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Biomedical subjects

S G Darke

Publications and source records attributed to S G Darke.

At least 19 recordsLinked to original sources
PubMed1996

Intraoperative heparinisation, blood loss and myocardial infarction during aortic aneurysm surgery: a Joint Vascular Research Group study.

OBJECTIVES: The primary aim of this prospective multi-centre study involving patients undergoing elective abdominal aortic aneurysm (AAA) surgery was to investigate the relationship between intraoperative intravenous heparinisation, blood loss during surgery and thrombotic complications. METHODS: Two hundred and eighty-four patients were randomised to receive intravenous heparin (n = 145) or no heparin (n = 139). Groups were evenly matched for age, sex, weight, aneurysm size, haemoglobin concentration, platelet counts and distal occlusive disease measured by ankle/brachial systolic pressure. RESULTS: There were no statistically significant differences in blood loss (median 1400 ml vs. 1500 ml; z = 0.02, p = 0.98, 95% C.I. = -200 to 200), blood transfused (4.0 units vs. 4.0 units; z = 1.09, p = 0.28, 95% C.I. = -1 to 0) or distal thrombosis between the two groups. However, analysis of the clinical outcome revealed that 5.7% of the non-heparin group but only 1.4% of the heparinised patients suffered a fatal perioperative myocardial infarction (MI); p < 0.05. All MI, including non fatal events, affected 8.5% and 2% respectively (p = 0.02). CONCLUSIONS: Heparin does not increase blood loss or the need for blood transfusion during surgery. Heparin is not necessary to prevent distal thrombosis when the aorta is cross clamped. The results of the study are consistent with the known mechanisms leading to intraoperative MI and strategies for its prevention. Intravenous heparin, given before aortic cross clamping, is an important prophylaxic against perioperative MI in relation to AAA surgery.

Anticoagulants↗
PubMed1995

Benzodiazepine use among injecting heroin users.

OBJECTIVES: To determine the extent and patterns of benzodiazepine use among heroin users, and whether preferences for different benzodiazepines exist among this group. SUBJECTS AND METHODS: 210 heroin users who were current users of benzodiazepines volunteered for the study and completed a structured questionnaire. RESULTS: Heroin users had used a median of five different benzodiazepines, most commonly diazepam. Almost half the subjects (48%; 95% CI, 41-55) had injected benzodiazepines, 17% (95% CI, 12-22) within the preceding six months. Diazepam and temazepam were the most widely injected benzodiazepines. CONCLUSIONS: Flunitrazepam, diazepam and temazepam should be prescribed to heroin users with caution. A less popular and rarely injected benzodiazepine, nitrazepam, may be a better option for this group.

Adolescent↗
PubMed1994

Diagnostic features and management of bacterial arteritis with false aneurysm formation.

Primary bacterial arteritis with false aneurysm formation is an uncommon condition. This report presents seven patients admitted to one unit over a 5-year period. Interesting aspects of the clinical presentation are discussed. The importance of surgical debridement, extra-anatomic bypass, antibiotic therapy and antibiotic irrigation of the infected aneurysm cavity is stressed. The relative merits of extra-anatomic bypass and in situ grafting for aortic infection are discussed. By following these principles, this series of patients have had a successful surgical outcome and all the signs of infection have been eradicated.

Aged↗
PubMed1992

Venous ulceration and saphenous ligation.

Over an 8-year period prospective series of 213 consecutive patients with venous ulceration of 232 limbs has been studied. By means of clinical, hand-held Doppler ultrasound and comprehensive ascending and descending venography examination, it was possible to identify underlying morphological abnormalities and on the basis of these to divide patients into four principal types. Type I:4%--ankle perforator incompetence alone; Type II:39%--ankle perforator and saphenous incompetence; Type III: 35%--primary deep incompetence (usually associated with perforator and saphenous incompetence); Type IV:22%--patients with postphlebitic damage. This study reports the outcome of Type II patients that have been treated by saphenous ligation alone (no perforator ligation). Healing was maintained over a mean period of 3.5 years in all but five patients. In these, other factors were shown in retrospect to be contributory to failed healing. It is concluded, therefore, that approximately 40% of venous ulcers can be ascribed to a combination of incompetence of saphenous and ankle perforating veins and that medium-term healing can be achieved in at least 90% of these by saphenous ligation alone.

Adult↗
PubMed1992

The morphology of recurrent varicose veins.

Over an 18-month period, of 444 patients referred for treatment for varicose veins, 95 (21%) had had previous surgery. By means of clinical hand-held Doppler and in selected venographic evaluation these were subdivided into three groups as follows. Type 1:29 of the 95 patients had recurrence through thigh perforators. Type 2:10 patients had developed incompetence through a second saphenous system, in nine of the 10 in the short saphenous having had previous long saphenous surgery. Type 3:46 patients had recurrent sapheno-femoral incompetence and 10 sapheno-popliteal incompetence. A persistent long saphenous trunk in the thigh was present in approximately two-thirds of cases of types 1 and 3. In over half of the type 3 patients saphenofemoral recurrence was by reconstitution of the junction by neovascularisation. These morphological studies demonstrate why there may be an increased risk of recurrence if the long saphenous trunk is not excised at the time of primary surgery.

Adolescent↗
PubMed1987

The assessment of primary varicose veins by Doppler ultrasound--the role of sapheno-popliteal incompetence and the short saphenous systems in calf varicosities.

One hundred consecutive limbs presenting with primary varicose veins to a surgical outpatient clinic were assessed clinically and by Doppler ultrasound. By this means the incidence of sapheno-femoral and sapheno-popliteal incompetence was established and the relative role of these two systems in the development of varicosities determined.

Female↗
PubMed1987

The place of first rib resection in the management of axillary-subclavian vein thrombosis.

Eight patients with axillary-subclavian vein thrombosis were studied. Three presented acutely and five with chronic symptoms of pain and swelling exacerbated by and limiting normal use. Initial venography showed complete occlusion of the axillary vein in 7 cases and marked narrowing in the remaining patient. Venographic evidence of narrowing or occlusion was also seen in 6/8 clinically normal contralateral arms. One of these arms became symptomatic 2 years later, and required surgery. The patients presenting acutely were anticoagulated. Symptoms resolved slowly in 2 cases, but persisted in one. This patient and the five presenting chronic symptoms underwent decompression of the thoracic outlet by transaxillary resection of the first rib. Satisfactory decompression was confirmed at operation by eliciting and then abolishing "nipping" of the surgeon's finger between the first rib and the clavicle on abducting and then relaxing the arm. Symptomatic relief was achieved in 5/7 limbs thus treated (one patient had bilateral first rib resection). Although postoperative venographic improvement was seen in some cases, clinical success did not depend on recanalisation of the main axillary-subclavian vein. The two patients with persistent symptoms after first rib resection subsequently had venous bypass procedures. Despite initial patency, both had occluded with return of symptoms within 4 months.

Adolescent↗
PubMed1987

Slow-release potassium and perforation of Meckel's diverticulum.

A case of peritonitis following perforation of gastric-type mucosa in a Meckel's diverticulum is described. At laparotomy a wax core of a combined diuretic-slow-release potassium preparation was found extruding through the perforation and a further pellet was found free in the peritoneal cavity. Intestinal perforation due to potassium-containing drugs is recognized and led to the development of enteric-coated and slow-release delivery systems. The association of perforation of Meckel's diverticulum with a slow-release potassium perforation has not previously been described.

Aged↗
PubMed1986

Stripping the long saphenous vein: peroperative retrograde saphenography in patients with and without venous ulceration.

Peroperative retrograde saphenography was used to study 80 incompetent long saphenous veins (LSV) in 60 patients with primary varicose veins. In 53 limbs presentation was uncomplicated (group A, 40 patients); in 27 limbs there was ulceration (group B, 20 patients). All limbs in group B had a normal deep system as shown pre-operatively by ascending and descending venography. Varicose changes were found in 52 (65 per cent) of 80 LSV; the overall mean length of normal vein seen was 16 cm. The incompetent LSV appears unlikely to be suitable for arterial replacement. All valves identified on operative saphenography above the knee appeared incompetent. In only 9 LSV of group B were there recognizable valves either above or below the knee, significantly fewer than 34 of group A (P less than 0.05). This finding suggests that a deficiency of saphenous valves may contribute to the development of venous ulceration. Hunterian perforators of variable size were seen on 70 saphenograms (87 per cent) passing directly from the LSV to the superficial femoral vein. Stripping of the incompetent LSV will disconnect such perforators from an incompetent system and may thus reduce the incidence of both recurrent varicose veins and persistent ulceration.

Female↗
PubMed1985

The value of perioperative Doppler ankle systolic pressure measurements in reconstructive arterial surgery.

This study evaluates the use of ankle systolic Doppler indices for the detection of technical errors during reconstructive surgery. Measurements taken peroperatively, following declamping, are expressed as a ratio of brachial systolic pressure and compared with preoperative and postoperative readings. A study has been made of 377 limbs in 272 patients, including patients undergoing surgery for aneurysm, claudication and limb salvage. In the majority of patients the peroperative ratios were similar to, or improved on, pre-operative levels. No technical errors or primary failures were apparent in those patients in which this was the case. In contrast, in the 27 limbs in which a pre-operative ratio had been measurable, but no peroperative signal obtained, 21 technical errors were identified and corrected immediately. There were 16 limbs with severe ischaemia, and neither pre-operative nor peroperative signals, in which the outcome was less certain. In ten, major amputation subsequently became necessary because of inadequate run-off which was demonstrated radiologically. Finally, there were four limbs in which failure occurred postoperatively in spite of a restored peroperative signal. It is concluded that this simple technique is useful and sensitive.

Adult↗
PubMed1984

Long saphenous incompetence as a cause of venous ulceration.

Four hundred and seventeen consecutive patients referred with significant chronic venous disorders of the lower limb have been studied. Two hundred and ninety-nine were considered to have uncomplicated primary varicose veins, with saphenous incompetence. The remaining 118 presented with past or current skin ulceration, prominent pain and swelling, or both. Ascending and descending venography and further Doppler studies revealed only 18 patients (17 with ulceration) with an incompetent long saphenous system and ankle perforators as the only identifiable abnormalities. In 12 of these, patients' dorsal foot vein pressures were measured at rest and the maximum fall demonstrable after exercise expressed as a percentage of this (12.9 per cent +/- 6.0). This test was repeated with a narrow tourniquet inflated to 160 mmHg, applied to the mid-thigh (35.6 per cent +/- 7.4) (P less than 0.05), and again after accurate groin ligation and stripping of the long saphenous vein to the knee (31.9 per cent +/- 10.7) (P less than 0.05). These results seem to validate the use of the foot pressure/tourniquet test in assessing the relevance of saphenofemoral incompetence, and suggest in a proportion of venous ulcers this is a princical factor.

Female↗
PubMed1983

Abdominal aortic aneurysm with retroperitoneal fibrosis and ureteric entrapment.

Eleven of 157 patients undergoing surgery for abdominal aortic aneurysm, with features of both aneurysm and periaortic retroperitoneal fibrosis, are presented. The clinical details, implications and management are reported. The possibility that this association may present with differing relative severity of these two conditions is discussed. aortic replacement is advocated as the treatment of choice because the risk of rupture still exists and this procedure seems to halt, or even reverse, the inflammatory process. Synchronous ureterolysis is reasonably safe and can be undertaken if obstruction is present. Steroids represent an alternative option, where aortic replacement is too hazardous.

Aged↗