Graft-enteric erosion: an unusual colonoscopic diagnosis.
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Aged↗
Biomedical subjects
J M Perkins
Publications and source records attributed to J M Perkins.
Transmetatarsal amputation: an 8-year experience.
This study retrospectively reviews an 8-year consecutive series of transmetatarsal amputation (TMA) for forefoot ischaemia in diabetic and non-diabetic patients. Forty-one patients had TMA. Peri-operative mortality was 17% (7/41). A healed stump was achieved in 19 patients (46%) and 18 of these patients were independently mobile, or mobile with sticks. Non-diabetic patients (8/12) healed significantly better than diabetics (11/29). Median time to healing was 7 months (range 3-20 months). All non-healed survivors had a higher amputation (14 below-knee, 1 Syme's). A healed TMA gives good mobility, but prediction of who will heal after operation is unreliable. Time to healing is often lengthy, and failed healing results in higher amputation. These issues need to be fully discussed with the patient who is considered for TMA.
Adult↗
Carotid duplex imaging: variation and validation.
BACKGROUND: Duplex imaging is increasingly used as the only investigation before carotid endarterectomy, but many different criteria exist in the literature for the detection of a severe (70-99 per cent) carotid stenosis. This study aimed to investigate current practice in carotid duplex imaging in Great Britain and Ireland. METHODS: A postal questionnaire was sent to 86 vascular surgical units. RESULTS: The median number of scans performed per year was 450 (range 60-4500). Thirty-six per cent of units who responded used peak systolic : end diastolic velocity ratio to calculate carotid stenosis. Overall, nine different major duplex criteria were used to grade carotid stenosis in 14 different systems of percentage bands. Only 51 per cent of units verified their duplex criteria against angiography. Eighteen per cent of units used two or more different types of duplex scanner and applied the same diagnostic criteria to each machine. CONCLUSION: A wide variation in diagnostic duplex criteria and methods of grading stenosis exists among vascular units. Internal validation is not performed routinely. Standardization of duplex criteria would ensure greater consistency, but would not replace the need for validation of results within each unit.
Carotid Artery, Internal↗
The long-term outcome after axillo-axillary bypass grafting for proximal subclavian artery disease.
OBJECTIVES: to investigate the outcome of patients undergoing axillo-axillary bypass grafting for symptomatic subclavian artery stenoses or occlusions. DESIGN: retrospective case-note review and prospective review of patients available for follow-up. PATIENTS AND METHODS: sixteen patients had axillo-axillary grafts in a 17-year period. Ten patients were available for review and assessed clinically, by measurement of arm blood pressures, and by duplex scanning of their grafts. RESULTS: one patient died and three grafts occluded within 30 days of operation. Nine out of 10 grafts scanned were patent, with three further grafts clinically patent at death. Overall secondary patency was 75% at a combined median follow-up of 56 months (range 12-204 months). Recurrent symptoms occurred in two patients, one with an occluded graft and one with a patent graft. CONCLUSION: axillo-axillary bypass grafts give good long-term symptom-free results.
Axillary Artery↗
Varicose veins on the internet.
OBJECTIVES: to evaluate the quality of information on the Internet concerning varicose veins. DESIGN: review of retrieved pamphlets and their scoring for educational value. MATERIALS: a sample of 41 documents were retrieved from the Internet using four "search engines". METHODS: characteristics, including country of origin, authorship, length, and presence of references were recorded. Based on factors such as disease summary, treatment options and complications a weighted score was created by two independent observers. RESULTS: eleven documents were published by an academic institution or professional organisation. Twenty-seven documents originated from private practice groups, the source of three was unidentifiable. The median weighted score was 21.5 (interquartile range: 7.5-48.5). Scores originating from non-profit making organisations were significantly higher than those from private practice groups (44.5 vs 13, p=0.04). The length of the document showed a significant positive correlation with its educational quality as measured by the information score (r=0.82, p<0.001). CONCLUSION: there is a plethora of data concerning varicose veins on the Internet. Some documents offer comprehensive information but many are confusing or misleading. Longer pamphlets and information presented by non-profit making organisations are more reliable than short documents and information offered by private medical groups.
Female↗
Rate of carotid endarterectomy in Wessex might already be higher than necessary.
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Carotid Stenosis↗
Prospective evaluation of quality of life after conventional abdominal aortic aneurysm surgery.
OBJECTIVES: To evaluate the changes in quality of life following conventional abdominal aortic aneurysm repair. DESIGN: Prospective study. MATERIALS AND METHODS: Fifty-nine consecutive patients (50 men; nine women) in two surgical centres were investigated preoperatively, and at 6 weeks, 3 months and 6 months postoperatively. Quality of life was measured using the Short Form 36 (SF 36) questionnaire and the York Quality of Life questionnaire, from which the Rosser index was calculated. RESULTS: Rosser index assessment showed restoration of quality of life to preoperative levels by 3 months, and significant improvement at 6 months. Changes in the SF 36 revealed significant improvement in mental health, and physical role limitation at all times postoperatively. Social function worsened at 6 weeks but improved to preoperative levels by 3 and 6 months after surgery. CONCLUSIONS: Quality of life was improved after open aortic aneurysm repair. The time course of recovery shows a predominant improvement between 6 weeks and 3 months postoperatively.
Aged↗
Phlegmasia caerulea dolens and venous gangrene.
Phlegmasia caerulea dolens and venous gangrene are rare conditions that tend to occur in association with malignancy. They are characterized by total or near-total occlusion of the venous drainage of the limb, including the microvascular collaterals. Associated mortality and morbidity rates are high, especially when progression to venous gangrene has occurred. Treatment options are limited; elevation and anticoagulation are recommended as first-line management. Experience with thrombolysis has been disappointing although intra-arterial administration of thrombolytic agents may improve results. Thrombectomy cannot be advocated routinely. Little advance in management, or in life and limb salvage, has been made in the past 30 years.
Female↗
Carotid patches.
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Endarterectomy, Carotid↗
Exercise training versus angioplasty for stable claudication. Long and medium term results of a prospective, randomised trial.
OBJECTIVES: To compare percutaneous transluminal angioplasty (PTA) against exercise training in the treatment of stable claudication. DESIGN: Prospective, randomised trial. MATERIALS: Fifty-six patients with unilateral, stable, lower limb claudication assessed prior to randomisation, at 3 monthly intervals for 15 months, and at approximately 6 years follow-up. Thirty-seven patients were available for long term review. OUTCOME MEASURES: Ankle/brachial pressure index (ABPI), treadmill claudication and maximum walking distances, percentage fall in ankle systolic pressure after exercise. RESULTS: Significant increases were seen in ABPI in the patients treated with PTA at all assessment to 15 months. However in terms of improved walking performance, the most significant changes in claudication and maximum walking distance were seen in the exercise training group. At long term follow-up, there was no significant difference between the groups. Subgroup analysis by angiographic site of disease showed greater functional improvement in those patients with disease confined to the superficial femoral artery treated by exercise training. The overall prognosis for the whole group of patients was benign, with only two (4%) undergoing amputation. CONCLUSIONS: Exercise training confers a greater improvement in claudication and maximum walking distance than PTA, especially in patients with disease confined to the superficial femoral artery.
Angioplasty, Balloon↗
Carotid artery bifurcation advancement: an alternative to patching.
Carotid bifurcation advancement uses the in situ external carotid artery to patch the internal carotid after carotid endarterectomy. This avoids the potential complications of patch rupture and pseudo-aneurysm formation seen with vein and synthetic patches. In 25 cases a Dacron patch was used to close and nine bifurcation advancement closures were compared retrospectively with 30 cases using simple primary closure and 13 using a saphenous vein patch. Follow-up with carotid duplex scanning revealed six restenoses > 50% in the primary closure group, whereas the patch angioplasty and bifurcation advancement groups had no restenoses (P = 0.002). No significant difference in post-endarterectomy flow increase was shown between the patch angioplasty groups and the bifurcation advancement group. Operation times did not differ significantly between the patch closure and the bifurcation advancement groups. Carotid bifurcation advancement is an alternative method of vessel closure with comparable rates of restenosis, post-endarterectomy flow increase, and operation time as compared with conventional patch angioplasty closure techniques.
Blood Flow Velocity↗
Duplex-guided compression of femoral artery false aneurysms reduces the need for surgery.
In a 1-year period, 13 patients underwent duplex-guided compression (DGC) of femoral artery false aneurysms. Of the 13 false aneurysms, 11 arose after cardiac catheterisation, and DGC was successful in 10 (77%) cases. The number of percutaneous cardiological procedures has risen over the past 5 years, and with time a greater proportion of these procedures have become more complex, involving coronary angioplasty or coronary stenting. The rate of vascular complications has risen from 0.2% in 1991-1992 to 0.61% in 1994-1995. Duplex-guided compression has reduced the number of operations performed for the vascular complications of percutaneous cardiological procedures by 50%. No complications have arisen from DGC, and it is recommended as the first line of management for femoral artery false aneurysms after percutaneous cardiological procedures.
Aged↗
Regarding "Is transcranial Doppler a worthwhile addition to screening tests for cerebrovascular disease?".
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Adult↗
Carotid duplex scanning: patterns of referral and outcome.
OBJECTIVE: Review of the results of carotid Duplex scanning. DESIGN: Retrospective review of new referrals for carotid Duplex scanning to a regional vascular laboratory. MATERIALS: 1041 referrals made over an 18 month period. METHODS: Referrals were reviewed for scan quality, diagnostic category and outcome of scanning. RESULTS: The overall detection rate of ipsilateral stenoses > 70% and occlusions was 13.5%; the detection rate of surgically significant carotid lesions (70-99%) was only 8%. Analysis by diagnostic category revealed a significantly greater detection rate for carotid lesions > 70% in patients presenting with amaurosis fugax (24%) in comparison to those with TIAs (9.5%, p = 0.0005) or following a stroke (13%, p = 0.01). Patients referred with asymptomatic bruits or prior to cardiac surgery showed a positive scan rate of 30%. Sixty-seven carotid endarterectomies have resulted from scans performed in this period. CONCLUSION: The overall rate of detection for surgically relevant lesions is low, but in comparison to a similar audit conducted in 1992, the absolute number of carotid lesions > 70% has risen by 60%. An 8% detection rate for surgically relevant lesions may be valuable in projecting the need for carotid endarterectomy arising from a given number of Duplex scans.
Adolescent↗
Is follow-up necessary after transurethral resection of the prostate?
OBJECTIVE: To assess the necessity for routine out-patient review following transurethral resection of the prostate (TURP) for benign prostatic hypertrophy. PATIENTS AND METHODS: One-hundred and two patients with histologically proven benign prostatic hypertrophy were prospectively reviewed as out-patients. The views of their general practitioners were established by postal questionnaire. RESULTS: At their first out-patient review 94 of 102 (92%) patients were discharged and only 2% (2/102) patients remained under review after 1 year. Apart from routine urine analysis, only four additional investigations were initiated at the routine clinical assessment. One patient was listed to undergo prostatic surgery again following the post-operative out-patient review. Over the next 16 months only three patients (3%) were re-referred with further urological problems. Confidence in a system without routine hospital out-patient review was expressed by 90% of general practitioners and 78% of patients. CONCLUSION: Follow-up after TURP cannot be justified in terms of the perceived therapeutic benefit to patients. Patients should be discharged to the community and be assessed rapidly in out-patients if and when problems arise.
Aged↗
Efficiency in the outpatient department: the lessons from urology.
To determine the scope for improvements in efficiency in the outpatient management of urological patients, a retrospective analysis was undertaken of outpatient records from one consultant's practice in a regional teaching hospital. Two hundred consecutive patients referred between March and May 1992 were studied for 1 year after referral. Each outpatient visit was judged to be unavoidable or potentially avoidable. Of referrals, 72% were in one of four diagnostic categories (bladder outflow obstruction; haematuria; scrotal disorders; frequency/dysuria syndromes). Of these patients, 90% were seen only once or twice for each episode of illness. Of the visits, 150/347 (42%) were potentially avoidable. Patients with suspected bladder outflow obstruction, haematuria and scrotal disorders should undergo imaging of the relevant anatomy before referral. Patients with haematuria should be referred directly for a flexible cystoscopy after imaging. Urologists need to educate general practitioners more clearly about the indications for the treatment of scrotal swellings in elderly men and mild bladder outflow obstruction in middle-aged men. Patients need not be reviewed routinely after transurethral resection of the prostate for benign prostatic hypertrophy or after investigations for haematuria have revealed no serious abnormality.
Efficiency, Organizational↗
Oral and dermal pharmacokinetics of triclopyr in human volunteers.
Blood levels and urinary excretion of triclopyr, the active ingredient in Garlon herbicides, were followed in six volunteers given single oral doses of 0.1 and 0.5 mg/kg body weight. Five of these volunteers later received dermal applications of Garlon 4 herbicide formulation equivalent to 3.7 mg triclopyr/kg body weight applied to the forearm. Following oral administration blood levels peaked at 2-3 h and declined to undetectable levels within 48 h; more than 80% of the dose was found as unchanged triclopyr in the urine. A two-compartment pharmacokinetic model was used to describe the time-course of triclopyr clearance; half-lives for the rapid initial and slower terminal phases were 1.3 h and 5.1 h respectively, and were independent of dose. Due to the slow half-life for dermal absorption (t1/2 = 16.8 h) the rapid initial elimination phase was obscured and the pharmacokinetics could be simplified by a one-compartment model. An average of 1.37% of the applied dose was recovered in the urine; when corrected for recovery after oral administration this was equivalent to an absorption of 1.65%. Triclopyr is slowly absorbed through skin and is rapidly eliminated. It has very low potential to accumulate in man or to be absorbed through the skin in acutely toxic amounts.
Administration, Oral↗