Shotley Bridge Hospital

<b>Scadding, J. G. (1974).</b><i>Thorax</i>, <b>29</b>, 271-281. <b>Diffuse pulmonary alveolar fibrosis.</b> The problems of diagnostic categorization of diffuse pulmonary alveolar fibrosis are outlined, and attention is drawn to the different implications of categories defined aetiologically and histopathologically. The pattern of pulmonary insufficiency associated with changes of these sorts is described, and the importance of using a terminology of pulmonary insufficiency which refers unequivocally to disorders of function is emphasized. The usage of the word `interstitial9 in the context of inflammations of the lung is critically examined. It seems to be used to imply predominant involvement of alveolar walls, which in other contexts would be regarded as `parenchyma9. This unresolved conflict which accepted anatomical usage can be avoided by general acceptance of complementary conventions that `pneumonia9 refers to inflammations of the lung characterized by exudation into alveolar spaces leading to consolidation, and `alveolitis9 to those affecting predominantly alveolar walls. Some cases of alveolitis, so defined, can be shown to be due to reactions with inhaled organic dusts in the gas-exchanging part of the lungs in specifically sensitized individuals, constituting a group of aetiologically defined categories `extrinsic allergic alveolitis9. A few are due to ingested toxic substances. Many remain of unknown cause and show a strong and early tendency to alveolar wall fibrosis: they constitute a histopathologically defined category `cryptogenic fibrosing alveolitis9.

An ultrasonic transducer was used to detect gaseous microemboli during open heart surgery. When placed over the carotid artery of patients during surgery it was recognized that gaseous emboli were released into the systemic circulation following recognizable surgical procedures and from the oxygenator during bypass. Fixation of the transducer on the arterial return from the oxygenator demonstrated that the two types of disposable bubble oxygenators and disc oxygenators tested delivered microbubbles in the arterial blood. Some factors affecting the number of bubbles released were recognized and are discussed. Case reports of two patients who received large volumes of gaseous microemboli from different sources are presented.

1 The relationship between warfarin dose, total and free plasma warfarin concentration, and anticoagulant effect was examined at several steady-state levels in fifteen patients during withdrawal of warfarin therapy. 2 Total plasma clearance was significantly correlated with the free fraction in plasma (r=0.955). 3 There was an age related decline in the dose of warfarin, and in the total and free plasma warfarin concentrations required to produce the same anticoagulant effect. However, neither total nor free plasma warfarin clearances varied with age. 4 Individual patients' log concentration-effect relationships were linear above a prothrombin ratio of 1.2 and there was a significant correlation (r=-0.586) between the slope and the free fraction of warfarin in plasma. It is suggested that plasma protein binding may reflect the interaction between warfarin and its effector site in the hepatocyte.

Two hundred and fifty men admitted to a thoracic surgical centre and matched controls were questioned in detail about their occupations after leaving school and their smoking habits. Of 201 men with confirmed bronchial carcinoma 58 gave a history of occupational exposure to asbestos, whereas only 29 out of 201 men matched for age and residential area who were admitted with other diseases gave such a history. This difference was statistically highly significant. The usual association of bronchial carcinoma with heavy smoking was observed, but asbestos exposure increased the risk of carcinoma whatever the level of smoking. These results are consistent with the hypothesis that asbestos exposure and the level of smoking act independently in causing bronchial carcinoma. The patients with carcinoma who had been exposed to asbestos presented on average three years earlier than those who had not been exposed. Asbestos regulations have eliminated the risk of exposure to workers in scheduled industries, so asbestos-induced diseases will probably be increasingly found among the many workers who have had incidental exposure to asbestos. It is therefore important to take a full occupational history.

Primary Care Trusts (PCTs) and Local Strategic Partnerships (LSPs) are being asked to assess local health inequalities in order to prioritize local action, to set local targets for reducing levels of health inequality locally and to demonstrate measurable progress. Despite this, little guidance has been provided on how to quantify health inequalities within PCTs and LSPs. This paper advocates the use of a metric, the slope index of inequality, which provides a consistent measure of health inequalities across local populations. The metric can be presented as a relative gap, which is easily understood and enables levels of inequality to be compared between health conditions, lifestyles and rates of service provision at any one time, or across different time periods. The metric is applied to Sunderland Teaching PCT, using routine data sources. Examples of the results and their uses are presented. It is suggested that more widespread use of the metric could enable levels of health inequalities to be compared across PCTs and lead to the development of local health inequality and inequity benchmarks.

In a series of 420 ascending aortic cannulations for cardiopulmonary bypass, major complications occurred in three patients. Aortic dissection occurred in one patient believed to be due to aortic cross-clamping. Avoidance of this manœuvre is suggested when the aorta is grossly atheromatous. Two patients developing false aneurysms due to mediastinal infection are described. Prevention of mediastinal infection and its treatment are discussed. The method of treatment of false aneurysms by deep hypothermia is described.

During the last 20 years great advances have been made in the recognition of diaphragmatic hernia, and many series of cases reported by numerous authors have helped to place the diagnosis and treatment on a sound surgical basis (Dunhill, 1935; Barrett and Wheaton, 1934; Donovan. 1945 ; Morton, 1939; Harrington, 1940; Gross, 1946). More recently progress in thoracic surgery and anaesthesia has given a more direct approach to the lesion itself and has placed the treatment of diaphragmatic hernia on a basis comparable with the treatment of other types of herniation of the abdominal organs

Abscess formation may arise in several different ways. A carcinoma occurring in a medium-sized bronchus causes partial bronchial obstruction, atelectasis, and retention infection. The inflam- mation may progress to destruction of lung tissue, resulting in the formation of many suppurative foci or a more localized lung abscess. Necrosis of the tumour establishes free drainage, and the destroyed tissue is coughed up. Alternatively, necrosis may develop in the centre of a tumour mass. This occurs when a rapidly growing tumour outstrips its blood supply, and the process of ulceration and liquefaction is aided by infarc- tion and infection. The necrotic debris is then discharged into a bronchus, leaving an abscess cavity in the centre of the tumour. Sometimes so much of the tumour tissue is coughed up that only a thin carcinomatous wall is left round the on July 16, 2023 by guest.

AIMS: To investigate whether changes in carbohydrate structure of IgG are related to malignancy and stage of disease in myeloma and monoclonal gammopathy of uncertain significance (MGUS). METHODS: 61 patients were studied at diagnosis: 14 with MGUS, nine with stage I multiple myeloma, 11 with stage II, 21 with stage III, and five with solitary plasmacytoma. IgG was extracted from serum by protein G affinity chromatography. Oligosaccharides were cleaved from the protein backbone enzymatically by N-glycosidase F. Oligosaccharide analysis was performed by high pressure anion exchange chromatography with pulsed electrochemical detection (HPAE-PED). RESULTS: Up to 15 oligosaccharide peaks were identified in three major fractions: neutral, monosialylated, and disialylated. Patients with myeloma showed an increase in the proportion of sialylated oligosaccharides in comparison with patients with MGUS. The ratio of neutral to sialylated oligosaccharides (N:S) was reduced at all stages of myeloma compared with MGUS: MGUS, 11.35; myeloma stage I, 7.6 (p = 0.047); stage II, 5.20 (p = 0.035); stage III, 3.60 (p = 0.0002); plasmacytoma, 7.5 (p = 0.046). The N:S ratio was independent of paraprotein concentration (r = 0.05). CONCLUSIONS: The ratio of neutral to sialylated oligosaccharides may act as a new marker of malignancy in IgG paraproteinaemia and warrants further investigation.

1. In two hospitals, post-operative staphylococcal wound sepsis occurred with equal frequency in patients who were and in those who were not nasal carriers of Staph. aureus . 2. Nasal carriage of Staph. aureus was not always associated with skin carriage at the site of operation, but even patients who were skin carriers suffered no more sepsis than non-carriers. 3. Self-infection was a less frequent cause of sepsis than was cross-infection. Other investigations of this type have revealed conflicting findings on the frequency of self-infection. These may be due to differences in the epidemiological properties of staphylococci infesting the hospitals; to different methods of preoperative skin preparation; and to the different types of operation concerned. 4. In one of the hospitals, 31% of probable operating-room infections were with organisms similar to those carried by some member of the surgical team. In infections thought to have occurred in the ward, only 10% showed this similarity. In 11 of 35 presumed operating-room infections, the source may have been a member of the surgical team. For help and co-operation we are grateful to Mr G. A. Mason, Senior Surgeon, Newcastle Regional Thoracic Surgery Service; and Dr Joan Millar, Miss G. Jones, Miss E. Smith, Mrs Jean Best, Miss Winifred Mahon, Dr K. Hodgkin, Dr W. Stewart, Mr S. Griffin, Mr W. C. Barnsley, Mr R. Dobson, Mr W. H. Bound, and many nurses and other hospital workers. Our especial thanks are due to Professor R. E. O. Williams, who phage-typed many of the staphylococci, and then taught us to do this for ourselves.

The use of cyanoacrylate tissue adhesives is well described in the literature for closure of skin wounds. The main problem with their application in my hands is that the glue tends to flow/run away from the point of application, making precise application difficult even when the supplied plastic tube is used. This problem is inherent to the low viscosity of the adhesive. I hereby describe a simple, inexpensive technique whereby a "blue" needle is fitted to the tip of the Histoacryl tube and used to apply the adhesive in a precise, fine, and predictable manner to the specific area or point required, reducing any "running" of the glue to undesired adjacent areas. A fast, simple, and elegant way of insetting a skin graft using cyanoacrylate glue is also described.

To establish the viable storage time of human skin stored by refrigeration at 4 degrees C in McCoy's 5A medium and to establish whether oxygenating the medium improves the viable storage time, the following experiment was conducted. Eighty discs of human split-thickness skin graft, each 3 mm in diameter, were stored in 40 sterile sealable containers under four different conditions: in 0.9% saline, in McCoy's 5A medium, in oxygenated McCoy's 5A medium, and in carbon dioxide supplemented McCoy's 5A medium. Skin graft viability was assessed using tissue culture. Skin stored in saline was viable for only 1 week, whereas skin stored in McCoy's 5A medium and in oxygenated McCoy's 5A medium was viable for 4 weeks. Skin stored in carbon dioxide supplemented McCoy's 5A solution did not even survive the first week. These findings show that McCoy's 5A medium allows at least 4 weeks of viable human skin storage by refrigeration at 4 degrees C. Furthermore, oxygenating the medium does not seem to improve the viable storage time, and carbon dioxide supplementation is detrimental. The advantages of skin storage by refrigeration and the implications of the above findings are discussed. A clinical case in which split-thickness skin was stored for approximately 5 weeks and still resulted in good graft take is quoted as an example of our experience with the use of McCoy's 5A medium.

Background: Over recent years there have been a number of studies investigating the effects of therapy for verb and sentence processing difficulties in people with aphasia. A variety of therapies have been described, with apparently different foci and different methods. Despite this, similarities in the outcomes reported would suggest that the therapy techniques are in fact targeting similar processes. Aims: The paper describes two periods of speech and language therapy intervention with a person with non‐fluent aphasia, MV. The contrasting effects of the two therapy periods are discussed and the mechanisms underpinning the improvements seen following the second period involving “verb and noun association therapy” are considered. Methods & Procedures: A case study approach is used to evaluate the effects of two periods of intervention. The client, MV, was diagnosed with a semantic impairment resulting in a noun and verb retrieval deficit, as well as difficulties with argument structure and mapping. In the first intervention period, therapy consisted of verb‐centred mapping therapy and tasks promoting divergent noun and verb retrieval. In the second intervention period, “verb and noun association” therapy was used. Therapy was preceded and followed by detailed assessment of single word and sentence comprehension and production. Outcomes & Results: The initial period of therapy resulted in no linguistic improvement. In contrast, the verb and noun association therapy resulted in item‐specific improvement in verb naming and a parallel improvement in verb comprehension. Significant gains in sentence production were also seen; MV was able to produce more nouns within a sentence context and produce more thematically complete and grammatically accurate sentences. These gains were not related to her ability to produce the nouns targeted within the therapy. Conclusions: It is proposed that the gains in sentence production following the verb and noun association therapy were a consequence of the improved specification of the argument structure around verbs. It is not clear whether this resulted from improved access to lexically specified argument structure information or more generalised gains in argument structure production. The study suggests that gains in sentence production can be achieved for some clients without explicit identification or cueing of arguments and that this approach may be more beneficial for people who struggle with the demands of a more “meta‐linguistic” approach.

The 109 female survivors of a mental hospital population surveyed in 1965 for facial dyskinesia were followed up 16 years later. The 99 survivors with non-organic brain syndromes were analysed. Prevalence of dyskinesia had risen from 18.4% to 46.5% during follow-up and its development was significantly associated with neuroleptic dosage. Enlarged ventricles on brain scans were significantly associated with dyskinesia, cognitive impairment and neuroleptic prescribing.

Seventy-eight mothers who did not want to breast-feed their newborn infants took part in a trial to assess whether metergoline could effectively suppress puerperal lactation. Metergoline 8 mg/day was given to 69 women within 24 hours after delivery and continued for five days to prevent lactation. The remaining nine women were given a course of metergoline once lactation had started. The drug was effective in both preventing and suppressing lactation. Milk secretion, engorgement, and pain were significantly reduced in women taking metergoline. Metergoline has a similar effect to bromocriptine in suppressing lactation, but its mechanism of action remains unknown.

The paper draws attention to the increased incidence of clinical depression reported during the climacteric period of the female life continuum. It seeks to identify factors which may be responsible for this phenomenon, drawing upon research and anecdotal evidence from both the biological and social sciences. With this aim, changes during the climacteric period for women are examined within a bio-psycho-social framework. Nursing care and treatment of those suffering depression within this stage of the middle years are discussed briefly and the influence of personal beliefs, held by both the patient and clinician, emphasized. The relevance and importance of these factors when employing the Roy Adaptation model in the care of such clients is also considered. In conclusion, the author stresses the need for a holistic approach and highlights the value of Roy's model in care provision for this patient group.

Paired samples of blood were examined from 48 patients undergoing major surgery who were receiving metronidazole at a 12-hourly dosage interval, as part of a regimen for prophylaxis or therapy. Twenty-five patients were given 400 mg metronidazole orally twice a day and 23 received 500 mg metronidazole iv twice daily. Assay of the samples demonstrated trough serum concentrations of metronidazole of 3-11 mg/l (mean 5.5 mg/l) and 2-15 mg/l (mean 6.7 mg/l) with the oral and intravenous routes, respectively. The corresponding peak serum concentrations were 10-26 mg/l (mean 17.4 mg/l) and 13-28 mg/l (mean 23.6 mg/l). The trough concentrations are well in excess of the MICs for the majority of obligate anaerobes and thus the 12-hourly regimen achieves and maintains therapeutic serum concentrations of metronidazole.

Journal Article Surgical repair of a traumatic rupture of the thoracic aorta Get access F Ellis F Ellis Newcastle upon Tyne Regional Thoracic Surgery Centre, Shotley Bridge Hospital Search for other works by this author on: Oxford Academic Google Scholar British Journal of Surgery, Volume 46, Issue 199, March 1959, Pages 495–499, https://doi.org/10.1002/bjs.18004619918 Published: 06 December 2005

SUMMARY

Anderson, P. J. M.D., F.D.S.R.C.S.(Ed.), F.R.C.S.; Zuk, J. A. M.R.C.Path., G. S. Rao, M.S., F.R.C.S.; Berry, R. B. F.R.C.S. Author Information