Biomedical subjects
Publications and source records attributed to Z H Krukowski.
A total of 1504 consecutive abdominal operations were studied prospectively over a five year period. The incidence of wound (2.8%) and intraperitoneal (0.8%) infections was low compared with contemporary reports. It is difficult to justify modifying existing practice on the basis of small controlled clinical trials when information from accurate audit discloses results superior to those of experimental studies.
There is little uniformity in either the indications for operation, the classification of the pathology or the operative management of generalized or faecal peritonitis secondary to perforated diverticular disease. Nevertheless, this review has shown a clear advantage both in terms of immediate mortality and morbidity for primary resection over conservative operations in which the colon is retained in the abdomen. We propose that, when a clinical diagnosis of localized sepsis secondary to diverticular disease is made, the management should be nonoperative with systemic antibiotics and supportive therapy. Operation should be reserved for those patients with obvious generalized peritonitis or failure of conservative treatment. When operation is necessary the affected sigmoid loop should be resected and the operation completed as a Hartmann's procedure in all but the most favourable circumstances when a primary anastomosis may be considered after on-table irrigation of the colon.
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The results of the follow-up of 50 consecutive atuogeneous vein bypass grafts during 1958-65 are described. Arteriography was performed at regular intervals throughout the follow-up lasting from 8-15 years. 11 grafts failed in less than 2 years and were considered technical failures. Thereafter, of the 37 cases on whom arteriographic information is available, a further 5 grafts failed. Deterioration of the graft itself occurred in 19 percent, proximal anastomosis dilatation it 16 percent, and distal anastomosis narrowing in 25 percent. Improvement of flow to the lower leg vessels did not accelerate progression of the long saphenous vein at the time of operation is the limiting factor in longterm graft deterioration. The majority of grafts remained patient without degeneration for up to 15 years.