Percutaneous cervical pharyngostomy. A comfortable and convenient alternative to protracted nasogastric intubation.

For patients who require lengthy periods of enteral nutrition or gastrointestinal decompression, the use of a tube placed through a cervical pharyngostomy provides a convenient means of access to the upper gastrointestinal tract. The discomfort and complications of nasogastric intubation can be avoided, and the use of parenteral nutrition can be reduced in many cases where the gastrointestinal tract is functioning but the patient is unable to ingest food normally. The result of this technique in 42 patients over a 4 year period have been described herein. The patients found the method comfortable, cosmetically acceptable, and easily managed both in the hospital and at home. The technique of inserting the tube through the pyriform sinus is easy and safe to perform, and there have been no major complications in using the technique for periods up to 119 days. If accidentally displaced, the tube is easily reinserted through the neck without special equipment and with no discomfort. The method can provide a considerable improvement in the effectiveness of overall patient management. We suggest it could be more widely used in general surgical practice.

The usefulness of naftidrofuryl in severe peripheral ischaemia--a symptomatic assessment using linear analogue scales.

The effect of Naftidrofuryl (Nafronyl) on the symptoms of severe peripheral vascular disease has been studied in 40 hospital inpatients. Assessment of ischaemic symptoms and of symptoms which may occur with any type of chronic pain was made using a linear analogue system. Patients treated with naftidrofuryl showed a significant symptomatic improvement compared to patients treated without vasoactive drug therapy. These results show that this drug has a useful place in the treatment of severe ischaemic symptoms during assessment for vascular reconstruction and in those patients found to be unsuitable for limb-salvage operations.

Mianserin induced agranulocytosis presenting as an abscess.

A case of Mianserin induced agranulocytosis presenting as a localised infection is presented and the literature reviewed. The importance of a thorough drug history in patients presenting with minor surgical ailments is stressed.

Measurement of tissue pH in skin by glass microelectrodes.

Alterations in metabolic activity may be used as an indicator of tissue perfusion and haemodynamic status in peripheral ischaemia. A new type of microelectrode was used to measure pH in the skin of patients with vascular disease, and a decrease in pH was demonstrated along the leg, commensurate with the severity of the disease. Measurement of skin pH by this technique is easy and may be useful for assessing tissue perfusion or skin viability in other conditions.

Treatment of acute pancreatitis with fresh frozen plasma.

A consecutive series of 239 patients experiencing 336 separate attacks of acute pancreatitis have been treated with fresh frozen plasma during the first 5 days of the illness. Using established criteria, 96 attacks occurring in 69 patients were judged to be severe at the time of admission. The overall mortality was 3.7 per cent per patient population and 2.7 per cent per total number of separate attacks. Four of 69 patients with severe pancreatitis (5.8 per cent) have died and the mortality rate for the 96 severe attacks was 4.2 per cent. No complications which could be directly attributed to fresh frozen plasma were encountered in the series. The results of this prospective pilot study with naturally occurring human proteinase inhibitors have been encouraging and indicate the need for randomized clinical trials.