PubMed Health⌕ Search

Biomedical subjects

A Shandall

Publications and source records attributed to A Shandall.

At least 19 recordsLinked to original sources
PubMed2006

Temporal artery biopsy...who needs one?

OBJECTIVE: To review a 10 year period of temporal artery biopsies, using the American College of Rheumatology (ACR) 1990 criteria: a five point scoring system for the diagnosis of giant cell arteritis (GCA). DESIGN: Population based, retrospective cohort analysis. SETTING: One district general hospital in the United Kingdom, over one decade. PARTICIPANTS: All patients who underwent temporal artery biopsy from July 1994 to June 2004. MAIN OUTCOME MEASURES: ACR score and temporal artery biopsy result. RESULTS: During the 10 year period 111 patients were identified. The median (range) age at presentation was 71 (29-85) years. Seventy five patients had an initial ACR score of three or four at presentation. There were 20 positive biopsy specimens. In 19 of these cases at least three of the other criteria were positive so there was already sufficient clinical information for a confident diagnosis. In only one case did the positive result influence the diagnosis by changing the ACR score from two to three. In our series, corticosteroid treatment before biopsy did not significantly reduce the yield of the biopsy. CONCLUSIONS: The ACR score of three or more has a sensitivity of 93.5% and specificity of 91.2% for the diagnosis of GCA. Using these criteria, 68% of patients had sufficient clinical features when referred to make a confident diagnosis of GCA. Temporal artery biopsy was therefore unnecessary in this group. In the remaining group (ACR score < or =2) there was one positive biopsy. The biopsy only changed the diagnosis in this one case-less than 3% of the uncertain cases and less than 1% of the total cases. Using the ACR criteria and restricting biopsy to those cases in which it might change the diagnosis will reduce the number of biopsies by two thirds without jeopardising diagnostic accuracy.

Adrenal Cortex Hormones↗
PubMed1999

The retroperitoneal approach to unusual abdominal aortic aneurysms.

A retroperitoneal approach was used to repair an infrarenal abdominal aortic aneurysm in three patients. The technique was used because of unusual pathology obscuring the aneurysm neck. We discuss the technique of retroperitoneal exposure and suggest advantages over conventional transperitoneal repair in patients with uncomplicated infrarenal abdominal aortic aneurysm.

Aged↗
PubMed1997

What do we do when thrombolysis fails? A United Kingdom survey.

We conducted a postal survey amongst members of the British Cardiac Society to determine current strategies for the detection and management of failed thrombolysis for acute myocardial infarction. The response rate was 290/387 (75%). On-site cardiac catheterisation facilities are available to 162 (60%), 112 (41%) of which are prepared for urgent angiography +/- angioplasty. Streptokinase is the preferred routine thrombolytic agent (n = 242, 90%). After thrombolysis, 121 (45%) respondents rarely search for evidence of reperfusion; a further 55 (20%) confine their search to selected cases. Practice varies amongst those with an active management strategy following proven failed thrombolysis (n = 149, 55%): 50 (19%) perform urgent angiography +/- angioplasty, 49 (18%) administer another thrombolytic agent, 6 (2%) administer another dose of the same agent and 44 (16%) combine these approaches. Transfer to an interventional centre is considered by only 11/106 (10%) without on-site access to cardiac catheterisation. These data indicate considerable variation in the management of failed thrombolysis. Randomised, controlled trials are required to elucidate optimal treatment for this common and important clinical situation.

Fibrinolytic Agents↗
PubMed1994

Intravenous digital subtraction angiography versus computed tomography in the assessment of abdominal aortic aneurysm.

Results of preoperative investigation of 127 patients who underwent elective aortic aneurysm repair during a 3-year period were examined and compared with findings at operation. The accuracy of preoperative computed tomography (CT) and intravenous digital subtraction angiography (DSA) in assessing proximal and distal aneurysm extent was compared. From a total of 118 CT scans, ten of 12 suprarenal aneurysms were correctly predicted, with 11 false positives (positive predictive value 48 per cent, sensitivity 83 per cent, specificity 90 per cent). After 103 DSA investigations, six of ten suprarenal aneurysms were correctly predicted with one false positive (positive predictive value 86 per cent, sensitivity 60 per cent, specificity 99 per cent). Using CT, 30 of 54 aneurysmal iliac arteries were correctly diagnosed with 20 false positives (positive predictive value 60 per cent, sensitivity 56 per cent, specificity 88 per cent). Thirty-six of 48 aneurysmal iliac arteries were diagnosed correctly using DSA, with 32 false positives (positive predictive value 53 per cent, sensitivity 75 per cent, specificity 79 per cent). Intravenous DSA also provided useful information about renal and peripheral occlusive disease. Both investigations have their own specific limitations; clinicians should be aware of these when ordering and interpreting them.

Angiography, Digital Subtraction↗
PubMed1994

Inadequate management of hyperlipidaemia after coronary bypass surgery shown by medical audit.

OBJECTIVE: To audit the detection and management of hyperlipidaemia in patients who have had coronary bypass surgery. PATIENTS: 100 consecutive patients (81 men), mean age 61, who had survived at least 3 months after coronary bypass surgery. METHODS: Retrospective review of case notes and computerised biochemistry records. RESULTS: 83 patients had at least one lipid measurement in the hospital, and of the remaining 17 patients, 10 had undergone urgent or emergency surgery. The median (range) total cholesterol was 6.7 (4.0-11.7) mmol/l and the triglyceride concentration was 2.1 (0.6-18.4) mmol/l. Only 30 patients were referred to a dietician, and 12 were given a lipid lowering drug--these interventions were no more frequent in patients with a cholesterol concentration above than below the median. CONCLUSIONS: Although a high proportion of patients who undergo routine coronary bypass surgery have their plasma lipid concentrations measured, many patients with raised cholesterol concentrations, who would benefit from lipid lowering interventions, are not offered them.

Adult↗
PubMed1994

Out-of-hours workload of junior and senior house surgeons in a district general hospital.

The objective of this study was to assess the out-of-hours workload of junior and senior house officers in general surgery working in a busy DGH in relation to the 'New Deal' guidelines on junior doctors' hours of work. We also wanted to identify safe levels of manning for these grades of staff and to collect accurate data on workload upon which decisions could be made regarding any change in manning levels consequent upon the 'New Deal'. The study is a prospective audit of all work undertaken by 11 junior and senior house surgeons attached to six consultants between 1700 hrs and 0800 hrs during a 16-day period in August 1992. The results showed that the out-of-hours workload of the five JHOs and six SHOs proved to be very onerous. The rotas were 1:5 or 1:6 for emergencies depending on grade plus 1:11 for ward cover. The JHOs were occupied for 70 per cent of the period between 1700 hrs and 2400 hrs and 32.5 per cent of the period after 2400 hrs. For the same periods the SHOs were busy for 61 per cent and 29 per cent respectively. The doctors covering ward duties were occupied for 48 per cent of the period up to midnight when the duty period ended. Both grades got four hours sleep on five of 16 nights. Non-medical tasks accounted for 29 per cent of the ward doctors working time but were a small part of the other doctors work. It was concluded that in this typical busy DGH junior and senior house officers work extremely hard when on call, and that they cannot be reasonably be asked to further increase their level of activity. It follows that a reduction in the hours of work will require additional staff if the standard of care delivered to the patients is to be maintained.

Hospitals, District↗
PubMed1993

An assessment of the long saphenous vein for potential use as a vascular conduit after varicose vein surgery.

PURPOSE: There is controversy in the surgical management of varicose veins between stripping of the long saphenous vein (LSV) and high ligation. Moreover, preservation of the LSV is desirable for future coronary or peripheral artery bypass. We have studied 75 limbs in 44 patients after high saphenous ligation with multiple stab phlebectomy. METHODS: Subjective assessment of the outcome of surgery was made with a linear analog scale, and objective cosmetic outcome was assessed by an independent observer (LF) who had not been involved in the surgical treatment of these patients with our modification from the criteria first described by Jakobsen. Patency, length, and diameter of the LSV was measured 6 to 14 months (mean 12 months) after operation with a duplex scanner and a color-flow scanner. Valvular incompetence in the LSV and perforators was also assessed. RESULTS: Results show a good subjective and objective outcome in 95% and 97% of limbs, respectively. The LSVs were patent from ankle to groin in 68% and from ankle to knee in 82%, with a mean diameter of 4.0 +/- 0.1 mm (mean +/- SEM). There was no statistically significant difference in symptomatic outcome and presence of reflux in the LSV (X2 = 0.465; p = 0.4954; NS) or objective cosmetic outcome and the presence of reflux in the LSV (chi 2 = 2.916; p = 0.0877; NS). CONCLUSIONS: It is concluded that high saphenofemoral ligation combined with multiple "stab avulsions" preserves an LSV with characteristics suggesting suitability for future use as a vascular prosthesis with good early symptomatic and cosmetic results.

Esthetics↗
PubMed1993

Hepatic 'pseudotumours': an important diagnostic pitfall.

Hepatic 'pseudotumours' are radiological abnormalities which give the appearance of tumour. They may be focal areas of disease such as fatty infiltration or areas of focal sparing in diffuse processes. We present four cases of hepatic 'pseudotumours' due to diffuse fatty infiltration with focal sparing and emphasise the need for further radiological assessment of focal lesions found on ultrasound scanning. Measurement of CT attenuation allows a confident diagnosis of fatty infiltration with focal sparing, thus preventing unnecessary investigation. Other forms of hepatic pseudotumour may require further investigation.

Adult↗
PubMed1990

Aortic aneurysms--who should do them?

All patients undergoing abdominal aortic aneurysm repairs in a district general hospital between 1 January 1983 and 31 December 1987 were reviewed. Of the 76 cases, 53 were planned and 23 were ruptured aneurysms. The male:female ratio was 4.4:1, and the age range was 47-84 years (mean 67.6 +/- 6.97 years). Half underwent an ultrasound scan, showing a maximum diameter range of 3-12 cm. Fifty-seven (75%) had tube grafts, and 19 (25%) bifurcation grafts. The 30-day mortality was 3.7% for planned cases, and 26% for ruptured cases. The principal operator in 55 (72.5%) cases was a consultant; consultant anaesthetists were involved in 61.3% cases. We conclude that aneurysm surgery can safely be performed in a district general hospital by a general surgeon with an interest in vascular surgery.

Aged↗
PubMed1989

Role of B-mode venous mapping in infrainguinal in situ vein-arterial bypasses.

Two hundred and eighty patients underwent B-mode mapping (B-map) of their saphenous vein over a period of 3 years (1984-1987) before lower limb revascularization. B-map deemed that 229 veins were suitable for bypass, 26 were questionable and 25 were unsuitable. A successful bypass was achieved in 97.8 per cent of the suitable group (all in situ), 85 per cent of the questionable group (in situ and composite vein), and 80 per cent of the unsuitable group (composite vein). At a minimum follow-up period of 1 year the overall patency rate was 95.0 per cent with a revision rate of 15.8 per cent. There was no correlation between revision rate and vein complexity or calf vein diameter. Calf vein diameter greater than 2.5 mm was correlated with a successful bypass (P less than 0.001). It is concluded that B-map is the investigation of choice for saphenous vein assessment before infrainguinal bypass surgery.

Aged↗
PubMed1985

Mechanism of protection against "reperfusion injury" by aprotinin. Roles of polymorphonuclear leucocytes and oxygen radicals.

We have proposed that reperfusion injury results from the overproduction of reactive oxygen metabolites by PMN as a result of increased sensitivity to oxygen during the low oxygen phase. Aprotinin was demonstrated to inhibit this overproduction and also radical production evoked by chemotactic peptide, 50% inhibitions occurring in the range 5-20 microM. Over this range, no effect on cell viability was observed. This inhibitory effect may provide a scientific basis for the protective effect of aprotinin in reperfusion induced injury.

Aprotinin↗
PubMed1985

Laparoscopy or scanning in oesophageal and gastric carcinoma?

A prospective study was undertaken of the accuracy in diagnosing intra-abdominal metastatic disease of the liver by scintigraphy, ultrasound scanning and laparoscopy. The effect of laparoscopy on management was also studied. Fifty patients were studied: 23 oesophageal carcinoma, 14 gastric carcinoma and 13 with suspected intra-abdominal metastatic spread. Accuracy was determined by laparoscopic biopsy, laparotomy and autopsy. The accuracy was 72 per cent for scintigraphy, 75 per cent for ultrasound and 96 per cent for laparoscopy (with 10 per cent failed ultrasound due to intra-abdominal gas). There was no morbidity or mortality associated with laparoscopy, with one failure due to adhesions. Thirteen patients without hepatic metastases had nodal and/or peritoneal spread diagnosed only by laparoscopy. Laparotomy was avoided in 58 per cent, and 74 per cent died in the 18 month follow-up period. Laparoscopy can obviate the need for laparotomy in inoperable cases of oesophageal carcinoma and allow better planning for potentially curable surgery. In gastric carcinoma the value of laparoscopy is doubtful as a high percentage require at least palliative surgery.

Abdominal Neoplasms↗
PubMed1985

Colonic anastomotic healing and oxygen tension.

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).

Animals↗