ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1988.tb01078.x

出版商:Blackwell Publishing Ltd    

年代:1988

数据来源: WILEY

ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1988.tb01079.x

出版商:Blackwell Publishing Ltd    

年代:1988

数据来源: WILEY

ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1988.tb01080.x

出版商:Blackwell Publishing Ltd    

年代:1988

数据来源: WILEY

摘要:

The results of 100 free microvascular transfers to the lower limb are presented. These show a high success rate with successful salvage of 95 limbs. The major complications were infection and delayed healing, osteo myelitis, and non‐union. Early skin cover, within 14 days of injury, reduced the incidence of complications by half. Aggressive debridement and provision of early skin cover should be the aim of management of tibial trauma with tissue los

ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1988.tb01081.x

出版商:Blackwell Publishing Ltd    

年代:1988

数据来源: WILEY

摘要:

In a review of 61 patients with compound injuries to the upper and lower extremities, Operating Theatre costs were added to the costs of inpatient hospitalization after commencement of reconstruction with either a pedicled flap or free tissue transfer. The cost of pedicled groin flap to the upper limb and cross leg flap groups was double that of comparable free tissue transfer groups. The cost of abdominal tube pedicle to the lower limb was three times greater than for the free flap technique. The conclusion is drawn that apart from general advantages to the patient, the cost to the community is significantly reduced.

ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1988.tb01082.x

出版商:Blackwell Publishing Ltd    

年代:1988

数据来源: WILEY

摘要:

False aneurysm formation is a major complication of vascular surgery. The most frequent site of anastomotic false aneurysm formation is the femoral artery. Between January 1974 and June 1986, 26 patients with 42 femoral false aneurysms were treated at the Princess Alexandra Hospital. Aneurysms developed following Dacron arterial grafting (29 aneurysms), saphenous vein grafting (10 aneurysms), umbilical vein grafting (one aneurysm) and femoral embolectomy (two aneurysms). Arterial wall failure (with intact suture and graft) was the most frequent operative finding. Ten recurrent aneurysms developed. There was a significantly greater number of recurrences when resuture or patch repair was employed than when an interposition graft was used as a repair. The development of a femoral anastomotic false aneurysm should be viewed as a total failure of that anastomosis and repair should be by replacement with an interposition graft rather than repair of the failed anastomosis by suture or patch.

ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1988.tb01083.x

出版商:Blackwell Publishing Ltd    

年代:1988

数据来源: WILEY

摘要:

The role of various parathyroid hormone (PTH) radio‐immunoassays in the diagnosis of primary hyperparathy‐roidism (PHP) is controversial. A series of 204 patients with surgically proven PHP was studied. Serum total calcium, serum ionized calcium, amino (N)‐terminal PTH and carboxyl(C)‐terminal PTH were assessed in relation to the volume and weight of adenomatous or hyperplastic parathyroid tissue excised at operation.N‐terminal PTH was elevated above the normal laboratory range in only 24% of patients and correlated relatively poorly with the volume of abnormal parathyroid tissue (r = 0.20,P= 0.05).C‐terminal PTH was elevated above the normal range in 91% of patients and had a strong correlation with the volume of abnormal parathyroid tissue (r = 0.63,P<0.001). The correlation coefficients betweenC‐terminal PTH and serum total calcium and serum ionized calcium were both 0.63 (P<0.001). In contrast, there was no correlation betweenN‐terminal PTH and serum total calcium (r= ‐0.02), serum ionized calcium (r=‐0.04) orC‐terminal PTH (r = 0.09).A combination of hypercalcaemia and elevatedC‐terminal PTH can be regarded as strong diagnostic evidence of PHP. Furthermore, the level ofC‐terminal PTH can assist the surgeon by approximately predicting the amount of adenomatous or hyperplastic parathyroid tissue that may be expecte

ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1988.tb01084.x

出版商:Blackwell Publishing Ltd    

年代:1988

数据来源: WILEY

摘要:

A total of 86 procedures were performed in 58 patients referred in the postoperative period, for percutaneous stone extraction through the T‐tube track. In 43 patients, the stone or stones were extrahepatic, intrahepatic in nine, and both intrahepatic and extrahepatic in six patients. Of the 58 patients with residual bile‐duct stone(s), 48 (83%) were treated successfully by percutaneous removal, seven (12%) had an endoscopic sphincterotomy following unsuccessful T‐tube track extraction, one (2%) had a re‐operation and two (3%) remain with residual stones. No major complications occurred in this series. In contrast to endoscopic sphincterotomy, percutaneous T‐tube extraction of retained bile‐duct stones is associated with no mortality and low morbidity and is advocated as the procedure of choice in the presence

ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1988.tb01085.x

出版商:Blackwell Publishing Ltd    

年代:1988

数据来源: WILEY

摘要:

The value of routine use of operative cholangiography was evaluated in 225 patients. In 65 patients (29%). there was one or more clinical or operative indications for common duct exploration and only 21 cases showed positive cholangiographic findings and were explored. There were four negative explorations in this group. In the remaining 160 patients who had no indication for common duct exploration, 157 had a normal cholan‐giogram and three had false positive cholangiographic findings and were explored unnecessarily. If operative cholangiography had been performed only on those patients with clinical or operative indications for common duct exploration, no ductal stone would have been missed. A selective use of operative cholangiography is advocated and the investigation should be restricted to those patients with clinical or operative indications for exploration of the common bile‐d

ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1988.tb01086.x

出版商:Blackwell Publishing Ltd    

年代:1988

数据来源: WILEY

摘要:

The Melanesians of the North Solomons arc exposed to intense equatorial sunlight and yet have a very low incidence of skin cancer. lhis study reveals no proven cases of basal cell carcinoma in these people, and demonstrates the rarity of squamous cell carcinoma and melanoma arising in normal pigmented skin. Most, if not all squamous cell carcinomas, arise in skin damaged by tropical ulceration, burns or osteomyelitis. Melanoma arises from the unpigmented skin of the sole of the foot. North Solomon Islanders are very deeply pigmented. Presumably, dense cutaneous melanin in normal undamaged skin provides the highly effective protection against solar carcinogenesis which these people enjoy. Chronic or recurrent skin ulceration with subsequent repair, scarring and loss of pigment is the precursor to almost all non‐melanoma skin cancer in these people. Most of these cancers could be prevented by split thickness skin grafting of chronic ulcers. and protection of ulcerated, depigmented and scarred skin from solar radiatio

ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1988.tb01087.x

出版商:Blackwell Publishing Ltd    

年代:1988

数据来源: WILEY