bluuebunny/crossref_metadata_2025 huggingface dataset:
Single-Dose Antibiotic Prophylaxis of Abdominal Surgical Wound Infection: A Trial of Preoperative Latamoxef against Peroperative Tetracycline Lavage
Authors: Sauven P , Playforth M J , Smith G M R , Evans M , Pollock A V
Published: January 2017

A randomized controlled clinical trial was undertaken in 542 consecutive emergency and elective abdominal operations, with one group of patients receiving tetracycline peritoneal and wound lavage and the other a single intravenous injection of 1 g latamoxef at induction of anaesthesia. Seventy-five patients were withdrawn because no potentially contaminated hollow viscus was opened, and a further 36 because they could not be assessed for wound infection. Of the remaining 431 patients, 212 received latamoxef resulting in 5 major and 8 minor wound infections in hospital; another 4 minor infections occurred at home (total incidence 8.0%). In the tetracycline group ( n = 219) there were 7 major and 19 minor wound infections in hospital and 10 minor infections later (total incidence 16.4%). This is significantly higher than the rate with latamoxef ( P=0.012). Monitoring of operative and postoperative bleeding revealed no evidence (except in one doubtful case) of excessive bleeding associated with the use of a single dose of latamoxef.

It is concluded that single-dose preoperative latamoxef is more effective than peroperative tetracycline lavage for the prevention of wound infections after potentially contaminated abdominal operations.
Abdominal Tuberculosis: Still a Problem Today
Authors: Wells A D , Northover J M A , Howard E R
Published: January 2017

Thirty cases of abdominal tuberculosis were diagnosed over an 18-year period, 26 being in immigrants; the mean age at presentation was 33 years. There were 25 cases of tuberculous peritonitis, two of tuberculous mesenteric lymphadenitis, and one each of gastric tuberculosis, colonic tuberculosis and tuberculous ischiorectal abscess. The presenting symptoms were of vague ill-health and not diagnostic, and the most common findings were of pyrexia, abdominal tenderness and ascites. The most common haematological abnormalities were raised ESR (22 patients) and mild anaemia (15 patients). Most commonly, diagnosis was made by formal laparotomy (19 cases) with biopsy (18 cases); histological examination gave a positive diagnosis in all 18 cases, but bacteriological examination yielded the tubercle bacillus in only 10 (56%). There were 2 deaths in the series, not directly related to the abdominal tuberculosis.

In view of its infrequent and vague presentation, care is required to avoid overlooking the diagnosis of abdominal tuberculosis, particularly in the immigrant population.
Obstructive Jaundice Secondary to Carcinoma Arising in Brunner's Glands
Authors: Shorrock K , Haldane J S , Kersham M J , Leach R D
Published: January 2017

Carcinoma of Brunner's glands is an exceptionally rare tumour with specific histological features that differentiate it from other duodenal tumours. A case is presented of obstructive jaundice arising as a result of this disease and its successful treatment by radical pancreatoduodenectomy.
Spontaneous Sternal Fracture — A Misnomer
Authors: Bowyer R C , Touquet V L R
Published: January 2017

Spontaneous sternal fractures, although rare, may present to the Accident and Emergency Department as a severe central chest pain of sudden onset. These may be confused with myocardial infarction1 or pulmonary embolism2. Treatment in the uncomplicated case may be symptomatic with analgesics, but this fracture may require sternal wiring if paradoxical sternal movement embarrasses respiration. Spontaneous fracture of the sternum appears in the majority of cases to be due either to secondary metastatic infiltration, myelomatosis or extreme osteoporosis3. We report a case which emphasizes the importance of investigating these patients.
Bladder Muscle Biopsy and Urethral Sphincter EMG in Patients with Bladder Dysfunction after Pelvic Surgery
Authors: Kirby R S , Fowler C J , Gosling S A Gilpin J A , Milroy E J G , Turner-Warwick R T
Published: January 2017

Eleven patients who suffered persistent bladder dysfunction after pelvic surgery have been investigated by needle urethral sphincter electromyography (EMG) and bladder muscle biopsy, and the results compared with those obtained in a series of controls. Individual motor units recorded from the urethral sphincter in patients who had undergone pelvic surgery were strikingly abnormal, suggesting the presence of reinnervation, and the density of detrusor innervation was significantly reduced. However, since reduction in the density of detrusor innervation may occur in circumstances other than peripheral nerve injury, we conclude that urethral sphincter EMG provides the most effective means of assessing damage to vesico-urethral innervation as a result of previous pelvic surgery.
Cardiovascular Risk in Patients with Treated Familial Hypercholesterolaemia and Patients with Severe Hypertriglyceridaemia
Authors: Way BPJ , Ball M J , Thorogood M , Cobbe S M , Mann J I
Published: January 2017

A study was performed to determine the morbidity and mortality from ischaemic heart disease (IHD) in patients with heterozygous familial hypercholesterolaemia (FH) and severe hypertriglyceridaemia (pretreatment plasma triglyceride > 5 mmol/l). Twenty-nine (38%) of 76 patients with FH and 8 (44%) of 18 patients with hypertriglyceridaemia had evidence of IHD. Over a mean follow-up period of 5.5 years, 2 patients with hypertriglyceridaemia died but there were no deaths in patients with FH. This contrasts with earlier reports which showed a high mortality in FH patients. The lower mortality may be due to improved treatment and consequent lower levels of cholesterol.
Neurological Manifestations of the Hyperventilation Syndrome
Authors: Perkin G D , Joseph R
Published: January 2017

Seventy-eight patients with the hyperventilation syndrome are described, none of whom had been diagnosed prior to referral for neurological assessment. There is a constellation of symptoms associated with this condition, and attacks need to be reproduced by hyperventilation in order for the diagnosis to be established. Loss of consciousness and paraesthesiae were more frequent than in previously published series.
Spironolactone in the Treatment of Idiopathic Hirsutism and the Polycystic Ovary Syndrome
Authors: Evans D J , Burke C W
Published: January 2017

Forty-eight hirsute women were treated with spironolactone 100 mg twice daily for 3 to 12 months. Both facial and body hirsuties improved by 30–40%, and there was a threefold reduction in frequency of local treatments such as waxing or shaving. Plasma testosterone fell by 30%, though the improvement in hirsuties grading did not correlate with the fall in plasma testosterone. Six subjects discontinued treatment because of lack of effect, and 4 because of menstrual disturbance. Spironolactone was equally effective in the treatment of idiopathic hirsutism and of the polycystic ovary syndrome.
Anaesthesia for Hip Replacement in Ankylosing Spondylitis
Authors: Wittmann F W , Ring P A
Published: January 2017

Thirteen total hip replacements in 8 patients with ankylosing spondylitis are reviewed. Complications of the disease which can lead to anaesthetic difficulties are discussed, and the importance of a preoperative visit and the value of indirect laryngoscopy emphasized. As intubation problems may occur, especially in undiagnosed cases, equipment for emergency intubation should always be readily available. The results fully justify the operation.
Association between Azathioprine Therapy and Lymphoma in Rheumatoid Disease
Authors: Pitt P I , Sultan A H , Malone M , Andrews V , Hamilton E B D
Published: January 2017

Three out of 41 patients treated with azathioprine and low-dose corticosteroids from 1976 to 1983 developed non-Hodgkin's lymphoma. This strikingly high incidence of lymphoma may be a reflection of long-term use of azathioprine.
Effects of Sperm Protamine on Human Cervical Epithelial Cells and BHK 21 Cells in Vitro
Authors: French P W , Coppleson M , Reid B L
Published: January 2017

The addition of protamine, of both human and animal origin, to cultures of epithelial and fibroblastic cells has demonstrated that this component of sperm proteins may be capable of bringing about neoplastic transformation in vitro.
Pathology Prize Evening Polycythaemia following Renal Transplantation
Authors: Davis H P
Published: January 2017

Polycythaemia has developed in 10 of 59 regularly reviewed patients with renal transplants surviving more than three months. The pathology of the raised haemoglobin level was heterogeneous. Three patients had a picture characterized by a normal red cell mass and reduced plasma volume. Seven patients had a raised red cell mass; in 3 of these this was associated with a period of abnormal liver function and fitted with the state of raised red cell mass in association with hepatic transaminitis.

The remaining 4 patients form a unique, previously undefined group with no features to explain the underlying aetiology of the polycythaemia. The patients had a trouble-free post-transplant course with early establishment of graft function. It is proposed, from the data obtained from in vitro culture studies, that the early return of good renal function allows the erythroid compartment to expand in response to circulating erythropoietin. The establishment of an erythron of increased size allows for a persistently raised haemoglobin in the presence of normal erythropoietin levels.
Postviral Fatigue Syndrome: Persistence of Enterovirus RNA in Muscle and Elevated Creatine Kinase
Authors: Archard L C , Bowles N E , Behan P O , Bell E J , Doyle D
Published: January 2017

Enterovirus-specific probes have been prepared by reverse transcription of conserved sequences in purified Coxsackie B2 virus genomic RNA and molecular cloning techniques. These probes were used in quantitative slot blot hybridizations to test for the presence of enterovirus-specific RNA in skeletal muscle biopsy specimens from 96 patients who had suffered from the postviral fatigue syndrome myalgic encephalomyelitis for up to 20 years. Biopsy specimens from 20 patients were positive for the presence of virus-specific RNA with hybridization signals more than three standard deviations greater than the mean of the normal muscle controls. Biopsies from the remaining 76 patients were indistinguishable from the controls.

These data show that enterovirus RNA is present in skeletal muscle of some patients with postviral fatigue syndrome up to 20 years after onset of disease and suggest that a persistent virus infection has an aetiological role.
Spontaneous Rupture of Phaeochromocytoma Mimicking Leaking Aortic Aneurysm
Authors: Sue-Ling H M , Foster M E , Wheeler M H , McMahon M J
Published: January 2017

Phaeochromocytomas are vascular tumours, and small areas of haemorrhage are commonly found in tumours which have been removed electively1. We report two cases of spontaneous haemorrhagic rupture of phaeochromocytoma presenting as abdominal emergencies.
Autopsy Proven Pulmonary Embolism in Hospital Patients: Are We Detecting Enough Deep Vein Thrombosis?
Authors: Sandler D A , Martin J F
Published: January 2017

To investigate the present status of pulmonary embolism as a cause of death in a general hospital patient population, a 5-year retrospective study of all autopsy reports and associated hospital records was undertaken. Pulmonary embolism was thought to be the cause of death in 239 of 2388 autopsies performed (10%): 15% of these patients were aged less than 60 years and 68% did not have cancer. Of these patients, 83% had deep-vein thrombosis (DVT) in the legs at autopsy, of whom only 19% had symptoms of DVT before death. Only 3% of patients who had DVT at autopsy had undergone an investigation for such before death. Twenty-four per cent of patients who died from pulmonary embolism had undergone surgery a mean of 6.9 days before. Screening tests for DVT should be applied widely in the hospital population.
Pattern, Severity and Aetiology of Injuries in Victims of Assault
Authors: Shepherd J P , Shapland M , Pearce N X , Scully C
Published: January 2017

Although the incidence of assault and other violent crime is increasing in the UK, the cause and overall pattern of injury, and the need for admission have not been defined in adult victims who attend hospital. In a prospective study, all 539 adult victims of assault attending a major city centre Accident & Emergency department in 1986 were therefore interviewed and examined.

Facial injury was extremely common: 83% of all fractures, 66% of all lacerations and 53% of all haematomas were facial. The upper limb was the next most common site of injury (14% of all injuries). Twenty-six per cent of victims sustained at least one fracture and nasal fractures were the most fiequently observed skeletal injuries (27%) followed by-zygomatic fractures (22%) and mandibular body (12%), angle (12%) and condyle (9%) fractures. Seventeen per cent of victims required hospital admission.

Overall, the type of injury observed correlated with the alleged weapon used ( P=<0.001) though 20% of victims who reported attacks with sharp weapons sustained only haematomas or fractures. Injury most often resulted from punching (72% of assaults) or kicking (42% of assaults). Only 6% of victims reported injury with knives but 11% were injured by broken drinking glasses. Those who were kicked were most likely to need hospital admission.
Psychological Aftermath of the King's Cross Fire
Authors: Rosser R , Dewar S , Thompson J
Published: January 2017

The King's Cross fire occurred at the end of the evening rush hour, on 18 November 1987. King's Cross station is within the department's health district and we felt a responsibility to respond to the psychological aftermath.

The unique features of our intervention were the degree of inter agency coordination, the use of a systematic outreach and screening programme, the collection of psychotherapy outcome measures and the development of an ongoing clinic.

The work represents a sustained attempt to assess the nature and prevalence of post-traumatic reactions and the most medically and economically effective form of intervention.

In this paper we describe the way our team responded to the high level of psychological distress that we found, we present some preliminary results, outline two therapeutic trials, and refer to the long-term consequences for the work of our department.
Residual Gastric Content after Gastric Lavage and Ipecacuanha-Induced Emesis in Self-Poisoned Patients: An Endoscopic Study
Authors: Saetta J P , Quinton D N
Published: January 2017

Flexible endoscopy was used to assess the intragastric residue after either ipecacuanha-induced emesis or gastric lavage in 30 self-poisoned patients.

Of the 13 patients treated by induced-emesis, five (38.5%) had residual solid in the stomach; 17 patients were treated by gastric washout, and 15 (88.2%) of these had residual intragastric solid.

The study provides direct evidence that the gastric decontaminating procedures employed, and especially gastric lavage, do not remove stomach contents completely.
Why Do Hospital Doctors Wear White Coats?
Authors: Farraj R , Baron J H
Published: January 2017

Seventy-two per cent of all hospital doctors and medical students wear white coats and most wear them > 75% of the time. White coats are worn chiefly for easy recognition by colleagues and patients, to put items in the pockets and to keep clothes clean. Psychiatrists and paediatricians try to maximize rapport with patients by deliberately not wearing white coats.
Balancing and Attitude Control of Double and Triple Inverted Pendulums
Authors: Medrano-Cerda G. A. , Eldukhri E. E. , Cetin M.
Published: January 2017

The design of robust computer control systems for balancing and attitude control of double and triple inverted pendulums is considered in this paper. For the double inverted pendulum, a DC motor mounted at the upper hinge is used to balance and control attitude of the upper link. For the triple inverted pendulum a DC motor mounted at the middle hinge is used to control the middle link, whereas proportional position control applied to a motor at the upper hinge is utilised to maintain the upper link in alignment with the middle link. In both cases the lower hinge is left free to rotate. The controller designs are based on linearised discrete-time models of the inverted pendulums. Each controller utilises state feedback implemented via reduced-order state observers. The relative stability properties of the control systems are evaluated using Nyquist plots of suitably defined functions. The controllers are designed using Matlab and implemented in a PC using C language. Experimental results showed satisfactory performance.
Morphological or syntactic deficits in near-native speakers? An assessment of some current proposals
Authors: Franceschina Florencia
Published: January 2017

Lardiere (1998a, 1998b) and Prévost and White (2000b) have proposed that adult second language (L2) learners can in principle acquire native-like syntactic representations of the L2 and that the commonly observed differences between native speakers (NSs) and nonnative speakers (NNSs) are due to the malfunctioning of the morphological module of the grammar or of its interface with the syntactic module. Indeed, they reject the idea that such differences arise as the result of a deficit in the syntax. However, the model of grammar which underlies this proposal is as yet far from clear. To test the strength of the claim it is important to examine closely the assumed interactions between lexicon, syntax and morphology.This article is a modest attempt to begin this process of scrutiny. Once detail is added to the proposal it becomes clear that theoretical and empirical problems arise. Moreover, some new data collected from a near-native speaker of Spanish bring the empirical problems into sharper focus. It will be concluded that existing evidence against a deficit in the syntax is not compelling.
First language acquisition... second language acquisition: ‘What’s Hecuba to him or he to Hecuba?’
Authors: Foster-Cohen Susan
Published: January 2017

Second language (L2) research appeals to first language acquisition research frequently and standardly. It is important, however, to take stock from time to time of the uses that second language acquisition (SLA) makes of its sister field. Whether we use first language (L1) research to generate or bolster the importance of a particular research question, to argue for a fundamental similarity or a fundamental difference between the two sorts of acquisition, or to offer guidance in the formulation of research paradigms, it is important that we do so with our critical eyes open.This article examines the possible and specific relationships between L1 acquisition and SLA, with the aim of showing that a number of assumptions warrant closer inspection. It begins by examining the expressions ‘first language acquisition’ and ‘second language acquisition’, suggesting that the syntactic and lexical parallelism between the two masks important issues internal to the fields involved. It then explores problems in distinguishing L1 from L2 acquisition from three different perspectives: individual language learner histories, the data, and the mechanisms proposed to account for the two types of acquisition. Finally, it takes a brief look at the sociology of L1 and L2 studies, and suggests that second language study has yet to assume fully its rightful place in the academy.
Surgery for Recurrent Sapheno-Femoral Incompetence Using Expanded Polytetrafluoroethylene Patch Interposition in Front of the Femoral Vein: Long-Term Outcome in 119 Extremities
Authors: Creton D.
Published: January 2017

Objective:

To assess the long-term results of re-do surgery for recurrent varicose veins using polytetrafluoroethylene patch interposition to correct a recurrent varico-femoral junction (RVFJ).

Methods:

In 170 extremities (137 patients) with RVFJ greater than 3 mm in diameter, re-do surgery was done with patch interposition and without extensive resection of neovascularisation. Follow-up data based on physical and ultrasound examinations were obtained for 119 of these extremities (100 patients).

Setting:

Private-practice vascular surgery centre.

Results:

At follow-up (mean 4.9 years), 5 extremities (4.2%) had another RVFJ. In the 114 extremities with no RVFJ, 27.7% had no varicose veins or incompetent superficial veins, 45.3% had several small varicose veins without reflux, and 22.6% had diffused varicose veins and a new site of incompetence between the deep and superficial venous system.

Conclusions:

Re-do surgery using patch interposition lowers the long-term risk of another RVFJ. Wide resection of neovascularisation in the groin seems unnecessary.
Factors Associated with Varicose Veins in Pregnant Women
Authors: Coughlin L. B. , Gandy R. , Rosser S. , de Cossart L.
Published: January 2017

Objective:

To examine the associated features in pregnant women with superficial venous reflux, compared with those without reflux.

Methods:

Pregnant women were recruited at booking and underwent colour flow duplex ultrasound scanning of the lower limbs to ascertain the presence or absence of reflux in the superficial veins. Body mass index and CEAP scores were calculated. A questionnaire regarding parity, smoking habit and family history of varicose veins was administered. Statistical analysis was carried out using ARCUS.

Results:

Three hundred and twenty-nine women were recruited, of whom 83 were identified as having reflux (25%). No relationship was observed between reflux and obesity, smoking or family history. Multiparity was significantly correlated with varicose veins (p<0.03). CEAP scores were higher in multiparous women with varicose veins. An increase in symptoms was associated with a positive family history (especially maternal). Smoking was associated with fewer symptoms in those with reflux, as was obesity.

Conclusion:

Increased parity increased the likelihood of varicose veins, but obesity and family history appeared to make no difference. Symptoms were greater in multiparous women, but less inobese women. An association was made between smoking and fewer symptoms.
Ambulatory Strain Gauge Plethysmography: Correlation to Symptoms and Skin Changes in Patients with Venous Insufficiency
Authors: Struckmann Jan Reinhold
Published: January 2017

Ambulatory strain gauge plethysmography (ASPG) is one of several different methods applicable in the quantification of venous insufficiency. The present material demonstrates a correlation between this muscle pump quantification and symptoms in patients with venous insufficiency. Patients with few symptoms differed in their muscle pump values from those with many symptoms. A correlation was demonstrated between skin changes and the measured degree of pump dysfunction. In 81 patients and eight normal controls, the diagnostic validity of ambulatory strain gauge plethysmography was calculated. The predictive value of a negative test (PVneg) for RT (venous return time) was 0.94 and for EV (expelled volume) 0.75. Correspondingly the predictive value of a positive test (PVpos.) was found to be 1.0 for RT and 1.0 for EV.
Dynamic Popliteal Phlebography
Authors: Perrin M. , Bolot J.E. , Genevois A. , Hiltbrand B.
Published: January 2017

Phlebography of the popliteal vein is reviewed. An anatomical summary considers the superficial and deep venous systems, perforating veins and the gastrocnemius veins. Techniques and methods are described. Results of 2500 investigations are reported To date the puncture failure rate is only 0.3%. The method is useful in identifying incompetence in a wide variety of veins, varicose veins and post-phlebitic disease. The system is compared to other types of investigation. It is concluded that the technique enables a rapid evaluation of venous pathology in many instances and is ideal for use on out-patients.
Evaluation of the Microcirculatory Effects of Venoruton (H.R.) in Patients with Chronic Venous Hypertension by Laser-Doppler Flowmetry, Transcutaneous PO2 and PCO2 Measurements, Leg Volumetry and Ambulatory Venous Pressure Measurements
Authors: Belcaro G. , Rulo A. , Candiani C.
Published: January 2017

The effect of Venoruton on the symptoms and microcirculation was investigated in an open randomised placebo controlled study involving 35 patients with chronic venous hypertension. Treatment was for 6 weeks. There was a significant symptomatic relief (ache, cramps, skin irritation and swelling) according to an analogue scale line score in the active treatment group, but not in the placebo group. The symptomatic relief in this group was associated with a reduction in leg volume ( p < 0.5), resting and standing skin blood flow ( p < 0.05), restoration of the venoarteriolar reflex, a decrease in transcutaneous PO2 ( p < 0.01) an increase in PO2 ( p < 0.05).

These parameters did not change in the placebo group. The results of this study demonstrate that Venoruton therapy has a marked effect on the microcirculation and indicate possible mechanisms of the relief of symptoms.
Viscidation of Blood during Short Term Bed Rest – Its Possible Importance in the Etiology of Deep Vein Thrombosis
Authors: Ernst E. , Saradeth T. , Magyarosy I. , Matrai A.
Published: January 2017

Twelve male volunteers were submitted to strict bed rest. Before, 36 hours, and 84 hours after the start of immobilisation venous blood was drawn. Blood viscosity, haematocrit, plasma viscosity, red cell aggregation, red cell deformability, blood pressure, heart rate and body weight were determined. Results show marked haemoconcentration with significant elevations of blood viscosity, haematocrit, plasma viscosity and red cell aggregation during bed rest. Body weight declines by more than 1 kg. It is suggested that haemoconcentration reduces the fluidity of blood, which in turn decreases flow, thereby predisposing to venous thrombosis in clinical situations with bed rest
Near Parity in the Final Diagnosis of Deep Venous Thrombosis by Duplex Scan and Phlebography
Authors: Cranley John J. , Higgins Roger F. , Berry Robert E. , Ford Clynn R. , Comerota Anthony J. , Griffen Louie H.
Published: January 2017

A collective experience in six vascular laboratories, using the same equipment and instrumentation, provided 351 extremities in which both duplex scan and phlebography were performed, most within 24 h of each other. When the phlebogram was positive, it was a true standard and in these instances the sensitivity of duplex scanning was 95.65%. When the phlebogram was negative, it was incorrect six times, making the sensitivity of phlebography 96.9%. The specificity of phlebography was 100%. When the duplex scan was positive and the phlebogram truly negative, the duplex scan was falsely positive five times (97.3%).
Oxygen Diffusion in Oedematous Tissue and through Pericapillary Cuffs
Authors: Michel C. C.
Published: January 2017

The effect of oedema upon the diffusion of oxygen from capillary blood into the surrounding metabolizing tissue is considered in calculations based on the Krogh-Erlang model. While diffusion distances are increased in oedema, the oxygen consumption per unit volume of tissue is correspondingly reduced and the increments of capillary Po2 necessary to meet the tissue oxygen requirements are small. Pericapillary cuffs of oedema fluid would appear to have minimal effects on oxygen diffusion. It appears unlikely that pericapillary cuffs containing fibrin act as diffusion barriers to oxygen unless the fibrin molecules occupy more than half the volume of the cuff.
Duplex Scanning of Recurrent Varicose Veins
Authors: Richardson G. D. , Beckwith T.
Published: January 2017

Successful treatment of recurrent varicose veins depends on accurate assessment of the cause. Clinical examination with knowledge of previous treatment and Doppler assessment should detect most causes. Previously venograms for vulval veins, short saphenous disease and unusually distributed veins have helped. Experience with B-mode ultrasound for several years, duplex scanning for 18 months, and the manufacture of standoffs, has enabled us to examine veins from the inferior vena cava to very superficial varicosities. Previous research on vulval varicose veins has been re-examined by duplex scanning, but the evaluation of pelvic veins is more difficult. While the round ligament and male varicocele can be reasonably assessed, the preoperative assessment of the sapheno–femoral and sapheno–popliteal junctions is so accurate that it has supplanted the use of venograms. The study of Doppler wave forms to assess valve function and the detection of reversed flow, should also help in further studies on chronic venous insufficiency and perforating vein disease.
External Valvuloplasty of the Sapheno–Femoral Junction Using Perforated Prosthesis
Authors: Zamboni P. , Liboni A.
Published: January 2017

External valvuloplasty of the sapheno–femoral junction restores valve function by reducing vein wall dilatation. For this purpose an external prosthetic support has been used surrounding the dilated proximal long saphenous vein. Perforated PTFE or Dacron grafts were used in order to decrease the risk of infection and thrombosis.
The Role of External Banding Valvuloplasty with the Venocuff in the Treatment of Primary Deep Venous Insufficiency
Authors: Guarnera G. , Furgiuele S. , Camilli S.
Published: January 2017

Objective:

Evaluation of the role of external banding valvuloplasty in the treatment of primary deep venous insufficiency.

Design:

Retrospective analysis of patients subjected to external banding valvuloplasty (EBV) with the Venocuff in relation to the evolution of venous reflux.

Setting:

Department of Vascular Surgery, Instituto Dermopatico dell'Immacolata, Rome, Italy.

Patients:

Ten patients with signs and symptoms of chronic venous insufficiency.

Interventions:

Application of a Venocuff to the superficial femoral vein.

Main outcome measures:

The correction rate of the primary deep venous reflux assessed by venography and colour duplex ultrasound.

Results:

In a mean follow-up period of 10 months, deep vein reflux was completely abolished in nine patients (90%).

Conclusions:

The Venocuff is an improvement over the previous techniques, of surgical treatment of primary deep venous insufficiency in reducing the dilated valve bulb to the correct size in a quick, standardized and precise way.
Neovascularization in Recurrent Sapheno-Femoral Incompetence of Varicose Veins: Surgical Anatomy and Morphology
Authors: Glass G. M.
Published: January 2017

Objective:

To investigate the surgical anatomy and morphology of recurrent sapheno-femoral incompetence after correctly performed sapheno-femoral ligation. To test the hypothesis that such recurrence develops through neovascularization.

Design:

Prospective study of single patient group.

Setting:

Varicose vein clinic of teaching hospital.

Patients:

One hundred and twenty-eight patients (141 limbs) were reviewed 4 or more years after accurately performed sapheno-femoral ligation with catgut, silk or tantalum wire.

Intervention:

Clinical assessment, phlebography, surgical exploration and examination of recurrent veins by radiographic and histological methods.

Main outcome measures:

Presence of reflux through newly formed veins at the site of previous ligation.

Results:

Of 141 limbs, clinical or phlebographic evidence of sapheno-femoral recurrence was confirmed in 35 of 37 on surgical exploration. The continuity of the saphenous vein with the previously ligated sapheno-femoral junction was restored through a newly formed vein or complex of veins.

Conclusions:

Neovascularization was the cause of recurrent sapheno-femoral incompetence after correctly performed sapheno-femoral ligation.
In Vivo Compliance of the Human Saphenous Vein Measured by Sonography: Comparison with Plethysmographic and in vitro Measurements
Authors: Lefthériotis G. , Pochet Th. , Abraham P. , Subayi-Kamuanga J. B. , Jardel A. , Saumet J. L.
Published: January 2017

Objective:

To evaluate a non-invasive and selective measurement of in vivo venous compliance of the human saphenous vein using sonography.

Design:

An experimental study in patients prior to coronary bypass surgery.

Setting:

Departments of Physiology and Cardiothoracic Surgery, University Hospital of Angers.

Patients:

Thirty patients investigated prior to coronary bypass surgery.

Interventions:

Simultaneous strain-gauge venous occlusion plethysmography (VOP) and measurements of the circumference of the great saphenous vein by sonography at four different occlusion pressures: 20, 30, 40 and 50 mmHg. In 10 of the same patients, in vitro determination of pressure–volume relationship during progressive inflation of excised saphenous vein samples.

Main outcome measures:

Venous compliance obtained with the three methods.

Results:

Weak correlation coefficients were found between in vitro measurements and VOP ( r=0.478, p<0.01) and sonography ( r=0.497, p<0.02). Although individual correlations between in vitro and VOP measurements ranged from 0.928 to 0.999, a wide heterogeneity was found with sonography (from 0.620 to 0.985).

Conclusions:

Sonography allows the selective measurement of in vivo venous compliance, although the measured compliances differ from other techniques.
Reproducibility of Duplex Ultrasound in the Measurement of Venous Reflux
Authors: Evans C. J. , Leng G. C. , Stonebridge P. , Lee A. J. , Allan P. L. , Fowkes F. G. R.
Published: January 2017

Objective:

To determine the reproducibility of duplex ultrasound in the measurement of reflux duration in lower limb veins.

Design:

Repeatability study.

Setting:

Vascular clinic in a tertiary referral centre.

Participants:

Twenty-one patients with severe venous disease.

Interventions:

Patients were scanned using duplex ultrasound by two of three observers, then rescanned by a different pair of observers after a mean interval of 51 days.

Main outcome measures:

Duration of venous reflux.

Results:

On a Wilcoxon signed rank test, observers 2 and 3 showed no significant interobserver variability. The other pairs of observers agreed at the majority of segments, but differed at the popliteal vein ( p≤0.001), and superficial femoral and common femoral veins ( p≤0.05). Observer 2 showed no significant intraobserver variability, but observer 1 differed at the common femoral and superficial femoral veins ( p≤0.05), and observer 3 differed at the short saphenous vein ( p≤0.05).

Conclusions:

Reproducibility was reasonable at certain sites, but appeared to be influenced by position of the vein.
Clinical Predictors of the Severity of Chronic Venous Insufficiency of the Lower Limbs: A Multivariate Analysis
Authors: Mota-Capitão L. , Menezes J. Daniel , Gouveia-Oliveira A.
Published: January 2017

Introduction:

Chronic venous insufficiency (CVI) affects a large proportion of individuals and, with the ageing of the Western European population, its prevalence is bound to increase. Epidemiological data, particularly regarding risk factors, are scarce and controversial.

Objective:

Identification of clinical factors associated with an increase in severity of CVI.

Setting:

Community-based study of patients presenting to their general practitioner.

Methods:

Four hundred and seventy-four unselected patients with symptoms suggesting CVI were evaluated by 18 general practitioners. CVI was diagnosed and assessed by clinical examination and portable continuous-wave Doppler. Severity of CVI was graded according to the nomenclature of the International Society for Cardiovascular Surgery. Patient demographic and clinical factors showing a linear relationship with the severity of CVI were analysed with the proportional odds model to evaluate the simultaneous effect of several factors in the severity of CVI.

Results:

A multivariate model is proposed, where age is a major risk factor for increased severity. Other factors that are independently correlated with the severity of CVI are body weight, environmental heat, sedentarily, CVI in both parents, high-dose oestrogen formulations, osteoarticular disease of the lower limbs, presence of truncal varices, involvement of the internal saphena, lymphoedema and history of thrombophlebitis.

Conclusion:

Because most studies do not adjust for age when testing for risk factors, this may be an important reason for the multiplicity of reported factors and the lack of consistency of their results.
The Long Saphenous Vein Compartment
Authors: Caggiati A. , Ricci S.
Published: January 2017

Objective:

To define the relationship between the long saphenous vein and the connective framework of the subcutaneous tissue (hypodermis) of the lower limb.

Methods:

The connective skeleton of the hypodermis was studied by anatomical dissection, stereomicroscopy of cross-sectioned specimens and ultrasound imaging in 88 lower extremities.

Results:

The long saphenous vein runs for most of its length in a narrow compartment delineated deeply by the muscular fascia and superficially by a connective tissue lamina descending from the inguinal ligament in the anteromedial part of the thigh and medial aspect of the calf. These two fascia fuse at the boundaries of the compartment. The long saphenous vein adventitia is anchored to both fasciase by thick connective tissue strands.

Conclusion:

The anatomical relationship between the long saphenous vein and the connective framework of the hypodermis suggests that: (1) only the vein running within the deep compartment of the hypodermis should be considered as the ‘true’ long saphenous vein; (2) the other subcutaneous veins running outside the compartment should be considered as collaterals of the long saphenous vein; (3) the connective sheath surrounding the long saphenous vein could oppose dilatation of this vessel should valvular incompetence develop; and (4) thigh muscle contraction could modify the calibre of the long saphenous vein as happens in the deep veins. Finally, the authors propose to term the deep compartment of the medial thigh and the leg hypodermis the ‘long saphenous vein compartment’ and consequently the hypodermic connective lamina, by which it is superficially delimited, as the ‘long saphenous vein fascia’.
Inferior Vena Cava Compression Caused by Ruptured Abdominal Aortic Aneurysms: Report of Two Cases
Authors: Martínez-León J. I. , Bohórquez-Sierra J. C. , Sánchez-Guzmán A. R. , Arribas-Aguilar F. N. , Ceijas-Lloreda F. , Rodríguez-Piñero M. , Bohórquez-Sierra C.
Published: January 2017

Objective:

To report two cases of inferior vena cava (IVC) and iliac vein thrombosis secondary to expansive and ruptured abdominal aortic aneurysms.

Design:

Case report.

Setting:

Angiology and Vascular Surgery Unit, Hospital Universitario Puerta del Mar, Cádiz, Spain.

Patients:

Patients with clinical and radiological evidence of IVC and iliac vein thrombosis secondary to a sealed rupture from expanding aortic aneurysms.

Interventions:

Surgical repair in one case and conservative management in the second case.

Conclusions:

Venous compression was relieved, avoiding the risk associated with anticoagulant therapy in the presence of an aortic aneurysm. Ultrasound scanning is useful in assessing deep venous thrombosis and detecting compressive masses such as aortic and iliac aneurysms. Inappropriate management of patients with venous obstruction from undiagnosed arterial aneurysms may cause serious complications.
A Simple Technique to Reduce Blood Loss and Improve Cosmesis in Varicose Vein Surgery
Authors: Rehman A. , Rallapalle V. S. P. , Iqbal R. , Grimley R. P. , Jayatunga A. P.
Published: January 2017

Objective:

To assess the effectiveness of preoperative compression hosiery in reducing blood loss during surgery for varicose veins and improving cosmetic results.

Setting:

Vascular Surgical Unit, Dudley Group of Hospitals NHS Trust, West Midlands, UK.

Design:

Randomized, single-blind, prospective, controlled trial.

Patients:

Thirty-nine patients with varicose veins in 50 legs.

Intervention:

Group A, the control group ( n = 19), were given compression stockings on the first postoperative day after the bandages were removed. Group B, the study group ( n = 20), used compression stocking 24 h before surgery as well as in the postoperative period. The surgical procedure was standardized.

Main outcome measures:

Blood loss, weight of veins removed, operation time and cosmetic result after 6 weeks.

Results:

In group B, patients were noted to have reduced blood loss, a shorter operation time and a greater weight of avulsed veins. Poor cosmetic results were recorded in group A.

Conclusions:

Preoperative emptying of veins by using a compression stocking is useful in reducing blood loss and improving the cosmetic result after routine varicose vein surgery.
Left Renal Vein Anatomical Anomalies: Radiological and Surgical Implications
Authors: Martínez-León J. I. , Doménech-Pérez C. , Martínez-León J. , Martínez-Castillo C. , Martínez-Almagro A.
Published: January 2017

Objective:

To emphasize the incidence and clinical, diagnostic and surgical implications of left renal vein developmental anomalies.

Design:

Retrospective analysis of case notes.

Setting:

Clinical Anatomy Department and Surgery Department, Faculty of Medicine, University of Valencia, Spain.

Patients, participants:

Standard radiological examinations (CT scan) performed on 745 patients; surgical findings at operation in 128 patients with aorto-iliac atherosclerotic disease, and 72 donor cadavers for transplantation.

Main outcome measures:

Incidence of left renal vein anomalies (retro-aortic left renal vein and peri-aortic renal venous collar), based on radiological (CT scan) and surgical observations. Analysis of implications to surgical management.

Results:

The radiological series disclosed a 2.68% incidence of left renal vein anomalies: 1.33% retroaortic left renal vein, and 1.33% peri-aortic renal venous collar. The surgical series showed a 1.5% incidence of both anomalies.

Conclusions:

The importance is stressed of these relatively uncommon but hazardous conditions, which should be familiar to anatomists, radiologists and surgeons.
Indomethacin in the Treatment of Soft Tissue Lesions
Authors: van Marion W F
Published: January 2017

Royal Netherlands Navy, The Medical Department, Lt.-Cdr Sq, Royal Naval College, Den Helder, The Netherlands Eighty three patients with traumatic soft tissue disorders were studied in a double blind completely randomized trial comparing 150 mg and 100 mg indomethacin (Indocid®) daily against placebo. Indomethacin was effective in reducing spontaneous pain, tenderness, swelling and limitation of movement. No serious side effects were observed. The results in this study indicate that 150 mg indomethacin daily is to be preferred over the 100 mg dose, especially in severe cases.
Combined Administration of Thioridazine and Nicotinic Acid in the Treatment of Geriatric Patients
Authors: Ananth J V , Saxena B M , Lehmann H E , Ban T A
Published: January 2017

Fifteen chronic geriatric female patients aged 67 to 92 years were included in a twelve week uncontrolled study to test the efficacy of a thioradazine and nicotinic acid combination in the treatment of psychiatric ailments in the elderly. Doses ranged from 300 mg of nicotinic acid and 25 mg of thioridazine to 1500 mg of nicotinic acid and 75 mg of thioridazine daily. Each patient was regularly assessed on a number of psychiatric rating scales and a battery of psychometric tests. Routine haematological and biochemical tests were performed.

The combined treatment brought about improvement in symptoms of emotional withdrawal, conceptual disorganisation and uncooperativeness, and preoccupation with self. Symptoms of somatic concern, irritability and autonomic reactions deteriorated. Improvement in the performance of certain psychometric test procedures was observed. Numerous adverse reactions including two cases of severe leucopenia occurred.
Urinary Electrolyte Profiles after Amiloride, Hydrochlorthiazide and the Combination
Authors: Lammintausta R , Kanto J , Mäntylä R
Published: January 2017

Acute effects of amiloride (5 mg) (A), hydrochlorthiazide (50 mg) (H) and the combination (50 + 5 mg) (HA) on urinary electrolyte excretion and pH of ten healthy volunteers – taking placebo five times and twice randomly A and HA and once H – were studied during one day.

Amiloride showed a natriuretic effect, which in combination was additive to that of hydrochlorthiazide, but the excretion of water did not increase significantly after A. The urinary excretion of potassium decreased with amiloride below normal levels and was at the level of placebo after the combination (HA). There was a striking linear correlation between urinary sodium and potassium with all the drugs, although showing with A a higher potassium retention during high sodium excretion. Urinary pH rose after A and HA during the first 8 hours, but this effect was not seen, however, after H.

No significant differences in the effect of the two brands of A (Medamor® and Puritrid®) on the urinary electrolyte excretion and pH, nor in those of the two brands of HA (Moduretic® and Amitrid®) were found. Similarly, the plasma concentrations of hydrochlorthiazide, determined gas chromatographically, were equal after Moduretic® and Amitrid® tablets. The systemic availability of H was faster in the combination of HA than alone. In the AUC value of H, however, there was no significant difference between HA and H tablets.
A Comparison of the Antibiotic Activities of Sisomicin, Gentamicin and Aminosidine Sulphate against Pseudomonas Aeruginosa
Authors: Pitzus E , Ghinelli P , Turano A , Romano F , Cadenelli G P
Published: January 2017

Sisomicin, gentamicin and aminosidine sulphate were compared for their antibiotic activity against Pseudomonas strains freshly isolated from clinical material. The activity of the three agents, expressed as a minimum inhibitory concentration, was determined using the same automatized system.
Pirenzepin in Gastric and Duodenal Ulcer: A Double-Blind Trial
Authors: Čerlek S , Papa B , Katičić M , Čolić-Cvrlje V , Mielenz H
Published: January 2017

In seventy-five out-patients with gastric and duodenal ulcer a comparative double-blind trial with pirenzepin against placebo was performed. The dose was 50 mg pirenzepin daily or placebo respectively, the duration of treatment being 4 weeks.

The healing effect of pirenzepin in duodenal ulcer patients could be proven endoscopically and was statistically significant when compared with placebo (p ≤ 0.05). Strong evidence for the therapeutic efficacy of pirenzepin could be further demonstrated in both duodenal and gastric ulcer patients by measuring the marked reduction of ulcer size, even though statistical difference against placebo in gastric ulcers was not fully achieved.

Pirenzepin was well tolerated by all patients, except for a mild case of diarrhoea which occurred in one patient. No patient complained of dryness of the mouth or of blurred vision.
Pefloxacin in the Treatment of Lower Respiratory Tract Infections in Geriatrics
Authors: Vanderdonckt J.
Published: January 2017

Pefloxacin was administered to 24 geriatric patients as treatment for lower respiratory tract infections contracted in hospital. Efficacy was evaluated by clinical, bacteriological and radiological parameters. Two-thirds of the patients responded well to therapy. Only two of 30 pathogens were not eradicated, but seven patients had superinfection or colonization by another organism. Tolerance was excellent, with only slight gastro-intestinal disorders. Pefloxacin was shown to be an effective and safe therapy for lower respiratory tract infections contracted in hospital in elderly patients.