25, 50 & 75 years ago
2009; Wiley; Volume: 79; Issue: 12 Linguagem: Inglês
10.1111/j.1445-2197.2009.05137.x
ISSN1445-2197
ResumoR. P. Morton and P. M. Stell. Supraglottic laryngectomy: A perspective for New Zealand. ANZ J. Surg. 1984; 54: 63–6. A series of 794 patients with laryngeal cancer in Liverpool from 1965 to 1983 were reviewed with particular reference to the results after supraglottic laryngectomy. The results indicated that radiotherapy is to be preferred for T1N0 supraglottic tumours, and supraglottic laryngectomy is indicated only for patients with small primary tumours, and clinically involved lymph nodes. On comparing 274 patients with laryngeal cancer from Auckland, seen over a similar period (1965-1979), it is clear that even fewer patients than in Liverpool, both absolutely and relatively, would be eligible for supraglottic laryngectomy in New Zealand. In view of the reportedly high morbidity and mortality associated with the operation, one may question the wisdom of performing supraglottic laryngectomy in New Zealand, where suitable patients are rare. D. A. F. Morgan and J. W. Walters. A prospective study of 100 consecutive carpal scaphoid fractures. ANZ J. Surg. 1984; 54: 233–41. For many years it has been recognized that the fracture of the carpal scaphoid is often a complication prone condition in most fracture clinics. Many theories have been advanced as to the pathomechanics of union failure in this, the ‘unsolved fracture’ of the upper limb, with only partial agreement. Whilst union rates of between 75% and 90% have been consistently reported, there is a small but economically important group in whom the time to union is unacceptably long. For this reason, a prospective study of scaphoid fractures which presented to the Royal Brisbane Hospital during the period of 1980 and 1981 was performed. . . . In this prospective series of 100 scaphoid fractures in 98 patients, 96% united with conservative measures only in an average time of eight weeks. This is slightly beter than some results published in the literature to date. This may well relate to the fact that it was a prospective series, and therefore a high index of suspicion with respect to wrist joint injuries existed. Twelve per cent of the series were treated on clinical suspicion alone, at the time of the initial presentation. Despite the declared intention of the authors to employ an early operative regimen, only 3% of the series, but all three cases resolved without sequelae. The 7% incidence of delayed union, and the 2% of non union is in close agreement with the modern literature. It would appear very clear that an ‘at risk’ group has been identified. High velocity trauma may well explain the predominance of young active males in this group, and would also correlate well with the displaced fractures. Proximal one third fractures have always had a poor reputation and along with their vertical oblique waist fracture counterparts, may well be representative of the unique vascularization of the carpal bone. A high index of clinical suspicion is the only way in which early diagnosis and treatment can be instituted in this potentially troublesome fracture. With this, and the other ‘at risk’ factors constantly in mind, a high therapeutic success rate appears assured. Of concern to the authors is the case of unrecognized non union caught in the two year follow up sieve. It is possible that other such cases exist in the 78 patients who failed to return at two years. For this reason it is strongly advised that careful attention be paid to the final declaration of union prior to the eventual discharge of the patient with a scaphoid fracture. Anatomical classification of scaphoid fractures. Irwin Faris, Paul Jury and Peter Malycha. Blunt injury to the subclavian artery. ANZ J. Surg. 1984; 54: 249–51. There are many possible approaches to the subclavian artery. The origin of the left subclavian artery can be approached via an anterolateral thoracotomy through the left third intercostal space. For wounds at the base of the neck a variety of cervico-thoracic incisions may be made. The cervico-thoracic approach was used in the first case because of the amount of swelling in the supraclavicular fossa and the need to obtain control of the origin of the subclavian artery. In the second case control was obtained through the cervical incision although we were prepared to perform sternotomy had difficulties occurred. Graham et al have reported that in their series of penetrating injuries an initial supraclavicular incision was made in 42 cases but needed to be extended by a sternotomy in 34 of these cases. Thus when performing the supraclavicular approach instruments must be available to allow sternotomy to be performed quickly. Graham et al. argue that in these circumstances a median sternotomy can be performed more rapidly and gives better access than resection of the clavicle. . . . Injuries to the subclavian artery will be encountered rarely. A high index of suspicion and prompt exploration using the principles outlined will enable these patients to be managed successfully. R. M. Mitchell. Studies on renal transplantation in sheep. ANZ J Surg 1959; 28: 263–73. Following early experiments on transplantation of the kidney by Carrel (1902), a large body of literature on this subject has accumulated. Several articles are available in which the history of renal grafting has been reviewed. (Dempster, 1950; Hume et alii, 1955). An outstanding contribution to our knowledge of the behaviour of renal transplants came from Carrel (1906, 1911) who described the survival of a dog for two and one half years after double nephrectomy with re-implantation of one kidney. Williamson (1923) showed that whereas a re-implanted or autografted kidney functioned well, a kidney from another animal or homograft, after functioning for four to ten days became oedematous and anuric. He recognized that biological rather than technical factors limited the function of such homografted kidneys. Later Williamson (1926) described clearly the histological changes associated with homograft rejection. The next major advance came from the work of Simonsen et alii (1953) who showed that a second homografted kidney from the same donor was destroyed at a faster rate than the first. Previous transplants of spleen or skin produced this same accelerated destruction of a kidney homograft from the same donor, demonstrating that an acquired tissue immunity was involved in renal homograft destruction. Dempster (1953b) showed that no only does the host react violently to a foreign kidney but also the kidney itself reacts against its host thereby accelerating its own destruction. . . . Many unsuccessful attempts to perform renal homografts in man have been described. In some, surprising results have been achieved with function up to five months (Hume et alii, 1955) but present knowledge suggests that all are doomed to failure with one exception. In identical twins it has been shown that a renal homograft will function satisfactorily (Merrill et alii, 1956; Murray et alii, 1958) and results indicate that the ‘take’ appears to be permanent, at least for the period of follow up which is now approximately three years. J. K. Clarebrough and J. L. Connell. Surgical consideration in hiatus hernia. ANZ J. Surg. 1959; 29: 21–37. In our present state of knowledge we recognize two principle factors responsible for the retention of the oesophago-gastric junction in its normal position. Muscular tone and integrity of the right crus. Attachment to the oesophago-gastric junction of the phreno-oesophageal ligament, extraperitoneal tissues and peritoneum of which the first is the most important.A third factor – The length of the gastric vessels – has been suggested, but considerable doubt exists as to the importance of this. As a result of age, obesity and many other causes of increased intra-abdominal pressure, such as repeated pregnancies, the factors above are so interfered with that herniation occurs. The aim of surgical treatment is to severe complete and permanent reduction of the gastro-oesophageal junction below the diaphragm, and this aim can only be achieved surgically by careful attention to the restoration of both factors. The simple approximation of crural fibres and a few stitches in the stomach will not suffice to prevent recurrence. . . . As was mentioned earlier when the stomach rises into the mediastinum it carries with it a pouch of peritoneum lying anteriorly and laterally and with this pouch the phrenooesophageal ligament is stretch and forms part of the sac wall. Many people doubt the existence of this ligament, which is a condensation of deep fascia passing from the under surface of the diaphragm to the region of the oesophago gastric junction, there blending with the fascia propria of the oesophagus. It is covered on the thoracic surface of pleura and on the abdominal surface is separated from the peritoneum by a variable amount of extraperitoneal fat. Diagrammatic representation of a hiatus hernia showing the absence of the peritoneal pouch posteriorly. Oc – oesophagus. St – stomach. D – diaphragm. Pr – fascia propria of oesophagus. Ph – phreno-oesophageal ligament blending with fascia propria.Pe – peritoneum. G. M. Bedbrook Spinal injuries – A Challenge. ANZ J. Surg. 1959: 28; 245–56. The treatment of spinal paralysis has undergone great changes in the past fifteen years. For the past four years in Western Australia all spinal injuries and those patients with spinal paralysis not caused by injury have been treated in a special unit. Such special units, with their teams of workers have resulted in improved management, a reduced death and morbidity rate and an economic saving, for it is no longer ‘can a paraplegic ever leave hospital?’ but simply, ‘How long?’ Scientific stock takings are always necessary if advances are to be made and thus this review for the years 1954-58 will set out the results of treatment and some experience gained. . . . There is now no doubt that all cases of paraplegia are best handled by a specialized unit. During the four year period under consideration 150 patients with spinal paralysis have been seen – a few for consultation only, but most for management (Table 1). Most cases of injury have been seen within hours of accident and some 65 acute cases have been observed. Of these 34 were quadriplegic, 30 are paraplegic. In the time of review 15 other patients were seen whose traumatic spinal cord injury had occurred a varying number of years before. These presented with complications. Some 16 cases of secondary carcinoma have been treated in the final stage of their illness and 18 cases of poliomyelitis were also encountered (a large number of which occurred during a local epidemic). . . . The average stay in hospital for acute spinal injuries was one hundred and fifty eight days, the longest stay being one thousand for hundred and sixty one days, the shortest forty two days. The time spent in hospital can now only be reduced when adequate discharge agencies, such as homes and hostels exist. Economically, the provision of a hostel for paraplegics who, though independent, cannot go to their own homes would be sound. During each month that such patients remain in hospital awaiting final discharge this State pays on hundred and fifty four pounds ten shillings (£154/10/-). E. S. J. King. Pilonidal sinus of the axilla. ANZ J. Surg. 1959; 28: 196–201. The term ‘pilonidal sinus’ has been applied most commonly to the condition found in the sacro-coccygeal region but the relatively uncommon and, in some cases, rare lesions found in other parts of the body, because of their bearing on the pathogenesis of the condition in general, have an importance and significance out of all proportion to their frequency. They incidentally emphasize that the name ‘pilonidal’ means merely a ‘nest of hair’ . . . A condition such as pilonidal sinus was to be explained as a development anomaly, such a view being apparently supported by the occurrence in the postanal region of similar states indubitably congenital in time of occurrence. . . . Only in the last decade was the development hypothesis questioned by Patey and Scarff (1946, 1948) and the writer (King, 1947). This alternative view that the lesion is an acquired one is supported by the discovery of sinuses of this type in various parts of the body. These have been found in diverse places which, however, all have the common features of mobile tissue where movement causes opening and closing of a cleft or sulcus with consequent changes in pressure in its depths. Despite some disagreement regarding the precise mode of formation, opinion has come round gradually to the idea of the post natal and acquired nature of the sinus. Julian Smith, Junior. The preparation of catgut for surgical use. ANZ J. Surg. 1934; 4: 122–9. The gut is usually received from the surgical warehouses in ten foot lengths coiled like a rope. The procedure then frequently employed is to wind the gut on to small glass reels, often under tension. The effect of this is obvious. The gut is wound forcibly against its natural coil and often twisted, and furthermore the glass reels are so small that they cannot accommodate the natural coil of the catgut. When lengths of catgut are cut from these reels, a marked recoil takes place, making the gut very unwieldy. If small glass reels are used, the catgut should be very loosely wound in figure of eight. . . . The method preferred by the writer is to roll the gut loosely (no purpose is to be served by employing tension) on to large wooden reels, which besides receiving the catgut in its natural coil, can accommodate a greater length of material and are unbreakable with ordinary use. . . . When lengths are cut from these reels, no recoil takes place and the material is handled with perfect ease. These wooden reels can be made by any wood turner. Three sizes are used to correspond with the three sizes of catgut –‘fine’, ‘medium’ and ‘stout’. These terms are used to designate gut to sizes ‘000’, ‘1’, and ‘2 or 3’ respectively. . . . ‘fine’ is used to tie off all subcutaneous bleeding vessels, ‘medium’ for the more important ligatures, such as for the mesoappendix, for suturing the peritoneum in lower abdominal wounds, while ‘stout’ is used, for example, in restoring the sheaths of the rectus muscle after an upper abdominal incision has been made. If a suture of ‘stout’ or ‘medium’ catgut appears to be inadequate for any particular purpose, then it is used double in preference to employing a catgut of larger size. C. H. Kellaway and F. Eleanor Williams. The sterilization of catgut. ANZ J. Surg. 1934; 4: 118–21. The occurrence of another hospital in Melbourne in 1931 of tetanus attributable to infected catgut led Cooper and Williams to investigate the methods of sterilization of catgut in use at the Melbourne Hospital. . . . Last year at still another Melbourne hospital and in private practice there were further disasters, and this year yet another tragedy has occurred in private practice Melbourne. In all these suspicion fell upon catgut prepared by the biniodide method. It is therefore desirable to draw the attention of the profession to the fact that biniodide sterilization of catgut cannot be relied upon, since it is not effective against spore-bearing organisms.
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