ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1996.tb01163.x

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY

摘要:

Background: Colorectal cancer is an important disease in the Australian community. Whilst there has been much discussion about the appropriate management of local disease, particularly with respect to the issue of adjuvant therapy, there has been relatively little local discussion of treatment options in metastatic colorectal cancer.Methods: The critical principles underlying treatment in this setting are briefly outlined in the present article, indicating wherever possible what options could be considered standard, and based on the available literature, which approaches must still be considered experimental at this time.Results: Overall, the results of treatment in this group of patients remain poor.Conclusion: Further clinical trials are required to address the issues affecting patients with metastatic colorectal cancer.

ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1996.tb01164.x

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY

摘要:

Background: Laparoscopic surgery has been widely embraced, often without adequate data concerning the range and incidence of complications. In the present series, our experience of complications requiring Intensive Care Unit (ICU) admission following laparoscopic surgery is described.Methods: The records of patients requiring ICU admission at John Hunter Hospital (JHH) following laparoscopic surgery over a 39 month period were retrospectively reviewed by an independent multidisciplinary panel.Results: Twenty‐three ICU admissions were identified. Twenty‐one followed general surgical laparoscopic procedures and two followed gynaecological laparoscopies. Ten cases were operated on initially at JHH and 13 were transferred from other hospitals. During the study period, 2444 laparoscopic surgical cases were performed at JHH; 725 general surgical procedures (1.37% admitted to ICU) and 1719 gynaecological procedures (no ICU admissions). Twelve cases suffered surgical complications (including five gastrointestinal tract perforations and three biliary tract injuries) and 11 cases were admitted for non‐surgical problems. In 75% of surgical complications there was delay in diagnosis of more than 24 h. The duration of ICU stay for surgical complications (16.4 days) was significantly longer than for the non‐surgical group (3.9 days).Conclusions: There was a greater likelihood of ICU admission following general surgical rather than gynaecological laparo‐scopy. Fifty‐two per cent of the admissions were for surgical complications. Surgical complications are characterized by delay in diagnosis and longer ICU admission periods. Strategies to prevent some of these complications ar

ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1996.tb01165.x

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY

摘要:

Background: Elevated pancreatic duct pressure is a potential source of pain in patients with chronic pancreatitis. Endoscopic pancreatic duct stenting is a minimally invasive way of reducing this pressure and may be a useful adjunct to surgery in these patients.Methods: We prospectively reviewed a series of nine symptomatic patients with obstructive chronic pancreatitis and relative contraindications to open surgery, who were managed by attempted endoscopic placement of a pancreatic stent.Results: Stents were successfully inserted endoscopically into the main or accessory duct in six patients and into a pseudocyst, transduodenally, in one patient. Of the two unsuccessful insertions, one proceeded to longitudinal pancreato‐jejunostomy and in the other a stent was inserted at distal pancreatic cyst‐jejunostomy. Median follow up was 21 months (range 14–43). In all eight cases with stent insertion there was rapid pain resolution, pain scores falling from 9/10 (8–10) to 2 (1–5) after 2 days (1–7). Associated symptoms of weight loss, nausea and vomiting settled in all eight cases. In one patient with a persistent pancreatic fistula, the fistula resolved. In the three with pseudocysts, the cysts resolved on computed tomography (CT) (one recurred). Five patients subsequently proceeded to stent removal after 6 months (5–23). In three of these, the stent was removed endoscopically, and replaced endoscopically in two cases, with pain resolution. Two patients underwent transduodenal pancreatic duct septectomy (one had stent change prior) and one proceeded to pseudocyst‐gastrostomy, with pain resolution. The remaining three patients with stentsin situremain symptom‐free. No patient suffered acute pancreatitis.Conclusions: In selected patients with obstructive chronic pancreatitis, insertion of a pancreatic stent is a safe procedure, which can lead to rapid symptomatic control over the intermediate period. A significant proportion will need fur

ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1996.tb01166.x

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY

摘要:

Background: The poor survival rate of surgically treated patients with oesophageal cancer has not improved substantially over the last 25 years, but combined modality therapy has shown early promising results.Methods: A prospective study was undertaken to determine the effect of pre‐operati ve synchronous chemoradiotherapy followed by oesophagectomy in 53 patients with squamous cell carcinoma (SCC) of the oesophagus. The patient group was unselected, other than by fitness for surgery.Results: In 25% of patients, complete pathological regression of the tumour was achieved. All but one of the patients in this subgroup had T2 tumours on pre‐operative clinical staging and two had evidence of lymph node involvement, but postoperative pathological examination revealed that pre‐operative chemoradiotherapy had downstaged their disease to TONO. There was no hospital mortality in this subgroup and the actuarial 7 year survival was 69%.Conclusions: For squarnous oesophageal tumours deep to the submucosa this is an extremely good survival. For the present, this form of therapy for SCC of the oesophagus appears capable of achieving results comparable to, or better than, those reported for 3‐field lymphade

ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1996.tb01167.x

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY

摘要:

Background: The choice of a defunctioning stoma in restorative resection of rectal carcinoma is unclear. Traditionally, the loop colostomy has been preferred.Methods: All patients with either a defunctioning loop ileostomy or colostomy treated by a single surgeon (MS) were studied. The morbidity of stoma construction and closure, as well as problems experienced in the intervening period, were entered on a database.Results: No significant difference in the morbidity of closure was noted when loop ileostomy was compared to loop colostomy. Although a trend favouring loop ileostomy was noted when interval morbidity was examined, this difference was not statistically significant.Conclusions: Loop colostomy and ileostomy are both effective in defunctioning the distal colon following a restorative resection for rectal carcinoma. There is some morbidity associated with both but when a stoma is constructed, loop ileostomy is preferable. The loop ileostomy is generally easier to manage and is not associated with a greater rate of complications (in its construction and closure) than the loop colostomy.

ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1996.tb01168.x

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY

摘要:

Background: Symptomatic testicular hydrocele and cyst of the epididymis may be treated with either operation or sclerotherapy.Methods: The current report presents the experience of a 9 year prospective study using sodium tetradecyl sulphate (STD) sclerotherapy for the treatment of symptomatic hydrocele and/or epididymal cyst.Results: A total of 102 lesions were treated during the study period, with an initial success rate of 76% which improved to 94% with multiple treatments. The overall median follow up during the study was 30 months (range 2–100).Conclusions: Sclerotherapy offers a cost‐effective outpatient method for the treatment of symptomatic scrotal cy

ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1996.tb01169.x

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY

摘要:

Background: Non‐tuberculous mycobacterial lymphadenitis has been recognized since medieval times by an array of names. The condition is familiar to paediatricians and paediatric surgeons but it often is not recognized in its early stages. A paediatric surgeon's experience of the condition in Newcastle over 30 years is reviewed.Methods: A personal series of children with non‐tuberculous mycobacterial lymphadenitis treated in Newcastle from 1966 to 1994 is reviewed. Clinical diagnosis was supported by multiple Mantoux skin testing in most patients using human purified protein derivative (PPD) and avian antigens. All were treated surgically with histological confirmation of the diagnosis. A total of 89 patients were encountered. Twenty‐two were seen in hospital practice between 1966 and 1976 and have already been reported. The current paper presents the results of analysis of the clinical features, diagnosis and surgical treatment of the remaining 67 patients seen in paediatric surgical practice between 1976 and 1994.Results: There was equal sex distribution. Ages ranged from 1 to 10 years, with none under 1 year, and 82% of the patients were in the pre‐school age group. Cervical lymph nodes were involved in all, the majority being jugulo‐digastric or subman‐dibular. Surgical excision by limited dissection of lymph nodes was performed in 55 patients with one recurrence, and by excision and curettage in eight patients with two recurrences. Simple bacterial wound infection occurred in four patients and two had prolonged postoperative suppuration as a result of mycobacterial wound infection. Paresis of the mandibular or cervical branch of the facial nerve occurred in 50% of patients where the nerve was at risk, but the majority of these recovered although it took over 6 months in some children. Culture for mycobacterial organisms was positive in only 29 patients.Conclusions: The diagnosis of non‐tuberculous mycobacterial lymphadenitis is clinical and its early recognition requires an awareness of the condition. It can be confirmed by multiple Mantoux testing or fine needle aspiration biopsy. The treatment is local excision of the affected lymph nodes. Histological examination and mycobacterial culture should

ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1996.tb01170.x

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY

摘要:

Background: Eighteen cases of auger injuries in the Wimmera region of Victoria were treated over 8 years.Methods: The records of auger related injuries presenting to Wimmera Base Hospital from March 1987 to March 1995 were reviewed.Results: Five of these were severe injuries. Sixteen were male farmers. Their fingers were most commonly injured by being caught in the auger flight.Conclusions: Augers have numerous mechanical features which make them one of the most potentially dangerous pieces of farm equipment. This, combined with human error and fatigue, results in significant but preventable morbidity in a hardworking population.

ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1996.tb01171.x

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY

摘要:

Background: The value of carotid surgery is largely dependent on the safety of the procedure. With changes in population life expectancy, increasing numbers of elderly patients are being considered for surgery.Methods: In the present paper, the results of 113 patients (octogenarians:>80 years of age) who underwent carotid endarterectomy in the 17 years prior to 1994 are reported. This group composed 6.2% of the 1818 patients treated in the period, 665 (36.6%) operations were performed on patients 50–65 years inclusive and 1040 (57.2%) on patients aged 66–80 years inclusive.Results: The overall peri‐operative stroke rate was 2.5% and the postoperative mortality was 1.9% with no statistical difference apparent between the age groups despite hemispheric strokes being the most common indication for operation in the octogenarian group (29.5%) and the least common indication in the youngest age group (16.2%,P<0.01).Long‐term follow up (2–7 years) of octogenarian patients undergoing carotid surgery suggested maintenance of pre‐operative levels of living independence.Conclusions: The results of the study indicated that octogenarian patients should not be denied carotid endarterectomy on the basis of age alone and that results comparable to those of younger patients can be

ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1996.tb01172.x

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY