ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1990.tb07360.x

出版商:Blackwell Publishing Ltd    

年代:1990

数据来源: WILEY

ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1990.tb07361.x

出版商:Blackwell Publishing Ltd    

年代:1990

数据来源: WILEY

摘要:

Dupuytren's contracture is a fascinating, deforming, fibrotic condition of the palmar fascia which has confounded clinicians and scientists for centuries. The aim of this paper is to place in perspective the longstanding associations of age, sex, race, hereditary factors, diabetes and alcohol consumption with the more recent novel investigations at the cellular level.In concert, the findings indicate that a number of factors may lead to the narrowing of palmar fascia microvessels, with localized ischaemia and oxygen free radical release. Oxygen free radicals are likely to damage the surrounding stroma, and stimulate fibroblast proliferation. Proliferating fibroblasts lay down collagen and contract in the lines of stress. The process is likely to encourage further microvessel ischaemia with a positive feedback effect that is consistent with the progressive nature of the condition.

ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1990.tb07362.x

出版商:Blackwell Publishing Ltd    

年代:1990

数据来源: WILEY

摘要:

Colorectal cancer is the most common internal malignancy in Australia, and the rectum is the most commonsite. The morbidity, mortality and survival of 561 consecutive patients with rectal cancer who had a resection at Concord Hospital during the 16‐year period 1971–86 were evaluated.More than half of the operations performed were low anterior resections (LAR), with total abdominoperinal excisions (APE) of the rectum comprising another third. There was a 5.1% mortality rate in LAR patients and a 3.1% mortality rate in the APE group. Respiratory complications, urinary tract infections and wound infections were the most common causes of morbidity in both LAR and APE.The median survival for patients treated by LAR and APE standardized for clinicopathological staging was 111.5 and 47.1 months (A), 79.0 and 65.5 months (B), 41.3 and 28.5 (C), and 14.7 and 12.4 (D) respecticv

ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1990.tb07363.x

出版商:Blackwell Publishing Ltd    

年代:1990

数据来源: WILEY

摘要:

Today, a standardized method of staging that is internationally accepted is urgently needed for the management of patients with colorectal cancer. The use of a uniform, sensitive staging system would greatly improve case selection and avoid unnecessary bias when entering patients into adjuvant therapy trials. This would allowa more accurate evaluation of new treatment protocols and assist in the development of more effective follow up programmes.

ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1990.tb07364.x

出版商:Blackwell Publishing Ltd    

年代:1990

数据来源: WILEY

摘要:

Prior to 1986, there was no uniform protocol for the collection, storage and safe transfer of allograft bone in South Australia. A programme was instituted that resulted in the collection of 100 femoral heads, of which 46 heads were used for a variety of orthopaedic procedures in 31 patients. Wastage was high with 46 femoral heads being discarded because of infection or failure to adhere to all aspects of the protocol. The donor population was found to be a safe source of bone with no cases of unsuspected hepatitis, syphilis, humanimmunodeficiency virus, or malignancy being detected. There was no infection in recipients. By observing strict criteria for the acceptance of donor bone and aided by a diligent clerical service, this type of allograft can provide a way of dealing with extensive bone deficiency in a number of surgical settings.

ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1990.tb07365.x

出版商:Blackwell Publishing Ltd    

年代:1990

数据来源: WILEY

摘要:

Sixty‐three patients undergoing oeasophagogastrodudenoscopy (OGD) (n=24)or proctosigmidocolonoscopy (PSC) (n= 39) had continuous monitoring of arterial oxygen saturation (SaO2), pulse and mean blood pressure (BP). The degree of patient distress, duration, dose of aedalive and details of the endoscope and operator were recorded.Marked hypotensive (>40% fall in BP) and hypoxic (>8% fall inSaO2) or changes occurred in 13% and 17% of the overall group, respectively. There were no significant differences in fall in BP,Sao2or pulse between the OGD and PSC groups. The dose of sedative was significantly related to the fall inSaO2(P<0.001) but not to the fall in BP. The falls in bothSaO2and BP were related to the duration of the procedure (P<0.001,P= 0.03, respectively). There were no correlations between the degree of hypoxia or hypotension and the patient's age or previous medical history. Hypotension and hypoxia occur in both colonoscopy and OGD and are neither predictable nor usually recognizable clinically. Pulse oxinietric and BP monitoring throughout gastrointestinal endoscopy are recommended for maximal safet

ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1990.tb07366.x

出版商:Blackwell Publishing Ltd    

年代:1990

数据来源: WILEY

摘要:

In an attempt to predict early graft occlusion secondary to poor distal run‐off, the outflow resistance was measured intra‐operatively and compared with the intra‐operative angiogram in 50 patients undergoing lower limb bypass procedures. With arterial inflow occluded, 60mL of plasmalyte was infused via a catheter and the resultant pressure generated in the graft was measured through a second catheter connected to a pressure transducer and recorder. Using the infusion rate and integrated pressure value, outflow resistance was calculated. High resistance measurements were defined as grafts with outflow resistance>1.1 mmHg/mL per min, low measurements were defined as values<0.5 mmHg/mL per min and intermediate measurements were those in the range 0.5–1.1 mmHg/mL per min.Angiograms were classified independently of resistance measurements by scoring the numbers of run‐off vessels crossing the ankle and stenoses, with subsequent assignment of the patient to one of three groups with either low, intermediate, or high probability of graft failure.Early graft failure was defined as cessation of graft function within 3 months of surgery. Early graft failure occurred in both cases with high outflow resistance and in seven of 44 with low outflow resistance. Of these nine occluded bypasses, six had been placed in the high probability of occlusion category on angiographic appearance and three in the intermediate category. Assessment of angiographic appearance and prediction of patency on a prospective basis had a sensitivity rate of 67% and a specificity rate of 78%. The corresponding sensitivity and specificity rates with resistance measurements were 22% and 100%, respectively. Thus, intraoperative angiographic assessment of the run‐off was more useful than outflow resistance measurement in predicting early graft patency.The presence of diabetes did not assist in the prediction of patients who subsequently developed early graf

ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1990.tb07367.x

出版商:Blackwell Publishing Ltd    

年代:1990

数据来源: WILEY

摘要:

To compare a non‐invasive technique with contrast venography in the diagnosis of lower limb deep venous thrombosis (DVT), 355 patients (380 limbs) were examined over 15 months, using Duplex ultrasound. During this period, ascending venograms were performed in 53 of these patients (56 limbs) and the results were compared. Duplex detection of intraluminal thrombus was based on venous compressibility, Doppler‐derived flow spectra, and visualization of thrombus within the lumen. Venography was designated the ‘gold standard’. Duplex scanning had a sensitivity of 90.9%, and specificity of 91.3% in diagnosing DVT anywhere in the lower limb. Sensitivity, specificity, and accuracy were best in the femoral segment (95.2%, 100%, 98.2%, respectively), and fell slightly in the more distal limb: popliteal segment (90.4%, 97.1% and 94.6%), and calf veins (88.8%, 92.0% and 90.4%). These results indicate that duplex scanning produces sufficiently accurate data in the diagnosis of lower limb DVT to warrant its clinical use. It provides both the facility for diagnosis without the risks of contrast venography, and permits repeated imaging to follow the immediate progression of disease and efficacy of tr

ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1990.tb07368.x

出版商:Blackwell Publishing Ltd    

年代:1990

数据来源: WILEY

摘要:

The Jepson classification of Raynaud phenomenon, based on its pathogenesis, is presented. Raynaud phenomenon can be induced in the fingers of the normal hand as the digital vessels are sensitive to the direct effects of cold. A ‘local fault’ in the digital arteries renders the fingers more susceptible to a fall of environmental temperature, as do limb artery occlusions which impair the digits' ability to maintain their temperature. Other vasoconstrictive influences act similarly to precipitate the onset of the phenome

ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1990.tb07369.x

出版商:Blackwell Publishing Ltd    

年代:1990

数据来源: WILEY