Traumatic 'degloving' of the colon in blunt abdominal injury

We describe two cases of traumatic 'degloving' of the colon in blunt abdominal trauma. This is an extremely rare injury with the potential to present late. The mechanism of injury appears to be a combination of focal blunt abdominal trauma associated with a shearing force. The potential diagnostic dilemma posed by colonic 'degloving' is outlined and following review of the literature we conclude that CT scanning is the most reliable way of detecting such injuries, if emergency laparotomy is not indicated

Body composition, physiological function and psychological changes in patients with predicted severe acute pancreatitis

Background: Serious sepsis and major blunt trauma have adverse effects on body composition, physiological function and psychological state. The effect of severe acute pancreatitis on these groups of variables has not yet been reported.Methods: We have studied the effect of predicted severe acute pancreatitis (admission APACHE II score >=ge6) on body fat and mid arm muscle circumference (assessed by dual-energy X-ray absorptiometry and anthropometry), respiratory function (measured by spirometry and vitalography), voluntary muscle function (measured by hand dynamometry) and psychological state (measured by use of the hospital anxiety and depression score and visual analogue scale for fatigue) on admission, and three and seven days there- after.Results: The median APACHE II score of the 15 patients (7 men) in this study was 10 (6-13). The patients showed significant improvement in respiratory function (FEV1 1.3, 1.6, 2.3 litres/s, p < 0.01; FVC 1.5, 2.0, 2.9 litres, p < 0.01; PEFR 304, 372, 409 litres/min, p = 0.01 but no change in voluntary muscle function (210, 205, 213 N, p = 0.41) over the 7-day study period. Psychological state improved in terms of fatigue (2.4, 4.2, 7.0, p < 0.01) and depression (6, 9, 4, p = 0.12) but not in anxiety (8, 6, 7, p = 0.07). Body fat measured by DEXA (17.3 kg on admission, 16.7 kg on day 7, p = 0.13) and the mid upper arm muscle circumference (262, 248, 251 mm, p = 0.10) did not change implying that energy and nitrogen balance over the 7-day study period was achieved.Conclusion: Predicted severe acute pancreatitis has an adverse effect on respiratory function and psychological state similar to that observed in serious sepsis. Improvement in these variables is apparent over 7 days of effective treatment. Further research is indicated to examine the effect of nutritional support on these variables

Blind percutaneous insertion of Hickman lines by a specialist team

Background: Long-term intravenous lines for the delivery of chemotherapy can be inserted by the percutaneous route or under direct vision by surgical exploration. Though the percutaneous route is widely used, many centres still employ a surgical approach. This study evaluates the safety of the blind percutaneous approach. Method: Prospective records were kept of all Hickman lines inserted on the oncology unit of a large teaching hospital. Results: 127 consecutive lines were inserted in 115 adults by a single surgeon over a 30 month period using a blind percutaneous approach. There were 4 complications of insertion: 2 pneumothoraces (1.6%), 1 arrhythmia (0.8%) and bleeding from the subcutaneous tunnel (0.8%). Only 1 line had to be removed in the first 14 days because of hub fracture and leakage. Conclusions: Percutaneous insertion of Hickman lines using the blind technique is associated with a low incidence of complications when performed by an experienced operator

Body composition, muscle function and psychological changes in patients undergoing operation for hepatic or pancreatic disease

Background: There is currently a dearth of data with respect to changes in body composition, physiological function and pychological state in patients undergoing operative treatment for pancreatic or hepatic disease although marked changes in these variables have been reported in colorectal surgical patients.Methods: In 36 patients (37 operations) we have studied the effect of a pancreatic or hepatic operation (with and without nutritional support) on body fat and body protein (assessed by Dual energy X-ray absorptiometry (DEXA) and anthropometry), respiratory function (measured by spirometry and vitalography), voluntary muscle function (measured by hand dynamometry) and psychological state (measured by use of the hospital anxiety and depression score and visual analogue scale for fatigue) over a 1-week period postoperatively.Results: On the 3rd postoperative day there were significant changes in: grip strength 307 (135-499) to 249 (85-461) N; FEV1 2.28 (0.48-3.98) to 1.02 (0-2.42) litres/min; FVC 2.90 (0.75- 5.02) to 1.28 (0.22-3.31) litres; anxiety score 7 (0-17) to 6 (1-20); depression score 3 (0-10) to 5 (0-20), and fatigue 3.9 (0.4-10) to 6.8 (1.0-9.7). These persisted on day 7 by which time mid-arm circumference and total body fat (by DEXA) had fallen from 30.1 (21.1-45.0) to 29.5 (20.2-43.2) cm, and 20.7 (5.8-53.7) to 20.4 (6.6-53.5) kg, respectively. Conclusion: We conclude that operative treatment for pancreatic or hepatic disease has an adverse effect on body composition, physiological function and psychological state