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Biomedical subjects

C V Ruckley

Publications and source records attributed to C V Ruckley.

At least 163 records · Page 9Linked to original sources
PubMed1991

Edinburgh Artery Study: prevalence of asymptomatic and symptomatic peripheral arterial disease in the general population.

Intermittent claudication has been studied in cardiovascular surveys but limited information is available on asymptomatic peripheral arterial disease. The purpose of this paper is to describe the prevalence of both asymptomatic and symptomatic disease and relation to ischaemic heart disease in the Edinburgh Artery Study. A cross-sectional survey was conducted on an age-stratified sample of men and women aged 55 to 74 years selected from age-sex registers in ten general practices in the city. Arterial disease was assessed in 1592 participants by means of the WHO questionnaire on intermittent claudication and measurement of the ankle brachial systolic pressure index (ABPI) and change in ankle systolic pressure during reactive hyperaemia. The prevalence of intermittent claudication was 4.5% (95% confidence interval (CI): 3.5%-5.5%). Major asymptomatic disease causing a significant impairment of blood flow occurred in 8.0% (95% CI: 6.6%-9.4%). A further 16.6% (95% CI: 14.6%-18.5%) had criteria considered abnormal in clinical practice: 9.0% had ABPI less than 0.9 and 7.6% had reactive hyperaemia pressure reduction greater than 20%. Intermittent claudication was equally common in both sexes. The ABPI and reactive hyperaemia results suggested a slight preponderance of asymptomatic disease in males and were consistent with an increasing prevalence with age and lower social class. Mean ABPI was higher in normal men than women, and was lower in the left leg than the right suggesting a unilateral predisposition to disease. Subjects with major asymptomatic disease had more evidence of ischaemic heart disease than in the normal population (relative risk (RR) 1.6; 95% CI: 1.3-1.9).(ABSTRACT TRUNCATED AT 250 WORDS)

Age Factors↗
PubMed1991

Echocardiography in acute limb ischaemia.

In a retrospective study carried out over a 5-year period, 88 patients with acute limb ischaemia underwent echocardiography. Of this group, 74 were thought to have an embolic cause of ischaemia on either operative or arteriographic findings. Two-dimensional echocardiography detected a cardiac source in 30 patients (sensitivity 41%, specificity 100%). Clinical examination on admission correctly indicated an embolic source in 36 patients (sensitivity 49%, specificity 36%). The combination of echocardiography and clinical examination detected an embolic source in 60 of 74 (81%) patients. In this study echocardiography complemented clinical examination in the diagnosis of a cardiac source of acute limb ischaemia.

Acute Disease↗
PubMed1991

Doppler colour flow imaging in peripheral arterial disease.

Duplex scanning is unique in its ability to provide both anatomical and physiological information about the circulation, but it is time-consuming and difficult to perform. Technological advances now allow the Doppler information to be colour-coded, making scanning both quicker and more accurate. This article describes the technique and potential use of Doppler colour flow imaging in the investigation and treatment of peripheral arterial disease.

Arterial Occlusive Diseases↗
PubMed1990

Vacuum drainage of groin wounds after vascular surgery: a controlled trial.

A pilot study of 100 consecutive groin wounds after vascular surgery demonstrated lymph leaks in 12 per cent. Lymph leak was significantly associated with wound infection and with prolongation of in-patient stay. A controlled trial was therefore instituted to assess the influence of vacuum drainage in groin wound healing. One hundred and twenty-seven wounds were randomized to drainage (n = 65) or no drainage (n = 62) and the wounds were examined 'blind' by independent observers. No difference in the incidence of lymph leakage or wound infection was noted between the two groups. The routine use of suction drainage for groin wounds in vascular surgery is unnecessary.

Aged↗
PubMed1990

Bacteriology of aortic aneurysm sac contents.

Aerobic and anaerobic cultures from the intraluminal thrombus of infrarenal aortic aneurysms were obtained from 239 patients. Culture results were related to the mode of presentation and the incidence of graft infection. Positive cultures were obtained from 27 patients (11.3%). No statistical correlation between the result of thrombus culture and the mode of presentation was found.

Aorta, Abdominal↗
PubMed1989

Increasing incidence of aortic aneurysms in England and Wales.

The numbers of patients being admitted to hospital with aortic aneurysms have increased recently. A study was carried out to try to find out whether this was a true increase in incidence or whether it could be attributable to more accurate diagnosis and better surgical techniques. From analyses of routine statistics it was found that from 1950 to 1984 age standardised mortality rose 20-fold in men to 47.1 per 100,000 population and 11-fold in women to 22.2 per 100,000 and that this was mainly due to more deaths from abdominal aneurysms. Hospital admissions of men with abdominal aneurysms were found to have increased steadily from 1968 to 1983, but the increase for women admitted did not begin until 1978. An increase in both emergency and elective admissions and only a marginal fall in deaths in hospital (from 45% to 39%) suggest that admissions for abdominal aneurysms increased across a wide range of severity of disease. It is concluded for the following reasons that the true incidence of aortic aneurysms, particularly abdominal aneurysms, has been increasing in England and Wales: the trends are not wholly compatible with advances in diagnosis and surgery, there are inconsistencies by age and sex, and increases have occurred in the number of complicated as well as uncomplicated cases.

Adult↗
PubMed1989

Acute ischaemia of the upper limb compared with acute lower limb ischaemia; a 5-year review.

A series of 61 patients with acute upper limb ischaemia treated over a 5-year period is analysed and compared with patients presenting with acute lower limb ischaemia during the same period. The mean age was 74 years with a female to male ratio of 2.2:1. Eighty-two per cent were treated by operation. Three patients died and no survivors required a major or minor limb amputation, in contrast to a 5 per cent major limb amputation rate in patients with acute lower limb ischaemia. Mortality for upper limb ischaemia was 5 per cent compared with a 30 per cent mortality rate in patients with acute lower limb ischaemia in whom cardiopulmonary debility (New York Heart Association score 3-4) was significantly greater.

Acute Disease↗
PubMed1989

Acute ischaemia of the lower limb: the effect of centralizing vascular surgical services on morbidity and mortality.

Surgical audit data for two 5-year periods (1974-78 and 1983-87) have been compared in a Health Board Area to assess the impact of centralization of emergency vascular services on the treatment of the acutely ischaemic lower limb. Patient populations in each period were comparable. Mortality rates remained constant in both periods at approximately 30 per cent. A significant improvement in overall limb salvage was observed (from 54 to 67 per cent, P less than 0.05). Limb salvage in survivors was improved from 80 to 95 per cent (P less than 0.001) and was paralleled by an increase in the number of reconstructive vascular procedures performed. We concluded that the centralization of emergency vascular services has not led to a reduced risk of mortality but has been associated with improved limb salvage.

Acute Disease↗
PubMed1989

Ten-year review of non-ruptured aortic aneurysms.

Between 1978 and 1987, 587 cases of abdominal aortic aneurysm were operated on in the Vascular Unit of the Royal Infirmary of Edinburgh. Over this ten-year period there was a dramatic increase in the number of patients treated. Rupture had occurred in 278 patients. Of the 309 patients with non-ruptured aneurysm 175 were asymptomatic, 84 were symptomatic and 50 were acutely symptomatic. Two hundred and fifty-nine patients underwent elective operation and the 50 acutely symptomatic patients were operated on as emergencies. The overall mortality for the non-ruptured series was 2.9 per cent. The mortality in patients undergoing elective surgery was 1.9 per cent (1.1 per cent in asymptomatic and 3.6 per cent in symptomatic patients) and 4.0 per cent for patients undergoing emergency surgery.

Adult↗
PubMed1989

Morbidity and mortality in acute lower limb ischaemia: a 5-year review.

A series of 204 consecutive patients with acute lower limb ischaemia was treated over a 5-year period in a Regional Vascular Unit. The mean age was 70 years, with a range of 41-98 and a female to male ratio of 1:0.94. Eighty-eight percent were treated by operation. Twenty-one had simultaneous vascular reconstructive procedures. Fifty-three patients died within 30 days (mortality rate 26%), and 12 required major amputation. Of these, four died resulting in a limb salvage rate of 95% in the survivors. An analysis of factors affecting outcome has shown increasing age, level of occlusion, recent myocardial infarction, pre-existing peripheral arterial disease and cardiopulmonary functional class to be major determinants of morbidity and mortality.

Adult↗
PubMed1989

Femoro-popliteal versus femoro-distal bypass grafting for limb salvage in patients with an "isolated" popliteal segment.

In a prospective, multicentre trial, 59 patients with an ischaemic limb and an "isolated" popliteal segment on angiography were randomised to undergo infrainguinal bypass grafting to either the popliteal segment or to a reconstituted distal vessel lower in the calf. Limb salvage was attained with 88% of the femoro-popliteal grafts and 80% of the femoro-distal grafts. There was no difference in the one year graft patency rate between the femoro-popliteal group (79%) and the femoro-distal group (70%). Mean postoperative increase in ankle/brachial pressure index was similar in the two groups despite the presence of occluded or significantly diseased vessels distal to the popliteal anastomoses. Technical difficulties were encountered in 8% of the popliteal group and 24% of the distal group. Femoro-distal bypass grafting confers no apparent benefit over femoral bypass grafting into a patent popliteal segment, even though the popliteal run-off is impaired or occluded.

Aged↗
PubMed1988

Reproducibility of reactive hyperaemia test in the measurement of peripheral arterial disease.

The reproducibility and sources of variation in ankle and brachial systolic pressures were determined for a reactive hyperaemia test used to assess peripheral arterial disease in the lower limbs. Thirty-six subjects had repeat measurements taken by four observers on two separate days using a Doppler probe and random zero sphygmomanometer. Ankle pressures were measured before and after 4 min of arterial occlusion above the knee. The 95 per cent confidence limits for a postocclusion reduction in pressure was approximately +/- 25 mmHg and for the postocclusion ankle-brachial ratio was +/- 20 per cent. The corresponding figures for the mean of four measurements taken by two observers on 2 days was approximately +/- 17 mmHg and +/- 13 per cent. In patients with vascular disease analysis of variance showed that the greatest sources of variation in the postocclusion ankle-brachial ratio were the 'biological' variations between subjects and between legs. But for postocclusion reductions in pressure, variability due to observers and repeat readings was as important as the 'biological' differences between subjects and legs. Thus, in respect of variability, the ratio may be a better parameter to detect differences between subjects.

Adult↗
PubMed1988

Trends in abdominal aortic aneurysm surgery in Scotland (1971-1984).

The trends in diagnosis, operative workload and mortality of patients with abdominal aortic aneurysm in Scottish hospitals between 1971 and 1984 were analysed using the Scottish Hospital In-patient Statistics. The frequency of diagnosis of aneurysm increased from 25.8 per 100,000 population aged over 55 in 1971 to 63.6 per 100,000 in 1984. The proportion of diagnosed aneurysms treated by operation rose from 24% in 1971 to 41% in 1984, resulting in a 4-fold increase in operative workload. Despite the rise in diagnosis of abdominal aortic aneurysm, the ratio of elective to emergency procedures has only improved slightly during the 14 years, the majority still being operated on as emergencies. The operative mortality following elective procedures fell from 10.5% in 1971 to 4.3% in 1984, while that for emergencies fell from 50% to 36%. The reasons for the increased surgical workload are multifactorial. It is not solely a consequence of an ageing population as the proportion of Scots aged over 55 years increased by only 4% during this period. The evidence from this study suggests that the rise in workload is secondary to an increase in the frequency of diagnosis of abdominal aortic aneurysm in all age groups and to the fact that a greater proportion of diagnosed cases are now offered surgery.

Aged↗
PubMed1988

Variability of ankle and brachial systolic pressures in the measurement of atherosclerotic peripheral arterial disease.

The aim of this study was to determine the variability of measurements of ankle and brachial systolic pressures and ankle brachial ratios in order to assess their suitability for use in epidemiological studies of arterial disease in the lower limbs. Thirty-six subjects had repeat measurements taken by four observers on two separate days using a Doppler probe and random zero sphygmomanometer. The variability in the measurement of ankle systolic pressure was comparable to that for brachial systolic pressure. The 95% confidence limits of one measurement of the ankle brachial ratio was estimated to be +/- 16%, reducing to +/- 10% for the mean of four measurements taken by two observers on two days. Analysis of variance indicated that the variability in the measurement of ankle brachial ratios attributable to observers, days, timing of measurements on the same day, and repeat measurements was considerably less than the "biological" variability between subjects and between legs. These results suggest that repeatability of the ankle brachial ratio is such that a single measurement is suitable for most epidemiological studies of atherosclerotic peripheral arterial disease.

Adult↗
PubMed1988

Chronic leg ulceration: socio-economic aspects.

Six hundred patients with chronic leg ulcers were assessed and classified with regard to social class, mobility and employment. It has been shown that there is no increased incidence of chronic leg ulceration in the more disadvantaged socio-economic groups, but when leg ulceration occurs it is more likely to be recurrent and take longer to heal. Although in only 11% of patients was mobility affected by leg ulceration alone, the condition interfered with work and or leisure activities to a moderate or severe degree in 42%.

Activities of Daily Living↗