The British journal of surgery
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Sequential changes of body temperature have been measured for 48 h in 147 patients after major elective abdominal, cardiac, orthopaedic and pelvic surgery. Core temperature (aural canal) started to increase immediately after surgery reaching a mean peak value of 37.5 degrees C 14 h (range 8-16) after the end of surgery. ⋯ A close examination of core temperature oscillations during a 72-h postoperative period and a comparison with a pre-operative 24-h cycle in a group of 14 patients who underwent cardiac surgery did not show any circadian rhythm. In the third part of the study, analysis of postoperative body temperature and metabolic rate showed a similar pattern of increase for core and mean skin temperatures, and oxygen consumption.
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A review of 353 lower limb amputations over the last 7 years has been performed to assess the results of the skew flap myoplastic below-knee amputation which was introduced in April 1983 because of reported advantages in terms of wound healing and earlier ambulation. Comparing the first 3 1/2 year period with the second, the total number of amputations decreased by 31 per cent. The number of above-knee amputations remained similar in the two periods (82,62), whilst the number of Gritti-Stokes amputations fell from 79 to 21 (0.001 greater than P greater than 0.01). ⋯ The time to full stump healing was significantly shorter in the skew flap group compared with the earlier Burgess type BK amputation (P = 0.001), and there was a trend to fewer stump failures in the skew flap group. We therefore feel that the skew flap amputation gives superior results to the Burgess BK amputation in terms of healing and a lower complication rate, allowing a higher proportion of BK amputations to be performed. A prospective randomized trial of the two techniques is in hand to determine the accuracy of this hypothesis.
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To assess the safety of a conservative approach to fibro-adenoma of the breast we prospectively studied 321 women with this clinical diagnosis, and performed aspiration cytology and excision biopsy. There was histological confirmation of fibro-adenoma in 217 (68 per cent), the remainder having various benign conditions and 4 (1.3 per cent) had carcinoma. Aspiration cytology had a sensitivity of 87 per cent and a specificity of 76 per cent for fibro-adenoma. ⋯ To estimate the risk of missing carcinoma we compared the annual frequency of carcinoma with fibro-adenoma in young women and found a ratio of 1:470 between 15 and 19 years, 1:133 between 20 and 24 years and 1:9 in the 25-29 age group. To assess patients' views on non-operative treatment of benign breast masses we asked 124 women, 10 days postoperatively, whether they preferred a conservative approach for a cytologically benign lump: 26 (21 per cent) opted for conservative management in the future and 8 (7 per cent) would have preferred conservatism rather than their recent excision. A conservative approach is safe for clinically and cytologically benign breast lumps in women under 25 years, but very few will accept it.
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During the 31 year period 1954 to 1985, 225 major hepatic resections have been performed for symptomatic primary carcinoma of the liver, of which right hepatic lobectomy was performed in 115, extended right hepatic lobectomy in 11, trisegmentectomy in 2, left hepatic lobectomy in 94, and middle hepatectomy in 3. In addition there were 107 partial hepatic resections for 89 asymptomatic small hepatocellular carcinomas. In the 225 patients undergoing major hepatic resection, the operative mortality was 8.0 per cent. ⋯ Of 207 cases who survived major hepatic resection, 119 cases died within one year after the operation, mainly due to recurrence of cancer in the remaining residual lobe, lung metastasis or late hepatic failure. The 5 year survival rate is 18.0 per cent, 12 patients are still alive and well after more than 5 years and the longest survival is 23 years. Of the 89 patients with small asymptomatic hepatocellular carcinomas, 28 died within one to four years of surgery because of a second new growth.
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Nine patients with soft tissue sarcomas close to the pelvic girdle and one patient with a primary malignant bone tumour of the pelvis were referred for consideration of hindquarter amputation. Patients were considered unsuitable for hindquarter amputation on clinical grounds if malignant disease infiltrated into the perineum or across the sacro-iliac joint. If disease in the femoral triangle extended above the inguinal ligament the tumour's operability was seriously questioned. ⋯ In another patient, considered suitable for hindquarter amputation on clinical grounds, CT suggested that en bloc wide excision of the tumour was feasible enabling the affected limb to be preserved. Four patients after clinical examination were considered unsuitable for hindquarter amputation and in all cases inoperability was confirmed by CT. CT complements clinical examination and provides an objective and reliable means of selecting patients for hindquarter amputation which should avoid unnecessary surgical exploration.