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Biomedical subjects

F Wells

Publications and source records attributed to F Wells.

At least 19 recordsLinked to original sources
PubMed2005

Mitral repair best practice: proposed standards.

OBJECTIVES: To define best practice standards for mitral valve repair surgery. DESIGN: Development of standards for process and outcome by consensus. SETTING: Multidisciplinary panel of surgeons, anaesthetists, and cardiologists with interests and expertise in caring for patients with severe mitral regurgitation. MAIN OUTCOME MEASURES: Standards for best practice were defined including the full spectrum of multidisciplinary aspects of care. RESULTS: 19 criteria for best practice were defined including recommendations on surgical training, intraoperative transoesophageal echocardiography, surgery for atrial fibrillation, audit, and cardiology and imaging issues. CONCLUSIONS: Standards for best practice in mitral valve repair were defined by multidisciplinary consensus. This study gives centres undertaking mitral valve repair an opportunity to benchmark their care against agreed standards that are challenging but achievable. Working towards these standards should act as a stimulus towards improvements in care.

Atrial Fibrillation↗
PubMed2005

Transiently elevated diastolic blood pressure is associated with a gender-dependent effect on cardiovascular risk.

We assessed the morbidity and mortality of subjects with transiently elevated diastolic pressure in the General Practice Hypertension Study Group (GPHSG) population. A total of 23 578 patients (aged 18-65 years) from seven UK general practices were screened in 1974 for a diastolic blood pressure (DBP4) of > or = 90 mmHg. Two further readings of DBP4 determined hypertensive (either DBP4 > or = 90 mmHg) or transient hypertensive (both DBP4 < 90 mmHg) status. Transients (n = 850) were matched with normotensive controls (n = 824) and risk ratios calculated over a mean follow-up of 18.7 years. Rescreening was conducted in six of the practices (n = 20 942) after 7.7 years. Male transients had a higher relative hazard for cardiovascular mortality than controls (11.8%, 8.6%, adjusted relative hazard 1.59, P = 0.056). Female transients had a lower relative hazard for cardiovascular mortality than controls (3.6%, 5.4%, adjusted relative hazard 0.39, P = 0.018). In all, 422 patients with transient hypertension were rescreened along with 367 matched controls. Significantly more transients were on antihypertensive treatment compared with their controls (odds ratio (OR) [95% CI]) for both male (4.2 [1.6-11.1]) and female patients (2.4 [1.0-5.56]) and more untreated female transients developed hypertension. Male transients had a higher rates of diabetes mellitus (adj OR = 5.1, P = 0.04) and stroke (adj OR 15.9, P = 0.03). This study has shown that transiently elevated DBP in GPHSG is associated with a significantly higher risk of later hypertension in men and women and of diabetes, stroke and cardiovascular mortality in men. Women with this condition have a significantly lower cardiovascular mortality.

Adolescent↗
PubMed2002

Macroinvertebrate regionalisation for use in the management of aquatic ecosystems in Victoria, Australia.

The development of a broader, more holistic approach to aquatic ecosystem management has been called for in recent years. Physical and chemical objectives alone are no longer considered sufficient for the protection of aquatic ecosystems and should be supplemented with biological objectives. The ubiquitous and sedentary nature of macroinvertebrates, combined with their measurable response to environmental conditions, favour their use as important indicators in environmental policies. To establish biological objectives, there is a need for a regional framework to limit the variability between ecosystems. Past studies have demonstrated that an a posteriori regionalisation approach may be more useful than an a priori approach in explaining single component (e.g. macroinvertebrates) patterns across ecosystems. This is particularly important as aquatic resource management agencies often focus on one or two components of the ecosystem to assess environmental health. This study uses an a posteriori method to delineate and describe biological regions based on edge and riffle macroinvertebrate data. The regionalisation will provide a framework for setting biological objectives, based on the range of reference conditions measured within each separate region. The objectives will include regional checklists for taxa and biotic indices. Predictive modelling in the style of RIVPACS or AUSRIVAS will also be used within each region to develop objectives, incorporating local, regional and systematic features as predictor variables.

Animals↗
PubMed2001

Guar gum reduces postprandial hypotension in older people.

OBJECTIVE: To determine whether slowing of gastric emptying and glucose absorption with guar gum would reduce the fall in blood pressure after an oral glucose load in older subjects. DESIGN: A randomized, experimental, cross-over study. SETTING: Department of Nuclear Medicine, Royal Adelaide Hospital, Adelaide, SA, Australia. PARTICIPANTS: Ten healthy subjects, age 67 to 78. MEASUREMENTS: Simultaneous measurements of gastric emptying, blood pressure, blood glucose, serum insulin, and oral glucose absorption (3-O-methyl-D-glucose [3-OMG]) on two occasions after ingestion of 300 mL water containing 50 g glucose and 30 mL lemon juice, 3 g 3-OMG labeled with 99mTc-sulphur colloid; with or without 9 g guar gum. Blood pressure and gastric emptying were monitored for 180 minutes. RESULTS: The magnitude of the falls in systolic (P = .02), diastolic (P < .05), and mean arterial (P = .05) blood pressure were less, and gastric emptying slower (P < .05), after guar. Blood glucose, insulin, and 3-OMG concentrations were reduced (P < .001 for all) by guar. 3-OMG concentrations were inversely related to the intragastric retention of glucose (r = -0.72, P = .02) and blood pressure was inversely related to 3-OMG (r = -0.64, P < .05) after the drink without guar. The blood glucose concentration was related to 3-OMG (r > 0.64, P < .05). CONCLUSION: Guar gum reduces the magnitude of the fall in blood pressure after oral glucose. Slowing of gastric emptying and glucose absorption may represent a novel approach to the treatment of postprandial hypotension.

Age Factors↗
PubMed1999

[Lung transplantation at the Papworth Hospital: 9-year experience].

OBJECTIVE: To review and compare our results for single lung transplantation (SLT) and double lung transplantation (DLT). METHODS: One hundred twenty-three patients transplanted between September 1988 and July 1997 (99 SLT and 24 DLT) were reviewed. Mean follow-up was 749 days. RESULTS: The following variables were significantly different for the two recipient populations: the most common indication was restriction for SLT and sepsis for DLT; mean ages were 50.3 +/- 9.2 and 40.6 +/- 14.3 for SLT and DLT, respectively; and nutritional status measured as body mass index was 21.5 +/- 4 for SLT and 18.6 +/- 2.7 for DLT. DLT patients experienced longer periods of ischemia during surgery (287 +/- 75 min versus 242 +/- 65 min for SLT, p = 0.01) and more of them required extracorporeal circulation (67% versus 37%, p = 0.005). Early postoperative morbidity after DLT was greater because of bleeding (1,046 +/- 848 ml versus 690 +/- 503 ml; p = 0.01) and time of intubation (9 hours, interquartile range 7 to 13 for DLT patients versus 5 hours, interquartile range 1 to 10 for SLT; p = 0.001). DLT recipients also suffered more respiratory infections during the first 3 months after surgery. Long term, DLT patients had greater pulmonary function capacity than did SLT patients, a difference that was maintained over the three years of follow-up. Readmission was more frequent among DLT patients because of infection (0.40 versus 0.26 readmissions per patient per 100 days; p < 0.02). CONCLUSIONS: Both unilateral and bilateral lung transplants are valid therapeutic options for patients with terminal phase lung disease. DLT offers more hope of long term functional recovery without negatively affecting survival.

Adolescent↗
PubMed1998

Improving surgical resection rate in lung cancer.

BACKGROUND: Surgical resection is the recognised treatment of choice for patients with stage I or II non-small cell lung cancer (NSCLC). In the UK surgical resection rates have remained far lower (< 10%) than those achieved in Europe and the USA (> 20%), despite the recent introduction of fast access investigation units. It remains unclear therefore why UK surgical resection rates lag so far behind those of other countries. METHODS: A new quick access two stop investigation service was established at Papworth in November 1995 to investigate all patients presenting to any of three surrounding health districts with suspected lung cancer. Once staging was complete, all patients with confirmed lung cancer were reviewed by a multidisciplinary team which included an oncologist and a thoracic surgeon. Time from presentation to definitive treatment and surgical resection rates were reviewed. RESULTS: Two hundred and nine (76%) of a total of 275 consecutive patients investigated had confirmed lung cancer (28 small cell, 181 non-small cell). Of the remainder, eight patients (2%) had metastatic disease, four (1%) had other thoracic malignancy (thymoma, mesothelioma), four patients (1%) had benign thoracic tumours, and 50 (18%) had other non-malignant diseases. Of the 181 patients with non-small cell primary lung cancer, 47 (25%) underwent successful surgical resection, of whom 59% had stage I and 21% stage II disease. The failed thoracotomy rate was 11%. Median time from presentation at the peripheral clinic to surgical resection was 5 weeks (range 1-13). CONCLUSION: Quick access investigation, high histological confirmation rates, routine CT scanning, and review of every patient with confirmed lung cancer by a thoracic surgeon led to a substantial increase in the successful surgical resection rate. These results support the growing concern that many patients with operable tumours are being denied the chance of curative surgery in our present system.

Aged↗
PubMed1997

Two teenagers, traumatic aortic disruption, and transoesophageal echocardiography.

A report of two teenagers is presented who were passengers of the same vehicle when it was involved in a serious road traffic accident. Their vehicle was hit on the side at high speed by a second vehicle. Both teenagers sustained multiple injuries. On arrival at a district general hospital they required resuscitation, exploratory laparotomies, and postoperative intensive care. Neither had radiographic evidence to suggest any mediastinal injury, but transoesophageal echocardiography demonstrated aortic disruption in both patients. They were transferred to a regional cardiothoracic centre where their lesions were successfully repaired and both have made a full recovery.

Accidents, Traffic↗
PubMed1995

Clinical experience with a collagen impregnated woven Dacron graft.

Vascular grafts continue to evolve. Recent developments have been aimed at decreasing porosity, increasing strength of prosthesis, increasing ease of handling and suturing and optimising flow characteristics. This study describes results with a recently developed collagen impregnated polyester prosthesis Hemashield Woven Double Velour, which does not require pre-clotting. Between January 1988 and December, 1991 such prostheses were used in 90 patients at Papworth Hospital. Fifty-eight, were used to replace the ascending aorta, 10 for the arch of the aorta and 28 for the descending aorta seven of whom were for coarctation and four for traumatic transections. In 60 cases the underlying disease was a dissected or ruptured aorta requiring emergency operation. There were 66 survivors with X-ray and CT follow-up of 6-52 months. Median blood loss was 630 ml range 380-1800 ml. There was no leakage from any of the grafts during surgery despite full perioperative heparinisation. For emergency/elective operations (N = 60/30) early mortality was 25%/10% (15/3) and late mortality 5%/6.6% (3/2). Of 15 patients who had interposition grafts for Type A dissection CT scans at 5-47 months showed one with chronic dissection proximal to the repair and 11 with persistent distal dissection. There was no evidence of late bleeding, seroma impaired healing or thickened neointima formation. It is concluded that there are no clinical disadvantages associated with collagen impregnation to set against the notable convenience of initial impermeability.

Adult↗
PubMed1993

Multiple recurrent intrapulmonary and endobronchial mesenchymomas (hamartomas).

A patient is described with multiple, benign, chondromatous intrapulmonary and endobronchial mesenchymomas of the lung, which recurred after resection on two occasions over a period of 30 years. In such a patient presenting at a young age or with a history of previous recurrence, a wedge excision may be necessary to prevent further recurrence.

Adult↗
PubMed1992

Massive hemothorax due to enlarging arteriovenous fistula in pregnancy.

A 37-year-old woman with hereditary telangiectasia suffered a life-threatening hemothorax due to an enlarging pulmonary arteriovenous malformation in pregnancy. This was treated by emergency right lower lobectomy and excision of arteriovenous malformations in the right middle and upper lobes, with no postoperative complications, and the subsequent delivery of a normal infant. Women with hereditary telangiectasia contemplating pregnancy should be screened for the presence of PAVM to anticipate complications.

Adult↗