The British journal of surgery
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The purpose of this study was to review the outcome of adopting colour-coded duplex ultrasonography as the primary imaging modality in patients with symptomatic lower-limb arterial disease. Over a 12-month period 467 consecutive lower-limb duplex scans were performed of which 437 (94 per cent) were technically adequate. ⋯ In patients referred for surgery there were no unexpected findings. Colour-coded duplex imaging can safely replace diagnostic arteriography in up to 97 per cent of lower limbs with arterial disease.
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Anorectal function after anterior resection may be impaired as a result of reduced luminal capacity in the pelvis. The aim of this study was to evaluate the colonic J pouch neorectum by means of ambulatory manometry. Twelve patients with a colonic pouch following anterior resection and seven healthy controls were studied for a median of 6 (range 6-24) h using a probe with two pouch-rectal and two anal canal transducers. ⋯ The frequency of slow-wave activity in patients with a pouch was significantly lower than that in controls (7 versus 16 cycles per min, P = 0.001). Coordination between the colonic J pouch and the anal canal, in the form of sampling episodes, was observed in more than half of the patients with a functioning pouch. Large isolated contractions (pressure greater than 30 cmH2O and lasting longer than 20 s) and rhythmic contractions were the most frequent pattern of pouch motility.
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Uncontrolled diabetes severely impairs early healing of experimental intestinal anastomosis. This study aimed to compare the potential beneficial effect of insulin treatment, started before or immediately after surgery. A normal blood glucose level was attained in diabetic rats by twice-daily administration of insulin, commenced either 4 days before operation (insulin-1 group) or on the day of operation (insulin-2 group). ⋯ After 7 days mean bursting pressures in both ileum and colon were restored to control levels in the insulin-1 group but not in the insulin-2 group. Anastomotic abscess formation after 3 days was also significantly (P < 0.017) more common in the diabetic and insulin-2 groups, but not in the insulin-1 group than in the control group. Postoperative blood glucose control alone does not completely prevent the detrimental effects of uncontrolled diabetes on healing intestinal anastomoses.