摘要:

In medicine, the Internet is already playing a significant role in the delivery of information on medical conditions, medical and academic institutions and non‐profit‐making support groups for patients. This article explores some of the available information on the Internet relevant to surgery and discusses its role in surgical train

ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1996.tb00711.x

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY

摘要:

Background: Trauma is a common cause of surgical admission in Papua New Guinea (PNG) but to date there has been no study of the whole trauma burden in provincial hospitals.Methods: A 1‐year retrospective study was made of all surgical admissions to the provincial hospital at Mendi.Results: Trauma was the third commonest reason for hospital admission and accounted for 43% of all surgical cases. The common causes of injury were tribal fights (24%). domestic violence (14.3%). assault (16.7%). road accidents (14%) and domestic accidents (25.1%). which comprised falls, penetrating wounds and bites. Males accounted for two‐thirds of cases, and 19% were children below the age of 16. Only eight of 454 patients died (1.8%). because most trauma deaths occur before the patient reaches hospital. There were only 37 multiple injuries and only five patients had an injury severity score of greater than 16. The average inpatient stay for trauma admissions was 10.6 days.Conclusions: The cost of trauma in Mendi is difficult to calculate, but is enormous. In addition to 11% of the recurrent hospital expenditure (over US$I.1 million, excluding pharmaceuticals), the community costs include loss of earnings and productivity, as well as permanent disability. The social disruption caused by tribal fights results in cessation of the local economy, burning of aid posts, schools and homes and destruction of gardens for subsistence farming. Those who reach hospital alive tend to have single injuries and surv

ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1996.tb00712.x

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY

摘要:

Background: Both stereotactic imaging and ultrasound have been used to localize non‐palpable breast lesions for core biopsy analysis. In particular, stereotactic core breast biopsy with a dedicated recumbent mammographic unit is an accurate and reliable technique, and this has been substantiated in a number of recent prospective studies comparing percutaneous core biopsy with open excisional biopsy.Methods: This article reviews biopsies of 521 lesions from 502 cases using both stereotactic localization (469 lesions) and ultrasound (33 lesions). The types of breast cancer and benign breast disease diagnosed with core sampling are reviewed. In this series it was not intended to compare all the results of core biopsies with those of open excisional biopsy, but a subset group, which comprised certain benign lesions and malignancies, as well as lesions diagnosed on core biopsy in which the radiology and pathology did not correlate, was further evaluated and compared to the findings with open biopsy. The cases where there were differences in core and excisional biopsy diagnosis are discussed.Results: In this series the benign to malignant ratio was 2.7:1; in other words, 27% of the lesions biopsied were malignant. The sensitivity for detecting cancer was 97% with the positive predictive value being 99%.Conclusions: This series further substantiates the accuracy of core biopsy. It is recommended that certain lesions diagnosed as benign on core biopsy histology should also proceed to open biopsy. Correlation between clinical findings, radiology and pathology further improves the reliability of core biopsy under imaging guidanc

ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1996.tb00713.x

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY

摘要:

Background: There appears to be an emerging consensus that early postoperative nutritional support benefits the high‐risk patient by decreasing septic morbidity, maintaining immunocompetence and improving wound healing. Enteral nutrition via a feeding jejunostomy has been associated with serious complications, with a reported mortality rate as high as 10%. while total parenteral nutrition has also been associated with a wide variety of complications.Methods: Ninety‐seven patients undergoing oesophagectomy or gastrectomy underwent pre‐operative nutritional assessment and were randomized to receive either total parenteral nutrition (47 patients) or enteral nutrition (50 patients).Results: There was no significant difference in the number of catheter‐related complications between the two groups, but 9 (45%) patients in the total parenteral nutrition group had major morbidity (potentially fatal in two patients) requiring active intervention.Conclusions: This study demonstrates enteral nutrition to be safe and associated with mainly reversible minor complications. It is probable that immediate postoperative enteral feeding conserves the gut's integrity. Whether this leads to a reduction in postoperative septic complications has not been demonstrated by this study although there appears to be a trend in this direction, supporting the concept of enteral feeding as ‘primary therapy’. This can be safely, simply and economically achieved using a feeding jejunostomy placed at the time

ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1996.tb00714.x

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY

摘要:

Background: Between 1991 and 1993 a single set of reusable laparoscopic instruments was used to perform 404 cholecystectomies, 102 hernia repairs and 66 advanced procedures. Disposable instruments were used only when no suitable reusable instrument was available or when reusable instruments were not working to the satisfaction of the surgeon.Methods: The cost of performing those laparoscopic operations using this policy was calculated by adding the purchase cost,the maintenance costs and the repair and replacement costs of the reusable instruments. To this figure was added the cost of disposable instruments which were used instead of reusable instruments during the study period.Results: The total cost was $253 385, at an average of $443 per case. The cost per case for reusable instruments remained approximately $100 through the 3 years, while the cost per case of disposable instruments fell from almost $600 in 1991 to about $200 in 1993.Conclusions: Our future policy is to continue using reusable instruments initially, with backup disposable instruments.

ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1996.tb00715.x

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY

摘要:

Background: The present study examines the surgical outcome of the Hartmann's and Hartmann‐type procedures, the problems with the remnant rectal stump and the issues related to the colorectal anastomosis as well as the differences in patient outcome. Methods: One hundred and five consecutive patients (mean age 66) were evaluated. Surgical morbidity and mortality were analysed with regard to the colorectal pathology and the type of rectal stump remnant. The surviving patients were reviewed according to whether they had second‐stage anastomosis.Results: In 65% of cases there were obstructed or perforated malignancies and in 16% complicated diverticular diseases. The peri‐operative mortality and morbidity were 11.4% and 24%. respectively. Seventy‐two patients had intraperitoneal rectal stumps and stump blowout occurred in three intraperitoneal and one extraperitoneal remnant stumps. Local tumour recurrence (four) and diversion proctitis (three) were diagnosed in the rectal stump among asymptomatic patients. When the second‐stage reversal of Hartmann's procedure was considered (35 cases), twice as many were performed for diverticular and other benign conditions as for tumour cases.Conclusions: Although there is a good anatomical basis for advocating extraperitoneal rather than intraperitoneal stumps, in practice the stump blowout rate is not statistically significant (3%vs4.1%). However, the chances of regaining normal rectal function are much better for benign disease (68%vs32%—Fisher's exact test,P= 0.004). Complications from second‐stage re‐anastomosis are not determined by timing of the closure, provided the septic episo

ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1996.tb00716.x

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY

摘要:

Backgrounds and Methods: This study reviews the clinical features and reports the preliminary results of treatment of 34 consecutive patients with clinically significant bleeding from chronic, radiation‐induced proctitis, using a combination of endoscopic YAG Laser and the application of topical formalin dressings to the rectal rnucosa.Results: Bleeding ceased in 25 patients (74%); bleeding continued but occurred only slightly and occasionally in five patients (15%); and three patients required operation to control the bleeding (9%). One patient relapsed after treatment and died while receiving a further transfusion.Conclusions: This experience has been used to develop a management protocol for patients with this serious complicatio

ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1996.tb00717.x

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY

摘要:

Background: Infantile intussusception often presents with symptoms more common to less dangerous conditions, and diagnosis must be established as early as possible. Clinical diagnosis is often wrong and contrast enema is invasive. Sonography is painless and harmless and if it provides a reliable method of diagnosis or exclusion of intussusception, diagnosic delay will be avoided.Methods: In the John Hunter Hospital, Newcastle, between 1993 and 1994, the names of all children referred for abdominal sonography with a degree of suspicion of intussusception were recorded, and the histories were subsequently reviewed.Results: Fifty patients were studied. Forty‐one patients had no sonographic evidence of intussusception and nine patients had positive findings. None of the 41 patients who had negative sonograms proved to have intussusception. The nine patients who had positive findings were subjected to air enema. In two patients the sonographic diagnosis was proved wrong. In the other seven patients it was confirmed. Thus there were two false positives and no false negatives.Conclusion: Sonography is a reliable aid to the clinical diagnosis of intussusceptio

ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1996.tb00718.x

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY

摘要:

Non‐small‐cell lung cancer (NSCLC) accounts for more than three‐quarters of all lung tumours and is the leading cause of deaths due to cancer in Australia. More than half of the patients with NSCLC present with advanced disease. Radiation therapy has been the mainstay of active treatment for these patients. There is increasing evidence supporting the benefit of chemotherapy as an addition to radiation therapy in locally advanced non‐metastatic disease. The use of cisplatin‐based chemotherapy prior to radiation therapy would appear to be a new standard of care in patients with stage III B NSCLC. In advanced (metatastic) disease, palliation of symptoms remains the major goal of current treatment programmes. This can be achieved with the best supportive care, radiotherapy, and, in selected patients, platinum‐based chemotherapy. Clinical trials to test new treatments, with survival, quality of life and cost‐benefit as endpoints, are essential. The present study discusses the current status of conventional and newer treatment methods in locally advanced and metas

ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1996.tb00719.x

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY

摘要:

Background: Bizarre parosteal osteochondromatous proliferation (BPOP) is a rare tumour‐like condition mostly affecting the tubular bones of the hands and feet. Although it recurs in 50% of cases after local excision, it is a form of heterotopic ossification and its behaviour is otherwise benign. The present study describes seven cases of BPOP collected by the Bone Tumour Registry of New South Wales.Methods: Clinical data, radiographs and histological specimens collected by the Bone Tumour Registry of New South Wales were examined, and further clinical data were sought from the referring doctor where necessary.Results: Six males and one female aged 18 to 37 years (median 30 years) presented between 1988 and 1995. There were three cases involving the hands, three involving the feet and one involving the distal humerus. Initial treatment was by local excision in all cases. There was local recurrence in three cases. The initial diagnosis was wrong in five of the seven cases. Radiologically, BPOP appears as a well‐defined tumour arising directly from the bony cortex, without periosteal reaction or change to the underlying bone. Histologically, a large amount of hypercellular cartilage shows maturation to trabecular bone, which frequently contains spindle cells in the intertrabecular spaces.Conclusion: BPOP is a rare, locally recurrent but otherwise benign condition of bone which must be distinguished from more sinister lesions such as parosteal osteosarcoma and chondrosarc

ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1996.tb00720.x

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY