Stomal and recurrent ulceration: Medical or surgical management?

During the past 15 years we have treated 175 patients with stomal or recurrent ulcers, approximately half of whom had undergone primary surgery elsewhere. Medical treatment with cimetidine was no more effective than placebo in a controlled trial involving 24 patients. Forty-three patients have been treated with cimetidine, and healing was achieved in 24 (56 percent). Of these 43 patients, 17 (40 percent) have already undergone operation.One hundred fifty patients have been treated surgically with no primary mortality. In 142 patients an acid-reducing procedure was used. With vagotomy or revagotomy alone, there were 6 further recurrences among 38 patients (16 percent). With gastric resection alone, there were two recurrences among 33 patients (6 percent), whereas there was only one recurrence among 71 patients with revagotomy and antrectomy (1.4 percent). Of the nine patients with rerecurrences, eight needed further operation; two of these patients died after emergency reoperation for hemorrhage. There is little difference between the results of Billroth I and Billroth II antrectomy, but if the latter is used the addition of a Roux loop should be considered.     

Ischaemic colitis: a sequel to femoral artery laceration

Ischaemic colitis is presented as a sequel to a femoral artery laceration. The course and complications are described and the possible mechanism is discussed.     

Traumatic pancreatic fistula with associated gastro-colic fistula

A case of traumatic pancreatic fistula complicated by gastric and colonic fistulous tracts is presented, and management is discussed.     

Mitral Annuloplasty in Endomyocardial Fibrosis: An Alternative to Valve Replacement

The case of a patient with left ventricular endomyocardial fibrosis (EMF) causing severe mitral regurgitation is presented. Excision of the fibrotic tissue through the left atrium and mitral annuloplasty resulted in symptomatic relief and uncomplicated pregnancy. An X-linked congenital dermatological condition, Bloch-Sulzberger syndrome (incontinentia pigmenti), associated with chronic eosinophilia, was also present. This occurrence with EMF has not previously been reported. Atrioventricular valve reconstruction is a feasible alternative to valve replacement in EMF.     

Severe thoracic intra-abdominal and vertebral injury occurring in combination in a patient wearing a seat belt

A case of combined thoracic, intra-abdominal and vertebral injury occurring in a patient wearing a seat belt is presented; the possible mechanisms are discussed.     

Experience in the accident and emergency department of the Royal Victoria Hospital with patients from civil disturbances in Belfast 1969-1972, with a review of disasters in the United Kingdom 1951-1971

Within a period of 3 years the Royal Victoria Hospital, Belfast, had to use its disaster drill on 46 occasions. On attempting to find the number of disasters in the United Kingdom since the setting up of the National Health Service, records of 42 other disasters were found. Reports of these disasters were studied, the literature in British medical journals was read, and this with personal experience in the Royal Victoria Hospital is the basis of a discussion on disaster planning. Some recommendations are made.     

Aortobronchial fistula: a late complication of division of the persistent ductus arteriosus

An 11-year-old girl had nearly fatal hemoptysis due to false aneurysm and aortobronchial fistula following ductus division 9 years previously. Silk suture material was implicated as a causative agent in association with dilation of the aortic isthmus. To our knowledge, no previous report of this complication exists in the literature. Twenty-two cases of false aneurysm have been described, 86.3% following ligation. The use of elective hypotension during ligation and monofilament suture during division may prevent this serious late complication in the future.     

Popliteal arterial thrombosis resulting from disruption of the upper tibial epiphysis

As a result of a fall, a young athlete sustained a type 2 epiphyseal fracture of the proximal tibia. Three days later it became apparent that the popliteal artery had thrombosed and a successful arterial reconstruction was carried out.     

Symptoms at one year following concussion from minor head injuries

Of 131 patients with mild concussion, 19 (14.5 per cent) still had symptoms after 1 year. Of these 19 patients, 10 had some symptoms of which they had not complained at 6 weeks. Symptoms at 1 year were more common among women and among patients who had had positive neurological findings at 24 h. Of the 19 patients who had symptoms at 1 year, 8 were involved in law suits and 6 had been suspected of malingering 6 weeks after their accident. Five of these patients were both involved in law suits and suspected of malingering.     

The definition and classification of disasters

The universe, we are told, began with a big bang, and ever since, nature has provided a series of unexpected bangs and calamities of one type or another. Since the advent of the industrial revolution, man has been more or less controlling larger and larger amounts of energy. World population has rocketed. The interaction of crowded humanity and escalating energy has added a series of man-made disasters to the continuing natural calamities.     

An assessment of the validity of the injury severity score when applied to gunshot wounds

Injury Severity Scores were calculated for the injuries of 875 patients suffering from gunshot wounds. These scores were plotted against mortality. Increasing ISS is associated with increasing mortality, but the relationship is not linear.     

Hangman's fracture

The injury known as hangman's fracture is described. The patients seen in Belfast with this injury over the past 20 years are reviewed. It is noted that there is disagreement in the literature over the best form of treatment and we strongly advocate the case for conservative management. We also put forward a simple explanation for the absence of neurological sequelae associated with the accidental form of this injury.     

Another curious gunshot injury

An unusual complication of a gunshot injury to the knee is described. The bullet lodged in the subchondral plate of the tibia. The lead was dissolved by synovial fluid, which produced an intense synovitis resulting in gross osteoarthritis of the joint.     

Intravenous regional anaesthesia in upper limb trauma

Practical experience in the use of Bier block anaesthesia of the upper limb is described. The revival of this well-tested technique is particularly relevant in circumstances where, for a variety of reasons, the administration of a general anaesthetic is impracticable. The quality of surgery, the safety of anaesthesia and the patient's comfort can be well maintained by following a few simple rules. We have satisfied these criteria in this series by using low doses which are safe and sufficient in a busy accident department.     

Complete transection of the main bronchus

Reports of bracheo-bronchial rupture have increased over the past 30 years. However, it remains an uncommon injury and the majority of victims do not reach hospital alive (Ecker et al., 1971; Bertelsen and Howitz, 1972). This is the first case of complete bronchial transection seen during 20 years in this unit, which serves a population of 1.5 million.     

Intestinal injury due to non-penetrating abdominal trauma

Five cases of intestinal injury alone due to nonpenetrating abdominal trauma are presented. The possible mechanisms of intestinal injury are discussed, together with the presentation, investigation and management of these cases.     

A new flexible design of drop-footorthosis

The use of polypropylene thermoplastic has caused a revolution in the design of ankle and foot orthoses in recent years. There are many variants in design to suit individual needs. A lively orthosis has been developed at this centre for those patients with weak or absent dorsiflexion of the foot and free passive ankle movements. This design overcomes problems of fatigue failure found in conventional designs and greatly enhances the dynamic cosmesis of this type of orthosis.