PubMed Health⌕ Search

Biomedical subjects

M J Callam

Publications and source records attributed to M J Callam.

At least 19 recordsLinked to original sources
PubMed2006

Surgery versus non-surgical treatment for femoral pseudoaneurysms.

BACKGROUND: Femoral pseudoaneurysms may complicate up to 8% of vascular interventional procedures. Small pseudoaneurysms can spontaneously clot, while others need definitive treatment. Surgery is considered the gold-standard treatment, although is not without risk in patients with severe cardiovascular disease. Less invasive treatment options, such as Duplex ultrasound-guided compression and percutaneous thrombin injection are available, however, evidence of their efficacy is limited. OBJECTIVES: To assess the effects of different treatments for femoral pseudoaneurysms resulting from endovascular procedures, specifically assessing less invasive treatment options such as ultrasound-guided compression or percutaneous thrombin injection. SEARCH STRATEGY: We searched the Cochrane Peripheral Vascular Diseases Review Group's Specialised Register and the Cochrane Central Register of Controlled Trials (CENTRAL) in The Cochrane Library Issue 3, 2005 (last searched October 12, 2005). Additional searches were also made of bibliographies of papers found through these searches and by handsearching relevant journals. SELECTION CRITERIA: Randomised controlled trials comparing two treatments for femoral pseudoaneurysms following vascular interventional procedures were considered for inclusion in the review. DATA COLLECTION AND ANALYSIS: Two studies were included in the analysis: ultrasound-guided application of a mechanical device (FemoStop) versus blind application; ultrasound-guided compression versus percutaneous thrombin injection. Data were extracted independently by both authors. MAIN RESULTS: Mechanical compression with a FemoStop was effective in achieving thrombosis of the pseudoaneurysm although ultrasound-guided application of this failed to confer any benefit (relative risk (RR) 1.07; 95% confidence intervals (CI) 0.75 to 1.53, P = 0.7). Percutaneous thrombin injection was more effective than ultrasound-guided compression in achieving thrombosis of a pseudoaneurysm (RR 7.50; 95% CI 2.06 to 27.25, P = 0.002 at 24 hours after treatment; RR 2.50; 95% CI 1.35 to 4.65, P = 0.004 at 48 hours after treatment). There was no statistically significant difference in the length of hospital stay between the two groups and no complications were reported. AUTHORS' CONCLUSIONS: The limited evidence base appears to support the use of thrombin injection as an effective treatment for femoral pseudoaneurysm. A pragmatic approach may be to use ultrasound-guided compression as first-line treatment, reserving thrombin injection for those in whom the procedure fails.

Aneurysm, False↗
PubMed2004

Type of incision for below knee amputation.

BACKGROUND: Below knee amputation (BKA) may be necessary in patients with advanced critical limb ischaemia or diabetic foot sepsis in whom no other treatment option is available. There is no consensus as to which surgical technique achieves the maximum rehabilitation potential. OBJECTIVES: To look at the evidence comparing different surgical techniques for BKA using stump healing, wound infection, reamputation rate and mobility with a prosthetic limb as outcome measures. SEARCH STRATEGY: Publications describing randomised controlled trials comparing different types of incision for below knee amputation were sought using the search strategy described by the Cochrane Review Group on Peripheral Vascular Diseases. This involved searching the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE and EMBASE. Additional searches were made of bibliographies of papers found through these searches, and also by handsearching relevant journals. SELECTION CRITERIA: Randomised controlled trials comparing two or more types of skin incision for BKA were identified. All patients with lower limb ischaemia (acute or chronic) and/or diabetic foot sepsis were considered for inclusion. Patients undergoing below knee amputation for other conditions were excluded. DATA COLLECTION AND ANALYSIS: Three studies were included in the analysis: two-stage versus one-stage BKA; skew flaps BKA versus long posterior flap BKA; sagittal flaps BKA versus long posterior flap BKA. Data were extracted independently by both authors. MAIN RESULTS: BKA using skew flaps or sagittal flaps conferred no advantage over the well established long posterior flap technique. For patients with wet gangrene, a two-stage procedure with a guillotine amputation at the ankle followed by a definitive long posterior flap amputation leads to better primary stump healing than a one-stage procedure. REVIEWER'S CONCLUSIONS: Evidence suggests that the choice of amputation technique has no effect on outcome and can therefore be a simple matter of surgeon preference. Factors which might influence this include previous experience of a particular technique, the extent of non-viable tissue, and the location of pre-existing surgical scars.

Amputation, Surgical↗
PubMed2000

Age-related variation in the treatment and outcomes of patients with breast carcinoma.

BACKGROUND: There is controversy regarding the effect of age on breast carcinoma, and previous analyses have often excluded the most elderly patients as well as those with advanced cancers. This study assessed treatment variations and outcome in relation to age for a complete series of patients who presented with breast carcinoma within a defined geographic district. METHODS: Data were collected prospectively for all 784 patients who presented with breast carcinoma in North Bedfordshire, United Kingdom, from 1990 to 1996. Stage of disease, treatment, and outcome were compared for different age groups. RESULTS: Older patients had more advanced cancers: 14% of lymph node negative patients age > or = 60 years had T3 or T4 tumors compared with 4% of younger lymph node negative patients (P < 0. 0001). Treatment varied with age: 94% of lymph node negative patients age > or = 60 years received tamoxifen compared with 73% of younger lymph node negative patients (P < 0.0001). For lymph node positive patients, outcome was unaffected by age; however, for lymph node negative patients, outcome was best for patients ages 60-69 years: disease free survival was 91% compared with 78% for other ages at 3 years (P = 0.008), and the locoregional recurrence rate was 2% compared with 7% at 3 years (P = 0.04). The improvement in the locoregional recurrence rate applied to all lymph node negative patients age > or = 60 years: the recurrence rate was 2% compared with 9% for younger patients at 3 years (P = 0.04). CONCLUSIONS: These data support the theory that breast carcinomas are more aggressive in younger patients. The high prescription rate of tamoxifen for older lymph node negative women may have contributed to the low locoregional recurrence rate for this group.

Adult↗
PubMed2000

Effect of surgical subspecialization on breast cancer outcome.

BACKGROUND: There is increasing pressure for specialization of medical services. The effect of surgical specialization on the outcome of breast cancer in Bedford has been assessed. METHODS: The Bedford Breast Cancer Registry, which contains prospective diagnostic, treatment and follow-up data on all breast cancers treated in North Bedfordshire, was analysed to compare breast cancer outcome between 1990-1992 and 1993-1996, that is before and after the advent of surgical subspecialization. All 784 patients were analysed, including patients with metastases (4 per cent) and those treated by tamoxifen alone (8 per cent). Outcome was compared in terms of disease-free survival (DFS), locoregional and all (locoregional and metastases) recurrence rates assessed by Cox proportional hazard and Kaplan-Meier analyses. RESULTS: Overall DFS was 75 per cent and the locoregional recurrence rate was 8 per cent at 3 years. The tumour stage and grade at presentation and the proportion of screen-detected cancers were similar for both intervals. The outcome for patients before specialization (1990-1992; n = 329) was worse: hazard ratio (HR) for DFS 1.5 (95 per cent confidence interval 1.2-2.0) and HR for locoregional recurrence 2.0 (1.2-3.5). After subspecialization (1993-1996, n = 455) DFS improved from 70 to 79 per cent (P = 0.009) and the all recurrence rate fell from 22 to 12 per cent (P = 0.0004) at 3 years. The improvement in outcome was mainly in younger patients (aged less than 70 years), in whom DFS improved from 72 to 81 per cent (P = 0.02) and the all recurrence rate fell from 24 to 12 per cent (P = 0.001) at 3 years. The improvement was associated with increased axillary surgery (47 to 74 per cent; P < 0.0001), and more frequent use of tamoxifen (74 to 84 per cent; P = 0.004) and chemotherapy (10 to 27 per cent; P < 0.0001) in this age group. CONCLUSION: There was a significant improvement in outcome for patients with breast cancer after surgical subspecialization in Bedford. This may relate to the more frequent use of appropriate systemic therapy.

Adult↗
PubMed1994

Epidemiology of varicose veins.

Assessment and treatment of varicose veins comprises a significant part of the surgical workload. In the UK, National Health Service waiting lists suggest that there is still considerable unmet need. This review analyses all published data on the epidemiology of varicose veins, paying particular regard to the differing epidemiological terminology, populations sampled, assessment methods and varicose vein definitions, which account for much of the variation in literature reports. Half of the adult population have minor stigmata of venous disease (women 50-55 per cent; men 40-50 per cent) but fewer than half of these will have visible varicose veins (women 20-25 per cent; men 10-15 per cent). The data suggest that female sex, increased age, pregnancy, geographical site and race are risk factors for varicose veins; there is no hard evidence that family history or occupation are factors. Obesity does not appear to carry any excess risk. Accurate prevalence data allow provision of appropriate resources or at least aid rational debate if demand is greater than the resources available.

Age Factors↗
PubMed1994

Recurrent varicose veins: assessment of the saphenofemoral junction.

Thirty-six consecutive unselected patients, who had apparently previously undergone saphenofemoral ligation for primary uncomplicated long saphenous varicosities and who had then re-presented with recurrent thigh varices emanating from the groin, underwent preoperative clinical assessment, hand-held Doppler and duplex ultrasonographic examination and varicography to establish the presence or absence of saphenofemoral incompetence as the cause of recurrence. All patients underwent reexploration of the saphenofemoral junction (SFJ) via a lateral approach. Twenty-six patients had an intact SFJ (type I recurrence) and ten had varices arising from either a thigh perforator, or from abdominal or perineal veins (type II recurrence). Clinical examination alone was poor at distinguishing type I from type II recurrence. Doppler ultrasonography was sensitive (88 per cent) but non-specific (40 per cent). In contrast, duplex scanning was insensitive (42 per cent) but extremely specific (100 per cent) and accurate, with a positive predictive value of 100 per cent. Varicography also had a specificity and positive predictive value of 100 per cent, a sensitivity of 73 per cent and in addition provided a precise anatomical 'road-map'. A combination of clinical examination and hand-held Doppler ultrasonography seems to be the most appropriate first-line method of preoperative assessment in these patients. Duplex ultrasonography, if available, will provide additional useful information about both the SFJ and the presence of thigh perforators. Contrast examination may be reserved for patients who have equivocal results on non-invasive investigations, who have had more than one previous groin operation or who have, in addition, deep venous disease.

Adult↗
PubMed1993

Comparison of long-term survival after successful repair of ruptured and non-ruptured abdominal aortic aneurysm.

Long-term survival was assessed after the repair of non-ruptured (n = 311) and ruptured (n = 227) abdominal aortic aneurysm. Follow-up was 94.2 per cent complete, and the overall survival rate at 8 years was 43.6 per cent. There was no significant difference in 8-year survival rates between patients with non-ruptured (45.2 per cent) and ruptured (40.5 per cent) aneurysms. The survival curves were also compared with that for an age- and sex-matched population derived from Scottish Home and Health Department data.

Aged↗
PubMed1993

Foot volumetry and duplex ultrasonography after saphenous and subfascial perforating vein ligation for recurrent venous ulceration.

Forty-three patients undergoing superficial and perforating vein ligation for recurrent venous ulceration underwent preoperative and postoperative foot volumetry and postoperative duplex ultrasonography. Patients were followed for a median of 66 (range 18-144) months. Of nine patients who developed recurrent ulceration, six had femoral vein incompetence and all had popliteal vein incompetence demonstrated by duplex ultrasonography. Of the 34 patients who remained ulcer-free, five had femoral vein incompetence and a single patient had popliteal vein incompetence on duplex scanning, giving positive predictive values for recurrent ulceration of 55 per cent (femoral vein incompetence) and 90 per cent (popliteal vein incompetence). Patients with saphenofemoral incompetence on late follow-up were also more likely to suffer recurrence. Preoperative foot volumetry with tourniquet occlusion of superficial veins showed that the median expulsion fraction of patients who developed recurrent ulcer during follow-up was 0.8 (range 0.6-2.3) per cent compared with 1.5 (range 0.4-2.9) per cent for those who remained ulcer-free (P = 0.025); the median half-refilling time of patients with recurrent ulcer was 1.5 (range 0.5-5.5) s compared with 5.0 (range 0.5-23.0) s for those without recurrence (P < 0.01). Postoperative foot volumetry showed similar differences. Deep venous incompetence, particularly of the popliteal segment, as demonstrated by duplex ultrasonography and foot volumetry, is a useful predictor of recurrent ulceration after subfascial perforator and superficial venous ligation.

Adult↗
PubMed1991

Reoperations for late complications following abdominal aortic operation.

Fifty patients were identified who, following abdominal aortic operation, developed late complications affecting the vascular graft or endarterectomy and who underwent their first reoperation between 1979 and 1989. Thrombosis was the commonest complication affecting 28 (56 per cent) patients, followed by false aneurysm in 11 (22 per cent), enteric fistula in nine (18 per cent) and graft infection in two (4 per cent). The 30-day mortality rate for reoperation was 8 per cent; longer follow-up revealed mortality rates of 22, 50 and 63 per cent at 1, 3 and 5 years respectively. Thirty-four complications required reoperation within 5 years of the original surgery. Reoperation was needed for 35 patients whose original pathology was occlusive disease and for 15 whose original pathology was aneurysm. The nature of the complication was related to initial pathology; thrombosis was far commoner in those with occlusive disease, and enteric fistula and false aneurysm were commoner in those with aneurysmal disease.

Adult↗
PubMed1991

Ruptured aortic aneurysm: a proposed classification.

There is a wide variation in reported operative mortality rates for ruptured abdominal aortic aneurysm, ranging from 14 to 70 per cent. Although many factors influence this variation, such as the expertise and facilities available at an individual institution, considerable differences could be due to variations in the pattern of referral and the proportion of cases accepted for operation. In this paper a classification applicable to all patients with ruptured aortic aneurysm is proposed; it has been applied prospectively to 100 consecutive patients with ruptured abdominal aortic aneurysm referred to the Edinburgh Vascular Surgical Unit. The classification illustrates how surgical mortality rates ranging from 29 to 52 per cent may be reported using the same mortality data. Two major benefits may derive from the use of such a standard reporting system. Firstly, it allows management deficiencies to be identified easily and, secondly, it should facilitate comparison of results reported from different centres.

Age Factors↗
PubMed1988

Chronic leg ulceration: socio-economic aspects.

Six hundred patients with chronic leg ulcers were assessed and classified with regard to social class, mobility and employment. It has been shown that there is no increased incidence of chronic leg ulceration in the more disadvantaged socio-economic groups, but when leg ulceration occurs it is more likely to be recurrent and take longer to heal. Although in only 11% of patients was mobility affected by leg ulceration alone, the condition interfered with work and or leisure activities to a moderate or severe degree in 42%.

Activities of Daily Living↗
PubMed1987

A controlled trial of weekly ultrasound therapy in chronic leg ulceration.

In a controlled trial to ascertain whether ultrasound given weekly in conjunction with a standard treatment for chronic leg ulcers improves the rate of healing 56 patients were randomised to standard treatment (paste impregnated bandage and a self-adhesive elastic bandage) and 52 to standard treatment plus pulsed ultrasound given weekly. After 12 weeks the proportion of ulcers healed was 20% greater in the ultrasound than in the control group.

Aged↗