摘要:

A 12 month prospective study was undertaken to determine the frequency of untreated life‐threatening extracranial injuries in patients transferred to a major trauma centre because of head injury. Of the 43 patients transferred (15 with isolated head injury and 28 with multiple injuries), four (9%) had an untreated life‐threatening extracranial injury, which caused death in two.All four patients with untreated extracranial injuries were transferred from hospitals with general surgical staff and facilities. In three of the patients (none with a major head injury), the extracranial injuries were recognized at the referring hospital, but were left untreated in the rush to transfer the patient to a neurosurgical facility. In the fourth patient, who had a severe head injury, recurrent hypotension from a ruptured spleen was mistakenly ascribed to a scalp wound.The series shows that the dangerous practice of hurriedly transferring patients to trauma centres because of actual or perceived head injuries, while leaving major extracranial injuries untreated, continues despite warnings in the literature and the efforts of the Royal Australasian College of Surgeons through the Early Management of Severe Trauma progra

ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1992.tb06913.x

出版商:Blackwell Publishing Ltd    

年代:1992

数据来源: WILEY

摘要:

Two cases of cavernous angioma involving the medulla oblongata are presented. Both cases underwent surgical excision with excellent outcome. The use of surgery via craniectomy is contrasted with stereotactic radiosurgery in light of the known natural history of the lesions. As a result, it is suggested that surgical excision provides immediate protection from the risks of recurrent haemorrhage, establishes a tissue diagnosis, allows complete removal at the primary intervention, avoids complications of radiation‐induced damage and is performed more easily in these vascular anomalies due to the presence of a capsule with surrounding gliotic tissue. Additionally, it is implied that the natural history of lesions in this region is still unclear. For these reasons, it is suggested that surgical excision should be the primary therapeutic intervention for cavernous angiomata that involve the brainste

ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1992.tb06914.x

出版商:Blackwell Publishing Ltd    

年代:1992

数据来源: WILEY

摘要:

Cricket fast bowlers are the potent strike force in a multidiscipline team. They subject their spines to repetitive sagittal plane and rotatory movements over many years. The effect of this repetitive stress has not previously been analysed. This study examined 20 former fast bowlers to determine the incidence of spondylolysis, spondylolisthesis and degenerative change.Fast bowlers are noted to have an increased incidence of spondylolysis. A mixed front/side bowling style involving more lumbar hyperextension or rotation has significant association with spondylolysis when compared with side‐on bowling styles.There was a high incidence of radiological thoracolumbar degenerative facet joint and disc disease in former fast bowler

ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1992.tb06915.x

出版商:Blackwell Publishing Ltd    

年代:1992

数据来源: WILEY

摘要:

Aspects of peri‐operative management, amputation level and rehabilitation of the lower limb amputee are reported in the context of a review of a rehabilitation service for amputees which includes an integrated prosthetic service. Two hundred admissions were reviewed and some complex cases described.It is concluded that: a very close liaison between the surgeon and the rehabilitation team (ideally with pre‐operative consultation) is in the patient's best interests; any person previously walking (or a potential walker) should be considered for a trial of prosthetic walking; an integrated prosthetic service enhances the efficiency of the rehabilitation service; and that modification of the current Artificial Limb Scheme to allow manufacture of first definitive limbs in prosthetic rehabilitation units would further enhance service to patie

ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1992.tb06916.x

出版商:Blackwell Publishing Ltd    

年代:1992

数据来源: WILEY

摘要:

Isolated splenic abscess is an uncommon condition. Seven cases seen between 1980 and 1990 are reviewed. The clinical presentation is non‐specific and diagnosis is usually delayed. Computerized tomography allowed for accurate diagnosis in all cases.Pseudomonasspecies as a causative organism is reported to be rare, but were present in three of the present cases. Antibiotic therapy alone is insufficient and splenectomy remains the treatment of choic

ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1992.tb06917.x

出版商:Blackwell Publishing Ltd    

年代:1992

数据来源: WILEY

摘要:

Penile curvature causing functional impairment of sexual intercourse is uncommon but a number of patients are significantly inconvenienced by this condition. Seven patients who had marked erectile deviation were treated with surgical plication for their penile deformity. Mean follow‐up was 16 months (range 3–48 months) and no postoperative complications were encountered. In six cases the penis has remained straight. In one patient recurrence of deformity occurred 12 months after corporeal plication. The simplicity of the corporeal plication technique with the low incidence of associated complications makes it an attractive surgical alternative for the treatment of penile erectile deform

ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1992.tb06918.x

出版商:Blackwell Publishing Ltd    

年代:1992

数据来源: WILEY

摘要:

Pulsed dye laser lithotripsy is a recently developed technique for the management of urinary calculi. This article reports the results of treatment of a cohort of patients managed with this technology. Post‐treatment bed stay was generally less than 48h, narcotic analgesia was not regularly required, and no significant post‐treatment complications were encountered. This treatment appeared to complement an existing extracorporeal Shockwave lithotripsy (ESWL) service at St Vincent's Hospital and may offer a financial advantage in the treatment of patients with urinary calc

ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1992.tb06919.x

出版商:Blackwell Publishing Ltd    

年代:1992

数据来源: WILEY

摘要:

This paper details the indications, operative technique and results of perineal proctectomy in the management of complete rectal prolapse in a high risk, elderly and debilitated group of patients. Eighteen procedures were performed by one surgeon (A.L.P.) on 16 consecutive patients over a 5 year period. Data collection was via: (i) retrospective analysis of hospital and office records; and (ii) response to a postal questionnaire by the patient, a relative or attending nursing staff.There were 14 females and two males with a mean age of 81 years. All patients had significant associated medical conditions. The interval from the time of a surgical procedure until review varied from 3 to 37 months with a mean follow‐up period of 16 months. Total hospital stay varied between 6 and 20 days with a mean of 7 days. Eleven procedures were performed under general anaesthesia and seven under spinal anaesthesia. There was no postoperative mortality. One patient suffered an anastomotic haemorrhage that required operative intervention and another patient suffered a rectal stricture that necessitated dilatation. Two patients were re‐operated for recurrent symptomatic prolapse at 34 and 36 months after the initial procedure. Continence improved in seven patients, worsened in one and was unchanged in the remaining patients. Fifteen of 16 patients were considered to have had a successful result from the operation with satisfactory control of the symptom of rectal prolapse.Perineal proctectomy is a low risk operative procedure for the elderly and debilitated group of patients in controlling complete rectal prolapse. If the condition recurs, the procedure can be repeated with equally low morbid

ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1992.tb06920.x

出版商:Blackwell Publishing Ltd    

年代:1992

数据来源: WILEY

摘要:

Laparoscopic cholecystectomy is rapidly becoming accepted as the best method for the treatment of symptomatic cholelithiasis. Randomized clinical trials comparing laparoscopic cholecystectomy with open cholecystectomy are unlikely to be performed. In order to compare these two operations, surgeons need an historical control group of patients who have undergone a conventional open cholecystectomy. The aim of this study was to document a control group of patients having an open cholecystectomy and compare them with patients having a laparoscopic cholecystectomy. This was achieved by a retrospective study of all patients who had an open cholecystectomy from January 1985 to December 1989. Four hundred and fifty‐seven patients, 345 women and 112 men, had a cholecystectomy. Exploration of the common bile duct (ECBD) was performed in 59 (12.5%) cases. The mean operative duration was 73 min for cholecystectomy and 118 min for cholecystectomy and ECBD. The shortest mean postoperative stay was for an elective cholecystectomy (5.3 days) and the longest mean postoperative stay was for urgent admissions requiring ECBD (12.0 days). Operative dissection was difficult in 14.1% of elective cases and 51.8% of urgent cases. Ninety‐seven (19.5%) patients had an additional procedure, unrelated to cholelithiasis, at the same operation; 44 did not require laparotomy, 31 had interval appendicectomies, and 22 other cases required laparotomy in order to perform the additional procedure. All but one patient required postoperative narcotic analgesia. The mean duration of narcotic analgesia was 2.3 days. The complication rate was 35.2% for cholecystectomy and 62.5% for ECBD. If pulmonary atelectasis is excluded as a complication, these complication rates fell to 6.8% and 20.1%, respectively. There was one right hepatic duct injury and no postoperative deaths. Comparison of these results with the published results for laparoscopic cholecystectomy revealed that although open cholecystectomy takes less time to perform, it is associated with a longer postoperative stay, greater narcotic analgesic requirements and more respiratory complicati

ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1992.tb06921.x

出版商:Blackwell Publishing Ltd    

年代:1992

数据来源: WILEY

摘要:

Hurthle cell tumours (benign and malignant) have been regarded as lesions with uncertain biological behaviour. However recent clinico‐pathological studies have shown that they should be categorized as benign or malignant on the basis of capsular and/or vascular invasion, like other differentiated thyroid neoplasms. The fact that the tumours are composed of Hurthle cells is irrelevant. Currently, histological parameters do not seem to predict biological behaviour of Hurthle cell carcinoma

ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1992.tb06922.x

出版商:Blackwell Publishing Ltd    

年代:1992

数据来源: WILEY