PubMed Health⌕ Search

Biomedical subjects

R M Greenhalgh

Publications and source records attributed to R M Greenhalgh.

At least 163 records · Page 9Linked to original sources
PubMed1979

The value of the electromagnetic flow probe in experimental and clinical microvascular anastomosis.

The Gould Statham Blood Flowmeter Model SP 2204 has been used to assess microanastomosis in 25 superficial femoral arteries of rabbits. When a pulsatile wave form has been achieved this correlates with a satisfactory anastomosis and vice versa. The digital read out of estimated volume flow past the anastomosis made by this instrument will need further evaluation. We are persisting with the electromagnetic flow probe in the assessment of our clinical microvascular anastomoses at operation.

Animals↗
PubMed1978

Intraoperative autotransfusion for elective aortic surgery.

Intraoperative autotransfusion using the Bentley ATS 100 was used in 23 patients requiring Dacron replacement of their abdominal aorta. An average 2000 ml of blood was reinfused and a total heparinization dose was given. The mean haemoglobin fell 2.8 g/dl and on average 2 pints of banked blood were given in the postoperative period. Coagulation studies performed before and after surgery showed minimal alteration. We feel that further evaluation of this system is essential so that an alternative is established for when banked blood is not available. The system is particularly useful at the present time for such emergencies as a leaking abdominal aortic aneurysm and severe trauma to the liver.

Aorta, Abdominal↗
PubMedDate not supplied

Comparison of endovascular aneurysm repair with open repair in patients with abdominal aortic aneurysm (EVAR trial 1), 30-day operative mortality results: randomised controlled trial.

BACKGROUND: Endovascular aneurysm repair (EVAR) is a new technology to treat patients with abdominal aortic aneurysm (AAA) when the anatomy is suitable. Uncertainty exists about how endovascular repair compares with conventional open surgery. EVAR trial 1 was instigated to compare these treatments in patients judged fit for open AAA repair. METHODS: Between 1999 and 2003, 1082 elective (non-emergency) patients were randomised to receive either EVAR (n=543) or open AAA repair (n=539). Patients aged at least 60 years with aneurysms of diameter 5.5 cm or more, who were fit enough for open surgical repair (anaesthetically and medically well enough for the procedure), were recruited for the study at 41 British hospitals proficient in the EVAR technique. The primary outcome measure is all-cause mortality and these results will be released in 2005. The primary analysis presented here is operative mortality by intention to treat and a secondary analysis was done in per-protocol patients. FINDINGS: Patients (983 men, 99 women) had a mean age of 74 years (SD 6) and mean AAA diameter of 6.5 cm (SD 1). 1047 (97%) patients underwent AAA repair and 1008 (93%) received their allocated treatment. 30-day mortality in the EVAR group was 1.7% (9/531) versus 4.7% (24/516) in the open repair group (odds ratio 0.35 [95% CI 0.16-0.77], p=0.009). By per-protocol analysis, 30-day mortality for EVAR was 1.6% (8/512) versus 4.6% (23/496) for open repair (0.33 [0.15-0.74], p=0.007). Secondary interventions were more common in patients allocated EVAR (9.8% vs 5.8%, p=0.02). INTERPRETATION: In patients with large AAAs, treatment by EVAR reduced the 30-day operative mortality by two-thirds compared with open repair. Any change in clinical practice should await durability and longer term results.

Aged↗
PubMedDate not supplied

Acute phase proteins in patients with abdominal aortic aneurysms.

Both stenosis and aneurysmal dilatation are associated with atherosclerosis of the distal aorta. As part of an investigation into factors predisposing to aneurysmal dilatation we compared the levels of acute phase proteins in patients with stenosing and aneurysmal disease. Increased levels of acute phase proteins were found in patients with abdominal aortic aneurysms compared with patients with stenosing aortic disease. In 20 aneurysm patients the C-reactive protein was 56 +/- 10 mg/l, alpha 1-proteinase inhibitor 2.5 +/- 0.13 g/l and ceruloplasmin 0.41 +/- 0.01 g/l. In 20 patients with stenosing aortic disease the C-reactive protein was 28 +/- 8 mg/l, alpha 1-proteinase inhibitor 1.65 +/- 0.11 g/l and ceruloplasmin 0.35 +/- 0.03 g/l. These results argue for the participation of an inflammatory process in the aortic wall in the pathogenesis of all aneurysms.

Acute-Phase Proteins↗
PubMedDate not supplied

Leg swelling after aortic surgery.

Thirty patients undergoing aorto-femoral reconstruction, during which i.v. heparin was used, are reviewed (19 bilateral and 11 unilateral procedures). No operation was performed therefore on 11 of 60 limbs. Ankle swelling occurred in 12 operated limbs (9 transient and 3 permanent swelling) and 1 non operated limb. Deep vein thrombosis (DVT) occurred in 7 limbs and in only 3 of these was swelling coincident (1 permanent swelling). The coincidence of limb swelling and DVT of the arterial reconstruction is insignificant.

Adult↗
PubMedDate not supplied

Treadmill testing in the assessment of peripheral arterial disease.

A treadmill exercise test is used in many vascular laboratories to measure the claudication time and the total walking time of patients with intermittent claudication. Three hundred and nine consecutive outpatients in the peripheral arterial disease clinic were assessed on the treadmill. Fifty-nine were unable to walk on it at all, and of the remaining 250 patients, 68 (27%) could manage five minutes of treadmill exercise, and 87 (35%) patients stopped for reasons other than intermittent claudication. Only 95 (38%) stopped walking within five minutes as a result of intermittent claudication. Fifty of these 95 patients were retested approximately 10 days later and the mean change from day 1 to day 2 in the claudication time and in the total walking time was calculated to establish the normal range. From these results, if a treadmill is to be used to infer any improvement, we calculate that the claudication time must increase by at least 63 seconds and the total walking time by 93 seconds. Treadmill testing for the assessment of symptoms, if it is used at all, should be used in conjunction with objective methods of assessment.

Exercise Test↗