Differences in mortality after fracture of hip. Doubt remains over anticoagulant prophylaxis for deep venous thrombosis.
Explore the source record for details and available documents.
Biomedical subjects
Publications and source records attributed to E C Ashby.
Explore the source record for details and available documents.
Might leg elevation and avoidance of poor postures provide better prophylaxis against venous thromboembolism than heparin or mechanical methods? 12 supine subjects tilted in 3 degrees increments from 6 degrees leg-down to 12 degrees leg-up showed linear increase in mean peak blood velocity and reduction in calibre in the common femoral vein (colour-duplex ultrasound). Between horizontal and 6 degrees leg-up, velocity was increased by 17% and diameter reduced by 14%. A ranking of mean peak velocities in six postures (sitting; standing; trunk raised 35 degrees to legs which were first horizontal and then tilted up 6 degrees; supine, first horizontal then 6 degrees leg-up) showed significant increases in velocity between consecutive positions.
Forty-nine patients with chronic obscure groin pain, bilateral in four, presented to one general surgeon in a 12-month period. Inflammation ('enthesopathy') at the pubic insertion of the inguinal ligament was the cause in 30 patients (32 groins). This has not previously been recognized as a cause of chronic groin pain, possibly because the exact site of tenderness can be obscured by the pubic pad of fat. Enthesopathy also occurred in five rectus and one adductor longus tendons (one patient had inflammation in both). Infiltration with long-acting steroid (1 per cent triamcinolone) and local anaesthetic (2 per cent lignocaine) was offered to all patients with localized tenderness of tendon or ligament. A questionnaire survey 3-15 months after injection showed a better outcome after treatment than when injection was declined. Other causes of pain included nerve entrapment (five cases), spinal referred pain (five in four patients) and ureteric stones (two). Inguinal hernia is sometimes coincidental rather than causative of the pain. In three patients the pain had subsided and no diagnosis was made. Simple diagnostic and therapeutic measures may relieve chronic groin pain and spare patients elaborate investigation or unnecessary operation.
Preoperative mechanical bowel preparation, peroperative topical antiseptic measures, and postoperative antibiotic therapy have all been shown to reduce infection after colorectal surgery. We report the results of a randomised trial of preoperative irrigation with a 10% aqueous solution of povidone-iodine (Betadine) versus water in patients undergoing major resection for large bowel carcinoma. All patients had mechanical bowel preparation, preoperative topical povidone-iodine and per and postoperative antibiotics. Of 22 study patients only one (4.6%) developed abdominal wound infection, whereas in 23 controls nine (39.1%) did so (P less than 0.01). In three of the study patients cultures of swabs taken at operation from the transected bowel ends showed no bacterial growth. Arguably the bacterial population would have been markedly reduced in other patients. These results suggest that povidone-iodine irrigation before large bowel resection reduces wound sepsis.
Explore the source record for details and available documents.
Five minutes after transrectal prostatic biopsy 16 out of 21 patients were shown by blood culture to have bacteraemia. Antibiotic prophylaxis--routinely with ampicillin and metronidazole for 48 hours--prevented progression to septicaemia, and four days after the procedure all blood samples were negative. Irrespective of whether antibiotic prophylaxis is used, blood culture should be routine in all patients undergoing transrectal prostatic biopsy.
A physical sign was assessed and operation findings were noted in boys with testes which tended to deviate lateral to the external ring who were seen over a five-year period. Tensing the abdominal muscles by straight-leg raising not only facilitated palpation of such testes but also helped to domonstrate lateral deviation. The view that testes found lateral to the external ring and which could be pushed some way into the scrotum were merely retractile was questioned. Such testes were deviated by inguinal tethering. The spermatic cord was short enough in over half the tethered testes to require retroperitoneal dissection to achieve the fully descended position, not a significantly different proportion compared with the obstructed group.
Explore the source record for details and available documents.
A prospective study was made of 73 patients presenting in one year with abdominal pain provisionally diagnosed as of spinal origin. The criteria for audit of diagnosis and treatment are defined. The diagnosis was confirmed in 53 patients, 49 of whom had been treated with a lignocaine intercostal block in the relevant segment. Thirty-three of these (67.3%) had both complete and prolonged relief. It is suggested that the block causes interruption of a vicious circle of pain and muscle spasm in a 'spinal reflex pain syndrome'.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
In 81 patients with fibrous intra-abdominal adhesions there was a high incidence of other lesions in which there was a substantial element of fibrosis. These included chronic peptic ulceration, ovarian cysts, fibrous stenotic lesions, and thickened scars. It is suggested that in some patients a generalized fibrotic tendency as well as local factors may play a part in the pathogenesis of adhesions.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
Explore the source record for details and available documents.