ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1994.tb04528.x

出版商:Blackwell Publishing Ltd    

年代:1994

数据来源: WILEY

ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1994.tb04529.x

出版商:Blackwell Publishing Ltd    

年代:1994

数据来源: WILEY

摘要:

Mesenteric cyst is one of the rarest abdominal tumours, with approximately 820 cases reported since 1507. The incidence varies from 1 per 100000 to 250000 admissions. The lack of characteristic clinical features and radiological signs may present great diagnostic difficulties. The cyst may present in one of three ways: (i) non‐specific abdominal features; (ii) an incidental finding; or (iii) an acute abdomen. Abdominal pain is the major presenting symptom. Abdominal mass is found in more than 50% of cases and 40% of cases are discovered incidentally. More than one aetiological mechanism is probably involved in the development of mesenteric cysts. Mesenteric cysts have been reported from the duodenum to the rectal mesentery but are most commonly located in the ileal mesentery. Malignant cysts occur in less than 3% of cases. Enucleation of the cyst is the treatment of choice. Knowledge of these tumours is important due to the various complications associated with suboptimal surgical management. Two cases of mesenteric cysts are presented including a recurrent mesenteric cyst in a post‐partum woman demonstrating the inferior technique of internal marsupialization. The association of mesenteric cyst with pregnancy is discus

ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1994.tb04530.x

出版商:Blackwell Publishing Ltd    

年代:1994

数据来源: WILEY

摘要:

A population‐based study of all cases of breast cancer diagnosed in Western Australia (WA) in 1989 revealed 701 cases of cancer in 692 women. Three hundred and ninety‐six (56.5%) of these cancers had fine needle aspiration (FNA) cytology. Forty‐three cases were managed non‐surgically, on the basis of an FNA diagnosis and without histologic follow up. Of the cases with histological follow‐up, 73% received an unequivocal diagnosis of malignancy by FNA, and abnormal cells (atypical, suspicious or malignant diagnoses) were reported in 94.2%. Of the cases, 3.2% were reported as benign and in 2.6% the samples taken were unsatisfactory. There were no false positive cytological diagnoses of malignancy. This study is the first to examine the results of FNA diagnosis of breast cancer from a medical community as a whole, rather than for individual or specialist units; the accuracy of diagnosis was similar for different pathology practices including public and private sector laboratories. Lower absolute sensitivity (the proportion of cases given an unequivocal diagnosis of malignancy) was seen in very small and very large tumours, pure duct carcinomain situ(DCIS), and invasive lobular carcinoma. False negative rates (the proportion of cases given a benign cytological diagnosis) were very low for all laboratories (0–4.5%) and for all types of carcinoma, and the proportion of unsatisfactory samples was exceptionally low for all laboratories (0–4.5%). The overall figures for accuracy are similar to those reported from other centres in Australasia and overseas, and confirm the effective use of FNA cytology throughout the clinical and pathology co

ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1994.tb04531.x

出版商:Blackwell Publishing Ltd    

年代:1994

数据来源: WILEY

摘要:

Testicular cancer is the most common malignancy in young men and is frequently associated with delays in presentation. It has been postulated that ignorance and poor awareness of this type of cancer may contribute to such delays, which may result in high stage disease and subsequent treatment‐related morbidity. This study was undertaken to assess the level of awareness of testicular cancer in a sample of 500 men from Wellington, New Zealand, and to specifically examine awareness related to the age, race, and socio‐economic level of the respondents. Sixty‐one per cent of men returned a satisfactorily completed questionnaire. Most (70%) were unaware that cancer of the testis could develop. Of those who correctly identified testis cancer as occurring, half recognized the most commonly affected age group, 40% understood testis cancer could be tréated, and 14% believed testis cancer could be cured with treatment. The lowest awareness scores (mean ± s.d.) were found in the 18–30 age group. The score in this group (2.82 ± 1.47) was significantly lower than that seen in the 31–40 (mean 3.66 ± 1.81,P= 0.009) or 41–50 (mean 3.57 ± 2.16,P= 0.036) age groups. Differences were also seen between ethnic groups, with Maori having significantly lower scores than non‐Maori (Maori, mean 2.69 ± 1.52; non‐Maori, 3.45 ± 1.83;P= 0.044). Higher scores were associated with higher socio‐economic grouping. The overall poor awareness of men in this study supports the need for a public education programme aimed at encouraging men to seek early advice following the recognit

ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1994.tb04532.x

出版商:Blackwell Publishing Ltd    

年代:1994

数据来源: WILEY

摘要:

The treatment of anal carcinoma with concurrent chemo/radiotherapy has largely replaced abdominoperineal resection as the primary management. This report details the outcome of 62 patients with anal carcinoma treated at a single institution over a 10 year period, during which this approach has become the mainstay of therapy. Of the 34 patients treated with combination radiotherapy and chemotherapy (5‐fluorouracil and mitomycin‐C), 31 were evaluable and a complete response was achieved in 77%. The estimated 5 year failure‐free survival was 67% and the overall survival was 81%. The overall survival was superior to that in patients treated with radiotherapy alone. Eighty‐four per cent of patients received the treatment as planned, while the remainder had a reduction in the dose of radiation or chemotherapy due to acute toxicity. The use of combination therapy for primary management of anal carcinoma is generally well tolerated, appears to provide a treatment outcome at least equivalent to surgery, and allows preservation of anal function. Concurrent chemo/radiotherapy should be considered in the initial management of patients with anal ca

ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1994.tb04533.x

出版商:Blackwell Publishing Ltd    

年代:1994

数据来源: WILEY

摘要:

Impaired hepatic function is a major contributory factor to the high incidence of postoperative morbidity and mortality in patients with malignant biliary obstruction. Dynamic hepatic function tests such as indocyanine green (ICG) retention and aminopyrine breath tests were evaluated in such patients to define whether they were clinically useful for prediction of postoperative morbidity and mortality. Forty‐four patients with malignant biliary obstruction undergoing surgery for relief of obstructive jaundice were recruited into the study. Indocyanine green retention and aminopyrine breath tests were carried out in all patients pre‐operatively and repeated in 36 patients postoperatively. The ICG retention was abnormal in all patients before surgery and there was significant improvement 2 weeks after surgery (32.8 ± 2.5%vs18.3 ± 2.8%,P= 0.001). The change in ICG retention levels correlated with the serum bilirubin levels but the pre‐operative ICG retention value could not predict postoperative morbidity and mortality. The aminopyrine breath test was abnormal in all but one patient. It correlated with pre‐operative prothrombin time of the patients before surgery but it did not improve significantly after surgery and was not predictive of postoperative outcome. It is concluded that both ICG retention and aminopyrine breath tests have limited clinical value in the pre‐operative evaluation of patients with malignant biliary

ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1994.tb04534.x

出版商:Blackwell Publishing Ltd    

年代:1994

数据来源: WILEY

摘要:

This paper assessed the efficacy of arterio‐venous fistulae, vein grafts, and synthetic grafts for long‐term haemodialysis. Over a selected 10 year period, 486 primary access sites were established and 182 revisions were necessary. Access procedures were assessed for primary survival, the success or otherwise of revision surgery, and long‐term efficacy for haemodialysis. Significant differences were shown for long‐term survival of fistulae over vein grafts and synthetic grafts. Successful revision surgery favoured fistulae over synthetic grafts. Arterio‐venous fistulae offered the best prospect for effective long‐term dialysis. Revision surgery with continued dialysis using the primary‐access site was largely unsuccessful, secondary access reconstruction being required in 78.2% of

ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1994.tb04535.x

出版商:Blackwell Publishing Ltd    

年代:1994

数据来源: WILEY

摘要:

The author has recently had referred to him three patients with median nerve injuries who have had open carpal tunnel decompression via a small transverse wrist incision. Despite previous adverse reports, some surgeons persist with this technique.

ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1994.tb04536.x

出版商:Blackwell Publishing Ltd    

年代:1994

数据来源: WILEY

摘要:

Fusion of the metarcarpophalangeal joint of the thumb is an accepted treatment in the management of instability or osteoarthritis following trauma to this joint. A review was made of the literature and 30 of the senior author's (RH) patients who had had this operation, in order to determine what effect the operation had on the pain in their thumb, any symptoms of instability, interference with work and daily activities, and strength in the hand. All of the patients achieved bony union and the average angle of fusion was 7.6 degrees of flexion. All of the patients were either satisfied or very satisfied with the results of the operation, and had an average increase of 6.3 points on a 12 point rating scale. However, 48% of patients had some mild intermittent pain and 43% complained of some difficulty with fine motor tasks. Twelve patients were able to attend for formal evaluation including the Jebson and Crawford Hand Function Tests which revealed some decrease in hand function in all of those tested. It was concluded that this method of arthrodesis of the metacarpophalangeal joint of the thumb gives reliable results, with high patient acceptance, but does not result in an entirely normal thumb or hand function.

ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1994.tb04537.x

出版商:Blackwell Publishing Ltd    

年代:1994

数据来源: WILEY