The problem surgical colleague.

The surgical profession, more than any other medical specialty, is constantly in the limelight. Frequently, concerns are expressed about our colleagues. The concerns may be personality clashes rather than failure in behaviour or performance.

Arterial problems in athletes.

Background: Athletes may present with arterial problems that are unusual in the typical patient with peripheral vascular disease. They are often handicapped only at the extremes of physical exertion and may have normal arterial pulses beyond any arterial occlusion.

Methods: A Medline search was undertaken for articles on arterial disease in athletes.

Operative versus conservative management of adhesional intestinal obstruction.

AIMS: This prospective controlled trial was undertaken to resolve the controversy over whether intestinal obstruction due to postoperative adhesions should be managed by immediate operation or by conservative care. METHODS: A randomized prospective controlled study was undertaken of all private and public sector patients admitted under the care of one surgeon with intestinal obstruction due to postoperative adhesions over a 15-year period. The patients were randomly allocated either to immediate operation or conservative care with nasogastric aspiration and intravenous fluids.

Use of a semipermeable polyamide dressing over skin grafts to venous leg ulcers.

A polyamide semipermeable mesh interface placed over a skin graft allows absorption of exudate and soaking of the graft with an antiseptic solution. Forty-five patients with large venous leg ulcers (more than 100 cm2) were treated by a split skin graft covered by a polyamide mesh. The mean time to healing and graft take was compared with those of a similar group of 30 patients whose graft was not protected by an interface.

Evaluation of vascular and metabolic deficiency in patients with large leg ulcers.

A consecutive series of 50 patients with large leg ulcers (surface area > 100 cm2) were investigated for evidence of arterial, venous and nutritional problems. Arterial insufficiency was found in 34%, venous reflux in 50%. A group of eight patients had no arterial or venous problem but had serious deficiencies of vitamin C and zinc.

Use of management techniques to control elective surgery.

From January 1989 the new outpatients seen each year have been restricted to 1,540. It was predicted that this would create 770 intermediate equivalents of operating time. Throughout 1991 and 1992 each patient seen in Outpatients was given a scheduled date for his/her operation.

An explanation of the role of individual performance review in surgical training.

The consultant's success depends upon his/her staff. If the consultant is to provide a more efficient service the staff must be encouraged to develop and supplement their own skills. Individual Performance Review (IPR) is a technique that has been introduced to develop the managerial skills of NHS staff.

Case report: large bowel strictures in retroperitoneal fibrosis.

Large bowel strictures in retroperitoneal fibrosis (RPF) are uncommon. We report a case of multiple colonic strictures in a patient presenting with RPF and document their resolution following steroid therapy.

Mesenteric arteritis.

Four patients are presented with small bowel infarction secondary to a vascular arteritis. In three patients there was a history of rheumatoid arthritis. In each patient infarcted bowel was resected and a primary anastomosis performed.

The distribution of aztreonam in serum, bile, skin and subcutaneous tissues in patients undergoing cholecystectomy.

The distribution of aztreonam was measured in patients undergoing elective cholecystectomy. In 14 patients 2 g aztreonam was injected preoperatively and the concentration of the antibiotic was assessed in the bile from the gall bladder and common bile duct, subcutaneous tissues and serum. Samples from bile and any wound discharge were cultured and sensitivities determined.

A 5 year follow-up of Dacron femoropopliteal bypass grafts.

Over a 5 1/2 year period, 66 Dacron femoropopliteal grafts were performed for patients with an absent or unsuitable long saphenous vein. The minimum follow-up has been 6 months and cumulative patency was 50 per cent at 5 years. Twenty-five patients had critical ischaemia (preoperative Doppler ankle pressure less than 40 mmHg) and 41 patients had severe ischaemia (pre-operative ankle pressure greater than 40 mmHg).

Assessment of myocardial function before aortic surgery by radionuclide angiocardiography.

A consecutive series of 41 patients undergoing elective aortic surgery had pre-operative assessment of cardiac function by radionuclide angiocardiography. Their subsequent progress was monitored. There were 4 patients whose pre-operative left ventricular ejection fraction was less than 30 per cent and 3 of these patients died of cardiac failure postoperatively.

The role of percutaneous transluminal angioplasty for atherosclerotic disease of the lower extremities.

A consecutive series of 62 patients (74 symptomatic limbs) were admitted with atherosclerotic disease of the legs in a 6-month period from 1st July 1982. All patients had an arteriogram under local anaesthetic the day after admission and if possible a transluminal balloon dilatation was performed. If dilatation failed an operation was performed the following day.