bluuebunny/crossref_metadata_2025_split huggingface dataset:
Relationship between lower limb symptoms and patterns of deep and superficial venous reflux on duplex ultrasonography
Authors: Bradbury A W , Evans C J , Allan P L , Lee A J , Ruckley C V , Fowkes F G R 
Published: December 2004

Abstract

Background
There are inconsistent and sex-dependent relationships between lower limb symptoms and the presence and severity of trunk varicose veins on clinical examination. The relationship between lower limb symptoms and patterns of venous reflux on duplex ultrasonography were investigated.

Methods
This was a cross-sectional study of an age-stratified random sample of 1566 subjects (699 men and 867 women) aged 18–64 years selected from 12 family practices. Subjects completed a self-administered questionnaire regarding symptoms (heaviness/tension, a feeling of swelling, aching, restless legs, cramps, itching, tingling) and underwent duplex ultrasonographic examination of both legs. Reflux greater than 0·5 s was considered pathological.

Results
Isolated superficial reflux was significantly related to the presence of heaviness/tension (P &lt; 0·025, both legs) and itching (P = 0·002, left leg only) in women. Isolated deep venous reflux was not significantly related to any symptom in either leg in either sex. Combined superficial and deep reflux was related to a feeling of swelling (P = 0·02, both legs), cramps (P &lt; 0·005, left leg only) and itching (P &lt; 0·005, left leg only) in men, and aching (P = 0·03, right leg only) and cramps (P = 0·026, left leg only) in women.

Conclusion
Duplex ultrasonography may be superior to clinical examination alone in identifying patients whose lower limb symptoms are truly of venous origin and thus most likely to benefit from surgery.
Prospective, multicentre audit of complex vascular wound and graft infections: the impact of methicillin-resistant Staphylococcus aureus
Authors: Hayes P D , Darke S , Naylor A R 
Published: December 2004

Abstract

Background
A number of studies have looked at the outcome of vascular graft infections, but these often include small numbers of patients collected over a prolonged period of changing practice. Many of these studies do not contain cases of methicillin-resistant Staphylococcus aureus (MRSA).

Methods
Between February 1998 and January 1999, a prospective, multicentre audit was performed in order to examine the outcome of complex wound and graft infections in vascular surgery, with particular reference to MRSA.

Results
Some 66 grade II or III Szilagyi wound infections occurred. Overall, 23 per cent of type II infections progressed to graft infection. Of those with type III infections, 83 per cent had an adverse outcome (death, major amputation or ongoing infection). No vein graft became infected, but 12 of 38 prosthetic grafts were affected. MRSA accounted for 42 per cent of infections and was present in 67 per cent of patients with an adverse outcome. Adverse events occurred in 32 per cent of MRSA cases and in 10 per cent of non-MRSA cases (P = 0·04). Wound infection proceeded to graft infection in 58 per cent of MRSA cases and in 32 per cent of non-MRSA cases (P = 0·08). Seven of eight patients with MRSA before operation developed postoperative MRSA infection. Median length of stay was 31 days for MRSA versus 18 days for non-MRSA infections (P = 0·001). Forty-three graft infections occurred; 12 were associated with a complex wound infection. Median time to presentation was 39 (range 2–2450) days. There were 16 deaths, nine major limb amputations and three ongoing infections among patients with a graft infection. The median length of stay was 36 days. MRSA was present in 36 per cent of all graft infections. Only one of these infections involved a vein graft (P = 0·001). MRSA infection occurred more frequently where the primary procedure had been urgent rather than elective (P = 0·03). MRSA graft infection accounted for seven of the nine major limb amputations. The median length of stay in patients with MRSA graft infection was 25 days longer (P = 0·001).

Conclusion
Complex wound and graft infections continue to be associated with postoperative deaths and amputations. MRSA infection is now the most common organism involved in complex infections following vascular procedures. It is associated with an increase in the number of adverse outcomes and a significant increase in length of stay.
Effect of carotid endarterectomy on cognitive function: long-term follow-up
Authors: Lloyd A J , Hayes P D , Naylor A R , Bell P R F 
Published: December 2004

Abstract

Background
Long-term effects of carotid endarterectomy (CEA) on cognitive function are not known. Evidence suggests that perioperative embolization may disrupt cognitive function in the short term.

Methods
A controlled study was conducted to examine the cognitive function of 109 patients undergoing CEA before and at 6 months after operation (n = 100). The objective validated psychometric tests assessed attention, memory, language and visuospatial skills. Perioperative embolization was determined using transcranial Doppler ultrasonography.

Results
Patients who were spontaneously embolizing before operation had significant preoperative cognitive impairment (P = 0·03). The controlled cognitive function tests showed no evidence of a cognitive deficit 6 months after CEA. The total number of emboli detected for each patient ranged from 0 to 700 (mean 32). There was no evidence of a significant correlation between the number of emboli detected during CEA and change in cognitive function (r = 0·07).

Conclusion
CEA is not associated with worsening cognitive impairment. Asymptomatic perioperative microembolization has no long-term effect on cognitive function.
Synergistic effects of tumour necrosis factor α and lymphotoxin α during lethal endotoxaemia
Authors: Netea M G , Kullberg B J , Verschueren I , Van der Meer J W M 
Published: December 2004

Abstract

Background
Tumour necrosis factor (TNF) α and lymphotoxin (LT) α are members of the TNF family which bind to the same receptors and which play a crucial role in the modulation of the immune response. Their differential and possible redundant roles during lethal endotoxaemia have been investigated in mice deficient in either TNF-α (TNF–/–) or TNF-α and LT-α (TNF–/– LT–/– double knockout) mice.

Methods
TNF–/– or TNF–/– LT–/– mice were injected intravenously with Escherichia coli lipopolysaccharide (LPS) 1 or 2 mg per mouse. Circulating levels of interleukin (IL) 1α and 1β were measured 3 h after the LPS challenge, and mortality rates were calculated.

Results
When LPS 1 mg per mouse was used, 80 per cent of the wild-type mice succumbed, whereas none of the TNF–/– or TNF–/– LT–/– mice died (P &lt; 0·01). However, when LPS 2 mg per mouse was administered, the mortality rate in the control and TNF–/– mice was 100 per cent, whereas none of the TNF–/– LT–/–mice died (P &lt; 0·01), suggesting that the absence of LT-α has an additional protective effect in lethal endotoxaemia. In comparison to the wild-type control mice, 3 h after the LPS challenge, the circulating concentrations of IL-1α were 47 and 55 per cent lower in the TNF–/– and TNF–/– LT–/–mice respectively. Moreover, circulating concentrations of IL-1β were 40 per cent lower in the TNF–/– mice, but 71 per cent lower in the TNF–/– LT–/– mice compared with the wild-type controls.

Conclusion
TNF-α and LT-α act synergistically during lethal endotoxaemia, and immunomodulation of both TNF-α and LT-α should be considered in experimental and clinical settings.
Infrainguinal reconstruction with endoscopically harvested saphenous vein
Authors: Holdsworth R J 
Published: December 2004

Abstract

Background
Endoscopic saphenous vein harvesting is gaining popularity in cardiac units because of a perceived reduction in lower limb wound complications. The requirements of the cardiac surgeon for saphenous vein differ from that of the peripheral vascular surgeon in that longer individual vein grafts are required for peripheral reconstruction.

Methods
Endoscopic vein harvest has been evaluated in the reconstruction of 36 legs. Vein was harvested successfully in all cases, although major vein damage occurred in one patient. All veins were reversed and routed through a new tunnel, and used for 18 above-knee femoropopliteal bypasses, 12 below-knee femoropopliteal bypasses, four distal and two pedal grafts. Mean follow-up was 20 (range 3–36) months.

Results
There were six graft occlusions, two in the immediate postoperative period, two at 1 month and two late closures at 1 year. Three patients had wound infections, two had significant haematomas and four had problematic oedema after operation. Postoperative stay was 2–18 days, with 17 patients being discharged within 5 days and 28 within 9 days.

Conclusion
Although this technique can be used successfully for vein harvesting, the immediate impact on patient morbidity and postoperative stay is only marginal and probably does not justify the increased cost of the procedure.
Midterm follow-up of 1000 patients in the Registry of Endovascular Treatment of Abdominal Aortic Aneurysms (RETA)
Authors: Thomas S M , Gaines P A , Beard J D 
Published: December 2004

Abstract

Background
The aim was to present the midterm follow-up data of patients in the Registry of Endovascular Treatment of Abdominal Aortic Aneurysms (RETA).

Methods
RETA now has a cohort of 1000 registered patients. Follow-up data are available for 483 patients at 1 year (80·8 per cent follow-up rate), 191 at 2 years (78·0 per cent follow-up rate) and 64 at 3 years (64·0 per cent follow-up rate).

Results
The mortality rates were 10·8, 12·6 and 6·3 per cent at 1, 2 and 3 years' follow-up respectively. The majority of deaths at follow-up were unrelated to the endovascular aneurysm repair. However, ruptures have occurred, with five (1·0 per cent) occurring in the first year of follow-up and three (1·6 per cent) reported in the second year of follow-up. This gives a cumulative risk of rupture of 1·0 per cent at 1 year and 2·6 per cent at 2 and 3 years. Three of the ruptures had persisting primary proximal endoleaks and two had documented secondary endoleaks. Complications related to the aneurysm or device occurred in 11·1, 14·8 and 12·8 per cent of cases at 1, 2 and 3 years' follow-up. The commonest problems were secondary endoleaks, although most of these had successful endovascular treatment. Graft or limb occlusions were the next most common problems. Follow-up of patients having secondary procedures with endovascular treatment suggests these treatments are durable, although the numbers at present are small. The cumulative endoleak-free survival rate was 73·4, 57·9 and 49·9 per cent, and the cumulative freedom from endoleak rate was 88·3, 81·2 and 75·6 per cent at 1, 2 and 3 years' follow-up respectively.

Conclusion
Most deaths occurring at follow-up are not related to the aortic aneursyms. Ruptures have occurred, some related to primary proximal type I endoleaks. Others may be related to secondary endoleaks that have not been detected. Late complications related to the device or aneurysm occur at a rate of about 10 per cent per year. Most frequently these are new endoleaks and are amenable to endovascular treatment, but recurrence may occur, so continued surveillance is necessary.
Successful subintimal angioplasty for leg ischaemia is dependent on length of occlusion, not site of lesion
Authors: Boyle J R , Perry D , Gonem N , Cowan A R , Sutton G L , Pemberton R M 
Published: December 2004

Abstract

Background
The development of subintimal angioplasty offers an endovascular approach to the treatment of long occlusions not suitable for conventional transluminal angioplasty; it remains, however, the remit of relatively few radiologists in specialist centres. The authors have adopted the technique in view of promising published results.

Methods
Between May 1997 and July 2000, 50 patients had attempted subintimal angioplasty (median age 71 (interquartile range (i.q.r.) 61–80) years). Patients were divided into two groups by length of occlusion; 26 patients (group 1) had occlusions greater than 10 cm in length (iliac, one; superficial femory artery (SFA), 24; crural, one) and 24 patients (group 2) had occlusions of less than 10 cm (iliac, five; SFA, five; popliteal, nine; crural, five). The primary technical success rate, ankle: brachial pressure index (ABPI) before and after the procedure, complication rate and symptomatic improvement were recorded for both groups.

Results
The groups were well matched for age and indication for intervention. Primary technical success was significantly better for occlusions of less than 10 cm than for the longer lesions (83 versus 50 per cent; P &lt; 0·01) with corresponding significantly greater rises in ABPI (P &lt; 0·05). Complications included one death in each group, one amputation in group 2 and six in group 1, all after failed salvage grafts.

Conclusion
Subintimal angioplasty gives excellent results for occlusions of less than 10 cm in length irrespective of arterial site. Results for longer lesions are poor, with failed subintimal angioplasty often precipitating urgent distal vascular reconstruction and associated high risk of major amputation.
Thoracic stent grafts
Authors: Gerrard D J , McGuinness C L , Sabharwal T , Reidy J F , Taylor P R 
Published: December 2004

Abstract

Background
The Endovascular Aneurysm Repair trial of infrarenal aortic aneurysm repair requires 20 operations to be performed at each centre to eliminate learning curve errors. An analysis was undertaken of the authors' learning curve experience of commercially made thoracic stent grafts.

Methods
Stent grafting was attempted in 26 patients. Aortic pathology included 13 atheromatous aneurysms, six dissections, one coarctation, three false aneurysms and three transections. Successful deployment was performed in 24 patients (92 per cent), but failed in two women due to small iliac arteries. Stent grafts used were Gore Excluder (16 patients), AneuRx (six), Vanguard (one) and Stenford (one). Four patients required two stents, two needed three stents, and 18 had a single stent.

Results
Thirteen elective procedures were uneventful. Two deaths occurred in 11 urgent procedures, from pulmonary embolism and aortic rupture of an unsuspected false aneurysm. The overall in-hospital mortality rate was 8 per cent (two of 24 patients). One graft with a persistent endoleak was removed at open repair at 6 weeks. The subclavian artery origin was covered in three elderly patients, resulting in minor distal ischaemia. No spinal cord problems were seen. One patient died from pneumonia at 8 weeks, and another died from rupture at 28 months as a result of prolapse of the stent into the aneurysm sac.

Conclusion
Assessment of the diameter of the iliac arteries is important, especially in women, to ensure that they accommodate the size of the sheath. Patients with false aneurysms have a poor outcome, and treatment by stent grafting may not be durable. Covering the origin of the left subclavian artery can be undertaken in elderly patients with transient minor symptoms. The use of stent grafts in acute type B dissection should be the subject of a randomized trial. Continued surveillance is essential.
Assessment of degree of internal carotid artery stenosis based on duplex velocity measurements using an artificial neural network
Authors: Mofidi R , Brabazon A , Powell T , Hurson C , Sheehan S , Mehigan D , MacErlaine D , Keaveny T V 
Published: December 2004

Abstract

Background
Duplex imaging is increasingly used as a stand-alone investigation before carotid endarterectomy. There is concern regarding the wide variation in diagnostic methods of grading internal carotid artery (ICA) stenosis using duplex velocity criteria. The aim of the study was to design an artificial neural network (ANN) that is able to provide a measure of the degree of ICA stenosis based on the four most commonly used duplex velocity profiles.

Methods
One hundred and four consecutive patients who were admitted for assessment of carotid occlusive disease were included. All patients underwent arch injection digital subtraction angiography and carotid duplex ultrasonography. Peak systolic velocity (PSV) and end-diastolic velocity (EDV) in the ICA and common carotid artery (CCA) were measured. The degree of angiographic stenosis was measured by two blinded investigators. A three-layered perceptron ANN was constructed using the NeuroSolutionsTM version 1 software program (NeuroDimension, Gainesville, FL, USA). The accuracy of the model in predicting the degree of ICA stenosis was expressed as the mean squared error (MSE) of the actual degree of angiographic stenosis. The performance of the neural network model was compared with that of the linear regression model at predicting the degree of ICA stenosis and classifying a degree of ICA stenosis greater than 50 per cent.

Results
One hundred and sixty-eight carotid bifurcations were available for analysis. The MSE of the ANN at predicting the degree of ICA stenosis was 0·096 (overall accuracy of 84 per cent), which was superior to a linear regression model (MSE 0·132; overall accuracy 73 per cent) (P &lt; 0·001). Both models were equally accurate at identifying a degree of ICA stenosis greater than 50 per cent (ANN accuracy 0·91 versus regression model accuracy 0·89; P = 0·09).

Conclusion
Neural network algorithms are able to predict the degree of ICA stenosis with reasonable accuracy and outperform linear regression analysis on the basis of a limited set of duplex velocity measurements. With further refinement, ANN models could replace duplex criteria in assessment of the degree of ICA stenosis.
A carotid POSSUM model for predicting death
Authors: Kuhan G , Prytherch D , Sutton G L , Payne S P , Chetter I , Abidia A , McCollum P T 
Published: December 2004

Abstract

Background
Risk adjustment to allow for differences in case mix aids comparative audit of carotid endarterectomy (CEA). The aim of this study was to test the predictive accuracy of P-POSSUM (Physiological and Operative Severity Score for the enUmeration of Mortality and morbidity – Portsmouth predictor equation for mortality) and V-POSSUM (P-POSSUM-based model for vascular surgery) and to develop a procedure-specific model for CEA.

Methods
A total of 709 CEAs performed in two vascular units from 1992 to 2000 were analysed. The physiological and the operative severity scores were calculated; the outcome used was 30-day mortality. Predicted mortality was calculated using P-POSSUM, V-POSSUM and V-POSSUM (physiology only = PS) equations. The observed and the predicted mortality were compared. The new model was developed on a set of 350 CEAs and validated on 359 CEAs. The data sets of the two units were combined and split into two by the procedure date order. The predictive accuracy of the model was analysed with the χ2 test.

Results
P-POSSUM and V-POSSUM models showed lack of fit in predicting death.
There was no evidence of any lack of fit in the new model.

Conclusion
P-POSSUM and V-POSSUM overpredict mortality and are unsuitable for the comparative audit of CEA. Procedure-specific models based on P-POSSUM can accurately predict death.
Length of the antral segment in pylorus-preserving gastrectomy
Authors: Nakane Y , Michiura T , Inoue K , Sato M , Nakai K , Yamamichi K 
Published: December 2004

Abstract

Background
Pylorus-preserving gastrectomy (PPG) has the advantages of preventing dumping syndrome and duodenogastric reflux. However, time was required to reduce symptoms of gastric fullness or to improve food intake after surgery. The aim of this study was to investigate whether the length of the retained antral segment influenced the postoperative symptoms in patients who underwent PPG.

Methods
Thirty patients with early gastric cancer who underwent PPG were divided into two groups according to the length of the retained antrum. In group 1 (n = 20) the transection was 1·5 cm and in group 2 (n = 10) it was 2·5 cm proximal to the oral edge of the pyloric ring. The subjects were interviewed and examined periodically to assess symptoms, food intake, body-weight and serum nutritional variables. Endoscopy and a radioisotope gastric emptying test were performed 1 year after the operation.

Results
In group 1 gastric fullness after meals was common, resulting in poor food intake and poor recovery of body-weight. A high incidence of food residue in the remnant stomach was found in group 1. With regard to gastric emptying, seven of 20 patients in group 1 and one of ten in group 2 had a delayed emptying curve 1 year after operation.

Conclusion
Group 2 was superior to group 1 in terms of postprandial symptoms, food intake, recovery of body-weight and gastric emptying. The length of the retained antrum may play an important role in the motility of the pyloric ring following PPG.
Abnormal expression of E-cadherin and β-catenin may be a molecular marker of submucosal invasion and lymph node metastasis in early gastric cancer
Authors: Tanaka M , Kitajima Y , Edakuni G , Sato S , Miyazaki K 
Published: December 2004

Abstract

Background
Impaired expression of E-cadherin and α- and β-catenin is frequently observed in several human cancers. The aim of this study was to examine immunohistochemical expression of these adhesion molecules, focusing on early gastric carcinomas, and to investigate differences between differentiated and undifferentiated gastric cancer at the early phase of carcinogenesis.

Methods
Immunohistochemical staining of E-cadherin and α- and β-catenin was performed using specimens from 143 patients with early gastric cancer.

Results
Abnormal E-cadherin and β-catenin staining correlated with depth of tumour invasion in differentiated-type tumours. In contrast, abnormal staining was frequently found even in intramucosal carcinoma of undifferentiated-type tumours, suggesting an apparent difference in the onset of E-cadherin–catenin complex abnormality between the two cancer types. Absent staining of β-catenin was associated with lymph node metastasis. Multivariate analysis revealed abnormal E-cadherin expression as an independent factor that correlated with submucosal invasion in early gastric cancer.

Conclusion
Abnormal E-cadherin expression is a possible marker of submucosal invasion in differentiated-type early gastric cancer and absent β-catenin staining could be used as a predictor of lymph node metastasis in both types.
Evidence for separate disease phenotypes in intestinal Crohn's disease
Authors: Borley N R , Mortensen N J McC , Chaudry M A , Mohammed S , Clarke T , Jewell D P 
Published: December 2004

Abstract

Background
This study investigated the hypothesis that separate phenotypes of Crohn's disease exist which display differing patterns of recurrence with a tendency to preservation of phenotype between serial operations.

Methods
Some 483 abdominal operations (278 patients) were identified from a prospectively compiled database. Patterns of recurrence (reoperation) were analysed by Kaplan–Meier plots and log rank tests according to disease phenotype (perforated, stenosed or ulcerated). Serial operations were analysed by agreement of phenotype and microscopic features of disease using kappa statistics and correlation coefficients.

Results
There was no significant difference in recurrence according to disease phenotype (median reoperation-free survival time 43·0, 50·2 and 47·9 months for perforated, stenosed and ulcerated types respectively; log rank χ2 = 3·5, P = 0·18). There was poor agreement in phenotype between serial operations (κ = 0·22 for first/second operation and κ = 0·15 for second/third operation) and no significant correlation between pathological features was identified (r between −0·19 and 0·48).

Conclusion
No evidence was found for the existence of separate disease phenotypes with differing natural histories or underlying pathological characteristics.