ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1986.tb06132.x

出版商:Blackwell Publishing Ltd    

年代:1986

数据来源: WILEY

ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1986.tb06133.x

出版商:Blackwell Publishing Ltd    

年代:1986

数据来源: WILEY

摘要:

A pilot study of the Trauma Score (TS) was performed from July to September 1983. The Vital Signs Score (VSS) used by the ambulance paramedics, was compared with TS. Of 266 patients suitable for study, TS data was collected for 110. Other exclusions resulted in a detailed analysis of data from 65 patients among whom there were eight deaths. There was a significant correlation between TS and VSS, however, TS more accurately defined the population at risk of death. A score>12 correlated with a mortality of zero for the TS, but for the VSS it correlated with a mortality of 4.4%. A score ≤ 12 correlated with a mortality of 61.5% for the TS but only 30% for the VSS. Stepwise regression analysis of the TS, VSS and combinations of their components was performed to determine their capacities to predict death. A combination of three components of the TS, corresponding to the Triage Index of Champion, was a better predictor than the total TS. Neither the VSS nor any combinations of its components had the predictive capacity of the total TS. If the TS and the VSS were used to select high risk patients for a particular rescue or resuscitation protocol, and scores were selected which gave 100% sensitivity with the highest possible specificity, the positive predictive values of the TS and VSS would be respectively 61.5% and 26.7%. The protocol would be administered unnecessarily to 73.3% of patients selected by the VSS, but only to 38.5% of patients selected by the TS. The TS is proposed as an aid to triage. Audit and modification of the VSS is recommende

ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1986.tb06134.x

出版商:Blackwell Publishing Ltd    

年代:1986

数据来源: WILEY

摘要:

A prospective study was carried out in which four quadrant cold cup biopsies of the bladder were taken from patients with either a bladder tumour (57) or irritative bladder symptoms(44), and a control group(23). Five histopathological patterns were recognized: normal urothelium, mild, moderate and severe dysplasia, and carcinomain situ(CIS). In the control group, 22 of the 23 patients had normal urothelium, giving a 4% incidence of mild dysplasia. Of the 57 patients with all stages and grades of transitional cell carcinoma, 38 (67%) had dysplastic urothelium. This association is significant (P<0.01, chi‐squared).Thirty‐seven patients had Taor T1tumours, and 24(65%) of these had dysplasia, including four (11%) with CIS. Twenty patients had T2‐T4, Grade 111 tumours and 14 (70%) of these had dysplasia, including five (25%) with CIS. There was no statistical difference between these two groups. The recurrence rate was evaluated for all patients presenting with a first bladder tumour. Seventy‐three percent of patients with normal cup biopsies remained recurrence free during a mean follow‐up of 3 years (s.d. 1.15 years). Of patients with dysplastic urothelium, 72% remained recurrence free over a mean follow‐up of 3.25 years (s.d. 1.23 years). Hence, the presence of dysplasia did not predict the likelihood of tumour recurrence. Thirty patients had dysuria or suprapubic pain for which there was no explanation. Sixteen (53%) had dysplasia on cup biopsy including three (10%) with CIS (P<0.01, chi‐squared). It seems clear, therefore, that the dysplasia was the cause of these symptoms. The mean age of these patients was 53 years (s.d. 13.5) compared to a mean age of 63 years (s.d. 11.7) for those patients with both dysplasia and bladder tumour (P<0.01,ttest). This suggests that dysplasia precedes the development of transitional cell tumour by an interval of approxima

ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1986.tb06135.x

出版商:Blackwell Publishing Ltd    

年代:1986

数据来源: WILEY

ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1986.tb06136.x

出版商:Blackwell Publishing Ltd    

年代:1986

数据来源: WILEY

摘要:

A prospective randomized single blind controlled clinical trial was undertaken to compare prophylactic therapy using a systemic antibiotic active against both aerobic and anaerobic bacteria with an oral antibiotic agent active only against anaerobic bacteria in elective colorectal surgery. One hundred and thirty‐one patients received ticarcillin and 130 received tinidazole. The wound infection rate was 8% in those patients receiving ticarcillin prophylaxis and 20% in those receiving tinidazole (P<0.05). Multivariate analysis of the factors affecting wound infection rate showed that there were three independent factors that reached statistical significance: the prophylactic antibiotic used; the type of hospital (public or private) in which the operation was performed, and the presence of a stoma at operation. The wound infection rate in those patients receiving tinidazole prophylaxis was more than twice that reported previously by the authors. The mortality in patients receiving ticarcillin prophylaxis was 1.5% compared to 9.2% in those receiving tinidazole prophylaxis (P<0.05). The clinical anastomotic leakage rate was similar in each antibiotic prophylactic group, 8.6% in those receiving ticarcillin and 7.3% in those receiving tinidazol

ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1986.tb06137.x

出版商:Blackwell Publishing Ltd    

年代:1986

数据来源: WILEY

摘要:

To determine the clinical utility of routine determination of serum isoamylase (pancreatic/salivary) and/or lipase activity, sera were tested from 109 consecutive patients with elevated total serum amylase. Without knowledge of the isoamylase and lipase results, an assessment was made of the confidence with which the attending medical staff had made or excluded a diagnosis of acute pancreatitis. The attending staff had considered acute pancreatitis to be probable in 78, possible in 12 and unlikely in 19 patients. The confidence of the clinical diagnosis of acute pancreatitis was directly related to the degree of elevation of the serum total amylase: (mean IU/I ± s.e.m.) probable pancreatitis 1807±313, possible pancreatitis 680±74, pancreatitis unlikely 493±50. Pancreatic isoamylase was elevated in 97% of patients with probable pancreatitis, 92% with possible pancreatitis and 68% in whom pancreatitis had been considered unlikely. Lipase elevations generally parallelled these results. Although gall‐stones were usually sought among patients with probable pancreatitis, they were rarely sought in patients in the other categories. In conclusion, amylase isoenzyme or lipase determinations add little information in cases of clinically suspected acute pancreatitis with marked hyperamylasemia. The tests may have a role in the evaluation of patients with clinically unexplained hyperamylasemia by defining more precisely the origin of the am

ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1986.tb06138.x

出版商:Blackwell Publishing Ltd    

年代:1986

数据来源: WILEY

摘要:

There is still dispute as to the best treatment for obstructive jaundice of malignant origin when the bile ducts are blocked high in the porta hepatis. Intrahepatic duct‐to‐jejunal anastomoses provide a surgical solution which frees the patient from the need to wear external appliances. A series of eight patients having such anastomoses have been studied to determine the adequacy of bilirubin clearance, the durability of relief from jaundice, the length of hospital stay, the operative mortality and survival from the time of surgery. Intrahepatic bypasses were shown to allow bilirubin clearance in the lower range of normal. Freedom from jaundice persisted until death at a median time of 5 months from operation. Cholangitis was not a problem in any patient postoperatively. There was only one operative death. The major disadvantage of the technique arose from the hospital stay, a median of 30 days. It is suggested that all these factors should be considered in studies to compare surgical bypass with endoscopic or percutaneous methods for the relief of malignant jaund

ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1986.tb06139.x

出版商:Blackwell Publishing Ltd    

年代:1986

数据来源: WILEY

摘要:

The records of all 28 patients with rectal adenocarcinoma treated by potentially curative local excision by one surgeon (A.M.C.) between 1970 and 1984 were reviewed. Patient age, sex, tumour size, site, degree of differentiation and level of invasion are reported. The procedure was associated with no mortality and minimal morbidity. Twenty‐two patients, followed for an average of 51 months, have either died of other causes or remain free of recurrent or disseminated malignancy. Six patients have required further surgery for local recurrence. Of these, one patient has had a repeat local excision while the remaining five patients have had an abdominoperineal excision of the rectum. All six patients, followed since the second operation for an average of 50 months, are free of further recurrent or disseminated disease. The results reported in this review suggest that in a selected group of patients with rectal adenocarcinoma curative local excision may offer a safe alternative to more radical forms of surger

ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1986.tb06140.x

出版商:Blackwell Publishing Ltd    

年代:1986

数据来源: WILEY

摘要:

Between 1978 and 1984, 19 patients at Royal Perth Hospital (RPH) underwent parathyroidectomy for secondary (renal) hyperparathyroidism. This represented 6.0% of the overall dialysis population treated at RPH during this period of time. The mean duration of pre‐operative dialysis for these 19 patients was 48 months, compared with a mean duration of 30 months for the overall dialysis population. The principal indications for parathyroidectomy were symptomatic hyperparathyroid bone disease (10), hypercalcaemia (six), progressive lower limb ischaemia (two) and painful peri‐articular calcification (one). The complications of chronic renal failure that were most consistently improved by parathyroidectomy were the clinical, radiological and biochemical manifestations of hyperparathyroid bone disease and hypercalcaemia. Features such as pruritus, soft tissue calcification, vessel wall calcification and peripheral ischaemia responded less predictably. Hyperparathyroid bone disease and hypercalcaemia remain the principal indications for parathyroidectomy in chronic renal failure. Profound postoperative hypocalcaemia was the major early postoperative management problem (seven patients) and was closely linked with the severity of pre‐operative hyperparathyroid bone disease. It was also seen more frequently in those patients undergoing total parathyroidectomy with immediate autotransplantation of parathyroid tissue (TP‐A), than in those in whom residual parathyroid tissue was left in situ (subtotal parathyroidectomy or STP). Recurrent hyperparathyroidism (four patients) was the major late postoperative complication, but was more frequently the result of a supernumerary or previously overlooked fourth parathyroid gland (three), than due to hyperplasia of residual parathyroid tissue (one). STP and TP‐A were equally effective in controlling or reversing renal hyperparathyroidism, but the former was associated with a lower incidence of postoperative management problems and should be the preferred operation in this group of

ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1986.tb06141.x

出版商:Blackwell Publishing Ltd    

年代:1986

数据来源: WILEY