ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1993.tb00356.x

出版商:Blackwell Publishing Ltd    

年代:1993

数据来源: WILEY

摘要:

The potential advantages of laparoscopic surgery for a number of abdominal operations including appendicectomy have been heralded. In this study the aims were to assess prospectively the role of routine diagnostic laparoscopy in the diagnosis of acute appendicitis and determine the efficacy of laparoscopic appendicectomy. Patients with suspected acute appendicitis had diagnostic laparoscopy. When the diagnosis was confirmed laparoscopic appendicectomy was performed. Where an alternative diagnosis was made the appropriate treatment was instituted. If no diagnosis could be made the macroscopically normal appendix was removed by laparoscopic appendicectomy. Eighty‐one patients (50 female, 31 male) had an initial diagnostic laparoscopy; 53 had appendicitis and proceeded to laparoscopic appendicectomy. A diagnosis could not be established at diagnostic laparoscopy in six patients and they also proceeded to laparoscopic appendicectomy. An alternative diagnosis was made in the remaining 22 patients (19 female and 3 male), with five proceeding to laparotomy and one patient with mesenteric adenitis having laparoscopic appendicectomy. Seven patients having laparoscopic appendicectomy required conversion to an open operation due to a retrocaecal3or perforated4appendix. The median operating time for successful laparoscopic appendicectomy was 55 min (range 30–95). Morbidity occurred in five of 53 patients having a successful laparoscopic appendicectomy. The median postoperative hospital stay was 2 days. The median time before return to normal activities was 8 days. Diagnostic laparoscopy is a useful diagnostic technique in women with suspected acute appendicitis, as it improves diagnostic accuracy, reduces the negative appendicectomy rate and avoids unnecessary laparotomy. Laparoscopic appendicectomy is a significant technical advance in the management of acute appendicitis. Preliminary results reveal similar morbidity to open appendicectomy with the potential advantages of a reduced postoperative hospital stay and a more rapid return to normal activities. Randomized trials are required to confirm t

ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1993.tb00357.x

出版商:Blackwell Publishing Ltd    

年代:1993

数据来源: WILEY

摘要:

Postoperative adhesions account for 64–79% of admissions with small bowel obstruction (SBO). The aim of this study was to identify the operative procedures and the types of adhesions that cause SBO. A retrospective analysis of all patients with an admission diagnosis of acute adhesive SBO between January 1982 and December 1990 was performed. One hundred and nineteen patients had 144 admissions with an initial diagnosis of acute SBO due to adhesions. The previous operations were: appendicectomy 23.3%; colorectal resection 20.8%; gynaecological surgery 11.7%; upper gastrointestinal (gastric, biliary or splenic) surgery 9.2%; small bowel surgery 8.3%; and more than one previous abdominal operation 23.6%. Sixty‐one admissions required surgery to relieve the SBO. Eighteen patients had strangulated small bowel. All but two of these patients had a single band adhesion causing the SBO and associated strangulation. Band adhesions were commonly found following appendicectorny, colorectal resections or gynaecological operations. Seventeen of the 21 patients with previous surgery for a colorectal malignancy had benign adhesions causing the SBO, while four of the six patients with either previous ovarian or previous gastric carcinoma had recurrent malignancy causing the SBO. Five patients had previously undiagnosed carcinomas (three ovarian and two caecal) as the cause of the

ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1993.tb00358.x

出版商:Blackwell Publishing Ltd    

年代:1993

数据来源: WILEY

摘要:

Bile duct or choledochal cysts are rare congenital anomalies and presentation in adult is infrequent. Seven cases of type I/IV bile duct cysts presenting in adult life have been treated by the authors during the past 2 years. The diagnosis was made using a combination of ultrasound and cholangiography (endoscopic retrograde cholangiopancreatography/percutaneous transhepatic cholangiography). All cases underwent total cyst excision and Roux‐en‐Y hepaticojejunostomy. There were no operative complications and all patients were asymptomatic in the follow‐up period, which ranged from 3 to 23 m

ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1993.tb00359.x

出版商:Blackwell Publishing Ltd    

年代:1993

数据来源: WILEY

摘要:

Long‐term venous access using Hickman catheters and implantable subcutaneous ports is a well established technique. These devices have customarily been inserted via the internal jugular, subclavian or cephalic veins. On occasions, these routes may be unavailable. This article reviews the outcome of 53 prolonged venous access catheters (39 Hickmans and 14 catheters attached to implantable ports) inserted percutaneously via the external iliac vein into 37 patients over a period of 5.7 years. The indications for insertion were chemotherapy (40%), total parenteral nutrition (36%), intravenous antibiotics (13%), poor venous access (7%) and bone marrow transplantation (4%). The main reasons for use of the external iliac vein were thrombosis of the subclavian veins or superior vena cava and subclavian central line sepsis. The only complication of insertion was one inadvertent puncture of the external iliac artery. Twenty‐seven catheters (51%) remained complication free and functioning for the time for which they were required. Four catheters (7%) are still functioningin situhaving been present for 1–5 years. Sixteen catheters (30%) became infected, with a 17% incidence of septicaemia. Venous thrombosis was associated with three catheters (6%). Catheters remainedin situfor a median period of 30 days (range 5–569 days). The authors conclude that long‐term venous access using percutaneous external iliac vein insertion is a useful technique when other routes are unavailable, but there is a relatively high incidence of catheter‐rel

ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1993.tb00360.x

出版商:Blackwell Publishing Ltd    

年代:1993

数据来源: WILEY

摘要:

The purpose of this study was to compare the technical success and short‐term outcome of intra‐operative balloon angioplasty (IBA) with percutaneous transluminal angioplasty (PTA) in the iliac and femoropopliteal segment. From January 1988 to February 1991, 99 consecutive patients underwent 114 angioplasties in the iliac (37 PTA, 26 IBA) and femoropopliteal segment (15 PTA, 36 IBA). Mean age and sex distributions were similar between the groups. Claudication was the primary indication for both groups. All patients who underwent IBA had another concomitant surgical procedure performed. Immediate technical success for PTA and IBA were 50/52 (96%) and 58/62 (94%), respectively. Cumulative patency up to 12 months following angioplasty of the iliac artery was 94% for PTA and 78% for IBA (P‐value NS). For the femoropopliteal segment, 12 month patency results were 100% for PTA and 78% for IBA (P‐value NS). Complications requiring surgical intervention occurred in 3 (6%) PTA and 5 (8%) IBA cases. Results from this study indicate that technical success and early patency are similar for PTA and IBA in the iliac and femoropopliteal segments. However angioplasty‐related complications were not avoided by performing balloon angioplasty in the opera

ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1993.tb00361.x

出版商:Blackwell Publishing Ltd    

年代:1993

数据来源: WILEY

摘要:

Between 1987 and 1992, one surgeon performed 242 parotidectomies in 229 patients. Among 97 patients with benign disease, pleomorphic adenoma (46) and sialo‐adenitis (28) predominated, while metastatic melanoma (22) and squamous cell carcinoma (21) were the most common diagnoses among 132 patients with malignancy. The extent of parotidectomies were: 114 ‘appropriate’ resections, 77 complete superficial parotidectomies, 35 near‐total conservative and 14 radical total resections. The facial nerve was sacrificed in 19 operations and reconstructed in four. One hundred and five patients had a concomitant neck dissection and 45 patients had adjuvant radiotherapy. Postoperative facial nerve function was normal in 90% of patients with localized tumours and 55% of patients overall. Patients with sialo‐adenitis or deep lobe tumours and those having a neck dissection were at greatest risk of facial weakness despite nerve preservation. At a median follow up of 34 months, 13 patients had developed tumour recurrence and attempts at salvage surgery have generally been disa

ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1993.tb00362.x

出版商:Blackwell Publishing Ltd    

年代:1993

数据来源: WILEY

摘要:

A clinical and histopathological analysis was carried out on 376 thyroid specimens removed under various diagnoses from the surgical clinics of Papua New Guinea over a period of 11 years (1980–90). Solitary nodular goitre (solid and cystic) was the most common clinical diagnosis. Nineteen per cent of the solid and 35% of the cystic solitary nodular goitres were found to be malignant. Malignant goitres were confirmed histologically in 73.3% of the clinically diagnosed cases of malignancy. The presence of amyloid goitre (1.9%) posed a significant diagnostic and therapeutic problem due to its clinical features resembling that of malignant goitre. Hemithyroidectomy (lobectomy) was the most common surgical procedure employed for all unilateral thyroid lesions and partial or subtotal thyroidectomy was performed for benign and most malignant lesion

ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1993.tb00363.x

出版商:Blackwell Publishing Ltd    

年代:1993

数据来源: WILEY

摘要:

The perfect suture has been defined, but in certain circumstances some features are more important than others. In paediatric gastrointestinal surgery lack of tissue drag is of great importance. Because the life expectancy of most paediatric patients having gastrointestinal operations is measured in many decades, and the long‐term effects of retained suture materials are relatively undocumented, absorbability is also of importance.A polyglyconate copolymer suture (Maxon, Davis&Geck, Gosport, UK) has undergone trial. It is a monofilament absorbable suture. It has a low coefficient of friction, very low tissue drag and is stronger (straight pull and knot strength) than corresponding gauges of braided synthetic absorbable sutures. It is slowly absorbed, its half life (in relation to strength) being 5 weeks and complete disappearance occurring in 6–7 months.The trial was prospective and randomized. All members of the Department of Surgery at the Children's Hospital, Camperdown participated. Sixty‐five anastomoses were performed in 56 patients. All varieties of joins were performed (oesophageal, duodenal, small and large bowel, and biliary‐enteric). There were no statistically significant differences in the result in terms of outcome and complications.Overall handling and tissue drag were assessed by the surgeon at the end of the operation on a visual analogue scale and analysis of these results showed no significant difference in overall handling, but significantly less tissue drag (unpairedt‐test).It is concluded that Maxon is superior to other currently available sutures for paediatric gastrointestina

ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1993.tb00364.x

出版商:Blackwell Publishing Ltd    

年代:1993

数据来源: WILEY

摘要:

The mortality from acute suppurative peritonitis may approach 70%, survivors often undergoing multiple operations and requiring protracted intensive medical support. Attempts to improve prognosis fail when they rely on the diagnosis of persistent or recurrent collections. The results of laparostomy in conjunction with continuous peritoneal irrigation (CPI), which aims to primarily eradicate and subsequently prevent the recurrence of sepsis are reported. Two deaths occurred in this series of seven patients, only one attributed to persistent sepsis.Overall, the mortality of 28% compares favourably with similar patient series and suggests that laparostomy with CPI deserves consideration in the management of selected patients with severely contaminated abdominal cavities.

ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1993.tb00365.x

出版商:Blackwell Publishing Ltd    

年代:1993

数据来源: WILEY