The remedial electromagnetic field.

This paper reviews the history and development of electric and electromagnetic fields used in the treatment of a variety of medical conditions. An account is given of their clinical use and some suggestions are advanced for an explanation of a possible physiological mechanism.

Continuous single-layer gastrointestinal anastomosis: a prospective audit.

Single-layer bowel anastomoses have conventionally been constructed using an interrupted suture technique. A single-layer continuous technique has been avoided on the grounds that it may predispose to ischaemia of the bowel ends. We have routinely used a single-layer continuous suture technique with an absorbable suture material (polyglycolic acid) to construct all recent intraperitoneal bowel anastomoses, and we present a 3-year audit of this technique. A total of 131 patients were studied of whom 66 had undergone upper gastrointestinal resections and 65 had had colonic resections. Twenty-two patients had emergency operations. Anastomotic failure was noted in 4.5 and 6.2 per cent of patients in each group respectively. The incidence of minor wound infection was 1.5 and 7.7 per cent respectively. The overall mortality rate was 8.4 per cent. This study suggests that a single-layer continuous suture technique gives acceptably reliable results when used in gastrointestinal anastomosis.

Discrimination is not impaired by excision of the anal transition zone after restorative proctocolectomy.

Anal sensation has been assessed using a constant current stimulator in 21 patients after restorative proctocolectomy (15 J pouch, 6 W pouch). The anal transition zone (ATZ) has been excised in 15 patients but preserved in 6. Results were compared with 14 age- and sex-matched patients with ulcerative colitis (UC) and 14 controls. Median threshold values in the lower, mid and upper zones of the anal canal in pouch patients were: 6.8 mA, greater than 15.0 mA and greater than 15.0 mA respectively compared with 3.9 mA (P less than 0.01), 5.7 mA (P less than 0.01) and 11.4 mA (P less than 0.01) in UC and 3.5 mA (P less than 0.01), 4.2 mA (P less than 0.01) and 11.4 mA (P less than 0.01) in controls. The mid and upper zone threshold anal sensation was significantly lower when the ATZ had not been removed and except in the lower zone did not differ from UC or controls (median threshold sensations when ATZ was preserved were: lower zone, 5.8 mA; mid zone, 5.5 mA; upper zone, 7.5 mA). Paired studies in eight patients showed that excision of the ATZ was associated with a significant impairment in anal sensation (mid zone: 5.7 versus greater than 15.0 mA, P less than 0.05; upper zone: 7.5 versus greater than 15.0 mA, P less than 0.05) whereas no change in anal sensation was recorded when the ATZ was preserved. Despite these physiological changes, no clinical benefit could be identified in patients in whom the ATZ was preserved. Discrimination was normal in all except one patient. The incidence of soiling, nocturnal incontinence and failure to defer defaecation for more than 1 h was recorded in 3/15 patients (20 per cent) whose ATZ had been removed, compared with 1/6 patients (17 per cent) in whom the ATZ had been preserved. We conclude that excision of the ATZ does not eliminate the ability to discriminate and does not increase the risk of impaired continence after ileo-pouch anal anastomosis.

Stimulation of bone union by externally applied radio-frequency energy.

Pulsed radio-frequency electrical energy has been used for many years in the treatment of various soft tissue lesions, and this paper describes its use in stimulating repair in delayed and non-union, with a success rate in 16 cases equal to that of the other electrical stimulation techniques. The equipment is described and a theory proposed that the cell membrane has a diode effect in allowing the absorption of electrical charge, which, by its influence on the calcium ion, stimulates the cell into activity.

Micropuncture study of pancreatic secretion in the cat.

Using micropuncture techniques, pancreatic electrolyte secretion was studied in 50 female mongrel cats. During maximal secretin stimulation (GIH, 4 to 6 U per kg-hr), juice was collected from intralobular (10 to 50 mu diameter), and extralobular (25 to 300 mu diameter) ducts by micropuncture and compared with juice simultaneously collected from the main duct. The juice [Cl-] steadily decreased from intralobular ducts (112 +/- 9 mEq per liter) to the main duct (46 +/- 8 mEq per liter). During in vivo perfusion, secretion of H2O and HCO3- by the extralobular ducts (25 to 150 mu diameter) was sensitive to secretin. There was no evidence for secretion by the main duct. Pancreatic secretion of water and electrolytes appears to result from the admixture of a Cl-rich primary secretion originating from intralobular structures and a larger volume of HCO3- -rich fluid originating from the smaller extralobular ducts. HCO3- cl- exchange in these ducts accounts for the characteristic changes in concentrations of HCO3- and Cl- as the flow rate varies.

The risk and accuracy of pancreatic biopsy.

Pancreatic biopsy in 171 patients produced complications in 4.7 per cent and death in 1.7 per cent. The biopsy diagnosis was confirmed in 86 per cent but was falsely negative in 14 per cent of pancreatic cancers. Frozen sections were interpreted correctly in all cases. Wedge biopsy resulted in fewer complications and fewer false-negative results than needle biopsy and is preferable except for periampullary lesions in which transduodenal needle biopsy is best. When the biopsy incision transected a pancreatic duct, suture ligation and drainage avoided complications. Open transduodenal biopsy of periampullary lesions was reliable, but the duodenotomy closure leaked in 10 per cent of the cases. Pancreatic biopsy with confirmation of malignancy should precede pancreaticoduodenectomy in most cases of suspected pancreatic cancer.

Microcannulation--a new micropuncture technique application in cat pancreas secretion.

A new micropuncture technique of microcannulation has been developed and applied in cats to study exocrine secretion in the pancreatic ducts. Two micropipets of different diameters are assembled with the smaller pipet (10-20 mum) mounted inside the larger (25-50 mum). Using the combination, a larger pancreatic duct (less than 300 mum) is directly punctured and the inner pipet is advanced into the lumen of a small (20-50 mum) duct, which would otherwise be inaccessible. In anesthetized cats, during maximal stimulation with secretin (GIH 4-6 units/kg per h iv) the average chloride concentration of juice obtained from small ducts (25-50 mum) was 106 +/- 3 meq/1 and from large ducts (50-150 mum) was 75 +/- 5 meq/1. The results were confirmed by conventional micropuncture techniques which were technically more difficult. This method to collect fluid from small ducts is more physiological than direct micropuncture and thus the technique is a useful addition to micropuncture methodology.