ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1986.tb01846.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.tb01847.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.tb01848.x

出版商:Blackwell Publishing Ltd    

年代:1986

数据来源: WILEY

摘要:

In an attempt to reduce the current morbidity and mortality from acute pancreatitis, a prospective randomized multicentre trial was begun in August 1982. Part of this study involved an attempt to develop a set of prognostic indices which would identify patients with severe pancreatitis on the day of admission to hospital. An analysis of a predetermined set of 10 indices (age, blood pressure, white cell count, blood urea, serum calcium, aspartate aminotransferase, lactate dehydrogenase, blood glucose, arterial blood pH andPO2) on admission to hospital, in 100 patients, is presented. The positive predictive value of these indices (excluding age) is 90%. These indices are readily available in most hospitals, and allow the early identification of the high risk patient with an accuracy equal to or better than that previously reported.

ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1986.tb01849.x

出版商:Blackwell Publishing Ltd    

年代:1986

数据来源: WILEY

摘要:

The relationship of a number of nutritional parameters to mortality and sepsis was assessed in a group of 82 patients requiring total parenteral nutrition (TPN). Duration of TPN ranged from 9 to 105 days with a mean of 32.3 days. Parameters assessed were serum albumin, transferrin, absolute lymphocyte count (ALC), delayed hypersensitivity skin test reaction, mid‐arm muscle circumference, triceps skin‐fold thickness and weight. Combinations of parameters were found to be more useful than single parameters. The only single parameter of significance was ALC. The best overall predictor of death and/or sepsis was a combination of reduced serum albumin, transferrin, ALC and anergy, which was found to be related to a significantly higher mortality (P= 0.002) and incidence of septic complications (P= 0.003). This combination of parameters also had the best specificity (90%), accuracy (79%) and positive predictive value (65%) for prediction of death and/or sepsis. Increasing age was also found to be associated with a higher mortality (P<0.001) and increased incidence of septic complications (P= 0.

ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1986.tb01850.x

出版商:Blackwell Publishing Ltd    

年代:1986

数据来源: WILEY

摘要:

Home parenteral nutrition (HPN) has been used in 1.1 patients over a 7 year period for intervals ranging from 14 to 608 days with a mean of 255 days. This represents a total experience of 3315 patient days or 9.1 patient years. The commonest causes for intestinal failure requiring HPN were short bowel syndrome following massive small bowel resection for mesenteric ischaemia (four patients), and radiation enteritis (three patients). Four patients died, including three of four who had presented with mesenteric ischaemia and one from disseminated malignancy. One of the deaths was from massive pulmonary embolus and may have been catheter‐related. Seven patients were able to cease HPN after a mean of 200.7 days because of treatment and/or improvement in the underlying cause of their intestinal failure. Central venous thrombosis was the commonest complication and occurred in six patients, including the four who die

ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1986.tb01851.x

出版商:Blackwell Publishing Ltd    

年代:1986

数据来源: WILEY

摘要:

The cause of an enterocutaneous fistula following an abdominal operation, in the absence of inflammatory bowel disease or irradiation damage, is often obscure. In this study, it is postulated that distal obstruction, associated with peritoneal adhesions or abscess, is the critical determinant of fistula persistence. The ‘venting’ effect of the fistula, and the presence of obstruction which is frequently partial, makes recognition of the obstructive element difficult. It is suggested that operations to cure postoperative fistula should be based on the assumption that distal obstruction is always present, and should include a complete lysis of adhesions involving the small and large bowel. A postoperative fistula was cured in 21 out of 23 patients treated on this ba

ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1986.tb01852.x

出版商:Blackwell Publishing Ltd    

年代:1986

数据来源: WILEY

摘要:

The aetiology, mechanisms of haemorrhage and results of treatment of a series of 63 consecutive cases of acute subdural haematoma are presented. Forty‐six cases were due to trauma (46% mortality) and 17 cases were non‐traumatic (41% mortality). Only 15 patients overall (24%) made a good recovery. The various mechanisms of venous and arterial bleeding leading to subdural haematoma are reviewed and the importance of brain swelling as a determinant of fatal outcome is stres

ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1986.tb01853.x

出版商:Blackwell Publishing Ltd    

年代:1986

数据来源: WILEY

摘要:

The origins, concept and structure of the Royal College of Surgeons of Edinburgh specialty examination in surgical neurology are described. The format and content of the examination are compared with the FRACS Part II examination in neurosurgery. Differences in status with respect to recognition of these two diplomas as specialty qualifications are described. The place of the Edinburgh specialty examination in the current and future training and accreditation of neurosurgeons in the United Kingdom is discussed by the authors, an examinee and an examiner in the specialty Fellowship examination.

ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1986.tb01854.x

出版商:Blackwell Publishing Ltd    

年代:1986

数据来源: WILEY

摘要:

The circular stapler was used for colorectal anastomosis in 38 patients (rectal carcinoma 37 cases, sigmoid diverticulitis one case). In Singapore Chinese patients, the most commonly used cartridge size was the EEA 28 mm and ILS 29 mm. The incidence of clinical anastomotic leakage in patients with complete resection rings was 10% (three leaks in 32 patients), leakage occurring only amongst the 24 patients who had resection of a tumour 6–9 cm from the anal verge. Significant, though easily dilatable, stenosis occurred in three patients (8%), and was associated with rectal membrane formation in two patients. Local recurrence, occurring in seven patients in a 0.5–3 year follow‐up period was associated with Dukes' C disease; two recurrences occurred in four patients in whom the distal bowel clearance was less than 1.5 cm. The circular stapler facilitates sphincter conservation in mid‐rectal cancer and its use in low anterior resection is justifiable when performed with a distal bowel clearance of 2 cm and complete excision of pararectal tissue above the pelvic floor

ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1986.tb01855.x

出版商:Blackwell Publishing Ltd    

年代:1986

数据来源: WILEY