Post-traumatic small bowel stenosis.
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Biomedical subjects
Publications and source records attributed to W W Barrie.
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Over a period of 10 years, 149 amputations were performed for lower limb ischaemia in 119 diabetic patients. Thirty patients required amputation of the second limb. Ninety per cent of the patients were over the age of 60 years. Sixty four ischaemic limbs were treated by primary local amputation or debridement--29 healed successfully, 30 proceeded to a higher amputation. The incidence of multiple local operations was high. A below knee amputation was performed in 56 limbs--7 failed to heal and required a more proximal amputation. Seventy five patients in the series have died; 58 of these survived less than 3 years from their first amputation. The hospital stay for all patients was long; for an unsuccessful local amputation the average stay was 109 days. Conservative management with the Scotchcast boot has been shown to be satisfactory. This must be compared with the significant costs to the patient of early operative intervention.
A case of nontraumatic gastric rupture in an adult is reported. Rupture occurred after distention of the stomach with blood from a bleeding gastric ulcer.
We report a case of amiodarone induced toxic goitre, presenting with thoracic inlet obstruction which required surgical intervention. Though thyrotoxicosis caused by amiodarone is recognised, to our knowledge thoracic inlet compression has not been previously described.
99m-Technetium labelled red blood cell scintigraphy was used in the investigation of 15 adult patients with suspected small or large bowel bleeding requiring at least five units of blood (mean 14.3 units) and one neonate with rectal bleeding. Scintigraphy was found to be an accurate method of detecting the site of haemorrhage and was superior to angiography. This technique may be of particular value in patients with profuse colonic haemorrhage when the view at colonoscopy is poor.
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Although the ultrasonic pulsatility index (PI) is used as a test of arterial inflow, the relationship between proximal arterial stenosis and PI has not been fully evaluated. In a series of experiments on dogs, over 200 measurements of pressure, flow (using an indwelling electromagnetic flowmeter), and PI were made distal to implanted arterial stenoses of varying length (0.5--9 mm) and cross-sectional area (36--94% reduction in area). It was shown that, whereas the reduction of PI correlates broadly with stenosis severity, the scatter of results is wide for all but the tightest stenoses. This scatter is due at least in part to the variability of the vascular bed distal to the site of measurement.
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In order to establish the relationship between the renal and other factors associated with the hypertension of coarctation of the aorta, aortic strictures were created in two groups of adult dogs (Groups A and B). Group B in addition had transference of total renal blood flow proximal to the stricture to eliminate the renal aspects of the hypertension. Carotid and femoral artery pressures were measured at monthly intervals for 24 weeks. Group A developed progressive generalised hypertension while Group B only developed hypertension proximal to the coarctation. The dominant role of a renal factor producing a generalised vascular response is confirmed, the localised proximal hypertension in Group B reflecting the mechanical obstruction imposed by the aortic stricture. There is no evidence to suggest that other organs distal to the coarctation are implicated in the development of arterial hypertension.
Using electromagnetic flow probes, cardiac output and hind limb blood flow were measured in dogs in which one hind limb had been rendered ischemic. Four dogs served as controls; seven were defibrinated by intravenous infusion of ancrod, 1 unit/kg, over a 30-minute period. In both groups, hematocrit readings remained constant, but cardiac output fell (this was attributed to barbiturate anesthesia), as did flow in the normal hind limb. In the controls after three hours, flow in the ischemic hind limb had decreased by 34%, but in the treated animals it had increased by 20%. The difference was statistically significant (P less than .001). The selective increase in blood flow in the ischemic limb may be explained by the greater reduction in blood viscosity at low shear rates achieved by defibrination.
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The effect of a low-dosage regimen of ancrod in the prevention of postoperative deep vein thrombosis was assessed in 24 patients having surgical repair of fractured neck femur and compared with 25 control patients who did not receive therapy. The objective of the therapy was to lower the preoperative fibrinogen level and produce a low concentration of fibrin degradation products yet avoid the haemorrhagic complications of total defibrination. Ancrod therapy proved feasible to carry out, was not associated with haemorrhagic complications, and produced sustained, predictable reductions in fibrinogen concentration. There were seven thromboembolic complications in the control patients compared to one such complication in the ancrod-treated patients. Five deaths occurred in the control group and one in the treated group. Though the incidence of deep vein thrombosis was not apparently affected by ancrod it appeared on venography that the thrombi in the treated patients were less extensive than those in the control patients. Finally, some discrepancies in the diagnosis of deep vein thrombosis by the three techniques of clinical examination, (125)I-fibrinogen scanning, and ascending venography were identified.
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