摘要:

A general reluctance to submit to open heart surgery elderly patients with acquired cardiac defects has wanned with increasing experience. Thirty‐five of 150 patients operated upon in 1971 were in fact over 60 years of age (23%). The first 100 elderly patients so operated upon have been selected for detailed study, and the results are presented. Results were excellent in patients with isolated aortic valve disease and coronary artery disease. They were satisfactory in those with isolated mitral valve disease, but generally disappointing following multiple valve procedures. It is considered that age alone should not be a contraindication to the proper selection of patients for cardiac surgery.SummaryThe results in 100 consecutive open heart procedures in patients aged 60 years of age and over are discussed. There has been a progressive increase in acceptance of the elderly patient as improvement in results has occurred. The results have been excellent in patients having isolated aortic valve replacement (8.5% early and 12% late mortality) and corrective procedures for coronary artery disease (no mortality). They were less satisfactory in patients having isolated mitral valve replacement (23% early and 16% late mortality), and were discouraging in patients having multiple valve replacement (25% early and 37% late mortality). The highe, mortality in these two groups is related to chronic mitral valve obstruction producing pulmonary disease, right ventricular failure and chronic systemic venous congestion. In the absence of such factors, age alone does not contraindicate open heart surger

ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1972.tb06756.x

出版商:Blackwell Publishing Ltd    

年代:1972

数据来源: WILEY

摘要:

The clinical details of six patients presenting with mycotic aneurysms as complications of aortic valve endocarditis are presented. A distinction is made between this little‐described condition and congenital sinuces and fistulæ. The lesion was demonstrated in all of the patients by cineangiography, and this investigation is strongly recommended. The mortality in the series was high, due to a combination of preoperative toxæmia and resistant heart failure. It is suggested that early investigation of patients presenting with unresponsive aortic endocarditis may reduce the mortality of surgery and will commonly demonstrate the presence of sinuses and fistulæ, facilitating both the planning and performance of the opera

ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1972.tb06757.x

出版商:Blackwell Publishing Ltd    

年代:1972

数据来源: WILEY

摘要:

Studies of the anatomy and pathology in children with extrahepatic portal thrombosis and portal hypertension have shown that the portal vein is generally free of thrombosis for a distance of 1'5 to 2 cm beyond the junction of the superior mesenteric with the splenic vein. In nine children, it has been possible to dissect out this stump of portal vein and anastomore it directly in an end‐to‐side fashion to either the vena cavn or to the central portion of the left renal vein where it crosses anterior to the aorta. The spleen is not removed. The operation can be employed successfully following previous splenectomy, or following a previous unsuccessful conventional splenorenal shunt. Follow‐up evalution has been gratifying, with apparent relief of portal hypertension in each instance.SummaryIn extrahepatic block, the portal vein is generally free of disease for a distance sufficient to permit its division and an end‐to‐side anastomosis to the vena cava or the left renal vein near the cava.In our experience with nine consecutive patients, this has proved to be a successful and effective means of portal decompression. No adverse effects have been encountered relative to Eck fistula in the grow

ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1972.tb06758.x

出版商:Blackwell Publishing Ltd    

年代:1972

数据来源: WILEY

摘要:

A case of bilateral ureteric and vena caval obstruction due to retroperitotneal fibrosis associated with an abdominal aortic aneurysm is reported Partial resection of the aneurysm and insertion of a Dacron graft resulted in regression of the ureteric and caval obstruction. It is suggested that freeing of the ureters at the time of operation for the aneurysm, as been advocated, may be unncessary.

ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1972.tb06759.x

出版商:Blackwell Publishing Ltd    

年代:1972

数据来源: WILEY

摘要:

The surgical management of degenerative conditions affecting the hip joint has undergone very radical changes over a number of years, necessitating a reassessment of our approach to this common problem. When considering surgery, it is important to recognize the main types of degenerative joint, which may present subluxation, or concentric or atrophic changes. The type of joint change as well as age, sex and multiplicity of joint problems must be considered in helping one to determine the appropriate operative management. This paper attempts to assess the present value of, and indications for, osteotomy, arthrodesis, and partial replacement arthroplasty in the light of recent developments in surgery of the degenerative hip joint. It is concluded that high femoral osteotomy and total hip replacement arthroplasty are the two most useful procedures available, and that other operations have only limited application in the treatment of osteoarthritis of the hip joint.SummaryIn conclusion, therefore, it is considered that cup arthroplasty and partial replacement arthroplasty have little place in the treatment of degenerative and rheumatic hip disease. Arthrodesis is indicated in very few patients, but it can be particularly indicated in a fit young man undertaking heavy physical work.The two operative procedures considered to be of value in the treatment of degenerative hip disease are high femoral osteotomy and total hip replacement. When these are used according to a number of well‐defined criteria, a high percentage of satisfactory results can be expected. Both procedures have problems. Osteotomy fails to achieve a high standard of normal function, and non‐union at the osteotomy site is a possibility. Total hip replacement can be complicated by loosening of the prosthesis, by wearing of the prosthetic socket, and rarely, by infection of the prosthetic jo

ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1972.tb06760.x

出版商:Blackwell Publishing Ltd    

年代:1972

数据来源: WILEY

摘要:

The experience of the surgery of the wrist in rheumatoid arthritis over a six‐year period (1964–1970) at Rancho Los Amigos Hospital in Southern California is reported. One hundred and sixteen operations were performed on 75 patients. The procedures fell into two groups: (I) Decompression and removal of exuberant synovium; and (2) Reconstruction of deranged wrists. In the latter group it was felt that wrist fusion was an unsatisfactory procedure, and that the operation of pseudofusion gave a much more satisfactory functional res

ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1972.tb06761.x

出版商:Blackwell Publishing Ltd    

年代:1972

数据来源: WILEY

摘要:

Smith's fracture is not common below the age of 20 years. The left wrist is more commonly involved. The ratio between Types 1, 2 and 3 of the fracture is 4:2:1. Pronation injury is the commonest mechanism. A fall on the back of the hand and compression with shearing force are the other two mechanisms. Closed manipulation and immobilisation in plaster extending from the middle of the arm up to the knuckles with the forearm in full supination is an excellent method of treatment. We have obtained excellent, good or fair results in 86.4% of our cases.

ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1972.tb06762.x

出版商:Blackwell Publishing Ltd    

年代:1972

数据来源: WILEY

摘要:

During 1970 and 1971, 100 major complications of treated hand injuries were referred to the Sydney Hospital Hand Clinic for further treatment. There were 21 cases of necrosis or infection complicating soft‐tissue injuries, 26 cases of severe stiffness complicating fractures and joint injuries, and 39 cases of loss of motor power and sensation complicating tendon and nerve injuries. There were 14 miscellaneous complications. A large proportion of these complications were probably preventable. Common errors and correct treatment are discussed.SummaryThe application alone of the principles described could probably have prevented a large proportion of the 100 major complications of early treated hand injuries reported in this series. It is the early treatment which decides the final outcome. Skeletal stiffness and failed tendon and nerve repairs may lead to permanent disability. It is far easier to prevent than to cure complications of hand injurie

ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1972.tb06763.x

出版商:Blackwell Publishing Ltd    

年代:1972

数据来源: WILEY

摘要:

Immediate pedicle flap reconstruction has widened the scope of combined resection of oral and oropharyngeal cancer. A series of 37 patients who have been treated in this way at the Royal Melbourne Hospital is reported. The low operative mortality, and a cancer control rate in the survivors of better than 50% at two years, have encouraged a greater use of these techniques in suitable patients.

ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1972.tb06764.x

出版商:Blackwell Publishing Ltd    

年代:1972

数据来源: WILEY

摘要:

Radical resection of the rectum is a widely practised treatment for rectal carcinoma whether for cure or palliation. However, this approach is attended by a significant postoperative mortality and morbidity, with a five‐year survival rate rarely exceeding 50%. The same experience has been found at the Prince Henry and Prince of Wales Hospitals, which are major teaching hospitals of the University of New South Wales. Lesser procedures than radical resection are therefore suggested as an alternative treatment in selected cases of rectal carcinom

ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1972.tb06765.x

出版商:Blackwell Publishing Ltd    

年代:1972

数据来源: WILEY