ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1995.tb00557.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.tb00558.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY

摘要:

Dipyridamole Thallium‐201 (201Tl) scintigraphy has been used widely for assessment of patients prior to vascular surgery. Recently, Adenosine has been reported to be a safe and useful alternative to Dipyridamole. The purposes of this study were to evaluate the safety and feasibility of the use of Adenosine, to evaluate the correlation of Adenosine201Tl scans with coronary angiograms (when available) and to evaluate the effect of scan results on clinician management style. Fifty adults with abdominal aortic aneurysm or other vascular disease underwent an intravenous infusion of Adenosine in conjunction with initial and delayed planar201Tl scans. Images were interpreted qualitatively and quantitatively by the consensus of two or more experienced observers with patients showing transient left ventricular dilatation or redistribution in one or more myocardial segments reported as being at high risk of peri‐operative cardiac events. Of the 50 subjects studied, 49 tolerated the maximum infusion dose with 60% experiencing minor transient symptoms. Low (n= 30) and high risk (n= 20) patients were defined according to Adenosine201Tl scans. Age, gender and clinical characteristics were similar in both groups. Thirteen (65%) high risk subjects had coronary angiography compared with only three (10%) low risk patients. Patients with high‐risk201TI scans were also more likely to proceed to coronary revascularization prior to non‐cardiac surgery [5/20 (25%)vs1/30 (3%)]. The positive predictive value of high risk201Tl scans for coronary artery disease was 85%. Thus, Adenosine is considered a useful and safe alternative to Dipyridamole. In conjunction with201Tl scintigraphy Adenosine has the potential to modify management of patients prior to elective non‐cardiac surgery and may reduce adverse peri‐operative car

ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1995.tb00559.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY

摘要:

Between January 1991 and December 1993, duplex ultrasound characterization of venous disease in leg swelling was studied in 214 patients (261 limbs; 167 unilateral and 47 bilateral). All patients were examined with a duplex scanner, the superficial and deep venous systems were evaluated for the presence of thrombus and valvular incompetence. Of the 261 limbs, 29 (11.1%) had deep venous thrombosis, 14 (5.4%) had superficial venous thrombosis, 66 (25.3%) had deep venous incompetence (31/66 limbs also had superficial venous incompetence), 65 (24.9%) had incompetence in the superficial veins only. and five (1.9%) had deep venous obstruction resulting from a popliteal cyst or a popliteal vein ligation. Eighty‐two limbs (31.4%) had no evidence of venous obstruction or incompetence at the areas evaluated. This study showed that venous obstruction and valvular incompetence had occurred in two‐thirds of swollen legs examined. Some of the venous obstructions resulted from surgically treatable diseases such as a popliteal cyst, and some of the venous disorders involved the superficial venous system only. Complete venous evaluation with duplex imaging can be very helpful in the determination of the underlying cause of the swell

ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1995.tb00560.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY

摘要:

There are a number of different primary problems in patients presenting with varicose veins. Treatment needs to be appropriate to the different causes. Doppler/ultrasound examination of varicose veins can very accurately define almost all abnormalities that cause varicose veins, but this can be time consuming. Over 3 years' experience of the clinical application of colour Doppler/ ultrasound investigation in the assessment of patients with varicose veins in a small general hospital is reported. The selection of patients and how improved understanding of the various presenting problems of patients examined may affect treatment are described. All surgeons with access to this technology are encouraged to include it in the investigation of their patients.

ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1995.tb00561.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY

摘要:

The aim of this study was to evaluate the administration of postoperative heparin thromboprophylaxis via an indwelling subcutaneous cannula. Fifty consecutive patients undergoing laparotomy, laparoscopy or varicose vein surgery were studied. Each patient on admission had a 24 gauge subcutaneous cannula inserted and a conventional subcutaneous heparin injection preoperatively. The first 20 patients received an alternating postoperative regimen of morning heparin via cannula and evening heparin via conventional injection into the abdominal wall. The remaining 30 patients received postoperative heparin twice daily via the cannula. Patients and nursing staff were interviewed and their preference for either method was recorded.There were no significant complications with the cannula system. Although it was more costly and nursing staff found it more labour intensive than conventional subcutaneous injections, the majority of patients preferred to receive heparin via the cannula. We conclude that this is an excellent method of administering prophylactic subcutaneous heparin, especially for patients with a strong aversion to injections.

ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1995.tb00562.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY

摘要:

Catheter‐related venous thrombosis is one of the most important complications of central venous catheters. The aim of this prospective study was to assess the risk factors that may be important in the development of catheter‐related thrombosis. Multiple lumen (n= 20) and single lumen (n= 24) polyurethane catheters were inserted to the subclavian vein by the infraclavicular approach in 44 consecutive patients. All variables that may be significant for the development of thrombosis related to the patient, the catheter the insertion technique and the solution administered through the line were recorded. Eighteen of 44 patients (40%) were found to have venous thrombosis. Two factors were found to correlate significantly with the development of central venous catheter‐related thrombosis, namely the number of vein punctures (onevstwo punctures,P<0.01) and the composition of solution (fluid replacementvstotal parenteral nutrition,P=

ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1995.tb00563.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY

摘要:

Appendicitis is one of the most common acute abdominal conditions that requires operation during pregnancy. The maternal and fetal complications occurring in such situations are well known. However, the diagnostic and therapeutic challenges of acute appendicitis complicating pregnancy persist in current surgical practice. Thirty‐eight obstetric cases who had an appendicetomy performed during pregnancy between 1986 and 1993, were reviewed. In 31 cases, acute appendicitis was proven at laparatomy, and by subsequent histopathology. In the confirmed cases, seven occurred in the first trimester, 12 in the second trimester, eight in the third trimester and four in the immediate postpartum period. Two miscarriages occurred in the first trimester group, and two late abortions and two preterm (26 and 28 weeks) deliveries occurred in the second trimester group. In the third trimester/postpartum group, all babies survived, but four patients had Caesarean sections with the appendicetomy and the incidence of perforatedgangrenous appendices was highest. Perinatal outcome was worst, with the highest fetal wastage rate if the acute appendicitis occurred in the second trimester, although maternal morbidity appeared to be the same across different gestational period

ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1995.tb00564.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY

摘要:

Gastric varices may be associated with oesophageal varices in patients with portal hypertension. Control of haemorrhage from gastric varices is often difficult. Between June 1988 and February 1990, six patients underwent gastric devascularization in an effort to control life‐threatening haemorrhage from bleeding gastric varices after non‐operative measures failed. In all six patients the bleeding was controlled. There was one peri‐operative death due to hepatic failure. Four patients experienced postoperative respiratory or urinary tract infections that responded to appropriate antibiotic and respiratory support measures. After a mean follow‐up period of 44 months, eradication of gastric varices was achieved in all five survivors. Gastric devascularization is an effective surgical measure for good palliation and control of life‐threatening haemorrhage from bleeding gastri

ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1995.tb00565.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY

摘要:

This paper reports a series of 316 patients with 322 stomas, of which 156 were end‐sigmoid colostomies (48.5%) and 123 urological ileal conduits (38.2%). An overall complication rate of 66.8% was detected, with parastomal herniation rate, stenotic rate, and prolapse rate of 31.1, 10.2 and 6.8%, respectively. Complications were detected much later in a urological stoma than in a colostomy. Patients bearing an abdominal stoma should be followed up stringently. The creation of an abdominal stoma should not be regarded as a minor surgical procedure. Certain stomas, such as loop transverse colostomy, should be avoided whenever possibl

ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1995.tb00566.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY