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A Clark polarographic oxygen electrode allowed detailed mapping of tissue oxygen (PtO2) levels on the anterior surface of the stomach in five patients undergoing cholecystectomy. No significant difference in mean PtO2 was detectable between greater and lesser curvatures. A significant difference in mean PtO2 was detected between the body of the stomach and the pylorus (Mann-Whitney, P less than 0.01). The effect of truncal vagotomy on PtO2 was evaluated in six patients undergoing this procedure for duodenal ulceration. Mean postvagotomy stomach PtO2 levels (46 +/- 12 mmHg) were significantly lower (Wilcoxon test, P less than 0.001) than prevagotomy levels (59 +/- 14 mmHg). Truncal vagotomy did not have any significant effect on small intestinal PtO2. This work provides the first objective evidence of the relatively diminished tissue oxygenation in the gastric antrum and pyloric region, and confirms blood flow studies of the effects of vagotomy.

A sample of 1000 members of the Association of Surgeons of Great Britain and Ireland was circulated with a postal questionnaire relating to their occupational stressors, their type A coronary-prone behaviour and their mental health. Six hundred and seventy-two (67 per cent) useable forms were returned anonymously. The major individual stressors were: (1) the interference of the job with personal life, (2) general administration, and (3) the number of patients in clinics. Type A behaviour was similar to that of other professional groups. Surgeons showed mean scores significantly higher than the general population on two subscales of the mental health index (free-floating anxiety and hysterical anxiety). The findings for the few female surgeons (2 per cent) were similar to those in men but they did not exhibit raised free-floating anxiety levels.

Using a Clark oxygen electrode and a 133Xe clearance technique, tissue oxygen tension (T02) and blood flow have been determined in the small and large bowel of a rabbit experimental model. The predictive value of perianastomotic T02 in colonic anastomoses was determined, healing being assessed by leakage rate, tensile strength and hydroxyproline content. The effect of suture technique on colonic perianastomotic T02 has also been studied. Colonic and small intestinal T02 correlated with blood flow (r = 0.93). Basal colonic blood flow and oxygen tension were significantly lower than in the small intestine (P less than 0.01). Interrupted and continuous suture techniques decreased colonic perianastomotic T02, although mean T02 in the continuous group was significantly lower than in the interrupted group (P less than 0.01). The leakage rate was 10 per cent (1/10) for anastomoses constructed with a perianastomotic T02 above 55 mmHg compared with 100 per cent (10/10) if less than 25 mmHg (P less than 0.001). Perianastomotic T02 correlated with breaking energy (P less than 0.001), breaking strength (P less than 0.01) and hydroxyproline content (P less than 0.05).

A randomized controlled trial to assess the effect of intravenous Trasylol on postoperative intraperitoneal adhesion formation has been performed in rats. Before undergoing a standard left colonic resection, animals received i.v. Trasylol 10 000 KIU. This dose was repeated 8-hourly for 3 days postoperatively. Control animals received saline placebo. The mean percentage circumference of the anastomosis covered with adhesions in the Trasylol group animals was 20.86 +/- 6.08 compared with 45.24 +/- 5.97 in the control group (P less than 0.01). Significantly more animals treated with Trasylol were completely free of adhesions than those receiving saline. Bursting pressures did not differ between the two groups. Intravenous Trasylol clearly inhibits intraperitoneal adhesion formation in this model.

A prospective randomized controller trial of dextranomer beads (Debrisan) and silicone foam elastomer (Silastic) dressings in open infected surgical wounds has been performed. The results indicate that the healing time for wounds treated by Debrisan (n = 25) and elastomer (n = 25) is similar, being 40.92 +/- 3.98 and 36.90 +/- 3.18 days respectively. The time taken for wounds to become pain-free was similar in both treatment groups, as was the persistence of signs in the wounds of erythema, oedema and slough. Comparison of cost reveals the elastomer dressing to be considerably cheaper than Debrisan.

Using a model of 'reperfusion injury' as a mechanism of oxygen radical (OR) production in vivo, we have demonstrated that superoxide (O2-) is the major source of damage. Inhibition of its production from polymorphonuclear leucocytes (PMNs) by aprotinin, a protease inhibitor, or by scavenging with superoxide dismutase (SOD), resulted in reduced oxidation of of tissue glutathione (P less than 0.002). Colonic healing after anastomosis was also improved by aprotinin as measured by histology (P less than 0.05), breaking energy (P less than 0.001), breaking strength (P = 0.02), and by hydroxyproline content (P = 0.01). Allopurinol, although inhibiting glutathione oxidation, had no effect on PMN leucocyte OR production and did not protect against histological damage. These data demonstrate that PMNs endogenous to the tissue or attracted there as a result of trauma are the source of OR production in 'reperfusion'. Their inhibition improves colonic healing.