Journal of the Royal College of Surgeons of Edinburgh最新文献_第9页

Anorectal malformations in female children--10 years experience. 女童肛门直肠畸形-10年经验。

Journal of the Royal College of Surgeons of Edinburgh Pub Date : 2000-06-01

M A Hashmi, S Hashmi

{"title":"Anorectal malformations in female children--10 years experience.","authors":"M A Hashmi, S Hashmi","doi":"","DOIUrl":"","url":null,"abstract":"Despite enormous interest in the development of an ideal operative procedure to treat anorectal malformations, the situation is as confusing as it was 30 years ago. The reasons could be inconsistency of the nature of the lesions found in patients along with multi-system associated malformations primarily affecting the prognosis of available procedures. High imperforate anus is a complex anomaly that requires a combination of careful preservation of structures and precise anatomic reconstruction for optimal results. A retrospective study, comprising a consecutive sample of female children with anorectal malformations treated over a period of 10 years, is presented. Of 130 patients, 83% (n = 108) presented later than 3 months of age as they could pass stools through associated fistulae, of which the commonest type was found to be an ano- or recto-vestibular fistula (65%, n = 83). Ninety-four cases (72%) had what are traditionally known as \"low\" anorectal malformations (perineal fistulae, anteriorly placed anus and anorecto-vestibular fistulae). Ten percent (n = 14) had translevator, and 17% (n = 22) were found to have \"high\" lesions. Seventeen percent of patients (n = 22) had associated congenital malformations, predominantly in intermediate and high anorectal lesions, 40% of which pertained to the urogenital system. In total, 137 definitive operative procedures were done including Mollard's anterior perineal approach in 81 patients and posterior sagittal anorecto plasty (PSARP) in 38, enabling a comparison to be made of the functional results and complications in the two groups. Out of 24 post-operative complications noted in the series, 17 were found in the group who had Mollard's procedure carried out (including 3 deaths) as compared with 7 in these cases who had PSARP (two-sided P utilizing Fisher's exact test = 0.475).","PeriodicalId":76058,"journal":{"name":"Journal of the Royal College of Surgeons of Edinburgh","volume":"45 3","pages":"153-8"},"PeriodicalIF":0.0,"publicationDate":"2000-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"21724190","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Centralisation of oesophageal cancer services; the view from the periphery. 集中食管癌服务;周边的景色。

Journal of the Royal College of Surgeons of Edinburgh Pub Date : 2000-06-01

A A Milne, J Skinner, G Browning

{"title":"Centralisation of oesophageal cancer services; the view from the periphery.","authors":"A A Milne, J Skinner, G Browning","doi":"","DOIUrl":"","url":null,"abstract":"There is debate as to whether patients requiring resection for oesophageal cancer should be referred to specialist centralised units rather than being managed by general surgeons in district general hospitals (DGH). The aim of this study was to determine the effects of centralising oesophageal cancer surgery on outcome and quality of service for patients with oesophageal cancer in a peripheral region. Patients with biopsy proven oesophageal cancer diagnosed over a 4 year period were identified from pathology records. Patients were divided into two groups; Group 1 (n = 60) from the first two years of the study who had any surgery performed by a general surgeon within the DGH and Group 2 (n = 53) from the latter two years of the study who had any surgery performed in a regional cardiothoracic unit. The post-operative mortality rate was lower in the specialist unit, 5.6% vs. 12.5%, but this was not statistically significant. There were no significant differences in survival rates; 3 month, 1 year, 2 year and 3 year survival rates were 63% vs. 62%, 24% vs. 25%, 12% vs. 8% and 7% vs. 6% in Groups 1 and 2, respectively. Referral rates for a surgical opinion were significantly lower in Group 2--92% vs. 63% p < 0.01 by Chi-squared test. Patients waited significantly longer from diagnosis to definitive treatment in Group 2--median 15 days vs. 23 days p = 0.17 by Mann-Whitney test. In conclusion, survival rates are not necessarily improved by centralisation of oesophageal cancer surgery and quality of service may be poorer.","PeriodicalId":76058,"journal":{"name":"Journal of the Royal College of Surgeons of Edinburgh","volume":"45 3","pages":"164-7"},"PeriodicalIF":0.0,"publicationDate":"2000-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"21724192","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Abdominal aortic aneurysms. 腹主动脉瘤。

Journal of the Royal College of Surgeons of Edinburgh Pub Date : 2000-06-01

E Macaulay, J Engeset

引用次数: 0

The management of femoral and tibial diaphyseal fractures. 股胫骨干骨折的处理。

Journal of the Royal College of Surgeons of Edinburgh Pub Date : 2000-06-01

S G Doig

引用次数: 0

Deaths following hernia surgery: room for improvement. 疝气手术后的死亡:改善的空间。

Journal of the Royal College of Surgeons of Edinburgh Pub Date : 2000-06-01

E McGugan, H Burton, S J Nixon, A M Thompson

{"title":"Deaths following hernia surgery: room for improvement.","authors":"E McGugan, H Burton, S J Nixon, A M Thompson","doi":"","DOIUrl":"","url":null,"abstract":"Background: Abdominal wall herniae are common and may well lead to death. The aim of this study was to examine the deaths of patients with an inguinal, femoral or incisional hernia to identify aspects of management which could be improved upon.Method: Data collected by the Scottish Audit of Surgical Mortality 1994-1997 was analysed by interrogation of the database for all deaths on a surgical ward or within 30 days of surgery where the principle diagnosis was inguinal, fermoral or incisional hernia.Results: There were 133 deaths out of 31,525 operations over the 4-year period. Mortality was highest among femoral hernia operations in women (37 deaths/1184 operations; 3.1%) and 59% of femoral hernia surgery was performed outwith normal working hours. The 133 patients were elderly (mean age 79 years) and unfit, but less than half the operations involved consultant anaesthetists or consultant surgeons. Delay in referral contributed to death in 15/133 patients and adverse factors in management, particularly in the perioperative period, caused the death of 2 patients and contributed to the death of a further 29/133.Conclusions: Herniae carry a significant mortality in elderly, unfit patients who require close attention to perioperative management. These patients should be anaesthetised and operated upon by consultant staff during the normal working day.","PeriodicalId":76058,"journal":{"name":"Journal of the Royal College of Surgeons of Edinburgh","volume":"45 3","pages":"183-6"},"PeriodicalIF":0.0,"publicationDate":"2000-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"21724196","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Correlating clinical appearance of nasopharyngeal carcinoma with tumour staging. 鼻咽癌临床表现与肿瘤分期的关系。

Journal of the Royal College of Surgeons of Edinburgh Pub Date : 2000-06-01

W K Low, J L Leong

引用次数: 0

Would measurement of C-reactive protein reduce the rate of negative exploration for acute appendicitis? c反应蛋白检测是否会降低急性阑尾炎的阴性探查率?

Journal of the Royal College of Surgeons of Edinburgh Pub Date : 2000-06-01

S J Parker

引用次数: 0

Would measurement of C-reactive protein reduce the rate of negative exploration for acute appendicitis? c反应蛋白检测是否会降低急性阑尾炎的阴性探查率?

Journal of the Royal College of Surgeons of Edinburgh Pub Date : 2000-06-01

E D Babu