Biomedical subjects
Publications and source records attributed to T Cheatle.
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Clearance of anti-personnel mines and unexploded ordnance in countries recovering from war usually continues long after conflict has ceased. We prospectively recorded 92 traumatic injuries sustained by 73 mineclearers working in seven countries over a period of 10 years. 15% of injuries were fatal, with an incidence of 116 injuries per 100000 workers per year. Limb injury occurred in 59% of cases, with an overall amputation rate of 30%. 44% of injuries were sustained by workers handling a mine, resulting in severe upper limb and facial injuries. The incidence of facial injuries fell after the introduction of visors.
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OBJECTIVE: The venous pump of the foot assists blood returning to the heart. The aim of this study was to evaluate the effect of mechanical activation of the foot pump on the microcirculation of the skin in patients with peripheral occlusive arterial disease. DESIGN: Single parallel group comparing patients with arterial disease to normal control subjects. SETTING: Department of Surgery, the University College and Middlesex Hospital, London, U.K. SUBJECTS AND MATERIALS: 15 patients with peripheral occlusive arterial disease and 15 control subjects. A pneumatic impulse foot pump was applied to the foot. OUTCOME MEASURES: The Laser Doppler flux (LDF) and transcutaneous oxygen tension (tcPO2) were measured on the big toe with the subject supine, before, during and after a 10 min period of foot pumping. The study was repeated with the subject sitting. RESULTS: On sitting there is a fall in LDF and rise in tcPO2. Application of intermittent pneumatic compression of the foot in the sitting position resulted in an increase in LDF. In patients, the median percentage increase was 57% and the median difference was 82 arbitrary units (AU) (95% CI 60-130, p < 0.001). In controls, the median percentage increase was 66% and the median difference was 124 AU (95% CI 73-275 p < 0.001). There was a corresponding "further" increase in tcPO2 in both groups of subjects. In patients, the median percentage increase was 8%, in controls the median percentage increase was 10% p < 0.01). CONCLUSION: We conclude that intermittent pneumatic compression of the foot in the dependent position increases LDF and tcPO2.
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Reconstructive arterial surgery for upper limb ischaemia has been performed since the early 1950s. The commonest site of occlusion is in the subclavian artery for which the widely preferred surgical reconstruction is the carotid-subclavian bypass graft. We present a series of eight cases of subclavian artery occlusion for which direct subclavian to carotid anastomosis was performed yielding results comparable with carotid-subclavian bypass.
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About 10% of all abdominal aortic aneurysms are characterized by an exuberant inflammatory reaction consisting of a dense white sheath over the aneurysm with peri-aortic fibrosis. The aetiology is unknown. There are characteristic ultrasonic and CT appearances but the condition is usually diagnosed at laparotomy. Surgery is the best treatment, keeping peri-aortic dissection to a minimum. Steroid therapy may occasionally be indicated where the situation is considered inoperable or when the patient declines surgery. If hydronephrosis is present because of ureteric involvement, surgical ureterolysis, as for retroperitoneal fibrosis, should be considered. We report 8 cases treated surgically over a 3-year period, with good results in 6, one postoperative amputation and one late postoperative death.
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Five anomalies of pulmonary venous drainage were seen among 12 children operated for lung sequestration. In two children, venous drainage from the sequestrated lobe and the rest of the right lung was via a single channel into the inferior vena cava ("scimitar syndrome"). In one of these children, the sequestrated lobe was resected and repair of the scimitar syndrome was delayed; in the second patient, the anomalous pulmonary venous drainage was not recognized preoperatively and the vein was ligated, resulting in acute hemorrhagic infarction of the right lung and death of the patient. Three patients had less severe anomalies of pulmonary venous drainage. We recommend very careful evaluation of patients with lung sequestration with special reference to pulmonary venous drainage.