ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1988.tb00991.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.tb00992.x

出版商:Blackwell Publishing Ltd    

年代:1988

数据来源: WILEY

摘要:

Blunt trauma in Australia is most commonly due to road accidents and is often multisystem in its effect on the body. Whereas some cases of intra‐abdominal injury result in massive bleeding, and may be readily diagnosed clinically, many abdominal injuries are difficult to diagnose on initial clinical examination. Delays in treatment can result in otherwise avoidable morbidity and mortality, and the practice of diagnosis by repeated clinical examination over long periods of time is to be condemned in principle. All abdominal injuries can (and should) now be diagnosed and treatment commenced within 2–4 h of admission to hospital.Diagnostic peritoneal lavage (DPL) is the most sensitive indicator of intraperitoneal blood after trauma, and if employed early, and interpreted with a low threshold for positivity, early treatment of all intraperitoneal organ disruption can be undertaken.The best organ‐imaging technique available for abdominal trauma is computerized tomography (CT) scan, but it is not as sensitive as DPL in the diagnosis of haemoperitoneum, and its accuracy in defining bowel injury is not proved.Several factors dictate the choice of DPL or CT scan in difficult trauma cases, and these include the stability of the patient, the availability of CT scan, the experience of the treating physician with either modality, the organs most at risk of injury in any case, and the decision to attempt conservative or operative management. In a small number of cases, doubt may still exist after CT and/or DPL, and an early laparotomy remains the ‘gold standard’ of diagnosis in such situations. In penetrating trauma, laparotomy is indicated if wound exploration shows penetration of the p

ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1988.tb00993.x

出版商:Blackwell Publishing Ltd    

年代:1988

数据来源: WILEY

摘要:

Extraperitoneal unilateral iliac artery bypass was used to treat chronic lower limb ischaemia in 105 patients (110 operations). This represented 20% of all operations for aorto‐iliac disease. Unilateral iliac bypass was the preferred primary procedure for 99 operations, and was used to correct complications in one limb of a prior aortic bifurcation graft in the other 11. Ipsilateral fernoropopliteal vein grafts were also performed in 45 legs (43%). prior to the iliac bypass in 18, as a synchronous operation in nine, and at a later date in 18 legs. This was a much higher proportion of combined operations than for patients by aortic bifurcation grafts (12%). Only 5 patients later required further proximal surgery, one for a blocked graft and four for contralateral iliac disease. The cumulative patency rate in surviving patients was 91% at 3 years. For the claudicants and for iliofernoral bypass operations, only one graft occluded. within 5 years, and no grafts occluded for operations where the superficial femoral artery was patent. The cumulative patency rates at 3 years were 85% for patients with critical ischaemia, 82% for ilioprofunda bypass operations, and 88% for operations where the superficial femoral artery was occluded. The cumulative foot‐salvage rate in surviving patients initially treated for critical ischaemia was 77% at 3 years. The cumulative survival rate was 90% at 3 years. Extraperitoneal unilateral iliac bypass is now preferred as the primary operation for patients with apparent unilateral iliac disease causing severe ischaemia, if balloon dilatation is not appropriate or has fai

ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1988.tb00994.x

出版商:Blackwell Publishing Ltd    

年代:1988

数据来源: WILEY

摘要:

Since adopting thein situ, non‐reversed saphenous vein technique for bypass procedures in the leg early in 1986, 50 bypasses have been performed in selected patients, primarily for limb salvage. A Mills valvulotome was used for retrograde disruption of the saphenous valves, after exposure of the whole length of vein. Significant peri‐operative complications occurred in nine patients and were strongly associated with technical factors. Early graft occlusion (n= 2) and residual arteriovenous fistulae (n= 2) were revised by timely reoperation, resulting in early (30 day) patency of all but one graft. In seven patients, angioscopic visualization of the valve division process was tested as a method of ensuring complete valvulotomy, while avoiding trauma to the vein wall. Distal anastomosis to the popliteal artery above the knee or close below the knee caused a considerable degree of graft angulation, which was exacerbated by flexion of the leg, whereas anastomosis to the more distal popliteal artery or tibial vessels resulted in a favourable curvature of the graft. Lessons learned during this initial experience and aspects of technique for prevention of complications are presen

ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1988.tb00995.x

出版商:Blackwell Publishing Ltd    

年代:1988

数据来源: WILEY

摘要:

Fifty‐two patients with vascular trauma have been managed by the St Vincent's Hospital Vascular Surgical Unit during the 5 year period 1982–86. The mean age of the patients was 39.7 years; 81% were male. Penetrating, blunt and iatrogenic trauma were equally represented. Forty‐nine of the patients underwent 63 operations performed by members of the unit. Twenty‐five of the patients had significant non‐vascular injuries, requiring 29 other operations. Pre‐operative angiography was used rarely in urgent cases. All vascular reconstructions were noted to be patent during the follow‐up period, with a mean of 20 months, except in one instance, where an amputation resulted from failed surgery. One patient died from a complication of the vas

ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1988.tb00996.x

出版商:Blackwell Publishing Ltd    

年代:1988

数据来源: WILEY

摘要:

This report reviews the contemporary value of diagnostic peritoneal lavage (DPL) in the assessment of abdominal trauma, and reports the methods and results of its application within one trauma centre (Washington Hospital Center). DPL was reserved for those patients where doubt existed as to the presence of intraabdominal injury, and gave a very accurate assessment of intraperitoneal injury. The complication rate was 0.4% and the accuracy of DPL was 97.7%. Except for laparotomy, DPL is the most sensitive indicator of haemoperitoneum available. It was first introduced with the aim of reducing the number of missed diagnoses of abdominal injury and it performs this task excellently when a low threshold for positivity is used. The open technique is safest and gives fewer false positive results, and the colorimetric method of analysis of lavage fluid is recommended, with strict adherence to advised criteria for negativity.A clinical algorithm is described, utilizing DPL, aimed at early diagnosis of all intra‐abdominal injuries. This was extremely sensitive and failed in only one case in 384 (0.3%). The attendant, non‐therapeutic laparotomy rate was 19%, and is regarded as acceptable within the aims of early diagnosis.In this series, there was no mortality or morbidity attached to the use of DPL or from non‐therapeutic laparotomy, and there was only one delayed diagnosis in the entire series. No bowel, bladder, diaphragmatic, duodenal or pancreatic injuries were missed or diagnosed

ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1988.tb00997.x

出版商:Blackwell Publishing Ltd    

年代:1988

数据来源: WILEY

摘要:

Two cases of hepatic artery aneurysm are presented. Both occurred as complications of cholecystectomy for gallstone disease. The aneurysm ruptured in both cases leading to very stormy clinical courses and resulting in the death of one patient. The subject of hepatic artery aneurysms is reviewed and proposals for management are made based on the collective experience reported in the literature.

ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1988.tb00998.x

出版商:Blackwell Publishing Ltd    

年代:1988

数据来源: WILEY

摘要:

Choledochal cyst is an unusual but serious condition which most commonly affects Oriental people. Recent experience of three patients with this condition in whom diagnosis was made by ultrasound examination is reported. Cholangiography (ERCP or PTC) was performed in two of the cases to define the anatomy. All three cases were successfully managed by cyst excision and biliary reconstruction by Roux‐en‐Y hepaticojejunos‐tomy. The rationale for and importance of cyst excision are disc

ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1988.tb00999.x

出版商:Blackwell Publishing Ltd    

年代:1988

数据来源: WILEY

摘要:

Patients with intussusception who have necrotic bowel requiring bowel resection or who are at major risk of perforation from attempted hydrostatic reduction may be better managed without barium reduction. Ideally, the clinician would like to identify such patients at presentation. Two groups of patients, representing the extreme ends of the intussusception treatment spectrum were investigated in order to highlight the clinical features of patients in whom an attempted barium reduction is not justified. A group of 200 patients who had successful and safe hydrostatic reduction was compared with 104 patients who ultimately required bowel resection. Four features were found to be indicators of an increased likelihood of resection: age 3 months or less, or greater than 2 years, duration of symptoms greater than 24 h, presence of small bowel obstruction on plain radiology, and clinical assessment of dehydration greater than 5%.The validity of these features as prognostic indicators was assessed by applying them to all patients who had attempted barium reduction to see how they predicted patient outcome. In isolation, each feature was found to be compatible with a safe and successful hydrostatic reduction. The rate of resection was increased in patients with multiple adverse features and in these patients the enema technique may require modification. Patients with three or four adverse features had an unacceptably high incidence of gangrenous bowel requiring resection and a low likelihood of successful hydrostatic reduction. It is believed that attempts at reduction are not appropriate in these patients.

ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1988.tb01000.x

出版商:Blackwell Publishing Ltd    

年代:1988

数据来源: WILEY