The British journal of surgery
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The need for centralized management of acute trauma was evaluated in a 1-year prospective study in Northern Ireland. All patients with an Injury Severity Score > 15 who reached hospital alive were included. The sample population was approximately 1 million people. ⋯ There was a high level of consultant involvement, especially in small hospitals. A system in which patients with acute trauma bypass the nearest hospital to reach a trauma centre may be neither beneficial nor cost-effective in Northern Ireland. Upgrading of the present system with stabilization of the patient and emergency surgery at the nearest hospital before transfer is recommended.
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Diagnosis of rejection in small bowel transplantation by the identification of a host-cell infiltrate is hampered by the physiological trafficking of host lymphocytes to the 'gut-associated lymphoid tissue' of the graft. This study compared physiological host-cell infiltration of small bowel grafts with that occurring in rejection and stable immunosuppression. Physiological host-cell infiltration, where the graft does not present an immune stimulus to the host, was assessed by transplanting bowel from DA to (DA x PVG) F1 hybrid rats. ⋯ By contrast, host cells were seen in the intraepithelial compartment only in rejection. Host-cell infiltration in the absence of an allogeneic stimulus suggests that histological identification of host cells in the lamina propria is not necessarily indicative of rejection. However, the presence of host cells in the intraepithelial compartment is specific for rejection in small bowel transplantation.
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Clinical Trial Controlled Clinical Trial
Computed tomography in the management of blunt abdominal trauma in children.
Sixteen children with suspected abdominal injury were reviewed. All underwent plain abdominal radiography and computed tomography (CT). ⋯ Only two patients required laparotomy, one for a ruptured left diaphragm and one for a major renal injury. These results support the use of CT as the optimal method for assessing the stable child following blunt abdominal trauma.
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Diabetes occurs frequently in patients with pancreatic cancer. To investigate the impact to tumour removal, seven patients were studied before and after 85 per cent subtotal pancreatectomy for adenocarcinoma of the pancreas. The frequency of diabetes was determined by the oral glucose tolerance test. ⋯ Improvements in diabetic status and glucose metabolism were found in all seven patients after operation, as demonstrated by increased glucose metabolic capacity during hyperglycaemia. This occurred despite a postoperative reduction in insulin secretion and is explained by the observed augmentation of whole-body insulin sensitivity after surgery. A diabetogenic factor may be produced by pancreatic adenocarcinoma that may be responsible, directly or indirectly, for the high frequency of diabetes in patients with pancreatic cancer.
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The outcome of treatment in 40 black patients (27 women, 13 men; mean age 62.9 years) with plantar melanoma over a 13-year period was analysed to evaluate the efficacy of wide local excision with split skin grafting. Substantial delay in seeking medical attention occurred in 35 patients. At presentation, 20 patients had stage I disease, one stage II, 15 stage III and four stage IV. ⋯ Graft sepsis occurred in six patients and local recurrence in two. Nine patients were alive at follow-up; the 5-year survival rate was 25 per cent. Delay in presentation and locally advanced disease may explain the poor prognosis of plantar melanoma in black South Africans.