ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1995.tb01762.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY

摘要:

This presentation is an account of the involvement of the Royal Australasian College of Surgeons in trauma care over the past 25 years. In October 1969 a 3 day seminar was held at the College entitled ‘The Management of Road Traffic Casualties’. This was in response to an increasing demand for the College to combat the devastating effects resulting from road traftic accidents. By the mid‐60s road trauma in Australia and New Zealand, as seen in other fully motorized countries, had reached epidemic proportions. Those directly involved in the care of surgical emergencies were aware of the frequency and severity of road trauma which was striking all sections of the community. Unlike the USA. Australia was not troubled by a high incidence of penetrating injuries due to guns and k

ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1995.tb01763.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY

摘要:

Fifty per cent of patients with colorectal cancer develop hepatic metastases but only a minority are candidates for potentially curative surgical resection. Hepatic artery chemotherapy (HAC) has been used to treat patients with non‐resectable metastases confined to the liver. Although response rates to HAC have been shown to be higher thnn response rates to systemic chemotherapy. the advantage in ternis of survival has been dehated. Furthermore. HAC requires surgical catheter placement which adds to the cost and morbidity of treatment. There have now been eight prospective randomized trials of HAC vs intravenous chemotherapy and/or supportive therapy. The present paper analyses the results of these trials with particular reference to survival. Surgical morbidity. treatment‐related toxicity and cost nre also discus

ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1995.tb01764.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY

摘要:

A prospective study was undertaken to evaluate the role of radionuclide bone scanning in the management of patients with multiple injuries. During a 7 month period, 14 patients with multiple injuries underwent a bone scan in order to identify occult skeletal injuries. All of the patients had new injuries diagnosed. The majority of new injuries occurred either in a limb in which an injury had already been diagnosed at presentation. or in the chest. Such findings are consistent with previously published data. Infrequently, there was a change in management of the patients in this series following the bone scan.

ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1995.tb01765.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.tb01766.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY

摘要:

Little attention may be paid during follow up of colorectal cancer patients to other medical problems because the follow up is normally focused upon the diagnosis of recurrence and the detection of metachronous neoplasms. Attention directed at improving the medical condition of patients would be justified if it were shown that other diseases had a significant effect upon survival. Review of a selected consecutive series of 207 patients included collection of data about variables relating to demography, pathology, presentation, smoking, present and past health, performance, surgery, complications, length of stay, mortality, follow up and cause of death. Significance of relationships between medical and surgical problems and the outcome was determined by analyses of variation. Medical problems were present in 79% of patients; correlated with advancing age. Medical problems were not associated with complications, or with inpatient death. Previous cerebrovascular accident. dementia, limited mobility and increasing numbers of problems were associated with prolonged stay. Prolongation of stay, however, was related mainly to surgical complications.Smoking, which was present in 50% of patients, did not alter performance status, stage or substage, stay or survival significantly. Smoking and respiratory complications were associated significantly. Patients with heart or peripheral vascular disease had significantly poorer survival (P= 0.07) than those without those problems. Survival was reduced significantly for patients known to have diabetes, cardiovascular and cerebrovascular disease and limited mobility. Other malignant neoplasms were responsible for 18% of deaths which were unrelated to colorectal cancer. Residual or recurrent colorectal cancer had a more rapid adverse influence upon outcome than did medical problems. Attention to preventative therapy of cardiovascular disease during follow up might improve survival of patients who have resections for colorectal carcinomata.

ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1995.tb01767.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY

摘要:

While the incidence of ‘negative’ appendicetomy has long been justified as a necessary evil in the management of acute appendicitis, attempts to improve diagnostic accuracy have met with mixed results. In a prospective study of 34 selected patients who presented with acute lower abdominal pain the potential role of99mTechnetium labelled leucocyte scanning in the diagnosis of acute appendicitis has been evaluated. Patient management was not based on the result of the nuclear scan. The clinical outcome was correlated with the scan diagnosis. There was one false positive and one false negative scan result with respect to the clinical diagnosis of appendicitis yielding a sensitivity of 90% and a specificity of 96%.99mTechnetium labelled leucocyte scanning may have an important role in the assessment of selected patients presenting with acute lower abdominal p

ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1995.tb01768.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY

摘要:

Glove perforation during surgery represents a potential risk of infection for the surgeon. The authors postulated that thicker latex gloves may offer greater protection. The perforation rates for the Ansell Gammex™ glove and the thicker Baxter Triflex™ gloves were compared in single‐ and double‐glove usage and no difference was found between the two brands, in either usage. The authors recommend double‐gloving for all orthopaedic operations with regular glove changes during major p

ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1995.tb01769.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY

摘要:

A retrospective analysis was performed to establish the prevalence and clinical significance of limb length discrepancy in congenital talipes equinovarus. Of 536 patients with the diagnosis of congenital talipes equinovarus, 259 were unilaterally affected and 277 bilaterally affected. Fifty‐eight patients were identified with limb length discrepancy greater than 0.5 cm. Forty‐six patients had unilateral foot deformity and in 12 cases that was bilateral. This represented a prevalence of documented limb length discrepancy in 18% of unilateral cases and 4% of bilateral cases. The discrepancy resulted in a surgical procedure to equalize the limb lengths in fourteen unilateral cases (5%). A further six unilateral cases were deemed likely to require limb length equalization, increasing the rate to 8%. Only three bilateral cases required or will require surgery for equalization (1%). There was a weak but significant correlation between the number of operations undergone and the magnitude of discrepancy. The tibia was as important in its contribution to the shortening in these patients as the foot. A total of 89% unilateral cases studied had at least 0.3 cm of tibial shortening and 43% had ipsilateral femoral shortening of at least 0.3

ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1995.tb01770.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY

摘要:

Thirty‐seven ischial pressure ulcers were repaired in 27 patients (eight quadriplegic, 19 paraplegic) between 1988–1993 using the V‐Y advancement hamstring myocutaneous island flap. Twenty‐one ulcers (57%) arosede nowand 16 were recurrent, with five patients having bilateral ulcers. The average duration of the ulcer was 5 months (range 1–30). All ulcers extended through the deep fascia (clinical grade IV), with the average diameter being 4.7 cm (range 2–10). There were four major flap complications (11%). All but one of the ulcers healed at discharge (97%). Mean follow up was 20 months (range 5–54) in 21 patients (78%), with six patients being lost to follow up. Seven of the 21 (33%) patients developed recurrent ulcers, with four of these having flap re‐advancement with successful healing, and one patient having two re‐advancements. Overall, 18 of the 21 (86%) patients with follow up had healed ulcers at time of follow up.The V‐Y advancement hamstring myocutaneous island flap is versatile, reliable, easy to perform, has few complications, and can be re‐advanced in th

ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1995.tb01771.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY