Mobility one year after unilateral lower limb amputation: a modern, UK institutional report.

The aim of this current retrospective study was to assess postoperative mobility one year after above knee (AKA) or below knee amputation (BKA) in a district general hospital. Data on patient demographics, diabetic status, risks for peripheral vascular disease, mortality and mobility at one year were recorded from the vascular database. Seventy-five patients underwent lower limb amputation over a 70-month period (AKA n=31, BKA n=44).

Connection between a long-standing traumatic arteriovenous fistula and development of aneurysmal disease.

Long-standing peripheral arteriovenous fistulas (AVFs) are always accompanied by ectasia of the proximal arteries. In the literature, traumatic fistulas of the lower limbs are frequently reported to be associated with iliac and even infrarenal aortic aneurysms; however, no study dealing with associated visceral aneurysms has been published. We report a case in which a traumatic AVF was accompanied by the late development of not only an infrarenal aortic aneurysm but also both superior mesenteric and right renal artery aneurysm.

Thoracoscopic (upper thoracic) sympathectomy for primary palmar hyperhidrosis in children.

Primary palmar hyperhidrosis is a disabling disorder that starts in childhood and causes physical and psychological inconvenience. Conservative treatment is not effective in severe cases. Thoracoscopic sympathectomy is the treatment of choice.

Inferior vena caval thrombosis complicating acute pancreatitis. Case report.

This case report describes a patient with acute pancreatitis who was found to have inferior vena caval thrombosis. This was diagnosed by CT scan and confirmed by digital subtraction venography. Of the many recognised vascular complications of acute pancreatitis, isolated inferior vena caval thrombosis has not been previously reported.

The use of varicography to identify the sources of incompetence in recurrent varicose veins.

We have studied patients with recurrent varicose veins which were incompletely controlled by a thigh tourniquet. We used varicography, (a phlebogram via the varices), to detect sites of incompetence. Thirty patients (mean age 46 years) were investigated, 38 limbs being subjected to varicography and surgery.

Depression of cellular immunity after multiple trauma in the absence of sepsis.

We have previously reported that severe burn injury was regularly accompanied by impaired lymphocyte responses to T cell mitogens, circulating suppressor lymphocytes, and serum factors suppressive of lymphocyte activation. However, in burned patients it was difficult to determine whether these manifestations of suppressed immunity were predictive of, or the result of, sepsis which was ubiquitous in this population. In an attempt to clarify this issue, we have studied 31 patients with multiple trauma (without burns) mean age, 31 years; average injury severity score, 22; range, 9-56; in whom sepsis was less common.

The demonstration of saphenofemoral incompetence; doppler ultrasound compared with standard clinical tests.

Patients with primary varicose veins were examined by a combination of the standard tourniquet test with detection of reflux by Doppler ultrasound. Results were compared with standard clinical tests: impulse or thrill at the saphenous opening on coughing, tap impulse at the groin, and the 'Trendelenburg' tourniquet test. The state of competence of the saphenofemoral junction was noted at operation.

The effect of short term postoperative intravenous feeding upon cell-mediated immunity and serum suppressive activity in well nourished patients.

Thirty-four patients undergoing elective abdominal aortic aneurysmectomy were studied, and they were randomly allocated to a "fed group receiving amino acid dextrose solutions intravenously and fat emulsions or an "unfed" group receiving standard postoperative care. Cell-mediated immunity was measured by lymphocyte count, the in vitro response to the T-cell mitogen PHA and determination of T-cell subsets using monoclonal antibodies. Serum suppressive activity was measured by the ability of the sera of the patient to suppress the response of normal lymphocytes to PHA.

Fatal infection in mice after injection of immunosuppressive serum fractions from surgical patients.

Following surgical or accidental trauma many patients show suppression of cellular immunity. In this investigation sera from severely burned patients and patients undergoing aortic aneurysm repair were studied. Sera shown to suppress phytohaemagglutinin-induced blastogenesis of normal human lymphocytes were fractionated using ion exchange and G25 Sephadex chromatography.

The place of abdominal aortography in abdominal aortic aneurysm resection.

We analyzed 110 patients who underwent abdominal aortography as a routine preliminary to abdominal aortic aneurysm resection. In 11 of the 15 patients for whom the procedures were useful in planning the operative tactics, the aortograms would have been performed anyway on clinical indications. In two patients, the changes in surgical maneuvers would not have been made through anatomic inspection at the time of the operations, but the lesions were asymptomatic.

Lymphocyte function in the critically ill surgical patient.

Lymphocyte function is commonly altered in critical ill surgical patients. There is controversy whether or not formation of antibodies is impaired; however, cellular immune responses are routinely depressed. Patients who have suffered major surgical or accidental trauma or burns frequently become anergic.

Depressed immune response in burn patients: use of monoclonal antibodies and functional assays to define the role of suppressor cells.

Recent experimental evidence has suggested that circulating suppressor leukocytes play an important role in mediating the suppression of immunity seen in burn patients. In order to shed further light on the relationship between suppressor cells and depressed cellular immunity 22 patients were studied (mean age 37) who had suffered severe burns of greater than 30% body surface area. Simultaneous studies were performed on 14 control laboratory personnel (mean age 32).