ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1996.tb00688.x

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY

ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1996.tb00689.x

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY

摘要:

Background: A distinctive feature of patients suffering from Crohn's disease is a predisposition to develop a variety of anal complications. The aetiology of such conditions is unclear, and the reported incidence of anal involvement in Crohn's disease varies party due to the various criteria used for classification. This study aims to review the management of patients with symptomatic anal pathology associated with Crohn's disease at St Vincent's Hospital, Melbourne.Methods: A database of 306 patients with Crohn's disease referred to the department between January 1978 and October 1994 was reviewed to identify those patients with symptomatic anal disease. The anal pathology was recorded and classified. Demographic data and the clinical and surgical history of the patient were recorded.Results: Of the 306 patients with Crohn's disease, 129 (42.4%) were identified as having symptomatic anal pathology. Patients were likely to present with anal symptoms after they had been diagnosed as having intestinal Crohn's disease (46.1%). The commonest presentations were perianal abscess (29.5%), anal fissure (27.6%), and low anal fistula (26.7%). A minority of patients presented with highkomplex anal fistulae (3.8%), or recto‐vaginal fistulae (5.2%). Five per cent of patients had Crohn's disease localized to the anal area. The pattern of intestinal disease in the remaining patients was small bowel 21.1%. small bowel and colon 31.9%, and colon 43.0%. A total of 244 local anal surgical procedures were performed on these patients; the commonest of these were drainage of an abscess (38.5%), examination under anaesthetic (29.1%). and laying open of a low anal fistula (22.5%). Following surgical treatment, the recurrence rate for perianal abscesses was 13%, and for low anal fistulae 6%.Conclusions: The majority of patients with Crohn's disease who develop anal pathology have an excellent prognosis. A minority of patients develop complex anal fistulae and these remain a therapeutic challeng

ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1996.tb00690.x

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY

摘要:

Background: The unplanned return of the patient to the operating room (OR) after a previous procedure has implications concerning the quality of surgery, but little has been written on this subject.Methods: The relationship of bed‐size and hospital type (private or public) was studied using data on this clinical indicator submitted to the Australian Council on Healthcare Standards Care Evaluation Program (ACHS CEP) by hospitals presenting voluntarily for accreditation in 1993.Results: The mean rate of an unplanned return to OR was 0.6% (95% confidence interval 0.5–0.7). After adjusting for potential confounders in a logistic model, the risk of unplanned return to OR did not significantly differ by type of hospital (private, public), and location (rural, metropolitan). The risk of an unplanned return to OR was higher in large compared with small hospitals.Conclusions: The finding of the risk of the event being greater in large compared with small hospitals is likely to be a reflection of casemix. An internal review of results (for any facility) is obviously necessary. With some operations a higher incidence of return to the OR may indicate vigilance in peri‐operative manag

ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1996.tb00691.x

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY

摘要:

Background: The practice of laparoscopic cholecystectomy in a community hospital is presented. The morbidity of the procedure is analysed and recommendations for improvement are made. Laparoscopic cholecystectomy was introduced into this 200 bed community hospital in October 1990. All five general surgeons accredited to the hospital agreed to participate in a quality assurance programme to determine the incidence of complications and to make recommendations for improvement.Methods: The records of all 534 patients having laparoscopic cholecystectomy between October 1990 and September 1993 were reviewed, and all complications recorded.Results: Of the 534 cases reviewed in the study 470 were considered uncomplicated and 64 patients experienced a total of 85 postoperative complications. The death of one patient was caused by a pulmonary embolus and another patient experienced a myocardial infarction. Twenty patients has postoperative atelectasis or pneumonia and urinary infection or retention occurred in seven. Complications of laparoscopic cholecystectomy requiring a conversion to open cholecystectomy occurred in eight patients, biliary complications occurred in 18 and 11 patients required re‐operation.Conclusions: Three areas of concern were identified. They were the incidence of major biliary injury (0.37% of all cases) and its management, the role of cholangiography. and the incidence and prophylaxis of deep venous thrombosis and pulmonary embolism. Recommendations for improvement in these areas were mad

ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1996.tb00692.x

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY

摘要:

Background: Operative cholangiograms during the year of introduction of laparoscopic cholecystectomy were reviewed to examine their quality and interpretation.Methods: 149 operative cholangiogram films (34 open and 115 laparoscopic) were reviewed retrospectively by a panel and scored for their ability to demonstrate biliary anatomy and detect bile duct stones.Results: Cholangiography performed by the cystic duct was of similar quality, whether performed laparoscopically or open. Cholangiography via the cystic duct (conventional films) produces superior results for both anatomical delineation and detection of choledocholithiasis (80% adequate) than cholangiography performed by direct gallbladder puncture (29–35% adequate).Conclusion: There is no clear evidence to suggest that an intra‐operative specialist radiological review of cholangiograms performed by the cystic duct would improve the detection of bile duct sto

ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1996.tb00693.x

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY

摘要:

Background: Nodular fasciitis is characterized by a proliferation of spindle cells which may be misdiagnosed as sarcomas due to the rich cellularity, mitotic activity and variant morphologic patterns.Methods: This report includes 42 cases of nodular fasciitis and related conditions of skin and soft tissue from the pathology files of the Royal Brisbane Hospital, Queensland, Australia. There were 33 cases of nodular fasciitis, three cases of ossifying fasciitis, three cases of proliferative fasciitis, two cases of proliferative myositis and one case of intravascular fasciitis. Two‐thirds of cases were referred from outside Royal Brisbane Hospital.Results: Nodular fasciitis and ossifying fasciitis occurred most commonly in young adults with 16 patients (44%) between the ages of 20 and 29. However, the other variants of nodular fasciitis including proliferative fasciitis, proliferative myositis and intravascular fasciitis occurred in older people (six patients being older than 49 years) and more commonly occurring in men (n= 5). A painless, rapidly growing mass was most common. The lesions of nodular fasciitis were most often located in the upper extremity with the forearm most commonly affected.Conclusions: Nodular fasciitis and related conditions are benign. All patients are alive and well 3 months to 13 years (mean 7.2 years) after simple local resectio

ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1996.tb00694.x

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY

摘要:

Background: Ten Vietnamese boat people with septicaemic shock or pneumoperitoneum were admitted between April and July 1993.Methods: In order to investigate the cause of unexplained septicaemic shock and spontaneous pneumoperitoneum in Vietnamese boat people, an audit was carried out. Attention was paid to the mode of presentation, abnormal physical signs, presence of injection marks, radiological signs, subsequent progress and outcome.Results: The clinical and radiological findings were all in favour of self‐inflicted conditions. A retrospective review from the hospital record revealed that the emergency admission rate and disappearance rate of the Vietnamese boat people was higher than those of other patients (P<0.001).Conclusion: It is concluded that self‐inflicted conditions are a serious problem among the Vietnamese boat people, who may use hospital admission to avoid the detention cen

ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1996.tb00695.x

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY

摘要:

Background: Brachial plexus injuries cause a devastating loss of function in the arm. The aim of this study was to review the results of surgical treatment of patients with brachial plexus injuries.Methods: Forty‐seven patients were reviewed. Five patients did not undergo surgery. Forty‐two patients had exploration and 38 had primary surgery with neurolysis, nerve graft or neurotization or a combination. Four patients had other reconstructive surgery primarily. Secondary reconstructive surgery consisted of joint fusions and tendon transfers to enhance or replace the primary surgery.Results: Nerve grafting achieved 62% Medical Research Council (MRC) grade M3 or better. Intercostal neurotization (ICN) of the musculocutaneous nerve (MCN) for elbow flexion achieved M3 or better in 69% of patients.Conclusions: Primary nerve reconstruction, combined with joint fusions and tendon transfers, provides a worthwhile return of function to many patients. We advise early exploration (i. e. within 2 weeks when possible) for patients with complete C5‐T1 lesions or C5, 6, 7 lesions in conjunction with high energy injuries. In order to obtain optimal results patients with brachial plexus injuries should be referred to appropriate units as early as pos

ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1996.tb00696.x

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY

摘要:

Background: Single‐layer intestinal anastomoses have been constructed conventionally using an interrupted suture technique. It is, however, increasingly popular to perform such anastomosis using a continuous suture.Methods: One hundred and eighty consecutive patients with 254 continuous single‐layer anastomoses performed over a 4 year period were included in the study. Sixty‐one patients underwent oesophagectomy, oesophageal bypass or gastrectomy, 32 underwent biliary bypass, hepatic, biliary or pancreatic resection and 88 had colorectal operations. The median age was 67 years.Results: There were 254 anastomoses of which four leaked (1.6%). Fifteen patients (8.3%) died in hospital.Conclusion: These results show that the single‐layer continuous suture technique is safe in gastrointestinal anas

ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1996.tb00697.x

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY