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Biomedical subjects

N R Hulton

Publications and source records attributed to N R Hulton.

8 recordsLinked to original sources
PubMed2000

Screening of abdominal aortic aneurysm: a pragmatic approach.

In order to evaluate the feasibility of a selective screening programme for abdominal aortic aneurysm (AAA) within an urban setting and assess its impact on the expected increase in workload for the local hospital(s), a population based, prospective study was performed. A total of 4823 men aged 65 years were invited for ultrasound examination of the abdominal aorta between January 1993 and April 1997 as part of a general practice-based aneurysm screening programme covering two districts with a general hospital each. All examinations were carried out by senior radiographers using a portable B mode grey scale machine and a 3.5 MHz curvi-linear array probe. Patients with a maximum aortic diameter of over 3 cm were annually recalled, those with over 4 cm were referred to hospital for an out-patient's appointment. Those with AAA greater than 5 cm were considered for surgery. Of those approached, 3497 (72.5%) took part in the study, 1206 (25%) did not attend and 120 (2.5%) were excluded by their general practitioners (GPs) on medical grounds. Of the men taking part, 3130 (89.5%) had an aortic diameter equal to or less than 2.5 cm, 196 (5.6%) between 2.6 and 3.0 cm, and 171 (4.9%) had aortic diameters greater than 3 cm--29 of whom had AAA greater than 5 cm with a mean diameter of 6.0 cm (range 5.1-9.0 cm). Of 127 men with an initial diameter of 3.1-4.0 cm (mean progression in size of 2.3 mm/year), 22 enlarged to > 4 cm and 3 to > 5 cm. Of 24 men with an initial diameter of 4.1-5.0 cm, 6 enlarged to > 5 cm. Some 69 (2%) patients were referred to hospital requiring a total of 125 consultations (1.8 consultations per patient); 21 underwent surgery and one died from rupture whilst awaiting surgery. Five patients refused their operation and two failed to attend the clinic (all > 5 cm) but remain well to date. No patient died following surgery. We conclude that, screening for AAA in men at age 65 years within an urban setting is feasible and well received by patients and GPs. Screening does not lead to a huge increase in terms of outpatient appointments and operations for AAA.

Aged↗
PubMed1994

The evolving role of laser-assisted angioplasty in a United Kingdom district general hospital.

Fifty-five patients with occlusion of the superficial femoral artery were studied. Of these, fifty-two had claudication and three had critical ischaemia. The mean length of the occlusion was 6.8 cm. In the first phase of the study, laser-assisted angioplasty (LAA) was used. In the second phase, a Terumo guide wire (TGW) was used first and if unsuccessful, a laser probe was used. An attempt was always made to push the laser probe through the occlusion without firing ('cold probe'). Otherwise, the Nd-YAG laser was activated ('hot probe'). The overall success rate for LAA alone was 79%. The TGW followed by LAA, if necessary, succeeded in 77%. The 'hot probe' resulted in four perforations; only one perforation was seen with the TGW. TGW is more straightforward to use and less likely to result in perforation making it a good first option with LAA as a backup.

Aged↗
PubMed1989

Is long-term follow-up of all colorectal cancer necessary?

To assess the value of long-term clinical follow-up of patients after 'curative' colorectal resections, 114 such patients were studied. Of the 100 patients in whom full follow-up was possible, 38% suffered a recurrence and less than 25% of these were discovered at a routine outpatient attendance. No long-term cures were achieved as a result of treatment of any recurrence. Indefinite follow-up of all patients by simple clinical assessment in the outpatient clinic after colorectal resection appears to be of limited value. More intensive short-term follow-up of high-risk groups may provide a greater yield of treatable recurrences. Adoption of this policy should lead to improved efficiency for the hospital in terms of time saved in outpatient attendance and the concentration of resources on those most likely to benefit from follow-up.

Aged↗
PubMed1986

Hypothermic anesthesia attenuates postoperative proteolysis.

The catabolic response that commonly occurs after major operation is characterized by net skeletal muscle proteolysis and accelerated nitrogen excretion. This response was absent in patients undergoing cardiac surgical procedures associated with the combination of cardiopulmonary bypass, narcotic anesthesia, neuromuscular blockade, and hypothermia. Forearm nitrogen release was 422 +/- 492 nmol/100 ml X min on the first postoperative day, approximately 25% of preoperative values (1677 +/- 411, p less than 0.05). Nitrogen excretion and the degree of negative nitrogen balance were comparable to levels observed in nonstressed, fasting subjects. The potential role of hypothermia, high-dose fentanyl anesthesia, and neuromuscular blockade in modifying the catabolic response to laparotomy and retroperitoneal dissection was further evaluated in animal studies. Six hours after operation, amino acid nitrogen release from the hindquarter was 84% less than control values (p less than 0.05). Nitrogen excretion and urea production were also reduced compared to normothermic controls. It is concluded that the combination of hypothermia, narcotic anesthesia, and neuromuscular blockade attenuates the catabolic response to injury and thus may be useful in the care of critically ill surgical patients.

Amino Acids↗
PubMed1986

Is it acute cholecystitis?

In a prospective study of 100 patients presenting with acute right hypochondrial pain and diagnosed clinically by a qualified surgeon as having acute cholecystitis, we have shown that the diagnostic error can be considerable. Twenty-five of these patients were found to have a different diagnosis on subsequent investigation and in a further 11 patients, no definite diagnosis could be established. This emphasises the need for careful investigation of patients with this presenting complaint.

Abdomen, Acute↗
PubMed1985

Surgical sepsis at a district general hospital.

A retrospective survey of 15,199 surgical wounds occurring over a 5-year period was carried out at a District General Hospital. Of 9495 'clean' operations, 4.5% became infected in contrast with 15.8% of 5704 'clean-contaminated' operations, an overall wound infection rate of 8.8%. There was a downward trend in the proportion of severe wound infections in 'clean-contaminated' operations which may be related to the increasing expenditure on antibiotics.

Bacterial Infections↗
PubMed1985

Limited effects of prostaglandin inhibitors in Escherichia coli sepsis.

Responses to bacteremia include fever, leukocytosis, elaboration of acute-phase proteins, hypoferremia, and increased protein catabolism. To evaluate the role of prostaglandins in the mediation of these responses, the effects of intravenous ibuprofen (12.5 mg/kg X dose) were studied in eight dogs infused with live Escherichia coli. Thirteen dogs served as noninfected controls. Two of the eight animals that received ibuprofen died during the study, whereas all control animals with sepsis survived. Prostaglandin inhibition prevented the rise in temperature resulting from sepsis, while alterations in white cell count, C-reactive protein, and serum iron levels were unaffected. In addition, protein catabolism appeared to be similar in both groups. This minimal metabolic effect coupled with observed renal side effects makes the use of nonsteroidal, anti-inflammatory agents in sepsis of questionable benefit.

Acute Disease↗