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We conducted a randomized, prospective, double-blind trial to compare the efficacy of subfascial (SF) versus subcutaneous (SC) lidocaine (10 mL 1%) given in the wound postoperatively through a catheter placed in the respective layer intraoperatively. The initial pain scores were similar in the two groups before injection of lidocaine. In the SC group, there was a reduction in pain scores during rest from 4 to 3 (P > 0.05), during cough from 6 to 5 (P > 0.05), and during mobilization from 7 to 5.5 (P > 0.05) at 15 min. In the SF group, the reductions in pain scores were from 4 to 2 (P < 0.05), from 6 to 3 (P < 0.05), and from 7 to 3 (P < 0.05), respectively. Supplemental analgesics after the lidocaine administration were needed earlier in the SC group than in the SF group (P < 0.01). We conclude that postoperative pain treatment with local lidocaine application after herniotomy has a better effect when applied in the SF, rather than the SC, layer.

Surgery for perforated appendicitis was used to estimate the infective dose of aerobic and anaerobic bacteria in postoperative wound sepsis. The wound sepsis rates were 22.6% (7/31) after treatment with intravenous ampicillin sodium and metronidazole and 23.5% (8/34) after penicillin G sodium, streptomycin, and metronidazole, a nonsignificant difference. Intraoperative sampling by velvet pads demonstrated that the density of aerobes did not differ significantly from that of anaerobes, either on the surface of the appendix, in peritoneal exudate (aspirated), or in the wound before closure. The predominant pathogens were Escherichia coli and Bacteroides fragilis. In 15 patients who developed wound sepsis, the density of aerobes and anaerobes was significantly higher at all sampling sites than in 50 noninfected patients. The median infective dose of aerobes and anaerobes together was 4.6 X 10(5) colony forming units.cm-2 in the operative wound. There was a significantly high correlation between the densities of bacteria during operation and subsequent wound sepsis.

Twenty-eight patients with stable chronic obstructive pulmonary disease (COPD) undertook a training program with a simple respiratory apparatus for 15 min three times daily for 6 weeks. Fourteen patients were allocated to an inspiratory resistance training program and 14 to a control group. In all subjects the median FEV1 was 0.72 and the median FEV1/FVC was 39%. There was no difference in FEV1 or FEV1/FVC between the control and the test groups. In both groups of patients FEV1 FVC and the corresponding values during inspiration, FIV1 and FIVC, as well as MVV, were found unchanged following the training period. Inspiratory resistance tolerance increased in both groups but no significant difference in the improvement could be observed between the two groups. Both groups also showed a similar increase, 23 (76-10) %, in stair-climbing ability. There was no correlation between increases in inspiratory load tolerance and stair-climbing ability. It is suggested that both inspiratory load tolerance and work ability can be improved in COPD patients, but that inspiratory resistance training does not contribute to these improvements.

Intraoperative autotransfusion (IAT) was proposed in 1818 by Blundell. In 1968 Klebanoff introduced the modern IAT system (Bently ATS-200) which can suck blood from the operative field and infuse up to 900 ml/min into the patient again. Ten patients in this series were autotransfused a median of 2275 ml blood during aortoiliac surgery for occlusive arterial disease. Blood samples taken before, during and after surgery showed no significant changes attributable to IAT, except for a minor decrease in the platelets. Total heparinization for elective vascular surgery and citrate (ACD or CPD) for emergencies is recommended. IAT was found safe, easy to operate, efficient in handling large quantities of blood and relatively inexpensive. Furthermore autotransfused blood--in contrast to bank blood--has a normal content of platelets and labile clotting factors.

In a Meckel's diverticulum, heterotopic tissue, inflammation and a vascular band co-existed. The band originating from the superior mesenteric artery, was separated from the mesentery and represented a remnant of the vitelline artery.