PubMed Health⌕ Search

Biomedical subjects

D C Berridge

Publications and source records attributed to D C Berridge.

At least 19 recordsLinked to original sources
PubMed2006

The PADHOC device is a better guide to the actual incapacity suffered by claudicants than the gold standard constant load treadmill test.

BACKGROUND: The Constant Load Treadmill Test (CLTT) is currently the primary method used to measure walking impairment in patients with peripheral vascular disease. The aim of this study was to compare the CLTT and PADHOC device as assessments of walking impairment. METHODS: 55 patients with intermittent claudication underwent a CLTT and a Double Physiological Walking Test (DPWT) using the PADHOC device. Health-related quality of life was measured using the Short Form 36 and the Claudication Scale. RESULTS: The initial claudication and maximum walking distance from the first part of the DPWT showed the best correlation with domains of pain and physical function. CONCLUSIONS: The DPWT is more representative of the functional incapacity experienced by patients with intermittent claudication. We believe that the PADHOC is a suitable alternative to the CLTT in the assessment of this patient group.

Aged↗
PubMed2006

Return to work following varicose vein surgery: influence of type of operation, employment and social status.

OBJECTIVES: To determine factors which influence the time taken to return to work in patients undergoing varicose vein surgery. DESIGN: Prospective collection of data from patients at outpatient interview. SETTING: The Department of Vascular and Endovascular Surgery at a teaching hospital in the UK. PARTICIPANTS: Two hundred and fifteen consecutive employed or self-employed patients attending the outpatient clinic for review following varicose vein surgery. METHODS: Data was collected from patients in the outpatient clinic approximately 6 weeks following varicose vein surgery. Type of procedure, gender, occupation status, category of occupation, the incidence of complications and the time taken to return to work (RTW) was recorded. Statistics were performed using Kruskal-Wallis H, Mann-Whitney U and chi-squared analysis. RESULTS: Two hundred and fifteen patients were included, 77 (36%) men and 138 (64%) women. One hundred and ninety-two (89%) were employed and 23 (11%) self-employed. One hundred and fifty-three underwent primary saphenofemoral (SFJ) surgery, 10 bilateral procedures, 23 primary saphenopopliteal surgery (SPJ), 14 redo operations, five combined SFJ and SPJ, two mid thigh perforator ligation, six phlebectomies without groin or popliteal surgery and two bilateral surgery for recurrence. There was no relationship of gender or incidence of complications to RTW. There was a significant difference (p<0.0001) between employed (median RTW 4 weeks, interquartile range 2-5 weeks) and self-employed patients (median 2 weeks, interquartile range 1-4 weeks). Occupation category did show an overall significant difference (p<0.0001) on Kruskal-Wallis H-testing. Paired Mann-Whitney U-analysis showed that this difference was between occupation class I (median RTW 2 weeks, interquartile range 1-3 weeks) and IIIN (median 3.5 weeks, interquartile range 2-5 weeks), IIIM (median 5 weeks, interquartile range 2-5 weeks), IV (median 4 weeks, interquartile range 2-6 weeks) and V (median 4 weeks interquartile range 3-6 weeks), and between class II (median 3 weeks, interquartile range 2-4 weeks) and classes IIIM, IV and V. CONCLUSIONS: Employed patients and those involved in intensive manual labour are less likely to return to work early. There is no effect of gender or incidence of complications. On the basis of this study we would recommend that patients could return to work within 3 weeks of varicose veins surgery.

Adult↗
PubMed2004

Infusion techniques for peripheral arterial thrombolysis.

BACKGROUND: Thrombolytic therapy is a useful tool in the management of acute peripheral arterial ischaemia. Fibrinolytic drugs are used to disperse blood clot to clear arterial occlusion. A variety of techniques are used to deliver these agents. OBJECTIVES: To determine the optimal technique for infusion of fibrinolytic drugs in peripheral arterial ischaemia. SEARCH STRATEGY: The Cochrane Library (issue 3, 2003) and the Specialised Trials Register of the Cochrane Review Group on Peripheral Vascular Diseases (July 2003) were searched. Proceedings from meetings of British, European and North American Vascular Surgical and Radiological Societies, plus reference lists of identified studies were also searched for relevant trials. Major pharmaceutical firms and trialists were asked about unpublished trials. SELECTION CRITERIA: Two reviewers independently selected randomised controlled trials comparing infusion techniques of fibrinolytic agents in the treatment of acute peripheral arterial ischaemia. Trials with poor quality methodology were excluded. DATA COLLECTION AND ANALYSIS: Data from included trials were collated and analysed for the following outcomes: limb salvage, amputation, death, vessel patency, time to achieve thrombolysis, and reduction in the need for surgical intervention. Complication rates were compared for: major haemorrhage, cerebrovascular accident and distal embolization. MAIN RESULTS: Intra-arterial delivery of thrombolytic agents appeared to be more effective than intravenous administration. Thrombolysis was more effective when the angiographic catheter was placed within the thrombus. Although 'high dose' and 'forced infusion' techniques achieved vessel patency in less time than 'low dose infusion', there were more bleeding complications, and no increase in patency rates or improvement in limb salvage at 30 days. REVIEWER'S CONCLUSIONS: Implications for practice Thrombolysis should be reserved for patients with limb threatening ischaemia, due to the high risk of haemorrhage or death. Greater benefit is seen when the thrombolytic agent is delivered into the thrombus. Systemic intravenous thrombolysis is less effective than intra-arterial thrombolysis and is associated with an increase in bleeding complications. 'High dose' and 'forced infusion' techniques, or adjunctive agents such as platelet glycoprotein IIb/IIIa inhibitors may speed up thrombolysis, but these are not accompanied by lower amputation rates or a decreased need for adjunctive endovascular or surgical procedures. 'Low dose continuous infusion', following initial lacing of the thrombus with a high dose of the thrombolytic agent, is the least labour intensive technique. Implications for research Only large multicentre trials with carefully controlled inclusion criteria will be sufficiently powerful to demonstrate genuine benefit for a particular thrombolytic regime.

Fibrinolytic Agents↗
PubMed2004

Randomized clinical trial of intraoperative autotransfusion in surgery for abdominal aortic aneurysm.

BACKGROUND: Perioperative homologous blood transfusion (HBT) is associated with adverse reactions and risks transmission of infection. It has also been implicated as an immunosuppressive agent. Intraoperative autotransfusion (IAT) is a potential method of autologous transfusion. METHODS: This was a single-centre randomized clinical trial of IAT in surgery for abdominal aortic aneurysm. Forty patients were randomized to IAT and 41 underwent surgery with HBT only. Patients in both groups received HBT to maintain haemoglobin levels above 8 g/dl. Transfusion requirements, and incidence of systemic inflammatory response syndrome (SIRS) and infection, were compared. RESULTS: Significantly fewer patients in the IAT group required HBT (21 versus 31; P = 0.038) and the median blood requirement per patient was 2 units lower (P = 0.012). There was a higher incidence of chest infection (12 versus four patients; P = 0.049) and SIRS (20 versus nine patients; P = 0.020) in the HBT group. Risk of SIRS was related to aortic cross-clamp time in the IAT group only. CONCLUSION: Use of autotransfusion effectively reduced the need for HBT and was associated with a reduced incidence of postoperative SIRS and infective complications.

Aged↗
PubMed2002

A mathematical model of post-canalization thrombolysis.

During the initial phase of lysis of an occlusive thrombus using lytic agents such as tissue plasminogen activator, blood flow through the centre of the clot is established (the process of recanalization). Following canalization, the clot remains on the vessel wall and further lysis is required. This paper develops a multi-species mathematical model to describe the bulk chemical reactions in the bloodstream and the convective and diffusive transport of chemical species to and from the clot surface in conditions following canalization. For the steady state case, the model indicates that the process of clot lysis following initial recanalization is dominated by surface chemical reactions and the bulk reactions play little role in the lytic process. Lytic rate is dependent on the clot geometry and flow conditions. The rate of clot dissolution is greatest at the upstream end of the clot and decreases steadily downstream due to lytic agent being removed from the flowing blood as it binds to the clot surface. This model may be further developed and used to simulate and compare different lytic regimes.

Animals↗
PubMed2001

A survey of deep venous thrombosis management by consultant vascular surgeons in the United Kingdom and Ireland.

OBJECTIVES: The aim of this study was to detail the current consensus amongst vascular surgeons in Great Britain and Ireland regarding their investigation and management of patients with suspected or proven deep vein thrombosis (DVT). METHODS: The database of the Vascular Surgical Society of Great Britain and Ireland (VSS) was utilised to send coded postal questionnaires to all consultant surgeon members. RESULTS: Replies were received from 281 (65%) consultants. Duplex ultrasound is used alone to confirm DVT by 69% of respondents. A thrombophilia screen is always performed by 14% of consultants, for patients with proven DVT, and is more commonly requested by consultants based in a teaching hospital. The majority (57%) of consultants treat DVT with unfractionated heparin (UFH) and warfarin, whereas only 38% utilise low molecular weight heparins (LMWH) and warfarin. A management policy for DVT is reported to be in place by 59%, and a set policy for the specific management of calf vein DVT by just 20%. CONCLUSION: New diagnostic modalities and treatments have been developed for DVT that are more convenient and cost-effective. Although clinical guidelines for the management of patients with DVT are beginning to emerge, there is still a wide discrepancy in many areas of DVT management, and practice at variance with the current evidence base, amongst vascular surgeons in the United Kingdom and Ireland.

Anticoagulants↗
PubMed2001

Do patients with critical limb ischaemia undergo multiple amputations after infrainguinal bypass surgery?

BACKGROUND: it has been suggested that an aggressive policy of bypass for limb salvage in critical ischaemia may result in patients subsequently undergoing multiple amputations. The aim of this study was to test this suggestion in the context of a dedicated Vascular Surgical Unit in a U.K. teaching hospital. METHODS: three hundred and sixty-eight patients undergoing lower limb bypass operations for critical limb ischaemia between April 1991 and March 1999 were studied retrospectively. Their median age was 69 years (IQR 64--75) and 243 (66%) were men. RESULTS: seventy-five operations were followed by one or more amputation (20%). Only 2% were multiple amputations. Age and sex had no effect on amputation rates, but emergency bypass operations led to a higher rate of amputation in those with critical limb ischaemia. CONCLUSION: patients with critical limb ischaemia who undergo lower limb bypass surgery rarely have subsequent multiple amputation.

Aged↗
PubMed2001

Long saphenous vein stripping and quality of life--a randomised trial.

OBJECTIVES: To assess the quality of life of patients undergoing sapheno-femoral junction (SFJ) ligation and long saphenous vein stripping (LSV), using two different techniques. DESIGN: Prospective, randomised trial. MATERIALS AND METHODS: Eighty patients were recruited and randomised to either Perforate Invagination (PIN) stripping (43) or Conventional stripping (37). Patients completed the Short Form 36 (SF-36) and EuroQol (EQ) questionnaires preoperatively, and postoperatively at 6 weeks and 6 months. RESULTS: Bodily pain, role function and physical summary were significantly improved at 6 months in the PIN stripping group. In the Conventional group, bodily pain and physical function were similarly improved, but not role function. EQ global quality of life was significantly and progressively improved at 6 weeks and 6 months in the PIN group (global score p<0.003; self-rated score p <0.001). In the Conventional group there was no overall improvement in global score or self-rated health. CONCLUSIONS: Primary varicose vein surgery is associated with significant and progressive improvements in quality of life scores. Whilst overall quality of health does improve in the Conventional group, this appears to be to a lesser extent than in the PIN group.

Adult↗
PubMed2001

A new device for the measurement of disease severity in patients with intermittent claudication.

OBJECTIVES: To assess a new method of determining functional impairment in patients with intermittent claudication, the Double Physiological Walking Test (DPWT) using the PADHOC (Peripheral Arterial Disease Holter Control) device, against a standard treadmill test. DESIGN: Patients with intermittent claudication presenting to the department were considered for both the DPWT and a standard treadmill test. METHODS: initial claudicating distance, maximal walking distance and speed of walking were determined for both parts of the DPWT. Initial claudicating distance and maximal walking distance were determined from the treadmill test. Comparisons were made between the treadmill test and the DPWT. RESULTS: The treadmill test was unable to be performed in 22% of patients due to defined contraindications. There were strong correlations in both walking distances and disease severity when comparing the DPWT and the treadmill test. Patients in whom the treadmill test was contraindicated had significantly shorter walking distances on the DPWT than those who were able to complete a treadmill walking test. CONCLUSIONS: The DPWT correlates strongly with walking distances obtained from a standard treadmill test. However, the PADHOC can be used in a number of differing locations and settings as well as in patients in whom a treadmill test is contraindicated. It therefore has a role to play in the initial assessment of patients presenting with intermittent claudication.

Aged↗
PubMed2001

Endovascular repair of an inflammatory abdominal aortic aneurysm complicated by aortoduodenal fistulation with an unusual presentation.

Aortoenteric fistulation (AEF) is a well-documented late complication of open abdominal aortic aneurysm (AAA) repair, occurring in between 0.4% and 4% of cases. In the absence of an anastomosis, AEF is likely to be rare after endovascular aneurysm repair (EVAR) and has only recently been described in the literature as a result of mechanical stent failure or migration. We present the case of a 61-year-old man who underwent EVAR for an AAA with a "nonspecific" periaortic inflammatory mass. Six months postoperatively, an AEF developed, presenting with metastatic sepsis followed by septic infective thromboembolization to his right leg, and amputation was necessary. His stent was well positioned and mechanically intact. We emphasize the need for vigilance about the risk of AEF when adopting an endovascular approach to repair the AAA with a nonspecific periaortic inflammatory mass and highlight the need for awareness about the unusual septic manifestations of AEF.

Aortic Aneurysm, Abdominal↗
PubMed2000

Surgery versus thrombolysis for acute limb ischaemia: initial management.

BACKGROUND: Peripheral arterial thrombolysis has become established as a useful adjunct in the management of peripheral arterial ischaemia. Much has been learnt about indications, risks and benefits using this technique, although data from randomised controlled studies is not extensive. The optimal initial management of the acutely ischaemic leg needs to be determined. OBJECTIVES: To determine if surgery or thrombolysis is the preferred option in the initial treatment of acute limb ischaemia. SEARCH STRATEGY: The search strategy was that adopted by the Cochrane Review Group on Peripheral Vascular Diseases. Additionally, reference lists of papers resulting from this search were reviewed. SELECTION CRITERIA: All randomised studies comparing thrombolysis and surgery in the management of acute limb ischaemia. DATA COLLECTION AND ANALYSIS: Trial quality was assessed and data were extracted independently by all three reviewers. MAIN RESULTS: Patients with acute lesions of less than seven days duration had a significantly increased survival at one year for patients having thrombolysis, compared to those undergoing initial surgery [84% v 58%, p=0.01; Odds ratio (95% CI) 0.28 (0.13,0.63)] largely associated with a reduced level of in-hospital cardio-pulmonary complications (Ouriel 1994). Lesions less than 14 days duration fared better with initial lysis with a reduced amputation and reduced death rate at six months [15.3% v 37.5%; p=0.001; Odds ratio (95%CI) 0.29 (0.12,0.72)] (STILE 1994), compared to initial surgery. Analysis of the same trial at one year however revealed that native vessel thromboses had a more favourable outcome with initial surgery, largely due to continuing ischaemia in the lytic group [64% v 35%; p<0.0001; Odds ratio (95%CI) 3.26(1.96,5.52)] (Weaver 1996). Bypass graft thromboses less than 14 days old treated with initial thrombolysis were shown to have a reduced amputation rate (15% v 47%; p=0.05). However, overall, one year results revealed that thrombolysis of thrombosed grafts was associated with a higher level of continued ischaemia [73% v 50%; P=0.010; Odds ratio (95%CI) 2.72(1.27,5.80)] (Comerota 1996). REVIEWER'S CONCLUSIONS: A universal initial treatment with either surgery or thrombolysis cannot be advocated on the available evidence. There is no overall difference in limb salvage or death at one year between initial surgery and initial thrombolysis. Thrombolysis may however be associated with a higher risk of ongoing limb ischaemia, and a higher overall risk of haemorrhagic complications including stroke. The higher risk of complications needs to be balanced against the risks of surgery in the individual patient.

Humans↗
PubMed1999

Variation in vascular activity in the United Kingdom: an analysis of five regions.

BACKGROUND: The aim of this study was to define variations in vascular activity that may exist between different demographic regions of the UK. METHODS: Five regions were studied. Data were obtained on OPCS codes for vascular surgery 1994-95 from the Department of Health or Welsh Office. Mortality and cause of death statistics were calculated for each region from OPCS data. RESULTS: Ranges of vascular reconstruction, iliac and superficial femoral artery angioplasty and major amputation were 26.2-44, 10.5-23.0 and 11.5-15.7 per 100,000 population, respectively. The highest rates of amputation were seen in areas of high standard mortality and highest death rate from atheroma and ischaemic heart disease. Rates of amputation also rose in proportion to the number of men in the population aged > 60 years. CONCLUSION: Variations exist in vascular activity between different regions. This may be caused by demographic differences in the population. It needs to be considered when calculating the number of vascular surgeons required in different areas of the country.

Amputation, Surgical↗
PubMed1999

Duplex-derived evidence of reflux after varicose vein surgery: neoreflux or neovascularisation?

BACKGROUND: Recurrent varicose veins remain a problem in surgical practice despite improvements to the preoperative investigation of, and surgery for varicose veins. Neovascularisation accounts for some cases of recurrence within a few years of surgery, but other factors relating to disease progression must also play a part. We investigated whether new venous reflux (neoreflux) could occur in the early postoperative period (within 6 weeks) following successful varicose vein surgery. METHODS: Eighteen-month prospective observational study in the dedicated vascular surgery unit of a university teaching hospital. Forty-six patients, with primary saphenofemoral junction reflux, awaiting varicose vein surgery were chosen consecutively from the waiting list. All saphenofemoral surgery was performed in a standardised fashion. Assessments were performed prior to, at 6 weeks and at 1 year after surgery. Duplex ultrasound was used to identify and locate sites of reflux. RESULTS: Neoreflux was present at the 6-week postoperative scan in nine limbs after varicose vein surgery (19.6%), and resolved in 55.6% of patients within 1 year. Neovascularisation was noted in two limbs at the 1-year scan. CONCLUSION: New sites of reflux, which may resolve spontaneously, occur in the early postoperative period despite adequate varicose vein surgery. It is our hypothesis that this is a manifestation of the effect of altered venous haemodynamics in a system of susceptible veins.

Adult↗
PubMed1999

Measuring serum total cholesterol: do vascular surgeons know what they are doing?

Raised serum total cholesterol (TC) is an accepted risk factor for both coronary and peripheral vascular disease and three landmark trials have shown the benefit of lowering TC using statins. Vascular surgeons tend to measure TC, but little is known about how they manage hypercholesterolaemia or whether they believe treatment will be of benefit. A questionnaire was sent to listed members of the Vascular Surgical Society of Great Britain and Ireland seeking responses to a range of questions on the measurement and management of raised TC. In all, 374 questionnaires were sent out. The response rate was 67%. Over 90% of respondents said they measured TC and considered a level below 5.5 mmol/l as normal. The cut-off for initiating drug therapy, referral to a dietician or to a lipid specialist varied from 5.5 to 7.5 mmol/l. Most (62%) believed that lowering TC improved coronary mortality, but fewer (26%) that it prevented worsening of claudication. Although most vascular surgeons check for raised TC, the level at which treatment begins and the form it takes varies; in many cases being at odds with recommendations. Few surgeons are convinced of the benefits of lowering TC for claudication and nearly one-fifth do not believe it improves coronary mortality.

Age Factors↗
PubMed1999

A prospective randomised trial of PIN versus conventional stripping in varicose vein surgery.

A prospective, randomised trial was carried out to examine the efficacy of perforate invagination (PIN, Credenhill Ltd, Derbyshire, UK) stripping of the long saphenous vein (LSV) in comparison to conventional stripping (Astratech AB, Sweden) in the surgical management of primary varicose veins. Eighty patients with primary varicosities secondary to sapheno-femoral junction (SFJ) incompetence and LSV reflux were recruited. Patients were randomised to PIN or conventional stripping with all other operative techniques remaining constant. Follow-up was performed at 1 and 6 weeks postoperatively. There were no statistically significant differences between the two techniques in terms of time taken to strip the vein, percentage of vein stripped or the area of bruising at 1 week. The size of the exit site was significantly smaller with the PIN device (P < or = 0.01). Optimal use of the conventional stripper provides results comparable to the PIN device. Choice of stripping device remains the surgeon's, bearing in mind that the PIN stripper achieves slightly better cosmesis.

Adult↗
PubMed1999

Calman, venous surgery and the vascular trainee.

BACKGROUND: Surgical training in Great Britain is undergoing inevitable changes to accommodate the processes of Higher Surgical Training. Junior surgeons have long argued that their training experiences have been haphazard or without satisfactory supervision. With the advent of changes following the Calman Report and the implementation of the Vascular Surgical Society recommendations, we have audited the venous surgical experience of vascular trainees in Great Britain. METHODS AND RESULTS: Questionnaires were sent to 90 vascular surgical trainees achieving an overall 76.7% response rate (n = 69). Just under half of the trainees had spent more than 12 months on a pure vascular firm. The majority of trainees had received formal training in sapheno-femoral junction ligation and sapheno-popliteal junction ligation. However, several areas of training were deemed insufficient at both the junior and senior trainee levels. Very few trainees gain instruction on deep venous surgery and the techniques of microsclerotherapy. CONCLUSIONS: Despite the participation of trainees in specialised vascular units, current training schedules fail to cover the field of venous surgery adequately. Training by vascular specialists needs greater focus and should be tailored to the trainee's experience on entry to their firm.

Health Care Surveys↗