ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1988.tb00094.x

出版商:Blackwell Publishing Ltd    

年代:1988

数据来源: WILEY

摘要:

The development of neurosurgery in Canada is traced through an analysis of the contributions of key early figures in this specialty. The evolution of Canadian training standards is discussed against the background of socio‐economic change in the nation at larg

ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1988.tb00095.x

出版商:Blackwell Publishing Ltd    

年代:1988

数据来源: WILEY

ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1988.tb00096.x

出版商:Blackwell Publishing Ltd    

年代:1988

数据来源: WILEY

摘要:

Fine needle aspiration (FNA) cytology is a cost‐effective and clinically reliable tool in the management of breast tumours. This report summarizes the experience with 364 patients who had FNA of the breast. There was a total of 115 cancers of which 108 (93.9%) were diagnosed on FNA. There were no false positives amongst aspirates diagnosed as ‘malignant’. Thirty‐one patients had mastectomy with prior frozen section and nine had advanced or recurrent disease with no biopsy confirmation. FNA was ‘suspicious of malignancy’ in 12 patients of which 10 were malignant and two were benign on histology. There were 216 patients with ‘benign’ FNA and 28 FNA were ‘unsatisfactory‘. Biopsy confirmation was recommended in all clinically malignant or doubtful cases. Forty‐one (19%) of the patients with ‘benign’ FNA and 13 (46%) of the ‘unsatisfactory’ group had excision biopsies which revealed six cancers, giving a false negative rate of 5.2%.FNA cytology gives rapid and reliable results which contribute towards planning of further management of the patient. It can replace the more painful tru‐cut biopsy and reduce the need for excision biopsy and frozen section in the initial diagnosis of breast tumours. It is also an effective modality to monitor and confirm suspected recurrences. Although a negative FNA does not completely exclude malignancy, it can be used to reassure the surgeon and the patient and to suppor

ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1988.tb00097.x

出版商:Blackwell Publishing Ltd    

年代:1988

数据来源: WILEY

摘要:

Fine needle aspiration biopsies of 42 histologically confirmed tuberculous cervical lesions were studied. Thirty‐four patients had subsequent excision of cervical lymph nodes and eight had incision and drainage of cervical abscesses. All aspirates except two (which were inadequate) were satisfactory for diagnosis and contained inflammatory cells. Twenty‐seven smears revealed cells typical of granulomatous lymph‐adenopathy, that is, epithelioid and rnultinucleated giant cells. Of all aspirates, 17 smears had bacteriological staining by Ziehl‐Nielsen technique, nine of which (53%) were positive for acid‐fast bacilli. An aspiration biopsy diagnosis of granulomatous or tuberculous cervical lymphadenopathy was made in 30 patients (71%). In regions where mycobacterial infection is common, the presence of granulomatous changes in lymph node aspirates is highly suggestive of tuberculosis. When the aspirates contain purulent material or when tuberculosis is suspected, staining and culture for rnycobacteria should be performed. FNA biopsy is a sensitive, specific and cost‐effective way to diagnose tuberculous cervical lymphadenopathy and is

ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1988.tb00098.x

出版商:Blackwell Publishing Ltd    

年代:1988

数据来源: WILEY

摘要:

A method of checking the integrity of mucosal repair after head and neck surgery using wound amylase levels is described. A low wound amylase concentration allows early resumption of oral intake; an increasing amylase concentration is a strong predictor of subsequent wound breakdown and fistula formation. A regimen has been developed which has prevented fistulae from developing in the small number of patients studied thus far.

ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1988.tb00099.x

出版商:Blackwell Publishing Ltd    

年代:1988

数据来源: WILEY

摘要:

The outcome of 78 patients hospitalized with acute diverticulitis was analysed to determine the indications for emergency operation and to examine the safety of sigmoid resection. Forty patients improved on medical therapy, but four relapsed soon after discharge. Forty‐two (55%) patients had emergency operations for non‐resolution of clinical sepsis (25). persistent symptoms or mass (14) and fistula (three). Operations performed were: sigmoid resection and primary anastomosis (23) with covering colostomy (six), Hartmann's operation (10). drainage with/without colostomy (seven) and right hemicolectomy (two). Findings at operation were: abscess (19). phlegmon (14). generalized peritonitis (six), colovesical fistula (three) and chronic diverticulitis (three). Complications included wound infections (six), respiratory complications (five) and one death. Six patients having drainage of the sigmoid inflammation alone as the first operation required subsequent resection, with prolonged and often complicated hospitalization. Minimal morbidity and shorter hospitalization were achieved when sigmoid resection was performed at the initial proced

ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1988.tb00100.x

出版商:Blackwell Publishing Ltd    

年代:1988

数据来源: WILEY

摘要:

The traditional operative management of emergency distal colon pathology has involved staged procedures, but recently Hartmann's operation has gained popularity. The indications for primary anastomosis without covering colostomy have remained controversial, but the technique of on‐table lavage has extended the use of this approach in the acute setting. A series of seven patients having this procedure for diverticular abscess (three), obstructing colonic carcinoma (one), perforating colonic carcinoma (one) and sigmoid volvulus (two) is presented.The saline irrigation is introduced by a Foley catheter inserted via the appendix stump and the effluent is diverted from the proximal colon by anaesthetic scavenger tubing. The lavage is continued until the effluent is clear and anastomosis performed with one‐layer interrupted absorbable sutures. There were no deaths in the series; one patient developed a wound infection and average hospitalization was 16 days (range: 6–31 days). Immediate anastomosis in selected cases of emergency distal colonic pathology is thus feasible and safe following on‐table colonic

ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1988.tb00101.x

出版商:Blackwell Publishing Ltd    

年代:1988

数据来源: WILEY

摘要:

A randomized. controlled clinical trial, of sequential design. was Undertaken to determine whether line catheter aspiration cytology of the peritoneal cavity, using the percentage of neutrophils in the sample as the main test marker. reduces errors about urgent laparotomy in patients admitted to a surgical unit with acute abdominal pain.One hundred and forty‐four patients with acute abdominal pain were studied. Of these, 26 were excluded because the test was unlikely to be useful and 20 did not consent. Conventional clinical assessment was undertaken and then the subjects were randomly allocated to have a peritoneal cytology test or not. After the test result was made available, the surgeon(s) decided whether to operate or continue conservative treatment. The correct decision was later ascertained by a blinded clinical referee.With the entry of the 98th patient the difference between the groups achieved the 5% significance level. The groups were well‐matched in regard to demographic and other variables. The decison about urgent laparotomy was incorrect in only 8.2% of the test patients, compared with 28.6% of the others.It is concluded that fine catheter aspiration cytology of the peritoneal cavity is likely to reduce the numbers of unnecessary or delayed laparotomies when used in most patients admitted with acute abdominal p

ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1988.tb00102.x

出版商:Blackwell Publishing Ltd    

年代:1988

数据来源: WILEY

摘要:

The records of 13 patients suffering from Merkel cell tumour of the skin have been reviewed and the treatment analysed. Pending further experience of this uncommon tumour, a recommendation is made for wide excision of the primary site with elective postoperative radiation to both the primary site, the in‐transit zone where practicable, and regional nodes. If malignant nodes occur, block dissection with postoperative radiotherapy is indicated. If widespread metastases develop, cyclophosphamide, doxorubicin, vincristine and prednisone chemotherapy may give a response. The prognosis is poo

ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1988.tb00103.x

出版商:Blackwell Publishing Ltd    

年代:1988

数据来源: WILEY