Biomedical subjects

T R Magee

Publications and source records attributed to T R Magee.

At least 19 recordsLinked to original sources

PubMed2007

Outcome following bypass, and proximal and distal ligation of popliteal aneurysms.

BACKGROUND: The aim of this study was to describe early and late results of proximal and distal ligation for popliteal aneurysm (PA), combined with bypass, with particular reference to the fate of the excluded aneurysm. METHODS: Of a cohort of 116 patients with PAs, 66 were treated with bypass and ligation. Graft patency was determined by duplex surveillance. In addition, 17 patients with bypassed PAs underwent a total of 33 duplex scans to determine flow within the aneurysm and change in size. RESULTS: For initially patent PAs, 3-, 5- and 8-year primary bypass graft patency was 78, 78 and 51 per cent respectively. These rates were not statistically significantly different from those following bypass for thrombosed PA, 3- and 5-year primary patency being 72 and 65 per cent respectively. No PA produced further symptoms after bypass and ligation. No flow was seen in any aneurysm at follow-up. Only one showed an increase in size. CONCLUSION: Proximal and distal ligation with bypass produced satisfactory long-term patency with good exclusion of the PA.

Aneurysm↗

PubMed2006

Vascular surgical emergencies: how will future surgeons be trained?

INTRODUCTION: We wished to assess whether pattern and impact of emergency vascular surgical referrals has altered since a previous study in 1990. Following introduction of shift working patterns, we wished to assess how these changes may affect vascular training and vascular on-call cover. PATIENTS AND METHODS: Prospective survey of emergency vascular referrals at two district general hospitals (DGH-R and DGH-L) in 2003. DGH-R received only regional referrals whereas DGH-L also received 'next day' referrals from a smaller hospital. Results were compared between centres and with a previous study undertaken at DGH-R in 1990. RESULTS: From 1990 to 2003 emergency vascular referrals at DGH-R increased by 51% (53 to 80). The number seen at DGH-R and DGH-L were similar in 2003. There were significantly more out-of-hours referrals in DGH-R than DGH-L (59% versus 35%; P = 0.0123). Referrals were more likely to be seen initially by the vascular team at DGH-L than DGH-R (80% versus 47%, P < 0.0001). CONCLUSIONS: Vascular emergency referrals have increased. A trainee was likely to see more emergency referrals at DGH-L than DGH-R. This may impact on future training.

After-Hours Care↗

PubMed2005

Remote superficial femoral endarterectomy: Long-term results.

PURPOSE: The aim of this study was to determine long-term results following successful remote superficial femoral endarterectomy (RSFE). METHODS: RSFE is a minimally invasive technique of revascularising the superficial femoral artery. A single incision was made over the origin of the superficial femoral artery. The endarterectomy was carried out in a closed fashion from above. The cut end of distal atheroma was secured with a stent. Following RSFE patients were followed up with intravenous digital subtraction angiography (IVDSA) and 3-monthly duplex scans. IVDSA was repeated if any abnormality was found. RESULTS: RSFE was attempted on 30 patients with 33 symptomatic legs to treat tissue loss (n = 3), rest pain (n = 3) or intermittent claudication (n = 27). In 26 limbs it was possible to complete the RSFE satisfactorily (technical success 79%), but during follow-up 18 later developed stenoses. Of 31 stenoses detected, 27 were treated by angioplasty. Primary patency at 1, 2 and 5 years was 38, 31 and 16%, respectively. Primary-assisted patency at 1, 2 and 5 years was 77, 65 and 60%. CONCLUSIONS: Primary-assisted patency following RSFE is reasonable, however, it is only achieved with life-long surveillance and intervention. Until results can be improved the widespread use of RSFE cannot be recommended.

Aged↗

PubMed2005

Popliteal aneurysms: distortion and size related to symptoms.

OBJECTIVES: To examine size and distortion of popliteal aneurysms (PA) in relation to symptoms produced at presentation. METHODS: A prospective study of all PA presenting to a single unit 1988-1994. Wherever possible patients underwent angiography, duplex scanning and measurement of both PA diameter and the most proximal angle of distortion. Symptoms and measurements were noted at the time of first presentation. RESULTS: Seventy-three patients presented with 116 PA. At initial diagnosis 44 PA (38%) were asymptomatic and 39 (34%) produced acute ischaemia. As the PA increased in diameter so did the degree of distortion (p < 0.0001). Size and distortion were greater in PA producing acute ischaemia or acute thrombosis than in asymptomatic PA (p < 0.01). Degree of distortion differentiated symptomatic from asymptomatic PA (p = 0.0066). Size was not significantly different between these two groups. For PA 3 cm or larger in diameter with greater than 45 degrees distortion sensitivity, specificity and positive and negative predictive values for thrombosis were 90, 89, 83 and 94%, respectively. CONCLUSION: Distortion and size can differentiate between PA producing different symptoms. Combining the two provides a reliable method of differentiating PA which should be managed by early elective repair.

Aged↗

PubMed2005

Critical appraisal of femorofemoral crossover grafts.

BACKGROUND: The aim of this study was to determine how often femorofemoral crossover grafting for critical ischaemia or intermittent claudication gives an ideal result. An ideal result is an uncomplicated operation with primary wound healing, relief of ischaemic symptoms without recurrence and no need for further intervention. METHODS: All patients undergoing primary femorofemoral crossover grafting between January 1988 and December 2003 were studied. RESULTS: Some 144 operations were analysed; 51 patients had critical ischaemia and 93 claudication. There was one postoperative death (0.7 per cent). Complications occurred within 30 days in 32 patients (22.2 per cent), including graft occlusion in three (2.1 per cent); six patients (4.2 per cent) required early reoperation. Primary patency for patients with critical ischaemia was 88, 82 and 74 per cent at 1, 3 and 5 years respectively. Respective figures for those who presented with claudication were 93, 92 and 90 per cent (P = 0.034). Late symptoms included graft occlusion (20 patients), disease progression (25), ongoing ulceration (six), graft infection (nine), false aneurysm formation (two) and late donor-site stenosis (two). CONCLUSION: When obtaining informed consent, simply describing patency and limb salvage rates does not provide an accurate picture of the outcome of femorofemoral grafting.

Aged↗

PubMed2005

Trauma calls: role of the general surgeon and CT scanning.

BACKGROUND AND OBJECTIVE: General surgeons are required in only a minority of trauma call cases to assess for abdominal injuries. Computed tomography (CT) accurately detects blunt abdominal injuries and may have replaced the need for general surgeons at trauma calls. This study evaluated the role of general surgeons at trauma calls and assessed use of CT in cases of suspected abdominal trauma. METHODS: (a) Eighteen month analysis of trauma calls at a district general hospital and (b) three month prospective study of all trauma cases presenting to A&E. RESULTS: (a) There were 73 trauma calls and the mechanism of injury in most cases was a road traffic accident (RTA). Most patients had orthopaedic and/or neurosurgical injuries. The general surgeons assessed 22 trauma call patients. Abdominal injury was excluded in 13 (four by clinical examination and nine following CT). (b) Forty three patients fulfilled the criteria for a trauma call and 14 trauma calls were made. The mechanism of injury in most was RTA and most had orthopaedic and/or neurosurgical injuries. The general surgeons assessed 10/43 potential trauma call patients, and abdominal injury was excluded in five (one by clinical examination and four following CT). CONCLUSION: A&E staff managed most trauma calls. Most patients did not require general surgical intervention. For penetrating injuries, presence of a general surgeon remained crucial. For blunt injuries CT was an important adjunct. These data suggest that general surgeons do not routinely have to attend all trauma calls but can be called if abdominal and/or vascular injuries are specifically suspected.

Abdominal Injuries↗

PubMed2005

Changes in the provision of vascular surgery in a single health region over 10 years.

INTRODUCTION: This study examines changes in vascular service provision and activity in a single UK health region over 10 years. PATIENTS AND METHODS: A questionnaire on involvement in vascular surgery was sent to all general surgeons in the Oxford region in 1992, 1997 and 2001. Data on involvement in vascular surgery were obtained from the Department of Health. RESULTS: Over 10 years the number of general surgeons not performing any emergency vascular (arterial) surgery rose from 33% to 65% (P = 0.002). There was also a fall in the number of general surgeons performing only emergency vascular surgery (P = 0.009). Trends were observed towards more vascular emergencies being transferred to another hospital (P = 0.068) and proportionally fewer general surgeons undertaking recurrent varicose vein surgery (P = 0.09). The number of vascular reconstructions was 20.8 per 100,000 population in 1990-1991, rising to 32.3 per 100,000 in 1997-1998 but falling to 27.2 per 100,000 by 1999-2000, the greatest increase in activity was seen in the regional centre. Endovascular procedures increased from 8.2 per 100,000 in 1990-1991 to 21.27 in 1995-1996 falling to 17.4 by 1999-2000. In the regional centre there was a fall of 57% in such procedures from 1996-1997 to 1999-2000. Over 10 years, the overall major amputation rate remained between 10-12 per 100,000. CONCLUSIONS: The changes reflect the gradual separation of vascular surgery from general surgery occurring nationally. They also suggest a more conservative approach in the management of certain vascular conditions.

Health Care Surveys↗

PubMed2005

Subintimal angioplasty for superficial femoral artery occlusion: poor patency in critical ischaemia.

INTRODUCTION: Subintimal angioplasty has been proposed for the treatment of long segment occlusive disease and for patients with critical limb ischaemia (CLI) with significant co-morbidity. There is no consensus as to short- and long-term patency. We present our experience with this technique. METHODS: Between 1995 and 2000, 43 consecutive patients (48 limbs) underwent subintimal angioplasty for superficial femoral artery occlusions. Outcome measures were haemodynamic and/or symptomatic patency. RESULTS: Technical success was achieved in 14/17 limbs with CLI (82%) and 30/31 (97%) with intermittent claudication (IC). There were 7 complications (15%), 6 occurring in the claudicant group. The median occlusion length was 10 cm for CLI and 6 cm for IC. Patency at 12 and 36 months, on an intention-to-treat basis, was 69% and 58% for claudicants and 25% and 25% for patients with CLI (P = 0.0005 and P = 0.0044, respectively). Following only technically successful procedures, 12-month patency was 72% (IC) and 31% (CLI) (P = 0.009). Patients with occlusions > or = 10 cm were more likely to re-occlude than those < 10 cm (12-month patency 60% versus 25%;P = 0.037). CONCLUSIONS: In this series, short- and long-term patency in patients with CLI is poor. Subintimal angioplasty in the treatment of CLI should be reserved for those patients not fit for surgical bypass.

Adult↗

PubMed2005

MRSA in lower limb amputation and the role of antibiotic prophylaxis.

AIM: Methicillin Resistant Staphylococcus Aureus (MRSA) colonisation is reported in 3-20% of vascular patients. Many develop infective complications. MRSA is associated with poor prognosis. Aim of the study is to assess MRSA in lower limb amputation and efficacy of antibiotic prophylaxis. METHODS: Prospective study of lower limb amputation. MRSA screen and wound swabs were taken at operation. Antibiotic prophylaxis included teicoplanin (400 mg) 1 dose at operation. RESULTS: Twenty-five patients underwent 33 primary amputations. At operation 15 legs (45%) were colonised with MRSA and 18 legs (58%) had active wound infection; MRSA (4) and other (14). Following surgery 3 patients died. Twenty-two legs (76%) had primary healing. Infection developed in 7 stumps (24%), MRSA (5) and Pseudomonas (2). Stump infection increased time to wound healing (p<0.0001). MRSA stump infection increased revision amputation (p=0.009) and duration of hospital stay (p<0.0074). MRSA wound infection at operation increased the risk of MRSA stump infection (p=0.007). Non-MRSA wound infection at operation was not associated with a worse outcome. No patient colonised with MRSA at operation developed postoperative MRSA stump infection. CONCLUSIONS: MRSA is more prevalent that previously reported. MRSA infection has a poor prognosis. Prophylaxis may be effective for patients colonised with MRSA.

Aged↗

PubMed2004

Results of thoracoscopic sympathectomy for the treatment of axillary and palmar hyperhidrosis with respect to compensatory hyperhidrosis and dry hands.

BACKGROUND: We examined the results of thoracoscopic sympathectomy (TS) for palmar and axillary hyperhidrosis with respect to operative method, symptom control, patient satisfaction and complications. METHODS: We performed a retrospective review of patient records with mail and telephone questionnaire follow-up of 55 patients (15 men) with a median age of 26 years (range, 15-52) who underwent TS between February 1994 and December 2001. RESULTS: There were no differences in complication rates between those having bilateral TS (n = 23) and those having unilateral procedures (n = 20) with a median follow-up of 21 months (range, 2-94). Forty-three patients returned questionnaires (response rate, 78%). Forty patients (93%) were satisfied with the results. Thirty-four patients (79%) noted compensatory hyperhidrosis and 22 (51%) excessively dry hands. CONCLUSION: Despite high rates of compensatory sweating, the majority of patients are very satisfied with the results. The high rate of excessively dry hands is a previously unreported finding and important to discuss when obtaining consent.

Adolescent↗

PubMed2004

Expansion rates of asymptomatic popliteal artery aneurysms.

OBJECTIVES: In the absence of symptoms the decision to operate on popliteal artery aneurysms (PA) is often made on PA diameter. Little information exists on growth rate and therefore optimum scanning intervals. The aim of this paper is to define growth rate of PA managed conservatively. METHODS: A prospective study of patients with asymptomatic PA was carried out. Patients were invited for ultrasound scanning at 6-12 months intervals. Diameter changes between consecutive pairs of scans were measured. A decision to operate was made in fit patients if PA became symptomatic and/or had a diameter above 3 cm. RESULTS: Twenty-one men (24 aneurysms) with a median age of 69 years (46-86) underwent 78 scans. Sixteen PA were on the right and eight on the left. Eighteen patients had bilateral aneurysms, 15 of which were complicated on one side at presentation and were dealt with surgically on that side. The median size at first scan was 19 mm (14-36). The median time interval to the first follow-up scan was 9 months and subsequent scans were 12 months. The mean rate of expansion at aneurysm sizes below 20 mm diameter was 1.5 mm/year. PA grew by 3.0 mm/year at sizes 20-30 mm and by 3.7 mm/year at sizes >30 mm. Among the risk factors analysed, hypertension appeared to increase the risk of aneurysm growth. CONCLUSION: The expansion rate of PA increases with increasing size of the PA. This rate of growth in relation to size at previous scan and threshold diameter for intervention should be borne in mind when planning surveillance intervals.

Aged↗

PubMed2004

Identification and characterization of a novel luciferase-like protein in the human female reproductive tract.

A novel cDNA was cloned from human endometrium, matching a human gene with the interim name KIAA1463. An mRNA identified by 5'-rapid amplification of cDNA ends was found to be 3349 nt in length. PCR analysis also identified another transcript of 6626 nt, with an open reading frame encoding a 900 amino acid protein. A fold recognition program identified similarity to firefly luciferase containing an AMP-binding motif; hence, we refer to the predicted protein as the AMP binding/luciferase-like protein (ALLP). ALLP mRNA and protein were expressed throughout the female reproductive tract with the highest levels found in the ovary and uterus. In situ hybridization and immunohistochemistry showed predominant localization of the ALLP mRNA/protein in endometrial glandular epithelium and within the theca and granulosa cells in the ovary. In the endometrium expression of ALLP, mRNA and protein were higher during d 16-21 of the secretory phase of the cycle. Western blot analysis showed decreased expression of ALLP in the postmenopausal endometrium, and hormone replacement therapy increased the expression of ALLP. Endometrial adenocarcinoma cell lines expressed more ALLP, compared with cultured primary endometrial cells or normal endometrial tissue. The ubiquitous expression of ALLP in reproductive and nonreproductive tissues suggests that this protein, which is probably regulated by ovarian steroids, plays an important metabolic role and may be involved in such processes as implantation and tumorigenesis.

Adenosine Monophosphate↗

PubMed2003

Natural history of the ectatic aorta.

OBJECTIVES: To define the natural history of ectatic abdominal aortas and to assess the clinical need for follow-up. DESIGN: Abdominal aortas were considered ectatic if they were diffusely and irregularly dilated with a diameter less than 3 cm. Ectatic aortas were identified either by AAA screening or as incidental findings. Patients who had only one scan were excluded from the study. Clinical data were analysed. SETTING: Two district general hospitals in Wales and England. SUBJECTS: 116 patients (90 men). RESULTS: : The median age of patients was 71 years (range 48-90). Co-existing risk factors included hypertension (75), IHD (22), PVD (8), diabetes (3), COAD (14), stroke (5), popliteal aneurysm (1), malignant disease (3) and 4 had a family history of AAA. The median follow-up was 24 months (range 5-72). The median and maximum growth rate of the ectatic aortas were 0.65 and 14.4 mm/year respectively. In three patients the expansion rate was more than 5 mm/year. In 22 patients the ectatic aorta became aneurysmal, reaching a diameter greater than 3 cm. There were no ruptures and no elective repairs. Two deaths occurred due to IHD. CONCLUSIONS: : This study demonstrates that if ectatic aortas do expand they do so very slowly. However, 22 of the 116 (19%) became aneurysmal in a follow-up of two years. Once identified ectatic aortas should be scanned at intervals of three years.

Aged↗

PubMed2003

A 1 year prospective study of management and outcome of patients presenting with critical lower limb ischaemia.

OBJECTIVES: to determine management of patients with critical lower limb ischaemia (CLI) from first presentation to investigation and treatment. DESIGN: prospective study of critical ischaemia patients. METHODS: one-year prospective survey (May 2000-May 2001). Follow-up 3-15 months. RESULTS: some 873 arterial cases presented, 134 patients had CLI. Of the latter 49% were men, 30% diabetic, the median age was 81 years. Only 15 (24%) of 62 cases were referred to outpatients as urgent. Patients waited a median of 25 days (range 1-100) to be seen in outpatients, and had symptoms for a median of 8 weeks. Treatment was conservative for 70 patients, and 11 primary amputations, six secondary amputations, and 62 revascularisation procedures (34 operative, 28 percutaneous transluminal angioplasty) were performed. At follow-up (3-15 months, median 9 months), rates of major amputation and death were 12 and 27% respectively. Significantly more diabetics underwent major amputation (p < 0.02) than non diabetics. Patients presenting with ulceration or gangrene were at greater risk of death than those with rest pain alone (p < 0.01). CONCLUSION: patients with CLI often have symptoms for many weeks before being seen by a specialist, and 76% are referred as non-urgent cases. This compares with patients with suspected malignant disease in the U.K. who are required to be seen within 2 weeks.

Adult↗

PubMed2003

The current role of intra-arterial thrombolysis.

BACKGROUND: the role of intra arterial thrombolysis (IAT) in the management of peripheral vascular disease has come under scrutiny. This study aims to assess current usage and indications for IAT in the U.K. METHOD: the use of IAT was assessed at our own centre and a questionnaire was sent to all centres that provide data for the U.K. "Thrombolysis Study Group". RESULTS: there has been a steady decline in the use of IAT at our centre from a peak of 40 cases per annum to zero. Response was received from 22 of 24 centres (92%). Nineteen (86%) reported a decline in IAT use. Main reasons were concerns over lack of efficacy (74%) and complication rate (63%). Most centres would use IAT for acute limb ischaemia (86%). However, for acute thrombosis in specific indications the results varied; synthetic graft (82%), vein graft (54%), supra-inguinal graft (54%) and thrombosed popliteal artery aneurysm (54%). When asked what their commonest usage for IAT was, the results again varied; acute limb ischaemia (40%), graft thrombosis (40%), embolism post radiological intervention (12%), other (8%). CONCLUSION: there has been a significant decrease in IAT use. Concerns exist as to efficacy and complication rate. There is no clear consensus on indications.

Acute Disease↗

PubMed2003

Protein inhibitor of nitric oxide synthase (NOS) and the N-methyl-D-aspartate receptor are expressed in the rat and mouse penile nerves and colocalize with penile neuronal NOS.

Nitrergic neurotransmission triggering penile erection is mediated by nitric oxide (NO) synthesized in the cavernosal nerves of the penis by penile neuronal NO synthase (PnNOS). In the central nervous system, nNOS is activated by the N-methyl-D-aspartate receptor (NMDAR) and, presumably, is inhibited by the protein inhibitor of NOS (PIN). The PnNOS and NMDAR are expressed in the penis, and PnNOS has been localized in penile nerves. Both proteins colocalize with PIN in the hypothalamus and the spinal cord involved in the control of erection. The present study aimed to elucidate the relationship between PnNOS, PIN, and NMDAR in the penis. It was found that in the rat, PIN was expressed in the pelvic ganglion and the cavernosal nerve, and penile PIN cDNA was cloned, sequenced, and expressed. Immunohistochemistry localized PIN to the cavernosal and dorsal nerve of the penis, whereas NMDAR was not detected in the latter. Dual-fluorescence labeling showed that PnNOS colocalized with PIN in both nerves but with NMDAR only in the cavernosal nerve. Aging did not affect the mRNA levels of PnNOS, nNOS, NMDAR, and PIN. Both PIN and NMDAR were detected in penile nerves of the wild-type and nNOS(-/-) mouse. The PIN protein did not inhibit or bind NOS in penile extracts, and in vivo, PIN cDNA reduced the erectile response to electrical field stimulation. In conclusion, PIN and NMDAR colocalize with PnNOS in penile nerves, but the functional significance of these protein interactions for penile erection remains to be elucidated.

Aging↗

PubMed2003

Variation in general practitioner referral of patients with arterial disease.

AIM: To compare patterns of referral for arterial disease in two areas in the UK. METHODS: A postal questionnaire was used to survey general practitioner (GP) referral patterns for arterial disease. Questionnaires were sent to West Berkshire GPs in 1993 and 2000 and to Llantrisant GPs in 2000. RESULTS: A 70-year-old man with claudication at half a mile and an 80-year-old man with claudication at half a mile or 100 m were significantly more likely to be referred (P < 0.001) in West Berkshire in 2000 compared with 1993. This referral change also applied to an 80-year-old man with an aortic aneurysm who was more likely to be referred in 2000 (P < 0.01). Patients with gradual onset of rest pain were more likely to be referred urgently or as an emergency in 2000 (P < 0.05). When comparing the two areas in 2000, significant differences emerged in the likelihood of referring patients with intermittent claudication. Scepticism continues towards the value of AAA screening in West Berkshire with only about two-thirds of GPs thinking that it was of value. On the other hand in Llantrisant, 94% of GPs thought AAA screening was valuable (P < 0.001). There was a significant decrease in the number of GPs who felt that they would refer patients directly to a regional vascular centre in West Berkshire between the two time periods (P < 0.001). There was a difference in likelihood of referral to regional centres between the two areas in 2000 (33% versus 6%, P < 0.001). CONCLUSIONS: Vascular referral patterns change with time and vary from one area to another. This has implications for planning vascular services.

Aged↗

PubMed2002

Antifibrotic role of inducible nitric oxide synthase.

Long-term treatment in rats with l-NAME, an isoform-non-specific inhibitor of nitric oxide synthase (NOS), leads to fibrosis of the heart and kidney, suggesting that nitric oxide (NO) may play a role in preventing tissue fibrosis. In this process, a likely target of NO is the quenching of reactive oxygen species (ROS) through peroxynitrite formation, and one possible source for this NO is inducible NOS (iNOS). Using Peyronie's disease (PD) tissue from both human specimens and from a rat model of PD as the source of fibrotic tissue, we investigated if NO derived from iNOS could act as such an antifibrogenic defense mechanism by determining whether: (a) tunical ROS and iNOS are increased in PD; and (b) the long-term inhibition of iNOS activity decreases the NO/ROS balance in the tunica albuginea thereby promoting collagen deposition. It was determined that in the human PD plaque, iNOS mRNA and protein, ROS, collagen, and the peroxynitrite marker, nitrotyrosine, were all increased in comparison to the normal tunica. In the rat model of PD, the fibrotic plaque also showed significant increases in iNOS mRNA and protein, nitrotyrosine, ROS as measured by heme oxygenase-1, and collagen when compared with the normal control tunica. When a selective inhibitor of iNOS, L-NIL, was given to rats with the PD-like plaque, this resulted in a decrease in nitrotyrosine levels but intensified ROS levels and collagen deposition. These data demonstrate that: (a) iNOS induction occurs in both the human and rat PD fibrotic plaque; and (b) that the NO derived from iNOS appears to counteract ROS formation and collagen deposition. Because the inhibition of iNOS activity leads to a decrease in the NO/ROS ratio, thereby favoring the development of fibrosis, it is proposed that iNOS induction in this tissue may be a protective mechanism against fibrosis and abnormal wound healing.

Animals↗