ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1994.tb02051.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.tb02052.x

出版商:Blackwell Publishing Ltd    

年代:1994

数据来源: WILEY

摘要:

Video‐assisted thoracoscopic surgery (VATS) has been suggested as the most appropriate choice for spontaneous pneumothorax. Thirty‐two patients (30 males, two females, age range from 16 to 42) with primary spontaneous pneumothorax (PSP) are reported. All had mechanical pleurodesis with Marlex mesh. Blebs or bullae could be identified in 24 patients (75%). All bullae over 2 cm were either excised (11 patients) or ligated (five patients). The median operating time was 45 min. There was minimal postoperative discomfort and the median postoperative hospital stay was 4 days. There was one minor wound infection and one recurrence (mean follow up of 11 months). It is concluded that VATS is a quick, safe and effective approach for the treatment of PSP. Long‐term results will better define its true merit in thoracic su

ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1994.tb02053.x

出版商:Blackwell Publishing Ltd    

年代:1994

数据来源: WILEY

摘要:

Video‐assisted thoracoscopy (VAT) offers a new approach to the diagnosis and treatment of many thoracic conditions. From September 1992 to August 1993, a total of 163 VAT procedures were successfully performed on 108 patients (87 male, 21 female; age range from 12 to 77) which consisted of 42 bleb eliminations and 64 mechanical pleurodesis for spontaneous pneumothorax, 11 wedge resections for pulmonary nodules, three wedge biopsies for diffuse pulmonary infiltrate, four thoracic sympathectomies, resections of two mediastinal masses, three pericardial windows, 10 guided pleural biopsies for undiagnosed effusions, six guided drainage of empyema and haemothorax, 16 staging of intrathoracic tumours and two explorations for penetrating thoracic trauma. There was no procedure‐related mortality. Complications included one recurrence for spontaneous pneumothorax, one re‐exploration for bleeding (also by VAT approach), one wound infection, and six persistent air leaks for more than 10 days. The median duration of postoperative chest tube drainage was 2 days and the median hospital stay was 4 days. It was concluded that VAT is a safe and effective approach in thoracic surgery and with further refinement in instrumentation even more procedures will be technically feasible. The long‐term results of VAT are being awaited in order to define its true merits in thoracic

ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1994.tb02054.x

出版商:Blackwell Publishing Ltd    

年代:1994

数据来源: WILEY

摘要:

Thyroid nodules are uncommon in the paediatric age group. One hundred and twenty‐two children and adolescents underwent thyroidectomy for nodular thyroid disease in the Endocrine Surgical Unit at the Royal North Shore Hospital over a 37 year period. In the adolescent age group (13–18 years) 99 thyroidectomies were performed and the pattern of thyroid disease was similar to that seen in adults. In the prepubertal age group (0–12 years), the major difference was the high incidence of thyroid malignancy, especially in males. Of 23 prepubertal children undergoing thyroidectomy for nodular disease, malignancy was found in 38% of boys and 13% of girls. Multicentric papillary cancer (66%) and cervical lymph node metastases (80%) were very common, despite which the long‐term survival was ex

ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1994.tb02055.x

出版商:Blackwell Publishing Ltd    

年代:1994

数据来源: WILEY

摘要:

The question of whether or not to reverse heparin following carotid endarterectomy is a topic of debate. The potential reduction of the risk of thrombosis at the endarterectomy site with non‐reversal has to be measured against a potential increase in the risk of wound haematoma. This study prospectively followed activated clotting time (ACT) of 42 consecutive patients undergoing carotid endarterectomy. A standard heparin dose of 100 units/kg was used, and heparin reversal was employed only if the wound appeared excessively haemorrhagic at the procedure's completion. Heparin was reversed in 11 patients. Following heparin administration, ACT increased to a mean 2.72 ± 0.09 times baseline (range 1.84–4.07), and fell with time, until at 3 h after heparin administration mean ACT in the non‐reversed patients was 1.48 ± 0.03 times baseline (range 1.1–2.03). There was one postoperative neurological event (2%), a contralateral hemisphere stroke. No patient developed a frank wound haematoma requiring evacuation, although three patients (7% of the total study group, 9% of patients not receiving heparin reversal) developed neck swelling and symptoms of airway compromise, and were intubated. Measurements of ACT suggest that a heparin dose of 100 units/kg achieves an adequate anticoagulant level in the operative and early postoperative phase, when thrombosis is most likely to occur, and is not associated with an increased risk of wound haematoma. If heparin is to be selectively reversed in patients felt to be at high risk of postoperative haematoma, the decision should be based on an objective measurement such as ACT, and not the surgeon's impression of wound ha

ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1994.tb02056.x

出版商:Blackwell Publishing Ltd    

年代:1994

数据来源: WILEY

摘要:

The contribution of duplex scanning to improving early diagnosis of graft stenosis was evaluated in 195 patients after infra‐inguinal bypass procedures. Over a 31 month period, 406 duplex scans were obtained on 232 limbs with 191 vein and 41 polytetrafluoroethylene (PTFE) grafts. Peak systolic velocities>200cm/s with spectral broadening and lumen reduction on B‐mode image were the criteria adopted for identification of a haemodynamically significant (>50%) stenosis. Sixty‐one stenoses were identified in 55 of the grafted limbs. Thirty‐three of the 55 limbs had a subsequent angiogram. The angiogram showed graft occlusion in six limbs, graft stenosis in 18, and native artery stenosis in four. Twenty‐one of the grafts had the angiogram within 1 month after the duplex had detected graft stenosis, and one (4.76%) became occluded in this interval. Seven had an angiogram more than 1 month after the duplex study, and five (71.4%) had become occluded. The angiographic study did not confirm a graft stenosis in five limbs. Three were submitted to operation and stenosis was confirmed. Seventeen graft thromboses were detected by duplex scanning. Graft thrombosis was demonstrated following a previous negative duplex scan in one of the 106 vein grafts (0.94%), and in four of 30 PTFE grafts (13.3%). Duplex scanning is effective in the detection of graft stenosis. The precise anatomical location is less accurate when in the region of an anastomosis. Early attention should be taken when duplex studies suggest critical graft stenosis because there is a high risk of occlusion. Polytetrafluoroethylene grafts tend to thrombose without a precursory focal

ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1994.tb02057.x

出版商:Blackwell Publishing Ltd    

年代:1994

数据来源: WILEY

摘要:

Day‐only admissions for surgery are strongly encouraged, in an effort to keep costs down. Varicose vein surgery has been considered too major for day‐only management despite the fact that there have been studies from overseas showing that it can be done with a morbidity comparable to inpatient surgery. The morbidity of day‐only surgery for varicose veins (both long and short saphenous procedures) was assessed and compared with the results of inpatient surgery. Patients were also asked whether they were satisfied with the surgery being done this way. There were 165 consecutive patients available for study, 64 day‐only and 101 inpatient. All patients attending Shellharbour Hospital, Shellharbour, had surgery done as day‐only (as it was a morning list and allowed adequate time for recovery). Patients attending Bulli Hospital, Bulli, had surgery done as an inpatient (afternoon list). All surgery was performed by one surgeon. There was no difference (Chi‐squared) in the age distribution (mean 48 years for day‐only, 51 years for inpatient) or sex proportion in either group (Chi‐squared test of proportions with continuity correction). Assessment of the results was done by review of the surgeon's notes, as well as telephone interviews for day‐only subjects. The complication rate in both groups was similar. Wound problems represented the main complication with an incidence of 10.5% in each group. There was one deep venous thrombosis (DVT) in each group (diagnosed by duplex scan). Response to the telephone interview suggested that most patients were happy to have the surgery done as a day‐only procedure. Sixty‐nine per cent responded that they would have it done this way again and 76% were satisfied with the result of the surgery. This study confirms the results of overseas studies, in that varicose vein surgery can be performed as day‐only procedures with a complication rate similar to inpatient procedures and with a high degree of patient satisfaction. It is suggested that this should be used as the method of choice for the majority of patients requirin

ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1994.tb02058.x

出版商:Blackwell Publishing Ltd    

年代:1994

数据来源: WILEY

摘要:

The role ofEnterobius vermicularisin appendicitis has been disputed. The aims of this retrospective study were to determine the prevalence of E.vermicularisin surgically removed appendices and to relate this to the age and sex of the patient, the time of the year, the presence of symptoms and the histological findings. The study included all appendices received in this laboratory during the 5 year period from 1984 through to 1988. There were 1867 appendices during this period of which 1108 were acutely inflamed and 759 were not inflamed (although 149 of these showed other pathological changes). The mean age distribution of all patients was 22.8 years.Enterobius vermiculariswas identified in 63 appendices (3.4%). Infestation was more frequent in female (4.6%) than in male (1.9%) patients. The peak age was 12.8 years in females and 12.1 years in males. Of 63 patients who hadE. vermicularis, 98% presented with symptoms of acute or recurrent appendicitis, yet 40 had no histological evidence of appendicitis or mucosal invasion by the parasite and only four had other possible explanations for abdominal pain. In an analysis of the subgroup of 147 patients who had incidental appendectomy at the time of laparotomy for other reasons, only one hadE. vermicularis.It is concluded thatE. vermicularisoccurs more frequently in uninflamed appendices. It may be a cause of symptoms resembling acute appendicitis although the mechanism for this does not involve mucosal invasion by the parasite.

ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1994.tb02059.x

出版商:Blackwell Publishing Ltd    

年代:1994

数据来源: WILEY

摘要:

Fifty‐six patients with possible appendicitis were evaluated clinically and by ultrasound. Ultrasound examination visualized the appendix in 18 of the patients evaluated and showed another pathology in six others. It was useful when the clinical picture was not clear (25 patients) as it showed an inflamed appendix in 10 patients. This was of particular value when there was another critical illness making clinical evaluation difficult (three patients), and for the diagnosis of other unsuspected pathological conditions (six patients). It did not affect the line of management when the clinical picture was clear enough to diagnose or exclude acute appendiciti

ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1994.tb02060.x

出版商:Blackwell Publishing Ltd    

年代:1994

数据来源: WILEY