Seat belts--six years on.
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Biomedical subjects
Publications and source records attributed to J N Simson.
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Malignant oesophago-respiratory fistula is an incurable and distressing condition. Surgery is difficult, unsatisfactory or impossible, and standard oesophageal tubes often fail to occlude the fistula. A new tube is described which relieves dysphagia and occludes the fistula without risk of pressure necrosis. After insertion of the tube, the patients may be treated by radiotherapy.
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Late rupture may follow simple ligation of the common iliac arteries after aortobifemoral grafting. Oversewing the origins of the arteries may prevent this rare but dangerous complication. A CT scan is recommended to investigate unexplained abdominal pain following aortic surgery.
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There is evidence that the solitary rectal ulcer syndrome is associated with rectal prolapse either overt or internal. The anterior rectal wall is affected in most cases and a modified abdominal rectopexy has been used with the aim of supporting both the anterior and posterior aspects of the rectum. Fourteen patients aged 19-70 years (mean 34.2 years) in whom conservative treatment has failed, have been treated by anteroposterior rectopexy. Tenesmus, bleeding and the passage of mucus have been abolished or greatly improved in 12, 14 and 13 patients respectively. The number of attempts to defaecate per 24 h has fallen from 8.7 +/- 1.4(s.e.m.) pre-operatively to 3.4 +/- 1.0(s.e.m.) postoperatively (P less than 0.05) and the time spent in the lavatory has been reduced from 146 +/- 18(s.e.m.) min to 15 +/- 3(s.e.m.) min. Two patients have developed severe constipation postoperatively and two others have had persistent or recurrent tenesmus. Combined anteroposterior rectopexy has improved 12 out of 14 patients with the solitary ulcer syndrome without external rectal prolapse when assessed at 2-48 months postoperatively.
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The records of 253 children with congenital diaphragmatic hernia admitted to The Hospital for Sick Children, Great Ormond Street, between 1961 and 1980 were analysed. The overall mortality of 37 per cent is greater than that reported in the preceding 13 years from the same institution, and showed no improvement over the 20 years. While there was no significant increase in the number of admissions over the study period, the proportion of children who underwent surgery within the first 6 h of life steadily increased from 13 per cent in the first five years to 39 per cent in the last five years. The mortality of this group (65 per cent) did not improve over the study period and this would account for the lack of improvement in the overall survival figures. However, analysis of birth weights, onset and severity of signs and lung weights indicates that the increasing number of early admissions was due to speedier transfer rather than to referral of more severely affected children in the later years.
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Thirty-four loop stomas without a tissue bridge were created in 33 infants. Whenever possible, the antimesenteric stoma was fashioned in the laparotomy wound. When a separate incision was used, the lack of a skin bridge resulted in a more cosmetically acceptable scar after closure of the stoma. Complications associated with such stomas and their closure were no greater than for the conventional loop stomas formed over a tissue bridge.