摘要:

Background: There is clinical evidence that adenocarcinoma of the lower oesophagus is increasing in the Australian society. The population‐based cancer registry of Victoria was used to describe the incidence of adenocarcinoma of the oesophagus and gastric cardia.Methods: Data were obtained from 1982 to 1991 and were analysed using the Poisson regression techniques.Results: In men, a statistically significant annual increase of 9.5% in oesophageal adenocarcinoma and a non‐significant increase of 1.6% in adenocarcinoma of the gastric cardia was observed. These increases were balanced by decreases in other histological types found in the oesophagus in men resulting in little change in the overall rate. No significant trends by age or histological type were observed in women.Conclusions: There is evidence for a rise in adenocarcinoma in men in Victoria. Possible risk factors include Barrett's oesopha

ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1996.tb01183.x

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY

摘要:

Background: Reported recurrence rates for incompletely excised basal cell cancers (BCC) vary widely (30–67%). and the destructive potential of recurrent BCC is well known. When surgically treated BCC are reported by the pathologist as incompletely excised the surgeon is placed in the dilemma of whether to perform an immediate wider excision, or to reserve further treatment until there is clinical evidence of recurrence. The aim of the present study is to determine if there are any clinical or morphological features which may help in this management dilemma.Methods: Middlemore Hospital histology records were reviewed. In 1986, 82 out of a total of 723 BCC excised were reported to be incompletely excised. The management and recurrence rates of the incompletely excised BCC were determined from the patient records and telephone follow up where necessary. The clinical and morphological features were correlated with the recurrence rates, with the aim of developing a management strategy.Results: The overall recurrence rate was 30.0%. Median time to recurrence was 18.5 months (range 1.5–55 months). Neither the margin of incomplete resection (deep, lateral or both margins), the site of tumour, the histological variant, the sex of the patient, nor prior treatment had any discernible effect on recurrence rates.Conclusions: Observation is an acceptable management option in most situations, as only one‐third of incompletely excised lesions needed further treatment. Most recurrences occurred early and careful follow up of these patients was indicated for at least 3

ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1996.tb01184.x

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY

摘要:

Background: An Australia‐wide multicentre prospective study was undertaken to audit cases of initial parathyroid exploration between 1 January and 31 December 1992. One hundred and sixty‐two cases were audited. The audit was designed to study pre‐operative biochemical assessment, localization techniques and the technique of exploration.Method: A pro forma audit form was circulated to all Australian surgeons known to perform parathyroid surgery. Eleven responded.Results: Free serum ionized calcium (iCa) was measured in 30% of cases, with the majority of pre‐operative calcium assays being performed using total serum calcium (tCa). In 40 cases (29%) pre‐operative localization techniques were used. These proved inaccurate in 10 cases. The intra‐operative technique of localization with methylene blue infusion was used in 11% of cases. All four glands were biopsied in 11 % of cases. No deaths were reported and a postoperative morbidity rate of 3.1 % was noted. Eighty‐eight per cent of patients were discharged within 5 days of surgery with a third going home within 48 h of neck exploration surgery. Only one patient (0.6%) required re‐exploration for persistent hypercalcaemia due to a second adenoma.Conclusions: The surgical treatment of hyperparathyroidism can be regarded as safe, with minimum morbidity in experienced hands. Pre‐operative localization studies in initial parathyroid exploration

ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1996.tb01185.x

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY

摘要:

Background: This review was undertaken to examine a collected series of patients with this uncommon condition.Method: Six definite and three possible cases of pyogenic infection of the sacroiliac joint are reported. Their manner of presentation, investigations, management and outcome are discussed in conjuction with a review of the literature. The patients were identified by searching the medical records of three hospitals over a 10 year period and the clinical data were analysed retrospectively.Results: All patients were clinically tender over the involved sacroiliac joint and were experiencing fever. Technetium‐99m bone scans demonstrated increased uptake in the sacroiliac joint in all patients, although two scans were initially negative. Plain pelvic radiographs, computed tomography scans and white cell counts were generally unhelpful in initially establishing the diagnosis. Blood cultures were positive in eight cases, andStaphylococcus aureuswas isolated. There were four women and five men with an average age of 25 years. Six reported recent respiratory tract or skin infections. Two of these had also reported an episode of minor pelvic trauma in the preceding 2 weeks. A further two patients were intravenous drug users. Treatment was bed rest and antibiotics in all cases and marked initial improvement was seen. The outcome was variable, with a significant proportion reporting discomfort on the affected side after heavy exercise many years after the infection.Conclusion: The importance of a thorough clinical assessment and suspicion of the diagnosis of this uncommon illness is emphasize

ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1996.tb01186.x

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY

摘要:

Background: Spinal epidural abscess is an uncommon and dangerous lesion. Once neurological complications occur the damage is often irreversible.Methods: The clinical presentation, operative findings, management and follow up of nine cases of spinal epidural abscess were reported. Four patients were diabetic and four others were intravenous drug addicts. The last patient had a history of a protracted stay in an intensive care unit complicated by pneumonia and pleural effusion. Ultrasonography was used intraoperatively to guide and to assess the adequacy of drainage and decompression of the epidural abscess.Results: Multiple level laminectomy was necessary andStaphylococcus aureuswas the most common organism cultured. None of the five patients presenting with acute complete paralysis regained neurological function. Two of the four patients with incomplete paralysis were able to walk with an aid.Conclusions: Spinal epidural abscess usually presents late and the prognosis is generally poor. Ultrasound may be useful in determining the extent of the abscess during operation to drain the collection.

ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1996.tb01187.x

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY

摘要:

Background: The experience with genitoperineal gangrene at the Department of Colorectal Surgery, Singapore General Hospital is documented.Methods: The results of 12 patients treated during the 5 year period between 1 January 1990 and 31 January 1995 were studied. There were 10 men and two women. The mean age of the patients was 55.2 (range 37–83) years.Results: Perianal pain and swelling were the commonest presentation. However, three patients were admitted in a toxic state with mental confusion. The gangrene progressed from anorectal sepsis in six patients. Five of these patients had diabetes mellitus.Escherichia coliwas the commonest organism cultured. Early diagnosis, immediate resuscitation, antibiotics and early aggressive surgery was our management policy. Applying these principles, all except two patients survived (mortality 17%). One had advanced malignacy and the other had extensive hum injuries.Conclusions: A high index of suspicion should he maintained in patients with diabetes and with anorectal sepsis. Should genitoperineal gangrene develop, aggressive surgery is often successfu

ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1996.tb01188.x

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY

摘要:

Background: Patients with chronic low back pain present physicians with diagnostic and therapeutic problems. Physical treatments tend to have low success rates and it is postulated that this may be because low back pain can be a manifestation of abnormal illness behaviour.Methods: A structured prospective study determined the prevalence of somatization in a sample of 131 adult patients with chronic low back pain using the Illness Behaviour Questionnaire (IBQ) and the Modified Somatic Perception Questionnaire (MSPQ). The scores on these psychological questionnaires were compared with the blind interpretation of pain distribution drawings and with the results of a mechanical classification of the patient's symptoms and signs.Results: Fifty‐four per cent of patients had four or more (out of five) abnormal illness indicators. The MSPQ values for the group were significantly above the control values in the literature. Thirty‐two per cent of pain diagrams were thought to be incompatible with an organic cause when assessed by an orthopaedic surgeon and sixty‐two per cent when assessed by a psychiatrist.Conclusions: Psychosocial factors are dominant in the presentation of chronic low back pain in adults and the disorder is not primarily a musculoskeleta

ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1996.tb01189.x

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY

摘要:

Background: Médecins Sans Frontières provides medical support to Batticaloa, a town on the east coast, which is in the conflict region of Sri Lanka.Methods: Information on the range of pathology, the services provided and the diseases treated was collected from a 25 day assignment in mid‐1995.Results: Services and facilities are limited and the amount of work is extensive, as indicated by the 248 patients who had one or more operations and 814 surgical cases who were admitted. Ten per cent of the work was with conflict‐injured patients and the remainder covered a wide range of specialties. Complications were surprisingly few.Conclusions: The surgical support supplied through MCdecins Sans Frontitres gives the people of Batticaloa much needed medical care and allows surgeons the opportunity to have an enormously satisfying exper

ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1996.tb01190.x

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY

摘要:

Background: Mutations of the p53 tumour suppressor gene lead to the loss of control of normal cellular proliferation and differentiation and have been shown to be associated with the development of malignancy.Method: Archival paraffin resection specimens from 86 cases of hyperparathyroidism treated surgically using the rabbit poly‐clonal CM1 antibody were investigated to detect p53 immunoreactivity in these sections.Results: Eighteen of the 86 sections examined (21%) showed nuclear immunoreactivity. No correlation was detected between tumour histology and p53 immunoreactivity (P =0.45). nor was there any correlation between tumour clonality and immunoreactivity (P = 0.54). Multiple endocrine neoplasia type I (MEN 1) status did not correlate with p53 immunoreactivity. A significant correlation between p53 immunoreactivity and preparathyroidectomy calcium levels of>1.5 mmol/L was detected (P<0.005) although no correlation was noted between p53 immunoreactivity and higher levels of preparathyroidectomy intact parathyroid hormone (PTH) levels.Conclusion: A relationship is postulated between abnormal serum calcium regulation and p53 mutation in hypercalcaemic states associated with hyperparathyroidis

ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1996.tb01191.x

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY

摘要:

Background: The aetiology of abdominal aortic aneurysms (AAA) is as yet undetermined. Smooth muscle cells (SMC) have been implicated in the pathogenesis of AAA as a result of their ability to produce elastin degrading proteases. The present study was undertaken to examine AAA SMC and aortic occlusive disease (AOD) SMC in terms of their respective migration and proliferationin vitro, in order to identify intrinsic differences between these cells.Methods: Five AAA specimens, four AOD and five inferior mesenteric artery (IMA) specimens were established in culture. The cultures were examined for the extent and the rate of SMC outgrowth and proliferation. Cells were counted following trypsinization using a haemocytometer.Results: For the AAA explants, the cellular outgrowths were first seen at 6.7 days, after culture initiation, while the corresponding outgrowth in the AOD group required 8.8 days (P<0.05) and the IMA group 11.4 days (P<0.05). AAA cells reached confluency at a mean of 22.4 days while AOD SMC required 28.6 days (P<0.05) and IMA 31 days (P<0.05). In the first passage, the time for AAA SMC doubling was 5.3 days compared to 6.2 days for AOD (P<0.05) and 8.1 days for the IMA group (P<0.05). Greater than 98% of the cells, in both groups, stained positive to SMC α‐actin.Conclusion: From these data it is clear that there are intrinsic differences in cellular kinetics between SMC from the two disease states, supporting the hypothesis that AAA are not the result of atheroscleros

ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1996.tb01192.x

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY