ISSN:0038-4348    

出版商:OVID    

年代:1986

数据来源: OVID

ISSN:0038-4348    

出版商:OVID    

年代:1986

数据来源: OVID

摘要:

Although nonoperative management is the standard initial treatment in children with splenic injury, this therapeutic option has been exercised infrequently in adults. Over the past two years we have hospitalized and observed 11 hemodynamically stable adults with splenic trauma and no other significant injury. Ten patients, sustained blunt trauma localized to the left, tipper quadrant, and one patient was stabbed in the left flank. Eight patients were normotensive on hospital arrival, while three had an initial, systolic blood pressure of 90 to 98 mm Hg. All patients remained normotensive after receiving 2 liters of crystalloid fluid IV. Nine patients had an initial hemoglobin, level of 11.1 to 14.0 gm/dl, and two a level of < 10 gm/dl. Liver-spleen scan done in ten patients yielded true-positive results in eight, false-positive results in one, and false-negative results in one. In the 11th patient, ä celiac arteriogram showed a splenic defect. Three patients had laparotomy 27 to 43 hours after hospitalization, owing to a decreasing hemoglobin concentration; one required partial splenectomy. Eight patients were successfully managed nonoperatively; only one required blood transfusion, and all tolerated oral alimentation by the second hospital day. All patients were discharged by the 12th hospital day; Nonoperative management can be successfully applied to adults with isolated splenic trauma.

ISSN:0038-4348    

出版商:OVID    

年代:1986

数据来源: OVID

摘要:

A retrospective analysis of all breast cancer primarily treated at this institution during the ten-year period from 1967 to 1977 revealed 336 cases; in 308 of these cases, complete follow-up of five or more years was available. Clinical staging using the TNM system (tumor, node, metastasis) showed stage I disease in 60 patients, stage II in 94, stage III in 105, and stage IV in 49. Pathologic classification of these 308 cases showed a high incidence of infiltrating ductal carcinoma (88%). Early in the study operative treatment consisted of radical mastectomy, with modified radical mastectomy being more common in the later years. Simple mastectomy was occasionally done palliatively. Adjuvant treatment using cyclophosphamide (Cytoxan), methotrexate, 5-fluorouracil, radiation, and/or hormonal manipulation was then given according to a set protocol. In general, five- and ten-year survival improved with this combined treatment. The mortality among patients with stage I infiltrating ductal carcinoma not given adjuvant therapy suggests the need for proper selection of patients in this group who should receive adjuvant chemotherapy because they are at increased risk.

ISSN:0038-4348    

出版商:OVID    

年代:1986

数据来源: OVID

摘要:

To identify factors that determine long-term survival after resection of extrarectal colonic cancer, we analyzed 138 such patients operated upon in a five-year period. Because rectal tumors have lower survival rates, they were excluded hoping to enhance the prognostic accuracy of the study. The sigmoid colon was the most common location of the tumor (59%) followed by the ascending (19%), the transverse (15%), and the descending colon (9%). In 95 patients (69%), operation was curative. In 12 patients (9%), a resection even with palliative aims could not be done; The five-year survival rates were 87% for 23 patients with Dukes' A and B lesions, 62% for 32 patients with Dukes' B2lesions, 36% for 42 patients with Dukes' C1lesions, and 0% for 34 patients with Dukes' C2or higher. The overall five-year survival rate was 42%. These results emphasize the prognostic reliability-of pathologic staging methods and bring into focus the importance of enhancing efforts for detecting extrarectal colonic cancers at early stages of development when curative resection offers maximal chances for cure.

ISSN:0038-4348    

出版商:OVID    

年代:1986

数据来源: OVID

摘要:

A retrospective analysis of 26 patients with squamous cell carcinoma of the esophagus treated at our center over a five-year period showed that the prognosis of this condition was still poor, with a mean length of survival of only 29 weeks after diagnosis; 88% of this period was spent in the hospital. The one-year survival rate was 23%. There were no two-year survivors. No major difference in survival based on method of treatment was evident though the groups were not truly comparable. We believe that a more thorough initial work-up including computerized tomography (CT) of the chest and upper abdomen in all cases would be invaluable in more accurately assessing the degree of spread. More frequent use of dilation and stents for palliation, rather than gastrostomy or jejunostomy will improve both survival and the quality of remaining life.

ISSN:0038-4348    

出版商:OVID    

年代:1986

数据来源: OVID

摘要:

I reviewed my experience with transthoracic needle aspiration (TNA) biopsy in a community hospital. TNA is effective (91% diagnostic accuracy) and safe (28% incidence of pneumothorax, 6% requiring a chest tube for reexpansion). TNA has a definite role in the evaluation of selected patients with focal pulmonary lesions. Success and complication rates are similar to those of other reported studies.

ISSN:0038-4348    

出版商:OVID    

年代:1986

数据来源: OVID

摘要:

Percutaneous endoscopic gastrostomy has gained acceptance as a primary means of placing enteral feeding tubes. Our adaptations of the basic technique lead to greater safety for and acceptance by the patient, long-term effectiveness of gastrostomy, and technical ease for the endoscopist.

ISSN:0038-4348    

出版商:OVID    

年代:1986

数据来源: OVID

摘要:

Gallstones are frequently found in patients with sickle cell anemia. The differentiation between acute calculous biliary tract disease and sickle cell crisis can be difficult and should be based on the clinical presentation, comparison with previous episodes of abdominal pain, and judicious use of hepatobiliary radionuclide scanning. Emergency cholecystectomy is associated with a high morbidity and should be avoided if possible. Elective cholecystectomy is associated with a lower but still significant risk of complications. We believe patients with sickle cell anemia and symptomatic cholelithiasis should have elective cholecystectomy. Careful management is essential to minimize the danger of postoperative complications.

ISSN:0038-4348    

出版商:OVID    

年代:1986

数据来源: OVID

摘要:

We used fluorescein dye to evaluate the vascularity of flaps in 73 patients and of the left colon in 23 individuals after resection and replacement of the abdominal aorta. Instant photographs of the dye pattern were taken in the light using a specially modified Polaroid camera. All areas of skin and bowel that showed adequate staining with the dye survived, and all but one of ten areas that were nonfluorescent became necrotic unless they were excised or revascularized. The intraoperative use of fluorescein dye with the fluorescence camera is a useful technique for all surgeons who need to evaluate the vascularity of tissue.

ISSN:0038-4348    

出版商:OVID    

年代:1986

数据来源: OVID