ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1990.tb07396.x

出版商:Blackwell Publishing Ltd    

年代:1990

数据来源: WILEY

ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1990.tb07397.x

出版商:Blackwell Publishing Ltd    

年代:1990

数据来源: WILEY

ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1990.tb07398.x

出版商:Blackwell Publishing Ltd    

年代:1990

数据来源: WILEY

摘要:

During an 8‐month period, 538 injured patients were transferred from primary hospitals to a referral hospital for futher management of their injuries. Delay at the primary hospital was identified in 20% of all transfers and in 40% of patients transferred for management of head injury or multisystem injury. Delay at the primary hospital resulted in a median time from injury to arrival at the second hospital of 4 h. Defects in clinical management during transport included inexperienced escorts, inadequate airway control, ventilation. fluid resuscitation and stabilization of chest injuries. Nearly half of transfers were inappropriate because of the relatively minor nature of the injuries. Most of these had solitary musculoskeletal injuries to the extremities. These patients reflect the marked deficiency of specialist orthopaedic services in western Sydney during the study.Development of a metropolitan regional system of trauma care in western Sydney requires urgent action towards reducing the frequency of transfer, minimizing delays in transfer and maximizing basic resuscitation of seriously injured patients. Some designation of hospital roles is required and needs to be accompanied by a prehospital triage process. The population also has a right to expect adequate specialty services at suburban hospitals to enable treatment of minor and moderate single system injuries. Future trauma system developments should adequately retlect population growth and technological advances in clinical car

ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1990.tb07399.x

出版商:Blackwell Publishing Ltd    

年代:1990

数据来源: WILEY

摘要:

The aim of this paper is to document experience in the management of cases of child abuse with suspected osseous injury. at the Adelaide Children's Hospital, during the period January 1974‐December 1986. The study is a retrospective review of the casenotes, radiographs and radiologists' report of 108 consecutive cases with suspected osseous injuries. Information regarding the osseous injuries sustained and the psychosocial environment surrounding the circumstances of the patients admitted was recorded.Of 108 cases of suspected osseous injuries, 90% had confirmed osseous injury, of whom 56 cases (52%) had multiple fractures. Twenty of the 41 cases of single osseous injury were due to skull fractures. In children less than 12 months of age, long bone injuries were the most common form of presentation, and in 83% of these the injuries were multiple. Metaphyseal injury in association with other fractures was present in 14% of cases, and 8% of cases showed evidence of periosteal reaction to injury. There were two deaths during the period of this study, as a direct consequence of abuse. The main cause of death in both of these cases was the combination of cerebral haemorrhage and liver trauma. There were 10 other deaths not associated with fracture during this period.The analysis of psychosocial factors demonstrated that 48% of the children were first‐born and 67% of parents were unemployed. Of the alleged abuser, the mother was known to be responsible in 50% of cases. In 10% of cases. the parent responsible for the injury admitted to the offence at the time of presentation at the hospital. Of the 48 cases that presented again with a further non‐accidental injury, I I children were reinjured despite being seconded to foster homes, and the remaining 37 children suffered further abuse of different degrees after being returned to the homes of their biological pa

ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1990.tb07400.x

出版商:Blackwell Publishing Ltd    

年代:1990

数据来源: WILEY

ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1990.tb07401.x

出版商:Blackwell Publishing Ltd    

年代:1990

数据来源: WILEY

摘要:

Past experience of breast self‐examination (BSE), family history of breast cancer, method of detection of the tumour, tumour size, node status, tumour attachment and type of treatment used for primary breast cancer, were surveyed on a sample of 117 female breast cancer patients diagnosed in Tasmania during May 1986‐June 1987. Family history of breast cancer was associated with higher levels of BSE practice. Three‐monthly or more frequent BSE in the year prior to diagnosis was associated with smaller tumours at presentation and less axillary node involvement. Breast‐conserving surgery was utilized in 38% of all cases treated, and 84% of these patients received radiotherapy as part of primary tr

ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1990.tb07402.x

出版商:Blackwell Publishing Ltd    

年代:1990

数据来源: WILEY

摘要:

To evaluate the impact of the routine use of fine needle aspiration cytology (FNAC) on the management of solitary thyroid nodules, 102 consecutive patients were assessed in regard to the proportion of patients being subjected to surgery and the corresponding yield of malignancy. This cohort was compared with a historical control where FNAC was not routinely applied as a diagnostic selection criterion. The percentage of patients operated on had decreased from 95% to 60% (p<0.001) without any significant decrease in the field of malignancy: 18.6% vs 17.6% (p = 0.97). The yield of malignancy of patients operated on had increased from 18.4% to 26.2%. Of those not subjected to surgery, 14 patients or 14% of the original cohort experienced spontaneous complete resolution of their nodules after a mean follow‐up period of 5.5 months (s.d. = 3.5) (non‐resected group). In the retrospective evaluation of diagnostic discriminants to maximize yield of malignancy while minimizing unnecessary surgery for thyroid nodules, the use of combined parameters of clinical suspicion, positive FNAC and age ≥ 50 years detected 100% of malignancies with only 50% of patients requiring surgery. This was superior to other modalities including clinical parameters and expensive investigations of radionuclide scans and ultrasonography. In conclusion, the use of FNAC in the evaluation of solitary thyroid nodules has resulted in a decreased proportion of patients requiring surgery and cost saving while maintaining the yield of malig

ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1990.tb07403.x

出版商:Blackwell Publishing Ltd    

年代:1990

数据来源: WILEY

摘要:

Four cases of gross peripancreatic sepsis have been managed with repeated laparotomies and packing of the lesser sac. A zipper was used For abdominal closure in three patients and the abdomen was left open in one. Sequential laparotomy enabled repeated debridement of non‐viable pancreatic and peripancreatic tissue and prevented intra‐abdominal septic accumulations. An additional benefit of this technique was the frequent detection and correction of clinically unsuspected complications of the septic abdo

ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1990.tb07404.x

出版商:Blackwell Publishing Ltd    

年代:1990

数据来源: WILEY

摘要:

Branched chain amino acids (BCAA) may serve as a major oxidative fuel for skeletal muscle during periods of starvation. This study compared the ability of protein‐undernourished rats to heal musculo‐aponeurotic wounds of the abdominal wall when they were infused with solutions containing 45% BCAA or 8% BCAA (conventional TPN). Although the provision of 45% BCAA tended to result in better nourished animals and significantly increased plasma glutamine concentrations, this was not associated with improved heal

ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1990.tb07405.x

出版商:Blackwell Publishing Ltd    

年代:1990

数据来源: WILEY