A report is given on 26 patients (18 men and 8 women) undergoing low anterior resection for carcinoma of the rectum, using both the TA 55 and EEA staplers. The average age was 65 years (range, 45 to 92 years). The preoperative level of the lesion from the anal verge averaged 9.8 cm (range, 4 to 17 cm). All had well-differentiated or moderately well-differentiated lesions. All lesions were removed using the following technique. The TA 55 stapler was placed across the lower rectum at the distal resection margin. The EEA stapler was introduced into the rectum with the anvil removed. The shaft was then passed through the rectum stump either through or immediately adjacent to the staple line. The anvil was refitted and the anastomosis completed between the more proximal colon and the rectal stump. A defunctioning colostomy was employed in only one patient. There has been no mortality. Follow-up has been 2 to 16 months, and there has been no early recurrence. The postoperative level of the anastomosis averaged 5.5 cm (range, 2 to 11 cm). Stapler-related complications occurred in three patients. One of these patients developed a postoperative anastomotic leak, which necessitated a defunctioning colostomy. Two anastomotic strictures occurred following either an anastomotic leak or postoperative radiation therapy. Early incontinence to gas, night-time anal soilage, and urgency occurred in eight patients (30 per cent). These symptoms improved or disappeared within three months following operation. The authors' preliminary experience has shown the double stapling technique to have definite advantages. It obviates the use of lower purse-string suture and permits a lower and easier anastomosis. It avoids the problem of disparity of sizes of the two ends of the bowel. The rectum is not opened and fecal spillage is minimized. To date, results have been good without excessive complications.
The double stapling technique (TA-55 and EEA staplers) was used to perform low anterior resections for rectal carcinomas in 79 patients (49 men, 30 women). The mean age was 66 years (range, 38 to 85 years). Curative resections were performed in 68 patients, and palliative resections in 11 patients. The mean level of the cancer from the dentate line was 9 cm (range, 5 to 16 cm). The mean follow-up has been 29 months (range, four to 58 months). Perioperative mortality was 2.5 percent (two patients). Technical problems related to the stapling technique occurred in 6 percent (five patients). The clinical anastomotic leak rate was 8 percent (six patients). There were 11 local recurrences among 68 curative resections (16 percent). Local recurrence according to individual surgeon showed marked variability (range, 0-43 percent, P greater than 0.05). There were no differences in location, differentiation, or stage in those that recurred. The mean distal resection margin for the recurrent cancer group was 3.0 cm and for the nonrecurrent group, 2.9 cm. Disturbances of continence were seen commonly (56 percent) in the first three months after surgery, but 85 percent of patients became fully continent with an acceptable bowel habit at later follow-up. The double stapling technique is useful for the restorative resection of suitable mid and low rectal cancers. The anastomotic leak rate, local recurrence rate, and functional results are acceptable.
The feasibility and precision of an ultrasound method for determining the volume of the liver have been assessed using a Nuclear Enterprises B-scan machine. A relation between estimated liver volume and body weight has been established, showing that liver volume can be determined with a precision of +/- 195 cm3 (P less than or equal 0-05). With the standard non-grey-scale imaging technique employed there is a degree of uncertainty in deciding the liver boundaries, and this constitutes the major source of error.
Summary. Measurements of transcutaneous oxygen tension were made on the foot and arm in 16 Type 1 (insulin-dependent) diabetic patients with no evidence of vascular or neurological disease on simple clinical examination and in 30 nondiabetic subjects. The mean transcutaneous oxygen tension measured at 45 ~ on the foot was significantly lower in the diabetic patients than in the non-diabetic subjects. The hyperaemic response in the arm after cuff occlusion (measured by transcutaneous oxygen tension at 37 ~ was also significantly lower in the diabetic patients. These results may reflect abnormal capillary blood flow in diabetic patients. As the methods are simple and non-invasive, they may prove useful in the early assessment and subsequent monitoring of peripheral vascular problems in diabetes.Key words: Transcutaneous oxygen tension, vascular response, Type 1 diabetes, capillary blood flow.The technique of transcutaneous oxygen tension (TcPO2) measurement can provide a non-invasive method of estimating both arterial PO2 and tissue perfusion [1]. If the vascular bed is maximally dilated by heating to 45 ~ and adequately perfused, there is a good correlation between TcPO2 values and arterial PO2 in healthy adults [2]. With the electrode operating at a lower temperature (usually 37 ~ the TcPO2 reading is then related to skin perfusion and the technique can be used to assess reactive hyperaemia in the skin [3].We have reported previously a reduction in TcPO2 values at 45 ~ in patients with peripheral vascular disease [4], but whether such abnormalities in TcPO2 can be detected in diabetic patients with no clinical evidence of vascular disease is unknown. Reduction in vascular reactivity in diabetic children has been reported [5] and we have, therefore, investigated a group of adult Type 1 (insulin-dependent) diabetic patients to determine whether there are any differences in TcPO2 or in vascular reactivity compared with normal subjects. Patients and MethodsSixteen Type 1 diabetic patients, eight females and eight males, mean +SD age 28_6years (range 18-39years) were studied (Tablet). None had any symptoms of leg pain or claudication and all had palpable lower limp pulses including dorsalis pedis and posterior tibial pulses. Lower limb reflexes, pin prick and touch sensation and ankle vibration sense using a tuning fork (128 Hz) were also normal in all patients. Thirty normal subjects (11 females and 19 males) aged from 20 to 63 years were also studied. Twenty-two of this group (11 females and It males) were aged < 40 years (mean + SD: 28.4 + 6.1 years) and were used as control subjects. All gave informed consent. Six of the diabetic patients and 11 of the control subjects were regular smokers of 20-40 cigarettes daily. All subjects refrained from smoking for a minimum of 1 h before the procedure and were studied supine. The left arm and left foot were exposed and clothing loosened around the arm and leg to prevent any obstruction to blood flow. The examination room was maintained close to 26 ~ to prevent vasoconstri...
The problems associated with the use of air drills in orthopaedic surgery are briefly reviewed. Battery-powered electric drills offer an alternative but they can introduce a different set of problems. We have investigated procedures for using a Makita, non-medical battery-powered drill in orthopaedic surgery and can conclude that, within certain limits, this drill is an alternative to an air drill with the advantage of absence of air hoses and the potential for cost-saving.
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