ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1993.tb00023.x

出版商:Blackwell Publishing Ltd    

年代:1993

数据来源: WILEY

摘要:

The advent of laparoscopic cholecystectomy (LC) has led to some controversy regarding the best method of managing bile duct calculi. This paper reviews the cases of 38 patients who underwent LC and endoscopic retrograde cholangiopancreatography (ERCP), from a series of 600 consecutive laparoscopic cholecystectomies. Twenty‐nine patients had ERCP performed pre‐operatively because of suspicion of choledocholithiasis. Duct stones were confirmed in eight patients. Recent or current jaundice was the best predictor of bile duct stones. Nine patients had ERCP done postoperatively because of duct stones seen on operative cholangiography. In two patients bile duct cannulation was not possible and a third procedure, open duct exploration, was necessary.Techniques in laparoscopic management of duct stones are improving and the role of ERCP and sphinc‐terotomy should be limited to jaundiced patients or those with proven bile duct stones in whom laparoscopic procedures have been unsucce

ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1993.tb00024.x

出版商:Blackwell Publishing Ltd    

年代:1993

数据来源: WILEY

摘要:

Pain management is an essential part of postoperative care. The present availability of multiple modalities of patient controlled and continuous regional analgesia requires the reorganization of existing hospital structures to be efficacious and safe. This article presents an Acute Pain Service (APS) as a model for a reorganized structure. Although anaesthesia based, this service requires close co‐operation of surgeons, nurses and other paramedical personnel to achieve the expected results.Prerequisites of an APS are careful selection of suitable techniques as well as the formulation of protocols and standing orders for the techniques. Inservice training of involved personnel, dedicated single ward trials and introduction of the revised technique for general use are further essential steps in its development.The organizational structures proposed include selection of the appropriate technique for a patient by the theatre anaesthetist, preparation and documentation by the recovery nurse, monitoring and ongoing skilled assessment by the ward nurse and ward rounds, advice and 24 h availability by anaesthetist

ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1993.tb00025.x

出版商:Blackwell Publishing Ltd    

年代:1993

数据来源: WILEY

摘要:

The hospital separation records for 1987 in the health planning regions of South Australia were reviewed using a selection algorithm to identify all hospitalizations involving a lumbar spine surgery (LSS) for low back or leg pain. Among 16 health planning regions (two additional regions were excluded from the analysis because of the low number of observations) the LSS rate varied almost four‐fold, from 25 to 92/100000, with a mean of 55/100000.The effect of 24 socioeconomic and health care supply characteristic variables upon observed differences in rates were tested. The unemployment rate was the only significant variable in the analysis, explaining 11 % of the variation in the surgery rates for the 16 regions. This finding is in agreement with studies from other countries that suggest that characteristics of small areas do not substantially predict the rates of elective surgical procedures. The decision‐making processes of surgeons and their patients remain poorly defined; the contributions to the rate of lumbar spine surgery by the health care delivery system, physician behaviours or patient expectations are not yet identif

ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1993.tb00026.x

出版商:Blackwell Publishing Ltd    

年代:1993

数据来源: WILEY

摘要:

This report describes the epidemiology of pedestrian injury in four inner metropolitan local government areas of Sydney. These data were obtained from the Roads and Traffic Authority of New South Wales. The spectrum of injury and clinical outcome was defined in patients with an Injury Severity Score (ISS)>15 admitted from the study area, during a 1 year period, to the four inner metropolitan teaching hospitals. The incidence of pedestrian death was 3.3 times the state average of 32/106/year. An average of 235 pedestrians, injured in the study area, were hospitalized each year during the period 1987–89. On average 24 pedestrians died each year, seven at the scene and 17 in hospital.Fifty patients (ISS>15) were admitted to the four teaching hospitals during a 1 year period 1990–91. Forty‐five were adults and five children. Multiplicity of injury was seen in 68% of patients. The pelvis and lower extremities were involved in 70%, the head in 66% and chest in 42%. The hospital mortality rate was 30% with five patients dying on the first day from blood loss and nine dying during subsequent days from head injury.This study has important implications for trauma service development. Successful clinical management of the severely injured pedestrian requires close co‐operation between pre‐hospital and hospital care providers. An integrated hospital trauma team response is mandatory to ensure appropriate management of what is often a shocked, hypoxic. head‐inju

ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1993.tb00027.x

出版商:Blackwell Publishing Ltd    

年代:1993

数据来源: WILEY

摘要:

Seven patients with renal cell carcinoma involving the inferior vena cava underwent surgical resection between 1975 and 1991. Pre‐operative staging defined five patients with stage T3bNoMo disease, one patient with stage T3bN1Mo, and one patient with stage T3bNoM 1 disease.1At operation one patient had tumour thrombus filling the right atrium. Two patients had tumour thrombus within the intrahepatic vena cava and four infrahepatic tumour thrombus. The mean follow‐up is 34.4 months (median 40 months). Four patients have been followed for over 4 years. Three of these patients are survivors, two have remained disease‐free since their initial surgery. The other patient had a liver resection at 49 months for a solitary metastases; he is currently disease free. One patient died at 38 months from a gastrointesinal haemorrhage. Three patients are 12 months or less postoperation. Operative mortality was zero. The mean postoperative hospital stay was 14.7 days.Data suggests that 3–10% of renal cell carcinomas will involve the inferior vena cava.2The small number of patients in this series suggests that many patients with renal cell carcinoma involving the inferior vena cava are not referred for surgical assessment. These patients are potential surgical candidates. Their survival after surgical resection, excluding the group with extension of tumour thrombus into the hepatic cava or above, is not reduced when compared with other patients with renal carci

ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1993.tb00028.x

出版商:Blackwell Publishing Ltd    

年代:1993

数据来源: WILEY

摘要:

Eleven patients with primary cerebral lymphoma were treated at a single institution over a 5 year period. Patient characteristics were typical of this rare disease. One patient died prior to receiving treatment and of the remaining 10, all received cranial irradiation and in addition, five received systemic cyclophosphamide, adriamycin, vincristine and prednisolone (CHOP) chemotherapy. Of the six patients who are alive and disease‐free, five received the combined modality therapy. The median survival for those patients receiving cranial irradiation alone was 18 months and for the combined modalities was 25+ months. Combination systemic chemotherapy, in addition to cerebral irradiation, may convey a survival benefit in patients with primary cerebral lymphoma but this requires further investigation with multicentre, prospective randomized trial

ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1993.tb00029.x

出版商:Blackwell Publishing Ltd    

年代:1993

数据来源: WILEY

摘要:

An epidemiological survey of all primary central nervous system tumours in Australia was commenced in 1986. Cases were reported by the treating physician to the Australian Brain Tumour Register, located at the Victorian Cancer Registry. Ninety‐three per cent of tumours were histologically confirmed and 69% were reviewed by an independent pathology panel. During the initial 3 years of the survey a total of 4577 brain tumours and 266 primary spinal cord tumours were reported to the Register. The age standardized rates for malignant tumours of the central nervous system, sum to 5.0/100000 males and 3.4/100000 females.Twenty‐eight per cent of gliomas were biopsied only. Radiotherapy was administered to 57% of cerebral gliomas and 2% of these tumours were treated with adjuvant chemotherapy. Forty per cent of meningiomas were considered to have had a complete tumour resect

ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1993.tb00030.x

出版商:Blackwell Publishing Ltd    

年代:1993

数据来源: WILEY

摘要:

Acute small bowel obstruction is commonly due to band adhesions.1In the past it has had an overall mortality rate of up to 11 % for elderly patients.1In this paper we report three cases of small bowel obstruction, treated by laparoscopic division of the causative bands. All patients recovered rapidly and were discharged within 5 days of surgery.

ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1993.tb00031.x

出版商:Blackwell Publishing Ltd    

年代:1993

数据来源: WILEY

摘要:

A method for simply and accurately locating the umbilicus in abdominoplasty is described. The method uses a shaped wire and ink.

ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1993.tb00032.x

出版商:Blackwell Publishing Ltd    

年代:1993

数据来源: WILEY