ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1989.tb01455.x

出版商:Blackwell Publishing Ltd    

年代:1989

数据来源: WILEY

ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1989.tb01456.x

出版商:Blackwell Publishing Ltd    

年代:1989

数据来源: WILEY

摘要:

Helothane hepatitis is a rare but sometimes fatal complication of halothane anaesthesia. Examination of case reports has pointed to a number of risk factors. Studies in animals and humans in the laboratory have provided evidence of a complex multifactorial basis for halothane hepatotoxicity, with the following factors playing a part: genetic predisposition; metabolism of halothane; repeated halothane anaesthetics; female sex; age of patient; intrahepatic hypoxia; and enzyme induction. Immunologic changes can be detected in a high percentage of cases of halothane hepatitis; however, studies establishing a cause‐effect relationship are not available to determine if these changes cause, or result from, hepatic damag

ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1989.tb01457.x

出版商:Blackwell Publishing Ltd    

年代:1989

数据来源: WILEY

摘要:

The records of all cases of injury to the cervical spine sustained in road crashes for the 6 year period (1 january 1981 to 31 december 1986) which were admitted to the spinal injuries unit of the royal adelaide hospital to the adelaide children's hospital, or were identified at post‐mortem examination were examined and the relevant data extracted. There were 291 cases in the non‐fatal group, and 161 in the fatal group. These represent a complete enumeration of all such patients in the state of south australia over the 6 year period, given that up to 50% of cervical injuries in fatal cases can be missed. Comparison of the two groups showed that the fatal group had a much higher proportion of pedestrians, and persons over 50 years of age. About one‐half of the fatal group had injuries at the level of ci or the atlanto‐occipital articulation. The most frequent level of injury in the non‐fatal group was c2 (29.2%). About 30% of the non‐fatal cases had some spinal cord damage. Case fatality rates were calculated, and ranged from 100% for injury at the atlanto‐occipital articulation to 8% at c2. The fatality rate of pedestrians was about 4 times higher than that of vehicle occupants. About three‐quarters of all cervical spine injuries occurred in vehicle occupants. There was an increase in the number of cases occurring in each year of the period studied. This rise was noted in non‐fatal cases, in males, in vehicle occupants, and in crash

ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1989.tb01458.x

出版商:Blackwell Publishing Ltd    

年代:1989

数据来源: WILEY

摘要:

Perihepatic packing was used in 25 of 197 (12.7%) patients presenting with liver trauma to westmead hospital over an 8 year period. Packing was used either to provide temporary haemostasis prior to transfer or as part of a definitive treatment plan at this hospital. Thirteen patients were packed prior to transfer. Only two were unstable on arrival, one of whom died. They were compared with 18 ‘comparison’ patients with liver injuries of similar severity. In this group 10 were unstable on arrival (p= 0.027). Nine of whom died (p= 0.015). Packing was used as part of a definitive treatment plan at westmead on 17 occasions. Four patients were coagulopathic and five had also been packed prior to arrival. Eight of this group died.Packing is a convenient and safe way of controlling major hepatic haemorrhage prior to transfer to a tertiary referral centre. It may also be part of a definitive treatment plan to control hepatic bleeding especially as many patients arrive with a coagulopathy or develop a coagulopathy during the course of surgery to control bleeding. Packing will control haemorrhage until the coagulopathy has been correc

ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1989.tb01459.x

出版商:Blackwell Publishing Ltd    

年代:1989

数据来源: WILEY

摘要:

The management of 27 patients who presented with cholangiocarcinoma of the hepatic confluence over the past 20 years is reviewed, and the dramatic changes, both in accuracy of diagnosis and modes of treatment, are documented. All 27 presented with jaundice, three underwent laparotomy only, four had a t‐tube inserted, one had a straight transhepatic tube inserted, seven u‐tubes were placed and four patients underwent surgical resection. More recently, seven patients were drained percutaneously and a further patient was treated by an endoscopic stent. There were six postoperative deaths. Of the 24 who received active treatment, the mean survival was 8 months with a range of 0–40 months. The advantages and disadvantages of the various methods of diagnosis and treatment are discussed. The possible role of radiotherapy and chemotherapy are reviewed br

ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1989.tb01460.x

出版商:Blackwell Publishing Ltd    

年代:1989

数据来源: WILEY

摘要:

This study evaluates prospectively the reliability of computerized tomography (ct) in the pre‐operative staging of 80 patients with rectal cancer. The scans were performed and reviewed by one radiologist without knowledge of either the operative findings or the final clinicopathological stage of the tumours.Fourteen of 60 patients (23%) who had a potentially curative resection were correctly staged by ct. The tumour was understaged in 28 patients (47%) and was overstaged in 18 patients (30%). Ct did not identify the one patient with histological demonstration of invasion of an adjacent organ and was equivocal or incorrect in 10 others on the, question of adjacent organ invasion. Ct failed to define accurately local tumour spread confined to the rectal wall (positive predictive value (ppv) 23%). Identify venous invasion (ppv 35%) or involved regional lymph nodes (ppv 42%). However, the negative predictive value for excluding synchronous liver metastases was 90%, and 11 patients who subsequently developed histologically confirmed local recurrence were all correctly diagnosed on ct.These findings suggest that pre‐operative examination of patients with rectal cancer by ct is not routinely justified specifically for purposes of staging the dise

ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1989.tb01461.x

出版商:Blackwell Publishing Ltd    

年代:1989

数据来源: WILEY

摘要:

Survival in 38 patients with bilateral breast cancer has been studied. The tumours were synchronous in 14 patients and metachronous in 24. Survival was less than that predicted for either tumour on the basis of a previously developed index involving lymph node status, oestrogen receptor content, progesterone receptor content, and patient age. Simple addition of the indices for the two tumours gave a better predictor although this also overstated the prospects for survival for both synchronous and metachronous tumours. This experience suggests, therefore, that the prospects of survival for patients with synchronous or metachronous bilateral breast carcinoma is poor, and worse than might reasonably be anticipated.

ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1989.tb01462.x

出版商:Blackwell Publishing Ltd    

年代:1989

数据来源: WILEY

摘要:

This report comprises a retrospective review of the clinical data on 157 patients seen in the auckland area having a diagnosis of cancer of the tongue, floor of the mouth, inferior alveolus, or buccal mucosa (retromolar area, vestibule of the mouth, and cheek mucosa) during 1970–86. One hundred patients were male, 95% were european, 85% were cigarette smokers, and 58% had a history of high alcohol intake. All primary tumours were squamous cell carcinomas, 50% were located in the tongue, 27% in the floor of the mouth, and 11.5% each in the buccal mucosa and inferior alveolus. The majority (60%) of patients with tongue cancer were clinically stage i at presentation while other intra‐oral tumours were evenly distributed between stages i and iv. Surgical resection of the primary intra‐oral lesion produced local control in 90% of stage i tumours, but this fell to below 70% in stage ii—iv tumours. Most patients (82%) who recurred locally had positive or ‘close’ margins, and this rate of local tumour recurrence as a consequence of narrow margins did not decrease with the addition of adjuvant radiotherapy. Of those patients with stage i disease who received only treatment of the primary lesion, 20% later developed regional nodal disease which was controlled in more than half by neck dissection, but control was achieved only in 11% of patients treated with radiation. The presence of regional disease at presentation was associated with a poor prognosis.It is concluded that local control of inferior oral cavity tumours can be achieved if resection is accomplished with clear margins. Regional control can be obtained in 50% of patients with neck dissection. Considered together, the high rate of regional recurrence with stage i lesions, and the poor results following salvage therapy (12% 2 year survival) indicate that these patients require as aggressive initial therapy (often involving neck dissection) as do those with more advan

ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1989.tb01463.x

出版商:Blackwell Publishing Ltd    

年代:1989

数据来源: WILEY

摘要:

Fine needle aspiration biopsy (fnab) of salivary glands was performed in 187 patients. In 106 patients with satisfactory fnab smears who proceeded to surgery, the original cytologic diagnosis was compared with subsequent histopathology. There were 74 benign tumours and 25 malignant tumours. Nineteen of the latter were primary malignant neoplasms of the salivary glands and 6 were metastatic. The cytologic diagnosis by fnab correlated exactly with the histologic diagnosis in 95% of benign neoplasms and in 68% of malignant neoplasms with an overall accuracy of 88%. A false negative diagnosis for malignancy was male in five cases and a false positive diagnosis in one case. Hence the sensitivity for malignancy was 80% and the specificity was 99%. The most frequently misdiagnosed lesions were pleomorphic adenoma and mucoepidermoid carcinoma.Fnab of salivary gland lesions is easy to perform and free of complications, but the cytologic patterns may be difficult to interpret, and considerable experience is necessary in order to achieve a high diagnostic accuracy.

ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1989.tb01464.x

出版商:Blackwell Publishing Ltd    

年代:1989

数据来源: WILEY