ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1996.tb01112.x

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY

摘要:

Background: With the advent of screening mammography more breast cancer will be detected at an earlier stage, apparently confined to the breast with no nodal involvement. However, 30% of these will recur due to micrometastases present at the time of diagnosis. Chemotherapy and tamoxifen have been shown to improve disease‐free survival in axillary node‐negative patients but not overall survival. In the search for a useful predictor of breast cancer recurrence the relationship betweenc‐erbB‐2 expression and recurrence and survival was examined.Methods: Eighty‐eight axillary node‐negative breast cancer patients were followed up for at least 5 years.Results: There was a significant relationship betweenc‐erbB‐2 expression and both tumour recurrence (P<0.001) and poorer survival (P = 0.003). In a Cox multiple regression analysis,c‐erbB‐2 staining remained the only significant prognostic variable for recurrence (P= 0.002) and survival (P = 0.032). Tumour recurrence in c‐erbB‐2‐positive cases tended to occur early in the course of follow up and was associated with poorer survival.Conclusion:C‐erbB‐2 was found to be a useful prognostic indicator for early recurrence and poorer survival in axillary node‐

ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1996.tb01113.x

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY

摘要:

Background: Nasopharyngeal carcinoma (NPC), unlike other head and neck cancers, is known for its propensity for distant metastases. Chemotherapy remains the mainstay of treatment because of this and the chemosensitivity of the tumour, but long‐term control is rare. The surgical management of pulmonary metastases of other extrathoracic malignancies prompted this review of surgical management of patients with NPC.Methods: Thirteen thoracotomies were performed in 12 patients with pulmonary metastases as the first and only site of relapse of nasopharyngeal carcinoma. Postoperative chemotherapy was given in four patients, radiotherapy to the mediastinum in one patient and both chemotherapy and radiotherapy in two patients. The survival pattern of this group of 12 patients was compared with a historical control group consisting of 65 patients without surgical resection.Results: Lymph node involvement was documented in four patients during operation. Four patients relapsed after surgical resection, two of them were from the group of three patients with lymph node involvement. The site of subsequent relapse was the lung for three patients and the skeletal system for the fourth. The 2 year actuarial survival of the surgically resected group compared favourably with the historical control group (80% and 24.1 %, respectively;P= 0.0002 by Mantel‐Cox test).Conclusions: Surgical resection of pulmonary metastases from NPC seems to be a promising approach though the effect of case selection cannot be excluded and further studies are indicated. The importance of exploration and dissection of mediastinal nodes in the surgical management of pulmonary metastases from NPC was demonstra

ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1996.tb01114.x

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY

摘要:

Background: Cholangiocarcinoma of the biliary tract is a rare tumour which has been treated with surgery, radiotherapy, chemotherapy, bypass procedures and stenting. Surgery remains the only curative treatment for these tumours, but a large proportion are unresectable. Intraluminal brachytherapy has been reported as an effective treatment for localized cholangiocarcinoma of the biliary tract. The purpose of our study was to analyse the survival of patients with biliary tract carcinoma treated with iridium‐192 brachytherapy.Methods: A retrospective review of patients treated at Peter MacCallum was undertaken. From 1989 to 1994, 16 patients underwent brachytherapy via a transhepatic approach for cholangiocarcinoma. There were 12 male and four female patients. The median age was 65 (range 40–83). All patients had cholangiocarcinoma. Prior treatment included complete resection in three, partial resection in one, bypass procedures in eight, endoscopic stents in five and external biliary drainage in 15 of the 16 patients. One patient had received external beam irradiation.Results: The median survival was 23 months and 61% survived 1 year. The most common acute complication was cholangitis seen in four patients and the most common late complications were duodenal ulcer seen in two patients and cholangitis seen in two patients.Conclusions: We conclude that iridium‐192 brachytherapy is a safe effective treatment for biliary tract carcinoma but a comparison between surgery and stenting would be of value. However, the cost of brachytherapy is not cheap and its value in this regard should be carefully ana

ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1996.tb01115.x

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY

摘要:

Background: An audit of neurosurgery in Papua New Guinea (PNG) based on the experience of a visiting neurosurgeon is presented. The objectives of the study were to determine the type and frequency of neurosurgical conditions in PNG, whether major neurosurgery can be performed successfully in PNG, and to develop a strategy for the development of neurosurgical services in PNG.Methods: The audit was carried out over two periods of 2 weeks duration in 1992 and 1993 in Port Moresby and Goroka. Instrumentation and equipment were limited and no additional equipment was used. Myelography and angiography were available in Port Moresby.Results: There were 82 patients in total, 55 (67.1%) were consultations, 23 (28%) had elective surgery, four (4.8%) had emergency surgery and 16 (19.5%) await surgery. Cases were subdivided into nine major groupings: neurotrauma 18 (seven severe); spine 18; congenital 13; hydrancephaly four; scalp, skull and orbit six; vascular three; peripheral nerve three; and neurology five. Seventy‐two (87.8%) patients required CT/MRI which were unavailable. Four ventriculograms were performed in lieu of CT/MRI. Fifteen (18.3%) cases could not be treated in PNG.Conclusions: Neurosurgical problems in PNG can often be adequately managed with limited resources. Complex procedures were performed with gratifying results and acceptable morbidity. There is sufficient pathology in a country of four million people to justify training a small number of neurosurgeons by the end of the decade. CT scanning will be a necessary adjunc

ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1996.tb01116.x

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY

摘要:

Background: The association of hyperparathyroidism with acute pancreatitis either pre‐operatively or postoperatively has been questioned in recent overseas literature.Methods: A review of medical records and histology reports in the Royal Hobart Hospital from 1971 to 1993 was carried out to identify all cases of acute pancreatitis associated with primary hyperparathyroidism.Results: Seven cases are presented, six with histological confirmation, of hyperparathyroidism associated with pancreatitis in a period when 137 confirmed cases of primary hyperparathyroidism were treated. None of these patients had gallstones. In two, alcohol abuse may have been the aetiological factor. Five patients had successful neck exploration and none of them have experienced any further attacks including a 25 year old who had four hospitalizations and one laparotomy for pancreatitis in the year before parathyroidectomy 12 years ago. Two patients died from acute pancreatitis, one without exploration and the other with a mediastinal parathyroid adenoma that was not located at surgery.Conclusions: Most parathyroid surgeons would proceed to mediastinotomy, if necessary, at initial exploration in a patient with previous hypercalcaemic crisis. This should also be considered in patients with a history of acute pancreatiti

ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1996.tb01117.x

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY

摘要:

Background: The value of the sigmoid tonometer in predicting sigmoid ischaemia and postoperative enteric organism infection has been reported but the value of tonometric measurements has been challenged. The purpose of this study was to examine the use of tonometric measurements in a series of patients undergoing infrarenal aortic aneurysm repair.Methods: We assessed the results obtained when sigmoid (n= 11) and gastric (n =8) tonometry were performed in patients undergoing infrarenal aortic aneurysm repair (n= 11). We measured blood flow ultrasonically (n =6) in the inferior mesenteric artery (IMA) and IMA stump pressures. Sigmoid and gastric tonometry were measured prior to clamping of the infrarenal aorta, during cross clamping and after clamp release at 1, 4, 16 and 20 h. Ultrasonic flow was measured before clamping. Stump pressures in the IMA were measured before, during and after clamping.Results: The IMA was chronically occluded in five patients. The IMA flow was 37.5 ± 8.7 mL/min (mean ± s.e.). The mean IMA stump pressures before, during and after clamping were 64 ± 13, 48 ± 8 and 69 ± 10 mmHg, respectively, and did not differ significantly. Mean systematic arterial pressures at these times were 89 ± 7, 95 ± 5 and 86 ± 8 mmHg. These did not differ significantly or when compared with IMA stump pressure. The gradient between systemic arterial pressure and IMA stump pressure did not vary significantly at any of these times. Sigmoid and gastric intramucosal pH (pHi) did not differ significantly at any of the above times. Both sigmoid and gastric pHi dropped on clamp application but 4 h afterwards had returned to baseline levels. Systemic arterial pH reflected significant ischaemia during clamping and shortly after release of the clamp (P= 0.008).Conclusions: Tonometry may reflect systemic events as much as regional ischaemia. Useful tonometry results may depend on the development of a trend rather than individual measurements. The routine use of tonometry to detect intestinal ischaemia may not be cost‐effective in aorti

ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1996.tb01118.x

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY

摘要:

Background: Pre‐peritoneal mesh repair has been a long‐standing technique for recurrent hernias. Laparoscopic technique has been applied to this operation with the aim of assessing its results at early follow up of 1 year.Methods: The outcome in 56 patients was reviewed and all patients contacted 12 months after surgery.Results: There was one immediate failure at 1 week, needing a further operation. There were no other recurrences at 1 year. Ten patients had minor postoperative complications.Conclusions: At early follow up, this is a satisfactory technique for recurrent hern

ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1996.tb01119.x

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY

摘要:

Background: Venous thromboembolic complications may be more common after laparoscopic surgical techniques, possibly due to changes in venous flow and blood coagulability.Methods: This study assessed fibrinogen, cross‐linked fibrin degradation products (D‐dimer), prothrombin international normalized ratio (INR), activated partial thromboplastin time (APTT) and platelets, during and after both open and laparoscopic Nissen fundoplication to determine whether coagulability is increased by the laparoscopic approach.Results: Seven patients underwent open and thirteen underwent laparoscopic Nissen fundoplication. Fibrinogen levels following open fundoplication fell from 2.8 ± 0.3 g/L pre‐operatively to 2.0 ± 0.3 g/L following skin incision, and then increased to 4.1 ± 0.4 g/L on the first postoperative day. Similar changes in fibrinogen occurred following laparoscopic fundoplication (2.7 ± 0.2, 2.5 ± 0.2 and 3.8 ± 0.4 g/L, respectively). No significant changes in the other coagulation indices were observed.Conclusions: These results demonstrate hypercoagulability on the first postoperative day, irrespective of the operative technique. No differences between the results following laparoscopic and open fundoplication were d

ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1996.tb01120.x

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY

摘要:

Background: Primary bone tumours have traditionally been treated by forequarter amputation. However, recent limb salvage techniques have become available which are comparable for tumour control and preserve a useful distal limb. This report describes the use of the Huckstep ceramic shoulder with ceramic spacers, non‐vascularized fibular grafts and Huckstep nail with ceramic spacers.Methods: Three techniques are described for the reconstruction of the humerus following primary tumour excision. The seven primary bone tumours in this series included three patients with osteosarcoma, two with chondrosarcoma, one with fibrosarcoma and one with an aneurysmal bone cyst. The mean age of the four males and three females was 27 years (range 18–57). Mean follow up was 8.8 years (range 1–18). The techniques used were the Huckstep ceramic shoulder prosthesis with spacers (three cases), non‐vascularized fibular grafts (three cases) and the Huckstep nail with ceramic spacers (one case).Results: One fibular graft required supplementary bone grafting and one patient with a shoulder prosthesis died of metastatic disease. The other five patients are well with a good range of shoulder abduction and external rotation.Conclusions: Limb salvage surgery of the upper limb is possible. Deltoid, rotator cuff and radial nerve functions can be pr

ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1996.tb01121.x

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY