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Berridge, D C; Makin, G S; Hopkinson, B R
doi: 10.1002/bjs.1800761204pmid: 2514002
The use of local low dose thrombolysis is gradually increasing. Most experience is with streptokinase, although newer agents such as recombinant tissue plasminogen activator (rTPA) may offer more effective lysis with reduced complications. We have reviewed the experience documented in 19 prospective series published between 1974 and 1988 in an attempt to define the incidence of stroke, major haemorrhage and minor haemorrhage. The overall risk of stroke was 1·0 per cent. of patients (14 cases). Major haemorrhage occurred in 5·1 per cent of patients (71 cases) and minor haemorrhage occurred in 14·8 per cent (92 out of 620 cases). There was little difference between the two thrombolytic agents, although the experience with lower doses of rTPA suggests it may offer a reduced risk of haemorrhagic complications. It is essential that all studies concerning thrombolysis should give their exclusion and inclusion criteria in full to allow an accurate appraisal of haemorrhagic complications, with the hope of improved patient selection and reduced morbidity in the future.
Clavien, P-A; Burgan, S; Moossa, A R
doi: 10.1002/bjs.1800761205pmid: 2691011
This review evaluates selective enzymes and blood tests available for the diagnosis and prognosis of acute pancreatitis. It is concluded that serum amylase and lipase measurements represent the best available diagnostic methods. Newer alternative assays still require careful evaluation.
Carr, N D; Cairns, S J; Lees, W R; Russell, B C G
doi: 10.1002/bjs.1800761206pmid: 2691012
Pancreatic trauma is rare and experience concerning its management is consequently limited. Lessons learnt in the investigation and treatment of a group of 11 patients (median age 28·0 years, range 14–44 years), who presented with the sequelae of trauma, are described. These patients were referred to a centre with an interest in pancreatic disease at a median time of 6·0 months (range 1·5–34 months) after blunt (n = 9) or penetrating (n = 2) injury to the pancreas. Ten of the 11 patients had undergone either single (n = 4) or multiple (n = 6) previous operations. Ten of the 11 patients had either strictures or disruptions of the main pancreatic duct demonstrated by endoscopic retrograde cholangiopancreatography (ERCP) and ultrasonography (n = 8) or by exploration of the pancreas (n = 2). Satisfactory results were achieved by non-operative treatment in one patient and by distal pancreatectomy in eight. One further patient, who underwent distal pancreatectomy, later required completion resection because of unsuspected ductal injury in the head of the gland. The final patient continued with symptoms of pancreatitis after pancreaticoduodenectomy. It is concluded that the non-resolving sequelae of pancreatic trauma are associated with injury to the main pancreatic duct and that specialist investigation should be performed before surgical intervention is contemplated.
doi: 10.1002/bjs.1800761207pmid: 2486302
Intravenous digital subtraction angiography is relatively hazardous and inaccurate. It appears from the literature to have little place in either the screening of patients with putative carotid artery disease or in the assessment of those about to undergo carotid endarterectomy.
Mutirangura, P; Stonebridge, P A; Clason, A E; McClure, J H; Wildsmith, J A W; Nolan, B; Ruckley, C V; Jenkins, A McL
doi: 10.1002/bjs.1800761208pmid: 2605465
Between 1978 and 1987, 587 cases of abdominal aortic aneurysm were operated on in the Vascular Unit of the Royal Infirmary of Edinburgh. Over this ten-year period there was a dramatic increase in the number of patients treated. Rupture had occurred in 278 patients. Of the 309 patients with non-ruptured aneurysm 175 were asymptomatic, 84 were symptomatic and 50 were acutely symptomatic. Two hundred and fifty-nine patients underwent elective operation and the 50 acutely symptomatic patients were operated on as emergencies. The overall mortality for the non-ruptured series was 2·9 per cent. The mortality in patients undergoing elective surgery was 1·9 per cent (1·1 per cent in asymptomatic and 3·6 per cent in symptomatic patients) and 4·0 per cent for patients undergoing emergency surgery.
Lepäntalo, M; Lindgren, K-A; Leino, E; Lindfors, O; von Smitten, K; Nuutinen, E; Tötterman, S
doi: 10.1002/bjs.1800761209pmid: 2605466
A total of 112 first ribs in 103 patients were resected over 11 years for thoracic outlet syndrome. Seventy-seven patients (84 operations) were followed up for 2·5 years or more to assess the long term results of this procedure and the factors affecting them. One month after surgery 52 per cent of limbs were asymptomatic and 77 per cent were at least improved. A follow-up examination was performed, on average 6·1 years after the operation, by two independent examiners. This evaluation showed a permanent success rate of 37 per cent among 84 limbs examined. These long term results compare unfavourably with previously published data. The reason for the poor final outcome seemed to be difficulty in selecting patients for the operation. This was not aided by any of the preoperative tests. Patients in this study were evaluated by independent examiners, and only a total absence of preceding symptoms was accepted as the criterion for success. We emphasize the importance of unbiased evaluation and long term follow-up.
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