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Biomedical subjects

C R Quick

Publications and source records attributed to C R Quick.

13 recordsLinked to original sources
PubMed1996

Prolapsing gastric polyp, an unusual cause of gastric outlet obstruction: a review of the pathology and management of gastric polyps.

Gastric polyps are rare and largely asymptomatic, but attract importance because of their strong potential to progress to carcinoma. Rarely, pedunculated polyps arising in the antrum may prolapse through the pylorus, causing intermittent gastric outlet obstruction. We describe here our experience of four cases collected over a ten-year period, each presenting dissimilarly with this phenomenon. We review the literature referring to the pathogenesis of gastric polyps and their association with malignancy and other disorders. We proceed to discuss the efficacy of barium studies versus gastroscopy in detecting these lesions, the relative roles and merits of endoscopic polypectomy and surgery, and the importance of prolonged follow-up of patients harbouring gastric polyps.

Aged↗
PubMed1995

Endovascular femoropopliteal bypass: a cadaveric study.

OBJECTIVE: Patency rates of standard femoropopliteal bypass in infra-inguinal occlusive disease have yet to be matched by minimally invasive percutaneous procedures. We report a feasibility study of a less invasive endovascular femoropopliteal bypass technique. METHODS: (1) groin exposure of femoral artery, (2) guidewire passage and mechanical dilatation of superficial femoral artery (SFA), (3) expandable helical cutter endarterectomy of SFA, (4) transluminal placement of PTFE graft, (5) graft balloon dilatation to shape and set distal interface and (6) end-to-end anastomosis of proximal graft to femoral artery. Development and testing was undertaken in 48 limbs of 26 fresh human cadavers. Limbs with no demonstrable SFA disease were excluded. Seventeen limbs had mild, diffuse disease. Three limbs had a single, short, tight stenosis. Seventeen limbs had multiple, high grade stenotic lesions 12-40 cm long (mean 24 cm). Eleven limbs had occlusive lesions, 8-38 cm long (mean 24 cm). RESULTS: We successfully completed the procedure in 39 (81%) limbs. We failed to complete the procedure in nine limbs; four from failed guidewire passage, four from vessel avulsion, and one from graft deployment failure. Histology confirmed endarterectomy cleavage in the standard plane. Angiography and explants demonstrated a patent graft and popliteal artery, and smooth distal graft/arterial interface with no obvious defects in 24 (62%) cases. Defects included combinations of: contrast extravasation/reflux, graft malpositioned/incorrectly sized, distal graft fold, and distal intimal flap. CONCLUSION: Endovascular femoropopliteal bypass is feasible and warrants further studies for possible clinical application.

Aged↗
PubMed1994

Antibiotic irrigation and conservative surgery for major aortic graft infection.

PURPOSE: Traditional surgical treatment for panprosthetic aortic graft infection entails radical excision of the graft, aortic stump closure, and extraanatomic revascularization of the lower limbs. This carries an early mortality rate of 24% to 45%. Amputation rates range from 11% to 37%. Multiple operations and prolonged hospital stay are usual. We have developed a more conservative management technique with the aim of improving outcome. METHODS: We describe an innovative method of treating the condition with prolonged, high-dose, local antibiotic irrigation therapy, systemic antibiotic treatment, surgical debridement, and graft conservation in a prospectively studied series of 10 patients. RESULTS: The actual 30-day patient survival rate is 90%, the 1-year survival rate is 80%, and the 4-year survival rate is 67%. Two patients died because of graft infection, and the third died, uninfected, of an unrelated cause. No limbs have been amputated. Only two patients required a second operation. Mean postoperative hospital stay was 32 days. The seven survivors have been closely followed up with regular computed tomography or indium scanning and clinical examination and appear to be free from infection at a mean of 61 months after cessation of irrigation therapy. CONCLUSION: The technique appears to represent a significant improvement in the management of this major complication of vascular surgery.

Adult↗
PubMed1994

An abdominal aortic aneurysm screening programme for all males over the age of 50 years.

Previously published ultrasound screening programmes for abdominal aortic aneurysm (AAA) have concentrated on males in the 65 to 75 year age range, suggesting this as the most cost-effective cohort to target. In this unique study we have broadened the criteria for screening. General practitioners in one health district were approached to supply details of all males aged 50 years and over to be offered aortic ultrasound scanning. Over a period of 18 months, 4145 individuals were asked to attend and 3030 (73%) have attended. Attendance rates were: between 50 and 64 years, 73%; between 65 and 79 years, 75%; for 80 years and over, 64%--significantly less (p = 0.01-0.001) than the other two age bands. Aortic dilatation (diameter > or = 2.5 cm) was found in 6.3% of the 50 to 64 year age group, 16.8% of the 65 to 79 year age group, and 23.3% of the 80 years and over age group. An established aneurysm (> or = 4.6 cm) was found in 0.3%--6 individuals (50-64 years), 2.5% (65-79 years) and 4.1% (> or = 80 years). The results suggest that aortic screening may be worthwhile extending to a wider age band. By focusing follow-up, this should give greater value for younger men in terms of community productivity and allows for selective intervention in the elderly.

Aged↗
PubMed1990

Conservative treatment of major aortic graft infection.

Major infections of Dacron aortic grafts involving the proximal anastomosis or the whole graft are rare but lethal. Traditional surgical treatment involves radical excision of the graft and extra-anatomic revascularisation of the lower limbs, and carries a forbidding mortality and complication rate. This paper describes an alternative conservative approach used on four patients, three of whom appear to have been successfully treated by continuous antibiotic irrigation of the prosthesis without removal of the graft, whilst the fourth died 42 months later of recurrent graft infection. This is the first time that prolonged survival has been reported following conservative treatment of major graft infection. The authors believe this method may offer substantial advantages over the traditional surgical treatment for this dreaded complication of aortic surgery.

Aged↗
PubMed1985

Staples for wound closure: a controlled trial.

Skin staples were compared with two conventional suture methods for speed, convenience, effectiveness and cost. One hundred and ninety-five patients having linear abdominal incisions were randomly allocated to one of three methods of interrupted skin closure--polypropylene sutures, polyglactin sutures or stainless steel staples and the wounds were assessed over 30 days. The mean rate of wound closure using sutures was 4.2 cm per minute while staples were faster at 22.5 cm per minute and saved an average of three minutes per wound. The time saved was considerably greater with long incisions. Staples cost 50p more per 15 cm wound than either suture. In other respects the three methods were comparable except that polyglactin caused the least wound pain. We believe the advantages of speed and convenience of skin staples outweigh the extra cost, provided the disposable instruments are reused until empty.

Adolescent↗
PubMed1982

The measured effect of stopping smoking on intermittent claudication.

One hundred and twenty-four limbs in patients suffering from intermittent claudication were studied over 10 months. Changes in ankle pressure and treadmill exercise tolerance over the period were compared between two groups, one of patients who continued to smoke (group 1) and the other of those who gave up (group 2). Resting ankle systolic pressure fell in smokers' limbs by a mean of 10.2 mmHg (t = 3.56, P less than 0.001), and rose in those patients who stopped smoking by a mean 8.7 mmHg (P = n.s.). Ankle pressures after exercise and maximum treadmill walking distance did not change in smokers but significantly improved in past smokers. Stopping cigarette smoking increased the chance of improvement in ankle pressure and exercise tolerance in intermittent claudication.

Ankle↗
PubMed1977

Doppler ultrasound in the functional assessment of extended deep femoral angioplasty.

Twelve patients who have had an extended deep femoral angioplasty (EFDA) for severe lower limb ischaemia have been assessed. The patients underwent a standard exercise ankle pressure test before operation and 6 months after operation. The test included the measurement of resting brachial and ankle pressures, walking distance on a treadmill and the post-exercise pressure response. A limb ischaemic score was derived from these measurements; 8 patients showed an improved score, 3 patients exhibited no change and 1 was worse. The mean improvement in walking distance of the successful cases was 182 per cent (s.d. 96 per cent). There were no amputation during the period of study.

Adult↗