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Biomedical subjects

A W Lambert

Publications and source records attributed to A W Lambert.

30 records · Page 2Linked to original sources
PubMed1999

Experience with heparin-bonded collagen-coated grafts for infrainguinal bypass.

The perfect conduit for infrainguinal reconstructive surgery does not exist. When autologous vein is not available, then a prosthetic graft must be used. The use of a heparin-bonded graft has the theoretical advantage of reducing smooth muscle cell proliferation and thrombus formation, thereby reducing occlusion rates. The application of a collagen layer to the external surface of the graft serves to reduce transfabric haemorrhage. Forty-six patients underwent 47 infrainguinal reconstructions using heparin-bonded collagen-coated Dacron grafts over a 4-year period. Twenty grafts were for disabling claudication and 27 for critical ischaemia. Twenty-two grafts were to the above knee popliteal artery (47%), 10 to the below knee popliteal (21%) and 15 to one of the crural vessels (32%). There was a cumulative patency at 4 years of 69% for the above knee grafts, and 30-month patency of 58% and 45% for the below knee and crural grafts, respectively. There were three deaths over the study period and eight patients required major amputations.

Aged↗
PubMed1999

The incorporation of a stent-graft into the porcine aorta and the inflammatory response to the endoprosthesis.

The fate of a non-sutured anastomosis and the inflammatory response to an endoprosthesis in a porcine aorta was determined. Self-expanding aorto-aortic endovascular prostheses were deployed into the infrarenal aorta of Large White pigs by the transfemoral route, in accordance with Home Office regulations. Animals were followed up at intervals to 1 year. The aortas were explanted and specimens were subjected to light microscopy. Thirteen animals, mean weight 103 kg, underwent placement of a prosthesis. There was early evidence of a neointima at 4 weeks and a well-developed neointima by 12 weeks, with complete incorporation of the endoprosthesis. The early acute inflammatory reaction seen at 4 weeks had become chronic by 12 and was largely absent by 26 weeks. There was no evidence of atypia. Complete incorporation of the non-sutured anastomosis is seen in this model. The acute inflammatory reaction to the prosthesis seen at 4 weeks had largely subsided by 26 weeks.

Acute Disease↗
PubMed1999

Popliteal artery entrapment syndrome.

BACKGROUND: Popliteal artery entrapment syndrome (PAES) is rare and may be underdiagnosed. Improved specialized, non-invasive imaging techniques are producing detailed topographical evidence of the anomaly. METHODS: A historical review of the literature and Medline search was performed with reference to the diagnosis and treatment of the condition. In addition, embryologically based theories for the condition have been postulated. RESULTS AND CONCLUSION: PAES may be the result of abnormal development of the popliteal artery or a consequence of excessive cranial migration of the medial head of the gastrocnemius muscle. Magnetic resonance imaging appears to be the most useful single investigation to demonstrate the anomaly. Popliteal artery release alone or with vein bypass is the treatment of choice when intervention is indicated.

Arterial Occlusive Diseases↗
PubMed1999

Experimental assessment of proximal stent-graft (InterVascular) fixation in human cadaveric infrarenal aortas.

OBJECTIVES: This paper investigates the radial deformation load of an aortic endoluminal prosthesis and determines the longitudinal load required to cause migration in a human cadaveric aorta of the endoprosthesis. DESIGN AND METHODS: The endovascular prosthesis under investigation was a 24 mm diameter, nitinol, self-expanding aortoaortic device (InterVascular, Clearwater, Florida, U.S.A.). Initially, a motorised digital force gauge developed an incremental load which was applied to the ends of five stent-grafts, to a maximum of 10 mm (42%) compression. Secondly, using a simple bench model, each ends of four stent-grafts were deployed into 10 cadaveric experimental aneurysm necks and a longitudinal load applied to effect distraction. RESULTS: Increasing load produced increasing percentage deformation of the stent-grafts. The mean longitudinal distraction load for an aneurysm neck of 20 mm was 409 g (200-480 g), for 15 mm was 277 g (130-410 g) and for 10 mm was 218 g (130-340 g). The aneurysm diameter and aortic calcification had p values of 0.002 and 0.047, respectively, while the p value for aneurysm neck length was less than 0.00001. CONCLUSIONS: These results suggest that there is a theoretical advantage of oversizing an aortic prosthesis and that sufficient anchorage is achieved in an aortic neck of 10 mm to prevent migration when fully deployed.

Aorta, Abdominal↗
PubMed1999

Age-related outcome for peripheral thrombolysis.

OBJECTIVES: To investigate the age-related outcome of peripheral thrombolysis and determine for which patient group this treatment is worthwhile. DESIGN AND METHODS: A combined retrospective and prospective analysis of consecutive patients undergoing thrombolysis for acute lower-limb ischaemia was made with respect to age-related outcome and other risk factors. RESULTS: One hundred and two patients underwent thrombolysis for acute limb ischaemia. In the under 60 age group there was a 40% amputation rate. Seventy-three per cent of this group smoked. In the over 80 age group, the amputation rate was 15% and only 8% were smokers. CONCLUSION: Advancing age is not an adverse risk factor for thrombolysis which appears to be safe and effective in this patient group. There is a high incidence of smoking in the younger age group (< 60 years), in whom failed thrombolysis frequently leads to amputation.

Acute Disease↗
PubMed1998

Popliteal artery entrapment syndrome: collaborative experience of the Joint Vascular Research Group.

BACKGROUND: Popliteal artery entrapment syndrome (PAES) is rare and probably underdiagnosed. This study reviewed a collected experience. METHODS: Patients were identified by the Joint Vascular Research Group (vascular surgeons from ten hospitals serving a population of approximately four million) during 1984-1995. Case notes were reviewed. RESULTS: Twenty-one legs in 17 patients were identified with PAES. There were 15 men and two women. The median age at presentation was 29 (range 14-45) years. One patient was excluded because no further information was available. PAES was bilateral in four patients in whom three legs were asymptomatic. At presentation, the duration of symptoms ranged from a few hours (acute leg ischaemia) to intermittent claudication of 6 years' duration. Primary investigation included angiography (20 patients), duplex imaging (four), plain radiography (one) and magnetic resonance imaging (one). In two cases, attempted thrombolysis failed. Surgery was carried out on 17 legs but failed in two. No amputations were required. Following surgery, 12 legs were asymptomatic and five had residual symptoms. CONCLUSION: PAES should be excluded in young patients with intermittent claudication or acute ischaemia.

Adolescent↗
PubMedDate not supplied

The public's image of nursing as described to baccalaureate prenursing students.

The purpose of this study was to evaluate the perceptions of nursing's image by nonnursing students, professionals, and other nonnursing individuals. Because the image of nursing has been a long-standing problem for nurses, an indication of the overall effectiveness of various individual and group efforts to change the public's image of nursing over the last several years was examined. Content analysis was used to analyze 831 responses to determine the respondent's perceptions of nurses and the nursing profession. Results indicated that the majority of individuals who participated in the study believed that nursing is most closely associated with the concept of caring, even though the meaning and practice of nurse caring was defined very differently.

Attitude to Health↗