ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1996.tb00821.x

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY

摘要:

Surgery in the South Pacific is different in many respects from surgery in Australia and New Zealand. It is primarily the surgery of trauma, infection, advanced malignancy, hollow‐tube obstruction and congenital abnormalities. Specific tropical infections such as tuberculosis, typhoid, pigbel and amoebiasis occur regularly but constitute only a small proportion of all cases. The patients tend to be young, rural and poor, and often present late because access to surgical services is limited. The treatment patients receive is also compromised by a lack of resources—the result of underfunding and inefficient administration. Standards for appropriate surgical practice should be determined in‐country and based at least on surgical audit and clinical studies. Even though Western diseases are emerging in the tropics, the best management may sometimes be different. Training of national surgeons is a priority if a sustainable surgical service is to be established. Such training is more effectively carried out in the home country, or at least in one with similar pathology and problems, rather than overseas. Project aid should support these schemes and encourage regional co‐operation through the Fiji and Papua New Guinea medical schools. There remains an important role for visiting surgical specialists, but they need to ensure that they transfer skills and encourage the professional development of promising local doctors rather than simply focusing on treating p

ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1996.tb00822.x

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY

ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1996.tb00823.x

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY

摘要:

Background: Along with fine needle aspiration (FNA) cytology, core‐biopsy has become an integral part of the assessment of mammographically detected breast lesions.Methods: A series of stereotactic large‐core‐biopsies of mammographically detected breast lesions was studied to assess the accuracy and limitations of the technique in diagnosing malignancy and in giving specific benign diagnoses, and its use in determining surgical management.Results: Eighty per cent of carcinomas were diagnosed as malignant (absolute sensitivity). In 88.8% of the cancers, the core‐biopsy was classified as malignant, suspicious or atypical/indeterminate (complete sensitivity), and in 72% of the invasive carcinomas, invasive tumour was present in the core. The technique was more successful for invasive carcinomas than for ductal carcinomain situ(DCIS) (absolute sensitivity 86.1 and 55.5, respectively;P= 0.28) and for malignant mass lesions than for a mass with associated microcalcifications or for pure microcalcifications (absolute sensitivity 91, 71 and 66.6%, respectively;P= 0.19). In five of the 45 cancers (11.1%), no tumour tissue was present in the core, but all were excised after mammographic review and no delays in diagnosis have been experienced to date. The benign to malignant ratio for excised lesions was 0.11:1. Of the benign lesions, a specific diagnosis was given in 49% (calcifications in the core in a background of fibrocystic change, or postoperative scarring, or fibro‐adenoma); the remainder showed non‐specific benign findings. All patients where invasive carcinoma was diagnosed in the core underwent axillary clearance and wide local excision or mastectomy at their first operation.Conclusions: This technique can markedly reduce the number of benign lesions needing open biopsy, and provide information allowing definitive management of most carcinomas at the first operation. The accuracy of core‐biopsy was lower in DCIS/ microcalcification lesions; extra core samples or a combination of FNA and core‐biopsy may be of value

ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1996.tb00824.x

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY

摘要:

Background: Patients who are elderly or who have locally advanced breast cancer may initially receive primary medical therapy.Methods: In order to avoid open biopsy in such patients, we routinely perform both fine needle aspiration cytology (FNAC) and core‐biopsy at the first clinic visit.Results: A retrospective review showed that of 109 such patients, 87 (80%) had the diagnosis confirmed on FNAC and 96 (88%) on core‐biopsy. Only eight patients did not have a diagnostic result from the first clinic visit, and five of these patients were diagnosed on a repeat core‐biopsy or FNAC. The remaining three patients had suspicious FNAC. Overall 97% had one or both investigations positive.Conclusions: When considered alone core‐biopsy was superior to FNAC. In this series the combined diagnostic approach of FNAC and core‐biopsy has allowed outpatient diagnosis for virtually all

ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1996.tb00825.x

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY

摘要:

Background: Fine needle aspiration (FNA) is used routinely in the management of palpable breast lumps; with the implementation of the stereotactic technique its use has been extended to the investigation of mammographic abnormalities. The advent of breast screening means that many mammographic abnormalities will be detected; because routine open biopsy is impractical and undesirable, stereotactic fine needle aspiration becomes the method of choice for investigation.Method: Within a 28 month interval, 81 Chinese women underwent stereotactic FNA in Kwong Wah Hospital, Hong Kong. Results: Fifty‐one women (62.9%) had a benign cytology result and no further investigations were required. Inconclusive results were obtained in 18.6% of the aspirates. Open biopsy was required in 16 women (19.8%).Conclusion: Stereotactic FNA is very useful in the exclusion of malignancy and the avoidance of open biopsy in asymptomatic women who have mammographic abnormalitie

ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1996.tb00826.x

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY

摘要:

Background: The purpose of this prospective study was to determine the value of water‐soluble contrast follow‐through radiology in predicting the outcome in patients with small bowel obstruction.Methods: Patients with clinical and radiological evidence of small bowel obstruction were selected according to pre‐set criteria. A water‐soluble contrast follow‐through examination using 76% urografin was carried out within 24 h of hospital admission. The result was interpreted as ‘significant obstruction’ if the contrast failed to reach the caecum in 4 h or if there was a clear cut‐off in the gastrointestinal tract. The result was interpreted as ‘insignificant obstruction’ if the contrast reached the caecum within 4 h. The surgeon was blinded to the result of the contrast examination in the patient management, and the decision to operate was based entirely on conventional clinical grounds.Results: Fifty‐one patients in an 18 month period underwent the contrast examinations. Thirty‐four patients (67%) had had previous abdominal operations. The results showed that significantly more patients who had ‘significant obstruction’ on contrast radiology required surgery to relieve the intestinal obstruction (17/19) than those who had ‘insignificant obstruction’ (1/32; Fisher's exact test,P<0.0001). This difference was found to be significant in both patient subgroups: patients with or without previous abdominal operation. There was no major morbidity or mortality related to the contrast radiology procedure.Conclusions: Urografin follow‐through examination is a safe procedure; using 4 h as the cut‐off it is highly predictive of the outcome in small bowel obstruction in patients with or w

ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1996.tb00827.x

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY

摘要:

Background: The outcomes of patients admitted acutely to hospital with left‐sided large bowel obstruction (LBO) were examined.Methods: All patients admitted to the colorectal service (University Department of Surgery, Wellington School of Medicine) with LBO between 1975 and 1990 were reviewed. Sixty‐four patients with left‐sided LBO were identified.Results: The most commonly found obstructing lesion was cancer. Two patients were not managed surgically. In 17.7% of patients there was development of postoperative respiratory complications and 16% developed wound problems following primary surgery. Fifty‐nine patients survived their primary surgery and 45 had stomas. The stoma closure rate was 71.1% (32 of 45). The overall mortality rate for patients managed surgically was 6.5% (four of 62). The mortality rate for stoma formation was 4.3% (two of 47). The mortality rate for resection and then stoma closure was 3.2% (one of 32).Conclusions: This study has shown that a staged approach to the management of unselected patients with left‐sided LBO is safe. Restoration of bowel continuity was achieved in 70% of

ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1996.tb00828.x

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY

摘要:

Background: The application of laparoscopic techniques to malignant colorectal disease has led to concerns regarding the adequacy of excision achieved. This study was performed to compare specimen histopathology following laparoscopically assisted right hemicolectomy (LARHC) with that following open right hemicolectomy (ORHC).Methods: Data regarding patient details and tumour pathology were obtained by case‐note review and from the Concord Hospital Colorectal Cancer Database. Thirty‐two patients had LARHC for neoplastic lesions and 34 had ORHC for similar lesions over the same period. The two groups were well matched with respect to age, sex, weight and tumour characteristics. Early stage disease was more common in the LARHC group.Results: There was no clinically significant difference between the groups in terms of margins of clearance or number of lymph nodes harvested.Conclusions: LARHC allows lymphovascular clearance indistinguishable from that afforded by open surgery. Long‐term outcome and survival data are required to confirm its role in the treatment of malignant colorectal di

ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1996.tb00829.x

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY

摘要:

Background: Serous effusions in chronic pancreatitis are infrequent but persistent. These occur usually as a consequence of internal pancreatic fistulae and commonly involve the pleural cavity or peritoneum.Methods: To assess strategies in operative management, the records of 12 patients who underwent surgery for internal pancreatic fistula with underlying chronic pancreatitis were reviewed retrospectively. Seven patients had pancreatic ductal calculi. Three cases underwent external drainage. Three cases with leaking pseudocysts underwent cystojejunostomy‐en‐Y. Three cases with ductal dilatation or calculi underwent lateral pancreaticojejunostomy and three patients had caudal pancreatectomy for distal disease.Results: Eight patients were completely controlled of all symptoms, with no sequelae. One case each had recurrent pancreatitis and ascites but did not require re‐operation. There were two deaths: one with massive haematemesis and one with pre‐existent multi‐organ failure and sepsis.Conclusions: Pancreatic duct stones may be causally associated with internal pancreatic fistulae. Delineation of ductal anatomy and pathological aberrations of the pancreas, including determination of the leak site, was of paramount importance in planning surgery. Peroperative ductography proved the most useful in th

ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1996.tb00830.x

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY