bluuebunny/crossref_metadata_2025_split huggingface dataset:
Surgery for venous insufficiency: are venous function tests necessary?
Authors: Bhowmick A , Picton A , McCollum C N 
Published: March 2003

Abstract

Background
The role of duplex imaging and measurement of ambulatory venous pressure (AVP) in the preoperative assessment of patients with venous insufficiency (VI) and primary varicose veins (VV) was investigated.

Methods
Venous incompetence was confirmed by duplex imaging in 58 legs: 38 had VI, demonstrated by eczema, oedema or pigmentation, and 20 had VV and normal skin. AVP was measured from a cannulated dorsal foot vein before and after ten tip-toe exercises. This was repeated following occlusion of the superficial veins by narrow tourniquets. Pressure relief index (PRI) was calculated as the fall in AVP in calf exercise × 90 per cent refilling time in seconds. The criterion for superficial vein surgery was doubling of PRI on superficial vein occlusion.

Results
Superficial venous incompetence (SVI) was confirmed in all legs with duplex imaging. Deep vein incompetence (DVI) was found in 17 legs (45 per cent) with VI and in two (10 per cent) of the VV legs (P = 0·012, χ2 test). Venous function was normal (PRI greater than 1000) in six. Median PRI in patients with VI and VV was 177 and 289, rising to 717 and 1026 respectively after superficial vein occlusion. Initial PRI was significantly lower in patients with DVI (P &lt; 0·001). PRI improved by 135 per cent in SVI and by 318 per cent in legs with DVI (P = 0·01). PRI did not double following superficial venous occlusion in 20 legs (35 per cent) with SVI and in three (16 per cent) with deep incompetence (P = 0·01).

Conclusion
Clinical examination and duplex imaging alone cannot predict who will benefit most from superficial venous surgery. AVP measurement rationalizes decision-making and may avoid unnecessary operations.
Association between hyperhomocysteinaemia and abdominal aortic aneurysm
Authors: Caldwell S , Burns P , Haggart P , Bradbury A W , Mosquera D A 
Published: March 2003

Abstract

Background
Hyperhomocysteinaemia is associated with occlusive vascular disease. In vitro evidence has demonstrated the induction of a serine elastase by homocysteine in vascular smooth muscle. Anecdotal evidence from case reports and post-mortem studies has suggested an association with abdominal aortic aneurysm (AAA). The aim was to determine the prevalence of hyperhomocysteinaemia in patients with AAA.

Methods
Some 120 subjects (60 controls and 60 patients with AAA) were studied prospectively. Epidemiological, clinical and haematological data were collected. Patients were defined as having AAA if ultrasonographic measurement of the aorta was greater than 4·5 cm. Those with evidence of occlusive peripheral vascular disease or an ankle: brachial pressure index lower than 0·8 were excluded. Homocysteine was measured with a commercial high-pressure liquid chromatography analyser. The reference range from age-matched controls was 8·9–14·3 µmol l−1.

Results
The median(s.d.) value of homocysteine for patients was significantly higher than that for the control group: 13·1(7·88) versus 10·9(5·07) µmol l−1 (P = 0·03, Mann–Whitney U test). Hyperhomocysteinaemia (homocysteine concentration greater than 14·3 µu;mol l−1) was present in 48 per cent of patients with AAA, compared with 24 per cent of the control population (P &lt; 0·01, χ2 test). There were no significant differences between groups with regard to age, folate levels, vitamin B12 concentration or renal function.

Conclusion
These results strongly suggest an association between hyperhomocysteinaemia and AAA. If studies currently ongoing demonstrate a causal relationship between hyperhomocysteinaemia and vascular disease progression, it raises the possibility of treating small aneurysms with vitamin supplementation to slow their growth.
P-selectin deficiency is protective against remote organ injury in a model of ruptured abdominal aortic aneurysm
Authors: Stewart J B , Norman K E , John A E , Chan P , Hellewell P G 
Published: March 2003

Abstract

Background
Multisystem organ failure (MSOF) accounts for 50–60 per cent of postoperative deaths following repair of ruptured abdominal aortic aneurysm (AAA). A murine model is described in which the combined insults of hypotension and aortic clamping reproduce the physiological changes during repair of ruptured AAA. The resulting remote organ injury (the hallmark of MSOF) is prevented in the absence of the adhesion molecule P-selectin, which mediates neutrophil–endothelial interaction.

Methods
C57BL6 wild-type mice (n = 4) and mice constitutively unable to express P-selectin (P–/–) (n = 4) were subjected to 60 min of controlled hypotension followed by cross-clamping of the infrarenal aorta for 60 min, reinfusion of shed blood and then 60 min of reperfusion. Controls (n = 16) were sham-operated, had hypotension only or clamp/reperfusion only. Lungs and kidneys were harvested and assayed for the neutrophil-specific marker myeloperoxidase (MPO), which indicates inflammatory infiltrate in the tissue.

Results
MPO levels in the organs of C57BL6 mice subjected to hypotension and aortic clamping were 50 times greater than those in sham-operated mice. MPO levels in sham-operated P–/– animals were similar to those in sham-operated C57BL6 mice. MPO levels in the lungs and kidneys of P–/– mice subjected to hypotension and aortic clamping were unchanged from those in sham-operated P–/– mice.

Conclusion
The combined effects of hypotension and infrarenal aortic clamping, followed by reperfusion, are synergistic. This gives rise to a profound early inflammatory reaction in tissues remote from the site of ischaemia–reperfusion, which is likely to contribute towards clinical MSOF after ruptured AAA repair. Absence of the adhesion molecule P-selectin protects against this remote organ injury.
Renal disease, age and outcome after aortic aneursym repair
Authors: Refson J , Wilmink T , Kerle M , Pillay W , Mansfield A , Cheshire N J W , Wolfe J H N 
Published: March 2003

Abstract

Background
The safety of conventional aneurysm repair is undergoing increased scrutiny as less invasive methods are developed, certain high-risk groups identified and the evidence for the risk of rupture is refined. An understanding of the relationship between preoperative risk factors and outcome is particularly important in elderly patients requiring a prophylactic operation.

Methods
Risk factors (extent of aneurysm, ischaemic heart disease, renal function, hypertension, diabetes, serum cholesterol concentration, age and sex) were studied in 393 consecutive patients undergoing elective juxtarenal and infrarenal aneurysm repair between 1993 and 1999 (inclusive), and were related to hospital mortality.

Results
The overall mortality rate was 5·1 per cent (20 of 393). Multivariate logistic regression analysis revealed that age and creatinine concentration were independent risk factors for in-hospital mortality. Extent of aneurysm was not an independent risk factor, nor was a history of myocardial ischaemia, sex, hypertension, diabetes or serum cholesterol level. The comparative risk related to age and serum creatinine concentration is shown in the Table.
Creatinine level had no influence on outcome in patients aged under 70 years. However, in those over 70 years of age, an increase in creatinine concentration of 10 μmol l−1 increased the relative risk by 0·1 (95 per cent c.i. 0·01–0·18). Increasing age by 10 years increased the relative risk by 1·5 (95 per cent c.i. 0·6–2·4).

Conclusion
Advances in preoperative and perioperative care appear to have reduced the significance of ischaemic heart disease and juxtarenal repair so that age and renal disease are currently major determinants of survival. In aneurysms of less than 7 cm in diameter, where the risk of rupture is less than 10 per cent per year, the natural history of the disease in elderly patients with renal failure appears to be more benign than the treatment.
Randomized prospective comparison of postoperative pain control and respiratory complications following midline or transverse laparotomy for aortic surgery
Authors: Tekkis P P , Krysa J , Chan S , Challiner A , South L M , Andrews S M 
Published: March 2003

Abstract

Background
Transverse abdominal incisions are thought to be less painful and followed by fewer pulmonary complications than midline incisions, but reports remain controversial. This study compared midline and transverse incisions for elective transabdominal aortic aneurysm repair with respect to postoperative pain, respiratory function and pulmonary complications.

Methods
Sixty patients were randomized to midline laparotomy and transverse incisions, and evaluated before and after operation for 7 days at regular intervals. Analgesia was provided via a thoracic epidural and pain scores were recorded by means of a visual analogue scale. Respiratory function (peak expiratory flow rate, forced expiratory volume in 1 s and forced vital capacity) and pulmonary complications were monitored as well as patient characteristics, operating time, blood loss, operative exposure, and length of stay on the intensive care unit (ITU) and in hospital.

Results
The two groups included a similar number of patients (n = 30 per group) and basic characteristics such as age and preoperative risk factors. Linear analogue pain scores were significantly lower in the transverse group of patients (P &lt; 0·001). There was no significant difference between the two groups with regard to postoperative ventilatory function and respiratory complications as well as analgesic requirements, operating time, blood loss, and length of ITU and hospital stay.

Conclusion
The direction of incision does not seem to influence the incidence of respiratory complications. However, a transverse incision in combination with a high epidural analgesia seems to offer better postoperative pain control.
Risk assessment and outcome in endoluminal aortic aneursym repair: effect of the learning curve
Authors: Chataway A , Brown V , Brabdner B , Barnard B , Baranowsky A , Raphael M , Brooks J , Adiseshiah M 
Published: March 2003

Abstract

Background
The aim was to investigate the effect of risk categorization on outcome from endoluminal aneurysm repair (ER) and to note changes in outcome with increasing experience.

Methods
Clinical and operative details of the first 70 patients undergoing ER (1995–1999) were analysed. American Society of Anesthesiologists (ASA) grade and POSSUM (Physiological and Operative Severity Score for the enUmeration of Mortality and morbidity) score were determined. The cohort was divided arbitrarily into two groups: group 1 included the first 35 patients, and group 2 the second 35.

Results
Median age was 73 (55–93) years; 65 of the patients were men. The overall 30-day mortality rate was seven of 70 (10 per cent). No deaths were directly attributable to the anaesthesia; four deaths were due to myocardial infarction. There was no difference in ASA grade or POSSUM score between the groups. Fourteen patients (20 per cent) were converted to open surgery, nine during the same period of anaesthesia as the ER.
The odds ratio (OR) for conversion comparing groups 1 and 2 was significant, but the OR for total mortality and for mortality in those who had successful ER was not significant.

Conclusion
ASA grading and POSSUM scoring has not changed with time. There was a learning curve, due largely to improvement in surgical technique. Four of the 14 patients undergoing conversion died; only one conversion occurred in the later experience. However, there was no statistically significant difference in total or ER mortality.
Endothelial integrity and nitric oxide synthase sources are better maintained in saphenous vein harvested by a ‘no-touch’ technique
Authors: Tsui J , Souza D , Filbey D , Bomfim V , Baker D , Dashwood M 
Published: March 2003

Abstract

Background
The saphenous vein (SV) is a commonly used conduit in bypass procedures. Early graft occlusion rates are greater than 20 per cent in both infrainguinal vein grafts and coronary artery bypass grafts (CABGs). Contributing factors include adventitial and endothelial damage, which may reduce nitric oxide availability in grafts. Nitric oxide has important vasorelaxant and thromboresistant properties beneficial to graft patency. Conventionally, during SV harvest, the perivascular tissue is stripped and the graft distended. A ‘no-touch’ technique has been described in which the SV is harvested together with a cushion of surrounding tissue without vein distension. This study compared endothelial integrity and the potential role of nitric oxide synthase (NOS) in segments of SV harvested by the two techniques.

Methods
SV was harvested from ten patients undergoing CABG. Distal and proximal ends of the SV were harvested using the no-touch technique, while the middle portion was stripped of the adventitia and distended. Sections of SV were cut and endothelial integrity was assessed with CD31 immunohistochemistry and quantified by morphometric analysis. Putative NOS was identified by reduced nicotinamide adenine dinucleotide phosphate (NADPH)–diaphorase histochemistry and autoradiographic localization of [3H]l-NG-nitroarginine binding.

Results
More dense CD31 staining was seen on the luminal aspect and vasa vasorum of vessels harvested by the no-touch technique. Morphometric analysis revealed a significant reduction in luminal CD31 staining in conventional compared with no-touch grafts (P &lt; 0·05, Student's t test). NADPH staining was almost continuous on the luminal aspect, and was also present in the adventitia of no-touch vessels, compared with poor staining of conventionally harvested vessels. The pattern of NADPH staining corresponded to endothelial cells lining the vessel lumen as well as vasa vasorum and paravascular nerves in the adventitia. Autoradiographic analysis of specific [3H]nitroarginine binding also showed greater binding in the no-touch vessels.

Conclusion
Endothelial integrity is better maintained by the no-touch technique. NOS sources on the endothelium and adventitia are preserved, suggesting that nitric oxide availability is retained by these grafts. This technique may therefore lead to improved early patency rates of SV grafts in bypass surgery.
Radiological intervention to the iliac segments for patients with claudication and coexistent significant infrainguinal disease
Authors: Phillips D , Handa A , Phillips-Hughes J , Boardman P , Perkins J , Hands L , Collin J 
Published: March 2003

Abstract

Background
The policy with regard to patients with lifestyle-limiting intermittent claudication is to investigate with duplex ultrasonography and then to treat suitable lesions in the aortoiliac system with balloon angioplasty with or without stenting. In those with coexistent infrainguinal disease, further management is conservative. The aim of this study was to assess the outcome of iliac intervention in this group of patients.

Methods
Over 30 months 600 patients with intermittent claudication were assessed; 110 subsequently underwent balloon angioplasty (87 aortoiliac and 23 infrainguinal). Of those undergoing aortoiliac angioplasty 47 also had significant infrainguinal disease. These 47 had a median claudication distance of 80 m and median maximum walking distance 180 m. They underwent angioplasty of 61 arterial segments (one aorta, 32 common iliac, 28 external iliac), with 11 stents deployed in eight patients. There were no immediate complications and a technically satisfactory result was obtained in all but one patient. All patients were reassessed at 6 weeks.

Results
The Table gives the findings at 6 weeks.
Fifteen patients (32 per cent) had a pain-free walking distance greater than 450 m and a further two were limited by angina rather than claudication. Overall the 47 patients had a median claudication distance of 270 m and median maximum walking distance of 420 m.

Conclusion
Even in the presence of significant infrainguinal disease, angioplasty in the aortoiliac segments at least doubles the claudication distance in 70 per cent of patients, and appears to be safe. Radiological intervention in these patients is worthwhile.
Treatment of the hostile groin: 5-year follow-up of the obturator foramen bypass
Authors: Coker J , Sobeh M S , Grahn M , Chaloner E J , Ham R J 
Published: March 2003

Abstract

Background
Infection in the groin threatens both life and limb. In recent times virulent organisms, especially methicillin-resistant staphylococci, have proved difficult to treat. The obturator foramen bypass, although performed infrequently, represents an extra-anatomical solution to the ‘hostile groin’. The aim of the study was to examine the primary and secondary graft patency rates in 26 patients (28 procedures) performed in one hospital over 10 years.

Methods
There were 17 men and nine women with mean age of 65 (range 49–78) years. All procedures except one were performed with expanded polytetrafluoroethylene (6 mm in 24 patients; 8 mm in three). Twenty-one patients had critical ischaemia with rest pain or tissue loss. The inflow vessel was the common iliac artery in 25 patients and the lower abdominal aorta in three. The distal anastomosis was to the profunda in two grafts, to the suprageniculate popliteal artery in 24 grafts and to the infrageniculate popliteal in two.

Results
Patency rates were calculated with the Kaplan–Meier life-table method.
There were nine primary failures (five in the first year and the remaining four between 2 and 5 years). All failed bypasses were re-explored. Three of nine bypasses required intraoperative angioplasty of the inflow, and one graft had angioplasty of the distal anastomosis. Six patients eventually had amputations, four above knee and two below knee, one of whom had a patent graft.

Conclusion
The obturator foramen bypass, although technically demanding, is a viable solution in the individual with groin sepsis and ischaemia. Frequently these patients have good calibre vessels above and below the problem groin.
Vein interposition grafting is a safe and durable method of repairing carotid arteries that are not suitable for standard endarterectomy
Authors: Lauder C , Naylor A R , Hayes P 
Published: March 2003

Abstract

Background
Standard carotid endarterectomy (CEA) and patch angioplasty is an effective method of reducing the risk of stroke associated with carotid atherosclerosis. If the posterior wall of the carotid artery becomes excessively thinned following endarterectomy, or the vessel is exceptionally tortuous, this standard approach to repair is not always appropriate. A different approach may also be necessary when an existing carotid patch becomes infected. In a number of these cases the authors have utilized a vein interposition graft to repair the vessel. This study examined the safety and durability of this procedure.

Methods
During the 5-year study, a standard operative protocol was followed including routine shunting and peri-operative monitoring. All data were collected prospectively. Long saphenous vein harvested from the groin was used as a graft. Patients were entered into a regular duplex graft surveillance programme.

Results
Forty patients had a vein graft inserted (4·3 per cent of all CEAs performed). Age, sex and presentation were not significantly different from those in patients undergoing routine CEA. There were no vein graft ruptures or deaths. The 30-day any stroke or death rate was 5 per cent. The operation was not significantly lengthened relative to standard CEA. The median length of follow-up was 29 (range 4–48) months. Five patients required subsequent angioplasty to treat stenosis in the graft of more than 70 per cent; this is significantly higher than with standard CEA (P &lt; 0·001). One patient developed an asymptomatic occlusion. At 1-year follow-up, 11 per cent of patients had a stenosis greater than 70 per cent, and at 2 years this was 6 per cent.

Conclusion
Interposition vein grafts can be used safely to repair the carotid artery when the standard technique does not appear appropriate. There is an increased rate of restenosis in this group and patients therefore require regular duplex surveillance of the graft.
Causes of re-recurrence after polytetrafluoroethylene patch saphenoplasty for recurrent varicose veins (Br J Surg 2000; 87: 1356–60)
Authors: Chandrasekar T S , Balasubramanian S P 
Published: March 2003

Abstract
The Editors welcome topical correspondence from readers relating to articles published in the Journal. Letters should be no more than 250 words in length and should be typed on A4-sized paper in double spacing
Revisiting transtibial amputation with the long posterior flap
Authors: Allcock P A , Jain A S 
Published: March 2003

Abstract

Background
The long posterior flap has been the procedure of choice for transtibial amputation for many years, but recently its theoretical basis has been challenged. This study assessed the results with the long posterior flap for leg amputation.

Methods
A prospective cohort study was performed. All patients who were referred to the Dundee Limb Fitting Centre for leg amputation between 1987 and 1996 had details of diagnosis, investigations, procedure, and both operative and functional outcome recorded contemporaneously.

Results
Some 126 patients required a transfemoral amputation and 445 needed a transtibial procedure. Fifty patients having the transtibial operation, who would otherwise have required a transfemoral amputation, had a medially based flap; the remaining 395 patients underwent a transtibial amputation by the long posterior flap technique. Primary healing was achieved in 317 patients, and 11 amputations healed by secondary intention. Fifty-one patients required a local wedge resection and 16 had a secondary transfemoral amputation.

Conclusion
These results compare favourably with those of other published series. The long posterior flap remains to be bettered for routine transtibial amputation.
Experimental study of the material composition of laparoscopic ports on tumour cell adherence
Authors: Brundell S , Tucker K , Chatterton B , Hewett P J 
Published: March 2003

Abstract

Background
Laparoscopic resection of intra-abdominal malignancies has yet to be widely adopted, partly because of concerns over the possible increase in the rate of port-site metastasis. The aetiology of these is unclear, but the laparoscopic instrumentation used may influence the deposition of tumour cells at the port sites during operation. An in vitro model to examine tumour cell adherence to laparoscopic ports and to port sites was developed to examine this hypothesis.

Methods
A pilot study (study 1) was performed in which six smooth plastic, six ribbed plastic and six metal ports were introduced through the shaved abdominal wall of a cadaveric sheep and suspended in a water-bath containing radiolabelled LIM 1215 human colonic cancer cells for 30 min. Radioactivity on both ports and port sites was measured and the number of cells adherent to each structure was calculated. The study was expanded to include a further 36 smooth plastic ports and 36 metal ports (study 2).

Results
In study 1 metal ports were found to have significantly more adherent cells than plastic ports (P = 0·004), as did ribbed ports when compared with smooth ports (P &lt; 0·05). In study 2 increased numbers of cells were again detected on metal ports (P &lt; 0·001) when compared with plastic ports. Significantly greater numbers of cells were also detected on the sites through which metal ports had passed than on sites through which plastic ports had passed (P = 0·03).

Conclusion
In this model, the use of metal ports as opposed to plastic ports resulted in increased deposition of tumour cells on both ports and port sites.