ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1992.tb07646.x

出版商:Blackwell Publishing Ltd    

年代:1992

数据来源: WILEY

ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1992.tb07647.x

出版商:Blackwell Publishing Ltd    

年代:1992

数据来源: WILEY

摘要:

The objective of this study was to prospectively evaluate the quality of palliation of 103 patients presenting to a joint oesophageal cancer clinic while recording the outcome in terms of treatment, morbidity, mortality and long‐term survival. Twenty‐five patients underwent surgical resection (S), 22 radical radiotherapy (RR), 30 palliative radiotherapy (PR), 13 intubation (I) and 13 had no treatment (NT). The quality of palliation was quantified by plotting a score out of 100 on a graph at each visit for Karnofsky performance, severity of pain and swallowing ability, then calculating the area under each curve created using an algorithm, Simpson's discrete approximation. Efficiency of palliation was estimated by comparing the area calculated to the maximum that could be achieved during the time frame being studied.The incidence of stricture (benign and malignant) was 16% after surgery and 50% after radical radiotherapy. Treatment mortality was as follows: RR, 0; S. I (4%); PR, 3 (7%); and I, 0. The median survival was 26 months after surgery and 16 months after radical radiotherapy. It was 6 months for palliative radiotherapy. 4 months for intubation and 4 months for no treatment. The difference in swallowing was the only statistical difference in the quality of palliation of patients having surgery and radical radiotherapy, there being no differences in patients having palliative measu

ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1992.tb07648.x

出版商:Blackwell Publishing Ltd    

年代:1992

数据来源: WILEY

摘要:

A study was undertaken to determine the patterns of management in the 2 years following resection of colorectal cancer by Victorian surgeons. Patients were identified by the Victorian Cancer Register as having colorectal cancer diagnosed between 1 July and 31 December 1987. The surgeon of each of the 947 eligible patients who underwent surgery was sent a questionnaire seeking information about the pre‐operative investigation. type of surgery and subsequent line of referral. Only 16% of colonic cancers and 39% of rectal cancers were biopsied pre‐operatively and colonoscopy was undertaken in one‐half and one‐third respectively. Of the 737 responses, 555 patients were considered to have had curative surgery, and details of their follow‐up during the four 6‐month periods following surgery was analysed; this includes the effect of tumour stage and surgeon activity on the use and frequency of each test. Most patients had a clinical examination in each of the 6 month periods, but almost half did not have a colonoscopy and two‐thirds did not have the serum CEA level measured at all. Only one in eight had a chest X‐ray and fewer had the liver scanned during this 2 year period.Eighty‐two patients (20% of those satisfactorily followed) suffered a recurrence during this period. Twenty‐six were asymptomatic at the time of recurrence and were diagnosed by a routine test and of these, eight were diagnosed by tests used infrequently. Sixteen (20%) were considered

ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1992.tb07649.x

出版商:Blackwell Publishing Ltd    

年代:1992

数据来源: WILEY

摘要:

Three cases of symptomatic colitis in the anal canal after restorative proctocolectomy are reported.

ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1992.tb07650.x

出版商:Blackwell Publishing Ltd    

年代:1992

数据来源: WILEY

摘要:

Sixty‐eight cases of acute cholecystitis managed by laparoscopic cholecystectomy (LC) are reviewed. Thirty‐two patients were admitted up to 10 days after onset of symptoms and 31 were completed by LC.One patient was referred from intensive care with gangrenous acalculus cholecystitis and was completed by LC but required subsequent laparotomy to control a bleeding omental vessel. Five patients were admitted with recurrent attacks of pain and histology confirmed resolving acute cholecystitis. Thirty patients had LC on routine operating lists, having recently had pain within 10 days of admission. Histology confirmed acute cholecystitis or resolving acute cholecystitis in these patients. All were completed by LC.Laparoscopic cholecystectomy is a very effective treatment for acute cholecystitis if complete dissection of anatomy can be perfor

ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1992.tb07651.x

出版商:Blackwell Publishing Ltd    

年代:1992

数据来源: WILEY

摘要:

Gall‐bladder conservation therapy has been evolving during the past decade. Popular techniques of conservative therapy are extracorporeal shock wave lithotripsy (ESWL) and medical dissolution therapy. The limitations of these procedures have prompted a search for alternative techniques, particularly in relation to percutaneous stone extraction. The cases of four patients with symptomatic gallstones who underwent percutaneous cholecystolithotomy under laparoscopic guidance are reported. The gall‐bladder was punctured with a long needle and the tract dilated so that a nephroscope could be introduced. Three cases required stone fragmentation by an ultrasonic lithotripter before removal. Postoperative recovery was uneventful in all ca

ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1992.tb07652.x

出版商:Blackwell Publishing Ltd    

年代:1992

数据来源: WILEY

摘要:

The results of laboratory investigations in 156 patients presenting with faecal incontinence are reviewed to see if and how these investigations supplement a careful clinical evaluation, and in particular to see if they help in the practical management of the problem. All patients underwent anal manometry, and in addition 52 underwent anal sphincter electromyography and 27 defaecatory proctography. Anal manometry quantified sphincteric weakness, and proved superior to digital assessment in this regard. Resting and squeeze pressures were less in those with complete than those with partial incontinence but the differences were not statistically significant. The measurements of rectal sensation and compliance were not additionally helpful. Single fibre electromyography provided the best measure of denervation with re‐innervation and was abnormal in about 85% of the group studied. Jitter studies were unhelpful. Most patients had some abnormality on defaecatory proctography but clinical significance could not be established. The choice of treatment was made on clinical grounds and was not influenced by these investigation

ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1992.tb07653.x

出版商:Blackwell Publishing Ltd    

年代:1992

数据来源: WILEY

摘要:

An analysis is made of functional studies performed in 96 constipated patients to see how these studies influenced the choice of surgical treatment. All patients underwent anal manometry, and other investigations included colonic transit studies (56), anal sphincter electromyography (42) and defaecatory proctography (34). Additionally nine patients underwent full thickness rectal biopsy. The resting anal canal pressures of the patients studied were lower than controls, and fibre density studies on electromyography were abnormal in half the patients studied suggesting a degree of denervation of the sphincter muscles, which possibly related to chronic straining on the toilet. There was evidence of reduced rectal sensation as shown by an increase in the least perceived volume on balloon distension of the rectum, and in those with megarectum and/or megacolon an increase in maximum tolerated volume. The recto‐anal inhibitory reflex was used to screen for adult Hirschsprung's disease, but in one patient the reflex was present despite absence of ganglia on full thickness rectal biopsy indicating the need for biopsy as the definitive diagnostic procedure. Delayed colonic transit using radio opaque markers was a necessary requirement before recommending colectomy, and delayed transit was demonstrated in 34% of the patients studied. Anismus on electromyography was found in 20% of the patients but there was poor correlation with failure of the anorectal angle to widen when bearing down on proctography. The investigations helped in the choice of treatment, but were difficult to interpret. They should be used in severe constipation when surgery is being contemplate

ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1992.tb07654.x

出版商:Blackwell Publishing Ltd    

年代:1992

数据来源: WILEY

摘要:

A new technique of ankle arthrodesis is described and the results of 12 consecutive procedures are assessed. The method described employs three cannulated transfixion screws and an anterior approach to the ankle. Eleven of the 12 ankles proceeded to solid fusion. One patient developed a painless fibrous non‐union. There were no other significant complications. This simple technique provides good compression and adequate resistance to rotatory and angulatory stresses about the ankle fusion sit

ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1992.tb07655.x

出版商:Blackwell Publishing Ltd    

年代:1992

数据来源: WILEY