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Biomedical subjects

K Hanel

Publications and source records attributed to K Hanel.

8 recordsLinked to original sources
PubMed1999

The cost of elective and emergency repair of AAA in patients under and over the age of 80.

BACKGROUND: As Australia's population ages, the number of elderly patients presenting for surgery of abdominal aortic aneurysms (AAA), both elective and ruptured, will increase. The aim of the present study was to compare the costs of treatment of patients with AAA, under and over the age of 80, in the elective and emergency settings in a hospital with a divisional structure in which the true costs can be accurately obtained. METHODS: A total of 40 patients were selected at random from a series of 267 patients treated with open surgery for AAA between January 1987 and December 1994, 10 in each of four groups: group A, elective repair in patients aged < 80 (171/267); group B, elective AAA repair in patients aged > 80 (25/267); group C, emergency AAA repair in patients aged < 80 (50/267); and group D, emergency AAA repair in patients aged > 80 (11/267). A retrospective analysis of the hospital costs of treatment of these patients at St George Hospital was conducted. These true costs were then compared to Australian National Diagnostic Related Group (AN-DRG) costs. RESULTS: Group A and B had no mortality. In Group C and D the mortality was 20 and 60%, respectively. The emergency treatment groups also had longer lengths of stay. A statistically significant difference in cost of AAA repair between elective and emergency groups in both age groups was seen; that is, group A cost less than group C and group B cost less than group D. Costs per survivor, however, showed a dramatic difference between the cost of group C patients ($30000) and group D patients ($60000). In comparison with AN-DRG calculated costs, the true costs of groups A and B were equivalent to AN-DRG costs. In the emergency groups, however, there were marked discrepancies between the true cost ($61000) and that calculated by the DRG ($25000) in group D, with similar differences seen in group C to a lesser extent. CONCLUSION: Emergency repair of AAA is significantly more expensive and has a high mortality in the over-80 age group. Also, there is a substantial shortfall between the true costs of treating these patients and the funds allocated for treatment in this group.

Aged↗
PubMed1998

Expansion rates of small abdominal aortic aneurysms.

BACKGROUND: The present study was carried out in order to examine those factors that influence the rate of expansion of small abdominal aortic aneurysms. METHODS: A retrospective study was undertaken of 112 patients who attended the St George Vascular Laboratory between 1987 and 1997. These patients had abdominal aortic aneurysms that were considered to be too small to warrant surgical repair at the time of presentation. Sequential ultrasound examinations were used to measure maximal anteroposterior aneurysm diameter. From these data, annual growth rates were calculated. Growth rate per annum was then compared with gender, age, initial aortic aneurysm diameter, presence of hypertensive disease, cardiac disease, family history of aneurysmal disease, diabetes mellitus, smoking, beta-adrenergic blockade and lipid lowering drugs. RESULTS: Univariate analysis showed that three factors were significantly related to growth rate: the initial size of the aortic aneurysm, the presence of cardiac disease and the presence of beta-adrenergic blockade. CONCLUSIONS: The presence of beta-adrenergic blockade appeared to have an independent effect on aneurysm growth rate, and suggests a possible role for beta-adrenergic blockade as a therapeutic strategy in controlling expansion rates of small abdominal aortic aneurysms. A controlled double-blind clinical trial is required to demonstrate this conclusively.

Adrenergic beta-Antagonists↗
PubMed1994

Aspects of central venous access catheter usage in patients with malignancy.

AIMS: A review of 5 years' experience with central venous access catheters (CVAC) to examine the results of catheter placement technique (open or percutaneous) on subsequent CVAC performance. In addition the catheter function and utilisation of both Hickman type and Access Port type of CVAC were reviewed to assess the indications and the types of access devices chosen in selected patients. METHODS: A retrospective review of CVAC between 1987 and 1991 was undertaken. During this time 113 CVAC were placed by the open (n = 76) or percutaneous (n = 37) method. The type of catheter used was Hickman (n = 79) or Access Port (n = 34). Indications for CVAC placement were haematological malignancy 74.2%, other malignancy 14.1%, and the rest were accounted for by TPN, HIV infection, osteomyelitis, anaemia and haemochromatosis. RESULTS: There was no difference between duration of function for CVAC placed by the open (5.1 months 95% CI, 3.8-6.4) and percutaneous methods (3 months, 95% CI 2.2-3.8). Nor was there a difference in duration of function between Hickmans (4.47 months, 95% CI 3.3-5.6) and Access Ports (4.3 months, 95% CI 2.8-5.8). CVAC morbidity included sepsis, accidental displacement, major venous thrombosis, bleeding and port erosion. There was no significant statistical difference in the incidence of complications between the open (25%) versus percutaneous (22%) techniques. The clinically significant difference in morbidity related to the type of catheter used: Hickman (18%) versus Access Port (35%). Infection and sepsis were a problem in the Port group accounting for 20.6% of the complications. CONCLUSIONS: We believe CVAC account for significant morbidity which is not often taken into account by those recommending their use, particularly in the management of malignant disease. In addition CVAC placement should be part of a service in consultation. There are cost-benefit advantages in using orthodox central lines in the sick patient with a view to placing a CVAC at a later date.

Adolescent↗
PubMed1994

Venous stasis during laparoscopic cholecystectomy.

The objectives of this research were (a) to determine the effect of insufflation at laparoscopic cholecystectomy to 12 mm Hg on femoral venous blood flow; and (b) to assess the function of intermittent pneumatic compressors (IPC) and intermittent electric calf stimulators (IECS) in the presence of a pneumoperitoneum. Measures of baseline venous blood flow velocity, femoral vein diameter, and maximum blood flow velocity achieved by IPC or IECS were made in the presence or absence of a pneumoperitoneum of 12 mm Hg. The ICP and IECS were randomly allocated to either leg. All measures were made by an experienced sonologist. Insufflation to 12 mm Hg caused a statically significant decrease in femoral blood flow velocity and was accompanied by a significant increase in femoral vein diameter. The IPC and IECS were able to achieve pulsatile venous blood flow despite the presence of a pneumoperitoneum, but they had no effect on the depressed baseline blood flow velocity. We concluded that insufflation to 12 mm Hg causes significant venous stasis in the lower limb and that IPC and IECS cannot completely eliminate this stasis. Further research needs to be done to clarify the optimal methods of prophylaxis in view of the implications for deep venous thrombosis.

Adult↗
PubMed1980

Complementary methods for evaluating carotid stenosis: a biophysical basis for ocular pulse wave delays.

Attempts to noninvasively estimate the significance of carotid arterial stenoses have resulted in a recent technological explosion. Ocular pulse wave timing [oculoplethysmography (OPG) pulse delay] has been strongly promulgated but also criticized on theoretical grounds and for lack of physiologic validation. Audiofrequency analysis of carotid bruits (carotid phonoangiography CPA) has been combined with OPG allegedly to improve accuracy. To evaluate these methods in a controlled model, we studied the effects of graded unilateral stenoses in the canine carotid artery on physiological parameters and associated OPG and CPA recordings. Arterial compliance was calculated from simultaneous diameter and pressure recordings distal to the stenosis. OPG time delay correlated directly with reductions in flow and pressure and with increasing arterial compliance (P less than 0.01). Thus, the delay is caused at least partially by a decreased pulse wave velocity, resulting from the increased compliance distal to stenoses associated with a significant pressure gradient. OPG is most discriminating for stenoses of higher grades. Because bruits arise from flow disturbances that occur even with moderate degrees of stenosis, CPA provides diagnostic information before profound flow reduction occurs. This study illustrates the value of complementary methods for analyzing complex hemodynamic phenomena and provides evidence to support use of the pulse delay concept to diagnose arterial disease.

Angiography↗
PubMedDate not supplied

Association of mast cells with fibrosis and fatty infiltration in the minor salivary glands of patients with Sjögren's syndrome.

OBJECTIVE: To determine the distribution and density of mast cells in the minor salivary glands of patients with primary Sjögren's syndrome (pSS) and of normal controls. METHODS: Minor salivary gland biopsies were obtained from 19 patients with pSS, 9 with systemic lupus erythematosus, one each with rheumatoid arthritis, sarcoidosis, and Hodgkin's disease, and from 10 individuals who had subjective xerostomia with normal salivary gland biopsies. Biopsy specimens were evaluated for the degree of inflammation according to Tarpley's classification. Sections were analysed for staining with Toluidine blue and with the mast cell specific marker c-kit. The data obtained were correlated with the histological findings of fatty infiltration, fibrosis and lymphocytic infiltration. RESULTS: There was a significant correlation between the number of mast cells identified and the degrees of fibrosis and fatty infiltrates. There was no correlation between the intensity of lymphoid infiltration and the number of mast cells. c-kit staining showed a high correlation when compared to Toluidine blue staining. CONCLUSION: Mast cells in the minor salivary glands of patients with pSS are strongly associated with fibrosis and cell acid infiltration. However, there is no correlation with parameters of disease activity such as lymphoid infiltration.

Adipose Tissue↗