Drug mixture which improves survival of ischemic rabbit epigastric skin flaps

The chief aim of this study was to maximize flap survival by counteracting the pathophysiological changes occurring during ischemia-reperfusion. Rabbit epigastric skin flaps given 21 hours of ischemia were infused intra-arterially with selected drugs at the start of reperfusion. Compared with control infused ischemic flaps, which had a 33% survival rate on day 7 post-ischemia, significant improvement was found with vasodilators nitrendipine (61%) and prostacyclin (65%) and the thrombolytic agent urokinase (65%); marginal improvement with the free radical scavenger desferrioxamine (53%); but no change with streptokinase (44%), heparin (21%), and ATP-MgCl₂ (35%). A drug mixture comprising all of these agents except streptokinase and urokinase produced 87% survival, suggesting an additive effect. Biochemical assays on skin homogenates and blood implicated oxygen free radicals, neutrophil infiltration, and thromboxane in flap failure. These results imply that multiple factors are responsible for ischemic flap failure and that a mixture of drugs needs to be infused to counteract all of the detrimental changes. © 1994 Wiley-Liss, Inc.     

Partners in adversity V: Support,personality and coping behaviour at the time of crisis

This paper presents further results from a study of married women in Edinburgh who had just suffered an adverse experience: either their husband's non-fatal myocardial infartion, their husband's death or their own arrival in a Women's Aid refuge for battered women. Interviews were carried out 4–6 weeks following the adverse experience and, where possible, again approximately 3 months later. Symptoms were assessed using the 30-item General Health Questionnaire and criterion-based measures of depression and anxiety derived from it. The extent and nature of crisis support from household members and from groups of people outside the household, and also of failures in expected support, was measured at first interview. A modified version of Tyrer and Alexander's (1979) personality schedule was administered at the follow-up interview, and the resulting personality data were then reduced to six factors using principal components analysis. An interviewer assessment of how well the subject was coping was made at both interviews. The vast majority of the sample received extensive practical and emotional support from family and friends, and perhaps because such positive support was so prevalent, variations in it seemed to have little effect on symptoms. However, subjects who were unexpectedly let down or criticised by friends or family tended to show higher symptom levels, although, surprisingly, this was less true for the bereaved wives than for the others. The six personality factors that emerged were labellednervousness (similar to neuroticism)impulsivity, social withdrawal, helplessness, inferiority andaggressiveness. There was evidence that subjects high on nervousness remained symptomatic longer following the adverse experience. The aggressiveness factor showed a curvilinear trend with high and low aggressives showing higher symptom levels than middle aggressives. However, for the coronary wives the trend was linear with low aggressives having high symptoms. Subjects low on impulsivity were more affected by being let down by friends and family. The interviewer-assessed coping measure was linearly related to nervousness and showed a curvilinear relationship with aggressiveness.     

Lower Limb Swelling Due to Femoral Aneurysms

A man of 53 presented with left lower limb swelling, which was found to be caused by compression of the femoral vein by a common femoral artery aneurysm. Seven years later a similar situation developed in the opposite limb. On each occasion the diagnosis was confirmed radiologically and the symptoms resolved rapidly following surgery.

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Reconstructive rectal surgery.

Rectal cancer causes approximately 6000 deaths in the UK each year. The role of the surgeon in rectal cancer is to control local disease and minimise the risk of recurrence. Reconstructive rectal surgery for cancer aims to combine a safe oncological procedure with the maximum quality of life possible. An improved understanding of rectal cancer pathology allied to modern surgical techniques such as intestinal stapling guns, endoanal anastomoses and the colonic pouch has led to an increased number of sphincter saving operations being performed. We have reviewed the background, technical advances and looked at the future of reconstructive rectal surgery for rectal cancer. Firstly we discuss the work which led to low anterior resection being accepted as an oncologically safe operation. followed by an overview of surgical techniques that have facilitated low anterior resection for rectal cancer with good functional results for the patient. Lastly, we look at the role of radiotherapy and the neosphincter in reducing the need for a permanent stoma.     

Surgical therapy of perianal Crohn''s disease

The surgical management of perianal Crohn's disease is complex with a wide range of operations being described. The initial emergency treatment is to drain any source of underlying sepsis. A loose seton drainage or a defunctioning stoma can then be used as a 'bridge' to definitive treatment allowing both adequate assessment of the condition and preventing further sepsis. The likelihood of success of any surgical repair must be weighed against the risk of faecal incontinence. Improved results of a local surgical repair are seen with optimal surgical and medical management of perianal Crohn's disease.     

The history of thought concerning the hypothalamus and its functions

Many initial studies related to identification of the boundaries and structural components, nuclei, tracts and interconnections of the hypothalamus, this continues. Early interest also focused on hypothalamic control of somatic activities and autonomie nervous system functions. During the present century chiefly, interest has developed in the hypothalamus and control of water balance, thirst, water retention and loss (diabetes insipidus and polydipsia). Its role in control of metabolism, body weight (obesity), and the regulation of body temperature has attracted the attention of physiologists for many years. Others have studied hypothalamic regulation of sex and reproductive phenomena. The hypothalamus is now attracting much attention because of its production of neuroendocrine secretions and role in control of the endocrine system. Physiologists realized very early that the hypothalamus is involved in emotional expression, in reaction to stress and adaptive adjustments. Its involvement in disease states and resistance thereto and in determining the nature of behavior has now been recognized as a matter of great importance. The origins of all these interests are reviewed.     

AUTOLOGOUS LYMPHOCYTE THERAPY FOR EXPERIMENTAL CANINE LYMPHOEDEMA: A PILOT STUDY

Obstructive lymphoedema, an accumulation of protein-rich fluid in interstitial spaces, was created in five dogs by a combination of the irradiation of one groin and subsequent surgical ablation of any remaining lymphatics. The lymphoedema was stable for up to 2 years. The aim was to test the efficacy of intra-arterial injection of autologous lymphocytes as a therapy for lymphoedema. The hypothesis was that cytokines produced by lymphocytes mediate proteolysis by macrophage proteinases in the lymphoedematous limb to remove the excess protein and relieve the oedema. A concentrated lymphocyterich preparation was isolated from blood by the Ficoll-Paque method. These preparations were injected into the femoral artery four times at approximately 4 weekly intervals. Three months after the first injection of lymphocytes, lymphoedematous limbs showed a marked 69% reduction in the mean excess circumferences compared with opposite control limbs. After treatment, skin thickness and hydroxyproline content (both measures of fibrosis) as well as water content (a measure of oedema) had reduced significantly. In specimens of interstitial fluid and in skin homogenates acidic proteinase activity increased and the protein concentration decreased significantly compared with controls. It is concluded that increased proteolysis, possibly due to activated macrophages recruited to the lymphoedematous limb, may partly explain these results.     

Cancer surveillance in ulcerative colitis

BACKGROUND: Patients with ulcerative colitis are at a higher risk of developing colorectal cancer than those without the disease. Surveillance programmes are used routinely to detect dysplasia and cancer in patients with ulcerative colitis. However, such programmes are poorly effective. This article discusses possible improvements suggested by recent research. METHODS: Papers relating to cancer associated with ulcerative colitis and surveillance programmes to detect such cancer were identified using Medline searches. Further papers were identified from the reference lists of identified papers. RESULTS: The probability of cancer for all patients with ulcerative colitis regardless of disease extent was 2 per cent at 10 years, 8 per cent at 20 years and 18 per cent at 30 years; the overall prevalence of colorectal cancer in any patient was 3.7 per cent. Indications for colonoscopic surveillance are extensive disease for 8-10 years, especially in those with active inflammation, a family history of colorectal cancer and primary sclerosing cholangitis. Problems affecting surveillance include the diagnosis of dysplasia, difficulty in differentiating 'sporadic' adenomas from a dysplasia-associated lesion or mass, and decision making based on surveillance findings. Molecular genetic and endoscopic advances to alleviate these problems are discussed. CONCLUSION: Rates of detection of dysplasia can be improved by chromoendoscopy. Molecular genetics has the potential to identify patients most at risk of cancer and can differentiate between different types of lesion.