The Australian and New Zealand journal of surgery
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Biography Historical Article
The George Adlington Syme Oration: Syme and the surgeon's image.
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The compulsory wearing of seat belts, first introduced in the world in Victoria in 1970, has effectively reduced the number of deaths and injuries by approximately one-third for car occupants involved in motor vehicle crashes. Initially, the legislation did not apply to children under the age of eight years, but in 1975 a further law was introduced banning children from the front seat of any vehicle unless properly harnessed. Seat belts offer the best protection for front seat drivers and passengers involved in frontal impacts, but offer less protection to the recipient of a side impact. Ten per cent of car occupants admitted to hospital after a frontal impact show injuries, mostly minor, directly attibutable to the wearing of seat belts.
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The experience of acute mesenteric ischaemia at St Vincent's Hospital, Melbourne, has been reviewed over 17 years. The mortality remains appallingly high. This applies particularly to those patients who had thrombosis of the superior mesenteric artery, amongst whom the mortality in this series was 97%. ⋯ Early diagnosis is all-important, and this depends on the performance of mesenteric angiography in any patient suspected of having mesenteric ischaemia. Appropriate surgery may then be carried out in the occlusive group and supportive treatment, including intraarterial papaverine infusion, given to those with non-occlusive ischaemia. There is a pressing need for simple non-invasive tests to segregate those patients suffering from acute mesenteric ischaemia from those whose acute abdomen is due to some other cause.
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Optimum results are obtained in the care of the critically ill patient if efforts are directed to maintaining the internal environment in a state as near normal as possible. This cannot be done without the use of basic monitoring procedures. ⋯ There is, however, a real risk of complex procedures becoming an end in themselves in general intensive therapy units, where they are apt to distract overworked nurses and medical attendants from the care of their patients. It is important, therfore, for clearcut indications for various monitoring procedures to be defined, and in this paper an attempt has been made to outline alogical approach to the monitoring of critically ill genral surgical patients admitted intensive therapy units.
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The operation of subcutaneous mastectomy is evolving as an alternative to simple mastectomy for diseases of the breast parenchyma where preservation of the skin capsule is thought possible. Simple mastectomy is a mutilating procedure, cosmetically unacceptable to both patient and surgeon. The psychological implications of breast absence in women are now well known, and attempts to preserve the shape and volume of the breast must receive attention.