The recent introduction of restorative proctocolectomy for the treatment of ulcerative colitis has reopened the debate about the effects of ileostomy on quality of life. This study analysed life quality and psychological morbidity in 113 patients with an ileostomy using a postal questionnaire which included questions about their opinion of the pouch operation. Of the questionnaires, 73 per cent were suitable for analysis. A total of 93 per cent of those responding were happy with the ileostomy and appeared to have adapted to a normal life with it. Some 87 per cent stated that they would keep the ileostomy in preference to an ileoanal pouch. In addition, psychological morbidity as assessed by the General Health Questionnaire occurred in only 5 per cent of patients.
SummaryAchilles tenotomy was performed on 66 limbs in 60 patients with severe intermittent claudication and the results were assessed two years later. Early improvement occurred in half of them but decreased to 17% two years postoperatively. Sympathectomy did not influence the result. The postoperative morbidity was 14%, and 21% of limbs were subsequently amputated. The late mortality in the group studied was 8%.
A double-blind crossover clinical trial of pyridinolcarbamate, a bradykinin antagonist, was carried out in 33 men with peripheral vascular disease causing intermittent claudication. Results in 25 men are reported.Peripheral circulation was assessed by measurement ofwork done before claudication in a step test, claudication point, and measurement of cal bloodflow by venous occlusion plethysmography before and after exercise in a temperature-controlled environment. Performance in all three tests decreased during the placebo control period, making the evaluation of treatment difficult. During the trial a significant improvement occurred in the step test. No dose-related drug effect was shown but a cumulative drug effect could not be decisively excluded. Performance in the step test correlated with alteration of external environmental temperature. Claudication point showed some improvement but only analysis over time produced a value significantly differentfrom the combined control. Calf blood-flow increased to a small extent over treatment and time but did not exceed control values sgnificantly.The possible role of bradykinin in peripheral vascular disease in relation to the rationale of treatment with pyridinolcarbamate and the possibility of a seasonal variation in sensitivity to bradykinin (to account for the findings noted) are discussed.
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