Eighty‐nine per cent of the patients were male and their racial distribution was 63% Chinese, 8% Malays, 26% Indians and 3% Others. Their mean age was 40.8 years. The presence of risk factors was high: 45.6% had hypertension; 34.8% were smokers; 21.2% had diabetes mellitus; and 12.1% had hyperlipidaemia. The main indication in these patients was either angina or a previous myocardial infarction (53%). There were no patients with peri‐operative infarction diagnosed by the presence of new Q wave. There was no hospital death. The stay of the patients ranged from 6 to 28 days with a mean of 10 days. Follow‐up ranged from 3 to 54 months. There were no late deaths.It was concluded that there is a high incidence of risk factors among young patients with coronary artery disease, which follows the pattern of many other studies. The operative risk in these patients is low and morbidity is minimal. The intermediate results of bypass grafting appear to be ex

ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1992.tb07532.x

出版商:Blackwell Publishing Ltd    

年代:1992

数据来源: WILEY

摘要:

The medical records of patients with T1NO, T2NO and T3NO squamous cell carcinomas of the glottis treated at the Peter MacCallum Cancer Institute between January 1983 and October 1988 were retrospectively reviewed. One hundred and twenty‐seven patients were identified. There were 93 T1, 26 T2 and eight T3 tumours. These patients were treated with curative radiotherapy (60–70 Gy). The survival from glottic cancer of patients with T1, T2 and T3 turnours at 5 years was estimated to be 97, 62 and 100% respectively. The local disease free survival for T1 and T2 disease at 5 years was estimated to be 82 and 65% respectively. The local disease free survival for T3 tumours at 2 years was estimated to be 63% with 5 year survival not yet reached. The surgical salvage rates for 24 radiotherapy failures were 77, 25 and 66% for T1, T2 and T3 turnours respectively. Radiotherapy remains the treatment of choice for T1 tumours and a viable alternative to primary laryngectomy in more advanced glottic tumours, with salvage surgery in rese

ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1992.tb07533.x

出版商:Blackwell Publishing Ltd    

年代:1992

数据来源: WILEY

摘要:

Thirty cases of phyllodes tumour (cystosarcoma phyllodes) of the breast that presented to the Clinical Oncology Unit at Guy's Hospital were reviewed. Tumours were classified as benign, malignant or borderline according to the following histological criteria: mitotic rate, nuclear pleomorphism, stromal overgrowth and tumour margins. In 14 (46.5%) cases the tumours were considered histologically benign, in 11 (36.5%) malignant, and in five (17%) borderline. Recurrence was seen in a similar proportion of patients with tumours classified as benign (21 %) and malignant (18 %) according to histological criteria. Malignant lesions tended to recur earlier. Infiltrating tumour margins were noted in all patients and stromal overgrowth in all hut one in whom recurrence was observed. Risk of recurrence also appeared to he related to tumour size. Only one patient developed distant metastases and died of her disease. Because of treatment variation no conclusion can he made regarding optimal therapy but the importance of adequate clearance, either through wide excision or mastectomy, is emphasized for all phyllodes tumours irrespective of histological features.

ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1992.tb07534.x

出版商:Blackwell Publishing Ltd    

年代:1992

数据来源: WILEY

摘要:

Improvements in instruments and camera systems have allowed the development of operative techniques for laparoscopic pelvic lymph node dissection. A series of dissections in 20 patients is reported. The mean operation time was 1 h and 40min. When the nodes appeared malignant, a node biopsy was sent for frozen section. If this was positive, the dissection went no further. In three patients it was necessary to complete the operation by open surgery. A mean number of five lymph nodes was dissected per side. After laparoscopic dissection, all patients were discharged the morning after surgery. The operation is possible without making great demands on hospital bed occupancy and the patient has a comfortable and speedy return to normal activity. Using laparoscopic techniques, node dissection becomes a more appealing option as an investigation and staging procedure.

ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1992.tb07535.x

出版商:Blackwell Publishing Ltd    

年代:1992

数据来源: WILEY

摘要:

Since it was first described in 1978 the abdominal cocoon continues to he a rare cause of intestinal obstruction. So far this rare condition where the small intestine is encased in a fibrous membrane has been reported only in females. Diagnosis is usually made at laparotomy and the treatment of choice is lysis of adhesions. Proper recognition of this benign condition will result in the correct management of it and prevent unnecessary bowel resections. Five new cases including one male patient, together with a review of previous reports in the English literature, are presented.

ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1992.tb07536.x

出版商:Blackwell Publishing Ltd    

年代:1992

数据来源: WILEY

摘要:

Photodynamic therapy (PDT) is an experimental treatment modality for malignant tumours. The effect of PDT with haematoporphyrin derivative (HpD) was studied using a human bladder tumour (BL‐17) which was implanted subcutaneously (s.c.) into immunodeficient Balb/c nude mice. This model is only suitable for short‐term investigation of PDT because of the high mortality that arises due to the immune deficiency of the animals. In a short‐term observation (2 weeks post‐treatment), HpD sensitized PDT was effective in the control of tumour growth, with 71 % of tumours cured. The effect of PDT was found to be highly dependent on doses of HpD and/or the activating laser light. The comparison of PDT effects of the gold metal vapour laser (GMVL) and argon ion pumped dye laser (AIPDL) indicated that no significant difference exists between these two different laser sources for PDT. The irradiation with laser light alone and the administration of HpD alone had no significant effect on tumour

ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1992.tb07537.x

出版商:Blackwell Publishing Ltd    

年代:1992

数据来源: WILEY