ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1985.tb00845.x

出版商:Blackwell Publishing Ltd    

年代:1985

数据来源: WILEY

摘要:

A prospective system of data collection, using computer storage, has been developed in the Spinal Injuries Unit, Austin Hospital. Three hundred and fifty‐two consecutive admissions to the Unit between 1 July 1978 and 31 December 1982 are analysed, and this epidemiological data compared with other reports. Over 92% of the admissions were the result of spinal cord trauma and the balance due to a variety of non‐traumatic causes. A high incidence of young males injured in road accidents, predominantly from motor cars, and lesser numbers from sporting, occupational and domestic accidents is noted. A high proportion of country accidents and a disproportionately high number of people who live in country areas indicates the need for greater concentration of preventative measures to rural areas. The study has confirmed the usefulness of such a sophisticated data collection system to collect, at relatively low cost, useful epidemiological data on a specific disability group. The system will help to plan treatment programmes, as well as preventative measures, for the fut

ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1985.tb00846.x

出版商:Blackwell Publishing Ltd    

年代:1985

数据来源: WILEY

摘要:

A prospective survey of 1757 general surgical patients undergoing operation was performed comparing 35 patients with wound infection yielding methicillin‐resistantStaphylococcus aureus(MRSA) with 184 patients developing wound infections due to other organisms. The following parameters were statistically significantly increased in the patients with MRSA wound infection; MRSA infection or colonization at other sites, 37% versus 2%, severe wound infection 31% versus 12%, wound drain tubes 23% versus 10%, multiple operations 37% versus 6%. malignant disease 43% versus 23%, postoperative complications 46% versus 16%, intensive care admissions 23% versus 5% and prophylactic antibiotics 51% versus 30%. There was no difference in postoperative mortality 11% versus 7%; mean age, 58 years versus 56 years; sex; diabetes, 11% versus 9%; or emergency operations 40% versus 39%. There were 18 patients with single organism MRSA wound infection who were compared with 35 patients with single organism methicillin‐sensitiveS. aureus(MSSA) wound infection. The patients with MRSA wound infections had a statistically significant increase in the following parameters: mean preoperative stay in hospital 8 days versus 4 days; prophylactic antibiotics 39% versus 3%; MRSA infection or colonization at other sites 39% versus 6%; and malignant disease 44% versus 17%. There were no deaths in either group and there was no statistically significant difference in other parameters, namely, multiple operations 11% versus 3%; intensive care admissions 6% in each group; wound drain tube 17% versus 11%; severe infections 22% versus 6%; and postoperative complications 22%) versus 9%. These latter parameters were statistically significantly increased when all MRSA wound infections were compared with all wound infections due to other organi

ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1985.tb00847.x

出版商:Blackwell Publishing Ltd    

年代:1985

数据来源: WILEY

摘要:

In aprospective randomized double‐blind trial using a 1 g single dose of cephamandole versus placebo, given I h before surgery, the wound infection rate after elective surgery for gallbladder stones in 200 consecutive cases was 11%, being 15% in the placebo group and 7% in the cephamandole group (x2= 4.03; P<0.05). The average hospital stay was 7.7 days in the absence of wound infection and 13.6 days in the presence of wound infection. Contaminated bile was significantly positively related to wound infection, and cephamandole significantly protected the culture‐positive group from wound infect

ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1985.tb00848.x

出版商:Blackwell Publishing Ltd    

年代:1985

数据来源: WILEY

摘要:

One hundred and twenty cases of fistula‐in‐ano were treated in 11 years by fistulectomy and primary closure. Injection of dye into the tract helped in identifying the tract and its ramifications which were excised. A lateral sphincterotomy was added in most cases for relief of postoperative pain and to promote good healing. Of the cases, 83.3% healed well in 2 weeks as compared with 4–5 weeks or more with conventional methods resulting in great economy in hospital stay and morbidity. Follow‐up of these cases for a variable period, up to five years, revealed only three recurrences, indicating a comparable long term effectiveness of this procedure as in the conventional

ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1985.tb00849.x

出版商:Blackwell Publishing Ltd    

年代:1985

数据来源: WILEY

摘要:

Abdominal retractors that are fixed to the operating table provide an electrical pathway to earth and are unsafe. Modifications to ensure the electrical safety of two table mounted abdominal retractors by the incorporation of insulators are described. Results of electrical testing show that the insulators provide high levels of insulation to direct current, 50 Hz alternating current and 400 kHz radio frequency current.

ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1985.tb00850.x

出版商:Blackwell Publishing Ltd    

年代:1985

数据来源: WILEY

摘要:

Long‐term central venous catheterization has been used as the sole method of vascular access in nine chronic dialysis patients with severe access difficulties. The catheters were inserted into the right atrium via external or internal jugular veins by a simple operative technique and have remainedin situfor 1–33 months. Although three catheters required replacement for incorrect positioning (two patients) and catheter‐associated thrombosis (one patient) no patient failed with the technique. Catheter‐related complications were infrequent. The study demonstrates that it is possible to undertake adequate and safe haemodialysis through a permanently indwelling central venous catheter in patients in whom conventional methods of vascular access, and other modes of renal replacement therapy, have failed rep

ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1985.tb00851.x

出版商:Blackwell Publishing Ltd    

年代:1985

数据来源: WILEY

摘要:

Pulmonary valve stenosis may require urgent surgical relief in infancy or elective valvotomy in childhood. A retrospective study has been made of 94 children who underwent pulmonary valvotomy for pulmonary valve stenosis between 1972 and 1983 using the technique of normothermic caval inflow occlusion. There were no early deaths nor late deaths. The group included 13 neonates less than I week old and 14 other infants under 1 year of age. The mean follow‐up is 45 months. No child has had a second valvotomy for recurrent valvar stenosis. Two children have required re‐operation for placement of a transannular right ventricular outflow patch for hypoplastic pulmonary annulus. Neonates who present early with critical pulmonary valve stenosis may remain moderately to severely cyanosed for several days after a satisfactory valvotomy but this is almost invariably followed by a progressive increase in oxygen saturation to an acceptable level. One neonate, who had a Blalock–Taussig shunt at 2 weeks of age for persistent postvalvotomy cyanosis, had the shunt ligated at 2 years. Pulmonary valvotomy under normothermic caval inflow occlusion is a safe, cost‐effective technique which provides excellent early and late haemodynamic results. This operation sets a standard against which the newly introduced technique of percutaneous balloon pulmonary valvotomy should be a

ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1985.tb00852.x

出版商:Blackwell Publishing Ltd    

年代:1985

数据来源: WILEY

摘要:

The pathogenesis of upper airway obstruction from cancer arising in the larynx, pyriform fossa and oropharynx is discussed. Endotracheal intubation for general anaesthesia can be a hazardous procedure and alternatives are presented.

ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1985.tb00853.x

出版商:Blackwell Publishing Ltd    

年代:1985

数据来源: WILEY

摘要:

A personal series of 216 non‐consecutive patients with renal calculi, measuring up to 0.7 cm in diameter, impacted in the lower third of their ureters were reviewed at least 2 years after either spontaneous expulsion of the calculus or surgical removal had been achieved in an endeavour to compare the natural history and complications of spontaneous expulsion with the results and complications of both attempted endoscopic and open extraction operations and the cost‐effectiveness of these different methods of management. Spontaneous expulsion, without detectable complications, occurred within 3 months of presentation in 88% (88 of 100 patients) with calculi measuring 0.5 cm or less but was achieved in only 44% (9 of 16 patients) with calculi measuring between 0.5 and 0.7 cm despite a maximum 12 months period of expectant management. Of 100 attempted endoscopic calculus extractions, the operative success rate averaged 62%, without any significant complication, for those calculi measuring 0.5 cm or less but only 22%, with a significant complication rate of 19%, for calculi measuring between 0.6 and 0.7 cm. The average 1983 costs ranged from $1960 for a non‐hospital spontaneous expulsion to $5278 for the failed endoscopic extraction of a larger calculus which subsequently required open surgical re

ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1985.tb00854.x

出版商:Blackwell Publishing Ltd    

年代:1985

数据来源: WILEY