ICLH replacement of the knee: 1977 and 1978

Investigations which began in 1968 have culminated in a knee arthroplasty which can now be confidently used to treat most patients with arthritic knee deformities. Our earlier studies showed that a prosthetic knee arthroplasty must be reliably aligned and stabilized in extension, that patellar pain and polyethelene wear were significant potential problems and that loosening and sinkage of the tibial component must be avoided. Our present knee prosthesis and instrumentation if properly used should avoid these pitfalls. Beginning in January 1977 we performed 84 knee arthroplasties utilizing the present design. A series of 79 knees has been available for our computer-assisted review; 46 patients had a diagnosis of inflammatory arthritis and 29 had primary osteoarthrosis: 22 knees had been previously operated upon. Although all femoral components were fixed with polymethylmethacrylate, the tibial components were completely cemented in 21 knees, partially cemented in 20, and no cement was used in 38 cases. In these latter knees special pegs provided a mechanical interlock with the tibia for fixation. Thirty-six patellae were replaced, of which 11 were fixed with a similar interlocking peg. The arthroplasties failed in 8 patients. Of the remainder, 90% of knees had acceptable pain relief and all but 4 patients were able to walk outdoors. Flexion to 90 degrees or more was achieved in 85% of the knees. Only 2 patients had unacceptable alignment. To date we feel that with the use of this improved prosthesis, in conjunction with the instruments which allow proper placement of the prosthesis, the majority of arthritic knees can be successfully corrected. However, further careful long-term follow-up studies must continue.

Lysis of a superior mesenteric artery embolus following local infusion of streptokinase and heparin

The successful lysis of a superior mesenteric artery embolus with streptokinase and heparin infused locally through catheter selectively placed in the superior mesenteric artery is described. There was minimal morbidity, and the hazards of surgical embolectomy were avoided.

THE EFFECT OF DIFFERENT INORGANIC NITROGEN SOURCES AND PLANT AGE ON THE COMPOSITION OF BLEEDING SAP OF PHASEOLUS VULGARIS

The composition of the bleeding sap N of Phaseolus vulgaris varied with the inorganic nitrogen source fed to the plant but was not changed by a fourfold difference in external nitrate concentration. Highest sap N concentration and fastest growth were observed in ammonium nitrate grown plants. With nitrate grown plants 60 % of the total sap N was inorganic nitrate-N and 40 % organic-N whereas with ammonium nitrate grown plants nitrate contributed 30 % to the total N and organic-N 70 %. Virtually all of the N in the sap of ammonium grown plants was organic-N. Allantoic acid was the major individual reduced N compound in the bleeding sap of plants fed with nitrate, ammonium or ammonium nitrate. During the development of the plant from seedling to mature plant with ripened pods, the concentration of N in the bleeding sap of nitrate grown plants decreased sharply initially and then gradually during pod formation; it increased again when the pods had ripened. Nitrate reductase activity of leaf extracts was correlated with nitrate content of bleeding sap and was not much affected by increases in reduced N compounds in the sap.

Status report of 376 mycosis fungoides patients at 4 years: Mycosis Fungoides Cooperative Group

The frequency and prognostic importance of various characteristics of patients registered by the Mycosis Fungoides Cooperative Group between November 1974 and December 1977 are reported. Variables which were considered include demographic and historical factors, symptoms, extent of disease, and other physical findings. A staging system which is based on the extent of skin involvement and the number of nodal sites clinically involved is described. Finally, a description of therapeutic results to date for patients randomized into Mycosis Fungoides Cooperative Group protocols is presented.

Field observations on the epidemiology of abomasal parasites in young sheep during winter and spring

A flock of spring born lambs was continuously exposed to natural parasite infection from birth until selected for slaughter in groups of two or three, at monthly intervals throughout winter and spring for abomasal worm counts. Meteorological data were recorded and regular estimates of infective pasture larval availability were made. Parasite population changes and inhibition patterns for Ostertagia spp, Haemonchus contortus and Trichostrongylus axei were recorded. Ostertagia spp were found to survive well both on the pasture and within the host, principally as arrested larvae. H contortus overwintered almost entirely in the host in the inhibited form and T axei overwintered mainly in the host, but in the adult stage.

Forecasting the peak of gastrointestinal nematode infection in lambs

The pattern of sheep nematode infective larvae on pasture shows a marked midsummer peak arising largely from the ewe peri-parturient egg output. Records of larval pattern over a nine-year period were examined in relation to meteorological data, and a correlation was demonstrated between the time of the summer peak and cumulative rainfall. A "wet score" was allocated to 12-hourly rainfall figures, and a "critical index" of 440 units of wetness was shown to be necessary before the larval peak was reached. A "warning index" of 350 to 380 wetness units is suggested which would allow a prediction to be made of the onset of major infection in lambs.

The use of parenteral nutrition in the management of external gastrointestinal tract fistulae

Malnutrition is common in patients with gastrointestinal tract fistula, and is an important cause of the high mortality seen with this surgical complication. A prospective review of three years' experience in the management of fistulae with parenteral nutrition was undertaken, and the results obtained were compared with those in a group of patients treated prior to the introduction of this form of therapy. The use of parenteral nutrition resulted in a reduction of the mortality from 63% to 23% in unselected cases. The mortality was zero where parenteral nutrition was used in patients under 65 years of age with non-malignant disease. With parenteral nutrition therapy, the fistulae in almost all cases closed spontaneously, in contrast with a high proportion requiring operation (20 in 38 cases) where parenteral nutrition was not used. It is concluded that all patients with significant gastrointestinal fistula should be given appropriate parenteral nutrition as their prime mode of therapy.

The organization, methods, and experience of a parenteral nutrition service

Malnutrition is an important component of prolonged illness. Parenteral nutrition can improve nutritional status, and its use is now common practice in certain disease states. In this paper the methods used by a parenteral nutrition service are described. The indications for, results from, and complications of, this form of therapy are also documented. This has been done on the basis of results obtained from a prospective survey of the use of parenteral nutrition in a major hospital over a one-year period.

Antibiotic irrigation and catheter-associated urinary-tract infections

To investigate the efficacy of antibiotic irrigation in preventing catheter-associated urinarytract infection, we carried out a randomized controlled trial of a neomycin-polymyxin irrigant administered through closed urinary catheters. Eighteen of 98 (18 per cent) of the patients not given irrigation became infected, as compared with 14 of 89 (16 per cent) of those given irrigation, yielding a mean daily incidence of 5 per cent in each group. The distribution of organisms and their antibiotic sensitivities differed in the two groups, the organisms from the patients with irrigation being more resistant. Disconnections of the catheter junctions were associated with high rates of infection. The rate of disconnections of the junctions in the group given irrigation was almost twice that of the control group because of the presence of the extra junction on overall infection rate represents the result of two opposing phenomena: the increased entry of organisms and the suppression of a portion of them.

External pancreatic fistula: a recent advance in management

The management of six consecutive recent cases of external pancreatic fistula is reported in which the use of total parenteral nutrition resulted in rapid closure of the fistula. The fistulae closed from 11 to 28 days after the commencement of total parenteral nutrition, with an average of 19 days. Surgical intervention to close the fistula was not required in any of the cases.

The efficacy of in-feed medication with fenbendazole against gastrointestinal nematodes of sheep, with particular reference to inhibited larvae

Anthelmintic activity of fenbendazole in a feed formulation was tested against nematode parasites of sheep. Dose rates ranging from 1.4 mg per kg for four days to 0.4 mg per kg for 14 days removed 98 to 100 per cent of the total gastrointestinal worm burden, including large numbers of inhibited fourth stage larvae of Ostertagia circumcincta. One hundred per cent effectiveness against adult Dictyocaulus filaria was also recorded.

Tissue diagnosis in lymphomas

An accurate histological diagnosis is sometimes difficult to achieve in the lymphoma patient. This problem is accentuated by incorrect choice of noded for biopsy or mishandling of tissues, either at surgery or during the fixative process. Practical guidelines are suggested to help minimize these problems.

The epidemiology of Dictyocaulus filaria in north east England

The seasonal pattern of Dictyocaulus filaria infection in four flocks of sheep under field conditions was studied by faecal examination for larvae. The prevalence of infection in lambs was low in spring and summer but increased in late autumn or winter, then fell again to a low level by May. However, most lambs became infected at some time during their first year of life. In ewes the prevalence of infection was generally low, but rose during winter and spring. Seasonal pattern and intensity of infection were influenced by weather conditions and the persistence of infection from the previous year, moist summer conditions giving rise to a higher level of infection in autumn and winter than a dry summer. The source of infection may be the ewes or yearlings, or infective larvae surviving over the winter on pasture. Autoinfection occurred, some lambs becoming infected with at least three generations of the parasite, but at the levels of infection recorded clinical disease was rare.

Wall analyses of lophocolea seta cells (bryophyta) before and after elongation

Lophocolea heterophylla (Schrad.) Dum. (a leafy liverwort) produces sporophytes with seta cells that elongate 50-fold in 3 to 4 days. Wall components of these cells have been characterized by microscopic histochemistry, colorimetry, and gas chromatography of neutral sugars. Seta cell walls are qualitatively similar to primary cell walls of higher plants. The pectic fraction, however, responds differently to standard histochemical staining and extraction. Quantitatively, mannose, fucose, and rhamnose are in higher percentage, and arabinose and xylose are lower than typically found in vascular plants. Hexuronic acids increase on a percentage basis during elongation; pentoses decrease slightly, while hexose levels remain about the same. Increase in total wall carbohydrate after 2,400% elongation of setae was 1.8-fold.

Epidemiological studies on gastro-intestinal nematode parasites of sheep: the seasonal number of generations and succession of species

Monthly post mortem worm counts were carried out from June to September on grazing lambs, in association with faecal egg counts and pasture larval counts. Similar patterns were recorded by all three methods, and egg counts proved to be a reliable reflection of worm burden over this period. A succession of species was recorded, in particular Ostertagia spp and Nematodirus spp in June; Haemonchus contortus in July; Trichostrogylus virinus in August; T axei, T colubriformis and Cooperia curticei in September. A new explanation for this succession is given, based on the overwintering capabilities and freeliving development time of individual species.

Retrograde gastric mucosal prolapse as a cause of haematemesis

Three cases of haematemesis associated with alcohol abuse are described. Early fibreoptic endoscopical examination in each showed a focal, well demarcated area of gastric mucosal haemorrhage, close to the oesophagogastric junction. Two patients showed prolapse of the lesion into the lower part of the oesophagus, and the third had coexistent Mallory-Weiss tears. Our observations suggest that forceful vomiting is responsible for this lesion, by causing abrupt retrograde gastrooesophageal prolapse. The prognosis of the lesion appears good.

Upper gastrointestinal endoscopy in surgical practice

The use of fiberoptic endoscopy provides an accurate diagnosis in more than 90% of patients with lesions in the oesophagus, stomach and proximal duodenum. It is, however, an expensive and time-consuming investigation and is not always necessary when a satisfactory diagnosis has been made after radiological examination. Groups of patients have now been identified in which endoscopy is of particular value to the surgeon. When there is doubt about the diagnosis after radiological examination, particularly regarding the malignancy of a gastric ulcer, when an upper gastrointestinal haemorrhage occurs, when postgastrectomy patients present with symptoms, and when persistent symptoms occur in the absence of radiological findings, endoscopy is mandatory for an accurate diagnosis to be achieved and rational treatment instituted.