ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1993.tb00511.x

出版商:Blackwell Publishing Ltd    

年代:1993

数据来源: WILEY

摘要:

Neurogenic faecal and urinary incontinence result from a stretch‐induced injury to the pelvic nerves, from difficult childbirth or from chronic straining at stool. It has been suggested that the condition occurs less frequently in societies where the squatting position is used during defaecation, and that squatting may minimize pelvic floor descent. This is a prospective study which evaluates the position of the pelvic floor during defaecation straining in 52 patients. The position of the perineum was measured at rest and during maximal defaecation straining using a perineometer, with the patient in the left lateral, sitting and squatting positions. There was a significant difference in the position of the perineum at rest and on straining between the left lateral position and both the sitting and squatting positions. However, there was no significant difference at rest or on straining between the sitting and squatting positions. These results show that squatting does not reduce pelvic floor descent during defaecation straining, and imply that squatting would not help reverse stretch‐induced pudendal nerve dam

ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1993.tb00512.x

出版商:Blackwell Publishing Ltd    

年代:1993

数据来源: WILEY

摘要:

A colonoscopy and colonoscopic polypectomy service was established at Wellington Hospital, New Zealand in April 1975. Between April 1975 and March 1990 1157 polyps were either removed or biopsied and examined histologically. Twenty‐five polyps were lost. Patient‐age seemed to increase through the spectrum hyperplastic, tubular, tubulovillous, villous and polypoid carcinoma.Sessile<6 mm in diameter hyperplastic polyps were more numerous than small adenomatous polyps. Pedunculated tumours were most commonly adenomata in all sizes, whereas sessile tumours in the rectum and sigmoid colon were usually hyperplastic. As polyp size increased the numbers of hyperplastic polyps decreased relative to the numbers of adenomatous polyps. The majority of hyperplastic polyps were found in the distal colorectum. Site distribution for hyperplastic polyps corresponded to the site distribution for colorectal carcinomata.One of five patients with hyperplastic index polyps was found to have an adenomatous polyp at follow‐up. Strong evidence for a sequential relationship between hyperplastic and adenomatous polyps was not found in this study. It is unlikely that an aggressive attitude to the investigation and removal of hyperplastic polyps will have a significant effect on the later development of colorectal c

ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1993.tb00513.x

出版商:Blackwell Publishing Ltd    

年代:1993

数据来源: WILEY

摘要:

This study sets out to develop a set of clinical indicators for the frequently performed procedure, simple cholecystectomy. Four hundred consecutive cases of cholecystectomy were reviewed retrospectively and data were collected regarding the pre‐operative condition of the patient as well as any postoperative complications. From this database a set of clinical indicators for simple cholecystectomy are recommended: wound infection rate 4.5%, re‐operation or performance of another therapeutic procedure 3.5%. length of stay 7 days, and mortality<0.025%. These threshold figures are to serve only as a ‘flag’ to possible p

ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1993.tb00514.x

出版商:Blackwell Publishing Ltd    

年代:1993

数据来源: WILEY

摘要:

Laparoscopic procedures have previously been shown to interfere little with respiratory homeostasis. This study was designed to determine whether respiratory homeostasis, as well as temperature, is maintained with longer laparoscopic procedures and cold carbon dioxide insufflation.This study examined 21 American Society of Anesthesiologists status I and II patients undergoing laparoscopic cholecystectomy. A constant minute ventilation (80mL/kg per min) was instituted prior to peritoneal insufflation and end‐tidal carbon dioxide measurements were followed throughout the procedure. Although they showed a small statistically significant increase (32.3 ± 3.8 to 38.9 ± 6.0 mmHg,P= 0.0001) they were not of clinical significance. Similarly, rectal temperature measurements showed a statistically. but not clinically, significant fall in temperature over the course of the procedures (36.4 ± 0.46 to 36.2 ± 0.35°C,P =0.0001). The changes in end‐tidal carbon dioxide and temperature showed no correlation with the volume of carbon dioxide used.The above findings will, however, require further investigation in both longer procedures and patients with more significant

ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1993.tb00515.x

出版商:Blackwell Publishing Ltd    

年代:1993

数据来源: WILEY

摘要:

Between 1980 and 1991, 15 cases of non‐iatrogenic extrahepatic biliary tract trauma have been managed at Westmead and the Royal Canberra Hospitals. There were seven cases of gall‐bladder injury and eight bile duct injuries. Four cases resulted from penetrating trauma whereas 11 resulted from blunt trauma. Associated injuries were common. Cholecystectomy was the preferred method of management for gall‐bladder injuries whereas the bile duct injuries were managed by a variety of techniques. There were three deaths in the series, mostly related to associated injuries. Bile duct injuries were associated with longer hospitalization than gallbladder inj

ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1993.tb00516.x

出版商:Blackwell Publishing Ltd    

年代:1993

数据来源: WILEY

摘要:

A retrospective study for the period 1978–91 revealed 33 patients with fractures involving the distal femoral growth plate and epiphysis. Treatment by closed reduction and casting resulted in a high rate of loss of position. Twenty‐three of the patients were followed up for an average of 4.8 years. Salter‐Harris type II fractures predominated. An analysis of this group showed that treatment by open reduction and internal fixation gave better results than closed reduction and casting, or percutaneous fixation.The authors advocate treating all displaced Salter‐Harris type II, III and IV fractures by open reduction and internal fixation. If closed means are employed, extra care needs to be taken in short‐ and long‐term follow up, and the patient and parents advised of the likelihood of loss of position, deformity and/or growth

ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1993.tb00517.x

出版商:Blackwell Publishing Ltd    

年代:1993

数据来源: WILEY

摘要:

This study describes the results of treating selected patients suffering from recurrent dislocation of the patella, with closed lateral retinacular release. Thirty‐nine patients were reviewed after a mean follow‐up time of 28 months. Thirty patients were substantially improved by the procedure, two patients had sustained a further dislocation. The major complication — haemarthrosis — occurred in four patients. These results compare favourably with those achieved by major realignment procedures. So lateral retinacular release is an effective treatment for selected patients with recurrent patella dislocation, and it offers distinct advantages over other pro

ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1993.tb00518.x

出版商:Blackwell Publishing Ltd    

年代:1993

数据来源: WILEY

摘要:

A standard household 650 W microwave oven was used to sterilize polyethylene catheters of the type used for intermittent self‐catheterization. The Catheters were infected withProteussp. bacteria and microwaved at 650 W for periods of 2, 4, 6 and 8 minutes. The effect of microwaving was assessed by determining the resultant colony counts following catheter culture. It was determined that 6 minutes of microwaving were required to achieve sterility. It is suggested that use of a microwave oven is a reliable and cost‐effective method of sterilizing polyethylene catheters for intermittent self‐catheteriz

ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1993.tb00519.x

出版商:Blackwell Publishing Ltd    

年代:1993

数据来源: WILEY

摘要:

The maximal, axial torque generated by the lumbar back muscles was determined by modelling the action of the 49 fascicles of longissimus thoracis, iliocostalis lumborum and the lumbar multifidus on radiographs of the lumbar spine of nine young male subjects in upright standing and in full lumbar flexion. No single fascicle exerted more than 2 Nm of axial toque in the upright posture, and the collective torque of all muscles acting a segment did not exceed 5 Nm. All torques were considerably less in full flexion. The lumbar back muscles exert very little torque on the lumbar spine, and contribute only about 5% of the total torque involved in trunk rotation. None of the lumbar back muscles can be considered a rotator. The oblique abdominal muscles are the principal rotators of the trunk. Preventative and rehabilitation programmes concerned with torsion injuries should focus on the abdominal muscles rather than the back muscles for stability in axial rotation.

ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1993.tb00520.x

出版商:Blackwell Publishing Ltd    

年代:1993

数据来源: WILEY