摘要:

Modern science is preoccupied with basic mechanisms at the level of the gene, molecule, atom and fundamental particle. This preoccupation has affected attitudes to medical science. Paradoxically, politicians and Departments of Health are largely cor cemed with clinical epiphenomena — outcomes, interventions, effectiveness, efficiency — that are often disregarded by medical scientists and viewed without favour by granting bodies. In the surgical sciences, there is renewed interest in clinical research.The small computer and the readily available database with its wmpatible statistical package have added a new dimension to clinical research. Database design and analysis are as much a part of the surgical investigator's skills as are laboratory techniques. There are simple rules that govern database design. The database should be simple and flexible, but provide an adequate patient profile. Entry should be standardized by precise inclusion criteria and precise definitions. Data input should be numerical whenever possible. The database program should convert simply to a comprehensive statistical program.The clinical database is useful for both observational and investigational studies. Case series, case control studies and cohort studies can all be developed from well maintained databases.In the Department of Surgery at Westmead Hospital, databases have been maintained for 10 years. The hepatobiliary and pancreatic group of databases have led to 34 publications. The liver tumour database has produced 12 studies and nearly 20 papers. The process of development of one study is outlined in detail. The chance observation of an excess incidence of gallstones in patients having regular ultrasound examinations after major abdominal surgery has been confirmed in a case control study. Of those patients undergoing major abdominal surgery 28% developed gallstones during 3 years of supervision. A prospective study is planned to investigate this further.The time is appropriate for clinicians to return to clinical research, for which they are uniquely trained. There should be no stigma associated with doing ‘merely clinical rese

ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1992.tb07198.x

出版商:Blackwell Publishing Ltd    

年代:1992

数据来源: WILEY

ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1992.tb07199.x

出版商:Blackwell Publishing Ltd    

年代:1992

数据来源: WILEY

摘要:

A review of 174 consecutive patients admitted with a diagnosis of perforated peptic ulcer to eight Hunter Region hospitals during 1979–86 is presented. Among the female admissions, the proportion of patients>70 years of age was twice that in males. One‐third of all perforations were in females who accounted for two‐thirds of all perforated gastric ulcers. Multivariate analysis revealed that perforations located in the stomach and older age were both significant independent variables adversely affecting outcome following surgery. In contrast, shock at presentation and delay in operating were not statistically significant independent risk fa

ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1992.tb07200.x

出版商:Blackwell Publishing Ltd    

年代:1992

数据来源: WILEY

摘要:

Bleeding angiodysplasia of the gastrointestinal tract poses frustrating challenges to clinicians because these minute vascular lesions are difficult to diagnose pre‐operatively and to locate intra‐operatively. During the past 12 years, 24 patients were treated for histopathologically confirmed bleeding angiodysplasia of the gastrointestinal tract. Pre‐operative investigations and intra‐operative localization followed a fixed protocol for patients with gastrointestinal bleeding of obscure origin.The median follow‐up of these 24 patients was 51 months and the results of treatment for 22 patients were excellent. Two patients had recurrent bleeding but investigations failed to determine the bleedi

ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1992.tb07201.x

出版商:Blackwell Publishing Ltd    

年代:1992

数据来源: WILEY

摘要:

New Zealand (NZ) has a high risk population for the development of large bowel cancer (LBC). The Kingdom of Saudi Arabia (KSA) has a low risk population and is estimated to have incidence and mortality rates which are ten times lower than NZ. It has already been shown that in NZ, females have a higher incidence of right‐sided colonic cancer and males a higher incidence of rectal cancer. To determine whether the same situation exists in a low risk population the NZ data were compared with similar data from the cancer registry at the King Faisal Specialist Hospital and Research Center (KFSHRC).Between 1975 and 1989. 423 Saudi and Yemeni patients with LBC were registered at KFSH. The subsite distribution of tumours in this group were compared with the subsite distribution in 4678 patients registered in NZ between 1972 and 1975.The male to female (M:F) ratio for right‐sided tumours in KSA was 1:0.90 compared with 1:156 in NZ whereas the ratios for rectal tumours were 1:0.61 and 1:0.83 respectively.This study confirms the presence of a lower frequency of right‐sided tumours in females in a low risk country and further confirms the importance of gender in LBC. It may be that early and multiple child bearing, physical activity and relatively poor diets have been protective for Saudi fe

ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1992.tb07202.x

出版商:Blackwell Publishing Ltd    

年代:1992

数据来源: WILEY

摘要:

This article reviews the use of adjuvant hormone therapy in the treatment of breast cancer and its effect on disease free survival, overall survival and local tumour control.

ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1992.tb07203.x

出版商:Blackwell Publishing Ltd    

年代:1992

数据来源: WILEY

摘要:

Studies have noted that Asian women tend to have invasive breast cancer at a younger age compared with their Western counterparts. This is a rising trend among women in Singapore. This study compares 46 women3 months) in 27.6% of younger patients whereas it was seldom delayed for the other older group (0.3%). Eight patients<35 years were initially reluctant to undergo definitive surgery. These cumulative delays resulted in progression of disease in seven patients of the 11 patients whose therapy was delayed more than 6

ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1992.tb07204.x

出版商:Blackwell Publishing Ltd    

年代:1992

数据来源: WILEY

摘要:

Fine needle aspiration cytology is a widely recognized and yet sensitive technique which can provide diagnosis in lesions in the head and neck, enabling appropriate management plans for individual patients to be made. One hundred and eighty‐seven fine needle aspirates from head and neck masses in 128 patients seen at Green Lane Hospital were studied. The ages ranged from 9 to 87 years with a median of 63 years. Ninety‐five fine needle aspirates were of malignant lesions, mainly squamous cell carcinoma and lymphomas and 94 were non‐malignant. Comparisons were made between the fine needle aspirate cytology and the histological and clinical diagnosis. Overall, the sensitivity was 81%, specificity 89%, positive predictive value 91% and negative predictive value 78%. With respect to 72 lymph node aspirates there were no false positive values resulting in a sensitivity of 84%, specificity 100%, positive predictive value 100% and negative predictive value 65%. With respect to salivary gland lesions, there were no false positive or false negative fine needle aspirates. It was noted that diagnostic accuracy improved with experience and good communication between the cyto‐pathologist and the clinician. Most of the non‐diagnostic smears occurred during the early part of the study. The study confirms the useful application of fine needle aspiration cytology in managing head and neck disease appr

ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1992.tb07205.x

出版商:Blackwell Publishing Ltd    

年代:1992

数据来源: WILEY

摘要:

This study presents the results of treatment for Stage III and IV squamous cell carcinoma of the head and neck at the Princess Alexandra Hospital and Queensland Radium Institute, Brisbane. Patients were treated using a programme of sequential chemotherapy, surgery and radiotherapy. Between 1980 and 1988, 116 patients commenced the programme and 85 completed the treatment as planned.The Price‐Hill regimen of chemotherapy was used until 1986 after which time it was replaced by cisplatin/5‐fluorouracil (5FU). Two courses were usually given achieving an overall response rate of 36% (12% complete response). Cisplatin/5FU produced an overall response rate of 56% compared with 24% for the Price‐Hill regimen. Radical surgical resections were performed using a free flap reconstruction in the majority of patients. Radiotherapy fields usually covered the primary site and both cervical lymph node areas to a dose of 50–60 Gy in 5–6 weeks.The lengthy treatment was generally well tolerated although there were two chemotherapy and two peri‐operative deaths. The overall actuarial survival for the 85 patients completing the triple therapy was 60%. These patients were analysed in more detail for possible prognos

ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1992.tb07206.x

出版商:Blackwell Publishing Ltd    

年代:1992

数据来源: WILEY

摘要:

During a period of 5 years, 39 cases (37 patients) with metastatic bone disease in the proximal femur were treated by the insertion of a Zickel intramedullary nail using a ‘closed’ operative technique. The use of methyl methacrylate as an adjunct to fixation was not considered necessary. The results were satisfactory in terms of achieving stabilization of the fracture if present, relief of pain and the ability to commence early ambulat

ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1992.tb07207.x

出版商:Blackwell Publishing Ltd    

年代:1992

数据来源: WILEY