ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1994.tb02212.x

出版商:Blackwell Publishing Ltd    

年代:1994

数据来源: WILEY

摘要:

Laparoscopic inguinal herniorrhaphy with or without application of mesh does not correct the basic problem. Unless the dense fascial and bony margins of the posterior inguinal canal wall are palpated under direct vision for suture of the mesh, fortification is not possible and recurrence is invited. The many neural structures cannot be seen with the laparoscope, and their stapling is a prominent hazard. The procedure should not be accepted or approved.

ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1994.tb02213.x

出版商:Blackwell Publishing Ltd    

年代:1994

数据来源: WILEY

ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1994.tb02214.x

出版商:Blackwell Publishing Ltd    

年代:1994

数据来源: WILEY

摘要:

Carcinoma of the oropharynx poses particular challenges and problems to head and neck clinicians. These include relative anatomic inaccessibility, field cancerization and the need to minimize speech and swallowing dysfunction. The aim of this review is to bring together an appreciation of the issues involved in the management of this disease and the more recent results of its treatment.

ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1994.tb02215.x

出版商:Blackwell Publishing Ltd    

年代:1994

数据来源: WILEY

摘要:

Facial fractures are exceedingly common, and fractures of the mandible are the most common facial fracture. Over the past two decades a changing trend in the aetiology of these fractures has been apparent, with a decline in the percentage resulting from motor vehicle trauma, and an increase in the percentage resulting from assaults. A 3 year prospective study of 324 patients presenting to the Royal Adelaide Hospital with mandibular fractures was conducted and the patient groups, influence of alcohol, aetiology and type of fracture were examined and compared with other large series from around the world.

ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1994.tb02216.x

出版商:Blackwell Publishing Ltd    

年代:1994

数据来源: WILEY

摘要:

Blunt thoracic aortic rupture (TAR) initially presents with subtle signs but is usually fatal if not diagnosed and treated early. Does the diagnostic process affect outcome? The definitive test most widely promoted is thoracic (arch) aortography but is usually only available in major teaching hospitals. Thoracic computerized tomography (CT) scanning is more readily available but its role in diagnosis of TAR is unproven.A retrospective review of trauma databases and medical record indexes over a 7 year period identified 38 patients presenting with TAR at Westmead and Royal North Shore Hospitals in the period 1984–91.Thirteen patients (34%) were dead on arrival or died within 15 min of arrival at either hospital. Five patients (13%) who arrived in cardiac arrest (with suspected TAR) died after immediate thoracotomy (two in the Emergency Department and three in the operating room). Two patients (5%) died from severe head injuries and were not investigated for TAR.Eighteen patients (47%) remained alive long enough for investigation and were considered potentially salvageable. Nine of these survived. Only 13 patients had arch aortography. No patient survived without an aortogram. Five patients had a chest CT scan; aortography followed in four patients. Computerized tomography scans delayed aortography or were misinterpreted. Review of all trauma thoracic (arch) aortograms for the same period at Westmead Hospital revealed a diagnosis of TAR in 7.4%.Blind thoracotomy did not result in survival. Computerized tomography scanning of the chest was of no value in the management of this injury. Early suspicion of possible thoracic aortic rupture demands urgent arch aortography and this remains the diagnostic ‘gold standa

ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1994.tb02217.x

出版商:Blackwell Publishing Ltd    

年代:1994

数据来源: WILEY

摘要:

The use of the bone‐patellar tendon‐bone graft has been well established in anterior cruciate ligament (ACL) reconstruction. The value of this graft in posterior cruciate ligament (PCL) reconstruction has not been documented. A template was used to identify the origin and insertion of the PCL on standard lateral radiographs of the knee. Those patients who were found at arthroscopy to have an intact articular surface were measured using the template.Thirty‐nine patients (40 knees) were included for study, the difference between the PCL and patellar tendon length was expressed as a percentage. The mean was 125% (range 98–165%). To assess the reproducibility of the technique, in 17 patients a repeat radiograph was taken and the two measurements compared. These were found to have a significant correlation (R, coefficient 0.79,P<0.001).The use of autologous bone‐patellar tendon‐bone graft obviates the need for allograft with its incumbent problems. This method of measurement indicates that the patellar tendon graft would be long enough to be suitable for PCL reconstruction in the majori

ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1994.tb02218.x

出版商:Blackwell Publishing Ltd    

年代:1994

数据来源: WILEY

摘要:

A prospective study of anorectal physiological testing in 26 patients with obstructed defecation and 20 patients with faecal incontinence was performed. There were overlaps in individual test parameters between the two groups of patients. However, patients with severely blunted rectal sensation (maximum tolerated volume>300 mL) and anismus were more likely to have obstructed defecation. Patients with very low anal canal pressures, a short (2.1 ms) pudendal nerve terminal motor latency and a grossly distorted anal canal (vector symmetry index ≤ 0.75) were more likely to have faecal incontinence. Thus, patterns of anorectal physiological test results together with clinical evaluation, rather than individual test measurements, are more valuable in defining the underlying defecatory disorders and providing guidance on therap

ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1994.tb02219.x

出版商:Blackwell Publishing Ltd    

年代:1994

数据来源: WILEY

摘要:

A prospective study of the efficacy of topical steroid in the treatment of childhood phimosis is reported. Boys referred to a paediatric surgical practice with pathological non‐retractable foreskins were treated for at least 1 month with topical beta methasone cream.One hundred and thirty‐nine patients were treated and 111 completed the study. A satisfactory result, defined as foreskin retractability appropriate for the boys' age, was achieved in 80% of patients. In 10% the response was inadequate at the end of the study period, but these boys were still under treatment or surveillance because their parents declined circumcision. In 10%, circumcision was performed because of failure of treatment. In six patients this was due to balanitis xerotica obliterans (lichen sclerosis et atrophicus) which does not respond to conservative treatment.Successful treatment depends upon the presence of a normal, supple foreskin at the outset, and on parental complia

ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1994.tb02220.x

出版商:Blackwell Publishing Ltd    

年代:1994

数据来源: WILEY

摘要:

Mastalgia is a common but often poorly understood condition with little Australian data available on the subject. Details are presented of 170 patients who have attended a specific mastalgia clinic at the Princess Alexandra Hospital, Brisbane, Queensland, over a 3 year period. The aims and management protocol of the clinic are outlined.The mastalgia sufferer in this study had an average age of 42 years and 87% were multiparous. Cyclical pain occurred in 59% as determined by a daily pain record chart. Unilateral pain occurred in 38%. Lack of previous breast feeding and low levels of regular physical exercise were identified as two significant factors in the history of those attending the clinic. The responses to treatments are outlined. Response rates of 18 and 26% to two commonly used ‘natural products’, Vitamin B6and Evening Primrose Oil, respectively, are considered little better than placebo effect. A complete response was achieved in 67% of women who took low dose danazol with minimal side effects. The overall response rate to all treatments was 65% with a mean follow up of 15.5 months for those women who continued to attend the clinic. For women with mastalgia, a systematic approach can achieve relief of p

ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1994.tb02221.x

出版商:Blackwell Publishing Ltd    

年代:1994

数据来源: WILEY