ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1992.tb07549.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.tb07550.x

出版商:Blackwell Publishing Ltd    

年代:1992

数据来源: WILEY

摘要:

Primary infra‐inguinal arterial reconstructions were reviewed for primary patency and outcome of thrombosis in 144 patients. Distal anastomoses in these patients were to the popliteal artery and were above the knee in 63, below the knee in 53 and at the tibial level in 28. The treatment used was: polytetrafluoroethylene (PTFE) in 33 cases, PTFE with an interposition vein cuff in 29 cases, autogenous saphenous vein (ASV)in situin 47 cases, and reversed technique in 26 cases.Life table analysis showed a 59% overall primary patency at 3 years. Patency rates of above knee anastomoses (65%) and below knee (61%) were statistically different from the tibial anastomoses (42%.P =0.005). In both above and below knee popliteal anastomoses there was a statistically significant difference in the patency of ASV and the PTFE/vein cuff technique (P= 0.0006) but there was no difference between ASV and FTFE. There was no difference in patency rates for the various types of grafts with tibial anastomoses. Data were analysed at 3 years, taking into account the variables of smoking, diabetes or indications for surgery respectively and no difference was found in patency. The number and calibre of the run‐off vessels did not influence patency significantly, hence anastomosis to any good quality vessel regardless of run‐off is recommended.The poor results with the interposition vein cuff technique are unexplained but this study suggests that the technique should he reserved for anastomoses below the popliteal a

ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1992.tb07551.x

出版商:Blackwell Publishing Ltd    

年代:1992

数据来源: WILEY

摘要:

The results of technetium renography were compared with arteriography to determine whether this is a satisfactory screening test for renal artery stenosis (RAS). Sixty‐three patients were studied before aortic surgery. All were investigated by aortography and isotope renography. These tests were assessed blind and all arteriograms were graded by a single independent radiologist. Renal artery stenosis was detected by arteriography in 34 (54%) patients. Twenty‐three (37%) had mild (80%) stenosis. Of these 34 patients, only 6 (18%) were correctly diagnosed by isotope renography. None of the four with severe stenosis were identified. Isotope renography resulted in six true positives, six false positives, 23 true negatives and 28 false negatives. It was concluded that isotope renography did not fulfil the criteria for a screening test for the detection of RAS and appeared to be of no value in those patients undergoing aortic surgery in whom arteriography was not indi

ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1992.tb07552.x

出版商:Blackwell Publishing Ltd    

年代:1992

数据来源: WILEY

摘要:

The supply of homologous blood in Australia is limited, but the demand for blood and blood products is steadily increasing. Elective surgery is a major part of this demand. In many institutions the blood ordering practices for elective surgery have been haphazard. This study was undertaken to document current patterns of blood use in a major city teaching hospital. A retrospective analysis of blood ordering and transfusion for elective surgical procedures was carried out over a 12 month period. As in several previous studies, an inefficient use of blood was demonstrated. Possible strategies to rationalize the use of blood in elective surgery have been proposed. These include the use of a ‘group and screen’ procedure instead of a full cross‐match when transfusion is unlikely to be necessary, and ordering according to a ‘maximum blood order schedule’ when transfusion is usually required for a

ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1992.tb07553.x

出版商:Blackwell Publishing Ltd    

年代:1992

数据来源: WILEY

摘要:

Non‐invasive methods of venous assessment have been developed to improve diagnostic accuracy in the assessment of venous insufficiency. Of these, continuous wave Doppler (CWD) ultrasound and photoplethysmography are the cheapest and most simple to perform. In this study duplex scanning was used to test the accuracy of these two methods. One hundred and thirty‐six patients attending the venous outpatient clinic at Middlesex Hospital, London were examined by all three techniques and a diagnosis was reached using each technique. The technicians performing the examinations were unaware of the diagnoses reached by the other methods. Continuous wave Doppler ultrasound was found to be most accurate in the diagnosis of long saphenous incompetence (sensitivity 73%, specificity 85%). Due to the variability of venous anatomy at the popliteal fossa and the ‘blindness’ of the technique, it was inaccurate in the diagnosis of short saphenous incompetence (sensitivity 33%) and deep vein reflux (sensitivity 48%). Photoplethysmography was found to be most accurate in the diagnosis of deep vein reflux (sensitivity 79%, specificity 70%) but was inaccurate in identification of the site of superficial vein reflux. Inaccuracies may be attributed to the presence of incompetent perforating veins and variation in arterial

ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1992.tb07554.x

出版商:Blackwell Publishing Ltd    

年代:1992

数据来源: WILEY

摘要:

Most patients undergoing treatment for primary varicose veins have only a clinical assessment or examination with a continuous wave Doppler. In this study duplex ultrasound was used to determine the site of deep to superficial reflux in 137 limbs of 96 patients presenting with primary varicose veins. The incidence of saphenopopliteal (22%) and perforator (28%) incompetence was higher than that in previous studies based on clinical examination. Only five limbs had deep venous incompetence at the popliteal level and three of these limbs had lipodermatosclerosis or ulceration. The saphenopopliteal junction was either absent or more than lOcm from the knee joint in 13% of limbs. The information obtained from duplex scanning of patients with primary varicose veins facilitates surgical management and may lead to a lower recurrence rate.

ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1992.tb07555.x

出版商:Blackwell Publishing Ltd    

年代:1992

数据来源: WILEY

摘要:

Forty‐three patients were prospectively studied following tracheo‐oesophageal puncture at the time of laryngectomy (primary voice restoration). Blom‐Singer voice prostheses were used.The surgery was regarded as successful if a patient continued to use the voice prosthesis as the major means of communication with clear intelligibility 4 months after the operation. Using this criterion, the success in this series was 70%. No attempt was made to assess the quality of speech. Complications and causes of failure are disc

ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1992.tb07556.x

出版商:Blackwell Publishing Ltd    

年代:1992

数据来源: WILEY

摘要:

The results of 67 consecutive patients referred to the New South Wales Lithotripter Centre with distal ureteric calculi were evaluated. All these patients were treated on the Dornier HM3 Lithotripter. Distal ureteric calculi were classified as those at, or distal to, the proximal margin of the sacro‐iliac joint.Eleven patients with stones overlying the sacro‐iliac joint were treated in the prone position, while 56 patients with stones distal to the sacro‐iliac joint, were treated in the saddle (astride) position.Of the 64 patients in whom follow‐up was available, 44 (69%) were rendered totally stone free by extracorporeal shock‐wave lithotripsy (ESWL).Lithotripsy has proved an effective treatment for distal ureteric calculi and has rendered 69% of patients stone free with minimal morbidity. Stones overlying the sacro‐iliac joint can be successfully treated in the pro

ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1992.tb07557.x

出版商:Blackwell Publishing Ltd    

年代:1992

数据来源: WILEY

摘要:

Four sets of conjoined twins were reviewed. One set was of the omphalopagus type with no associated abnormalities and were successfully separated at 12 days of age. The other three were of the thoracoomphalopagus type with major cardiac and other abnormalities, they were not amenable to surgery and did not survive. Conjoined twins require precise clinical and radiological evaluation. Many factors contribute to the management of such twins and ethical issues must be considered before surgical separation is undertaken.

ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1992.tb07558.x

出版商:Blackwell Publishing Ltd    

年代:1992

数据来源: WILEY