ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1983.tb02385.x

出版商:Blackwell Publishing Ltd    

年代:1983

数据来源: WILEY

摘要:

Most adult hernias have a defect in the posterior wall of the inguinal canal even though the initial defect, in an indirect hernia, is the presence of a sac at the internal ring. It is imperative to strengthen the posterior wall without disturbing the normal shutter mechanism of the inguinal canal. A technique is described which achieves this by applying the keel principle to the repair. Data regarding 215 such repairs done during the last five years is presented. The follow‐up available however does not satisfy the standard critical criteria and as such this is presented only as a preliminary report and a rational ide

ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1983.tb02386.x

出版商:Blackwell Publishing Ltd    

年代:1983

数据来源: WILEY

摘要:

Nasogastrointestinal intraluminal tube stenting using a Dennis tube (Sherwood Medical St Louis, Missouri, USA) was performed on 25 patients. Two intubations were for midgut volvulus, 13 for small intestinal obstruction after extensive adhesolysis, and 10 as an adjunct to the operative management of enterocutaneous fistulae following extensive adhesolysis, resection and anastomosis. No patient developed recurrent small bowel obstruction for periods up to three years after operation. Use of an intraluminal tube stent in preventing recurrent small bowel obstruction due to adhesions is safe and effective when used on appropriately selected patients. Its effectiveness should be more widely recognized.

ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1983.tb02387.x

出版商:Blackwell Publishing Ltd    

年代:1983

数据来源: WILEY

摘要:

Fifty‐one patients who had suffered blunt abdominal trauma were assessed clinically and with diagnostic peritoneal lavage. The latter has been shown to be a safe, accurate means of determining the presence or absence of haemoperitoneum. Furthermore, in patients with disturbed conscious states, the initial clinical assessment has been found to be inaccurate and the performance of diagnostic peritoneal lavage has resulted in a statistically significant increase in diagnostic accuracy (P = 0.006). However, in patients with a normal conscious state, the improvement in diagnostic accuracy achieved by the performance of diagnostic peritoneal lavage was not statistically significant. The technique of diagnostic peritoneal lavage is discussed in detai

ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1983.tb02388.x

出版商:Blackwell Publishing Ltd    

年代:1983

数据来源: WILEY

摘要:

Portal systemic shunting for the treatment of bleeding oesophageal varices in non‐alcoholic patients is thought to have a better outcome than in patients with alcoholic portal hypertension. In a retrospective study of twenty‐five non‐alcoholic patients who had undergone portal systemic shunting for the treatment of bleeding oesophageal varices, the perioperative and long term mortality was found to be unacceptably high. Therefore, an analysis was made to define the factors which may have contributed to the high mortality. It was found that the presence of one or more of the following factors contributed to the patient's demise: presence of active liver disease at the time of surgery, previous abdominal surgery, and the performance of shunting as an emergency in order to stop bleeding. It is concluded that in patients having one or more of these risk factors, currently available non‐operative means of treating bleeding oesophageal varices should be con

ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1983.tb02389.x

出版商:Blackwell Publishing Ltd    

年代:1983

数据来源: WILEY

摘要:

Pancreatic carcinoma is an increasingly common malignancy, cure of which is rarely feasible. Ideal management involves the safe and effective palliation of symptoms once the diagnosis has been established beyond reasonable doubt and the unlikely possibility of cure by radical surgery ruled out. In this retrospective study of 173 patients, management fell short of the ideal. Histological confirmation of the diagnosis was obtained in only 42% of patients, and there was a 16% reoperation rate because of the failure of an initial palliative procedure to relieve actual or potential biliary or gastric outlet obstruction. Still more patients developed recurrent obstructive jaundice or duodenal obstruction but did not undergo further surgery. To achieve optimal palliation, it is recommended that a gastroenterostomy be performed whenever a palliative operation is undertaken for the relief of obstructive jaundice, and that biliary drainage be accomplished by anastomosis of bowel to the common hepatic duct rather than the gall‐bladder whenever possible, to minimize the risk of recurrent obstruction. It is further recommended that an attempt be made to obtain a tissue diagnosis in every case, since other methods of diagnosis are unreliabl

ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1983.tb02390.x

出版商:Blackwell Publishing Ltd    

年代:1983

数据来源: WILEY

摘要:

Gastric bypass was performed for eight patients with advanced oesophageal cancer complicated by an established oesophago‐airway fistula. There was one operative death. Seven patients could be discharged from hospital with complete relief from aspiration and eating a normal solid diet. The preoperative preparation, anaesthetic management and operative technique is described. Gastric bypass is compared to other methods of palliation for malignant oesophago‐airway fistu

ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1983.tb02391.x

出版商:Blackwell Publishing Ltd    

年代:1983

数据来源: WILEY

摘要:

During the 10 years from 1968 a total of 1119 patients with chest and associated injuries were admitted to the Royal Newcastle Hospital (RNH); 530 of these needed ICU treatment and fifty‐nine died. Common causes of death included irreparable associated injuries to brain and exsanguination due to major vessel injury. However, the commonest cause encountered was refractory respiratory failure due to pulmonary sepsis. This condition was associated with hypovolaemic shock, intra‐abdominal injuries, failure of conservative treatment and injuries in the older age gro

ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1983.tb02392.x

出版商:Blackwell Publishing Ltd    

年代:1983

数据来源: WILEY

摘要:

Three cases of oesophago‐pleural fistula are presented. Two resulted from foreign body perforation of the oesophagus and one followed left lower lobectomy for bronchiectasis. All three presented late; the time lapse ranged from 6 days to 2 months. An initial course of conservative treatment was given to all three patients. Alimentation via nasogastric tube feeding, gastrostomy or total parenteral nutrition was carried out. The pleural fluid grew the anaerobe,Baaeriodies melaninogenicus, in all three cases. Gram‐negative aerobes,Escherichia coliandProteus mirabilis, were also cultured. Closed intercostal drainage and a course of appropriate antibiotics were instituted. The patients were subjected to surgery after the infection had been brought under control. Simple repair was performed in two patients. Exclusion of the oesophageal leak with drainage and later reconstruction was carried out in the third patient. Although all three patients recovered, the morbidity was considerable. The duration of hospital stay ranged from 2 to 4 mon

ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1983.tb02393.x

出版商:Blackwell Publishing Ltd    

年代:1983

数据来源: WILEY

摘要:

Discovery of an absent vaginal orifice in the presence of normal external genitalia raises the problem as to the exact extent of the abnormality. Careful history taking may give a guide. However, ultrasound examination has been shown to be extremely useful in clarifying the situation. By this test, a more accurate appreciation of the problem is obtained.

ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1983.tb02394.x

出版商:Blackwell Publishing Ltd    

年代:1983

数据来源: WILEY