ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1988.tb00960.x

出版商:Blackwell Publishing Ltd    

年代:1988

数据来源: WILEY

ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1988.tb00961.x

出版商:Blackwell Publishing Ltd    

年代:1988

数据来源: WILEY

摘要:

The fundamental changes in body composition which accompany surgical illness are loss of body protein, gain in extracellular water, and erosion of body fat stores. The rate at which each of these processes occurs and the balance between them determine the clinical picture observed and an understanding of them opens the door to intelligent management of many complex disorders. Recent advances in technology have lent impetus to body composition research and a number of new findings have major implications for clinical practice. In this review, some of the work from the body composition laboratories in the University Department of Surgery at Auckland Hospital will be described with special emphasis on that which is directly relevant to the practising surgeon.

ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1988.tb00962.x

出版商:Blackwell Publishing Ltd    

年代:1988

数据来源: WILEY

摘要:

A total of 246 operations were performed in 230 patients for correction of acquired tricuspid valve disease. All but three of the patients had multivalvular heart disease. There was an 11% hospital mortality which fell to 7% in the later era (1973–82). Mortality was similar for tricuspid annuloplasty and tricuspid replacement and for double and triple valve surgery. On multivariate analysis the incremental risk factors for hospital death were extreme functional disability (Class V), being of Caucasian race, and having a high cardiothoracic ratio (CTR). Actuarial survival was 58% at 9 years postoperative. The incremental risk factors for late death were prior cardiac surgery, age at operation ≥ 55 years. and advanced functional disability (Classes IV, V). The actuarial incidence of significant tricuspid incompetence following annuloplasty was 12% at 3 years, and following stented homograft semilunar valve replacement was 6% at 3 years and 24% at 8 years. Severe homograft valve incompetence was always associated with recurrent left‐sided valve lesions or residual pulmonary hypertension. It is concluded that a homograft valve is a superior form of bicuspid valve replac

ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1988.tb00963.x

出版商:Blackwell Publishing Ltd    

年代:1988

数据来源: WILEY

摘要:

A group of patients with diagnosed primary hyperparathyroidism (PHP) in Auckland between 1982 and 1986 is reviewed. Of the 119 patients, 55 had pre‐operative scanning, 36 had no scanning prior to surgery and 29 were managed conservatively.Of the 52 patients who had pre‐operative localization with ultrasound scanning, only 27 (52%) had their adenoma correctly predicted upon neck exploration. Of the 14 patients investigated with thallium‐201 and technetium‐99m (Tl/Tc) subtraction scanning, 10 (71%) had their adenoma positively identified in the predicted locations, whereas the cause of the parathyroid pathology was correctly identified in 33 of the 36 patients (92%) who had surgery alone with no pre‐operative scanning.In 11 patients both ultrasound and Tl/Tc subtraction scanning were employed. In eight patients the results of the two scanning modalities agreed, and in seven of these eight patients the adenoma was correctly predicted (six single adenomas and one with double adenoma). In the three patients in whom the results of the two modalities differed, the Tl/Tc subtraction scanning correctly predicted the site of the adenoma in two patients and in the third patient (with a small 223 mg adenoma) both modalities were incorrect.Of the six patients with histologically proven parathyroid hyperplasia, only three had pre‐operative localization with ultrasound alone, and all three had incorrect predictions (one false positive for adenoma, and two false negative scans).Overall the results cast doubt over the usefulness of pre‐operative scanning as a routine investigation prior to initial neck exploration for primary hyperparathyroidism. However Tl/Tc subtraction scanning in particular may be useful in aiding surgical decision making for patients undergoing ‘redo’ neck exploration. Pre‐operative scanning was unhelpful in detecting hyperplasia. In the detection of adenomas Tl/Tc subtraction scanning was superior to ultrasound (71% vs 52%), but when both scanning modalities were employed, and both yielded the same results, the position of the adenoma was correctly predicted in seven out of eight cases. The results also emphasize the importance of the 24 h urinary calcium determination as part of the work‐up of the h

ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1988.tb00964.x

出版商:Blackwell Publishing Ltd    

年代:1988

数据来源: WILEY

摘要:

The survival of 78 patients with Dukes' B colorectal carcinoma was evaluated in relation to the presence (36 patients) or absence (42 patients) of tumour cells within lymphatic capillaries. Age‐adjusted survival analysis did not reveal a statistically significant difference in survival between these two group

ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1988.tb00965.x

出版商:Blackwell Publishing Ltd    

年代:1988

数据来源: WILEY

摘要:

A controlled randomized clinical trial was undertaken to assess the ability of combined non‐specific and specific immunotherapy to alter the disease‐free interval and overall survival of patients with Stage B or C large bowel cancer. The immunotherapy consisted of a 2 year programme of vaccinations with BCG and neuraminidase‐treated autologous tumour cells. Three hundred and one patients entered the trial. At 5 years of follow‐up there is no evidence that this form of immunotherapy can alter either the disease‐free interval or survival in this group of

ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1988.tb00966.x

出版商:Blackwell Publishing Ltd    

年代:1988

数据来源: WILEY

摘要:

A series of 227 consecutive laparoscopies performed over 3 years at a provincial hospital in the North Solomons Province is presented. There were no deaths due to the procedure and morbidity was 2.4%. Positive findings were revealed in 89% of patients, allowing rapid decisions to be made regarding patient management: a vital consideration in a busy surgical unit with limited resources.Laparoscopy provides an efficient, safe, rapid and direct approach to many abdominal problems encountered in general surgery, particularly liver disease, blunt abdominal trauma, intraperitoneal infection and neoplasia.

ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1988.tb00967.x

出版商:Blackwell Publishing Ltd    

年代:1988

数据来源: WILEY

摘要:

Dorsal enteric cysts have been recognized in association with a wide variety of developmental anomalies of the back, the spine, the central nervous system, the mediastinum and the gut. These lesions can be lethal and they caused the deaths of three of the eight patients in this study: two from meningitis and one from erosion into the aorta. Two of these deaths might have been prevented if they had been fully investigated earlier and the life‐threatening components of these complex lesions removed. In the most recent case, however, the lesion was detected antenatally, expediting postnatal investigation and surgery. Three of the five survivors have neurological sequelae attributable to their intraspinal patholog

ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1988.tb00968.x

出版商:Blackwell Publishing Ltd    

年代:1988

数据来源: WILEY

摘要:

Injection studies were done in cadavers to demonstrate the blood supply of scrotal flaps and lay the foundation of the basis of their use in regional reconstruction. Eighty‐seven scrotal flaps, antero‐lateral. posterior, extended posterior and bipedicled (including de‐epidermized flaps) were used as peninsular or island flaps in 60 patients and 64 situations. The flaps were used for lengthening of phallus stumps. neophalloplasty, providing groin cover, urethral repair, construction of simulated testis, hernioplasty and for providing cover in a precise manner after scrotectomy in filarial scrotum and other condi

ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1988.tb00969.x

出版商:Blackwell Publishing Ltd    

年代:1988

数据来源: WILEY