Late mortality after vagotomy and drainage for duodenal ulcer.

Seven hundred and thirty five patients who underwent elective vagotomy and drainage procedures in one hospital during 1957-67 were followed up until 1 September 1982. At this time 281 were dead compared with an expected 184. This gives a ratio of observed to expected deaths of 1.53 (p less than 0.0001). The most important cause of increased mortality was lung cancer, which accounted for 33 of the excess deaths (observed to expected ratio 3.53). Gastric cancer yielded an observed to expected ratio of 3.3. Other causes of death that were significantly more common than expected were cerebrovascular accident, bronchopneumonia, and colorectal cancer. It is concluded that although gastric cancer occurs more commonly after vagotomy and drainage than in the general population, it is not as important a cause of death as diseases related to smoking.     

Recovery after subarachnoid haemorrhage.

OBJECTIVE--To determine the implications of subarachnoid haemorrhage for quality of life and aftercare. DESIGN--Prospective follow up study of patients surviving subarachnoid haemorrhage over one year (at discharge, three months, and one year) by examination of cognitive functions (a test battery) and changes in everyday life (semistructured interview). SETTING--Regional neurosurgical unit at a tertiary referral centre. PATIENTS--100 Patients with subarachnoid haemorrhage; 17 were lost during the study because of ineligibility (further surgery, previous head injury, relevant psychiatric history, and cultural differences), loss of contact, and non-compliance; a further 13 patients who developed a neurological deficit were considered separately. MAIN OUTCOME MEASURE--Performance on cognitive test battery and reported changes in quality of life. RESULTS--At discharge patients with and without neurological deficit scored below established norms with most tests, but by three months the difference had resolved in patients without deficit. Reduced quality of life attributable to subarachnoid haemorrhage at one year mainly included less energy (seven patients), adverse emotional changes (five), early retirement, affected social life, and domestic tension (three each). None reported reduced capacity for work. CONCLUSIONS--Patients surviving subarachnoid haemorrhage without neurological symptoms have a good prognosis and should be encouraged to return to a normal lifestyle within about three months.     

Consequences of fetomaternal haemorrhage after intrauterine transfusion.

Fetomaternal haemorrhage was studied after 68 consecutive fetal intravascular transfusions performed in 20 patients with Rh isoimmunisation. alpha Fetoprotein concentration was assayed in maternal blood taken before, and immediately after each transfusion and three and 24 hours later. An increase of 50% or more in the concentration in any of the samples after transfusion was considered to indicate fetomaternal haemorrhage. Fetal alpha fetoprotein concentration in blood sampled before transfusion was also assayed and the amount of fetomaternal haemorrhage calculated. Fetomaternal haemorrhage occurred in 21 of 32 patients with an anterior placenta and in six of 36 with a posterior or fundal placenta. The mean estimated volume of haemorrhage was 2.4 ml, which was on average equal to 3.1% of the total fetoplacental blood volume. When the volume of fetomaternal haemorrhage at the first transfusion was greater than 1 ml there was a greater increase in maternal Rh (D) antibody titres and a greater fall in fetal packed cell volume. Sampling of fetal blood should not be routinely done early in patients with Rh isoimmunisation, and intrauterine transfusion should be delayed as long as possible. Sampling sites other than the placental cord insertion reduces the risk of fetomaternal haemorrhage.     

Postpartum haemorrhage after induced and spontaneous labour.

The labour records of 1000 consecutive deliveries were studied to compare the incidence of postpartum haemorrhage after induced labour with that after spontaneous labour. The discovery of an increased incidence of postpartum haemorrhage in the induced group prompted further analysis of the incidence of haemorrhage among 3674 normal deliveries. This analysis confirmed that the incidence of postpartum haemorrhage was increased after induction of labour; among primiparous patients the increased incidence after induced labours was nearly twice that after spontaneous labours, even when only normal deliveries were considered. These findings indicate that postpartum haemorrhage is another complication of induction that needs to be taken into account when induction is being considered.