ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1994.tb02235.x

出版商:Blackwell Publishing Ltd    

年代:1994

数据来源: WILEY

摘要:

The results of external beam radiotherapy for clinically localized adenocarcinorna of the prostate in 448 patients treated in the period 1980–90 were reviewed. The average follow up was 4.9 years. The patients were aged 44–87 years (median 69 years) and all had histopathological evidence of adenocarcinoma by needle biopsy or transurethral resection of prostate. The histopathological grading was: 127 G1; 154 G2; 127 G3; 12 G4; 28 Gx. Clinical staging according to TNM (American Urological Association) was: 29 T0(A2); 4 T1(B1); 173 T2(B2); 176 T3(C1); 63 T4(C2); 3 Tx. Routine surgical pelvic lymph node staging was not performed but patients had radiological (computerized tomography scan or lymphogram) nodal staging: 350 N0; 22 N1; 12 N2; 64 Nx. High energy linear accelerator external beam radiotherapy was given by multiple fields to total doses of 50–70 Gy (median 60 Gy). The majority of patients (307, 69%) was treated by a uniform policy under the care of one radiation oncologist (HM). The rates of local and distant failure at 5 years were 10% (s.e. = 2%) and 42% (s.e. = 3%), respectively. The late complication rate at 5 years was 25% (s.e. = 2%), comprising mild 16%, moderate 7% and severe 1.3%. The 5 year overall survival rate was 64% (s.e. = 2%) and the cancer‐specific survival rate was 74% (s.e. = 3%). Both histological grade and clinical stage were strongly predictive of overall survival and distant failure. Only histological grade was predictive of local failure. Treatment with external beam radiotherapy for this common cancer resulted in survival and disease control rates that compare favourably with other published radiotherapy series and has been accompanied by acceptably low mo

ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1994.tb02236.x

出版商:Blackwell Publishing Ltd    

年代:1994

数据来源: WILEY

摘要:

A retrospective review of prospectively gathered data from 249 trauma patients was undertaken to study the association of lower urinary tract disruptions with pelvic fractures and to confirm guidelines for the initial investigation and management of such patients in the emergency room. Of 249 patients with pelvic fractures, 124 (50%) had haematuria and 17 (7%) had lower urinary tract disruptions (7 urethral ruptures, 9 bladder ruptures and 1 patient with both bladder and urethral ruptures). Gross haematuria or blood at the urethral meatus was noted in 16 of 17 patients with urological injuries. Twenty‐five per cent of patients with unstable pelvic fractures had lower urinary tract disruption compared to 6% of patients with stable fractures (P<0.05). Retrograde urethrography followed by cystography is indicated in all cases of pelvic fractures with blood at the urethral meatus, macroscopic haematuria or associated signs such as inability to void and perineal haematoma. Urinary diversion alone was used in partial urethral ruptures while surgical exploration and repair were performed in complete urethral ruptures and in most cases of bladder rupture

ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1994.tb02237.x

出版商:Blackwell Publishing Ltd    

年代:1994

数据来源: WILEY

摘要:

The study's objective was to examine whether there is evidence that colonoscopic polypectomy reduces the incidence of colorectal cancer. The records of all patients who underwent colonoscopic polypectomy by a single surgeon between 1974 and 1991 were reviewed. Patients with colorectal cancer diagnosed at the initial colonoscopy, with a history of colorectal cancer, inflammatory bowel disease or familial adenomatous polyposis or with only hyperplastic polyps were excluded. There were 1008 remaining patients, of whom 645 have attended at least one follow‐up colonoscopic examination, and these 645 patients form the basis of the study, because the incidence of cancer is known exactly in this group. The mean period of follow up was 4.4 years and the mean number of follow‐up colonoscopic examinations was 2.2. There was a total of 2847 person‐years of colonoscopic follow up. The expected incidence of cancer, age and sex adjusted, is calculated using Australian epidemiological figures. The observed incidence of cancer was 3 cases (all asymptomatic) per 2847 person‐years, which is indistinguishable from the general population's risk of 3.75 cases per 2847 person‐years. Analysis of previous publications suggests that patients with adenomas are at an increased risk of developing colorectal cancer of about 2.5 times the general population's risk. If correct, then the observed incidence of 3 cases per 2847 person‐years is less than the expected incidence of 9.4 cases per 2847 person‐years. This analysis suggests colonoscopic polypectomy does reduce the incidence of colo

ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1994.tb02238.x

出版商:Blackwell Publishing Ltd    

年代:1994

数据来源: WILEY

摘要:

Acalculous cholecystitis is probably more common than the medical literature would suggest. This paper reviews a series of 13 patients who presented with symptoms of cholecystitis and who had normal ultrasound or cholecystogram examinations. Eleven patients underwent cholecystectomy and all had their symptoms ameliorated or cured. Laparoscopy is suggested as an early diagnostic procedure in these patients, followed by cholecystectomy if there is objective laparoscopic evidence of cholecystitis.

ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1994.tb02239.x

出版商:Blackwell Publishing Ltd    

年代:1994

数据来源: WILEY

摘要:

Laparoscopic cholecystectomy is the preferred method of treatment for symptomatic choledocholithiasis. Since its introduction there has been an increase in postoperative diagnostic and therapeutic endoscopic retrograde cholangiopancreatography (ERCP). The aim of this study was to assess the indications and results of ERCP following laparoscopic cholecystectomy.Sixty‐one patients had an ERCP following laparoscopic cholecystectomy. Two broad groups were identified: Group 1 (35 patients) had filling defects (consistent with stones) noted on operative cholangiography, which were not successfully flushed or extracted at the time of laparoscopic cholecystectomy; Group 2 consisted of patients who developed problems following laparoscopic cholecystectomy. Nine patients had post‐laparoscopic cholecystectomy pain with abnormal liver function tests (LFT), four of whom had common bile duct (CBD) injuries and three had CBD stones. Eleven patients had post‐laparoscopic cholecystectomy pain with a normal diameter common bile duct on ultrasound and normal LFT; only one had a CBD stone. Five patients with a persisting bile leak following laparoscopic cholecystectomy had an ERCP and endoscopic sphincterotomy. In three the leak ceased, while two required subsequent open surgery to drain bile collections and ligate the cystic duct. One patient presented with an episode of transient jaundice but had a normal ERCP.There were six post‐ERCP complications; three patients had mild pancreatitis, two had a minor haemorrhage and one an asymptomatic duodenal perforation.Endoscopic retrograde cholangiopancreatography post‐laparoscopic cholecystectomy was most valuable for the management of retained stones and the diagnosis and management of post‐laparoscopic cholecystectomy pain in association with abnormal LFT. The diagnostic yield was low (9%) when the LFT

ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1994.tb02240.x

出版商:Blackwell Publishing Ltd    

年代:1994

数据来源: WILEY

摘要:

Over a 12 year period, 25 psoas abscesses occurring in 17 patients were managed at Royal Perth Hospital (900 bed hospital). Symptoms were present, on average, for 5 weeks prior to diagnosis, which was typically confirmed by computerized tomography. Fifty‐nine per cent of cases were primary and percutaneous drainage effected a cure in 80% of all cases. Percutaneous drainage resulted in a non‐significant trend towards shorter inpatient s

ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1994.tb02241.x

出版商:Blackwell Publishing Ltd    

年代:1994

数据来源: WILEY

摘要:

Two cases of testicular tumours in non‐twin brothers of a cancer‐prone family are described. Cytogenetic studies of these two patients and human leucocyte antigen (HLA) typing of the family failed to identify any genetic defects. The authors propose using linkage analysis for further genetic studies but would require additional families for this to be perfor

ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1994.tb02242.x

出版商:Blackwell Publishing Ltd    

年代:1994

数据来源: WILEY

摘要:

This study compares the histology of the plantar‐digital nerve supplying the third web space in asymptomatic patients with those who have clinically diagnosed Morton's metatarsalgia. Despite several studies concentrating on the histological changes in the interdigital nerve, the relevance of these changes is a matter of contention while the exact pathological process responsible for the symptoms has not been determined. The histological findings in control patients were identical to Morton's patients with the exception of demyelination, which was more common in the Morton's group. This suggests that the characteristic nodule and fibrotic changes seen in the interdigital nerves of patients with Morton's neuroma cannot account for the symptoms and that the changes seen in the neurovascular bundle are degenerative in origin and are found in asymptomatic patient

ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1994.tb02243.x

出版商:Blackwell Publishing Ltd    

年代:1994

数据来源: WILEY

摘要:

A modification of the metal Berci cannula, which made open choledochography so much easier, has been adapted for the laparoscopic procedure.

ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1994.tb02244.x

出版商:Blackwell Publishing Ltd    

年代:1994

数据来源: WILEY