bluuebunny/crossref_metadata_2025_split huggingface dataset:
Platelet function during carotid endarterectomy and the antiplatelet effect of dextran 40
Authors: Robless P , Okonko D , Tegos T , Mansfield A , Stansby G 
Published: March 2003

Abstract

Background
Dextran 40 has been shown to reduce cerebral embolization following carotid endarterectomy (CEA). This study aimed to determine changes in platelet function during CEA and the antiplatelet effect of dextran 40.

Methods
Platelet function was measured by whole-blood flow cytometry in the peripheral arterial blood of patients during CEA and 24 h later. The binding index of P-selectin and PAC-1 expression were measured as markers of activation and aggregation. Patients were kept on aspirin 75–150 mg until the day of surgery and received an intravenous bolus of 5000 units unfractionated heparin before carotid artery clamping. High-intensity transient signals (HITS) in the ipsilateral middle cerebral artery were measured with transcranial Doppler (TCD) ultrasonography before, during and after operation. Results are presented as median (interquartile range) and statistical significance was determined using the Mann–Whitney U test.

Results
Thirty-eight patients undergoing CEA were studied. The P-selectin binding index rose significantly from incision (0·9 (0·2–2·7)) after carotid clamping (1·5 (0·6–3·6); P &lt; 0·01), clamp release (1·7 (0·3–3·0); P &lt; 0·01), 1 h after operation (1·5 (0·3–2·6); P &lt; 0·05) and 24 h after operation (1·3 (0·6–2·5); P &lt; 0·05). PAC-1 binding index increased from incision (0·4 (0·1–0·8)) after carotid clamping (2·0 (0·4–4·2); P &lt; 0·01) and clamp release (1·8 (0·3–2·9); P &lt; 0·05). TCD monitoring showed an increase in preoperative HITS per 30 min (2 (0–3)) during dissection (8 (1–15); P &lt; 0·05), after clamp release (16 (2–27); P &lt; 0·01) and during recovery (10 (2–29); P &lt; 0·01). After operation, patients with more than 50 HITS per 30 min were started on an infusion of dextran 40. Six patients had a dextran 40 infusion. The P-selectin binding index decreased from 1·6 (0·7–1·9) to 0·6 (0·3–1·5) 1 h after dextran (P &lt; 0·05) and 0·1 (0·1–0·2) 24 h after dextran (P &lt; 0·05). PAC-1 expression decreased from 0·4 (0·3–0·5) to 0·1 (0·1–0·1) 24 h after dextran (P &lt; 0·05).

Conclusion
Significant platelet activation and aggregation occurs during CEA despite the use of antiplatelet treatment. A simultaneous increase in HITS was demonstrated with TCD. Dextran 40 was shown to have an antiplatelet effect after CEA; this is further evidence that it may have a role in reducing thromboembolic complications.
Fifteen years of experience using 6 cm as a criterion for abdominal aortic aneurysm surgery
Authors: Scott R A P , Ashton H A , Lamparelli M J 
Published: March 2003

Abstract

Background
One criterion for abdominal aortic aneurysm (AAA) surgery in the authors' unit is aneurysm diameter of 6 cm. The impact of applying this criterion on surgical workload and rupture rate was analysed.

Methods
Some 584 consecutive patients with an AAA of 3 cm or greater presenting to this unit since 1984 have had the following criteria for considering surgery applied prospectively: a diameter of 6 cm, an expansion rate of more than 1 cm per year, or symptoms.

Results
Forty-three patients had an AAA of 6 cm or greater on initial presentation and would have been treated in the same way, if a smaller diameter was used. Sixty-eight patients had an AAA that expanded to 6 cm on observation with ultrasonography over the period of up to 15 years. The total number of patients with a 6-cm AAA was therefore 111. Of the 541 aneurysms that were under 6 cm at the initial scan, 454 were followed with ultrasonography. Some 343 reached 4 cm and 204 reached 5 cm. Operating at 5 cm therefore would have doubled the potential workload, and 4 cm would have tripled it. During the 15 years, 24 (4 per cent) of the 584 AAAs ruptured. Of these 24 patients, 12 were unfit for surgery, five declined operation or follow-up, the aneurysm ruptured beforehand in three who were booked for an operation or outpatient visit, and four failed to reach the operative criteria before rupture occurred. Rupture could therefore possibly have been prevented in seven (1 per cent) of the 584 by operating at a smaller diameter. The reported mortality rate for planned surgery is 2–8 per cent.

Conclusion
By using these criteria for surgery, the workload is cut by half or more and the consequent risk of rupture is lower than the mortality rate associated with planned surgery.
Scottish Audit of Surgical Mortality, 1997
Authors: Black D A , Stonebridge P A , Bradbury A W , Cross K S , Duncan J , McKay A J 
Published: March 2003

Abstract

Background
A national audit of surgical deaths can be seen as the final step in what has been termed the ‘journey of care’ for both the individual patient and for the population as a whole.

Methods
The Scottish Audit of Surgical Mortality (SASM) examines all hospital deaths in Scotland occurring while under the care of a surgical specialist and all deaths within 30 days of an operation.

Results
Compliance for the completion of forms relating to vascular deaths during the first 4 years of the SASM (1994–1997) has remained over 92 per cent. In 1997 the compliance was 97 per cent. These figures compare favourably with the other surgical specialties where the overall compliance for 1997 was 92 per cent. Some 14 per cent of the 4408 deaths reported in 1997 occurred in patients admitted with vascular disease, the majority (83 per cent) being emergency admissions. Of these 507 vascular deaths, 293 were postoperative; the remaining 214 patients did not undergo operation. This represents an improvement over the years 1994–1996 when vascular deaths numbered 554, 573 and 524 respectively. The mean age of the patients who died from vascular disease in 1997 was 73 (range 19–92) years. A consultant surgeon made the decision to operate in 98 per cent of the patients with vascular disease who died at operation and was the principal surgeon in 70 per cent of cases. Vascular consultants carried out a higher percentage of operations than their counterparts in other surgical specialties (general surgery, 63 per cent; mean for other subspecialties, 60 per cent). In the non-operative group of vascular deaths in 1997, a vascular consultant was in charge in 66 per cent of cases; the figure for operated cases was 87 per cent. Adverse factors were believed to contribute to death in 10 per cent of cases, but were considered a direct cause of death in fewer than 1 per cent.

Conclusion
These figures reflect the high quality of vascular services in Scotland, where there is a considerable consultant presence in the management of high-risk patients. This consultant involvement is higher than in other subspecialties and, bearing in mind the high percentage of emergencies, has significant resource implications for the delivery of vascular services.
RETA: the registry of endovascular treatment of abdominal aortic aneurysms
Authors: Thomas S M , Gaines P A , Beard J D 
Published: March 2003

Abstract

Background
RETA is a voluntary registry within the UK established as a joint venture between radiologists and surgeons. The aim is to evaluate carefully the endovascular treatment of abdominal aortic aneurysms during introduction into clinical practice.

Methods
Some 367 patients have been included in the registry from 23 centres since its inception on 1 January 1996. In the majority (82 per cent) an elective repair was performed for an asymptomatic aneurysm. The mean age of the patients was 71·9 years and 28 per cent were deemed unsuitable for conventional repair. One hundred and ninety-nine bifurcated (54 per cent), 18 tube (5 per cent) and 148 aortouni-iliac with crossover (40 per cent) stent graft types were placed.

Results
At the end of the procedure 77 per cent of aneurysms were excluded with no complications. Twenty-one patients (6 per cent) required conversion to open repair. Forty-four (12 per cent) required additional endovascular procedures. At 30 days 87 per cent of the aneurysms were excluded or repaired. The 30-day mortality rate was 7 per cent (n = 24) with a significant improvement between 1996 and 1997, from 11 to 4 per cent. There were 25 persistent leaks (7 per cent). The death rate was related to the fitness of patient, device used and requirement for conversion. One-year follow-up data are available for 140 patients. There have been 13 deaths (9 per cent), three ruptures (2 per cent) and some form of complication in 20 per cent of cases overall.

Conclusion
Improving results have been demonstrated for the primary procedure. At present there is a relatively high complication rate and ruptures have occurred. Rigorous continued follow-up is required.
Laparoscopic bile duct injuries: a single-institution experience spanning 8 years
Authors: Mudan S S , Reddy K M , Knight M J 
Published: March 2003

Abstract

Background
This audit represents the authors' experience in the management of 42 bile duct injuries following laparoscopic cholecystectomy and is the largest series reported so far in the UK.

Methods
Between November 1990 and May 1998, 42 patients were referred for management of bile duct injury following laparoscopic cholecystectomy. The case notes of all patients were reviewed and follow-up information was obtained to provide a 100 per cent follow-up rate. Aspects of the cholecystectomy, presentation, investigation, definitive treatment and follow-up are discussed.

Results
The referral source was 25 surgeons from 17 different hospitals. The incidence peaked in 1992 (ten cases) and has been stable at four referrals per year over the past 4 years. The median age was 56 years and the M: F ratio 10: 32. Thirty-five laparoscopic operations were performed by consultants and seven by trainees. Intraoperative cholangiography was performed in three. Seventeen operations were converted to an open procedure because of intraoperative difficulty. Injury was noted at operation in nine and an immediate restorative procedure was attempted. Twelve patients had had a reconstructive procedure before referral to this unit and the remainder were referred with a fresh injury. Patients in whom the bile duct was transected (n = 34) presented mostly with jaundice; those with minor injuries not involving the common duct (n = 8) presented with peritonitis. Thirty patients required operation; 25 underwent hepaticojejunostomy reconstruction, two needed revision of a previous biliary–enteric anastomosis, two had primary bile duct repair over a T tube and one required relaparoscopy to clip a leaking cystic duct. At a median of 12 months four patients who had had a reconstruction were symptomatic for cholangitis. Percutaneous transhepatic dilatation was successful in two and a further two required revision of the anastomosis. Another four patients had asymptomatic stenosis and were treated successfully by a single episode of dilatation. Follow-up showed all patients to be asymptomatic at a median follow-up of 42 months; however, six had a raised level of alkaline phosphatase. The remaining patients were managed successfully by therapeutic endoscopic retrograde cholangiopancreatography or percutaneous transhepatic cholangiography. The overall median hospital stay was 18 days. Perioperative complications were seen in nine patients with no procedure-related deaths.

Conclusion
Although the initial learning curve seems to have been overcome, a steady state of problems now exists and seems likely to continue. Best results were obtained by hepaticojejunostomy. Most postrepair strictures were dealt with without operation.
Diagnosis and staging of pancreatic carcinoma: comparison of manganofodipir trisodium-enhanced magnetic resonance imaging and dynamic contrast-enhanced spiral computed tomography
Authors: King L J , Bell J R G , Healy J C , Amin Z , Predolac D , Wotherspoon A , Thompson J 
Published: March 2003

Abstract

Background
The efficacy of manganofodipir trisodium (MnDPDP)-enhanced magnetic resonance imaging (MRI) and dual-phase dynamic contrast-enhanced spiral computed tomography (CT) in the diagnosis and staging of pancreatic carcinoma was compared.

Methods
Nineteen patients (eight men) aged 50–84 (mean 64) years with known or suspected pancreatic carcinoma were prospectively evaluated with MRI and CT. Precontrast T1 and T2 MRI sequences were supplemented by axial and coronal T1 images at 1·0 T, 20 min and 24 h following intravenous infusion of MnDPDP 0·5 ml/kg. Spiral CT was performed before contrast and dynamically after contrast during the pancreatic and portal venous phases of enhancement. The MRI and CT images were assessed independently by two observers blinded to the results of the other modality. The presence, site and size of any focal pancreatic mass were recorded and potential resectability was assessed by evaluating extraglandular extension, vascular involvement, lymphadenopathy, peritoneal spread and presence of hepatic metastases. Findings on MRI and CT were compared with the findings at surgery.

Results
Pancreatic adenocarcinomas were diagnosed histologically in 15 of 19 patients. MRI and CT each identified all of the proven malignancies. Clear evidence of irresectability with liver metastases or vascular invasion was identified in six of 15 patients at MRI, who did not therefore go on to surgery. In one of these six patients the CT findings were equivocal. Nine of the 15 patients went on to laparoscopy (n = 2) or laparotomy (n = 7). Of␣these nine patients seven were correctly assessed as resectable or␣irresectable on MRI and six by CT. The overall accuracy for assessing resectability was therefore 87 per cent for MRI and 73 per cent for CT. Liver metastases were confidently identified in three of 15 patients on both MRI and CT. Two patients with indeterminate liver lesions on CT were shown to have only benign liver lesions (cysts or haemangiomas) on MRI.

Conclusion
MnDPDP-enhanced MRI performed slightly better than dual-phase dynamic contrast-enhanced CT in the preoperative assessment of pancreatic tumour resectability. MRI also appears to offer an advantage in the evaluation of associated focal liver lesions.
Transmural endoscopic drainage of pancreatic pseudocysts
Authors: Beckingham I J , Krige J E J , Bornman P C , Terblanche J 
Published: March 2003

Abstract

Background
Pancreatic pseudocysts requiring treatment for pain or obstructive symptoms may be drained by percutaneous or open surgical techniques. Endoscopic drainage has been reported in a few small series with short-term follow-up. The aim of this study was to determine the indications and success rates of transmural endoscopic drainage procedures.

Methods
All patients who presented over a 2-year period to a tertiary referral centre with pancreatic pseudocysts were included in the study. Endoscopic drainage was attempted using a side-viewing endoscope in patients with pseudocysts bulging into the stomach or duodenal lumen. Outcome measures were successful drainage of the pseudocyst, complication and recurrence rates.

Results
Sixty-six patients presented with pseudocysts of which 34 were thought to be suitable for endoscopic drainage. Twenty-four were successfully drained. Failures were associated with thick-walled pseudocysts (greater than 1 cm), location in the tail of the pancreas and pseudocysts associated with acute necrotizing pancreatitis. There were no deaths and only one patient required emergency surgery for bleeding from the pseudocyst wall. There were three recurrences with a median of 41 (interquartile range 3–51) months of follow-up, two of which were successfully redrained endoscopically. The long-term success rate of the initial procedure was 62 per cent.

Conclusion
Transmural endoscopic drainage is a safe procedure with minimal complications, although surgical facilities must be available. It should be the procedure of choice for pseudocysts associated with chronic pancreatitis or trauma, with a wall thickness of less than 1 cm and a visible bulge into the gastrointestinal lumen. Applying these criteria to the 66 consecutive patients with pancreatic pseudocysts presenting over this initial 2-year study period, 26 (39 per cent) were suitable for the procedure. Technical success was achieved in 24 of the 26 patients and long-term success in 22.
Role of biliary scintiscan in predicting the need for cholangiography
Authors: Mathur S K , Soonawalla Z F , Shah S R , Goel M , Shikare S 
Published: March 2003

Abstract

Background
Currently used predictors for bile duct calculi in patients undergoing cholecystectomy have low specificity resulting in unnecessary cholangiograms being performed. The role of biliary scintiscan in predicting the presence of bile duct calculi was assessed.

Methods
Seventy-five patients with symptomatic gallstone disease were studied prospectively regarding the value of a history of jaundice or acute pancreatitis, raised serum bilirubin and serum alkaline phosphatase levels, and visualization of stones or presence of dilated bile ducts on ultrasonography (standard criteria) in detecting bile duct calculi. Results of biliary scintiscan were evaluated against a combination of standard criteria. The ‘gold standard’ for evaluation was endoscopic or peroperative cholangiography.

Results
Biliary scintiscan had a higher sensitivity and specificity (93 and 94 per cent) than a combination of the above standard and modified predictors for biliary calculi (89 and 71 per cent). A combination of ultrasonography and selective use of scintiscan, in the absence of bile duct dilatation only, had higher values (96 and 98 per cent).

Conclusion
A combination of ultrasonography and biliary scintiscan can accurately predict bile duct calculi and could be used as a guide for selective cholangiography.
Abdominal content containment: practicalities and outcome
Authors: Ghimenton F , Thomson S R , Muckart D J J , Burrows R 
Published: March 2003

Abstract

Background
Alternatives to fascial closure of the abdominal wall are increasingly used in critically ill patients. They pose practical and logistical problems in management which are described in this single-institution study.

Methods
Between January 1994 and December 1997, 157 predominantly young male patients (100 trauma and 57 non-trauma) underwent temporary abdominal content containment (t-ACC) using plastic bags or polyglactin mesh. Indications for t-ACC were severe sepsis requiring reoperation, abdominal compartment syndrome, abdominal wall tissue loss or a combination of these. A total of 385 laparotomies were performed.

Results
Two t-ACC procedures failed owing to technical error and two were complicated by enteric fistulas. Six patients underwent early definitive abdominal closure within 15 days. The remaining survivors had a protracted hospital stay (mean(s.d.) 44·6(26·6) days) and all developed incisional hernias which were challenging to repair. The overall mortality rate was 44 per cent.

Conclusion
Plastic bags were cheaper and as effective as polyglactin mesh for t-ACC. Survivors require a multidisciplinary approach in management, undergo a protracted hospital stay and later need complex incisional hernia repairs.
Evaluation of Delorme's procedure as a treatment for full-thickness rectal prolapse
Authors: Watts A M I , Thompson M R 
Published: March 2003

Abstract

Background
Delorme's procedure is a well tolerated perineal operation for full-thickness rectal prolapse. However, prolapse recurrence is common and reported recurrence rates vary widely. This study attempted to standardize outcome assessment for recurrence following primary and subsequent Delorme's operations. Patient and operative factors were analysed to identify any that might improve patient selection.

Methods
Some 101 primary and 17 secondary Delorme's procedures were carried out on 113 consecutive patients presenting with rectal prolapse, who were followed for a minimum of 12 months, unless death or recurrent prolapse intervened. The rate of prolapse recurrence was calculated using the Kaplan–Meier method of analysis. Patient age, sex, grade of incontinence, presence of diverticular disease, length of mucosal resection and position in the operative series were analysed to identify factors affecting recurrence.

Results
The predicted recurrence-free period for 50 per cent of patients undergoing primary and secondary Delorme's procedures was 91 (95 per cent confidence interval 77–105) and 27 (15–39) months respectively. None of the patient or operative factors analysed was related to recurrent prolapse.

Conclusion
Delorme's procedure is a simple operation with satisfactory functional results which can be considered in all patients of all ages. However, high recurrence rates for primary and repeat operations should be explained to patients when planning their surgical management.
Spontaneous carotid artery aneurysms
Authors: Nair R , Robbs J V , Naidoo N G 
Published: March 2003

Abstract

Background
Spontaneous carotid artery aneurysms are infrequently reported, and are almost always non-atherosclerotic.

Methods
The records of 29 patients with a spontaneous carotid aneurysm treated in an academic vascular unit between 1990 and 1998 were reviewed.

Results
All 29 patients were black South Africans; three had bilateral aneurysms. There were 24 men and five women, of mean age 35 (range 13–62) years. Some 25 aneurysms involved the common carotid artery, 12 of which affected the bifurcation, and seven were located in the internal carotid artery. Twenty-five aneurysms were managed surgically, four of which were ligated owing to sepsis. Histological evaluation showed human immunodeficiency virus-related arteritis in four, tuberculous aneurysms in ten, Takayasu's arteritis in two, atherosclerosis in three and non-specific chronic inflammation in four patients. Microbiological examination was negative in all but one patient who had Salmonella sp. cultured. Outcome was generally favourable, but one patient died from massive hemispheric infarction. There were no other new neurological deficits.

Conclusion
Carotid aneurysms pose a considerable surgical challenge but are amenable to operative intervention with good result. Ligation appears to be well tolerated in this group of predominantly non-atherosclerotic aneurysms.
Gunshot injuries of the popliteal artery
Authors: Nair R , Abdool-Carrim A T O , Robbs J V 
Published: March 2003

Abstract

Background
Guidelines for the management of popliteal artery trauma emanate mainly from military experience. This study was undertaken to describe the management of popliteal injuries in a civilian vascular surgical unit with a large trauma workload.

Methods
A retrospective review of records of patients treated between 1983 and 1997 was undertaken.

Results
Some 117 popliteal artery gunshot injuries were treated (83 low velocity, 16 high velocity, 18 shotgun). Associated fractures occurred in 44 patients and 40 had popliteal vein injuries. Treatment of the arterial injury included vein graft interposition in 71, primary reanastomosis in 19, prosthetic graft interposition in four, lateral suture in one, vein patch in one and ligation in one patient; 84 fasciotomies were performed. No perioperative deaths occurred. There were 20 primary and 14 secondary amputations. Factors associated with amputation were high-velocity injuries, delay in revascularization in excess of 7 h, arterial transection, associated fracture, and compartment syndrome or muscle infarction.

Conclusion
Civilian popliteal gunshot injuries are attended by a high amputation rate. Prompt resuscitation and revascularization appear to be the only correctable factors that may improve limb salvage rates.