ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1994.tb02255.x

出版商:Blackwell Publishing Ltd    

年代:1994

数据来源: WILEY

摘要:

In France, the late Jean Papillon was responsible for much of the pioneering work in the radiotherapy treatment of patients with rectal cancer. This review is written in tribute to his contribution to, and vast experience in, the conservative management of this common tumour. It describes his protocols with minor modifications currently used at the Centre Hospitalier Lyon‐Sud, France. In Lyon, pre‐operative adjuvant irradiation is the preferred treatment for patients with T2and T3rectal cancer. Initial results suggest that this combined approach significantly improves the likelihood of successful sphincter preservation for patients with carcinoma of the lower third of the rectum. To date, the technique has given good local control with minimal postoperative morbidity and low mortal

ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1994.tb02256.x

出版商:Blackwell Publishing Ltd    

年代:1994

数据来源: WILEY

摘要:

This paper reports an evaluation of the first 2 years of a South Australian screening programme for colorectal cancer which was established in 1988 by the Institute of Medical and Veterinary Science. The programme uses an immunochemical test for faecal occult blood. Based on 1 year of follow‐up, over the period of this analysis there were 24 cancers and 99 adenomas detected in 6208 participants, and the estimated sensitivity and specificity of the test (for colorectal cancer) were 82.8 and 95.9%, respectively. In many cases the test was used to detect recurrence of disease in individuals with a previous diagnosis of colorectal cancer. The estimated predictive value of a positive test for colorectal cancer in this population was 7.5%. Results suggest that participants belonged to higher‐than‐average socio‐economic groups and were more likely than the general population to have a family history of colorectal cancer. Almost one‐third had suffered from bowel symptoms in the 6 months before taking the test. These unique characteristics of participants, which limit the generalizability of results to the wider population, may result from the programme's reliance on self‐recruitment methods. Consistent evidence for improvements in mortality in populations screened for colorectal cancer is still required before a recommendation for widespread screening in Australia

ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1994.tb02257.x

出版商:Blackwell Publishing Ltd    

年代:1994

数据来源: WILEY

摘要:

Three illustrative cases of magnetic resonance imaging (MRI) in patients with perianal Crohn's disease are presented. Modern MRI techniques provided excellent visualization of perineal anatomy, inflammatory tissues and an anorectal stricture. It also allowed detailed delineation of the patho‐anatomy of fistulous abscess and any communication to more proximal bowel. This report illustrates the potential of modern MRI as an important investigative adjunct in evaluating the anorectal manifestations of Crohn's diseas

ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1994.tb02258.x

出版商:Blackwell Publishing Ltd    

年代:1994

数据来源: WILEY

摘要:

The increasing age of the population has led to the more common occurrence of multi‐organ disease. Colorectal cancer (CRC) and abdominal aortic aneurysm (AAA) in the same patient is a difficult management problem. Over 10 years, 23 patients with CRC and AAA were treated at Concord Hospital. The management and outcome of these patients was reviewed to identify an optimum plan for patients with both conditions. The average age of patients was 71 years, ranging from 52 to 90 years. There was only one female patient in the series. In 19 of the patients, the AAA and CRC were synchronous, while in the other four patients the AAA and CRC were remote events. Within the group of patients with synchronous AAA and CRC, 12 had the diagnosis of both conditions made pre‐operatively. However, in seven cases an unexpected AAA or CRC was found at operation for the other condition. Sixteen patients underwent resection of the CRC, while only eight underwent repair of the AAA. There were three deaths following CRC resection, two following AAA resection, and one following simultaneous CRC resection and AAA repair. Two of 10 patients with large (>6cm) AAA, who underwent CRC resection, ruptured the AAA in the postoperative period. A further patient ruptured 10 months following CRC resection. Colorectal cancer was given priority over AAA when these conditions were found simultaneously. The present study suggests that a large AAA (>6cm) should be either given preferential treatment, or resected simultaneously, in view of the high risk of rupt

ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1994.tb02259.x

出版商:Blackwell Publishing Ltd    

年代:1994

数据来源: WILEY

摘要:

This study is a retrospective case series analysis of all 82 road deaths occurring in the Orana Area Health Service (OAHS) over the 2 year period 1989–90. The OAHS services a population of 112 800 in an area of 199077 km2in north‐west New South Wales. The aim of the study was to document timing, place and cause of deaths, severity of injuries, pre‐hospital management of victims, and a TRISS analysis of outcome. This was done using ambulance, hospital, police and autopsy reports. Seventy‐two (88%) of the victims were motor vehicle occupants, five (6%) were motorcyclists and four (5%) were pedestrians. The median ambulance response time to the scene of the accident was 17 min (range 2–103 min). All deaths occurred within 24 h of injury with 65 (79%) of the victims being dead at the scene, nine (11%) dyingen‐routeand eight (10%) reaching hospital alive. A TRISS analysis was performed on 51 deaths and 8% (4/51) of these had a greater than 50% probability of survival. Of the victims that had inevitable deaths according to TRISS, 11 % (5/47) may have survived if pre‐hospital care arrived sooner. Reduction in the rural road toll is achievable through preventative measures and strategies to improve access to care and administration of pre

ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1994.tb02260.x

出版商:Blackwell Publishing Ltd    

年代:1994

数据来源: WILEY

摘要:

From 1983 to 1990, 110 patients with abdominal trauma required laparotomy in the Albury‐Wodonga region. Splenic and liver injuries occurred in 50% of cases, and bowel trauma in 20%. The mortality rate was 8.2% (nine deaths) and major postoperative complications occurred in 18 patients (16%). Delay in therapeutic intervention of greater than 4h from hospital admission led to a statistically significant increase in the complication rate (P<0.01) despite a lower injury severity score in this group. Delayed repair of bowel injuries in particular led to an 80% major complication rate in survivors. A high index of clinical suspicion and the regular use of diagnostic peritoneal lavage is suggested to avoid such delays in diagnosis and subsequent surger

ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1994.tb02261.x

出版商:Blackwell Publishing Ltd    

年代:1994

数据来源: WILEY

摘要:

A new model for studying ileal reservoirs was used to compare J and W pouches. Sixteen female piglets were operated on between 62 and 67 days of age (median = 65). An approximately 50 cm vascularized segment of terminal ileum was isolated from the faecal stream and intestinal continuity restored. The distal 40cm of the isolated loop was opened along its antimesenteric border and the pouch constructed (J = 8, W = 8). The remaining proximal length of ileum was brought out through the abdominal wall as a mucous fistula. One piglet in the W pouch group died post‐operatively and in another, spontaneous closure of the mucous fistula prevented access to the W pouch for testing leaving six W and eight J pouches for comparison. Compliance was tested at 4 weeks by measuring intrapouch pressure during continuous distension by water. The volumes instilled at pressures of 20, 40, 60 and 80 cm of water were compared using the Mann‐WhitneyU‐Test. Volumes varied widely at all pressures within both study groups although W pouches tended to be of larger volume for any given pouch pressure (P= NS). The failure of this study to demonstrate more clearly a difference between J and W pouches may be due to the small numbers involved but the wide range of volumes seen raises doubts about the usefulness of this pouch

ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1994.tb02262.x

出版商:Blackwell Publishing Ltd    

年代:1994

数据来源: WILEY

摘要:

Two models of pancreas transplantation were examined in the rat with a view to choosing one for regular use in functional experiments. A cuff technique applied to the renal vessels of the recipient was used. The histology and endocrine functioning of whole pancreas‐duodenal transplant (Tx) plus bladder drainage (drainage model), and the pancreatic duct ligated segmental pancreas Tx (ligated model) were examined. Syngeneic operations were performed using either Lewis or Wistar rats. Streptozotocin (STZ) 60 mg/kg intravenously (i.v.) was used to render the recipient rats diabetic. A cuff technique was used with both models to anastomose the grafts to the renal vessels instead of the conventional technique of hand suturing to the abdominal vessels. This allows a shorter warm ischaemia time for the donor pancreas and leaves the systemic circulation intact leading to a high success rate for both techniques. Operation survival rates were 93% (n= 30) and 90% (n= 10) in the ligated and drainage models, respectively. The recipients in both groups were normoglycaemic for>100 days. Histological examination revealed atrophic exocrine tissue early in the ligated group but only two from the drainage group showed exocrine atrophy at>100 days. There was no statistical difference in i.v. glucose tolerance tests with both models showing a normal pattern. Thus, endocrine function remained independent of exocrine function. Both models are quicker than the conventional techniques. The duct ligation model was a simpler transplant to perform, suggesting that this should be the technique of choice in future experiment

ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1994.tb02263.x

出版商:Blackwell Publishing Ltd    

年代:1994

数据来源: WILEY

摘要:

The adrenal glands can be removed surgically by the anterior transperitoneal approach, or by the extraperitoneal approaches, either posteriorly or posterolaterally. While the extraperitoneal routes have become accepted as the preferred approach to the adrenal glands for small benign cortical adenomas, many authors still recommend the anterior transperitoneal route as the preferred operative approach for phaeochromocytoma, large tumours, adrenal cancers or bilateral hyperplasia. A series of 51 consecutive adrenalectomies performed for a wide range of adrenal disorders is presented, including phaeochromocytoma and large malignant tumours. In 47 cases the tumours were successfully removed through an extraperitoneal approach, with minimal morbidity. The anterior approach had to be employed in only four cases, and in three of these there was pre‐operative evidence of tumour invasion into either the major vessels or the liver. The extraperitoneal approach to the adrenal gland is technically simple and can be performed quickly, with a low postoperative morbidity and should be regarded as the routine approach for almost all adrenal procedure

ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1994.tb02264.x

出版商:Blackwell Publishing Ltd    

年代:1994

数据来源: WILEY