ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1987.tb01289.x

出版商:Blackwell Publishing Ltd    

年代:1987

数据来源: WILEY

ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1987.tb01290.x

出版商:Blackwell Publishing Ltd    

年代:1987

数据来源: WILEY

摘要:

This is the edited transcript of a continuing education meeting held under the auspices of the new south wales state committee, royal australasian college of surgeons, at the sheraton‐wentworth hotel, sydney, on 21 march 1986. The meeting took the form of a debate, in which a group of speakers were asked to assemble the appropriate facts and arguments for and against the proposition that ‘asymptomatic gallstones should not be removed’.As the contributors in some cases found themselves supporting a point of view with which they did not necessarily agree, individual participants are not identified in the trans

ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1987.tb01291.x

出版商:Blackwell Publishing Ltd    

年代:1987

数据来源: WILEY

摘要:

Fifty‐five consecutive patients presenting to a surgical unit for management of malignant obstructive jaundice are reported in this paper. An increasing incidence of bile‐duct carcinoma has been noted since the end of 1983. The hospital mortality for all cases was 15%, a figure which did not differ significantly from the 11% mortality associated with the surgical management of benign obstructive jaundice. The median survival of patients with malignant obstructive jaundice was 6 months and the 2 year survival 10%. The only long‐term survivors were those in whom pancreaticoduodenectomy was employed. Until radical improvements in treatment are achieved, effective palliation must remain the goal for the surgeon. This means that there is a need for rapid diagnosis, rapid decision making and early intervention to restore bile flow to the intestine. The best palliative procedure has yet to be defined and the status of stint insertion, of surgical bypass procedures and of palliative resection of some tumours remain unclear. Similarly, the place of adjuvant chemotherapy and radiotherapy have not been clearly established. There is a real need for a trial of various methods of treatment which employs an evaluation that takes into account both duration and quality of

ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1987.tb01292.x

出版商:Blackwell Publishing Ltd    

年代:1987

数据来源: WILEY

摘要:

In the 5‐year period, ending october 1986, 15 patients underwent resection for cholangiocarcinoma involving the confluence of the right and left hepatic ducts. The operative mortality was 13%percnt;. Accurate pre‐operative assessment is dependent on adequate cholangiography. Infra‐operative use of frozen section is important to be certain of histological clearance above and below the tumour. Hepatic resection was necessary to adequately reset the malignancy. To date, the mean survival is 20 months, with two patients alive 5 years after resection. The length and quality of survival following this major surgical approach is such that patients whose age and condition would allow resection, should be considered for exploration and potentially curative su

ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1987.tb01293.x

出版商:Blackwell Publishing Ltd    

年代:1987

数据来源: WILEY

摘要:

Fifteen quadriplegic (tetraplegic) patients from the spinal injuries unit of the austin hospital have had surgery to improve function in 17 of their upper limbs. Changes in strength, function, subjective ratings and the influence on 198 activities of daily living are reviewed. The posterior third of the deltoid muscle was transferred into 8 triceps tendons to provide active elbow extension in seven patients. Six patients had transfers of forearm muscles to provide grasp and lateral pinch or active extension of wrist and fingers. Other operations included transfer of the latissimus dorsi to the forearm producing elbow flexion, medial advancement of the anterior deltoid origin improving shoulder control (an operation which has not been described previously), and tenodesis for stabilizing the wrist. The objective results were satisfactory in 12 patients. Eleven patients had either good or excellent subjective results. The maximum force of active elbow extension achieved was 6.8 kg and the peak grip strength reached was 10.5kg. Six patients achieved subjective results higher than would have been expected from objective assessment. All patients benefited in some way. 13 patients felt that surgery was worthwhile and no patient lost appreciable function. The results of this series indicate that upper limb surgery has a definite place in rehabilitation of the quadriplegic patient. Improved surgical technique may reduce the time required for postoperative rehabilitation and thus make these procedures feasible for a larger number of patients.

ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1987.tb01294.x

出版商:Blackwell Publishing Ltd    

年代:1987

数据来源: WILEY

摘要:

A prospective study was conducted on 344 children aged from 3 months to 16 years with acute appendicitis. Most children presented with typical features of acute appendicitis (70%) or peritonitis (28%). Atypical presentation was uncommon and occurred only in seven young children, masquerading as intestinal obstruction, gastroenteritis or urinary tract infection. Prolonged delay in surgery was associated with a rise in incidence of late appendicitis (gangrenous and perforated appendicitis). This rise was especially marked 37 h after onset of symptoms. The main causes of delay were inability of the parents and primary care medical practitioners to recognize the disease early. Surgeons contributed very little to the delay. High risk factors for postappendectomy sepsis were young children under 6 years old, late appendicitis, obese patients, inferior systemic antibiotic regimes and inexperienced surgeons. Young children had high postoperative sepsis mainly because of the high incidence of late appendicitis due to their inability to express their symptoms properly. They were not especially prone to postappendectomy sepsis; they had the same degree of appendicitis compared with older children. Measures to decrease the postappendectomy morbidity are suggested.

ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1987.tb01295.x

出版商:Blackwell Publishing Ltd    

年代:1987

数据来源: WILEY

摘要:

The case records of 169 children admitted to hospital with suspected appendicitis were subjected to bayesian analysis in order to determine whether computer‐assisted diagnosis would be likely to reduce the negative laparotomy rate. The results suggest that the negative laparotomy rate could be reduced from 27% to 18% if computer‐assisted diagnosis was u

ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1987.tb01296.x

出版商:Blackwell Publishing Ltd    

年代:1987

数据来源: WILEY

摘要:

Symptomatic rectocele is known to contribute to the formation of piles in female patients. This paper describes a subset of women pile sufferers who have occult rectoceles which are asymptomatic, and which are not obvious on routine visual examination, even with the use of the speculum. These patients are mulatiparous and have sustained perinea! damage either from episiotomy or from laceration. They present with symptoms of piles. If treated by conventional pile surgery the postoperative course is beadevilled with difficult defaecation, the patient often needing to insert a finger into the vagina to gain satisfactory evacuation. An accurate case history will show all these patients to have a pre‐operative story of straining at stool.Anterior rectal wall pressure on rectal examination shows a definite occult rectocele (spinnaker deformity) coupled with a deficient scarred perineum. This paper describes is such patients who have been seen over the past 4 years. Treatment has been by either pile surgery and later colpo‐perineorrhaphy (four cases), by combined colpo‐perineorrhaphy and pile surgery (eight cases), or by surgical correction of the rectocele alone (three c

ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1987.tb01297.x

出版商:Blackwell Publishing Ltd    

年代:1987

数据来源: WILEY

摘要:

Patients with pilonidal disease presenting at wellington hospital between 1979 and 1982 have been studied retrospectively. Of 218 admissions, 113 were for pilonidal sinus and 105 for pilonidal abscess. Fifty‐five sinuses and 82 abscesses were ‘laid open’. Hospital stay, recurrence rates and costs were considerably lower in those patients who were laid open. It is suggested that laying open is the procedure of choice for patients with both pilonidal abscess and

ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1987.tb01298.x

出版商:Blackwell Publishing Ltd    

年代:1987

数据来源: WILEY