摘要:

Computerized tomography (CT) scanning and diagnostic peritoneal lavage have often been seen as competing modalities in the assessment of blunt abdominal trauma. Each has its own strengths and weakness. A judicious use of both modalities can result in improved diagnostic accuracy. An algorithm for their appropriate use is suggested.

ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1995.tb07263.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY

摘要:

There have been several recent advances in the understanding of the process of carcinogenesis in the thyroid and parathyroid glands. The specific abnormal molecules are, in many instances, well understood. This review provides an overview of the molecules in the cell that regulate cell growth and proliferation and identifies the molecules that have been found to be abnormal (or mutant) in various types of thyroid and parathyroid neoplasia.

ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1995.tb07264.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY

摘要:

During the period from May 1992 until April 1993, 108 patients were admitted to Liverpool Hospital with Injury Severity Scores (ISS)>15. Temperatures had been recorded in 100. Of these, 17 had a core temperature of less than 35°C documented within 24 h of arrival. The hypothermic group presented with more severe injuries and contained a disproportionate number of females. Hypothermia was found to be more common in the winter months, but it was not associated with a delay in reaching hospital from the time of injury. When injuries were ranked by ISS, both hypothermic and normothermic patients were equally likely to have received a blood transfusion; however, the mean number of units of packed cells transfused was greater for the hypothermic group with ISS<41 than for the similarly injured normothermic group. Two patients in the hypothermic group had sustained bums, and both of these were hypothennic on arrival. All of the hypothermic patients who required surgery developed hypothermia in the operating theatre

ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1995.tb07265.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY

摘要:

A system of regionalized trauma care was introduced to Sydney in early 1992. This study was carried out to assess the effect of regionalization on the outcome of patients suffering major head injury within the central Sydney area. A prospective before and after study extending over 3 years and centred on the time of designation of Royal Prince Alfred Hospital (RPAH) as a trauma centre, was the methodology used. The study group consisted of all patients admitted with head injury (Glasgow Coma Score15) to RPAH from the central Sydney area. Outcome criteria include survival rates, transfer numbers, and time to definitive neurosurgical care. Fifty patients were entered during the first 18 months of the study, and 38 during the second 18 months. Fifteen in the first group required evacuation of intracranial mass lesions, as did nine in the second group. The overall mortality fell from 42 to 26% (P= 0.13). During the study period there were 77 primary retrievals and 20 required evacuation of mass lesions. The median time from injury to commencement of operation in these patients was 2 h 13 min (range 1 h 3 min‐5 h 35 min). There were 11 transfers, four requiring craniotomy. The median time from injury to surgery was 7 h 24 min (range 3 h 2 min‐10 h 25 min;P<0.01). A trend towards a decreased mortality following regionalization, as well as a statistical difference (P<; 0.01) in the time taken for primary retrieval patients to undergo craniotomy when compared to transferred patients, has been shown. This evidence, in conjunction with the decrease in transferred patients post‐regionalization, helps validate regionalization in the setting of major neurot

ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1995.tb07266.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY

摘要:

Obstructed defecation poses a challenging clinical problem and in many patients presenting with this syndrome the underlying pathophysiology cannot be determined. Up to now, attempts to diagnose and treat obstructed defecation (anismus) have focused on the function of the somatic pelvic floor musculature surrounding the anorectum, and concepts such as ‘puborectalis paradox’ and ‘spastic pelvic floor’ have gained widespread acceptance despite there being no objective data to support such concepts. New evidence showing that defecation is an integrated process of colonic and rectal emptying suggests that anismus may be much more complex than a simple disorder of the pelvic floor muscles. In a small number of patients obstructed defecation is caused by a more simple mechanism, such as internal sphincter hypertonia or a large rectocele, which is easily corrected surgically. Careful selection of patients for treatment, based on identifying the underlying pathophysiological disorder, is emp

ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1995.tb07267.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY

摘要:

The clinical pattern and physiological abnormalities in solitary rectal ulcer syndrome (SRUS) occurring in Singapore, were investigated. Since April 1989. 25 patients have presented with histologically proven SRUS. There were 13 males and 12 females (20 Chinese, 4 Malay and 1 Indian) with a mean age of 47.5 (± 3.1) years. Ninety‐six per cent presented with rectal bleeding, 92% strained at stools, 40% had mucus discharge, 40% felt incomplete defecation and 32% digitated to defecate. Four had previous haemorrhoidectomies that did not cure their symptoms. The lesions were at a mean 6.8 (± 0.5) cm above the anal verge, usually anteriorly (64%) but one was circumferential. Anorectal physiology performed on 14 patients was compared with 13 age and gender matched normal controls. The measured mean resting perineum level in SRUS (1.4 ± 0.3 cm) was significantly lower than in normals (P<0.01). The mean anal electrosensory threshold (2.5 ± 0.52 mV) was also significantly higher than in the controls (P<0.05). Fifteen patients were successfully treated with a high fibre diet and avoidance of straining. Three patients required surgery and the most recent seven patients have responded well to biofeedback treatment. Awareness of this uncommon anorectal condition is necessary for early diagnosis and appropriate management. The physiological findings support a pelvic straining pathophysiology resulting in perineal descent, with less sensitive rectal mucosa prolapsing into, and raising, the anal canal electrosensory threshold. Treatment strategies aimed at correcting the straining have usually been succe

ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1995.tb07268.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY

摘要:

This paper documents a 15 year experience with Hartmann's operation in the Colorectal Service at the Wellington School of Medicine, New Zealand. There were 31 male and 30 female patients. The majority had either complicated diverticular disease (27) or rectal cancer (27). Fifty‐six patients were discharged home and five patients died within 30 days of surgery (8.2%). Of the 27 patients with complicated diverticular disease 19 proceeded to stoma closure with no mortality. Of the 27 patients who had complicated colorectal cancer only 2 had their stoma closed. There were 41 patients in whom bowel continuity was restored following construction of a Hartmann's stoma. Thirty‐nine anastomoses were hand‐sewn and two anastomoses were stapled. One patient developed a major anastomotic leak and one patient died postoperatively. Hartmann's operation has a definite place in the management of patients with complicated diverticular disease and recto‐sigmoid cancer. The operation can be performed and the stoma closed safely in the former group but is less likely to be followed by restoration of continuity in the latte

ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1995.tb07269.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY

摘要:

Anal stricture is an uncommon but well recognized complication following haemorrhoidectomy. Twenty‐seven (3.8%) out of 704 (500 elective and 204 emergency) cases of haemorrhoidectomy performed at the Singapore General Hospital over a 24 month period had clinical evidence of anal stricture post‐haemorrhoidectomy. Of the 27 cases, IS had haemorrhoidectomy as an elective procedure while 12 had it performed as an emergency procedure (X2= 3.26, 1 d.f.,P>0.05, not significant). The mean interval between surgery and presentation of anal stricture was 6 weeks (range 3–12 weeks). Eighteen of the patients were managed by anal dilatation in the outpatient clinic combined with bulk laxatives and a local anaesthetic agent. The other nine patients required a minor surgical procedure comprising either a lateral internal sphincterotomy (five) or an anoplasty (four) procedure. All patients were well, following treatment. None of these patients developed a recurrent stricture at follow up 3 months after treatment. It was concluded that although anal stricture following haemorrhoidectomy is rare, it should be detected and treated early in order to avoid pain and suffering, and treatment is usually succe

ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1995.tb07270.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY

摘要:

Total proctocolectomy and ileal pouch‐anal anastomosis (IPAA) is the best option in the surgical treatment of ulcerative colitis. and for some patients with familial polyposis. Contraindications to the procedure include old age, obesity, weak sphincters, perianal sepsis and previous enterectomy. In this study the results of IPAA in five patients with one or more of these contraindications are presented and ways of dealing with them are discussed. All patients had a favourable outcome showing that such contraindications are relative, and IPAA may be attempted as long as patients are fully informed and understand the risks to which they are subjec

ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1995.tb07271.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY

摘要:

The present study documents a 15 year experience with anal dilatation in patients with fissurein ano. Patients who were unable to tolerate rectal examination were admitted urgently for anal dilatation. Patients in whom rectal examination and proctoscopy was possible were offered an anal dilator and were reviewed after 4 weeks. Patients who preferred not to use an anal dilator or who had not become asymptomatic were admitted for elective anal dilatation. Four finger anal dilatation was performed under general anaesthesia. Between 1975 and 1990 104 patients underwent 111 procedures. The male to female ratio was 1.3:1. Five patients were re‐operated because of failure of resolution of symptoms. Three patients with anal fissures and Crohn's disease were successfully managed by anal dilatation. Nine patients had excision of a ‘sentinel pile’ in addition to anal dilatation. Ten patients were admitted acutely. One patient developed a perineal haematoma. Seventy‐four procedures were performed as day cases. There was no mortality associated with the procedure. At the time of discharge from the clinic no patient complained of problems with continence. These results support our policy of gentle anal dilatation as first management choice in the treatment of anal

ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1995.tb07272.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY