Ninety-four patients undergoing vasectomy as day cases were studied prospectively. An overall infection rate of 32.9% was recorded and, apart from haematoma formation and the nasal carriage of organisms, no factors were found that increased the risk of infection. A preoperative hibiscrub shower did not affect the infection rate, even though it was responsible for a significant reduction in skin flora. This raises the possibility of infection following vasectomy being secondary, not occurring at the time of surgery.
SUMMARYThe effects of two components of tissue injury, namely fluid loss from the circulation and tissue ischaemia, on cardiovascular reflex activity have been studied. Moderate blood loss (10-20% blood volume) in the unanaesthetized rat increased the slope of the regression line relating heart period to mean arterial blood pressure and usually displaced it to the left (i.e. towards a relative bradycardia). A blood donation of 500 ml (approximately 10% blood volume) increased the Valsalva ratio in conscious man without a change in resting pulse rate. However, a 15 min period of unilateral limb ischaemia in man reduced the Valsalva ratio. The pattern of change in the pulse rat response to the Valsalva manoeuvre produced by limb ischaemia closely resembles that found previously after limb injury in man. There was no evidence that the endogenous opioids were involved in the interaction between limb ischaemia and cardiovascular reflex activity in man.
Plasma catecholamine concentrations in acute states of stress and trauma Sir Plasma catecholamine concentrations may provide an index of sympathoadrenal activity, plasma noradrenaline reflecting 'spill-over' from sympathetic nerve terminals, plasma adrenaline arising from the adrenal medulla (Cryer, 1980). However, it is not clear how useful such measurements might be clinically. We have measured plasma catecholamine concentrations in volunteers and patients in a variety of acute 'stressful' and 'traumatic' conditions as part of our studies on metabolic and physiological control in such states (Table 1). In these studies the overall concentration ranges of noradrenaline (0 21-213 nmol/1) and adrenaline (0 03-230 nmol/1) covered more than three orders of magnitude, enabling us to look at relationships with 'severity' of the condition over a very wide spectrum. The estimations were made by HPLC with electrochemical detection after preparation on cation-exchange resin and alumina (Frayn & Maycock, 1983).Venepuncture alone significantly elevated concentrations of both noradrenaline (NA) and adrenaline (A). In patients with post-operative sepsis, levels were increased, and similar to those in patients soon after minor and moderate injuries. After severe injuries,
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