ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1995.tb01784.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY

ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1995.tb01785.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY

ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1995.tb01786.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY

摘要:

The aims of this study were to see if laparoscopic cholecystectomy is associated with a similar postoperative pain pattern to gynaecological lapnroscopy and to see whether the use of a suprahepatic suction drain makes recovery from laparoscopic cholecystectomy mnre comfortable. After routine laparoscopic cholecystectomy nnd insertion of a suprahepatic suction drain, patients were randomized to suction or no suction on the drain. The time course of the severity of wound, abdominal and shoulder tip pain was assessed by visual analogue scales administered in the morning and afternoon of the tirst 3 postoperative days. The control group had a high incidence of shoulder tip pain similar to that after gynaecological laparoscopy. Patients in the treatment group reported signiticantly less shoulder tip pain than the control group (O.R.0.16, 95% Cl, 0.06–0.40). There was a tendency for the treatment group to report reduced abdominal and. to a lesser extent, wound pain. The authors recommend suprahepatic suction as a simple and more effective way to improve patient comfort after laparoscopic cholecystectom

ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1995.tb01787.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY

摘要:

The introduction of laparoscopic inguinal hernia repair (LIHR) has been controversial. A questionnaire was sent to all general surgeons in New Zealand to document the early experience with LIHR and attitudes towards it. Of the 118 replies (response rate 55%). 74 were from laparoscopic surgeons. 26 of whom had performed 564 (201 public. 363 private) LIHR (23 bilateral) until January 1994. Only nine (35%) of these surgeons had assisted an experienced surgeon before performing an LIHR. and only four (15%) were supervised by an experienced surgeon during their first case. The transabdominal preperitoneal technique of LIHR was used by 14 (54%) surgeons. the extraperitoneal technique by eight (31%), and the tronsabdominal onlny technique by four (15%). There were 29 (5%) recurrences, 17 (3%) neuropathies. seven (1.2%) conversions, four (0.7%) miijor perforations. and one (0.17%) death. Of the 26 surgeons who performed LIHR, 20 (77%) were concerned about the absence of long‐term results. 14 (54%) considered that the optimal technique had not been established. 13 (50%) were concerned about the unique complications associated with LIHR. 11 (42%) were less enthusiastic about performing LIHR than previously. 10 (38%) were doubtful about its advantages, and six (23%,) were uncertain about its future and considered that it should only be performed within the context of a controlled trial. This study highlights a number of issues that need to be addressed before the role of LIHR can be determine

ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1995.tb01788.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY

摘要:

Cost awareness and accountability for the use of health care resources have become major issues for clinicians. In order to identify the economic costs associated with carotid endarterectomy (CEA), a retrospective review of 50 elective CEA between May 1993 and April 1994 was undertaken. Despite our belief [based on the Australian National Dingnostic Related Groupings (ANDRG)]. that our resource utilization had been retined to produce a median length of stay signiticantly below the New South Wales (NSW) State average, this study has identitied several areas of non‐productive expenditure. The mean cost of CEA per patient was $7053. This figure includes non‐productive expenditure of $793 per patient in the pre‐operative period and $395 per patient in the postoperative period. If these costs, which did not contribute to patient care. were removed the mean cost of CEA would be $5865.The major causes of non‐productive resource utilization included prolonged pre‐operative stay, duplicated or omitted investigations, as well as the use of the Intensive Care Unit for patient monitoring in the postoperati

ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1995.tb01789.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY

摘要:

A retrospective survey of 138 carotid endarterectomies performed in Northern Tasmania over a 6 year period was conducted to identify risk factors for postoperative neurological complications. A total of 80% of patients were operated on for transient ischaemic attacks (TIA) referable to stenosis of the ipsilateral internal carotid artery (ICA). A total of 77% of patients who were operated on had angiographic evidence of severe (over 80%) stenosis of the affected ICA. A combined postoperative permanent neurological deticit and mortality rate of 5.8% was achieved. Severe stenosis of the contralateral internal carotid artery and pre‐operative symptomatic instability were associated with the development of postoperative neurological complication

ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1995.tb01790.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY

摘要:

The aim of the study was to determine if there is a relationship between the stage of breast cancer at the time of detection and the costs of treatment and to assess whether any such relationship would have an influence on the cost of a mammographic screening programme.A retrospective analysis of the stage at presentation for primary breast cancer and the treatment costs over the duration of treatment was made. Multiple regression analysis was employed, with treatment cost as the dependent variable and categorical variables to represent stage at detection. A total of 301 women whose treatment for breast cancer commenced at the Royal Brisbane Hospital participated in the study.A statistically signficiant relationship was found between the stage of disease at the time of detection and subsequent treatment costs; more advanced stages of disease incurred higher treatment costs. This relationship was robust even after taking into account the age of patients, their discharge status, and differences between patients in the duration of treatment. When the effect of earlier detection on treatment cost was assessed in relation to a breast screening programme, cost savings were estimated to be in the range of 8–36% of total screening costs.There are treatment cost savings to be gained from breast cancer screening as a result of the detection of earlier stages of disease. These treatment cost savings should be offset against the cost of a mammographic screening programm

ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1995.tb01791.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY

摘要:

The breast is a variable organ and as such reconstructive surgeons need to use a variety of reconstructive techniques. Prosthetic reconstruction is a good technique for women who are either unsuitable for or not accepting of autogenous tissue reconstruction. We reviewed the last live years' experience at Monash Medical Centre with permanent tissue expander breast reconstruction. Forty patients underwent reconstruction of 54 breasts. Immediate reconstruction was performed in 70% with an overall average patient age of 45 years. The selection criteria. advantages. and disadvantages of this technique are discussed. Inflation of expanders took an average of 71 days and creation of breast mound (excluding nipple/areolar reconstruction) took an average of 2.3 operations. Overall aesthetic results have been judged to be good to excellent in 81%. Symmetry was more easily achieved in bilateral reconstructions. Capsular contracture rate was Baker Grade I or II in 83%. Minor complications occurred in 17% of patients. We believe that there still exists a significant number of women who are either unsuitable for or not accepting of autogenous tissue reconstruction. It is this group of women who, if well selected, can be reconstructed safely and efficiently by the use of permanent tissue expander breast prosthesis.

ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1995.tb01792.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY

摘要:

A prospective study was carried out in a university hospital to evaluate the results of extraperitonealization of the sigmoid colon in non‐gangrenous signioid volvulus. Eighty‐eight patients with non‐gangrenous sigmoid volvulus were operated upon using the technique of extraperitonealization of the sigmoid colon. There was no recurrence of the volvulus at I to 6 years follow up but 8 patients (9.1%) had constipation and 2 patients (2.2%) had distension of the lower abdomen. Extraperitonealization of the sigmoid colon is a reasonable non‐resection alternative for non‐gangrenous sigmoid volvulus and has minimal morbidity, mortality and no recurrence in o

ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1995.tb01793.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY