ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1993.tb00050.x

出版商:Blackwell Publishing Ltd    

年代:1993

数据来源: WILEY

摘要:

It is estimated that the hereditary polyposis and non‐polyposis colorectal cancer (CRC) syndromes, which have an autosomal dominant pattern of inheritance, represent less than 10% of the total CRC burden. Thus, more than 90% of all cases of CRC have previously been considered to arise ‘sporadically’, with no identifiable genetic link. However, recent clinical evidence now suggests that a significant proportion of CRC seen in the general population may involve an inherited genetic susceptibility. Therefore, constructing an accurate family tree on all patients with a family history of CRC is an essential part of identifying families with an increased risk for CRC who could then be offered screening. Also. molecular genetic study of colorectal adenomas and carcinomas has led to a proposed genetic model of colorectal tumorigenesis which involves interactions between oncogenes and tumour suppressor genes. This information has important potential implications for screening, determining prognosis and for providing multiple targets for altering the sequence of malignant transform

ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1993.tb00051.x

出版商:Blackwell Publishing Ltd    

年代:1993

数据来源: WILEY

摘要:

With extensive small bowel strictures due to Crohn's disease, resectional surgery may lead to short bowel syndrome. Strictureplasty (SP) has emerged as a useful alternative for selected strictures. This study reviews the results of 42 patients with diffuse obstructive Crohn's disease of the small bowel in whom at least four SP were performed in each patient (median: 7; range: 4–15; total SP: 315). Twenty‐three patients (55%) had had 1–5 previous small bowel resections. Co‐existing perforative disease was present in four patients (10%). Synchronous resection of a separate segment of small bowel was performed in 22 patients (52%). There was no operative mortality. Enterocutaneous fistula and/or intra‐abdominal abscess developed in three patients (7%) and only one of these needed operative intervention. The median follow‐up was 3 years (range: 10 months to 7 years). After SP, all patients experienced relief from obstructive symptoms. The median weight gain was 3 kg (range: ‐1–21 kg) and more than half the patients were weaned off steroids. Symptomatic recurrence occurred in 10 patients (24%) and was due to strictures (N= 9) and/or perforative disease (N =2) at new site(s) unrelated to previous SP. Rate of symptomatic restricture of the SP site was 1.6% and was associated with new strictures elsewhere in all cases. Thus, in selected cases, SP is a safe and effective treatment for diffuse Cro

ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1993.tb00052.x

出版商:Blackwell Publishing Ltd    

年代:1993

数据来源: WILEY

摘要:

Between September 1981 and August 1987 420 patients with 565 adenomas underwent colonoscopic polypec‐tomy to produce a ‘clean colon’. Data from these patients were analysed to identify associations between patient characteristics (age and sex), polyp characteristics (site, size, shape, multiplicity and villous content) and the degree of dysplasia in the index adenoma. In univariate analysis, severe dysplasia in the index adenoma was significantly but weakly associated with size (10mm), peduncular shape and villous architecture. Logistic regression confirmed an independent effect only from villous architecture. These findings suggest that it is unlikely that strong predictors of a patient developing a metachronous adenoma or colorectal cancer can be identified on the basis of an index adenoma found at initial colonoscopy. These patients will continue to be followed to investigate this que

ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1993.tb00053.x

出版商:Blackwell Publishing Ltd    

年代:1993

数据来源: WILEY

摘要:

Proctography is a standard method of investigating anorectal disorders. The parameters derived from this X‐ray include the anorectal angle. The reproducibility of this measurement was assessed in 43 defaecating proctograms viewed by four observers on two separate occasions. Measurements were made at rest and during defaecation straining. Significant intra‐ and inter‐observer variation was found. The anorectal angle is an inaccurate measurement, and should be interpreted with ca

ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1993.tb00054.x

出版商:Blackwell Publishing Ltd    

年代:1993

数据来源: WILEY

摘要:

Since secondary bile acids have mutagenic potency and choledochal cyst patients with or without cyst‐enterostomy have a high risk of developing bile duct carcinoma, we examined the hypothesis that secondary bile acids are elevated in the choledochal cyst and possibly cause biliary tract carcinoma. Eleven choledochal cyst patients with or without previous cyst‐enterostomy or biliary tract carcinoma, seven patients with biliary tract carcinoma not associated with choledochal cyst and five patients with cholecystolithiasis were examined. Samples were directly needle aspirated from the cyst or by cannulating a tube into the common bile duct through the cystic duct. The concentrations of each bile acid in these samples were quantified by gas‐liquid chromatography and compared. Neither the relative composition nor the absolute concentration of secondary bile acids (deoxycholic acid, lithocholic acid) elevated in patients with choledochal cyst compared with the values in the non‐choledochal cyst patients with or without biliary tract carcinoma. The presence of biliary tract carcinoma or previous cyst‐enterostomy did not affect the concentrations of secondary bile acids. The results suggest that the factor other than secondary bile acids can be primarily responsible for the high risk of bile duct carcinoma in patients with choledo

ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1993.tb00055.x

出版商:Blackwell Publishing Ltd    

年代:1993

数据来源: WILEY

摘要:

Twenty‐one patients underwent laparoscopic common bile duct exploration during a 9 month period. Ten had stones flushed after ampullary dilatation. Seven had stones removed with a Dormier basket and one had direct common duct incision with T‐tube insertion. Three failed attempted stone flushing and had stones removed by endoscopic retrograde cholangiopancreatography (ERCP) and sphincterotomy.Operating time ranged from 1.5 to 3.5 h. Nineteen patients were discharged by the second postoperative day. This early experience with laparoscopic stone removal is encouraging, reducing the need for pre‐operative or postoperative

ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1993.tb00056.x

出版商:Blackwell Publishing Ltd    

年代:1993

数据来源: WILEY

摘要:

A retrospective study was undertaken of 24 infants with septic arthritis of one or both hips who presented to the Children's Hospital, Camperdown, during the 15 year period from 1973 to 1989.Staphylococcus aureuswas found to be the most common pathogen. Umbilical catheterization was a significant aetiological factor in seven of 10 neonates studied. Young premature infants had the poorest outcome in regard to permanent bony changes in the upper femur, hip instability and leg length discrepancy. In patients with unstable and severely damaged upper femora, late salvage procedures were found to be unsatisfactory.

ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1993.tb00057.x

出版商:Blackwell Publishing Ltd    

年代:1993

数据来源: WILEY

摘要:

Seventy‐six patients who had sustained Bennett's fractures before 1985 comprised the patient base, Of these, 21 could be contacted and were reviewed at an average of 7 years 7 months after fracture to determine the effect of the quality of reduction on clinical and radiological outcome. Those cases that healed with up to 1 mm of fracture displacement were found to have superior results to cases where the reduction was less accurate. However even in those cases where a good reduction was not achieved the results were generally satisfactory with only one of 76 patients being known to have required a subsequent fusion of the first carpometacarpal joint. The subjective results in most patients had not deteriorated with time.It is recommended that a reduction with less than I mm displacement of the fracture be achieved in cases of Bennett's fracture. The particular technique by which the reduction is achieved and held is immateria

ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1993.tb00058.x

出版商:Blackwell Publishing Ltd    

年代:1993

数据来源: WILEY

摘要:

During the first 6 months of 1992, orthopaedic surgeons at Tamworth Base Hospital were involved in a feasibility study using allograft bone and donating femoral heads to Royal Newcastle Hospital Bone Bank. The two hospitals being separated by 300 km meant that storage, packaging and transportation had to be refined in order to ensure sterility and safe delivery of the bone.This study was undertaken because of the growing need for allograft bone in revision hip arthroplasty at Tamworth Base Hospital. This need for allograft bone has been expressed by other country based orthopaedic surgeons and will only increase during the next few years as primary hip prostheses age and revision hip surgery continues to advance.

ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1993.tb00059.x

出版商:Blackwell Publishing Ltd    

年代:1993

数据来源: WILEY