ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1989.tb01623.x

出版商:Blackwell Publishing Ltd    

年代:1989

数据来源: WILEY

摘要:

Craniolacial surgery has revolutionized the management of extensive malignancies and histologically benign but locally invasive tumours which encroach upon or directly invade the undersurface of the brain case. Approaches have been devised for tumours that involve the anterior middle and posterior fossae. Teamwork between head and neck and neurological surgeons is essential. Comprehensive pre‐operative evaluation, especially the adequacy of cross‐fill of the cerebral circulation via the contralateral arterial system through the circle of willis, must be done. Management of the internal carotid artery and cavernous sinus presents the most difficult surgical problems during the resection. During the closure, separation of the intracranial dissection from the paranasal sinuses and epipharynx by the use of flaps and grafts is essential to prevent cerebrospinal fluid leakage, cerebral support, and isolation of the carotid and dura from upper respiratory tract organisms. Well‐planned and executed craniofacial surgery can be done with acceptable morbidity and mortality rates and reasonable survival

ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1989.tb01624.x

出版商:Blackwell Publishing Ltd    

年代:1989

数据来源: WILEY

摘要:

The distribution of carotid plaque ultrasound appearance has been evaluated using duplex ultrasound in symptomatic and asymptomatic patients. There were 134 patients with unilateral carotid territory symptoms who subsequently underwent endarterectomy of the symptomatic carotid bifurcation, and 92 asymptomatic patients. Both carotid bifurcations in all patients were examined, thus providing three groups of vessels for study: (i) asymptomatic vessels in asymptomatic patients (n= 184); (ii) asymptomatic vessels in symptomatic patients (n= 134); and (iii) asymptomatic contralateral vessels in symptomatic patients (n= 134).Ultrasound appearances were classified as types 1–4. This classification has previously been compared prospectively with endarterectomy specimen pathology where the more echolucent type 1 and 2 lesions correlated well with the presence of intraplaque haemorrhage or ulceration.In the symptomatic arteries, type 1 and 2 lesions were predominant, whereas in the asymptomatic patients the most common lesions were types 3 and 4. This difference was statistically significant (p<0.01). Evaluation of the asymptomatic contralateral vessel in the symptomatic patients showed a pattern of plaque type distribution between the other two group

ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1989.tb01625.x

出版商:Blackwell Publishing Ltd    

年代:1989

数据来源: WILEY

摘要:

This paper reports a retrospective review of 40 patients who underwent 48 surgical procedures to treat extracranial cerebrovascular disease. The surgery was performed at the port kembla district hospital (a 145‐bed regional institution) between 4 october 1984 and 9 september 1987. Carotid endarterectomy was the most common operation (n= 44, 91.6%). The survey reports the patterns of presenting symptoms, risk factors, investigations, surgical detail and early and late complications, and compares these with other published series. Operative and peri‐operative morbidity and mortality were within contemporary international standards: mortality 0% (reference range: 0–1%); stroke 2.1% (1–3%); transient ischaemic attack 6.3% (0.8%). These results support the contention of other authors that international standards for extracranial cerebrovascular surgery are achievable in regional insti

ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1989.tb01626.x

出版商:Blackwell Publishing Ltd    

年代:1989

数据来源: WILEY

摘要:

Renal failure is a well‐documented complication of abdominal aortic aneurysm surgery. This study examined the use of pre‐operative cteatinine levels as a predictor of the development of acute postoperative renal failure. There was a statistically significant association between raised pre‐operative creatinine levels and the subsequent development of acute renal failure (p<0.05). The results of this study demonstrate the need for particular attention to be diverted to the protection of renal function in patients with pre‐operative raised creatinine

ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1989.tb01627.x

出版商:Blackwell Publishing Ltd    

年代:1989

数据来源: WILEY

摘要:

An audit of 43 breast cancer patients, considered to be or high operative risk and treated only with tamoxifen, was performed. All cases were potentially operable. Good outcome was obtained in only one‐third of patients. Salvage surgery had no operative mortalit

ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1989.tb01628.x

出版商:Blackwell Publishing Ltd    

年代:1989

数据来源: WILEY

摘要:

The clinical and histological features of six cases of granulomatous lobular mastitis are presented. All six patients were parous, 1–6 years after their last pregnancy with a mean age of 34 years; all had unilateral disease and presented with an extra‐areolar breast lump. Histologically, all demonstrated a non‐caseating granulomatous inflammatory condition centred on breast lobules; in four women there was an acute inflammatory process with micro‐abscess formation. Five of the six cases had persistent or recurrent disease despite wide local excision; surgery might not be the best treatment for recurrent

ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1989.tb01629.x

出版商:Blackwell Publishing Ltd    

年代:1989

数据来源: WILEY

摘要:

Clinical laboratory and endoscopic data were collected prospectively in 268 patients with bleeding gastric ulcer who were admitted between september 1985 and november 1987. There were 22 deaths, giving a hospital mortality rate of 8.2%. Surgery was undertaken in 68 patients (25.4%) with a mortality rate of 17.6% (11.8% al 30 days). There was one fatality in 104 (1.0%) patients>60 years compared with 21 deaths (12.8%) in patients>60 years (p>0.001). Cirrhosis (p>0.01), malignant disease (p<0.03), chronic obstructive airways disease (p<0.02), congestive cardiac failure (p<0.02) and ischaemic heart disease (p60 years was related to systolic blood pressure at admission (p<0.03), haemoglobin (p<0.02), serum bilirubin (p<0.02), and total transfusion requirements (p<0.001). For ulcers 1 cm, 1‐2cm in size, mortality rates were 1.9%, 11.4% and 18.0%, respectively. Initial endoscopy findings of a visible vessel, fresh blood, or active spurting/oozing haemorrhage were associated with rebleeding rates necessitating emergency surgery of 30.0%, 36.4% and 40.0%, respectively. There was no evidence of rebleeding in 187 patients (79.9%) managed conservatively and only five patients (2.7%) in this group succumbed, whereas rebleeding did occur in 47 patients (20.1 %) with 13 subsequent deaths (27.7%) (p1 cm in siz

ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1989.tb01630.x

出版商:Blackwell Publishing Ltd    

年代:1989

数据来源: WILEY

摘要:

Perforation of the thoracic oesophagus is a serious complication of oesophagoscopy and bougienage for oesophageal strictures. In the last 7 years. 10 such cases have been treated without mortality by following a particular treatment protocol. Irrespective of the duration of perforation, extent of contamination or severity of symptoms, all patients underwent thoracotomy for pleuromediastinal toilet and drainage. Decompressive gastrostomy and feeding jejunostomy was done and a nasogastric tube was left across the stricture to serve as a stent. A thread attached to the nasogastric tube helped in retrograde dilatation after healing of perforation. Infection was controlled with intravenous gentamicin, cloxacillin and metronidazole. In all patients, the perforation healed. Colonic transposition was done in three cases at a later date. The rest required periodic dilatation of the oesophagus either by peroral or retrograde approach.

ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1989.tb01631.x

出版商:Blackwell Publishing Ltd    

年代:1989

数据来源: WILEY

摘要:

The technique of eversion extraction of the oesophagus has been used in japan and china, but is little used in the western world. This is a report of the technique of the procedure as undertaken in 10 cases of oesophageal disease.

ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1989.tb01632.x

出版商:Blackwell Publishing Ltd    

年代:1989

数据来源: WILEY