ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1995.tb00597.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.tb00598.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY

摘要:

Carotid endarterectomy if advised for asymptomatic disease must be associated with a low peri‐operative morbidity and mortality and satisfactory long‐term results. Over a 12 year period between 1978–1989 181 carotid endarterectomies were performed on 163 patients with asymptomatic carotid artery stenosis. There were 112 males and 51 females with a mean age of 64.9 years. All patients had a high‐grade lesion (>70% stenosis). The combined operative mortality and stroke rate was 2.8%. On long‐term follow up six patients suffered a stroke. Only one patient however sustained a stroke in the same territory as the previously operated carotid artery. Four years following surgery 78% of patients were alive. Carotid restenosis or occlusion occurred in 8.3% of the remaining patients, all of whom were asymptomatic. All the immediate postoperative strokes occurred in patients with severe bilateral carotid artery disease. These patients with severe bilateral disease appear to constitute a high risk sub‐group for peri‐operative stroke. The role of ‘normal pressure‐hyperperfusion breakthrough’ syndrome as the presumed aetiology of two of the postoperative cerebral haemor

ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1995.tb00599.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY

摘要:

An overview of arterial surgery in Western Australia and the Department of Vascular Surgery at Royal Perth Hospital was undertaken for the ten year period from 1983 to 1992. The annual number of arterial procedures increased 116% from 937 to 2027 and lower limb amputations increased 44% from 335 to 483. Five arterial procedures were examined in detail. There was a marked increase in carotid endarterectomy and angioplasty, a moderate increase in aortic aneurysm repair and a small increase in aortofemoral and femoropopliteal bypass surgery. The major amputation rate was not influenced by bypass surgery. It rose from 113 per million population in 1983 to a peak of 148 in 1986, and then fell to 113 per million population in 1992. From June 1982 to June 1992 the population of Westem Australia rose 24%, from 1.34 to 1.66 million (and for persons 60 years and over, rose 38% from 0.16 to 0.23 million). At Royal Perth Hospital similar trends were observed. Mean duration of operation for all vascular procedures and for the individual procedures of carotid endarterectomy, angioplasty, aortic aneurysm repair and aortofemoral and femoropopliteal bypass remained unchanged. Average length of stay decreased for carotid endarterectomy (29%) and angioplasty (74%), but remained unchanged for aortic aneurysm repair and aortofemoral and femoropopliteal bypass.

ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1995.tb00600.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY

摘要:

Management of ischaemic ulcers in patients with compromised peripheral arterial circulations relies on the physical examination and the simple, non‐invasive assessment of arterial supply. This study aims to determine if transcutaneous oxygen pressure (tcPo2) measurement can improve management decisions based on ankle or toe systolic blood pressure measurement. Twenty‐two consecutive patients with ischaemic ulcers had tcPo2, measured and the ankle/brachial (ABI) and toe/brachial (TBI) indices calculated. Two months after surgery 12 of 22 (55%) ulcers were healing and 10 (45%) were indolent. Postoperative tcPo2values were predictive of wound outcome (P31 mmHg was invariably associated with healing whilst a tcPo2, 28 mmHg was associated with indolence. Anklebrachial indices and TBI were unable to be calculated in all patients due to falsely elevated pressures and hallux amputations, respectively, and neither was predictive of outcome (ABIP= 0.152, TBIP =0.069). The response to revascularization was less in diabetic patients with a mean tcPo2increase of 18 mmHg compared to non‐diabetic patients with a mean tcPo2increase of 37 mmHg. TcPo2measurement appears to be a reliable technique that can influence ischaemic ulcer manag

ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1995.tb00601.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY

摘要:

One hundred and seventy patients 70 years of age and older underwent isolated coronary artery bypass grafting (CABG) from January 1990 to December 1991 at St. Vincent's Hospital, Melbourne, Australia. The clinical records of these patients were analysed to investigate whether elderly patients could undergo safe coronary artery surgery and to determine the factors affecting the outcome. The 30 day or in‐hospital mortality was 2.9% (5/170). with 80% (4/5) of the deaths due to cardiac causes. Major postoperative complications occurred in 22.3% (38/170) patients. The median postoperative hospital stay for the patients was 8 days (range 3–103 days). Univariate analysis identified hypertension and female gender as pre‐operative risk factors and intra‐aortic balloon pump, prolonged ventilation, infarct, tamponade, need for inotropes, renal failure and a high APACHE Il scores in the intensive care unit as postoperative significant risk factors for operative mortality. There was a trend towards increased mortality with emergency operations; the operative mortality was 2.1% (2/97) for elective operations, 3.1% (2/64) in urgent cases and 11.1% (1/9) for emergencies. Multivariate logistic regression analysis identified prolonged mechanical ventilation, peri‐operative infarct and APACHE II score as significant independent predictors of mortality. The low operative mortality indicates that elderly patients can undergo safe revascularization. A high incidence of complications necessitates careful monitoring but ageper seshould not be considered a contraindication to isol

ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1995.tb00602.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY

摘要:

Bush thoracotomy is still practised in the South Western Highlands of Papua New Guinea, by traditional bush doctors. These bush thoracotomies are performed with the aim of letting out the ‘bad bloodRsquo; that is believed to have collected in the body cavities following injuries. During a 3 year period between 1989 and 1992, 183 patients with complications of bush thoracotomy were treated at the Sopas Hospital in the Highlands of Papua New Guinea. Of these patients, 55 had chest wall infections only, without any pleural involvement. Of the patients with empyemas. 14 were treated by decortication of the empyema with one death and all remaining patients were treated by drainage procedures with one death. We recommend early treatment by adequate drainage of the empyema and, where feasible, early decortication. Continuing education to eradicate the procedure, and provision of adequate surgical facilities for management of complications, should be the long‐term aim for this continuing prob

ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1995.tb00603.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY

摘要:

Trauma to the right hepatic artery during biliary surgery can lead to false aneurysm formation. Subsequent rupture into the biliary system, which may occur after a considerable delay, will then result in major haemobilia. This report details five cases referred to the Royal Melbourne Hospital over a 12 month period, four of which followed initial laparoscopic procedures, and emphasizes important management procedures to prevent and treat this previously rare complication.

ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1995.tb00604.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY

摘要:

Laparoscopic cholecystectomy (LC) has rapidly become the procedure of choice for the management of patients with gall‐bladder stones. This contrasts with patients who have common bile duct and intrahepatic duct stones who still usually need an open operation. On the basis of experience of a number of LC by one surgeon and animal experiments, we have completed laparoscopic exploration of both intra‐ and extrahepatic ducts and T‐tube drainage of 57 patients with intra‐ and extrahepatic bile duct calculi over 13 months during 1992–1993 with satisfactory results. The average operating time was 150min. with a range of 100 to 220 min. Most patients were mobile and on oral fluids within 24 h postoperative. Average hospital stay was 4 days. Retained stones were found via T‐tube cholangiography in four patients (7%) and for each patient these were removed by fibre‐optic choledochoscope 2 weeks postoperatively. Laparoscopic exploration of intra‐ and extrahepatic bile ducts is achievable by experienced surgeons and may be particularly helpful for patients who are not a good

ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1995.tb00605.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY

摘要:

Percutaneous endoscopic gastrostomy (PEG) is now a well‐established technique in children. In this study of 63 children (mean age 7.8 years, youngest 2.4 months), technical problems associated with insertion of the gastrostomy tube, and complications related to the procedure, were analysed. Complications included wound infection, oesophageal injury (probably sustained during extraction of the guide wire) and symptomatic gastro‐oesophageal reflux (GOR) occurring after PEG insertion. Many of these complications can be avoided or reduced in likelihood by refinements to the technique of insert

ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1995.tb00606.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY