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Biomedical subjects

P A Coughlin

Publications and source records attributed to P A Coughlin.

12 recordsLinked to original sources
PubMed2006

Arterial consequences of recreational drug use.

BACKGROUND: Recreational drug use is becoming an increasing problem throughout the world. Many of the drugs used and their routes of administration have the potential to cause damage to the vascular system. Intravenous drug administration with the risk of arterial puncture predisposes to the formation of infected pseudoaneurysms. Inadvertent intra-arterial injection predisposes to distal limb ischaemia. Cocaine has numerous effects not only on the heart, but also potentially on any vascular bed. METHODS: A systematic review of published literature with regard to the arterial consequences of recreational drug abuse was undertaken by undergoing an electronic search. RESULTS: Most of the available literature is in the form of case reports and case series. Pseudoaneurysm formation is a serious consequence for intravenous drug users. For femoral aneurysms vessel ligation is the safest option with a low amputation risk. A high proportion of patients do have symptoms of claudication in the long term. Intra-arterial injections can result in limb threatening ischaemia. Systemic anticoagulation forms the mainstay of treatment. Cocaine has significant effects upon both the myocardium and the arterial tree in general. Arterial problems must always be considered in cocaine users who present acutely. CONCLUSION: The consequences of recreational drug use will result in an increased exposure of vascular surgeons to its associated complications posing unique and challenging problems.

Aneurysm, False↗
PubMed2006

The PADHOC device is a better guide to the actual incapacity suffered by claudicants than the gold standard constant load treadmill test.

BACKGROUND: The Constant Load Treadmill Test (CLTT) is currently the primary method used to measure walking impairment in patients with peripheral vascular disease. The aim of this study was to compare the CLTT and PADHOC device as assessments of walking impairment. METHODS: 55 patients with intermittent claudication underwent a CLTT and a Double Physiological Walking Test (DPWT) using the PADHOC device. Health-related quality of life was measured using the Short Form 36 and the Claudication Scale. RESULTS: The initial claudication and maximum walking distance from the first part of the DPWT showed the best correlation with domains of pain and physical function. CONCLUSIONS: The DPWT is more representative of the functional incapacity experienced by patients with intermittent claudication. We believe that the PADHOC is a suitable alternative to the CLTT in the assessment of this patient group.

Aged↗
PubMed2004

Management of blunt liver trauma in a tertiary referral centre.

BACKGROUND: In recent years, several reports from North America have highlighted the success of conservative treatment in patients with blunt liver trauma. The aim of this study was to identify trends in the management of blunt liver trauma in a UK tertiary referral centre dealing with both adults and children over a 10-year period. METHODS: A retrospective case note review was performed on 71 consecutive patients (58 male patients) of median age 25 years admitted to the hepatobiliary unit over the 10-year period from 1992 to 2001 with blunt liver trauma. Data relating to referring source, severity of liver injury, initial and subsequent management and outcome were collected using a standard pro forma. RESULTS: Sixty-two of the 71 patients were referred from other surgical units. Of these, 14 had undergone laparotomy at the referring hospital, with ten having perihepatic packing; the other 48 were managed conservatively. Of the 62 patients transferred to the authors' unit, 12 required surgical intervention for the liver injury. The mean number of patients with blunt liver trauma increased between the first second 5-year periods, from 3.2 to 11.0 patients per year. There was a significant reduction in the proportion of patients requiring surgery for the liver injury in both the authors' unit (from seven of 16 patients in 1992-1996 to seven of 55 in 1997-2001; P = 0.017, chi(2) test) and referring hospitals (from six of 12 to eight of 50; P = 0.014, chi(2) test). The reduction in the mortality rate, from two (12.5 per cent) of 16 in the first period to four (7.3 per cent) of 55 in the second, was not significant (P = 0.880, chi(2) test). CONCLUSION: This study demonstrated a marked increase in the number of patients with blunt liver trauma referred to a regional hepatobiliary centre in recent years. It has confirmed that the majority of such patients can be treated successfully without surgery.

Adolescent↗
PubMed2002

Femorofemoral venous bypass graft for the treatment of venous occlusion of the common femoral vein in a nine year old boy.

Unlike arterial disease, most vascular surgeons have very little experience in performing bypass procedures for venous obstruction especially when occurring in children. Given the lack of published literature when compared to arterial procedures, we report a successful venous crossover procedure following iatrogenic injury and subsequent occlusion of the right common femoral vein in a nine year old boy.

Arteriovenous Shunt, Surgical↗
PubMed2002

Exercise training reduces the acute inflammatory response associated with claudication.

BACKGROUND: recent research has shown that episodes of claudication may be associated with a systemic inflammatory response that causes injury to the vascular endothelium. As claudicants are often directed to undertake regular walking exercises there has been a concern that this may accelerate endothelial injury. AIMS: the aim of our study was to assess the baseline markers of ischaemia-reperfusion injury (IRI) in claudicants and controls after acute treadmill exercise and to then examine the effect of a 3 month supervised exercise-training programme, on these markers, in the claudicant group. METHODS: forty-six claudicants and 22 age-matched controls undertook acute treadmill exercise. Neutrophil activation, degranulation, free radical damage and antioxidants were measured (by flow cytometry, ELISA, and chemiluminescence) at rest and at 5, 30 and 60 min post-exercise. Claudicants were then recruited into an intensive 3 month supervised exercise programme (SEP) after which the same parameters of IRI were reassessed at different time points, at 3 and 6 months. RESULTS: resting markers of IRI were similar in both groups. Exercise had no effect on the control group. Immediately after exercise, claudicants developed significant neutrophil activation and degranulation with free radical damage. This effect decreased sequentially after 3 months of exercise training. CONCLUSION: this study for the first time demonstrates that the exercise training of claudicants is beneficial, not only in terms of improving their walking distance, but also by decreasing the injurious effects of IRI that occur during claudication. Exercise training should be an essential part of the medical management of the majority of claudicants.

Adult↗
PubMed2001

A survey of deep venous thrombosis management by consultant vascular surgeons in the United Kingdom and Ireland.

OBJECTIVES: The aim of this study was to detail the current consensus amongst vascular surgeons in Great Britain and Ireland regarding their investigation and management of patients with suspected or proven deep vein thrombosis (DVT). METHODS: The database of the Vascular Surgical Society of Great Britain and Ireland (VSS) was utilised to send coded postal questionnaires to all consultant surgeon members. RESULTS: Replies were received from 281 (65%) consultants. Duplex ultrasound is used alone to confirm DVT by 69% of respondents. A thrombophilia screen is always performed by 14% of consultants, for patients with proven DVT, and is more commonly requested by consultants based in a teaching hospital. The majority (57%) of consultants treat DVT with unfractionated heparin (UFH) and warfarin, whereas only 38% utilise low molecular weight heparins (LMWH) and warfarin. A management policy for DVT is reported to be in place by 59%, and a set policy for the specific management of calf vein DVT by just 20%. CONCLUSION: New diagnostic modalities and treatments have been developed for DVT that are more convenient and cost-effective. Although clinical guidelines for the management of patients with DVT are beginning to emerge, there is still a wide discrepancy in many areas of DVT management, and practice at variance with the current evidence base, amongst vascular surgeons in the United Kingdom and Ireland.

Anticoagulants↗
PubMed2001

A new device for the measurement of disease severity in patients with intermittent claudication.

OBJECTIVES: To assess a new method of determining functional impairment in patients with intermittent claudication, the Double Physiological Walking Test (DPWT) using the PADHOC (Peripheral Arterial Disease Holter Control) device, against a standard treadmill test. DESIGN: Patients with intermittent claudication presenting to the department were considered for both the DPWT and a standard treadmill test. METHODS: initial claudicating distance, maximal walking distance and speed of walking were determined for both parts of the DPWT. Initial claudicating distance and maximal walking distance were determined from the treadmill test. Comparisons were made between the treadmill test and the DPWT. RESULTS: The treadmill test was unable to be performed in 22% of patients due to defined contraindications. There were strong correlations in both walking distances and disease severity when comparing the DPWT and the treadmill test. Patients in whom the treadmill test was contraindicated had significantly shorter walking distances on the DPWT than those who were able to complete a treadmill walking test. CONCLUSIONS: The DPWT correlates strongly with walking distances obtained from a standard treadmill test. However, the PADHOC can be used in a number of differing locations and settings as well as in patients in whom a treadmill test is contraindicated. It therefore has a role to play in the initial assessment of patients presenting with intermittent claudication.

Aged↗
PubMed2001

The analysis of sensitivity, specificity, positive predictive value and negative predictive value of cold provocation thermography in the objective diagnosis of the hand-arm vibration syndrome.

The diagnosis of digital artery vasospasm in the hand-arm vibration syndrome (HAVS) is clinically based, and the need for an accurate objective test to support the diagnosis has been highlighted. This study aims to analyse the potential of cold provocation thermography (CPT) to fulfill this role. CPT was performed on two groups of subjects: 10 controls and 21 patients with Raynaud's phenomenon (RP) secondary to HAVS. After taking a pre-cooling image, patients donned latex gloves and immersed their hands in water at a temperature of 5 degrees C for 1 min. The patients removed their hands from the water and discarded the gloves, and further images were taken every 30 s for 10 min. On each image, the temperatures of the tip and base were analysed for each digit. The sensitivity, specificity, positive and negative predictive values for fingertip temperatures only, fingertip and fingerbase temperatures combined, and fingertip temperature, fingerbase temperature and temperature gradient combined were determined. Patients with RP secondary to HAVS demonstrated significantly lower finger tip and base temperatures and lower digital temperature gradients at all time intervals when compared with controls (P < 0.01, Student's t-test). CPT has good sensitivity, specificity, positive predictive value and negative predictive value; it strongly supports the clinical diagnosis of digital vasospasm.

Adult↗
PubMed2001

A comparison between two methods of aesthesiometric assessment in patients with hand-arm vibration syndrome.

Hand-arm vibration syndrome (HAVS) is caused by prolonged exposure to vibration. The diagnosis and assessment of disease severity are subjective at present. The aim of this study was to determine sensorineural dysfunction in patients with HAVS using two methods of aesthesiometric assessment. We recruited three groups of age-matched subjects: 20 subjects diagnosed as having HAVS, 15 manual workers and 15 sedentary workers. We measured both two-point discrimination and depth sense perception using an aesthesiometer. We found that the two-point discrimination wheel was more accurate than the depth sense perception wheel at detecting levels of sensorineural dysfunction in subjects with HAVS. The increased sensitivity of the two-point disc would suggest that it should be used in preference to the depth sense disc for the assessment of sensorineural dysfunction in patients with HAVS.

Adult↗
PubMed2001

Cyclist's iliac syndrome: temporary relief by balloon angioplasty.

External iliac stenosis due to endofibrosis is a rare condition that predominantly affects top level cyclists. Short term symptomatic relief is reported in an Olympian after percutaneous transluminal angioplasty, which was performed to allow the patient to return to training without delay.

Adult↗
PubMed2000

An unusual cause of femoral embolus.

Acute lower limb ischaemia is associated with high morbidity and mortality. The authors describe an unusual cause of arterial occlusion two weeks following aorto-coronary bypass surgery. This case should make vascular surgeons aware of the possibility of prosthetic materials acting as emboli. Furthermore, they should also be mindful that the presenting symptom may be at a site and time remote from the original intervention.

Aged↗