ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1988.tb01052.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.tb01053.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.tb01054.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.tb01055.x

出版商:Blackwell Publishing Ltd    

年代:1988

数据来源: WILEY

摘要:

Between 1973 and 1986, 463 infrapopliteal bypasses were performed on 408 limbs in 383 patients at Royal Prince Alfred Hospital. There were 265 males and 118 females. Their mean age was 69 years, 30% were diabetic, 71 % smoked and 38% were hypertensive. The indication for surgery was threatened limb loss in 350 limbs and shon distance claudication in 58 limbs. The peri‐operative mortality rate was 5%. Cumulative graft patency was 58% (s.e.m. = 2.7) at 5 years. The limb salvage rate was 66% (s.e.m. = 2.5) at 5 years. Cumulative patency rate for autogenous grafts (n = 332) was 63% (s.e.m. = 3.2) at 5 years compared with the cumulative patency rate for synthetic grafts (n =131) of only 38% (s.e.m. = 5) at 5 years (P0.05). Autogenous graft material is the most important determinant of a durable result from femorotibial bypass. Proximal and distal anastomotic sites should be chosen to allow maximal utilization of available autogenous v

ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1988.tb01056.x

出版商:Blackwell Publishing Ltd    

年代:1988

数据来源: WILEY

摘要:

One hundred and thirty‐one patients undergoing 142 carotid endarterectomy procedures were randomized to have their operation performed either with or without intra‐operative electroencephalographic (EEG) monitoring. Patients with EEG monitoring were shunted if both the internal carotid back pressure (ICBP) was less than 50 mmHg and ipsilateral change was evident on the EEG after clamping. Patients without EEG monitoring were shunted if ICBP was less than 50 mmHg. There was one postoperative death (0.7%) with neurological deficits occurring in five patients (3.5%). There were significantly fewer neurological deficits (P = 0.02) in patients with no EEG change (one of 59) compared with those with EEG change (two of 13). There was a highly significant increase (P =0.005) in incidence of neurological deficit (two of five patients) when ICBP was considered ‘adequate’ at 50 mmHg or greater but EEG change occurred. No neurological deficit occurred in 14 patients who were not shunted with ICBP<50 mmHg but with no EEG change. There was no difference in the incidence of neurological deficit in patients with low and high ICBP when both 50 and 55 mmHg were used as the cut‐off points. It is concluded that EEG monitoring is useful in identifying patients requiring shunting during carotid endarterectomy. Use of a shunt is recommended if there is EEG change regardless of ICBP; conversely, if ICBP is low but there is no EEG change it would appear safe to proceed without

ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1988.tb01057.x

出版商:Blackwell Publishing Ltd    

年代:1988

数据来源: WILEY

摘要:

The early results are presented from a programme of education for Breast Self‐Examination (BSE) for self‐referral; 32000 women in one health district, between the ages of 40 and 65 years, were invited by letter for education in BSE.Since the study began (1981–85), 153 breast cancers have been diagnosed. and they have been compared with the 153 breast cancers in the same age group presenting in the same health district immediately prior to the start of the study.A significant amelioration of prognostic factors is seen in the study group. However, at this time there is no significant difference in survival between the Study and the Control groups. The benign to cancer biopsy ratio is 1

ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1988.tb01058.x

出版商:Blackwell Publishing Ltd    

年代:1988

数据来源: WILEY

摘要:

In a group of patients with breast lumps, diagnosis made by pre‐operative aspiration cytology was compared with that obtained by histological section of excised specimens. Results showed that aspiration cytology correctly diagnosed 89% of malignant lesions and 92.6% of benign lesions based upon histological diagnosis. Cytological diagnosis of benign disease had a false negative rate of 6% while cytological diagnosis of malignant disease had a 2.7% false positive rate. Only 3.5% of cytologies returned an inadequate diagnosis. This study shows that aspiration cytology should be useful in allowing a better psychological preparation of patients before surgery as well as better utilization of operation theatre facilitie

ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1988.tb01059.x

出版商:Blackwell Publishing Ltd    

年代:1988

数据来源: WILEY

摘要:

Cystosarconia phyllodes afllicting 106 female patients in a multiracial Asian society is reviewed and some interesting variations are noted when compared with Western patients.The incidence of phyllodes tumour is 3.83% of surgically removed breast tumours compared with 0.5–2.5% in Western series. This lends weight to the belief that non‐Caucasians are more prone to this enigmatic breast disease than the Caucasian population. The profile of the Asian phyllodes patient is that of a young female, aged 25–30 years, whereas her Western counterpart is in her 40s. As a result, she is liable to be mistaken clinically as having fibro‐adenoma. The disease is notably rare among the females below 20 years of age but in the Asian context, as much as one‐quarter‐one‐third may be in the adolescent group. There were only three malignant and six borderline phyllodes tuniours out of 106 cases, and this incidence is far below that of many other studies in which the malignant cases are believed to constitute 23–27%. However, this may not be a racial variation but explicable by the fact that the present study is an unselected cohort from a general surgical unit.The presence of associated benign breast disease in 25.5% cases helps to reinforce the widely held belief that fibro‐adenoma and phyllodes tumour are relat

ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1988.tb01060.x

出版商:Blackwell Publishing Ltd    

年代:1988

数据来源: WILEY

摘要:

A retrospective review of 102 cases of hepatic trauma in the Auckland area between 1979 and 1985 is presented. Particular attention has been focused on those cases where there was massive bleeding, and the prognostic factors that govern outcome have been determined.Mechanism and multiplicity of injury, and the presence of severe hypotension (systolic blood pressure<80 mmHg) either at presentation or following induction of anaesthesia were the four most important determinants of prognosis. Blunt trauma caused 82% of these cases, with the mortality in this group being 27%. compared with 6% for penetrating trauma cases. The mortality of those patients who presented with a systolic blood pressure<80 mmHg was 44% compared with 13% for those whose blood pressure was above 80 mmHg. Thirteen patients sustained severe bursting or avulsion‐type injuries, in eight of whom extensive resection of formal lobectomy was performed with a survival of 88%. The remainder exsanguinated either pre‐operatively (two patients) or before definitive hepatic surgery was begun (three patients). All patients with caval or retrohepatic venous injuries exsanguinated either pre‐ or intra‐operatively.It is concluded that the mortality of liver injury from blunt trauma far exceeds that of penetrating trauma, and that severe hypotension at the time of presentation indicates a poor prognosis. A good outcome is possible in those patients who have a significant disruption of the liver architecture of one lobe following resection of devitalized tissue. Caval or retrohepatic venous‐type injuries carry a grave

ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1988.tb01061.x

出版商:Blackwell Publishing Ltd    

年代:1988

数据来源: WILEY