Biomedical subjects

Ian Weir

Publications and source records attributed to Ian Weir.

3 recordsLinked to original sources

PubMed2006

Coronary artery stenosis.

The near exponential rise in percutaneous coronary intervention(PCI) in the treatment of patients with coronary artery disease and the consequent decline in referral of patients for coronary artery bypass grafting (CABG) has lead to a crisis in cardiac surgery. Is CABG, one of the most successful and widely applied surgical procedures, about to follow surgery for peptic ulcer disease into obsolescence? The question has serious implications for service provision and training as well as for informed patient consent. Keith Dawkins puts the case for PCI and gives a very clear and concise account of its inexorable rise to pre-eminence. David Taggart has taken on the Goliath of interventional cardiology and its associated industry by persuasively marshalling the data from the evidence base which strongly favours surgery in triple vessel and left main coronary disease. He points to the lack of long-term results and also to the weaknesses of many of the comparative studies so far published. His arguments have been positively received on both sides of the Atlantic but it is by no means certain that they will bring about the multidisciplinary approach to providing patients with treatment options which he and others advocate. It also remains to be seen whether the evidence base when it is eventually acquired will vindicate the present increasing dominance of PCI over CABG.

Angioplasty, Balloon, Coronary↗

PubMed2006

Coronary artery bypass.

Coronary artery bypass grafting as a means of myocardial revascularisation is a remarkably successful operation. Over 25,000 procedures are carried out each year in the UK with an operative mortality of the order of 2% achieved despite an ageing surgical population. Over the last decade, a remarkable increase in the number of patients treated percutaneously by angioplasty and stenting has lead to a levelling off, or even a decline, in the number of patients treated surgically. In an attempt to reduce further the operative morbidity and mortality by excluding that attributable to the extracorporeal circulation, several surgical groups have pioneered performing the procedure without the heart-lung machine (off-pump or OPCAB). Although not a new concept there has been a dramatic increase in its use, lead by the development of sophisticated and disposable devices for stabilising the heart to enable the demanding anastomotic technique required to suture vessels of 1-2 mm often containing degenerative plaque. Concerns remain about the completeness of revascularisation and about the quality of the anastomoses obtained, particularly in the right and circumflex territories which are less accessible than the anterior descending artery. Although some reduction in morbidity has been demonstrated, this has not been as marked as had been hoped. Davies and Wallwork from Papworth argue persuasively and colourfully in favour of the conventional operation and point out the difficulties in designing an appropriate, prospective, randomised,controlled clinical trial because of the apparently small differences in outcome between the two techniques. Amrani and colleagues from Harefield, leading proponents of off-pump surgery using it in virtually 100% of patients undergoing revascularisation, extensively review the comparative literature to date.

Coronary Artery Bypass↗

PubMed2004

Otogenic Fusobacterium meningitis, sepsis, and mastoiditis in an adolescent.

Fusobacterium necrophorum is a strict anaerobic organism responsible for a number of clinical syndromes known as necrobacillosis. Although meningeal infections with anaerobes are rare, delayed diagnosis and treatment can be potentially fatal. We report a unique case of Fusobacterium meningitis, mastoiditis, and sepsis in a previously healthy adolescent. Diagnosis and management of this condition are discussed in the context of a literature review.

Adolescent↗