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61.
The success of vertical gastroplasty may be jeopardized by gastric leakage or ulceration due to failure of the technique.
Reports of band erosion and staple-line leakage have led us to seek technical improvements to reduce technical failures. We
describe a modification to the technique of band placement and a manoeuvre to aid the placement of staples when the TA90 staple
gun is used. 相似文献
62.
Downie JR 《Obesity surgery》1992,2(1):75-78
This paper is based on observations on a personal series of patients who presented with severe ulcerating esophagitis, unresponsive
to medical treatment following a vertical stapled gastroplasty. With one exception this was a late complication in an effective
weight loss procedure. The therapeutic modalities chosen to treat this problem depended on patient choice, as well as personal
experience with treating earlier cases. Unfortunately, I could find little guidance in the literature or from my colleagues
on how to treat this problem. Conversion to a Roux-Y gastric bypass seemed the most satisfactory solution to the problem,
relieving the symptoms and maintaining the weight loss. 相似文献
63.
Carolyn R. Freeman B.S. M.B. FRCP Jean-Pierre Farmer M.D. FRCS José. Montes M.D. 《International journal of radiation oncology, biology, physics》1998,41(5):283-987
Developments in imaging and in neurosurgical techniques over the past decade have substantially altered the management of children with low-grade astrocytoma. Indications for surgery have become more clearly defined, and a larger proportion of children undergo complete or subtotal resection than in the past. Fewer receive adjuvant therapy, even though the options in this regard are more numerous now and theoretically likely to result in less morbidity than conventional external beam radiotherapy.
This review will address in particular the correlations between location, imaging appearance, and behavior that need to be more widely appreciated, and present recommendations regarding the management of these tumors. 相似文献
64.
Robert Fox MD MRCOG Robert Holmes MRCOG Mark James MRCOG Jeremy Tuohy MRCOG Peter Wardle MD FRCS MRCOG 《The Australian & New Zealand journal of obstetrics & gynaecology》1998,38(1):27-30
Summary: The aim of this study was to explore the hypothesis that serial transvaginal ultrasonography identifies early evidence of suture failure and that repeat cerclage delays delivery. We undertook a review of our policy of transvaginal ultrasonographic cervical surveillance after McDonald cerclage and of repeat suture insertion if persistent cervical effacement developed. Data from 26 pregnancies in 26 women are analyzed. The women had had a total of 57 mid-trimester miscarriages with a median of 2 (1–6) mid-trimester losses per woman. Twelve (46%) of the 26 women developed cervical changes at scan and underwent repeat cerclage. All 14 women who had a single suture inserted progressed to live births but 1 of the 13 women who had repeat cerclage had a mid-trimester miscarriage (p>0.05). The median gestation at delivery for the women who had repeat cerclage was 35 (22–39) weeks compared with 38 (36–40) weeks for those who had a single suture (p>0.05). The median interval from the detection of cervical changes at scan to delivery was 13 (4–19) weeks. Serial transvaginal ultrasonography after cervical cerclage identifies a group of women who are more likely to deliver preterm, and provides an opportunity for intervention (repeat cerclage) which appears to delay delivery by an average of 7 weeks. 相似文献
65.
Kinta Beaver PhD MRes BA DPSN RGN David Jones MD FRCS † Shabbir Susnerwala MD FRCR ‡ Olive Craven MSc RGN RM Onc.Cert § Mary Tomlinson BA RGN ¶ Gary Witham BA RGN Onc.Cert PG.Cert Karen A Luker PhD BNurs FMedSci †† 《Health expectations》2005,8(2):103-113
OBJECTIVES: To explore patient views on participation in treatment, physical care and psychological care decisions and factors that facilitate and hinder patients from making decisions. DESIGN: Qualitative study using semi-structured interviews with patients. SETTING AND PARTICIPANTS: Three NHS Trusts in the north-west of England. Theoretical sampling including 41 patients who had been treated for colorectal cancer. RESULTS: For patients, participation in the decision-making process was about being informed and feeling involved in the consultation process, whether patients actually made decisions or not. The perceived availability of treatment choices (surgery, radiotherapy, chemotherapy) was related to type of treatment. Factors that impacted on whether patients wanted to make decisions included a lack of information, a lack of medical knowledge and trust in medical expertise. Patients perceived that they could have a more participatory role in decisions related to physical and psychological care. CONCLUSION: This study has implications for health professionals aiming to implement policy guidelines that promote patient participation and shared partnerships. Patients in this study wanted to be well informed and involved in the consultation process but did not necessarily want to use the information they received to make decisions. The presentation of choices and preferences for participation may be context specific and it cannot be assumed that patients who do not want to make decisions about one aspect of their care and treatment do not want to make decisions about other aspects of their care and treatment. 相似文献
66.
Joan SK Ng FRCS William Wong FRCP Ricky WK Law FRCS Joannie Hui MRCP Esther N Wong MRCP Dennis SC Lam FRCOphth 《Clinical & experimental ophthalmology》2001,29(4):239-243
Purpose : To investigate ocular complications arising from nephrotic syndrome and/or its treatments in children. Methods : A cross‐sectional study was conducted in a teaching hospital. A total of 31 paediatric patients with nephrotic syndrome were studied. Comprehensive ophthalmic assessments on best‐corrected visual acuity, intraocular pressure, slit‐lamp and fundus examination were taken. Information regarding histological diagnosis of nephrotic syndrome and its treatment regimen in each patient was reviewed and analysed. Results : Bilateral posterior subcapsular cataracts were detected in three of 29 patients (10.3%) who received steroid therapy. Two had normal vision while one had visual acuity reduced to 6/15 in both eyes. The age of onset of the nephrotic syndrome in these three patients was 2 years, which was significantly younger than those without cataract (5.4 ± 3.2 years, P < 0.001). Three patients (9.7%) had isolated asymptomatic fundal findings of tortuous and dilated retinal vessels. Hypertensive retinopathy was found in one patient (3.2%). No steroid‐induced glaucoma, uveitis, ocular infection, or other eye complications related to the use of steroids or other immunosuppressive agents were noted. Conclusions : Children who have nephrotic syndrome often require prolonged, intermittent high dose of systemic corticosteroid therapy. Paediatricians should be aware of the potential risk of developing steroid‐related complications, especially posterior subcapsular cataract. It appears to have a higher risk when steroid therapy is used in very young patients. Early detection would help to prevent amblyopia development, particularly in the group of immature eyes. 相似文献
67.
Andrew A. Chang MB BS Alan Bank FRACO FRACS Ian C. Francis FRACO FRACS Medduma B. Kappagoda FRACO FRACS FRCS 《Clinical & experimental ophthalmology》1995,23(4):315-318
Exophthalmometry, the quantitative assessment of the position of the globe in the orbit, is a clinically useful measurement. The purpose of this study was to examine the performance of a simple exophthal-mometer that would lend itself to accurate and convenient use in clinical practice. In this study, two observers independently performed exophthalmometry on 100 eyes using the Hertel and Luedde instruments. The results were compared between instruments and between observers. There was no statistically or clinically significant difference between measurements taken with the Luedde as compared with the Hertel instrument. The Luedde exophthal-mometer has a number of advantages over the Hertel exophthalmometer, and represents a simple, inexpensive and equally reliable means of evaluating clinically the anteroposterior position of the eye in the orbit. 相似文献
68.
Hamady ZZ Malik HZ Finch R Adair R Al-Mukhtar A Prasad KR Toogood GJ Lodge JP 《Annals of surgical oncology》2006,13(11):1493-1499
Background Many colorectal liver metastasis patients are denied surgical resection on the basis of tumour size. The aim of this study was to explore the impact of metastasis size on modern liver resection.Methods Using a prospectively collected database, this was a retrospective analysis of 484 consecutive patients who underwent liver resection for colorectal liver metastases between 1993 and 2003. The cohort was divided into two groups: smaller metastases (<8 cm) and larger metastases (≥ 8 cm). Those with larger metastases were then further stratified into big metastases (8–12 cm) and giant metastases (>12 cm). Demographic, pathological, surgical technique and outcome data were compared between the groups.Results There were 88 (18%) patients with metastases measuring 8 cm or larger. There was an association between higher carcinoembryonic antigen (CEA) and cancer antigen (CA) 19-9 levels and larger metastases. The actuarial 5-year survival for patients with larger metastases was 38% compared with 42% for smaller metastases (not statistically significant). Patients with giant metastases had poorer overall and disease-free survival (both nonsignificant) compared with those with big metastases: 29% and 28% at 5 years, respectively.Conclusion Patients with colorectal liver metastasis greater than 8 cm and up to 12 cm in size should not be treated differently from those with smaller lesions. 相似文献
69.
Muhammad S. Sajid MBBS MSc MBA FRCS Kristian Hutson MBBS MRCS Lorain Kalra MBBS MRCS Riccardo Bonomi MBBS FRCS 《Journal of surgical oncology》2012,106(6):783-795
A systematic review of randomised, controlled trials investigating the effectiveness of fibrin glue (FG) in reducing the postoperative seroma and seroma related morbidities following breast and axillary surgery was conducted. FG failed to influence the incidence of postoperative seroma, average volume of seroma, wound infection, complications and length of hospital stay in patients undergoing breast cancer surgery. However, a major multicentre and high quality randomised, controlled trial is required to validate these findings. J. Surg. Oncol. 2012; 106:783–795. © 2012 Wiley Periodicals, Inc. 相似文献
70.
The primary therapy of anal cancer is curative radiochemotherapy. Following a confirmed diagnosis the role of the surgeon is the treatment of local complications of anal cancer by securing bowel passage and protection of the perineum by laparoscopic placement of a preternatural anus or stoma. For patients with a persistent or recurrent tumor following radiochemotherapy a clear improvement in the oncological process can be achieved by surgical salvage therapy using an abdominoperineal rectum extirpation. However, this is accompanied by a high morbidity of up to 80%. Of particular importance here are disturbances in wound healing in the perineum; therefore, a primary myocutaneous flap surgery can be used to cover the perineal resection wound and the rate of disturbances in wound healing can be substantially reduced. 相似文献