The British journal of surgery
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The effect of surgery on intermediary metabolism has been studied in six non-diabetic subjects, eleven type 2 diabetic subjects untreated during surgery, and nine type 2 diabetic subjects treated by glucose-insulin-potassium (GIK) infusion during surgery. Plasma glucose results were studied in all subjects and other metabolites whenever possible. Initial glucose concentrations were similar in both groups of diabetic subjects. ⋯ Blood 3-hydroxybutyrate was also lower in GIK treated (0.04 +/- 0.02) than in untreated diabetic subjects 4 h postoperatively (0.25 +/- 0.07 mmol/l, P less than 0.05). The levels of non-esterified fatty acid and 3-hydroxybutyrate found in the untreated diabetic did not differ from those found in non-diabetic controls. Plasma cortisol levels had risen in all groups 4 h postoperatively (P less than 0.01).
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Transcutaneous oxygen (PtcO2) measurements were made on 46 patients with severe ischaemia of the lower limbs and on 17 age-matched controls. Values breathing air, 100 per cent oxygen and the rate of change of PtcO2 breathing oxygen were recorded. Of 29 below knee amputations there were 4 failures; 16 had PtcO2 values less than 35 mmHg, but 12 of the 16 healed. ⋯ This study shows that low PtcO2 values are a poor indication of healing potential. A more reliable index of skin viability is provided by the dynamic measurement of PtcO2 changes during oxygen inhalation. The addition of an oxygen inhalation test, when making PtcO2 measurements, greatly enhances the applicability of the technique in the assessment of the oxygen supply to the skin.
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Randomized Controlled Trial Clinical Trial
Controlled trial of transcutaneous electrical nerve stimulation (TENS) for postoperative pain relief following inguinal herniorrhaphy.
We have evaluated the effect of transcutaneous electrical nerve stimulation (TENS) on postoperative pain following inguinal herniorrhaphy in a prospective randomized controlled trial. Forty male patients undergoing unilateral inguinal herniorrhaphy for the first time were randomized to receive either active or inactive TENS. Electrical stimulation was delivered by electrodes placed along either side of the wound following operation. ⋯ Pain was assessed over the first 3 postoperative days by visual analogue pain scores, expiratory peak flow rates and analgesic requirements. There was no difference between the two groups for pain scores, peak flow rates or analgesic requirements and we conclude that TENS as used in this trial does not reduce postoperative pain. However, TENS had considerable patient appeal and many patients believed that it was effective.
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In 1980 a review of lower limb amputation over a 3.5 year period between 1974 and 1978 was reported from our centre. More recently 193 amputations were performed for peripheral vascular disease over a similar 3.5 year period, representing an increase of 33 per cent in the amputation rate during the last 6 years. This cannot be explained by the increasing age of the population alone. ⋯ Thirty-seven per cent of patients had undergone reconstructive vascular surgery before amputation. Of the 26 patients requiring re-amputation 58 per cent had undergone arterial reconstruction in an attempt to salvage the limb (chi 2 = 5.65, P less than 0.02) and in 26.9 per cent of cases this was performed within the week before amputation. We feel that injudicious attempts at arterial reconstruction, when amputation appears inevitable, may adversely affect the subsequent level of amputation and jeopardize rehabilitation.