Lasers have been advocated to resect atherosclerotic plaques in the cardiovascular system, yet little information is available regarding the effects of laser on the range of occlusive lesions seen in the peripheral arterial tree. This study was conducted to assess the risk of perforation in human cadaveric aorta involved with variable degrees of atherosclerosis. Ten fresh segments of atherosclerotic human aorta were graded for extent of atherosclerosis, then subjected to argon laser energy within 48 hours. Using air as the conduction medium and with the fiber tip 2 or 5 mm from the vessel wall, the argon laser was applied to matched calcified and non-calcified arteries at 3.0-7.0 W and 10.0-13.5 W with energy density identical for matched pairs. Results were compared among segments which were normal in appearance or had only fatty streaks grossly with those with gross regional wall calcification. The mean penetration time (T) for calcified and non-calcified lesions at low and high power outputs was compared. (table; see text) Mean time to perforation and range of time necessary to produce perforation were greater in calcified than non-calcified segments at all power levels employed. These data suggest that atherosclerotic lesions vary in their response to argon laser. The presence of calcium may preclude resection of some plaques and protect against wall perforation. 相似文献
Objective : To study the effect and safety of laparoscopic cholecystectomy in haemodialysis patients. Method : From May 1994 to December 1998, the clinical progress of nine haemodialysis patients who underwent laparoscopic cholecystectomy were reviewed. Results : Eight patients recovered very well from surgery, while one patient had a mild complication of a collection of seroma represented by ultrasound in the gallbladder region. Conclusions : Perioperative management is important when performing laparoscopic cholecystectomy in patients on haemodialysis. Those patients on well‐managed haemodialysis will tolerate laparoscopic cholecystectomy. 相似文献
Objective : The aim of this study was to investigate the tolerance of warm ischaemia of liver grafts from non‐heart‐beating donors (NHBD). Livers harvested from NHBD would greatly expand the donor pool for transplantation. However, sensitivity of the donor liver to warm ischaemia is a major obstacle to the successful use of livers from NHBD and the limit of non‐heart‐beating time in the donor remains unclear. Materials and Methods : Rat orthotopic liver transplantation was performed in 5 groups (groups 1–5) with non‐heart‐beating time in the donor ranging from zero to 15, 30, 45 and 60 min. The cardiac‐arrest time was counted from clamping the base of the donor’s heart to the beginning of cold flushing the liver. Graft pathological changes, hepatic function and the recipients’ survival rates in each group were compared. Results : With a stepwise increase of the non‐heart‐beating time from zero to 15, 30, 45 and 60 min in donors, the recipient 1‐week survival rates from groups 1–5 were 100%, 75%, 62.5%, 25% and 0%, respectively. The stepwise increase of non‐heart‐beating time significantly reduced recipient survival rates after 30 min. The recipients in groups 1–4 could survive more than 60 days. Conclusions : The liver is less sensitive to warm ischaemia than was formerly believed. Rat liver can be used for transplantation after cardiac arrest for up to 45 min with a chance of survival. 相似文献
Objective: To assess the accuracy of sentinel lymph node biopsy (SLNB) using combined isotope and blue dye mapping technique. Method: Prospective analysis of 50 cases of SLNB in patients with breast cancer. Accuracy was assessed by comparing the histology of sentinel lymph node (SLN) with axillary dissection specimen. Results: Sentinel lymph nodes were localized in 47 cases (94%) and correctly predicted the axillary status in all cases (100% accuracy) with no false negative result. Frozen section analysis of SLN was associated with a 33% false negative rate. Immunohistochemical staining did not improve the detection of metastasis compared with haematoxylin–eosin paraffin sections. Conclusions: Sentinel lymph node biopsy is highly accurate in staging the nodal involvement in breast cancer using the combined mapping technique. Chinese Abstract Figure Chinese Abstract Open in figure viewer PowerPoint
In this short article, we highlight the venous drainage of the right colon with special emphasis on the accessory right colic vein. This vein is easily torn during mobilization of the right colon. It is, however, seldom mentioned in the Western anatomy or surgical textbooks. 相似文献
Two cases of interhemispheric subdural haematoma are presented. None of the patients had any neurological deficit on admission. They developed progressive neurological deficits within a day or two. Surgical treatment was by a large convexity craniectomy and a wide opening of the dura. The dura was left open in one case and primary duroplasty was done in the other. No deliberate attempt was made to remove the interhemispheric clot. Both patients made a quick and complete recovery by this simple procedure. Cranioplasty was carried out subsequently. Chinese Abstract Figure Chinese Abstract Open in figure viewer PowerPoint
A 20‐year‐old male underwent surgery for an occipital extraventricular multicystic tumour. The tumour’s histology was high‐grade anaplastic ependymoma. The clinical course, its radiological appearance and the prognosis are discussed. Chinese Abstract Figure Chinese Abstract Open in figure viewer PowerPoint
A 59‐year‐old Chinese man who presented with signs and symptoms of acute appendicitis is described. The patient received an appendicectomy, and the histology report of the appendix revealed villous adenoma with margin involved. Postoperatively, he developed a colocutaneous fistula and ended up having a right hemicolectomy and fistulectomy. The literature on villous adenoma and other tumours of the appendix is reviewed, and their surgical treatment is discussed. Chinese Abstract Figure Chinese Abstract Open in figure viewer PowerPoint
Anastomotic stricture in colorectal surgery is an established problem. The incidence and aetiology of these strictures are discussed as well as the treatment options. A simple method of resecting those strictures of the rectum that are not amenable to repeated dilatation is described. Chinese Abstract Figure Chinese Abstract Open in figure viewer PowerPoint
Introduction: Cerebrolysin is a compound with neurotropic activities and has a beneficial effect in the treatment of mild and moderate Alzheimer's disease. The present study investigated whether the addition of cerebrolysin to the initial treatment regimen in patients with moderate and severe head injury would improve their functional outcome. Method and Results: At 6 months, 42% of the rehabilitated patients achieved good recovery without significant cognitive deficit. The study group was compared with the historical cohort of patients eligible for active rehabilitation. Despite a younger population of the historical cohort, the functional outcome was not significantly different from the study group. No significant side‐effects requiring cessation of cerebrolysin was noted. Conclusion: Use of cerebrolysin as a part of the initial management of moderate and severe head injuries was safe and well‐tolerated. The result suggests that cerebrolysin is beneficial to the functional outcome in these patients, especially in elderly patients. 相似文献
Objective : Pineal region tumours are composed of a variety of tumour pathologies, for example germinoma, teratoma, pinealocytoma, pinealoblastoma, meningioma and benign pineal glial cyst. They commonly present with mass effect causing obstructive hydrocephalus or Parinaud’s Syndrome. This paper reviews seven patients with pineal region tumour who presented with obstructive hydrocephalus and who received neuroendoscopy as part of the management of their clinical condition. Method : Neuroendoscopic techniques include endoscopic third ventriculoscopy (ETV) and endoscopic third ventriculo‐cisternostomy (ETVC). Diagnostic ETV allows direct visualization, localization and biopsy of the lesion, as well as sampling of cerebrospinal fluid (CSF). Endoscopic third ventriculo‐cisternostomy allows CSF diversion for relief of obstructive hydrocephalus. Results and Conclusion : Four out of seven of the third ventriculoscopy cases had lesions successfully located and biopsy was performed in two cases. Endoscopic third ventriculo‐cisternostomy was performed in all 7 patients. Two patients with unknown pathology relied on ETVC as the only therapeutic procedure. Three patients were followed with subsequent definitive treatment (radiotherapy or surgery). All these patients showed clinical improvement or radiological relief of obstructive hydrocephalus. Minimal complications were recorded among these cases. 相似文献
Situs inversus totalis is a rare anatomical entity. We present a case in a young patient with situs inversis totalis and cholelithiasis, who underwent an uncomplicated laparoscopic cholecystectomy, despite the reversed anatomical relationships. The approach used was a ‘left‐right reversal’ of the conventional four‐port technique. The patient’s postoperative recovery was uneventful. 相似文献
Although primary peritonitis is relatively uncommon, failure of clinical recognition may result in unnecessary surgery and increased morbidity. While primary peritonitis can occur in healthy subjects, it tends to affect females and individuals with certain underlying conditions. Parencentesis and culture remain the key to diagnosis and to deciding modality of treatment. With the advent of antibiotics, surgical management is now reserved for complications or for patients with persistent signs. 相似文献
A case of metachronous non‐anastomotic aneurysms in a bifurcated double velour knitted Dacron aorto‐bifemoral graft is reported. The cause of non‐anastomotic graft aneurysms is most likely due to a basic structural failure in the graft, as a result of defects in fabrication, Dacron fibre deterioration or a combination of both. Local excision of the graft defect with interposition graft replacement is an accepted treatment for local graft failure. However, as fabrication defects and Dacron fibre deterioration are both factors affecting the whole graft, it is not surprising to find multiple aneurysms in the same graft synchronously or metachronously. Thus, a total graft replacement should be the treatment of choice for graft failure. 相似文献
Background: Intestinal perforations are common causes of generalized peritonitis, it is often severe because of faecal contamination and overwhelming sepsis resulting in high morbidity and mortality. The purpose of the present study was to determine the causes and factors affecting the prognosis in patients with generalized peritonitis as a result of intestinal perforation. Study design: Patients with acute generalized peritonitis from intestinal perforation were prospectively studied during a 6‐year period from 1995 to 2000. Personal, preoperative and postoperative clinical information of all the patients was entered into a predesigned proforma. Data were analysed and the effect of individual causes of peritonitis on the postoperative outcome was determined. Results: More males were affected by a ratio of 3 : 1, with the overall mean age of 27.6 ± 18.3 years (SD). The mean age in patients with typhoid perforation was 21 ± 14 years (SD) and highest in traumatic intestinal perforations (47.2 ± 17.6 years, SD). Typhoid perforation occurred in 75 (58%) patients, acute appendicitis in 21 (16.3%), peptic ulcer disease in 18 (14%), trauma in eight (6.3%), five were idiopathic and one malignant sigmoid carcinoid tumour. Wound infection occurred in 74 (58.3%) and mortality in 24 (18.8%) of the patients. Mortality was high in traumatic and typhoid intestinal perforation than other causes of intestinal perforation. Factors such as age, cause of intestinal perforation, and amount of pus drained during operation independently predicts the postoperative morbidity and mortality rates. Conclusion: Typhoid intestinal perforation was the most common cause of acute generalized peritonitis, followed by perforated acute appendicitis. Prognostic factors include age, the causes of perforation, amount of pus, wound infection, wound dehiscence, faecal fistula, and intra‐abdominal abscess. 相似文献
Objective: To review the yield and indications of colonoscopy in a surgical unit at the Prince of Wales Hospital, the result of which may help to select future patients for colonoscopy. Method: The records of 869 patients undergoing elective colonoscopy at the Prince of Wales Hospital within an 18‐month period were reviewed retrospectively. Exclusion criteria included the following: a personal history of colorectal malignancy or polyps, tumours or polyps detectable on rectal examination or rigid sigmoidoscopy, a positive physical examination suggestive of gastrointestinal malignancies, anaemia or positive faecal occult blood. Results: Per rectal bleeding was the most common indication for colonoscopy. Complete colonoscopy rate was 93.7% and abnormalities were reported in 338 patients. Forty‐three patients were found to have cancer whereby age, duration of symptoms, blood mixed with stool and abdominal pain were identified as independent predictive factors. Neoplastic polyps were confirmed in 200 patients. Old age and being male were the only factors predictive of neoplastic polyps. Conclusion: Although the majority of patients present with typical haemorrhoidal bleeding, colonoscopy should be considered seriously for elderly patients, especially those who are male. Chinese Abstract Figure Chinese Abstract Open in figure viewer PowerPoint
Background: Spontaneous supratentorial intracerebral haemorrhage (ICH) accounts for 10–30% of all strokes resulting in a high mortality and major morbidity. Although guidelines for medical treatment and surgical intervention for ICH are available, selection of patients for surgery in this group of patients is controversial and varies greatly throughout the world. Objective: In the current study, we aimed to review our selection criteria for treatment and their management results. Methods: We had prospectively collected the data of patients admitted to our centre with spontaneous supratentorial ICH in a 2‐year period (January 2001–December 2002). We divided the patients into three main groups according to the anatomical site: putaminal, subcortical and deep basal ganglia. Surgical treatment was limited to patients aged below 65 years, with a clot size between 30 and 100 mL, and motor scores of normal flexion to localizing to pain. Results: One hundred and twenty‐four patients were recruited in the current study. Thirty‐four patients managed by early surgery had an 18% mortality, 29% were independent and 53% dependent at 6 months. Early surgery for subcortical haematoma carried the best prognosis (42% achieved independence), whereas deep basal ganglia haematoma carried the worst prognosis (none achieved independence). Conclusions: Although this prospective audit was not intended to be a case–control study, data from the present study support early surgery for patients with putaminal and subcortical haematomas with a clot size larger than 50 mL. For smaller haematomas less than 30 mL, conservative management is associated with a superior clinical outcome. 相似文献
Objective: To review the experience of the management of carotid body tumours in a major vascular centre in mainland China. Patients and methods: This was a retrospective review of 52 cases of carotid body tumour. There were 24 male and 28 female patients with an age range of 18–67 years; and 23 right‐sided, 24 left‐sided and five bilateral lesions. The modality of preoperative imaging was as follows: duplex scan and computed tomography in 40 cases, magnetic resonance imaging in 10 cases, carotid artery angiogram in 32 cases with selective embolization of the feeding vessel in 19. Operative treatment was carried out for 55 lesions and was summarized as follows: simple tumour excision for 44 lesions and en bloc tumour excision together with carotid bifurcation for 11 lesions; ICA reconstruction with interposition graft in three cases; and external to ICA anastomosis in two cases. Results: There were no operative mortalities. Postoperative complications included two ischaemic strokes, one case of vagus nerve damage and one case of hypoglossal nerve damage. Conclusion: Carotid body tumour is a rare neoplasm. Its special anatomical position imposes great difficulty during surgery. Adequate preoperative preparation and embolization of feeding arteries could reduce operative blood loss, improve tumour excision and preserve the ICA flow. 相似文献
