PubMed Health⌕ Search

Biomedical subjects

S Livesey

Publications and source records attributed to S Livesey.

10 recordsLinked to original sources
PubMed2005

Mitral repair best practice: proposed standards.

OBJECTIVES: To define best practice standards for mitral valve repair surgery. DESIGN: Development of standards for process and outcome by consensus. SETTING: Multidisciplinary panel of surgeons, anaesthetists, and cardiologists with interests and expertise in caring for patients with severe mitral regurgitation. MAIN OUTCOME MEASURES: Standards for best practice were defined including the full spectrum of multidisciplinary aspects of care. RESULTS: 19 criteria for best practice were defined including recommendations on surgical training, intraoperative transoesophageal echocardiography, surgery for atrial fibrillation, audit, and cardiology and imaging issues. CONCLUSIONS: Standards for best practice in mitral valve repair were defined by multidisciplinary consensus. This study gives centres undertaking mitral valve repair an opportunity to benchmark their care against agreed standards that are challenging but achievable. Working towards these standards should act as a stimulus towards improvements in care.

Atrial Fibrillation↗
PubMed2001

Surgical ostioplasty for isolated ostial stenosis of the left main stem coronary artery.

We report the cases of 4 patients in whom surgical ostioplasty was performed for isolated severe ostial stenosis of the left main stem coronary artery. No perioperative death or myocardial infarction occurred. One patient required reoperation for symptomatic recurrent ostial stenosis after 6 months. The others remained angina free after a mean follow-up of 23 months. The literature associated with this procedure is briefly reviewed.

Adult↗
PubMed1999

Cardiac surgery in the elderly.

OBJECTIVE: There has been a gradual increase in the number of elderly patients referred for cardiac surgery. These patients present a difficult challenge, they are usually symptomatic yet at high risk for intervention. The aim of this study is to review our experience with cardiac surgery in patients aged 80 years or older. PATIENTS AND METHODS: Between January 1981 and October 1997, 242 patients; 135 female, 107 male, mean age 82.8 years (range 80-95) underwent surgery on cardiopulmonary bypass in our unit. Surgery was performed on 14 as an emergency and 136 on an urgent (patient restricted to a hospital bed due to symptoms) basis. Pre-operatively 182 (75.2%) were in NYHA functional class 3 or 4. RESULTS: Early mortality was 14 (5.7%). A mitral valve procedure and emergency surgery were significantly associated (P < 0.05) with an increased risk of operative mortality. Median ITU and in-hospital stay was 1 day (range 0-33) and 10 (range 6-49) days, respectively. Ninety-three percent of patients were living independently at home 2 months post-operatively. Survival (+/-SEM) is 98% complete (totals 557 patient years) and including early mortality at 1 and 5 years was 85.5+/-2.4% (n = 154), and 67.7+/-4.3% (n = 33). Survival for patients undergoing isolated aortic valve replacement (AVR) and coronary artery bypass grafting (CABG) at 5 years was 64.8+/-7.8% and 79.7+/-7.4%, respectively. Survival was significantly worse in patients undergoing a mitral procedure. Using Cox's proportional hazards model only type of operation (mitral surgery) was significantly associated with worse survival. CONCLUSION: Cardiac surgery can be performed in a selected elderly population with a low operative mortality. Post-operatively elderly patients attain an excellent quality of life and survival. Emergency and mitral surgery in this group of patients is less rewarding.

Aged↗
PubMed1998

Trends in exodontia under general anaesthesia at a dental teaching hospital.

AIMS: To survey the use of simple exodontia for children under general anaesthesia on an out-patient basis at a Northern Dental Hospital. To monitor any effects resulting from the introduction of the Poswillo guidelines on the referral for and treatment of patients under general anaesthesia. DESIGN: A retrospective longitudinal analysis. SETTING: A Northern Dental Hospital in England. MATERIALS: Information was recorded from original case records of children undergoing exodontia under general anaesthesia on an out-patient basis during October between 1989 and 1997. RESULTS: The mean and modal age of the children decreased from 7.7 years to 6.0 years respectively in 1989 to 5.7 years and 4.0 years in 1997. The proportion receiving a general anaesthetic for orthodontic extractions substantially decreased from 18.0% in 1989 to 0.7% in 1997 and the need for repeat dental general anaesthetics within 18 months was eliminated with the introduction of a pre-general anaesthetic screening service. CONCLUSION: Dental treatment under general anaesthesia should continue to be available where it is justified. A separate assessment appointment reduces the prescription of general anaesthesia and minimises its usage for orthodontic extractions and the necessity for repeat general anaesthesia.

Age Factors↗
PubMed1990

Ultrastructural localization of cytochrome b in the membranes of resting and phagocytosing human granulocytes.

Affinity-purified rabbit anti-neutrophil cytochrome b light or heavy chain antibodies were used to immunocytochemically and biochemically localize cytochrome b in neutrophils and eosinophils. The antibodies were monospecific, recognizing polypeptides of 91 and 22 kD, respectively, on Western blots of whole neutrophil extracts. The antibodies were used in Western blot analysis of subcellular fractions of purified neutrophils to confirm that the distribution of cytochrome b spectral absorbance matched that of the two subunits. Thin sections of cryofixed, molecular distillation-dried granulocytes were labeled with the anti-cytochrome b antibodies, followed by incubation with biotin-conjugated secondary antibody, and final labeling with streptavidin-conjugated colloidal gold. Electron microscopy revealed that the cytochrome b light and heavy chains were localized primarily (80%) to 0.1-0.2-micron round or elliptical granule-like structures in neutrophils and 0.4-0.5-micron granules in eosinophils. Approximately 20% of the cytochrome b was localized to the surface, confirming the subcellular fractionation studies. Double staining experiments on the neutrophils, using polyclonal rabbit anti-lactoferrin antibody, indicated that the cytochrome-bearing structures also contained lactoferrin and thus were specific granules. When the analysis was performed on neutrophils that had phagocytosed Staphylococcus aureus, cytochrome b was found in the phagosomal membrane adjoining the bacterial cell wall.

Animals↗
PubMed1989

Coronary ostial stenosis after radiotherapy: angioplasty or coronary artery surgery?

A thirty year old man underwent coronary angioplasty for an isolated ostial stenosis of the ostium of the right coronary artery after mediastinal radiotherapy given ten years previously. Despite an angiographically acceptable angioplasty result, he had a myocardial infarction two months later and coronary artery surgery was performed. The most effective form of myocardial revascularisation for radiotherapy related coronary artery lesions remains to be established.

Adult↗
PubMed1988

Cardiac surgery for patients aged 65 years and older: a long term survival analysis.

Between January 1973 and December 1984, 562 patients aged greater than or equal to 65 had cardiac surgery at Papworth Hospital. Most had mitral or aortic valve replacements (coronary artery bypass grafting was not introduced for this age group at Papworth until 1977). The overall operative mortality, defined as death within thirty days or death before leaving hospital, was 7.3%. There were no early deaths in patients undergoing coronary artery bypass grafting surgery. Questionnaires sent to general practitioners in East Anglia traced 86.0% of the patients who survived to leave hospital. The longer term survival rates for all patients were 88.0%. (95% confidence interval (CI) 85 to 91) at one year and 74.4% (95% CI 69 to 79) at five years. The rates for those patients who survived the initial few months were 96.3% (95% CI 94 to 98) at one year and 81.5% (95% CI 77 to 86) at five years and these rates were no different from those in the general population aged greater than or equal to 65.

Aged↗
PubMed1987

Hard contact lens migration into the upper lid: an unexpected lid lump.

Contact lens migration into the upper lid is a rare complication of wearing a hard contact lens. We present a case in which the only complaint was the cosmetically unacceptable appearance of a lump in the upper lid. The 76-month duration of the lesion is, we believe, the longest so far described. The histology and possible natural history of the cyst are also discussed.

Adult↗
PubMed1983

Initial impressions of dazoxiben in the treatment of the ischaemic limb.

1 Dazoxiben, a selective thromboxane synthetase inhibitor, which is active after oral administration, has been used to treat eight patients with severe peripheral vascular disease associated with ischaemic rest pain. 2 Patients were selected for treatment on the basis that amputation was the only alternative procedure. 3 Three of eight patients are well and pain-free 1, 7 and 11 months after initially receiving the drug and have not required amputation. 4 Dazoxiben may prove useful in the treatment of peripheral vascular disease.

Adult↗