The British journal of surgery
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A method of investigating the lymphatic system by radionuclide imaging in patients with chronic lower limb oedema is described. The clearance of 99mTc rhenium sulphur colloid from the interdigital space of 55 limbs and its appearance in the ilio-inguinal lymph nodes 30 min, 1, 2 and 3 h later has been measured using a gamma camera in 34 limbs (26 patients) with the clinical and radiological features of primary lymphoedema, 10 limbs (8 patients) with venous oedema and 12 control limbs (6 volunteers). ⋯ Estimation of the percentage uptake of the colloid in the ilio-inguinal lymph nodes at 1/2, 1, 2 and 3 h showed a markedly decreased lymph flow in the 34 lymphoedematous limbs and an increased flow in the 10 limbs with venous oedema. The results suggest that this technique can be used as a simple diagnostic outpatient technique in the investigation of chronic limb oedema.
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A retrospective study of 134 patients with a clinical diagnosis of fibro-adenoma of the breast indicated that histological confirmation of this diagnosis is made in only 50 per cent. The majority of the others have a diagnosis of benign mammary dysplasia. ⋯ In view of the high sensitivity of fine needle aspiration cytology in the diagnosis of malignant disease, we believe that there is justification to carry out a prospective study to determine this. In this study women with a clinical diagnosis of fibro-adenoma will be carefully observed provided they are less than 35 years of age and fine-needle aspiration cytology reveals no malignant cells.
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Randomized Controlled Trial Comparative Study Clinical Trial
A randomized trial to compare single with multiple phenol injection treatment for haemorrhoids.
One hundred and twenty consecutive patients were entered into a randomized trial of single versus multiple phenol injection for the treatment of haemorrhoids. Follow-up at 3 and 12 months was available in 105 patients (56 in the single group and 49 in the multiple group). The results have shown that injection therapy, whether this be single or multiple, is an extremely effective form of therapy for patients with first or second degree haemorrhoids.
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Thirty-seven patients undergoing femoropopliteal, fifteen undergoing femorodistal reconstruction and seven below knee amputees were subjected to prospective measurement of peripheral resistance. Resistance was significantly higher in the amputation and femorodistal groups than in the femoropopliteal group (P less than 0.03 and P less than 0.005 at 76 ml/min). In the femoropopliteal group patients with three vessel runoff had a significantly lower resistance than those with two or single vessel runoff (P less than 0.01). ⋯ Taking all the failed grafts there was a significant correlation between graft patency and resistance (P less than 0.003). Resistance measurement has been shown to correlate with the severity of the disease, with runoff defined radiographically and with graft patency. In a simplified form it may prove a useful adjunct to other methods of assessment in patients with distal disease.
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Randomized Controlled Trial Comparative Study Clinical Trial
Postoperative pain and pulmonary complications: comparison of three analgesic regimens.
In a prospective study, patients undergoing cholecystectomy were randomly allocated to receive (a) intermittent intramuscular morphine (n = 25), (b) continuous intravenous morphine infusion (n = 25) or (c) epidural bupivacaine (n = 25) for postoperative pain relief. Morphine by intravenous infusion provided comparable pain relief to intermittent intramuscular morphine; there was no significant difference in the incidence of postoperative pulmonary complications. ⋯ Arterial oxygen tensions were also significantly higher in the epidural group for the first three postoperative days (P less than 0.05). Epidural analgesia was associated with a significant reduction in the incidence of pulmonary complications (P less than 0.01) and chest infection (P less than 0.05).