The British journal of surgery
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After gastro-intestinal operations wound infection is usually caused by the inoculation of bacteria present within the intestinal tract into the incision during the surgical procedure. In theory, wound sepsis may be minimized by the following methods: (a) avoiding intestinal contamination of the incision; (b) altering the normal flora of the intestinal tract by adding oral antimicrobials to bowel preparation; (c) using topical or systemic prophylactic antibiotic administration for certain high-risk patients. The relative importance of these methods of prophylaxis is described.
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Forty-two patients with idiopathic megacolon who were seen at St Mark's Hospital over an 18-year period are reviewed with regard to presentation, investigation and management. The differential diagnosis is discussed with particular reference to Hirschsprung's disease. ⋯ The indications for surgical intervention in 14 patients are reviewed. The results following subtotal colectomy were better than following a localized sigmoid resection.
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A series of 45 patients with advanced occlusive arterial disease of the femoropopliteal segment underwent profundaplasty as the sole operative procedure. The value of this technique as a salvage procedure for the severely ischaemic limb is discussed.
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Nine patients with an unusual and serious intraabdominal complication of the beta-adrenergic blocking agent practolol seen since 1973 are reported. The striking and bizarre peritoneal changes induced by the drug have distinctive features that are not shown by other forms of peritoneal disease. The cases presented with small bowel obstruction, usually chronic in type and often associated with profound weight loss and an abdominal mass. ⋯ The obstruction was relieved by mobilizing the small bowel from the ensheathing tissue. Restoration of alimentary function after surgery was delayed but the long term result was satisfactory with full relief of symptoms and the absence of recurrent obstruction during the follow-up period. This complication may arise after treatment with the drug has been stopped, and although long term oral therapy has been discontinued, further cases will almost certainly present for some time to come.
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The medium term results of 112 profundaplasties for lower limb ischaemia are reviewed for periods of up to 9 years after operation. Death from cardiovascular causes was found to be more common than subsequent amputation. Though immediate relief from symptoms was not so dramatic as after a femoropopliteal graft, the longer term results showed a much lower late amputation rate. The only resonable operation for failure of a previous femoropopliteal graft appears to be a profundaplasty.