ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1987.tb01428.x

出版商:Blackwell Publishing Ltd    

年代:1987

数据来源: WILEY

ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1987.tb01430.x

出版商:Blackwell Publishing Ltd    

年代:1987

数据来源: WILEY

ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1987.tb01431.x

出版商:Blackwell Publishing Ltd    

年代:1987

数据来源: WILEY

摘要:

A retrospective review of 40 consecutive patients undergoing combined coronary artery bypass grafting (cabg) and unilateral carotid endarterectomy (cea) was carried out to determine the stroke rate for the procedure. Patients presenting with severe coronary artery disease judged to be at risk of imminent myocardial infarction, who had signs of cerebral ischaemia (70%) or asymptomatic carotid bruits (30%), were investigated for extracranial carotid vascular disease. Patients with severe stenotic carotid lesions associated with high risk coronary artery disease underwent combined cea/cabg. Three patients had a previous contralateral cea. The average age of the patients was 62 years, and there were 31 males and nine females. Cea was completed prior to cabg under the same general anaesthetic. There were 24 ceas on the left and 16 on the right. Six patients suffered a postoperative cerebral ischaemic event (15.4%): a reversible ischaemic neurological deficit in three (7.7%), a transient ischaemic cerebral event in two (5.1%), and a permanent stroke occurred in one (2.6%). Two deaths occurred and both were cardiac related. Combined cea/cabg in patients with stenotic lesions of the coronary and extra‐cranial carotid vascular systems who are at risk of cerebral or myocardial infarction, can be performed with a permanent stroke rate within the published range for either cea or cabg alone and with a mortality of 5

ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1987.tb01432.x

出版商:Blackwell Publishing Ltd    

年代:1987

数据来源: WILEY

摘要:

Six cases of primary cardiac tumour have been operated upon in a 7 year period from 1 june 1979 until 1 june 1986. All patients were under 6 months of age at the time of operation and two of the patients were in their first week of life. The principal indication for surgery was obstruction mainly at the right or left ventricular outflow tract level. More recently echo evaluation alone has been adequate to define the problem prior to surgery. Surgical excision has been performed without mortality or significant complications. In most cases resection has been complete, although in one case residual tumour has been left because of attachment of the tumour to vital structures. Follow‐up of this case has not resulted in further surgery being required because of regrowth of the tumour. In one case, with co‐existent congenital heart disease, the tumour was brought to notice after palliative systemic to pulmonary artery shunt had been performed. From the cardiac view point gratifying results have been obtained both in the short and long term following surgical resection. However, for patients with rhabdomyoma, later development of symptomatic tuberosclerosis should be anticipated in 50% of ca

ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1987.tb01433.x

出版商:Blackwell Publishing Ltd    

年代:1987

数据来源: WILEY

摘要:

A clinical study was conducted over a 2 year period to assess the effect of four different treatments on the healing of venous leg ulcers. The treatments consisted of standard local applications of povidone‐iodine or normal saline, with and without electrode therapy. At weekly intervals, ulcer areas were measured using a newly developed technique. This allowed time‐to‐heal data to be analysed. A comparison of the four treatments revealed a highly significant retarding effect on ulcer healing by the povidone‐iodine plus electrode treatment. There were no statistical differences for comparisons made between povidone‐iodine alone and normal saline alone or for normal saline with and without electrode. Covariates were considered in the analyses. Patient sex and initial ulcer area were identified as significant factors in ulcer's time‐to‐heal (p<0.05), white patient's smoking habits, age and ulcer's initial total organism count had

ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1987.tb01434.x

出版商:Blackwell Publishing Ltd    

年代:1987

数据来源: WILEY

摘要:

A postal survey of all general surgeons in western australia was undertaken in order to document their current attitudes towards the management of primary breast cancer. The commonest surgical procedure preferred for stages i and ii breast cancer was a modified radical mastectomy, although a substantial number (31%) of surgeons favour breast conserving procedures for primary tumours less than 2 cm in size. Few (3%) surgeons still perform a classical radical or extended radical mastectomy. There is a wide diversity of practices regarding pre‐operative investigations and postoperative management. Although many surgeons (68%) use aspiration cytology to determine the histologic nature of breast lumps, the majority (62%) do not use mammography to monitor the contralateral breast. After breast conserving surgery, 60% of surgeons would not refer their patients for adjuvant radiotherapy and over 33% would not favour the use of adjuvant systemic therapy for women with stage ii breast cancer. It is concluded that the wide diversity in the pattern of management reflects uncertainty regarding the best approach to this diseas

ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1987.tb01435.x

出版商:Blackwell Publishing Ltd    

年代:1987

数据来源: WILEY

摘要:

Fine needle aspiration cytology (fna) and tru‐cut needle biopsy (tnb) have been used for the pre‐operative diagnosis of cancer in breast masses as alternatives to open breast biopsy. The accuracy of clinical examination, fine needle aspiration biopsy and tru‐cut needle biopsy was assessed in 230 patients with palpable breast masses and the value of using both biopsy methods in the management was prospectively evaluated. Clinical diagnosis had a sensitivity of 89.2% and specificity of 78.4% (32.7% false positive, 6.5% false negative). Aspiration cytology was diagnostic in 78.4% of cancers and 71.6% of benign lesions [excluding non‐diagnostic samples (27.4%), sensitivity was 96.6% and specificity was 100%]. Tru‐cut needle biopsy identified 82.9% of cancers and 61.7% of benign lesions [excluding non‐diagnostic samples (33.3%), sensitivity was 96.7% and specificity was 100%]. There were no false positive errors with either aspiration cytology or needle biopsy. Statistical comparison showed that there was no significant difference between aspiration cytology and needle biopsy. The combined result of both biopsies was superior to clinical examination when non‐diagnostic samples were excluded. With the routine use of both biopsy techniques, frozen section was avoided in 73% of all cancers and unnecessary operations were avoided in 33.5% of patients which included breast cysts, benign mammary dysplasia and inflamm

ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1987.tb01436.x

出版商:Blackwell Publishing Ltd    

年代:1987

数据来源: WILEY

摘要:

Fifty‐four patients who had the angelchik antireflux prosthesis inserted during the period march 1981 to may 1985 were sent a questionnaire and their medical records were reviewed. Forty‐four patients replied: 68% said that they were cured, 25% said they were improved and two patients (4.5%) said they were worse after the operation. Of those who replied, 93% would recommend the procedure to others with a similar condition, 89% have had no further heartburn, and 72% have had no further regurgitation. However, it would appear from the responses that eight patients (18% of those who replied) have significant dysphagia not present before operation, at times varying from 8 months to 4 years and 10 months from operation (mean 38.5 months). Six additional patients (14%) had temporary dysphagia, now resolved and five patients (11%) have persisting minor dysphagia not present pre‐operatively. Five respondents are known to have postoperative heartburn, two of whom are known to have persisting oesophagitis with ulceration. Nine patients (20%) continue to experience regurgitation, related to dysphagia in eight. Three prostheses have been removed without replacement; one after an oesophageal leak (believed to be related to a simultaneous parietal cell vagotomy), one for severe dysphagia and one which was unsuccessfully used to hold reduced a very large hiatus hernia. Two prostheses have been replaced after they slipped down the stomach wall, one with the tapes detached. (this latter prosthesis was one of the original ones with the tapes attached to the ends of the prosthesis only—a problem which has since been rectified by the manufacturer.) general surgical complications are listed for compl

ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1987.tb01437.x

出版商:Blackwell Publishing Ltd    

年代:1987

数据来源: WILEY

摘要:

The aim of this study was to determine the average total cost and component costs of the surgical management of colorectal cancer (crc) in a large teaching hospital and to examine the relationships between cost and several characteristics of the patients. Data were compiled for 97 consecutive patients undergoing resection for crc at concord hospital in 1979. The cost of the following components was calculated for each patient: (a) pre‐and postoperative bed occupancy; (b) investigations; (c) operation; (d) anaesthetic; (e) prescribed drugs; (f) allied health services. The cost of bed occupancy was by far the largest item in the average total cost (72%), followed by the cost of investigations (11%). There was no correlation between pre‐and postoperative bed occupancy and no patient characteristic had a statistically significant effect on pre‐operative stay. Several factors were associated with prolonged postoperative stay including the number of clinical problems, operation for rectal as opposed to colonic cancer, having a two‐stage procedure, surgical complications and wound infection. By far the greatest reduction in total cost could be achieved by reducing the length of postoperati

ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1987.tb01438.x

出版商:Blackwell Publishing Ltd    

年代:1987

数据来源: WILEY