Biomedical subjects
R H Armour
Publications and source records attributed to R H Armour.
Hospital career structure.
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Medical manpower, staffing, and training requirements.
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Service commitment and the training of surgeons.
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Balloon catheter contol of a ruptured abdominal aortic aneurysm in a patient with Cullen's sign.
A patient with Cullen's sign due to a ruptured abdominal aortic aneurysm is reported. At operation a balloon catheter was used to stop severe retroperitoneal bleeding and the aneurysm was replaced with a graft.
Survivors of ruptured abdominal aortic aneurysm: the iceberg's tip.
In four and a half years 25 patients in one community suffered a ruptured abdominal aortic aneurysm. Eleven died at home, nine died without operation in hospital, and only five had the aneurysm removed. There were four survivors. A further seven patients might have lived had they had a prompt operation. The average operative mortality for ruptured aneurysms among series reported in British journals is 53%, but the survivors are a small minority of the total number of people in the community whose aneurysms rupture. No basis could be found for the view that replacing an aortic aneurysm with a straight graft (while leaving behind aneurysmal common iliac arteries) lowers the operative mortality. On the contrary, oversimplifying the operation may be hazardous.
Bypass grafting to the anterior tibial artery.
Four patients with severe ischaemia of a leg due to atherosclerotic occlusion of the tibial and peroneal arteries had reversed long saphenous vein grafts to the patent lower part of the anterior tibial artery. Two of these grafts continue to function 19 and 24 months after operation respectively. One graft failed on the fifth postoperative day and another occluded 4 months after operation. The literature on femorotibial grafting has been reviewed. The early failure rate of distal grafting is higher than in the case of femoropopliteal bypass, but a number of otherwise doomed limbs can be salvaged. Contrary to widely held views, grafting to the anterior tibial artery appears to give results comparable to those obtained when the lower anastomosis is made to the posterior tibial artery.
Recurrent severe haemorrhage from false aneurysm following fracture of the femur.
A case of traumatic false aneurysm presenting as recurrent exsanguinating haemorrhage from a surgical wound of the thigh is described. A plate, inserted to maintain reduction of a fracture of the femur, was removed during the third attempt to control the bleeding and only then was the source revealed. Diagnostic difficulty delayed definitive treatment.