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doi: 10.1002/bjs.1800671003pmid: 7427021
SummaryFoot volumetry is a simple, non-invasive technique for functional assessment of the venous system of the lower limb. The results of foot volumetry and venous pressure measurements were compared in 28 patients who were allocated to one of three groups—normal, uncomplicated superficial venous incompetence and deep venous incompetence—on the basis of clinical examination and ascending phlebography. Volumetry was found to differentiate more accurately between the three groups. Volumetry was also used in 113 patients who had suffered from phlebographically proved deep vein thrombosis (DVT). Seventy-seven per cent of 34 patients who sustained a major DVT and 16 per cent of 79 patients with calf vein thrombosis had evidence of severe haemodynamic impairment equivalent to that seen in the established post-phlebitic syndrome. The clinical significance of these findings is discussed.
Janvrin, S B; Davies, G; Greenhalgh, R M
doi: 10.1002/bjs.1800671004pmid: 7000224
SummaryUsing a new method of measuring whole blood clotting time, we have confirmed the findings of others, that blood clots faster when diluted with saline. A prospective trial was designed to test the hypothesis that intravenous saline peroperatively causes hypercoagulation and increases the risk of venous thrombosis. Sixty patients admitted for routine laparotomy were randomly allocated to either a group receiving intravenous fluids during or after operation (Wet), or a group receiving no intravenous fluids (Dry). The Wet patients became significantly more haemodilute and hypercoagulable than the Dry (P < 0·001), and these changes correlated. A postoperative deep vein thrombosis occurred in 30 per cent of the Wet patients, but in only 7 per cent of the Dry (P < 0·05). The need for intravenous fluids during uncomplicated surgery is probably unproved, and their greater use may have contributed to the increasing prevalence of venous thromboembolism.
Rennie, J A; Christofides, N D; Mitchenere, P; Fletcher, D; Stockley-Leathard, Helen L; Bloom, S R; Johnson, A G; Rains, A J Harding
doi: 10.1002/bjs.1800671005pmid: 7427022
SummaryTwo inhibitory mechanisms in the human colon which may contribute to postoperative ileus have been studied.Dopamine, a possible peripheral neurotransmitter, inhibited isolated colonic smooth muscle strips by a direct effect in longitudinal muscle and by a nerve-mediated mechanism in circular muscle.Plasma motilin levels were suppressed pre- and peroperatively and elevation of levels postoperatively correlated with the return of normal motility and the severity of the operation.
doi: 10.1002/bjs.1800671006pmid: 7427023
SummaryA reproducible model of reversible segmental ischaemia was used to evaluate methods of predicting intestinal viability after the release of strangulation. Visual assessment in the immediate period after reperfusion and at ‘second-look’ 24 hours later was inaccurate in identifying recoverable bowel. A Doppler probe used to detect the return of pulsatile blood flow was overpredictive of necrosis. The pattern of surface fluorescence after injection of the supravital dye fluorescein increased the accuracy of predicting intestinal recovery.A series of silicone rubber injections was carried out to investigate whether the patency of the microvessels influenced the outcome. It was shown that as the ischaemic period increased there was progressive failure of the microcirculation.It was concluded that the fluorescein injection test correctly identifies recoverable bowel and that the outcome after ischaemic injury is related to microvascular patency.
Veitch, P S; Shenton, B K; Proud, G; Taylor, R M R
doi: 10.1002/bjs.1800671007pmid: 6159039
Over the past few years many centres have shown that blood transfusions given to potential renal transplant patients are beneficial to subsequent graft survival. Results from this centre have shown that an elevated ability of plasma to suppress lymphocyte reaction to antigen is associated with blood transfusions in chronic renal failure patients. In a prospective study, plasma suppressive activity was measured at the time of transplantation in 49 patients who were followed for between 3 and 15 months. Results showed that patients with a low level of plasma suppressive activity were at risk from early graft loss due to acute rejection. Furthermore, most of the suppressive activity was related to the naturally occurring plasma protein, α2-macroglobulin.This prospective study reports a significant association between low plasma suppressive activity and early kidney graft loss through rejection, and suggests an explanation for the beneficial effects of blood transfusion on graft survival.
doi: 10.1002/bjs.1800671009pmid: 7427024
SummaryThe effect on digital blood flow of an acute exposure to vibration has been assessed. Vibration in the frequency range 40–200 Hz reduces digital blood flow, the effect being maximal at 120 Hz. Increasing the amplitude of vibration reduces digital blood flow. The results have implications in the formulation of industrial vibration standards and in the pathophysiology of vibration-induced white finger.
Chan, S; Radcliffe, A; Johnson, A
doi: 10.1002/bjs.1800671010pmid: 7427025
SummaryIn view of previous conflicting reports, the distribution of a water overload was investigated in 6 healthy volunteers. The fall in serum sodium was predictable from prior measurement of total body water (tritium) confirming that the induced hyponatraemia was dilutional.Using a standard intravenous fluid regimen, a prospective study for 6 days on 50 patients undergoing major abdominal surgery established a confidence band for change in serum sodium concentration. This band not only enables precise prediction of whether observed sodium values in patients are ‘normal’ for that point in their postoperative course, but also demonstrates that changes are more prolonged than was at first thought. Their dilutional nature following uncomplicated surgery is supported by linear relationships between serum osmolality and serum sodium (s-Osm = 1·86 [s-Na+] + 18·74; P < 0·001) and between observed and calculated osmolality (Obs-Osm = 0·97 [Cale-Osm] + 15·11; P < 0·001). More detailed investigation of 14 patients by isotope dilution provided independent evidence of dilutional change. This conclusion is additionally supported by lesser changes in patients on a more restricted fluid regimen.As a practical confirmation of the utility of this approach, departures from the simple dilutional relationships were observed in 7 critically ill patients whose postoperative course was complicated. In this group osmolal ‘gaps’ of 20–50 mosmol/kg were identified.Current standard postoperative fluid regimens cause dilutional changes; these are predictable and provide a vardstick for use in management of both the healthy and the ill surgical patient.
Shorthouse, A J; Smyth, J F; Steel, G G; Ellison, M; Mills, J; Peckham, M J
doi: 10.1002/bjs.1800671011pmid: 6253000
SummaryThe chemotherapeutic response of a series of patients with bronchial carcinoma has been compared with the response of their xenografts established in immune-suppressed mice.The in situ endpoint of growth delay in subcutaneous tumours was the main parameter used to assess xenograft response, but clonogenic cell survival studies were also performed to assess the extent of cell kill associated with in vivo responses.Histology, chromosome analysis and demonstration of ectopic hormone production indicated that the xenografts retained human morphology and functional behaviour. Clinical response was assessed by serial measurement of metastases. The chemotherapeutic validity of xenografts is supported by this study in which 21 separate responses in 16 patients and their respective xenografts were similar. Metastases regressed completely in 5 out of 7 patients with oat cell carcinoma. Xenografts derived from these were also highly responsive to similar chemotherapy. In contrast, minimal responses were observed in xenografts established from two chemoresistant patients.One large cell anaplastic, 3 squamous and 4 adenocarcinomas were universally chemoresistant in patients and their xenografts.It is concluded that the bronchial carcinoma xenografts broadly retained human morphology and functional behaviour, and reproduced the pattern of chemotherapeutic response of their source tumours. The present work suggests that the incorporation of human tumour xenografts into drug development programmes is justified, although their usefulness in a predictive capacity to select appropriate chemotherapy for individual patients remains limited.
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