ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1993.tb00422.x

出版商:Blackwell Publishing Ltd    

年代:1993

数据来源: WILEY

摘要:

The objectives of this study were to determine the number and distribution of orthopaedic surgeons in Queensland at present and to assess the adequacy of trainee intake for the future. Characteristics of the orthopaedic workforce in Queensland in 1990 were analysed with regard to the total number of orthopaedic surgeons, their regional distribution, their ratio to the population and their age distribution. Similar statistics were derived for the years 1981 and 1986 and trends were examined. By projecting these trends, the number of surgeons likely to be practising in 2001 was estimated. Using projected population figures, the number of orthopaedic surgeons required in 2001 was calculated, assuming an optimum ratio of surgeons to population of one per 25 000. It was found that in 1990 sufficient orthopaedic surgeons were practising in Queensland but that there was some rnaldistribution. With the increased intake of five new training registrars per year, the number of orthopaedic surgeons in Queensland in 2001 should be appropriate, as long as current trends continue.

ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1993.tb00423.x

出版商:Blackwell Publishing Ltd    

年代:1993

数据来源: WILEY

摘要:

The advent of laparoscopic cholecystectomy (LC) has led to a reassessment of the approach to the management of choledocholithiasis. In a consecutive series of 418 patients undergoing LC, common bile duct (CBD) stones were suspected pre‐operatively in 130 patients. Forty‐five of the patients (35%) were found to have CBD stones on either pre‐operative endoscopic retrograde cholangiopancreatography (ERCP; 20) or on operative cholangiography (OC; 25). Common bile duct stones were detected on OC in a further 12 of 288 patients (4.2%) without pre‐operative suspicion of choledocholithiasis. Of the total of 57 patients with CBD stones, the duct was cleared by pre‐operative ERCP and endoscopic sphincter‐otomy (ES) in 15 patients. In 13 patients, two of whom had had a pre‐operative ERCP and ES, duct clearance was achieved by relaxing the sphincter pharmacologically and flushing the CBD via the OC catheter. One patient had an on‐table ERCP and ES with successful stone extraction during LC. Eleven patients were converted to open operation with bile duct exploration. Sixteen patients had a postoperative ERCP. In five patients the CBD stones had passed spontaneously in the time between LC and ERCP. Ten patients required ES to clear the duct of stones. One patient had a failed ERCP and is still awaiting a repeat. The remaining patient was scheduled, but did not return for follow‐up ERCP.In summary, pre‐operative ERCP was indicated in less than 10% of patients in this series. It was possible to deal with over one‐third of CBD stones found at LC by the simple technique of pharmacological relaxation of the spincter of Oddi and flushing the duct through the cholangiogram catheter. Of the patients who required follow‐up ERCP, one third had passed their CBD stones by the time of the examination and the rest required ES for stone extraction. Less than 3% of the entire series of patients were converted to open operation for exploration

ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1993.tb00424.x

出版商:Blackwell Publishing Ltd    

年代:1993

数据来源: WILEY

摘要:

The applications of laparoscopy as a diagnostic and therapeutic tool are being continually expanded and applied to the younger patient. In this study, 28 boys with 32 non‐palpable testes underwent laparoscopy as part of their management. The patients' ages ranged from 10 months to 13 years. There was one failed laparoscopy and one minor complication. Blind ending vas deferens and vessels proximal to the deep inguinal ring were noted in six patients and no viable testes were found in these boys. Five abdominal testes were noted; three underwent scrotal fixation, one was excised after failed Fowler‐Stephens orchidopexy and one had a staged procedure. Twenty‐one non‐palpable testes were noted on laparoscopy to have the vas deferens and vessels entering the inguinal canal; of these, 12 were atrophic on inguinal exploration. The remaining nine testes were successfully fixed in the scrotum. This study concludes that laparoscopy is a safe and effective part of the management of the non‐palpable testis. The advantages of laparoscopy in the localization of the testis and its potential uses in treatment are hi

ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1993.tb00425.x

出版商:Blackwell Publishing Ltd    

年代:1993

数据来源: WILEY

摘要:

This study was performed to review the place of thoracoscopy in the diagnosis and treatment of intrathoracic disorders. A combined retrospective and prospective review was undertaken of the first 50 patients who undenvent diagnostic or therapeutic thoracoscopy in Ballarat.Recurrent pleural effusions (29), pneumothoraces (7), or diffuse or localized lung disease (14) were the main indications. Thoracoscopy was performed in conjunction with pleural or lung biopsy, excision of cysts, or pleurodesis.Patient tolerance of the procedure was excellent with minimal postoperative pain. Operative morbidity rates were very low (<4%). The low mortality rate was related to underlying disease processes. Hospital stay was short.The long‐term results were excellent. Adequate tissue was obtained on biopsy in most cases, cure achieved for pneumothoraces, and permanent palliation after talc pleurodesis for malignant effusions approached 80

ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1993.tb00426.x

出版商:Blackwell Publishing Ltd    

年代:1993

数据来源: WILEY

摘要:

Early diagnosis and surgical intervention is important in the management of peptic ulcer perforation. This study looks at the value of a pneumogastrogram in the diagnosis of patients suspected of having a perforated peptic ulcer. One hundred and twenty‐nine patients were studied. Pneumogastrograrn increased the diagnostic yield of pneumoperitoneum from 66% following plain erect X‐ray examination to 91%. The procedure was free of complicati

ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1993.tb00427.x

出版商:Blackwell Publishing Ltd    

年代:1993

数据来源: WILEY

摘要:

Gastric malignancy was the cause of bleeding in 35 of a consecutive series of 2260 cases (1.5%) treated with upper gastrointestinal haemorrhage. Fifteen patients came to emergency surgery (43%). In 13 of 30 early endoscopies performed the lesion was thought to be benign (43%) and seven of these cases came to emergency surgery. Two patients died after 15 emergency operations (13%) compared with 15 deaths after 109 emergency operations (14%) for benign gastric ulcer during the same period of study. A total of four patients with malignant ulceration died after surgery in 33 cases (12%), two after 15 emergency operations and two after 18 elective procedures. The only significant predictors of urgent surgery for malignant ulcer were shock on admission and active bleeding or visible vessel on endoscopy. Resection of gastric malignancy was performed in 29 patients during initial admission and in four cases at a subsequent admission giving a final resection rate of 91%. Of the 28 patients with adenocarcinoma, 19 had localized disease (Stage 1 or 11) (68%). Nine patients were treated by total gastrectomy, five at an initial elective procedure and four at a second procedurc.

ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1993.tb00428.x

出版商:Blackwell Publishing Ltd    

年代:1993

数据来源: WILEY

摘要:

Nine patients with gastroduodenal tuberculosis (GDTB) were seen over a period of 2 years at a tertiary level referral institute. Clinical presentation of GDTB is similar to that of peptic ulccr disease. Endoscopic biopsy and/or laparotomy and biopsy establish the diagnosis. Medical treatment is the mainstay of therapy, although surgical intervention may be required for the management of complications. Gastroduodenal tuberculosis should be suspected in patients, residing in areas where the disease is endemic, with a short history suggestive of peptic ulcer disease and an early onset of gastric outlet obstruction.

ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1993.tb00429.x

出版商:Blackwell Publishing Ltd    

年代:1993

数据来源: WILEY

摘要:

Metastatic cervical lymph node involvement is a major determinant of treatment planning and prognosis of upper aerodigestive tract tumours. If the metastatic tumour invades the carotid artery wall then complete tumour excision is not possible unless carotid artery ligation or replacement is planned. A prospective study was performed to assess the role of palpation, computerized tomography (CT) and B‐mode ultrasound scanning in the detection of metastatic cervical lymph node involvement in patients with upper aerodigestive tract tumours. In particular, detection of carotid artery wall invasion by tumour was examined. Thirty‐two neck dissection specimens were available for histopathological confirmation of findings. Palpation under general anaesthesia was 87.5% sensitive and 87.5% specific in the detection of involved nodes. If a positive finding was defined as detection of a node greater than 15 mm in largest diameter, CT scanning was 78.6% sensitive and 93.8% specific, and the sensitivity of ultrasound was 81.3% and specificity was 84.6%. Ultrasound scanning was sensitive in excluding carotid artery wall invasion, identifying five out of five cases with one false positive and no false negative reports. The combination of palpation under general anaesthesia and B‐mode ultrasound imaging provides a sensitive means of detecting the presence of metastatic cervical lymphadenopathy and invasion of the carotid artery

ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1993.tb00430.x

出版商:Blackwell Publishing Ltd    

年代:1993

数据来源: WILEY

摘要:

Computerized tomography (CT) now has a definite place in the assessment of aortic vascular disease. In a study of 96 patients with abdominal or thoracic aorto‐iliac problems, CT proved most useful in the management of haemodynamically stable patients with abdominal aortic aneurysms that were suspected of leaking. The complex anatomy associated with thoracic and abdominal aneurysms and aortic dissection was clearly defined. The interpretation of scans on postoperative aortic graft patients was difficult and less often helpful. The incidental finding of aortic disease during abdominal scans for a variety of other indications was infrequent and seldom contributed to patient management. The indications for CT have become far more selectiv

ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1993.tb00431.x

出版商:Blackwell Publishing Ltd    

年代:1993

数据来源: WILEY