Pancreatic angiography is still valuable preoperatively in insulinoma.
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Biomedical subjects
Publications and source records attributed to J R Logie.
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A questionnaire designed to investigate the technical training of general surgical trainees was distributed throughout Scotland. A total of 222 questionnaires were sent out and 179 (81 per cent) were returned. Of the responders, 38 per cent felt that the overall operative workload was too small and the majority thought that there was too little emphasis on supervised operating. Two-thirds of trainees were generally satisfied with the amount of unsupervised operating, although a substantial proportion (21 per cent) sometimes felt out of their depth when performing delegated emergency operations. Few had attended craft workshops or travelled to other centres, but of those who had, most considered both activities to be very useful. Photographic atlases and videos were not generally felt to be of great value by those who had used them. The majority of trainees did not believe that research activity had interfered excessively with their technical training.
Fifteen patients found to have active arterial bleeding from non-variceal lesions at upper gastrointestinal endoscopy were treated with local injection of 1/10,000 adrenaline. Permanent haemostasis was obtained in 13 patients, and two required emergency surgery for rebleeding. Adrenaline injection is an effective, simple method of endoscopic haemostasis.
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In a consecutive series of 93 patients who required emergency surgery for distal colonic lesions, 61 had primary bowel resection with immediate anastomosis after intra-operative antegrade colonic irrigation. The operative mortality was 8 per cent, anastomotic leakage rate 7 per cent and superficial wound infection occurred in 3 per cent of patients. The mean hospital stay was 13 days. Of the remaining 32 patients, 3 did not have a resection and 29 had a primary resection and end colostomy without anastomosis: bowel continuity was later restored in 17 of 28 survivors (61 per cent) but 11 (39 per cent) were left with a permanent colostomy. The hospital mortality in this group was 6 per cent, superficial wound infection rate 14 per cent and the mean hospital stay 26 days. The results of this study suggest that intra-operative colonic irrigation is an effective method enabling the surgeon to perform a primary anastomosis with reasonable safety after emergency resection of selected distal colonic lesions.
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Many patients in Britain with chronic renal failure suitable for renal replacement treatment die because not enough treatment facilities are available. Moreover, the number of renal transplants performed is insufficient to meet even present needs, so the number of patients on dialysis is rising. The integrated dialysis and transplant unit in Aberdeen, which has a population base much smaller than the average British unit, meets community needs for dialysis and transplantation. The problem of harvesting cadaver kidneys has been solved; the present supply has not only enabled the number of patients on dialysis to remain stable but has resulted in a net export of kidneys. The Aberdeen unit shows how estimated needs for chronic dialysis and renal transplantation may be met.
A study of 39 patients having a transurethral resection (TUR) of prostate for benign prostatic hyperplasia was carried out. Large quantities of mannitol, which was used as the irrigating fluid during the procedure, were found to enter the circulation. A corresponding fall in the serum sodium levels was noted. Those patients with serum mannitol levels greater than 4000 mg/l were noted to be hypotensive and have a bradycardia. These patients were nearly all hypovolaemic and the bradycardia was felt to be inappropriate. The possibility of this being due to a combination of factors including intravascular mannitol is considered.
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