ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1989.tb01570.x

出版商:Blackwell Publishing Ltd    

年代:1989

数据来源: WILEY

ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1989.tb01571.x

出版商:Blackwell Publishing Ltd    

年代:1989

数据来源: WILEY

ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1989.tb01572.x

出版商:Blackwell Publishing Ltd    

年代:1989

数据来源: WILEY

摘要:

A series of 30 patients with malignant parotid tumours selected for surgical treatment is presented. There were 18 males and 12 females, with an age range of 12–80 years. All presented with a parotid lump, one had an associated painful facial nerve palsy and one had clinically involved neck nodes. Four had previous surgery, surgical biopsy or radiotherapy. Pre‐operative fine needle aspiration was performed on one patient. Postoperative radiotherapy was administered to 14 patients. Follow‐up was for a mean of 5.5 years. The primary tumour was controlled by surgery alone in 15 of the 16 patients. There was one local recurrence and two patients in this group died from distant metastases. Of the group receiving postoperative radiotherapy, there was one local recurrence, one local and neck recurrence and one death from distant metastases. Mobile, discrete tumours can be treated by parotideclomy with preservation of the facial nerve and the selective use of radiotherapy. The malignant tumour with restricted mobility but no facial palsy is treated by parotidectomy, sacrificing only involved branches and postoperative radiotherapy. The clinically fixed lesions with facial palsy demand total parotideclomy in operable cases, nerve sacrifice and postoperative radioth

ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1989.tb01573.x

出版商:Blackwell Publishing Ltd    

年代:1989

数据来源: WILEY

摘要:

A retrospective analysis of 31 patients operated upon for cerebral secondary melanoma was conducted. There was no operative mortality and no operative complications in 76% of cases. Significant and life‐threatening complications occurred in five patients (17%). The major benefit from surgical excision is relief of symptoms: 64% had complete remission of symptoms while a further 20% were substantially improved. A few patients' lives were prolonged by surgery and there are a number of long‐term survivors. Surgical excision should be performed when a patient has an accessible solitary cerebral secondary without evidence of melanoma elsewh

ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1989.tb01574.x

出版商:Blackwell Publishing Ltd    

年代:1989

数据来源: WILEY

摘要:

The case‐notes of 30 patients presenting with primary gastric lymphoma in the auckland area during 1969–87 have been reviewed. The mean age of the study group was 62 years, and 16 were female and 14 were male. There were 22 european, one maori and seven polynesian patients. The most common presenting symptom was abdominal pain and five patients presented acutely with gastrointestinal haemorrhage. The lesions occurred more frequently in the distal stomach and half were polypoid and half were ulcerating. They tended to be of substantial size at presentation, with seven being greater than 10cm in diameter. Nine lesions were confined to the stomach, 12 involved the surrounding lymph nodes and eight were invading adjacent organs.Twenty‐three patients underwent partial or total gastrectomy. Four of these received postoperative radiotherapy, and adjuvant chemotherapy was administered to 13. Chemotherapy, or combination chemo‐and radiotherapy were used as the primary treatment in seven patients.Following surgical treatment, 18 patients remained alive and well. Five of the seven patients treated non‐surgically were dead of disease at the time of study and the other two remained alive with persisting disease.The following factors were found to affect prognosis adversely: weight loss of greater than 5 kg, tumour invasion of adjacent organs, and non‐surgical primary treatment. Involvement of the lymph nodes draining the stomach did not appear to worsen the outlook, and there was little correlation between lesion size an

ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1989.tb01575.x

出版商:Blackwell Publishing Ltd    

年代:1989

数据来源: WILEY

摘要:

Visceral artery aneurysms are uncommon. During (he period 1975–88, 32 patients were treated at the royal melbourne hospital for true and false visceral artery aneurysms. There were 18 males and 14 females, with an age range of 12–86 years. Of the 32 patients, 26 were symptomatic and six were asymptomatic. True aneurysms were found in 20 patients and false aneurysms in 10. A further two were dissecting aneurysms. Of the arteries involved, 17 were renal, six were hepatic, five were splenic, one was superior mesenteric, one was left colic and there were two patients with aneurysms at multiple sites. Aetiological factors included atherosclerosis, fibromuscular dysplasia, pancreatitis, and trauma. Only one patient presented in pregnancy. Rupture occurred in 12 patients and two died as a result of this complication. All the true hepatic artery aneurysms presented in this way. Pre‐operative investigations included plain radiology, computerized tomography with contrast, nuclear scanning and selective angiography. Operative treatment was required in 22 cases, 12 as an emergency and 10 as an elective procedure. Surgical options included aneurysm excision with or without arterial reconstruction, aneurysmorrhaphy with flap arterioplasty, or ligalion of the aneurysm. Embolization was successfully employed in two patients and eight were merely observed without complications. Surgical therapy is recommended for any patient with symptoms, for any woman of child‐bearing age and for all hepatic artery an

ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1989.tb01576.x

出版商:Blackwell Publishing Ltd    

年代:1989

数据来源: WILEY

摘要:

Budd‐chiari syndrome due to congenital membranous obstruction of inferior vena cava can be cured by appropriate surgical correction. A high index of suspicion is required to identify this condition and investigate it properly. Experience of three such cases is presented; two had a successful surgical correction and one refused any surgical intervention. Both patients who underwent operation are doing well and are symptom‐free after 4 and 6 years, respectively. The diagnosis and the presentation of inferior vena caval obstruction and the various surgical procedures that are available for relieving the congenital obstruction of inferior vena cava are revie

ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1989.tb01577.x

出版商:Blackwell Publishing Ltd    

年代:1989

数据来源: WILEY

摘要:

Four cases of low anterior resection without pelvic drainage are described. The outcome was unsatisfactory in three of the four patients. The role of pelvic drains and omentum in the management of the pelvic space following low anterior resection for rectal cancer is reviewed and discussed. Pelvic drains are required to remove blood and omentum may be used to fill the pelvic space. Pelvic collections are related to anastomotic leakage and the optimal management of the pelvic space can reduce the incidence of this complication. A suggested regimen for management of the pelvic space after low anterior resection is outlined.

ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1989.tb01578.x

出版商:Blackwell Publishing Ltd    

年代:1989

数据来源: WILEY

摘要:

During open heart surgery, myocardial protection provided by oxygenated blood‐based cardioplegia is superior to that provided by non‐oxygenated crystalloid cardioplegia. However, the widespread use of blood cardioplegia has been limited by the cost and complexity of the associated cooling and delivery systems. The performance of a simple system—a polyethylene coil immersed in ice—has been compared with three systems incorporating specialized, water‐jacketed heat exchangers: buckberg shiley, shiley bcd and bentley he‐100. Blood was diluted to a haematocrit of 22% and delivered to each cooling system at flow rates of 200–500ml/min and temperatures of 25°c and 30°c. Cooling water at 0–1°c was supplied to the heat exchangers at flow rates of 2, 4, and 6l/min. Performance was measured by comparing the blood outflow temperatures at the same inflow temperature under a variety of test conditions which simulated those occurring in clinical practice. All cooling systems, except the buckberg shiley, were able consistently to cool blood cardioplegia adequately (below 10°c), but the ice coil was the most effective. The heat exchanger systems are 3–4 times more expensive than the ice coil and require an external source of cold water. Thus the ice coil system has the advantages of simplicity, ef

ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1989.tb01579.x

出版商:Blackwell Publishing Ltd    

年代:1989

数据来源: WILEY