摘要:

SummaryThe mode of healing of the post‐operative prostatic cavity and of the bladder neck have been considered. It is noted that the “false capsule of the prostate behaves as if itwere an abraded muc

ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1958.tb03964.x

出版商:Blackwell Publishing Ltd    

年代:1958

数据来源: WILEY

ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1958.tb03965.x

出版商:Blackwell Publishing Ltd    

年代:1958

数据来源: WILEY

摘要:

SummaryAn account is given of the clinical features and the management of aneurysm of the ab‐dominal aorta. Rupture of the aneurysm is a common terminal event in this condition and it is desirable that operation should be undertaken before rupture occurs. Unfortunately many of these patients are not suitable for major surgery.The author's personal series comprises 22 operations for aneurysm of the abdominal aorta. Fifteen of these operations were carried out after the aneurysm had ruptured. Details of operative techniques and results are give

ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1958.tb03966.x

出版商:Blackwell Publishing Ltd    

年代:1958

数据来源: WILEY

摘要:

Summary1The mortality rate for all biliary tract surgery for stone should be in the vicinity of 1 per cent., with a lower figure for elective surgery.2Registrar training does not raise operative mortality. It aids in lowering it.3The addition of choledochostomy to cholecystectomy does not elevate the mortality rate.41. Choledochostomy is required so frequently in biliary tract surgery that there is no place for the cholecystectomist who rarely, if ever, performs it.5The removal of all stones in the bile ducts (Lahey's “third stage) has not yet been achieved.6The relating of operation and admission figures to give an operation rate per thousand admissions is worth investigation.7A follow‐up of 951 patients showed that there were certain reliable indications for biliary tract surgery, certain less reliable ones, and some common errors.8During the follow‐up the opportunity was taken to study biliary colic, jaundice and fatty dyspepsia.9An attempt was made to estimate the likelihood of the development of cancer or of symptoms in those with symptomless gall‐stones.10It would appear from this study that undue reliance on Graham's test can result in a cholecystectomy being performed when the only lesion present is a peptic ulcer.11In view of the vague descriptions of the post‐cholecystectomy syndrome in the literature, this review suggests that the post‐cholecystectomy syndrome is made up of these symptoms which the surgeon thought the operation should have removed. The subject is confused.12This study confirms the very old idea that the patient's history i

ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1958.tb03967.x

出版商:Blackwell Publishing Ltd    

年代:1958

数据来源: WILEY

摘要:

SummaryThe surgical anatomy of five types of intrathoracic complication of liver hydatid disease has been described.Seven case histories, illustrating the clinical picture and the surgical treatment of each type of hepato‐thoracic hydatid disease, are presented. Mr. John Hayward operated on Cases 2, 3 and 5, and I thank him for permission to include their clinical histories inthis series.If the subdiaphragmatic hydatid disease is adequately treated complicating lung abscesses and broncho‐biliary fistulae will heal. Definitive closure of a broncho‐biliary fistula is not indicated and drainage of a lung abscess or pulmonary resection will not be necessary.If pleural complications are present, both these and the liver hydatid require surgical treatment. The empyema contents must be evacuated, the lung and chest wall decorticated and the pleural cavity drained.A large hepato‐pulmonary hydatid cyst is best approached through a long thoraco‐abdominal incision. This exposure makes it more likely that all hydatid cysts will be removed, under vision, from the liver.After removal of the hydatid from the liver, the adventitia, if calcified, should be excised. Haemorrhage is usually severe; but it can usually be controlled. Excision of thecalcified adventitia decreases greatly the period of drainage from the liver cavity‐an infected, calcified liver cavity may drain forever. I am grateful to Mr. Fitzpatrick of Hamilton for suggesting an alternative method of dealing with a liver cavity with a calcified adventitial wall He suggests that the wall be swabbed and scraped, and the cavity closed by suture, and he advises against drainage of such cavities, even when obviously infected. In his extensive experience infection seldom recurs, and it is therefore rarely necessary to re‐operate to drain a liver cavity so treated. This method of treatment certainlyeliminates the possibility of a fatal haemorrhage from the liver during excision of the calcified adventitia.The coughing up of daughter cysts and the finding of daughter cysts in a lung hydatid at operation, usually mean that the patient is suffering from hepato‐thoracic hydatid disease. The liver hydatid should be sought and treated. It is realised that primary lung hydatids occasionally contain daughter cysts and that daughter cysts in a lung or pleural hydatid, which has developed because of spillage of hydatid elements due to a previous operation for lung hydatid, is fairly common.In Australia the commonest cause of the coughing up of bile is hepato‐pulmonar

ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1958.tb03968.x

出版商:Blackwell Publishing Ltd    

年代:1958

数据来源: WILEY

摘要:

SummaryA method of inducing pancreatic necrosis in dogs is described. The possible significance of this in regard to pancreatic necrosis in man is discussed.

ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1958.tb03969.x

出版商:Blackwell Publishing Ltd    

年代:1958

数据来源: WILEY

摘要:

SummaryA case of intestinal duplication which presented as an acute abdominal emergency is reported with the purpose of drawing attention to the condition in its various forms. The embryology and common symptomatology is also discussed.

ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1958.tb03970.x

出版商:Blackwell Publishing Ltd    

年代:1958

数据来源: WILEY

ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1958.tb03971.x

出版商:Blackwell Publishing Ltd    

年代:1958

数据来源: WILEY

摘要:

Summary1The development of induced hypotension is discussed and its hazards briefly outlined.2The superiority of trimetaphan camphor‐sulphonate (Arfonad) for hypotensive purposes is stressed.3The restricted utility of induced hypotension in neurosurgery, and the value of simpler alternatives for the control of bleeding, are indicated.4The necessity for adequate facilities and assistance, as well as for complete liaison between surgeon and anaesthetist in the conduct induced hypotension, is emphasize

ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1958.tb03972.x

出版商:Blackwell Publishing Ltd    

年代:1958

数据来源: WILEY

摘要:

SummaryHypothermia is not a therapeutic measure per se–it merely lowers metabolism and permits the vital organs to withstand prolonged hypoxia. Therefore, the prime indication for therapeutic hypothermia must be reversible hypoxia of vital organs.At present the greatest application is in disorders of the central nervous svstem. To be effective the temperature must be lowered to a point where metabolism is appreciably diminished. The highest useful temperature for central nervous system disorders is 30%C and probably much lower temperatures are more effective, especially if a major bloodsupply to a portion of the brain or spinal cord is to be interrupted.In cases of hyperthermia and in acute infections it is probably not necessary to coolbelow 3244%C.The technique involves surface cooling with sedation to control restlessness and shivering; so far chlorpromazine appears to be the best agent for this purpose. Initial hypertension is controlled by vegolysen.The procedure does not appear to be particularly hazardous provided detailed precautions are observed. The chief danger is ventricular fibrillation which is not a common complication in this type of patient who usually has a normal cardiovascular and respiratory system.There is much conflicting experimental evidence on the metabolic effects of prolonged hypothermia.It is important that we determine in human beings the significance of these alterations in metabolism and particularly whether these changes are normal physiological phenomena for the lower temperatures. It must also be ascertained whether the complex changes associated with hypothermia can be reversed after prolonged periods of low temperatures.With greater knowledge of the physiology, better sedatives and drugs to control shivering and more careful monitoring of the patient, we should be able to achieve even lower temperatures.There is every indication that, under these conditions, hypothermia will have a definite place as an adjunct to modern therap

ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1958.tb03973.x

出版商:Blackwell Publishing Ltd    

年代:1958

数据来源: WILEY