ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1995.tb01735.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY

ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1995.tb01736.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY

摘要:

A standardized vertical banded gastroplasty (VBG) was carried out by the one surgeon on 60 consecutive morbidly obese patients. All patients were followed at 4 week intervals for 1.5 years. Long‐term follow up was carried out at medians 5.7 and 9.6 years. All patients had significant weight loss at 1.5 years. However, at long‐term follow up, despite an apparently intact gastric restrictive procedure, only 40% of patients had maintained their weight loss. Sixty per cent had regained significant weight and 31% had returned to or were above their pre‐operative weight

ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1995.tb01737.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY

摘要:

Gastric pull‐up with cervical oesophagogastric anastomosis is a common procedure after oesophageal resection. Contrast studies are used by many surgeons for detection of anastomotic leaks but may be unnecessary. A prospective study was undertaken to compare gastrografin study and test feeding using water for detection of cervical anastomotic leaks. In 25 patients. gastrografin study showed three leaks, two of which were clinically silent and patients did not have any problems. One patient had aspiration of contrast and the study could not be completed. Two of the leaks detected clinically were missed by contrast study (one because of an incomplete study and the other was a satisfactory study). Delayed leaks occurred in two patients. All leaks healed spontaneously. A contrast study may thus be unnecessary for evaluation of a cervical oesophagogastric anastomosis and can be replaced with the simpler and safer technique of ‘test feeding’ using

ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1995.tb01738.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY

摘要:

Many clinicians still associate oesophagectomy for oesophageal carcinoma with low cure rates, poor palliation and prohibitive peri‐operative mortality. Surgical advances have rendered such perceptions inaccurate. A prospective study of all patients undergoing surgery for oesophageal cancer in an Australian teaching hospital between 1979 and 1993 has been undertaken. Selection. staging, pre‐operative preparation, surgical technique and postoperative care were all carefully controlled. One hundred and thirty‐seven patients were explored. Twenty‐one were inoperable. One hundred and sixteen underwent resection with intent to cure. Hospital mortality for oesophagectomy was 1.7%. There were no cases of clinical anastomotic leakage. Eighty‐nine per cent achieved excellent to good swallowing. The median survival for all cases was 14 months and the 5 year survival was 18%. Median survival for resected cases was 18 months and the 5 year survival was 26%. The long‐term survival was related to postoperative stage of the disease but not to tumour type. Oesophagectomy for oesophageal cancer will restore good swallowing in 90% of cases. Operative mortality should be less than 5% and the overall 5 year survival 20–3096. Early tumours can often be cured (ca in situ100%. stages I and II 50–60%), indicating the benefits of early detection. Poor survival in advanced disease (stage III 15%. stage IV 0%) on a background of low surgical mortality indicate the need for better staging and more effective adj

ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1995.tb01739.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY

摘要:

The effectiveness of autologous blood donation in reducing the need for homologous transfusion was evaluated in a review of 529 consecutive total hip replacements (THR) from 1988 to 1992. The review was retrospective from 1988 to 1990 and prospective from 1991 to 1992. Since 1988 there have been 188 primary THR performed using autologous blood donation. In 1988–89, this represented 18% of all primary THR, in 1990 37% and in 1991–92 73%. This increase reflects a growing enthusiasm for the programme and a loosening of age restrictions. In 1991–92, 4% of autologous donors undergoing primary THR required homologous transfusions compared to 84% of non‐autologous donors. Over the same period after revision THR, 36% of autologous donors required homologous transfusions compared to 100% of non‐autologous donors. The participation rate of patients undergoing revision THR was 33%. The prospective part of the study in 1991–92 compared autologous and matched non‐autologous patients. Blood loss, transfusion volumes and operating time were identical. The pre‐ and postoperative haemoglobin concentrations in the autologous group were lower by 15 and 10g/L, respectively, after primary THR and by 10 g/L in both instances after revision THR. This was not reflected in a l

ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1995.tb01740.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY

摘要:

This paper details the operative techniques, results and reasons for reversals of vasectomy in military personnel. Fifty‐two reversals were performed by two surgeons (AC&DW) over a 7 year period. Data collection was by (i) retrospective analysis of service documents, surgical registers and laboratory records and (ii) response to a questionnaire. The interval between original vasectomy and reversal vaned from 5 months to 16 years. Change of sexual partner was the most common reason for requesting the procedure. There were two recorded postoperative infections and no postoperative mortality. Post‐reversal semen analysis proved anastomotic success in 49 out of 51 cases (96%). Semen analysis was not returned for the remaining case. Of the couples who had been trying for at least 18 months, 28 out of 42 (67%) had conceived, including one miscarriage. A further seven cases had been trying for less than 18 months, or had no opportunity due to physical separation. Two of these seven patients ended their relationship soon after operation. Pregnancy outcome was unknown in three ca

ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1995.tb01741.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY

ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1995.tb01742.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY

摘要:

This study was performed to assess the changes occurring in the field of urology with developments in outpatient surgery during a 5 year period. Using ICD‐9‐CM code, data for all urology procedures performed in the main operating rooms, day surgery and laser centre operating rooms of a large, general hospital were collected for the years 1987–92. A substitution index (SI) was determined as the ratio of the number of outpatients to the total number of procedures and expressed as a percentage. Changes in the SI reflects the degree to which emphasis has shifted from conventional inpatient to outpatient surgery. It was found that 26% of urology procedures were being performed as outpatients in 1987, and this increased to 42% by 1992. When broken down according to organ, the greatest increase in SI from 1987 to 1992 was for the kidney (57%) and the least, the penis (2%). with ureter, urethra, testes and scrotum all revealing intermediate, but significant, increases (27, 28 and 24% respectively). This paper thus demonstrates that, as in other fields, urology has experienced a marked increase in outpatient surgery. With developments in surgical and anaesthetic techniques, financial pressures, changing physician and patient attitudes and technological advances, further increases in urology outpatient care can be exp

ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1995.tb01743.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY

摘要:

This study was designed to determine the efficacy of the 5α‐reductase inhibitor finasteride (Proscar, MK‐906) in men with reduced urinary flow rates and symptoms of urinary outflow obstruction secondary to benign prostatic hyperplasia. Forty‐five men were randomized to one of three groups receiving either placebo, 1 mg/day or 5 mg/day tinasteride for the first 12 months of the study period. At the end of this period all men received 5 mg/day finasteride for a further 2 years. Efficacy was determined by measurement of prostate volume, maximum urinary flow rate, and symptom score using a modified Boyarsky assessment. Prostate volume reduced by 20 and 27%. respectively, for those on 1 and 5 mg after the first year. At 3 years the volume had reduced by 43%. This reduction in prostate volume was associated with an improvement in maximum urinary flow rate by 50% (1 mg), and 35% (5 mg) at 1 year, and 36% at 3 years. The total, obstructive and non‐obstructive symptom scores decreased (improved) for patients on 1 and 5 mg tinasteride, with the total score reducing by 33% from baseline at year 3. The results demonstrate that finasteride causes a modest but signiticant clinical improvement in men with urinary outflow obstruction secondary to benign prostatic hyp

ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1995.tb01744.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY