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Biomedical subjects

L J Hands

Publications and source records attributed to L J Hands.

At least 37 records · Page 2Linked to original sources
PubMed1995

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↗
PubMed1995

Calf muscle mitochondrial and glycogenolytic ATP synthesis in patients with claudication due to peripheral vascular disease analysed using 31P magnetic resonance spectroscopy.

1. We set out to define abnormalities of oxidative ATP synthesis, cellular proton efflux and the efficiency of ATP usage in gastrocnemius muscle of patients with claudication due to peripheral vascular disease, using data obtained by 31P magnetic resonance spectroscopy during aerobic exercise and recovery. 2. Eleven patients with moderate claudication were studied and results were compared with 25 age-matched control subjects. Changes in pH and phosphocreatine concentration during recovery were used to calculate the maximum rate of oxidative ATP synthesis (Qmax.) and the capacity of net proton efflux. Changes in pH and phosphocreatine concentration were used to estimate rates of non-oxidative and (indirectly) oxidative ATP synthesis throughout exercise, taking account of abnormalities in proton efflux during exercise. 3. In patients with claudication, slow post-exercise phosphocreatine recovery showed a 42 +/- 9% decrease in Qmax., and the slow ADP recovery was consistent with this. pH recovery was slow, showing a 77 +/- 9% decrease in the capacity for proton efflux. Both abnormalities are compatible with a substantial reduction in muscle blood flow. 4. During exercise, increased phosphocreatine depletion and intracellular acidification were a consequence of impaired oxidative ATP synthesis and the consequent increase in non-oxidative ATP synthesis, compounded by reduced proton efflux. The acidification prevented an increase in ADP concentration which could otherwise partially compensate for the oxidative defect. All these abnormalities are compatible with a reduced muscle blood flow. 5. In addition, initial-exercise changes in pH and phosphocreatine concentration implied a 44 +/- 5% reduction in 'effective muscle mass', necessitating an ATP turnover (per litre of muscle water) twice as high for given power output as in control muscle. Some of this is probably due to a localized loss of muscle fibres, but the rest appears to reflect reduced metabolic efficiency of the muscle. This is not a direct consequence of reduced blood flow, and may be related to change in muscle fibre type.

Adenosine Triphosphate↗
PubMed1991

Gynaecomastia.

This paper reviews the development of excess breast tissue in the male. Gynaecomastia is a common problem and may have a physiological or pathological basis. It can be dealt with in most cases by reassurance or simple surgery.

Adolescent↗
PubMed1991

Infra-inguinal aneurysms: outcome for patient and limb.

The outcome of conservative treatment of infra-inguinal (femoral and popliteal) aneurysms was compared with that following vascular reconstruction. Over a 12-year period up to December 1988, 43 femoral aneurysms and 35 popliteal aneurysms presented to the Oxford Regional Vascular Service; 88 per cent of the femoral and 60 per cent of the popliteal aneurysms were treated by vascular reconstruction. The outcome was assessed in terms of limb symptoms or preservation and patient survival at the most recent point of follow-up (median 4.5 years). At least 12 of the 13 initially asymptomatic femoral and popliteal aneurysms which were untreated remained asymptomatic. In contrast, six of the 26 limbs with asymptomatic femoral aneurysms and three of the 11 limbs with asymptomatic popliteal aneurysms developed significant distal ischaemia after vascular reconstruction; four limbs came to amputation after intervention. Aggressive surgical management of all asymptomatic infra-inguinal aneurysms is unjustified and dangerous.

Adult↗
PubMed1990

Muscle ischaemia in peripheral vascular disease studied by 31P-magnetic resonance spectroscopy.

We have used 31phosphorus magnetic resonance spectroscopy (31P-MRS) to study foot muscle metabolism in patients with peripheral vascular disease. Sixteen patients with calf claudication, 32 patients with rest pain and 13 control subjects had spectra collected from the foot muscle, Extensor digitorum brevis, ankle pressures measured and, in most cases, transcutaneous O2 and CO2 recordings made over the foot. The intracellular pH and the ratio of inorganic phosphate to phosphocreatine (Pi/PCr) obtained from the MR spectra were significantly higher (p less than 0.005 and p less than 0.02, respectively) in the muscle of patients with rest pain and were particularly high in those with gangrene or ulceration. Ankle pressures and transcutaneous O2 and CO2 measurements failed to distinguish those patients with advanced peripheral ischaemia. These results suggest that MRS measurements of metabolic changes in foot muscle are useful in the detection and quantitation of significant distal ischaemia.

Aged↗
PubMed1989

The natural history of peptic oesophageal strictures treated by dilatation and antireflux therapy alone.

A total of 195 patients with benign peptic oesophageal strictures treated by endoscopic dilatation and antireflux medication between July 1977 and July 1986 were studied prospectively to determine the effect of such treatment on the subsequent course of this disease. Of the patients, 58% were female and they were significantly older than the males at the time of initial presentation (75 years vs 68 years, P less than 0.0001). 46% of both sexes required only one dilatation but the men required more dilatations over a longer period: 31% males vs 19% females required more than 3 dilatations (P less than 0.05) and 40% males vs 27% females were being dilated 2 years or more after the initial dilatation (P less than 0.05). Dilatation combined with antireflux medication is clearly an effective method of management for most patients with peptic oesophageal strictures. The value of antireflux surgery requires evaluation for that subset of patients, predominantly males, who require long-term and repeated dilatation.

Adult↗
PubMed1987

Use of a lipid containing medium chain triglycerides in patients receiving TPN: a randomized prospective trial.

Lipid emulsions which contain long chain triglycerides (LCTs) provide a valuable energy source for patients requiring total parenteral nutrition (TPN). We have investigated the use of a new lipid emulsion containing both long and medium chain triglycerides (MCTs) in a randomized prospective trial. Sixty patients received TPN including 500 ml of either 20 per cent Lipofundin S (LCT) or Lipofundin 10 per cent MCT/10 per cent LCT for at least 6 days. Patients with renal or hepatic impairment, or major trauma, were excluded from the study. The MCT/LCT emulsion was found to be as safe and as effective a source of calories as LCT but the differences in metabolic parameters did not differ significantly between the two groups of patients. A lipid emulsion containing MCTs may have important advantages for seriously ill patients, but appears to have no obvious advantages for the majority of patients receiving TPN who are not severely stressed.

Adult↗
PubMed1986

Biochemical investigation of human tumours in vivo with phosphorus-31 magnetic resonance spectroscopy.

The bioenergetic state of 15 human tumours was examined with phosphorus-31 magnetic resonance spectroscopy. A striking diversity in metabolic patterns was observed, and significant differences from normal tissue were seen in all cases. A common feature was an elevation of intracellular pH, which may be related to an increase in Na+/H+ exchange during cell activation. It is unlikely that the patterns observed directly correlate with malignancy, but characterisation of the energetic state of a given tumour in a given physiological environment may help in the design and evaluation of interventions for that specific case.

Adult↗
PubMed1986

A comparison between gap-length and Waterston classification as guides to mortality and morbidity after surgery for esophageal atresia.

In a retrospective study of tracheoesophageal fistula repairs in the Oxford Region, 1968 to 1982, 64 consecutive cases were classified according to Waterston group and gap length (less than 2 cm or greater than 2 cm); where possible their current status was assessed by interview or questionnaire. Waterston group and gap length varied independently. Both affected the course of the first admission but thereafter, Waterston classification was a poor prognostic guide. However, those with a long gap were significantly more likely to have respiratory and swallowing difficulties and stunted growth.

Esophageal Atresia↗
PubMed1986

Muscle metabolism in patients with peripheral vascular disease investigated by 31P nuclear magnetic resonance spectroscopy.

Eleven men with claudication and ten control subjects had calf muscle metabolism studied at rest and during exercise and the subsequent recovery period by 31P nuclear magnetic resonance (n.m.r.) spectroscopy. The muscle of patients with severe claudication had a significantly greater depletion of phosphocreatine and fall in pH during exercise and a slower recovery of phosphocreatine and pH after exercise. The muscle of patients with both mild and severe disease had slower rates of ADP recovery after exercise than that of control subjects. Surgical correction of the associated arterial stenosis abolished claudication and led to correction of the metabolic abnormalities in two patients. Claudication pain was not related to intracellular pH or concentration of phosphorus-containing metabolites. Energy production via oxidative metabolism is impaired but glycolysis may be increased in the calf muscle of patients with intermittent claudication.

Adenosine Diphosphate↗
PubMed1986

The use of laparoscopy in the management of right iliac fossa pain.

Fourty-six patients with a clinical diagnosis of acute appendicitis were laparoscoped before exploration. As a result the diagnosis was revised in 10 patients (22%). With experience the laparoscopic features of appendicitis can be recognised confidently so reducing the number of normal appendices removed.

Abdomen↗
PubMed1986

Assessment of the distal lower limb arteries: a comparison of arteriography and Doppler ultrasound.

Simple Doppler was compared with routine arteriography in assessing patency of the arteries at the ankle and the pedal arch. Fifty-six limbs were evaluated--29 with rest pain or trophic lesions, 20 with claudication, and 7 without symptoms. On Doppler examination 177 of 220 (80%) vessels were assessed patent, compared with 127 of 220 (58%) on arteriography. Of the 49 judged occluded on arteriograms, 59% were patent by Doppler and of 44 in which arteriograms were inadequate 82% had Doppler signals. Doppler signals could be heard in 20 of 177 (11%) vessels only with the feet dependant. This prospective, double-blind study provides numerical data to support the observation that a simple Doppler probe can detect patent distal vessels which may not be demonstrated by routine arteriography. This allows selection of patients for further more detailed arteriograms or for operative exploration with a view to distal bypass grafting.

Aged↗