Showing papers by "Royal Surrey County Hospital published in 1987"

Bile salts, endotoxin and renal function in obstructive jaundice.

Abstract: Surgical treatment for the relief of obstructive jaundice is still complicated by postoperative acute renal failure in almost 10 per cent of patients. Renal failure in the patient with jaundice is associated with the presence of bacterial endotoxin in the peripheral blood, and enteric endotoxin absorption is facilitated by the absence of bile salts from the intestine. Oral replacement of bile salts should prevent endotoxemia and renal failure. Forty-six patients with jaundice were studied. Twelve patients received sodium deoxycholate preoperatively, 12 received chenodeoxycholic acid and 22 acted as controls. Endotoxemia was measured by the limulus test and renal function assessed by 24 hour creatinine clearance. No patient given deoxycholate preoperatively had systemic endotoxemia or postoperative impairment of renal function. Endotoxemia was reduced in the chenodeoxycholic acid group, but not significantly, and renal function was not protected. Sodium deoxycholate is undergoing further evaluation in a multicenter randomized prospective study.

Osteomyelitis in a general hospital. A five-year study showing an increase in subacute osteomyelitis

Abstract: We have reviewed 60 patients with primary bone infections; 21 of these (35%) had subacute osteomyelitis, a figure which supports other recent observations that this variant of bone infection is becoming more widespread. In this group open culture and biopsy were necessary in order to exclude bony malignancy, and a raised erythrocyte sedimentation rate proved a useful diagnostic aid. All the patients with acute osteomyelitis or with vertebral infection responded to primary treatment, but five of those with subacute osteomyelitis had recurrences.

Phase variation in nasal airways resistance assessed by active anterior rhinomanometry

Abstract: Measurements of nasal airways resistance in normal subjects have shown a significant difference between values obtained in the two respiratory phases. Higher overall values are found during expiration in both the unprepared and decongested nose but these differences fail to maintain statistical significance after application of a decongestant. This indicates that the phase of respiration in which measurement is made must be routinely recorded especially when measurement is made without decongestant, and comparisons of data made only with recordings from equivalent parts of the nasal cycle.

Outpatient Fibreoptic Nasolaryngoscopy and Videostroboscopy

Abstract: A description of the uses and advantages of fibreoptic nasolaryngoscopy is given together with the applications of videostroboscopy.

The impedance bridge and ENG controlled fistula test: results in children with unilateral deafness and comparison with normal controls.

Abstract: The diagnosis of a perilymph fistula is normally made on clinical grounds. Thus in most cases suspicion is raised by the clinical history and the presence of a fistula confirmed at operation. In children such fistulae may be relatively silent and the diagnosis difficult to establish. This paper reports the results of using an impedance bridge and ENG-controlled fistula test in the routine screening of 24 children with unilateral sensorineural deafness, and compares the results obtained to those found from testing 21 normal and asymptomatic children of comparable age and sex. These tests have shown that fistula testing may mimic a previously recorded gaze or positional nystagmus and hence give false positive results. In the routine testing of patients with deafness only 1 subject had nystagmus invoked by fistula testing alone, and in this case it was obvious from all other criteria that no fistula was present. The conclusions drawn are that the method is prone to error if spontaneous, gaze and positional nystagmus are not recorded and that in routine clinical use the test may produce erroneous results. New criteria for the interpretation of the test in children are suggested, but it seems that the best means of diagnosis still remains an accurate history and a readiness to explore the ear to confirm the diagnosis.