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Biomedical subjects

C P Shearman

Publications and source records attributed to C P Shearman.

At least 73 records · Page 4Linked to original sources
PubMed1988

Systemic effects associated with intermittent claudication. A model to study biochemical aspects of vascular disease?

Patients with intermittent claudication were used as a clinical model to study the effects of transient episodes of ischaemia. Compared with age and sex matched controls significantly greater increases in serum lipid peroxides and urinary microalbumin occurred after exercise. These results suggest that even relatively minor ischaemic episodes, as occur with claudication, are sufficient to cause tissue damage which may be mediated by oxygen derived free radicals. There are also changes in renal permselectivity suggestive of a generalised increase in vascular permeability. These preliminary findings may have important diagnostic, aetiological and therapeutic implications for patients with vascular disease.

Aged↗
PubMed1988

Anastomotic arteriovenous fistulae--are they worth it?

An adjuvant distal arteriovenous fistula (ADAVF) has been claimed to increase arterial bypass graft flow and patency when run-off is poor but others have suggested that a patent fistula does not improve in distal limb perfusion. In 10 dogs, hind limbs were rendered ischaemic by proximal arterial ligations and then revascularised with vein grafts. In each dog an ADAVF was constructed on the left graft while the right was used as a control. Flow and pressure were measured in each graft and distal artery and the effect of temporary occlusion and release of the fistula noted. These measurements were repeated at re-operation 3 months later. Mean flow through control grafts was 83 +/- 8.57 (S.E.M.) ml/min, increasing to 146 +/- 22.89 (S.E.M.) ml/min with papaverine (P less than 0.001, Student's t test), and was unchanged at 3 months. Mean flow in grafts with a distal A-V fistula was 250 +/- 41.68 (S.E.M.) ml/min with no change after papaverine, and an increase to 730 +/- 110.5 (S.E.M.) ml/min at 3 months (P less than 0.001, Student's t test). However, arterial flow distal to the fistula was invariably retrograde at initial operation (20 +/- 3.0 S.E.M. ml/min), and this retrograde flow increased to 180 +/- 33.2 (S.E.M.) ml/min at 3 months (P less than 0.001, Student's t test). Distal arterial pressure at initial operation fell from 88.8 +/- 3.35 (S.E.M.) mmHg to 10.8 +/- 1.01 (S.E.M.) mmHg with the fistula open. We conclude that in this animal model an adjuvant distal arteriovenous fistula may improve bypass graft flow, but is unlikely to benefit distal limb perfusion.

Animals↗
PubMed1988

Single dose, oral antibiotic cover for transurethral prostatectomy.

A double-blind, randomised, placebo-controlled study was carried out to determine the incidence and significance of bacteriuria in 110 patients undergoing transurethral resection of the prostate (TURP) and to assess the effect of a single pre-operative dose of Ciprofloxacin, a 4-quinolone antibiotic. Fifteen (68%) of the 22 patients in the placebo group with a positive post-operative urine culture subsequently developed a clinically apparent urinary tract infection (UTI) or received antibiotics in view of a positive urine culture. Adequate prostatic concentrations of Ciprofloxacin were achieved in all who received the drug. A significant reduction in the number of positive post-operative urine cultures and urinary tract infections requiring antibiotic therapy was achieved in this group. Six patients (5.5%) developed clinical evidence of septicaemia, 5 of whom were in the placebo group. No organisms resistant to Ciprofloxacin were encountered. Prior to surgery, 19% of all patients were found to have previously unsuspected bacteriuria. Ciprofloxacin tended to reduce the chances of this group developing a UTI or requiring antibiotics. Further, there was a highly significant reduction in post-operative infective complications in those with sterile urine at the time of resection who had received the drug. This study suggests that antibiotic cover for TURP is of clinical benefit. Ciprofloxacin may prove suited to this purpose, although further experience with the drug is still required.

Administration, Oral↗
PubMed1987

The anatomical basis for the route taken by Fogarty catheters in the lower leg.

The infrapopliteal route taken by Fogarty catheters when introduced through a common femoral arteriotomy is uncontrolled. We studied the passage of a catheter into the femoral artery in twenty cadavers and related the infrapopliteal route taken, to the angles of origin of the three crural arteries. We then attempted to modify the direction of travel of the catheter by manipulation. In 85% of cadavers the catheter passed into the peroneal artery on each of three consecutive passes, and the tip arrested at mid calf. In 75% of cadavers a 30 degrees bend to the tip of the catheter allowed passage into the posterior tibial artery in which case, the catheter could always be passed into the foot. In only one instance, when the angle of origin was unusually narrow, could the anterior tibial artery be entered.

Aged↗
PubMed1987

The influence of patent branches on in situ vein graft haemodynamics.

The effect of patent graft branches on intra-operative graft flow and pressure has been studied in 50 patients undergoing in situ vein femoro-distal arterial bypass. In 35 grafts in which patent branches in the calf and thigh were preserved as arteriovenous fistulae, release of temporary branch occlusion increased mean proximal graft flow by 178.6% in 32, and reduced distal graft flow by 49.7% in 30. Seventeen limbs had thigh fistulae only: release of temporary fistula occlusion produced a fall in distal graft flow in only three. We identified three types of fistula: (a) cutaneous branches usually found in the thigh, which do not affect graft flow; (b) perforator branches which increase graft inflow but have no effect on distal graft flow: (c) perforator branches which increase graft inflow and decrease graft outflow, and are most frequently found in the calf. Discrimination between these haemodynamically differing branches at operation proved difficult. Since patent branches never improve distal graft flow and may reduce it, we recommend that all fistulae are ligated at operation.

Adult↗
PubMed1987

Subdural empyema: a rational management plan. The case against craniotomy.

A review of the management of 34 patients with subdural empyema treated at the Derbyshire Royal Infirmary has been undertaken. It is concluded that craniotomy has little part to play in the management of patients with this condition. With modern, improved antimicrobials and prompt burr hole lavage complete recovery should be obtained in the majority of cases. The treatment of the severely ill patient is discussed.

Adolescent↗
PubMed1986

Non-invasive femoropopliteal assessment: is that angiogram really necessary?

A method of non-invasive preoperative assessment of chronically ischaemic legs was developed that used clinical data and data derived from Doppler ultrasonography to produce a numerical score that could be compared with an angiographic score for stenosis of the popliteal artery trifurcation. The two scoring systems were applied retrospectively to 144 legs after femorodistal bypass. A close correlation was observed (r = 0.89, p less than 0.001), and both systems tended to predict the level of grafting undertaken. A prospective comparison was then made in 81 ischaemic legs that were examined by arteriography; the correlation between the two scoring systems remained close (r = 0.89, p less than 0.001), and the level of bypass was correctly predicted by the non-invasive assessment in 44 of 50 legs that were operated on. Use of the non-invasive assessment subsequently greatly reduced the indications for preoperative arteriography in patients requiring femorodistal vascular reconstruction.

Angiography↗
PubMed1986

Dumb-bell schwannoma of the jugular foramen.

This case represents the youngest patient recorded with a jugular foramen schwannoma and the first report of the classic 'dumb-bell' configuration of this tumor in a child. The case illustrates the importance of excluding an intracranial component when these tumors present as a swelling in the neck.

Accessory Nerve↗
PubMed1986

A clinical method for the detection of arteriovenous fistulas during in situ great saphenous vein bypass.

Residual arteriovenous fistulas are a potential source of morbidity after femorodistal bypass operation has been performed with the in situ great saphenous vein graft. A review of our initial experience with 155 operations in which various methods of intraoperative detection were used showed that fistulas were overlooked in 27 cases (17.4%), causing graft thrombosis in 10 cases (6.4%). After the introduction of a rapid and simple intraoperative test that used retrograde irrigation of the graft, only three superficial fistulas were overlooked in 70 operations (4.2%), with no associated graft thrombosis. The test had no detectable deleterious effects and graft distension pressures were within acceptable limits.

Angiography↗
PubMed1986

Which gastroplasty for the correction of massive obesity?

The results of vertical and horizontal gastroplasty were evaluated in 26 grossly obese patients. Weight loss with both techniques over 2 years was comparable to that of jejuno-ileal bypass, but without the metabolic complications. Horizontal gastroplasty however, had a higher rate of stoma revision as compared with vertical gastroplasty. Vertical gastroplasty is now the operation favoured in this unit.

Adolescent↗