ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1988.tb01016.x

出版商:Blackwell Publishing Ltd    

年代:1988

数据来源: WILEY

ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1988.tb01017.x

出版商:Blackwell Publishing Ltd    

年代:1988

数据来源: WILEY

ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1988.tb01018.x

出版商:Blackwell Publishing Ltd    

年代:1988

数据来源: WILEY

摘要:

A comparison was made of the methods used to manage primary breast cancer in Western Australia during 1978 and 1984. It was noted that the incidence of breast‐conserving surgery increased from 5% in 1978 (16 out of 313 patients) to 14% in 1984 (59 out of 431 patients). Of the 59 patients in the latter group, 37(63%) did not receive adjuvant radiotherapy. This is a matter of concern as failure to use adjuvant radiotherapy, subsequent to breast‐conserving surgery, may lead to an increased incidence of locally recurrent dise

ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1988.tb01019.x

出版商:Blackwell Publishing Ltd    

年代:1988

数据来源: WILEY

摘要:

Between January 1980 and December 1985, 121 patients with early breast cancer were referred to the Department of Radiation Oncology at Westmead Hospital for radiation therapy following initial tumour excision. After a median follow‐up of 26 months, five patients developed a loco‐regional recurrence (4%) and nine developed metastatic disease but with local control.There were 105 eligible patients who were sent a letter/questionnaire which included: a request to attend a clinic, to allow an objective assessment of the cosmetic result of the treated breast by two clinicians, questions regarding breast function as it affected quality of life, and a request that they undertake a self‐assessment of the treated breast from a cosmetic point of view.Seventy‐six patients attended for assessment of the following factors: whether surgery was optimal as determined by predefined criteria, measurement of breast oedema, arm oedema, breast retraction and telangiectasia, and an overall cosmetic assessment performed independently by both a radiation oncologist and surgeon. A physician not involved in management undertook a cosmetic assessment using standard photographs.Approximately 20% of patients replied that their choice of clothing had been affected by treatment, 10% were embarrassed and 70% experienced some continuing tenderness or discomfort in their treated breast.The extent of surgery was judged to be suboptimal in 22% but that proportion increased to 34% of cases referred from external clinics. The overall incidence of moderate or severe breast oedema was 9%, breast retraction So%, telangiectasia 16% and arm oedema 21%. Those patients with longer follow‐up (i.e.,>36 months) had a higher incidence of breast retraction (67%). telangiectasia (30%) and arm oedema (33%) but less breast oedema (7%).As expected, the patients rated the appearance of their breast more favourably than did clinicians. Overall, the result was rated as good or excellent by 75% of patients compared with 55% when the assessment was made by a surgeon or radiation oncologist.The main factor identified as contributing to a poor cosmetic result was the area of the iridium implant. The area of implant was larger when suboptimal surgery had been carried out, the main component of which was excessive lengt

ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1988.tb01020.x

出版商:Blackwell Publishing Ltd    

年代:1988

数据来源: WILEY

摘要:

A retrospective review was performed of nine patients with closed hepatic haematoma admitted to the Department of Surgery, Auckland Hospital, between 1980 and 1985. All resulted from blunt abdominal trauma due to motor vehicle accidents. Four haematomas were diagnosed at the time of laparotomy and were left undisturbed; four haematomas were diagnosed radiologically were also treated conservatively. One patient underwent partial right hepatic lobectomy, required a significant blood transfusion and developed a subphrenic abscess postoperatively. A further patient died from asSociated head injuries. The pen‐operative mortality for urgent hepatic resection in multiply‐traumatized patients is greater than 50%, even in experienced trauma units, and this review suggests that in haemodynamically stable patients with closed hepatic haematomas where the diagnosis can be radiologically ascertained, conservative treatment is a safe and reasonable opt

ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1988.tb01021.x

出版商:Blackwell Publishing Ltd    

年代:1988

数据来源: WILEY

摘要:

In order to compare trauma mortality of a designated Level I Trauma Center in the United States with a major metropolitan hospital in New Zealand, patients presenting to these institutions were reviewed. Over a I year period 824 patients (62 deaths) presented to the Southern New Jersey Regional Trauma Center (SNJRTC) and 602 (60 deaths) to the Resuscitation mom at Auckland Hospital (AH). There were no differences between age or severity of injury in those patients dying at the two institutions but brain injury was significantly more common a cause of death at Auckland Hospital (P<0.001). At SNJRTC exsanguination was significantly more common (P<0.05) and patients were more likely to die in the admitting area (P<0.01).The results confirm the similarity of the trauma mortality between a major metropolitan hospital in New Zealand and a United States Level I Trauma Center dealing primarily with blunt trauma. Effectiveness of trauma care in the two locations as judged by the average Injury Severity Score of CNS and non‐CNS related deaths, is comparable. This suggests that despite not being completely equipped as a Level I Trauma Center the commitment to caring for patients at the New Zealand hospital is an important factor affecting the outcom

ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1988.tb01022.x

出版商:Blackwell Publishing Ltd    

年代:1988

数据来源: WILEY

摘要:

Seven cases of complex open humeral fractures treated by external fiation are reported. The external fixation allowed the associated injuries to nerves, arteries and soft tissues to be adequately treated. Four cases developed non‐union and of these, three cases treated by bone‐grafting and plating united, but the one case treated by intramedullary nail without bone‐graft did not unite.Frame construction and pin placement are discussed. The recommended plan for treatment of these fractures is initial external fixation until adequate soft tissue healing is achieved and sepsis controlled. Then early bone‐grafting and plating is advocated if there is no progressive fracture healing. The problems and advantages encountered in the use of external fixation are also de

ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1988.tb01023.x

出版商:Blackwell Publishing Ltd    

年代:1988

数据来源: WILEY

摘要:

Sixteen patients with gastric cicatrization due to ingestion of corrosive agents were treated over a 7 year period at Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER) Hospital, Pondicheny. Fifteen patients developed gastric outlet obstruction due to ingestion of corrosives, while another had midgas‐tric stenosis due to formalin intake. An asSociated oesophageal stricture was present in 62.5% of the cases. Partial gastrectomy was found to be the most satisfactory procedure and carried out in 60% of the cases. Pyloroplasty done in one patient was found inadequate within 1 year of surgery. Gastrojejunostomy carried out in two patients was asSociated with prolonged hospitalization due to malfunction of the anastomotic sit

ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1988.tb01024.x

出版商:Blackwell Publishing Ltd    

年代:1988

数据来源: WILEY

摘要:

Surgically induced chronic gastric ulcers were created in rats. Cimetidine was administered for 1 year and the histological features of the gastric mucosa were studied to determine if cimetidine induced greater than normal proliferative or metaplastic changes or atypia. There were 60 rats in the study group and 51 and 55 in two control groups. The incidence of persisting chronic gastric ulcer in the cimetidine‐treated study group at I year was 45% compared with 58% in non‐treated control group (non‐significant difference). There was no tendency for proliferative or metaplastic changes to be asSociated with cimetidine treatment—these changes reflected the presence of the chronic ulcers. Cimetidine did not induce atypia and no cases of gastric carcinoma o

ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1988.tb01025.x

出版商:Blackwell Publishing Ltd    

年代:1988

数据来源: WILEY