ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1993.tb00376.x

出版商:Blackwell Publishing Ltd    

年代:1993

数据来源: WILEY

摘要:

The aim of this report is to review recent experience of removal of anatomical segments of the liver. Resection of one or more segments of the liver was undertaken in 49 patients; in 32 patients, the resection was for malignant disease and in the remainder it was for benign disease. Operating time was 130 (60–600) min and the median transfusion requirement was 0 (0–15) units, with 31 patients having a resection without the need for a blood transfusion. There was no postoperative or in‐hospital mortality. The removal of anatomical segments of the liver is a very useful technique for the safe removal of benign and malignant le

ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1993.tb00377.x

出版商:Blackwell Publishing Ltd    

年代:1993

数据来源: WILEY

摘要:

A consecutive series of 36 Japanese patients with ampullary carcinoma who underwent a pancreatoduodenec‐tomy at the Department of Surgery I, Kyushu University Hospital during the past 20 years were reviewed clinicopathologically to study prognostic factors. A univariate generalized Wilcoxon test showed that pre‐operative serum carcinoembryonic antigen (CEA) concentration, venous invasion, lymphatic permeation and perineural invasion were significant parameters. A multivariate Cox regression analysis showed that venous invasion was the only significant variable. In a sequential serum CEA follow up of 10 patients, an elevation of serum CEA levels was seen to correspond to the clinical development of a recurrence in six, while a high concentration of serum CEA was not evident despite the clinical manifestation of a recurrence in two, and serum CEA levels remained within the normal limits with no evidence of a recurrence in two others. According to the death certificates of 15 patients, where an exact site of metastasis was available, 11 died from liver metastasis, three from lung metastasis and one from peritoneal dissemination. These findings suppon the theory that a histologic invasion of the venous space is an independent prognostic factor and close attention should be paid to any signs of haematogenous metastasis, such as to the liver and lung, as well as to a serial serum CEA follow

ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1993.tb00378.x

出版商:Blackwell Publishing Ltd    

年代:1993

数据来源: WILEY

摘要:

Six cases of tubercular granulomatous mastitis were studied retrospectively. Three of these six cases posed diagnostic difficulties because of a lack of caseation in granuloma on fine needle aspiration cytology. A pragmatic approach is described here that is based on the correlation of the clinical features with the cytological findings. All six cases improved on therapeutic trial of antitubercular treatment.

ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1993.tb00379.x

出版商:Blackwell Publishing Ltd    

年代:1993

数据来源: WILEY

摘要:

Repair of inguinal hernia using local anaesthesia is becoming increasingly popular as it avoids many of the systemic side effects associated with general or spinaVepidural anaesthesia and provides excellent early postoperative pain relief. Dosages of local anaesthetic approaching the recommended maximum are frequently required for adequate anaesthesia of the inguinal region. The present study describes the disposition and safety of lignocaine with adrenaline in 14 elderly patients to ascertain its safety with a view to more widespread application of the technique in more complicated hernia repairs. Serial plasma lignocaine concentrations were determined for up to 24 h following doses approaching the recommended maximum for infiltration (7 mg/kg). Peak lignocaine concentrations (normalized to 7 mg/kg) ranged from 0.23 to 0.90mg/L (mean of 0.54mg/L): that is, the maximum recorded concentration was less than one‐fifth the toxicity threshold for lignocaine of 5 mg/L. The study suggested that the majority of patients tolerated the local anaesthetic approach very well and that the wide safety margin allowed ample scope to develop the local anaesthetic approach for the repair of more complex hernia repairs (e.g. large, bilateral or strangulated herniae, or those in obese patients) without risk of exposing patients to lignocaine concentrations which may cause toxic side effect

ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1993.tb00380.x

出版商:Blackwell Publishing Ltd    

年代:1993

数据来源: WILEY

摘要:

Two groups of patients with squamous cell carcinoma of the oral cavity and oropharynx treated by radical surgery were studied. Special emphasis was placed on analysing changing trends in reconstruction and the management of the mandible and their influence on complication rates, length of hospital stay and tumour control rates. Group I consisted of 97 patients treated between 1980 and 1984 and Group 2 consisted of 153 patients treated between 1987 and 1991. Anatomical distribution of cancers and clinical stages were similar in the two groups. The major trends identified were: (i) the increasing use of free flaps for reconstruction (0 in Group 1,41% in Group 2); (ii) more conservative mandibular resection and the increasing use of mandibular swing procedures (1% in Group I, 16% in Group 2) rather than segmental mandibular resection (44% in Group 1, 13% in Group 2); (iii) fewer procedures per patient (2.6 per patient in Group 1, 1.2 per patient in Group 2); and (iv) a decrease in mean duration of hospital stay from 34 to 16 days and fewer complications. Patients in Group 2 also had a lower rate of local recurrence of cancer when compared with patients in Group 1 (19vs29%).

ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1993.tb00381.x

出版商:Blackwell Publishing Ltd    

年代:1993

数据来源: WILEY

摘要:

The role of frozen section (FS) thyroid histology is controversial, some finding it helpful and others finding it inaccurate and of little assistance. The FS and subsequent permanent histology diagnosis were analysed retrospectively in 241 patients, 23 of whom were subsequently shown to have carcinoma. FS correctly identified five (22%) of these, deferred the diagnosis in three (13%) and made an incorrect benign diagnosis in 15 (65%). This impaired accuracy was attributed to the high proportion (13/23) of follicular neoplasms, which are difficult to categorize on FS. No false positive diagnoses were made in the 218 patients with benign disease. The possibility of a benign FS diagnosis being converted to malignant was 6.2%. The result of the FS affected management in that all five patients with the diagnosis of cancer underwent immediate contralateral surgery, but only seven of 18 in the negative FS group had further surgery when permanent histology demonstrated carcinoma, despite equivalent risk factors for poor prognosis in each group. This study suggests that the interpretation of FS and risk factors, in particular the tendency to interpret most follicular neoplasms as benign rather than defer decision, may be improved if pathologists and surgeons interested in thyroid disease are involved in the management of patients with thyroid nodules. Although FS remains flawed it is helpful in a small proportion of cases where it allows immediate contralateral surgery.

ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1993.tb00382.x

出版商:Blackwell Publishing Ltd    

年代:1993

数据来源: WILEY

摘要:

Twenty‐five patients with unstable tibial shaft fractures who were initially managed with calcaneal pin traction and subsequent plaster of Paris were retrospectively reviewed to determine if this form of management would adversely affect the outcome. There were no pin track problems. Residual subtalar joint stiffness, as measured by a foot‐plate goniometer, was noted in only three patients and this could not be attributed directly to this form of fracture management. All fractures went on to union. This method is a reasonable option in the management of unstable tibial fractu

ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1993.tb00383.x

出版商:Blackwell Publishing Ltd    

年代:1993

数据来源: WILEY

摘要:

This paper prospectively evaluates 33 dual lumen, right atrial catheters inserted into either an external or internal jugular vein by open operation in 29 patients, of whom 15 required haemodialysis and 14 required temporary plasma exchange. The median (range) catheter survival in the haemnodialysis and plasma exchange groups was 108 days (7–334 days) and 61 days (10–116 days), respectively. Life table analysis demonstrated that overall catheter survival was 58% at 200 days. The main causes of catheter failure were infection (four cases), poor flow (three cases) and accidental removal (one case). Another nine catheters were removed electively because of maturation of alternative methods of vascular access (five cases). completion of plasma exchange treatment (three cases), or successful renal transplantation (one case). Long‐term silastic catheters, inserted into the right atrium via a jugular vein. have distinct advantages over temporary subclavian vein catheters and external arteriovenous (AV) shunts; this form of access is the method of choice for hamodialysis and plasma exchange patients who require immediate and short‐ to medium‐term vascul

ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1993.tb00384.x

出版商:Blackwell Publishing Ltd    

年代:1993

数据来源: WILEY

摘要:

Spontaneous wound healing occurs partly by wound contraction, a process that requires intact functioning fibroblasts, and collagen production. Disruption of fibroblasts by the topical antimicrobials, silver sulfadiazine and mafenide acetate has been demonstratedin vitro. An acute rat wound model was used to show that wound contractionin vivois significantly impeded by silver sulfadiazine and mafenide acetate.

ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1993.tb00385.x

出版商:Blackwell Publishing Ltd    

年代:1993

数据来源: WILEY