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Biomedical subjects

R J Croft

Publications and source records attributed to R J Croft.

34 records · Page 2Linked to original sources

Popliteal artery entrapment syndrome.

Popliteal artery entrapment syndrome is an uncommon cause of peripheral vascular disease in young fit individuals, presenting as progressive claudication or sudden limb ischaemia. It can also present later in life with insidious symptoms relating to popliteal thrombosis or aneurysm. As a local cause of atherosclerosis in the popliteal artery it is probably under-diagnosed, as clinical and radiological features are subtle and varied. Early diagnosis and surgical division of aberrant muscular relations result in an excellent clinical result. Late surgical treatment with vein grafting is less durable. The disease incidence, clinical features, pathology, investigations, treatment and prognosis are reviewed.

Adolescent↗

How should we preclot knitted Dacron grafts?

We studied the change in water porosity over time of 10 Sauvage Bionit-II and 10 DeBakey Vasculour-II knitted velour Dacron grafts throughout the four stages of the Sauvage preclotting technique. Graft porosity decreased significantly (p less than 0.001) at the ends of stages 1 and 2 for both types of grafts, but stages 3 and 4 did not further reduce graft porosity. These results demonstrate that a two-stage preclotting technique is adequate for the preclotting of knitted velour Dacron grafts. A final rinse with heparinized blood is recommended as this may reduce graft thrombogenicity.

Blood Coagulation↗

A non-comparative study of parenteral ampicillin and sulbactam in intra-thoracic and intra-abdominal infections.

Fifty-four patients were treated with intravenous ampicillin and sulbactam in an open study of intra-thoracic and intra-abdominal infection. Thirty-one were treated with 500 mg each of the combination 6-hourly while 23 patients were given 1 g of ampicillin and 500 mg of sulbactam, 6-hourly. Thirteen of fourteen (93%) patients with severe respiratory tract infection and 22/26 (85%) patients in the intra-abdominal infection group responded clinically and bacteriologically. Seven patients with clinical sepsis (but not confirmed bacteriologically) improved on therapy. 50/55 (91%) clinical isolates from this study were eliminated. An increase in MIC was found in two cases. There were minimal side effects, pain at site of injection being the commonest complaint.

Abdomen↗

Does 'intestinal angina' exist? A critical study of obstructed visceral arteries.

A study of the mesenteric arteries was carried out in 203 unselected autopsies. Although mild degrees of stenosis were common, the incidence of a 'critical stenosis' was rare and no correlation between degrees of stenosis and previous gastrointestinal symptoms could be found. Radiological demonstration of stenosed or blocked visceral arteries remains therefore of doubtful clinical significance.

Adult↗

Surgery for stroke.

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Carotid Artery Diseases↗

Accuracy of carotid angiography in the assessment of atheroma of the internal carotid artery.

In a post-mortem study to determine the accuracy of angiography in defining atheromatous disease of the origin of the internal carotid artery, 64 carotid bifurcations were filled with a mixture of gelatin and contrast medium, X-rayed, cleared for pathological study, and assessed by a neurologist and a vascular surgeon. Agreement between the two observers on the X-ray appearances was 87.5% and between the agreed X-ray interpretation and the macroscopic pathological findings 78.6%. Closest agreement was seen with normal and stenosed vessels. Difficulties were encountered with lesser changes due to plaques and ulceration. Since the decision to recommend carotid endarterectomy in patients with a history of transient ischaemic attacks depends on the angiographic findings, knowledge of the accuracy of angiography can be critical.

Arteriosclerosis↗

Controlled clinical trial comparing intra-incisional cephaloridine and Polybactrin Spray.

300 patients undergoing various operations were randomly allocated to receive, intra-incisionally, just before skin suture, either a solution of 1 g cephaloridine or Polybactrin aerosol. An equal number of patients were allocated to each group, and various factors likely to influence the incidence of wound infections were evenly distributed. 13 wound infections (9.8%) developed in the cephaloridine group and 28 (20.1%) in the Polybactrin group (p less than 0.02). In the former group, the infections were milder and there were 44 fewer patient-days of hospitalisation. The difference in infection rates for 'potentially contaminated and contaminated' operations was greater (p less than 0.01), in favour of cephaloridine. Other differences are discussed and some reasons for the superiority of cephaloridine over other agents (e.g., povidone-iodine, ampicillin) are advanced.

Adolescent↗

Reperitonealization and invagination of the lesser curvature of the stomach following proximal gastric vagotomy.

Lesser curve necrosis usually presents as free perforation. A case of large gastric ulcer occurring very shortly after proximal gastric vagotomy (PGV) for a duodenal ulcer that was almost certainly due to ischemic necrosis of the lesser curve is presented here. Reperitonealization and invagination of the lesser curve is recommended following PGV so that, if necrosis occurs, it will take place within the stomach and not into the free peritoneal cavity. This maneuver may also avoid possible vagal reinnervation and the formation of dense adhesions between the stomach and liver.

Duodenal Ulcer↗

Free perforation of the small bowel in Crohn's disease.

A rare case of free double ileal perforation in previously asymptomatic and undiagnosed Crohn's disease of the terminal ileum is described. At operation, a primary resection and anastomosis of the diseased bowel was performed. The management of free perforation in Crohn's disease is discussed, together with a review of the literature. It is suggested that the absence of steroids in a previously undiagnosed case may favour primary resection and anastomosis.

Crohn Disease↗

An assessment of the value of the white cell count in the management of suspected acute appendicitis.

A prospective study of 100 consecutive patients was carried out to determine if a knowledge of the white cell count was a useful factor in determining the correct management of patients presenting with suspected acute appendicitis. A retrospective study of the differential white cell count and neutrophil morphology was performed to see if these investigations would provide more specific aids to diagnosis. These studies show that such haematological information is only of limited supportive value in the total assessment of these patients. Where the clinical findings are at variance with the white cell count, the clinical findings should take precedence.

Acute Disease↗