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P A Baskerville

Publications and source records attributed to P A Baskerville.

27 records · Page 2Linked to original sources
PubMed1985

The Klippel-Trenaunay syndrome: clinical, radiological and haemodynamic features and management.

Forty-nine patients with the Klippel-Trenaunay syndrome have been studied. Sixty-eight per cent have a superficial, embryological venous channel on the lateral aspect of the limb, 25 per cent have had one or more severe spontaneous haemorrhages from dilated varices and 22 per cent have suffered a venous thrombo-embolism. Twenty-nine per cent have had episodes of rectal bleeding or haematuria associated with pelvic angiomas. Foot volumetry (n = 31) showed that calf emptying was decreased in only five patients and only one of these had phlebographic evidence of deep venous obstruction, which conflicts with previous findings. The rate of calf refilling was increased in 81 per cent and phlebography demonstrated incompetent communicating veins in 45 per cent of patients. No patient had clinical evidence of an arteriovenous fistula, and arteriography (n = 22) and calf blood flow (n = 33) were normal, but lymphangiography (n = 14) showed lymphatic hypoplasia in 55 per cent of limbs. Eighty-eight operations have been performed on 38 patients but symptoms persist in 90 per cent. We suggest that surgery should be limited to the excision of localized symptomatic abnormalities and that the best form of control is provided by graduated compression stockings.

Adolescent↗
PubMed1985

The etiology of the Klippel-Trenaunay syndrome.

The etiology of the Klippel-Trenaunay syndrome (KTS) remains obscure. Although venous hypertension secondary to deep venous obstruction has been suggested as a cause, recent studies have demonstrated that most patients have unimpeded venous drainage. Calf blood flows have been measured in 33 patients with KTS using venous occlusion plethysmography. Although all flow rates were within normal limits, flow in affected limbs was invariably greater than in normal limbs (p less than 0.001), and this is related to the presence of the nevus. Biopsies of subcutaneous veins demonstrate the histological features of a response to chronically raised flow. The authors suggest that KTS is caused by mesodermal abnormality during fetal development, leading to the maintenance of microscopic arteriovenous communications in the limb bud, as a result of which the triad of nevus, hypertrophy, and superficial varices is produced. Deep venous abnormalities occur pari passu with the triad and are not responsible for its development.

Adolescent↗
PubMed1983

The diagnosis and treatment of peri-aortic fibrosis ('inflammatory' aneurysms).

A proportion of abdominal aortic aneurysms are found at laparotomy to have thick white walls and extensive peri-aneurysmal adhesions. Graft replacement in these patients is often difficult and associated with an increase in morbidity and mortality. In this study 103 patients with a clinical diagnosis of aortic aneurysm were scanned with computerized tomography to determine whether this condition could be diagnosed preoperatively. Of these, 15 showed diagnostic radiological criteria of peri-aortic fibrosis. Laparotomy revealed no false negatives and only one false positive. Clinical, serological and pathological findings have been compared to those with 'normal' aneurysms. In view of the similarities between this condition and retroperitoneal fibrosis, 5 patients were treated with Prednisone 5 mg twice daily for up to 18 months and a CAT scan technique developed to monitor the degree of thickening quantitatively. Abdominal pain disappeared rapidly, and sequential scanning showed a decrease in peri-aortic fibrosis. Measurements showed the fibrosis only to disappear, with no increase in the diameter of the aortic lumen. In some cases, the lumen was only minimally dilated, although clinical examination suggested an aneurysm. Consequently we suggest that the term peri-aortic fibrosis is a better description of this condition whose aetiology is still obscure, and in which aneurysm formation, when present, may simply be consequent upon the fibrotic reaction in the wall.

Aged↗
PubMed1983

Day case inguinal hernia repair under local anaesthetic.

Local anaesthetic day case inguinal hernia repair has been performed on 135 patients under the care of one surgeon in a nine month period. Results of a questionnaire answered by 129 patients (95.6%) and 31 of their general practitioners (85%) have been analysed. The complication rate is very low and both patient and GP acceptability is high.

Ambulatory Surgical Procedures↗
PubMedDate not supplied

[Thromboembolic disease and congenital venous abnormalities].

A pulmonary embolus and a bilateral thrombosis of the internal carotid artery caused the sudden death of two young adults with a congenital venous abnormality. The study of 49 patients suffering from a Klippel-Trenaunay syndrome showed that 11 out of 49 patients, or 22.5 p. cent had thrombosis problems: namely 7 pulmonary emboli and 8 deep thrombophlebitis. Phlebography did not permit to discover any specific anatomical abnormality. 5 out of 11 patients presented avalvular and dilated deep veins. 6 out of 11 presented angioma of the pelvis. In the group of patients with Klippel-Trenaunay who never presented a deep venous thrombosis, the same signs are noted in one third of the cases. It is possible that coagulation insufficiency may explain the high number of thrombophlebitis. However, an extended analysis of 11 patients did not permit to discover any abnormality. But, subsequently, a study of the fibrinolytic activity demonstrated a normal fibrinogen level, while the fibrinopeptide A level was markedly elevated in each case, with an abnormal thrombin activity.

Adolescent↗
PubMedDate not supplied

Peri-aortic fibrosis: progression and regression.

The natural history and aetiology of peri-aortic fibrosis is unknown. In one of our patients in whom steroid treatment had successfully controlled the progression of the disease' cessation of treatment was associated with recurrence of the fibrosis, progressive ureteric obstruction and dilatation of the aorta. In another patient, graft replacement of the aorta was associated with regression of the fibrosis but in a third patient replacement of the aorta did not prevent progression to complete ureteric obstruction. It would seem that it is the presence of the fibrosis that engenders the aortic dilatation not the presence of a patent aorta, dilated or not.

Aged↗