ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1990.tb07486.x

出版商:Blackwell Publishing Ltd    

年代:1990

数据来源: WILEY

ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1990.tb07487.x

出版商:Blackwell Publishing Ltd    

年代:1990

数据来源: WILEY

摘要:

A criteria audit of percutaneous nephrolithotomy management is reported. One hundred consecutive patients who underwent percutaneous stone removal over a 3‐year period were examined. An analysis of the cases of this relatively new surgical procedure are presented. The audit denionstrated the surgeons’learning curve, the current standards achieved and changes in patient admission rate. Criteria auditing was used and assessed as a quality assurance activ

ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1990.tb07488.x

出版商:Blackwell Publishing Ltd    

年代:1990

数据来源: WILEY

摘要:

A total of 2277 basal cell carcinomas (BCC) treated by surgical excision over a twenty‐year period has been followed and analysed into clinical and histopathological type. This paper documents the incidence of different BCC types and points to the importance of the infiltrating, morphoeic and multifocal types.Many BCC are of one homogeneous histopathological type, although others have important secondary characteristics which may not be obvious clinically.We reserve the use of the word ‘infiltrating’for BCC types which show microscopically the following characteristics: areas with lack of palisading; small cell clumps; and spiky thin cords of cells projecting out with loose stroma. These may penetrate far and wide along tissue planes and nerves, producing recurrence and spread, despite apparently adequate excision. The infiltrating BCC may also occur secondarily with other primary BCC types, accounting for their — at times — unexpectedly sever

ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1990.tb07489.x

出版商:Blackwell Publishing Ltd    

年代:1990

数据来源: WILEY

摘要:

Eighteen cases of ‘early gastric cancer’have been managed over a 14‐year period. This represents only 3.5% of all patients diagnosed as having adenocarcinoma of the stomach. The symptoms of early gastric cancer are similar to those of benign peptic ulcer disease and differ from those of invasive disease. The pathology of the lesions is described and the morphology shown to be similar to that seen in Japan. The overall 5‐year survival rate is 82% but no patient has developed recurrence within 5 years of surgery, confirming the biological behaviour of the lesion to be identical to that noted by Japanese rese

ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1990.tb07490.x

出版商:Blackwell Publishing Ltd    

年代:1990

数据来源: WILEY

摘要:

We analysed data on admissions to Victorian public hospitals for surgical treatment of breast cancer over the period July 1985 to December 1988. Of the 2993 women admitted, 28.7% received breast‐preserving surgery. The probability of a woman being treated conservatively was dependent on age, with women aged less than 50 or more than 70 years more likely to receive breast‐preserving surgery than women aged 50‐69. There was an age‐specific change, of marginal statistical significance, in the proportion of women receiving breast‐preserving surgery over the period. The public hospitals admissions database is a potentially useful means of monitoring patterns of surgical

ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1990.tb07491.x

出版商:Blackwell Publishing Ltd    

年代:1990

数据来源: WILEY

摘要:

Fine needle biopsy (FNB) is the most accurate method available for the investigation of single thyroid nodules. The exact technique employed, however, varies considerably among clinicians: in our institution the incidence of ‘inadequate’ specimens produced ranges from only 13 to 62%, depending on the individual performing the biopsy. In a prospectivein vivostudy, a variety of biopsy techniques employing different gauge needles and differing numbers of passes with and without aspiration were assessed with respect to the quality of cytological specimen produced. Criteria assessed included the number of cells or sheets of cells, cell clumping, blood contamination, amount of colloid, and overall slide quality. Samples obtained with a 21 gauge needle without aspiration consistently gave best individual cell morphology. On the other hand, samples obtained with a 23 gauge needle with five aspirated passes through the nodule gave the highest yield of cells with an acceptable minimal increase in the degree of blood contamination and cell clumping. In order to achieve consistent yields from FNB of thyroid nodules, a combination of these two techniques is recommen

ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1990.tb07492.x

出版商:Blackwell Publishing Ltd    

年代:1990

数据来源: WILEY

摘要:

Sessile (villous) tumours of the rectum are uncommon and individual surgeons are unlikely to have wide experience in their management. A study was made of a unique personal series (AMC) of 104 cases encountered from 1974 to 1984; minimum duration of follow‐up was 5 years. Clinically obvious rectal cancers were excluded from the study. Ages ranged from 42 to 89 years (mean 64.9 years) with a male : female ratio of 1.5:1. The commonest clinical presentations of sessile tumours of the rectum were rectal bleeding (45%) and altered bowel habit (38%). Hypokalaemia was a very uncomnion presenting symptom (1%). These tumours ranged in longitudinal diameter from 1 to 9 cm, with 66% of cases>3 cm and 33% of cases>5 cm. The incidence of malignancy in sessile adenomas>3 cm (27%) was more than triple that of adenomas<3 cm (8%) and the presence of induration on rectal examination was the most reliable clinical indicator of the presence of malignancy.Local transanal diathermy excision was a satisfactory form of treatment for most sessile tumours of the rectum (benign and malignant), especially if they were5 cm). In addition, a 5‐year follow‐up appears to be adequate for patients with sessile tumours of the rectum as all recurrences occurred within this p

ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1990.tb07493.x

出版商:Blackwell Publishing Ltd    

年代:1990

数据来源: WILEY

摘要:

We report two cases of villous adenoma of the duodenum, one arising from the main papilla and the other from the accessory papilla. Both were managed by local resection. In one case endoscopic biopsies and intraoperative frozen sections were negative for carcinoma but histology of the locally resected specimen revealed a focus of invasive adenocarcinoma. Villous adenomas of the duodenum have a high risk of malignant change and foci of carcinoma can be missed on endoscopic biopsy. The literature is reviewed and the clinical, diagnostic, pathological and therapeutic aspects of villous adenomas of the duodenum are discussed.

ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1990.tb07494.x

出版商:Blackwell Publishing Ltd    

年代:1990

数据来源: WILEY

摘要:

Pyogenic liver abscess is an uncommon condition which carries substantial morbidity and mortality if untreated. A review was undertaken of 31 patients who were admitted to the Royal Adelaide Hospital (RAH) between January 1980 and December 1987 and who were diagnosed as having pyogenic liver abscess. The aims of the study were to review the aetiology, current methods of investigation and treatment of the disease, and to formulate a management plan based on the findings.Hypoalbuminaemia, leukocytosis and elevated alkaline phosphatase were the most common findings. Hyperbilirubinaemia was not a usual feature. Computerised tomography (CT) scanning and ultrasound were the most useful imaging modalities in identification of the abscess. The sensitivity of CT scanning in evaluating the size of abscesses was lower than anticipated and this may lead to a higher than necessary rate of surgical drainage. A case is presented to illustrate this.Most abscesses were secondary and frequently due to extension of infection from biliary structures. Diseases causing diminished resistance to bacterial infection had a significant role in the pathogenesis.The overall mortality rate was 25%. Risk factors increasing mortality included advanced age, multiplicity of abscesses, depressed immune status and the presence of complications due to the abscess. Of patients who survived, four were treated with antibiotics alone. eleven with percutaneous drainage and antibiotics, and eight with surgery and antibiotics.We conclude that patients with hepatic abscesses should be managed initially by CT or ultrasound‐guided aspiration. If pus is obtained a percutaneous drain should be inserted into the cavity and systemic antibiotics administered. If serosanguineous fluid only is obtained this may indicate oedema around a small abscess (or inflammatory focus) and may be treated with systemic antibiotics only. Surgical drainage should be reserved for cases in which improvement does not occur with aspiration or percutaneous drainage and appropriate systemic antibiotic

ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1990.tb07495.x

出版商:Blackwell Publishing Ltd    

年代:1990

数据来源: WILEY