摘要:

AbstractPatients with moderate to severe fractures of the major long bones of the lower limb had generally warmer extremities if nursed in cubicles with a dryish (35–45 per cent relative humidity) and warm (29–30° C.) environment than if maintained at a normal temperature of 20–24° C. The additional heat was applied soon after the period of shock was over and was then provided for a further 10–12 days thereafter. The effect of a higher temperature in reducing the protein catabolic response to injury–which seems mainly to involve an increase in the catabolism of some muscle proteins accompanied by increased urinary excretions of potassium, creatine, and zinc–has already been described (Cuthbertson, Fell, Smith, and Tilstone, 1972). The effects of a warmer atmosphere on oral and skin temperatures over various surfaces are described in the present paper and these effects are compared with those found when extra bed coverings are applied under normal ward environmental conditions (20–22° C.). By the application of such heat the skin temperature of the extremities can be raised several degrees; that of the large toes by as much as 12° C. By the use of extra bed coverings conductive losses can undoubtedly be diminished, particularly at normal temperatures.Oral, axillary, and frontal and mastoid process temperatures are not apparently influenced by a higher environmental temperature but appear to be mainly related to the degree of traumatic fever.The advantage of the higher environmental temperature over extra bed coverings is presumed to be mainly in reducing total resting heat production from resting to basal values by providing thermoneutral conditions.Apart from a significant reduction in the rise in serum potassium around the fifth day after injury and a reduction in the normal increased urinary excretion of potassium previously noted, there were no significant changes in the concentration of other serum electrolytes as a result of the higher environmental temperature, nor were the other characteristic electrolyte patterns of urinary excretion altered by the change in the ambient temperature. There were also no distinctive differences in the pattern of urinary amino‐acids at t

ISSN:0007-1323    

DOI:10.1002/bjs.1800600602

出版商:John Wiley&Sons, Ltd.    

年代:1973

数据来源: WILEY

摘要:

AbstractAnalgesic nephropathy can present as an obstructive uropathy by ureteric impaction of a sloughed renal papilla. Five out of 12 patients admitted with analgesic nephropathy presented with obstructive renal failure. Endoscopic surgery to deal with the obstruction was successful in every case. Removal of the necrotic renal papilla with a Dormia ureteric stone basket was performed six times whilst ureteric catheterization was sufficient to restore urine flow on two occasions. Two of the 5 patients had had a previous nephrectomy for obstructive pyelonephritis. These results suggest that endoscopic surgery is safe and effective in the treatment of acute obstructive renal papillary necrosis.

ISSN:0007-1323    

DOI:10.1002/bjs.1800600603

出版商:John Wiley&Sons, Ltd.    

年代:1973

数据来源: WILEY

摘要:

AbstractWith the increasing number of abdominal, pelvic, and thoracic injuries due to trauma as a result of roadtraffic accidents rupture of the diaphragm is becoming more frequent. Two personal cases are presented and the literature as regards symptomatology, mechanism of rupture, site of rupture, and treatment is reviewed. Early operative treatment is recommended.

ISSN:0007-1323    

DOI:10.1002/bjs.1800600604

出版商:John Wiley&Sons, Ltd.    

年代:1973

数据来源: WILEY

摘要:

AbstractIn a series of 762 general surgical wounds 376 were selected at random to receive three parenteral doses of cephaloridine and 386 remained as untreated controls. In all types of operation, with the exception of wounds in the lower extremities associated with arterial surgery, the rate of wound infection was lowered by the prophylactic use of cephaloridine. The results were statistically significant for total wounds, clean wounds, total contaminated wounds, and contaminated wounds other than in colorectal surgery. We therefore recommend the routine use of three doses of cephaloridine.

ISSN:0007-1323    

DOI:10.1002/bjs.1800600605

出版商:John Wiley&Sons, Ltd.    

年代:1973

数据来源: WILEY

摘要:

AbstractSerum gastrin was measured by radio‐immuno‐assay in normal subjects and in patients with duodenal ulcer during insulin hypoglycaemia with and without concomitant aspiration of gastric acid. Insulin hypoglycaemia alone caused a rise in serum gastrin from 8.0 to 45.0 pg. per ml. in patients with duodenal ulcer, which was significantly greater than the rise from 13.0 to 29.0 pg. per ml. in normal subjects. During gastric aspiration serum‐gastrin levels remained elevated for longer periods. The maximum increase of serum gastrin after insulin during gastric aspiration provided an almost complete discrimination between patients with duodenal ulcer and normal subjects. This discrimination between the groups was complete when serum gastrin was measured during insulin hypoglycaemia combined with intragastric neutralization of acid. The timing of the peak serum gastrin and the lowest blood‐glucose coincided, but the peak acid output occurred 15–30 minutes later. Serum gastrin was inversely correlated with blood‐glucose. Blood‐glucose decreased to significantly lower levels in unaspirated than in aspirated subjects.These studies suggest that patients with duodenal ulcer produce more gastrin than normal subjects in response to insulin hypoglycaemia (and, by inference, to vagal stimulation). The results support the concept of an increased functional G‐cell mass in duodenal ulcer patients, and indicate the physiological roles of vagally released gastrin and of the acid inhibitory mechanism. Discriminant functions observed in the study could form the basis of tests for the presence of the duodenal

ISSN:0007-1323    

DOI:10.1002/bjs.1800600606

出版商:John Wiley&Sons, Ltd.    

年代:1973

数据来源: WILEY

摘要:

AbstractA study of patients with malignant melanoma, in various stages of the disease, by means of regular repeated examination of sera for the presence of tumour antibodies is presented.These antibodies were mostly seen in patients with early or localized tumours and were not related to the total mass or volume of the tumour present. Sequential testing in individual patients showed not only the disappearance of antibodies as the disease progressed from localized to disseminated, but also that the disappearance preceded the appearance of disseminated tumour by several months. It is, therefore, suggested that circulating tumour antibodies are important in preventing or delaying blood‐borne metastase

ISSN:0007-1323    

DOI:10.1002/bjs.1800600607

出版商:John Wiley&Sons, Ltd.    

年代:1973

数据来源: WILEY

摘要:

AbstractDeep‐vein thrombosis was found by phlebography in 60.3 per cent of 58 patients with fracture of the upper end of the femur. The incidence was higher on the left side. Thrombus was detected in the uninjured leg in many cases, and therefore the need for bilateral investigation is emphasized.The convenience of the radioactive fibrinogen test and ultrasound technique for detecting thrombosis in patients has been widely accepted, but we also consider that phlebography, using a portable radiograph machine, is a valuable and easy method for the detection of deep‐vein thrombosis in seriously ill patie

ISSN:0007-1323    

DOI:10.1002/bjs.1800600608

出版商:John Wiley&Sons, Ltd.    

年代:1973

数据来源: WILEY

摘要:

AbstractA relatively minor operation of partial eversion in which some residual sac is left in situ has been performed in over 500 cases of large tropical hydrocele. The method is applicable to smaller hydroceles, and also provides a method of treating recurrent testicular torsion.

ISSN:0007-1323    

DOI:10.1002/bjs.1800600609

出版商:John Wiley&Sons, Ltd.    

年代:1973

数据来源: WILEY

摘要:

AbstractInverting methods of suture should be used in colonic anastomosis. A two‐layer inverting anastomosis is usually recommended but it has been suggested that a single‐layer technique is preferable and safer.Single‐layer inverting, two‐layer inverting, and everting anastomoses were compared in the unprepared rabbit colon. Everting anastomoses gave inferior results by comparison with both inverting methods with respect to tensile strength, anastomotic leakage, and histological evidence of healing, but no difference was found between the single‐layer and two‐layer methods using these criteria and measurement of colonic collagen.It was concluded that single‐layer inverting methods of anastomosis had no particular advantages over the standard two‐layer i

ISSN:0007-1323    

DOI:10.1002/bjs.1800600610

出版商:John Wiley&Sons, Ltd.    

年代:1973

数据来源: WILEY

摘要:

AbstractMost surgeons recommend an inverting technique for anastomosis of the intestine using two layers of sutures, but it has been suggested that greater safety would be achieved by using an inverting method which involves only a single layer of sutures.Single‐layer inverting and standard two‐layer inverting intestinal anastomoses were compared in a randomized prospective clinical study of 60 patients. A similar incidence of anastomotic dehiscence and obstructive complications occurred after both types of anastomosis and it was concluded that single‐layer methods of anastomosis do not possess qualities which surpass the standard two‐layer

ISSN:0007-1323    

DOI:10.1002/bjs.1800600611

出版商:John Wiley&Sons, Ltd.    

年代:1973

数据来源: WILEY