ABSTRACT
Ninety-two consecutive infants aged up to 12 months underwent primary inguinal herniotomy over a 5-year period. All were treated in a district hospital paediatric surgical unit according to recommendations of the British Association of Paediatric Surgeons. After a mean follow-up of 45.8 months, one patient had a failed repair and four (4 per cent) a hernia recurrence. One infant developed a wound infection. Infantile hernia can be managed safely and efficiently in a district hospital.
Subject(s)
Hernia, Inguinal/surgery , Female , Humans , Infant , Infant, Newborn , Male , Postoperative Complications , Recurrence , Referral and ConsultationABSTRACT
Over a 2-year period we have successfully inserted 70 subclavian catheters in 68 patients from 76 attempts by cephalic vein cutdown. There were no complications of catheter insertion although 40% were inserted by junior surgeons (mean survival of catheters was 16.5 days) and in 30% of patients the catheter was removed before the completion of treatment for both infective and other complications. From our results, we recommend that direct cephalic vein cutdown is the route of choice for elective subclavian access because of its safety.
Subject(s)
Catheterization, Central Venous/methods , Subclavian Vein , Antineoplastic Agents/administration & dosage , Female , Humans , Male , Middle Aged , Parenteral Nutrition , Prospective StudiesABSTRACT
Forty boys with 54 incompletely descended testes took part in a double blind, controlled trial of intranasal luteinising hormone releasing hormone. In the control (placebo) group of 18 boys there was no significant change in testicular descent and all required orchidopexy; in the 22 treated boys, however, 12 of 29 testes (42%) were found in a lower position. This study supports the idea that a trial of intranasal luteinising hormone releasing hormone (1200 micrograms/day for 28 days) will help clarify the need for orchidopexy in at least 30% of boys with incomplete descent of the testis, particularly those in whom the testes have emerged from the inguinal canal.
Subject(s)
Cryptorchidism/drug therapy , Gonadotropin-Releasing Hormone/administration & dosage , Administration, Intranasal , Child , Clinical Trials as Topic , Double-Blind Method , Gonadotropin-Releasing Hormone/therapeutic use , Humans , MaleSubject(s)
Nutrition Disorders/diagnosis , Parenteral Nutrition , Surgical Procedures, Operative , Humans , Prognosis , RiskABSTRACT
The assessment of malnutrition by simple methods was studied in 120 patients undergoing elective major abdominal surgery to determine which index was of the most value in predicting postoperative complications. Weight for height and weight loss were of little significant value; serum albumin less than 35 g/l was more significant (p less than 0.05) but predicted only a quarter of those patients who developed serious complications. Measurements of muscle stores by anthropometry (arm and forearm muscle circumference) predicted nearly half the patients (p less than 0.01). By far the most useful index was hand-grip dynamometry, which predicted 90% of those who developed complications (p less than 0.001). The incidence of serious complications was 6 times greater in those patients with a low grip strength. Hand-grip dynamometry appears to be a useful screening test of patients at risk, and a valuable additional test for nutritional assessment.
Subject(s)
Anthropometry/methods , Nutrition Disorders/diagnosis , Body Height , Body Weight , Digestive System Neoplasms/surgery , Gastrointestinal Diseases/surgery , Humans , Postoperative Complications/prevention & controlABSTRACT
Radiological assessment of arm fat and muscle stores was performed in 46 controls and 10 malnourished patients. Values for arm fat and muscle thickness were obtained. In malnourished patients there was no significant correlation between fat estimation from the radiograph and measurement with skinfold calipers. Significant correlation between arm muscle circumference measurement and radiological muscle thickness however was found (P less than 0.05). Radiological assessment of arm muscle is a simple and useful test of muscle protein depletion in malnourished patients.
Subject(s)
Adipose Tissue/diagnostic imaging , Muscles/diagnostic imaging , Nutrition Disorders/diagnostic imaging , Aged , Arm/diagnostic imaging , Female , Humans , Male , Middle Aged , Radiography , Skinfold ThicknessABSTRACT
Prediction of serious postoperative complications by using standard anthropometric and biochemical nutritional variables was attempted in 225 patients admitted for major abdominal surgery. In 102 of the patients hand-grip dynamometry was also measured, and this proved the most sensitive test, predicting complications in 48 of the 55 patients (87%) who developed them (p < 0.001). Arm muscle circumference and forearm muscle circumference below 85% of the standard value were also of predictive value (p < 0.02 and p < 0.01 respectively); weight for height and serum albumin concentrations were less satisfactory, while weight loss of more than 10% was not significantly related to complications. Dynamometry is a useful, rapid, and inexpensive screening test for detecting malnutrition that is likely to predispose to serious postoperative morbidity.
Subject(s)
Nutrition Disorders/diagnosis , Abdomen/surgery , Adolescent , Adult , Aged , Anthropometry , Arm/anatomy & histology , Body Weight , Female , Forearm/anatomy & histology , Hand/physiology , Humans , Male , Middle Aged , Muscle Contraction , Nutrition Disorders/complications , Postoperative Complications/etiology , Serum Albumin/analysisABSTRACT
Two patients with anorexia nervosa were treated on a general surgical unit for acute gastric dilatation. In both cases the dilatation rapidly followed an increase in the usual low dietary intake of the patients, and the ingestion of extra food may have initiated the acute episode. Conservative treatment with parenteral fluids, nasogastric intubation, and then a gradual return to a normal diet proved a satisfactory method of management. In one patient the anorexia itself was improved.