Spontaneous combined intraperitoneal gas and supraclavicular subcutaneous emphysema.
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Biomedical subjects
Publications and source records attributed to M W Ward.
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Whole-body and muscle protein turnover have been studied in surgical patients, before abdominal surgery after an 18-h fast, using infusion of 1-[13C]leucine. Four patients received an unmodified hospital diet and four received extra nutritional support (1800 kcal, 70 g protein) by naso-jejunal tube for 7-10 d previously. In patients who received nutritional support there were significantly greater values of whole-body protein synthesis (+42 per cent, P less than 0.05) and breakdown (+45 per cent, P less than 0.01) and muscle protein synthesis (+36 per cent, P less than 0.05) than in those who received the unmodified hospital diet.
The utilization of a myocutaneous flap based on the gracilis muscle is described in two patients who had a persistent perineal sinus following proctocolectomy for Crohn's disease. In each case the posterior vaginal wall had eroded to form a fistula. This flap provided a cutaneous surface with good sensation to replace the posterior vaginal wall and tissue bulk to fill the excised cavity. A good functional result was obtained in each patient. This technique provides a useful contribution to the management of this unusual complication.
Thirty-seven patients with recurrent ulceration after vagotomy were treated by Polya gastrectomy and have been followed up for a minimum of 3 years (median 5 years). The diagnosis of recurrent ulcer was made by endoscopy or at operation. Nine patients were initially treated with cimetidine and either failed to respond or relapsed on maintenance dosage. There were 2 operative deaths and 2 patients were lost to follow-up. The results of Polya gastrectomy were Visick grade I: 61 per cent, Visick grade II: 15 per cent, Visick grade III: 9 per cent and Visick grade IV: 15 per cent, Two patients had further recurrent ulceration.
The effects of dietary protein deprivation on he healing of colonic anastomosis in the rat have been investigated. Nutritional status was assessed both before and after operation using body weight, nitrogen balance studies and serum albumin estimations. Healing of colonic anastomosis was assessed by bursting pressure measurements. Rats fed a protein-depleted diet throughout the study were compared both with rats restored to a full diet after surgery and rats receiving a full diet throughout. Although protein depletion caused a 12.5 per cent weight loss and a negative nitrogen balance, serum albumin remained normal in all rats at the time of operation. After operation, all rats were in negative nitrogen balance, although this was greater in the protein-depleted group. Similarly, in comparison to control animals, the protein-depleted group had significantly lower colonic bursting pressures and significantly lower serum albumin concentrations. Rats returned to a full diet after operation had smaller losses of nitrogen and normal colonic bursting pressures. The results indicate that a commonly encountered degree of malnutrition, insufficient to affect nutritional indices used in clinical assessment, may interfere with colonic healing. Early re-introduction of nutrition in the postoperative period may be able to reverse this effect.
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A follow-up of 93 patients with chronic duodenal ulceration treated by proximal gastric vagotomy without drainage five to nine years previously shows a high incidence of confirmed recurrent ulceration of 16.1%. In addition, there have been patients with transient recurrent ulceration, and a small group with persistent dyspeptic symptoms but in whom no ulcer has been demonstrated. The operation is commendable for its lack of side-effects, but the high incidence of recurrent or persistent symptoms may lead to some reservations about its general application in the treatment of chronic duodenal ulceration.
Four patients with ulcerative proctocolitis apparently confined to the rectum had incapacitating diarrhoea which was treated by rectosigmoid resection and a left iliac colostomy. In 3 patients disease recurred within a year, but responded well to conservation management. One of the patients required colectomy and ileostomy 5 years after the initial operation.
A case of bilateral myositis ossificans in the biceps femoris muscles causing a sciatic nerve palsy on the left side is described. Complete recovery of the sciatic nerve followed excision of the mass of ectopic bone. It is postulated that the patient's hobby of weight-lifting caused the ossification.
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We describe an apparatus modified for the chemiluminescent estimation of nitrogen in biological and clinical samples. Analytical characteristics have been assessed and results compared with those by the traditional Kjeldahl method. The chemiluminescence method, much faster and more sensitive than the traditional method, is at least as accurate, precise, and reproducible. Costs are low, and the method should find a place in laboratories needing, for example, rapid assessments of nitrogen balance in surgical patients and renal function in patients with renal failure, or estimations of small amounts of specific nitrogen-containing chemical substances in biological samples.
The first case of a carotid body chemodectoma that was diagnosed using dynamic radionuclide perfusion angiography and subsequently excised is presented. The value of this technic in the investigation of pulsatile tumors is emphasized.
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