ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1989.tb01500.x

出版商:Blackwell Publishing Ltd    

年代:1989

数据来源: WILEY

ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1989.tb01501.x

出版商:Blackwell Publishing Ltd    

年代:1989

数据来源: WILEY

ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1989.tb01502.x

出版商:Blackwell Publishing Ltd    

年代:1989

数据来源: WILEY

摘要:

The relative indications for operative common duct exploration (cde) and endoscopic spbincterotomy (es) in treating common duct stones are often unclear. This prospective study compared cde and es in treating choledocholithiasis after excluding patients with acute cholecystitis, idiopathic pancreatitis, sphincter of oddi dysfunction and malignant disease. One hundred and two patients had 105 cde and a further 50 patients had 57 es. Of the patients having cde, 76 also had cholecystectomy for gall‐bladder (gb) disease while 26 had prior cholecystectomy. With es, in 16 the gb was present and not removed while 34 patients had had prior cholecystectomy. Hospitalization was significantly less following es. There was one peri‐operative death after cde and none after es. There were two late biliary‐related deaths, 3 and 27 months after es, in patients who developed acute cholecystitis.In post‐cholecystectomy patients having es, complications were fewer and less severe after es (15%) than cde (41%). In patients with an intact gb, peri‐operative complications occurred in 30% after cholecystectomy and cde. Following es alone, complications occurred in 33% with the majority of these complications arising from the diseased gb. It is concluded that the optimal treatment for post‐cholecystectomy patients with bile‐duct stones is es. In elderly patients with an intact gb, the bile‐duct stones can be treated by es; whether subsequent cholecystectomy is necessary should be assessed on the likelihood of future g

ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1989.tb01503.x

出版商:Blackwell Publishing Ltd    

年代:1989

数据来源: WILEY

摘要:

Electrohydraulic lithotripsy was applied in 10 patients with biliary stones which were difficult to extract with the use of choledochoscopy and basket. The difficulties encountered included large impacted stones in the hartmann's pouch, intrahepatic ducts and lower end of common bile‐duct, stones situated at the orifice of acutely angulated segmental bile‐ducts and stones impacted just behind strictures. With the use of electrohydraulic lithotripsy all the stones were disintegrated and removed. The only complication was transient haemorrhage from ductal injury. It is concluded that electrohydraulic lithotripsy is a useful adjunct to the choledochoscopic removal of biliary sto

ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1989.tb01504.x

出版商:Blackwell Publishing Ltd    

年代:1989

数据来源: WILEY

摘要:

During a 2 year period, 229 non‐intensive care patients received total parenteral nutrition (tpn) for a mean of 23.2 days.Nutritional parameters of weight, triceps skin‐fold thickness (tsf), mid‐arm muscle circumference (mamc), total lymphocyte count (tlc), serum albumin and serum transferrin were measured prior to commencement of tpn and then at weekly intervals.All parameters showed an upward trend during the period of tpn. This was small and not statistically significant for weight, tsf, mamc and albumin; the trends were greater and statistically significant for transferrin (p= 0.001) and tlc (p= 0.002).In contrast, in the 14.4% of patients who died, albumin, transferrin and tlc all fell. Patients who died had a significantly lower initial albumin (p= 0.05), transferrin (p= 0.04) and tlc (p= 0.04). The last values obtained in patients who died were very significantly lower for albumin (p<0.001), transferrin (p<0.001) and tlc (p= 0.003).Single‐lumen tunnelled subclavian catheters had a significantly lower incidence of catheter sepsis (4.8%) compared with double‐lumen (17.4%) and triple‐lumen (13.7%) catheters (p= 0.01).There was also a greater incidence of mechanical and thrombotic complications with multiple‐lumen catheters compared with single‐lumen catheters (p= 0.02).This study shows that the nutritional indices albumin, transferrin and tlc have prognostic significance. Single‐lumen rather than multiple‐lumen catheters should be used for administration of tp

ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1989.tb01505.x

出版商:Blackwell Publishing Ltd    

年代:1989

数据来源: WILEY

摘要:

Carcinoid tumours in auckland diagnosed during 1976–87 have been reviewed retrospectively. Eighty‐three patients with carcinoid tumours were seen during this time (56 appendiceal, 11 small bowel, two colorectal, 10 pulmonary and four other). Three patients had carcinoid syndrome.The most common presentation for appendiceal carcinoid was acute appendicitis. The most common presentations for pulmonary lesions were incidental findings on chest x‐ray, recurrent chest infection or haemoptysis, while bowel lesions presented with abdominal pain or rectal bleeding.Following resection, 53 of 56 appendiceal patients were alive and well (two died from other causes) and 10 of 10 pulmonary carcinoids were alive and well. In contrast, both patients with colorectal carcinoid died from their disease within 1 year, and, of the patients with small bowel carcinoid, one died of the disease and more than half of the remainder are alive with metaslatic spread and symptoms at the time of study. The most important prognostic variables governing outcome were anatomical site of the primary lesion and the state of the histological margins following rese

ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1989.tb01506.x

出版商:Blackwell Publishing Ltd    

年代:1989

数据来源: WILEY

摘要:

A general discussion is made of the incidence, biological behaviour, diagnosis and management of metastatic disease involving the central nervous system secondary to malignant disease of the breast. Illustrative case histories selected from patients treated for carcinoma of the breast in the period 1978–88 are include

ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1989.tb01507.x

出版商:Blackwell Publishing Ltd    

年代:1989

数据来源: WILEY

摘要:

Twenty‐one cases of supracondylar fracture of the femur treated at st vincent's hospital, melbourne, during 1983–86, by intramedullary zickel supracondylar nails were reviewed. The causes were high energy trauma in young patients (six), minor trauma in elderly patients (13), and metastatic malignant fracture (two). The functional results were considered excellent in 10, good in six and poor in five. There were two cases of superficial wound infection. All cases united after 3–6 months. The best functional results were in those patients below 60 years or with pathological fractures. It is concluded that internal fixation of supracondylar fractures of the femur with zickel supracondylar nails is a successful technique and can be performed by open and closed methods. It is most useful in osteoporotic or pathological bone which is unsuitable for bone pl

ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1989.tb01508.x

出版商:Blackwell Publishing Ltd    

年代:1989

数据来源: WILEY

摘要:

The potential for femoral head rotation occurring during insertion of a compression hip screw has been investigated. Rotation to up to 30° has been demonstrated, and was not visible on an image intensifier. The insertion of a guide‐wire parallel to a hip screw does not control rotation adequately. Small threaded pins do not cause femoral head rotati

ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1989.tb01509.x

出版商:Blackwell Publishing Ltd    

年代:1989

数据来源: WILEY