H. L. Young

Mechanism of protection against “reperfusion injury” by aprotinin Roles of polymorphonuclear leucocytes and oxygen radicals

We have proposed that reperfusion injury results from the overproduction of reactive oxygen metabolites by PMN as a result of increased sensitivity to oxygen during the low oxygen phase. Aprotinin was demonstrated to inhibit this overproduction and also radical production evoked by chemotactic peptide, 50% inhibitions occurring in the range 5-20 microM. Over this range, no effect on cell viability was observed. This inhibitory effect may provide a scientific basis for the protective effect of aprotinin in reperfusion induced injury.

Management of synergistic bacterial gangrene in severely immunocompromised patients : report of four cases

We present four cases of perianal synergistic gangrene in severely immunocompromised patients. In all patients, gangrene was controlled by radical surgery, including defunctioning colostomy in three patients, backed up by appropriate antibiotic therapy. Three of the patients survived and left the hospital; the fourth died in the intensive care unit of overwhelming sepsis from an unidentified source other than the anus. We review the literature and conclude that such infections in these patients are not inevitably fatal and that radical surgery can result in a cure.

Peripheral Vascular Disease: 2. Venous Disorders of the Lower Limb

To understand disorders of the veins whichoccur in the lower limb, it is essential that there is a correct understanding of the venous drainage of the lower limbs. The system can be divided into superficial and deep. The superficial long and short saphenous veins lie outside the deep fascia and carry approximately 10% of the venous return from the limb. The long saphenous vein has a standard anatomical relationship extending from the front of the medial malleolus of the ankle up the medial side of the leg and enters the deep fascia at the saphenous opening to join the femoral vein. The short saphenous vein arises from the lateral side of the lower leg behind the lateral malleolus and enters the popliteal vein in the popliteal fossa (Fig.3).

Peripheral Vascular Disease 1. Arterial Disease of the Lower Limb

This article, in three parts, is about peripheral vascular disease. The topic has appeared on medicine and surgery examination papers regularly over the last few years. Examiners have become increasingly concerned about the content of many answers, the number of similar inaccuracies that have appeared and, in particular, the confusion between arterial disease and venous disorders, their treatment and management. Concern was also expressed at the disturbing tendency for amputation to be quoted as the only form of treatment available. The Education and Research Board takes the view that it is essential that therapists have a thorough, up-to-date understanding of the symptoms, management and prognosis of vascular disease, particularly since these conditions are often present in patients whose primary referral may have been for other reasons. In this article the topic of amputation is not considered in depth since this is considered to be only one option — a last resort in the range of treatments available. It is hoped that this article will assist students and occupational therapists alike to ensure that their knowledge and approach to this topic is up to date. — L S Phillips, Chairman, Examinations Standing Group (England, Ireland & Wales).