ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1995.tb00572.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY

摘要:

The purpose of this review is to detail the roles played by the cellular adhesion molecules (CAM) in inflammatory and immunological reactions relevant to surgery. The interactions between leucocytes and endothelial cells which are mediated by CAM are central to the development of ischaemia/reperfusion injury (IRI) as occurs when blood flow is restored after an ischaemic period; for example, following revascularization of replanted digits and microvascular tissue transfers, angioplasty and tourniquet procedures. Cellular adhesion molecules are also important in wound healing and other inflammatory processes. In addition, the immunological response to organ allograft transplantation is mediated by cellular interactions mediated by CAM. This review details the functions and regulation of the various CAM involved in inflammation and allograft rejection and summarizes the results of previous surgical studies in which various techniques have been used to block the interactions mediated by CAM in an attempt to improve surgical outcomes.

ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1995.tb00573.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY

摘要:

Basic demographic and injury data were collected on all major trauma patients (ISS>15) presenting to 25 Victorian hospitals over a 1 year period (March 1992‐February 1993). A total of 1076 patients were identified with an Injury Severity Score (ISS)>15. Of these, 957 resulted from blunt trauma, 68 from penetrating trauma and 51 from burns. Most serious blunt injury was transport‐related (n= 652) but falls made up a significant proportion (n= 206). The pattern of injury in blunt trauma demonstrated in this study showed a preponderance of serious head, thoracic and limb injuries with less frequent occurrences of abdominal, spine and facial injuries. In major penetrating trauma, serious injuries of the thorax and abdomen were more frequent. Head injury is the most common cause of morbidity in major trauma patients. Motor vehicle accidents caused the majority of head injuries but, proportionately, head injury was more common in pedal cycle, pedestrian, motorcycle injuries and falls. The low frequency of major abdominal trauma has important implications for surgical training and resource allocation. In Victoria, various injury prevention interventions have been introduced such as compulsory wearing of bicycle helmets, a safer home environment and behavioural modifications through advertising. Injury prevention strategies must continue to target the populations at risk and assess the impact of interventions by accurate injury surveilla

ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1995.tb00574.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY

摘要:

This study estimated prospectively the prevalence of high drug and alcohol levels in road trauma cases who met the criteria for activation of the Liverpool Hospital's trauma team. Urine analysis of road trauma victims between October 1992 and October 1993 was undertaken for drug and alcohol estimation.A total of 164 drivers were studied. A urine alcohol concentration (UAC) exceeding 0.08 g/dL was detected in 27 drivers (16.5%). Cannabinoids were detected in the urine of 25 drivers (15.2%). in 17 the concentrations exceeded 400 ng/mL. In one instance amphetamine, cocaine and heroin were detected in the same injured driver. Combined use of alcohol with some other drugs was detected in only four drivers. Alcohol and cannabinoid levels were prevalent in the urine of injured drivers in this study, particularly in young males who remain over‐represented in the group of injured drivers. In the population surveyed other drugs were rarely detected. The role of cannabinoids in road trauma and the use of cannabinoids in young male drivers will however need to be monitored more extensivel

ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1995.tb00575.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY

摘要:

Eighty‐five patients who suffered blunt trauma to the small intestine and/or to the colon were treated at either the Royal Brisbane Hospital (RBH), Brisbane, Queensland or the Flinders Medical Centre (FMC), Adelaide, South Australia, between 1980 and 1991. Data were collected by retrospective review of case notes from the medical records departments of both hospitals and analysed with respect to the cause, the anatomical distribution, the diagnostic methods and the mortality of these injuries. There were 129 intestinal injuries (44 colonic and 85 small bowel). Five (5.9%) deaths were recorded. Seventy‐two patients (84.7%) were injured in vehicular accidents. Fifty‐three patients (62.4%) underwent laparotomy based on clinical findings alone. Diagnostic peritoneal lavage (DPL) was used in 24 cases and was positive in 22 (91.7%). The most common small bowel injury was ‘blowout’ perforation on the antimesenteric border of the bowel (55.5%). The most common colonic injury was a serosal tearbruis

ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1995.tb00576.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY

摘要:

A review of liver trauma treated by the major trauma care facilities of Tasmania in the 5 year period between 1989 and 1993 is presented. The aim of this retrospective review was to provide an audit of the management of liver trauma in the island of Tasmania and to analyse the risk factors contributing to mortality and major morbidity. Thirty‐seven patients were treated with a median Injury Severity Score (ISS) of 14 (range 9–34). The overall mortality rate of this series was 5.8%. Age, mechanism of injury (blunt or penetrating), delay prior to hospital presentation and modality of treatment (operative or non‐operative) were not significant risk factors for mortality and morbidity; however, transfusion requirement of over 10 units of blood (P<0.005), ISS score of over 20 (P<0.005). haemodynamic instability at presentation (P<0.05) and a Hepatic Injury Score (HIS) grade of 3 or more (P<0.05) were statistically significant risk fa

ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1995.tb00577.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY

摘要:

The South Australian Bone Bank has expanded to meet an increased demand for allograft bone. During a 5 year period from 1988 to 1992, 2361 allografts were harvested from 2146 living donors and 30 cadaveric donors. The allografts were screened by contemporary banking techniques which include a social history, donor serum tests for HIV‐1, HIV‐2, hepatitis B and C, syphilis serology, graft microbiology and histology. Grafts were irradiated with 25 kGy.The majority of grafts were used for arthroplasty or spinal surgery and 99 were used for tumour reconstruction. Of the donated grafts 336 were rejected by the bank. One donor was HIV‐positive and two had false positive screens. There were seven donors with positive serology for hepatitis B, eight for hepatitis C and nine for syphilis. Twenty‐seven grafts had positive cultures.Bone transplantation is the most frequent non‐haematogenous allograft in South Australia and probably nationally. The low incidence of infectious viral disease in the donor population combined with an aggressive discard policy has ensured relative safety of the grafts. The frequency of graft rejection was similar to other bone banks but the incidence of HIV

ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1995.tb00578.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY

摘要:

Despite the trend in current surgical practice in the treatment of melanoma to produce smaller excisional defects, any technique which can introduce a surgical closure that does not require split skin grafting must be of benefit. This paper introduces and illustrates a range of island flap techniques that employ no skin grafting for the treatment of malignant melanoma defects. The new cutaneous island flap described, termed the Bezier or the French Curve, employs a double V‐Y appositional closure method, thus giving a more refined reconstructive result that fits into the line of the body curves aesthetically. The design of the Bezier flap is almost identical in size and shape to the excisional defect, with a fascial or muscular base for vascular support. Appropriate guidelines that determine the design and application of this island flap technique are listed. They are illustrated both diagrammatically and clinically. Other flaps illustrated include fasciocutaneous island flaps and myocutaneous island flaps that use a single V‐Y flap appositional closure technique. All these flaps were designed with special reference to the derma‐tomes, which act as an aid memoire upon which the flaps are m

ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1995.tb00579.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY

摘要:

The effect of loperamide suppositories on patients following restorative proctocolectomy was studied by means of a randomized, double‐blind, crossover trial comparing active suppositories (20 mg b. d. X 1 week) with placebo. Ten patients (8 male, 2 female; 7 J pouch, 3 W pouch; 8 ulcerative colitis, 2 familial adenomatous polyposis) were studied 3–60 months (median, 31.5) after ileostomy closure. Ages ranged from 24 to 63 years (median, 41.5). All patients kept a diary of their bowel habits and eight underwent a standardized test of pouch compliance. Urgency volume (UV) and maximum tolerable volumes (MTV) and the volume at onset of large isolated pouch contractions (LIC) were recorded. Statistical analysis was by the Wilcoxon test for paired data. Mean daily stool frequency during the placebo phase ranged from 3.7 to 7.8. It was reduced during the active phase in only seven patients (P>0.1) but was reduced in all six patients whose placebo phase stool frequency was five or more. Urgency volume was increased by use of active suppositories in six of the eight patients tested (P>0.1). There was no consistent effect on MTV. Large isolated pouch contractions were not seen in either test in one patient. In all of the remaining seven patients LIC were recorded after the placebo phase. After the active phase LIC first appeared at higher volumes in three but were not seen at all in four patients. High dose loperamide suppositories suppress pouch contractions and tend to lower stool frequency especially when high initially. They represent a novel therapeutic approach to high stool frequency in pouch patie

ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1995.tb00580.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY

摘要:

Resection of the proximal jejunum in the duodenojejunal junction area is described in four patients, in diverse clinical settings. The conventional approach would have been to perform a gastrojejunostomy because of the possibility of ischaernia at and around the duodenojejunal flexure. A uniform surgical approach was followed for mobilization, resection and end‐to‐end duodenojejunal anastomosis and the outcome was successful in all ca

ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1995.tb00581.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY