Double gloving and surgical technique.

A comparison of double gloving versus single gloving was made with regard to its effects on tactile discrimination and dexterity in 17 surgeons of all grades and specialties. Surgeons were assessed by their ability to tie surgical knots, and Dellon's moving two-point discrimination test. Tests were performed single gloved, double gloved with the larger glove on the outside, and double gloved with the larger glove on the inside. Double gloving did not alter two-point discrimination or the ability to tie surgical knots in this study. Wearing the smaller glove on the outside of the larger glove was considered more comfortable than the conventional technique.

Renal transplantation in children with occult neurogenic bladders drained by intermittent self catheterisation.

Children with neurogenic bladders have usually not been considered for renal transplantation because of the potential complications caused by chronic infections of the urinary tract. Two girls with occult neurogenic bladders who were practising intermittent self catheterisation were given renal transplants. Both took prophylactic antibacterial agents after transplantation, and both experienced infections at some stage, but none of these infections produced a deterioration in renal function. In one patient creatinine clearance fell and signs of obstruction appeared, but this was because the patient had been catheterising herself only two or three times a week. When she resumed catheterisation four times a day creatinine clearance rose and the urographic and renographic appearances returned to normal. These results suggest that, with adequate catheterisation and urinary chemoprophylaxis, infection is not a particular problem in children with bladder dysfunction who undergo renal transplantation.

Idiopathic retroperitoneal fibrosis--the role of autotransplantation.

The presentation and management of 12 patients with idiopathic retroperitoneal fibrosis (IRPF) are described. There was a high incidence of venous thromboembolism. External ureteric drainage was associated with complications. A case treated by autotransplantation is described.

Tetanus in phlegmasia caerulea dolens.

A case of phlegmasia caerulea dolens is reported. Thrombolytic therapy was instituted. The patient developed tetanus. Adequate tetanus prophylaxis under such circumstances is advised.

The treatment of major liver trauma by primary packing with transfer of the patient for definitive treatment.

Four patients are reported in whom massive haemorrhage from severe hepatic trauma was managed initially by conservative surgery and packing. The patients were then transferred by ambulance to Addenbrooke's Hospital where further treatment involved elective surgery and removal of packs. All 4 patients were discharged from hospital and have made full recoveries. It is felt that the management of liver trauma should be to do the minimum that is necessary to staunch bleeding, by suture, arterial ligation, lobectomy, resectional debridement or simply by packing. This allows the patient's haemodynamic state to be restored to normal before further surgery is attempted.

Preservation of ischaemically injured canine kidneys with hypertonic citrate solution: the importance of mannitol.

The ability of hypertonic citrate solution to preserve ischaemically injured canine kidneys was investigated. It was found that if mannitol was given i.v. before ischaemia and again after graft revascularization, kidneys subjected to 30 min of warm ischaemia could be preserved for 24 hr, maintaining immediate life-sustaining function.

Cyclosporin A in patients receiving renal allografts from cadaver donors.

Seven patients on dialysis with renal failure received transplants from mismatched cadaver donors and were treated with cyclosporin A (CyA), initially as the sole immunosuppressive agent. CyA was effective in inhibiting rejection but there was clear evidence of both nephrotoxicity and hepatotoxicity. A cyclophosphamide analogue was added to the CyA treatment in six of the patients. Five patients are out of hospital with functioning allografts, and two of these have received no steroids. One patient required an allograft nephrectomy because of pyelonephritis in the graft. Another died of systemic aspergillus and candida infection. Further careful study of this potentially valuable drug will by required before it can be recommended in clinical practice.

Liver transplantation in man. II. A report of two orthotopic liver transplants in adult recipients.

Two patients with primary hepatic malignancy were treated by hepatectomy and orthotopic liver transplantation. In both cases the donor liver was infused with cold solutions and kept chilled without continuous perfusion. There was immediate satisfactory hepatic function in both transplants.The first patient died after 11 weeks from overwhelming bacterial and fungal infections probably secondary to hepatic infarction due to thrombosis of the recipient hepatic artery. The thrombus occurred at the site of the arterial clamp. In an attempt to control the growth before transplantation, the patient had been treated with large doses of chlorambucil, which resulted in extreme marrow depression and septicaemia.The second patient developed cholestatic jaundice during the second and third weeks after transplantation, with histological evidence of mild rejection, which was controlled by increasing the dose of immunosuppressive agents. He is now well, having returned to work six weeks after the operation.Though the first patient showed no evidence of rejection, it is concluded that patients receiving liver allografts should receive immunosuppressive therapy.