bluuebunny/crossref_metadata_2025_split huggingface dataset:
Role of the neutrophil in the development of sepsis following abdominal aortic aneurysm surgery
Authors: Spark J I , Chetter I C , Kester R C , Scott D J A 
Published: July 2002

Abstract

Background
There is evidence to suggest that the neutrophil (PMN) plays a critical early step in development of the ischaemia–reperfusion syndrome and sepsis. Not all patients undergoing aortic aneurysm repair develop these postoperative complications. The PMN receptor CD16 plays an important role in phagocytosis, cell-mediated cytotoxicity and the release of free radicals and proteolytic enzymes. This study determined if there is any relationship between PMN CD16 expression, phagocytosis and the development of sepsis.

Methods
Some 50 patients (39 men and 11 women, median age 70 years) who underwent elective infrarenal abdominal aortic aneurysm repair were studied. Venous blood was taken before operation, throughout surgery and for 7 days afterwards. CD16 was measured, unstimulated and following further stimulation with phorbol myrisate, lipopolysaccharide and N-formyl-methionyl-leucyl-phenylalanine using flow cytometry. Phagocytosis was measured using flow cytometry and the production of elastase using an enzyme-linked immunosorbent assay. Sepsis was defined according to the ACCP/SCCM definition.

Results
There were 36 uncomplicated operations and 14 patients with sepsis. There was no difference between the two groups in respect of nutritional, co-morbid or technical factors. In the group that developed septic complications, the level of PMN CD16 expression was significantly higher before operation (30·2 versus 10·4 mcf; P &lt; 0·05, Mann–Whitney U test) and throughout the postoperative period. Surgery produced no change in CD16 expression in either the septic or uncomplicated group. Stimulation of the PMNs before operation caused an increase in CD16 expression in both groups. After operation, stimulation of PMNs in the septic group resulted in a fall in CD16 expression (40·8 versus 20·4 mcf; P &lt; 0·05, Mann–Whitney U test); surgery produced no change in the level of expression in the uncomplicated group. Phagocytic ability was comparable before operation (91·2 versus 94·2 mcf), but showed a greater reduction in the septic group after operation (73·4 versus 86·2 mcf; P &lt; 0·05, Mann–Whitney U test). Elastase concentration was also similar before operation (48 versus 49 μg l−1); after operation, there was a greater increase in the septic group (166 versus 104 μg l−1; P &lt; 0·05, Mann–Whitney U test).

Conclusion
This study provides evidence of functional differences in PMN behaviour in patients who subsequently develop sepsis following aneurysm surgery. This difference occurs early in the postoperative course and it may be possible to identify these patients before operation.
Prospective comparison of recurrent venous ulceration after superficial surgery or compression bandaging
Authors: Bello A M , Wheatley C , Scriven M , London N J M 
Published: July 2002

Abstract

Background
The purpose of this prospective study was to investigate and compare the recurrence rate of venous ulcers treated by superficial surgery or compression bandaging.

Methods
Patients received treatment for ulcers between May 1994 and July 1997. All legs in the study had an ankle: brachial pressure index above 0·8. The superficial surgery group consisted of 91 legs with superficial venous incompetence and normal deep veins which healed after superficial surgery. This group did not receive postoperative compression bandaging or hosiery. The community compression bandaging group consisted of 152 legs that healed during the recruitment period. A recurrent ulcer was defined as a further episode of venous ulceration in a previously healed leg. Patient follow-up was by surgeons, district nurses' telephone call and/or letter. Recurrence rates were calculated by life-table analysis (Kaplan–Meier). Patients who died or were lost to follow-up were censored to their last visit.

Results
The recurrence rate in the superficial surgery group at 1 and 2 years was 3 and 6 per cent respectively, compared with 26 and 33 per cent respectively in the compression bandaging group. The differences between the superficial surgery and compression bandaging groups were statistically significant (P = 0·00001, log rank test).

Conclusion
Ulcer healing after superficial surgery is sustained in the absence of postoperative compression. Conversely, the ulcer recurrence rate after compression bandaging is very high, probably because the underlying venous abnormality has not been corrected. The follow-up of this study needs to be continued to 5 years, but the data so far suggest that a prospective randomized study comparing superficial surgery with compression bandaging is required.
In major limb vessel trauma, reperfusion injury is increased by delayed venous reflow and prevented by antioxidant pretreatment
Authors: Harkin D W , Barros D'sa A A B , Mirakhur M , Halliday M I , Parks T G 
Published: July 2002

Abstract

Background
Clinical experience of the early use of intraluminal shunts in major limb trauma at this centre aimed at restoring arterial inflow and venous outflow has been shown to reduce amputation rates and morbidity. In a model of combined arterial and venous limb vessel trauma, ischaemia–reperfusion injury caused by delayed restoration of venous drainage locally on skeletal muscle and remotely on lung was studied. Furthermore, using antioxidant pretreatment the possibility of reversing these detrimental effects was investigated.

Methods
New Zealand white rabbits (n = 36) were randomized into six groups: (1) sham operation; unilateral hind limb arterial and venous occlusion for 1 h followed by (2) no reflow for 2 h; (3) arterial and venous reflow for 2 h; (4) arterial reflow alone for 2 h; (5) arterial reflow for 1 h followed by arterial and venous (delayed) reflow for a further 1 h; (6) pretreatment with an enteral combination antioxidant before combined arterial and venous occlusion with delayed venous reflow. Plasma hydroperoxide (HPO) concentration in the femoral vein was a measure of lipid peroxidation. Hindlimb skeletal muscle and lung wet-to-dry weight ratio reflected tissue oedema, and myeloperoxidase (MPO) tissue levels estimated neutrophil sequestration. Plasma glutathione peroxidase (GPx) levels in systemic vein (SV) and femoral vein effluent (FV) reflected antioxidant status. Hindlimb skeletal muscle injury was graded histologically.

Results

Conclusion
In combined major arterial and venous vessel injury of the limb, delayed venous repair leads to significantly greater local skeletal muscle injury and remote neutrophil-mediated lung damage. Reversal of these detrimental effects with antioxidant pretreatment suggests that failure of antioxidant scavenging systems may be central to the injury accentuated by delayed venous drainage. These results support the clinical rationale for early restoration of not only arterial inflow but also venous drainage by intraluminal shunts.
Smoking, cadmium accumulation and aortic aneurysm
Authors: Jones K G , Abu-Hayyeh S , Sian M , Powell J T 
Published: July 2002

Abstract

Background
Smoking is an important risk factor for abdominal aortic aneurysm (AAA), a disorder associated with loss of medial smooth muscle cells. Cadmium, one of the toxic components inhaled in cigarette smoke, is known to alter the metabolism of aortic smooth muscle cells. This was an investigation of the hypothesis that excess cadmium accumulation in the abdominal aorta is associated with the development of aneurysms.

Methods
Samples of abdominal aorta were obtained at the time of surgery from 12 patients with AAA (seven men and five women, mean age 72 years) and at autopsy from 17 patients (ten men and seven women, mean age 76 years) with an undilated aorta (diameter 1·6–2·2 cm). The smoking history of all patients was noted. The aorta was dissected into three layers, intima, media and adventitia; each was dried to a constant weight, hydrolysed and cadmium was measured by atomic absorption spectrometry. In separate experiments 5-bromo-2′-deoxyuridine uptake and picogreen assay of DNA were used to investigate the effect of cadmium on the proliferation of cultured aortic smooth muscle cells.

Results
The mean(s.e.) cadmium content of the intima, media and adventitia was 1·14(0·24), 3·25(0·53) and 1·87(0·38) ng per mg dry weight respectively; the medial concentration was significantly higher than the concentration in the other two layers (P &lt; 0·005). The medial cadmium content was similar in AAA and normal diameter aortas: 3·65(1·00) and 2·97(0·59) ng per mg dry weight respectively. Only trace amounts of cadmium were present in the aorta of those who had never smoked and there was a strong positive association between medial cadmium content and pack-year history of smoking (rs = 0·87, P &lt; 0·001). Cadmium inhibited the proliferation of smooth muscle cells cultured on polymeric collagen, 5-bromo-2′-deoxyuridine uptake (IC50 1·4 nmol l−1) and DNA content (IC50 6·3 nmol l−1). Cadmium was less toxic, by more than tenfold, to smooth muscle cells cultured on fibronectin, monomeric collagen or plastic.

Conclusion
Cadmium accumulates selectively in the medial layer of the abdominal aorta of smokers, where it may inhibit DNA synthesis and proliferation of smooth muscle cells. The toxic effects of cadmium on cultured smooth muscle cells depend on their underlying matrix and this may explain why the accumulation of cadmium in aortic media was not associated with the development of aneurysms.
‘Kissing stent’ insertion is not safe or durable
Authors: Brittenden J , Ingram S , Beattie G , Bradbury A W 
Published: July 2002

Abstract

Background
The morbidity, and clinical and haemodynamic outcome of kissing stent insertion was assessed.

Methods
A prospectively gathered database of endovascular procedures performed between 1 January 1993 and 31 December 1998 was analysed.

Results
Bilateral kissing stents were deployed in 12 patients (median age 62 (range 43–67) years; five men and seven women). Indications were bilateral intermittent claudication (IC) in nine patients, unilateral IC with contralateral rest pain in two and bilateral rest pain/tissue loss in one. Major morbidity occurred in three patients and comprised bilateral distal iliac dissection (treated medically), distal embolization (thrombolysis and suction aspiration) and false aneurysm (surgical repair). All patients reported an immediate improvement in symptoms. However, at a median (range) follow-up of 27 (3–70) months, symptoms have deteriorated in 13 legs, the ankle: brachial pressure index has fallen by more than 0·15 (with respect to values immediately after the procedure) in 15 legs, six stents have occluded (bilaterally in two patients, unilaterally in two) and four stents have stenosed significantly (greater than 50 per cent). Four patients have undergone aortobifemoral grafting and one further patient has undergone bilateral amputation following failed revascularization necessitated by stent thrombosis.

Conclusion
In contrast to the single previously published series of 20 patients which found the technique to be ‘effective’ with ‘few serious adverse events’, present data suggest that kissing stents are associated with significant morbidity and a poor outcome.
Combined surgical and radiological procedures
Authors: Dunlop P , Owen R , Gett S K , Akomolafe A B , Wilson L , Rose J D G , Jones N A G , Lambert D , Wyatt M G , Lees T A 
Published: July 2002

Abstract

Background
The aim was to audit the effect of provision of an interventional theatre on the management of vascular disease in a tertiary centre.

Methods
All patients undergoing joint vascular surgical and radiological procedures during 20 months were reviewed. Data are presented with respect to type of procedure, initial success and length of hospital stay.

Results
Between October 1997 and July 1999, 100 combined procedures were performed in an endovascular operating theatre. Sixty of these were for stent-graft repair of abdominal aortic aneurysm and are excluded from further analysis. Forty patients (23 men and 17 women, of median age 65 (range 37–80) years) underwent combined procedures for claudication (nine), rest pain (13), tissue necrosis (five), acute ischaemia (seven), iliac aneurysm (three), amaurosis fugax (one), arteriovenous malformation (one) and subclavian vein occlusion (one).
Combined intervention was successful initially in 35 patients. Of the five failures, three were technical (not possible to cross an occluded vessel) and two were due to absence of run-off vessels. There was no perioperative death. Median hospital stay was 9 (range 1–116) days.

Conclusion
These data confirm that patients requiring both radiological and surgical intervention can be treated successfully within the confines of an interventional operating suite. Cooperation and coordination between surgeon and radiologist allows the tailoring of procedures to the individual patient's needs.
Upper limb arterial injuries: experience of 713 patients and analysis of risk factors associated with limb loss
Authors: Hafez H M , Woolgar J , Robbs J 
Published: July 2002

Abstract

Background
Experience of upper limb arterial injury management was analysed and risk factors associated with limb loss were identified.

Methods
Between 1987 and 1997, data on 713 patients with 760 upper limb arterial injuries were analysed retrospectively.

Results
The mechanism of injury was stabbing in 52 per cent, gunshot in 23 per cent, blunt trauma in 14 per cent and shotgun in 5 per cent. The most frequently injured vessel was the brachial artery (53 per cent) followed by the axillary (20 per cent), subclavian (14 per cent), radial (7 per cent) and ulnar (6 per cent) arteries. Associated injuries included bony injury in 12 per cent, nerve injury in 39 per cent and remote injury affecting the head, chest or abdomen in 3 per cent. Surgical revascularization was carried out in 95 per cent of patients and arm fasciotomy was necessary in 9 per cent. The limb salvage rate for this series was 96 per cent (27 amputations) and the survival rate was 98 per cent (11 deaths). On stepwise logistic regression analysis, significant (P &lt; 0·01) independent risk factors for amputation were blocked graft (odds ratio (OR) 7·6), tense compartment at presentation (OR 6·5), neurological deficit at presentation (OR 5·4) and associated compound fracture (OR 5·4).

Conclusion
Despite good collateral circulation, upper limb arterial injuries carry a considerable risk of limb loss, particularly when associated with soft tissue damage.
Staged in situ bypass
Authors: Ojimba T A , Garnham A W , Samman Y , Simms M H 
Published: July 2002

Abstract

Background
After femoral revascularization, following embolectomy or proximal reconstruction, the need for additional distal revascularization may be unpredictable. This dilemma may be addressed by anastomosing the detached upper end of the long saphenous vein to the femoral arteriotomy, as for in situ bypass, permitting some outflow into proximal vein tributaries. Later, if ischaemia persists, distal arterial flow can be established by closed retrograde saphenous valvulotomy.

Methods
Over 12 years this technique was employed in 26 legs in 22 patients, following inflow reconstruction in 15 and femoral embolectomy in seven. Postoperative observation showed persisting distal ischaemia in 14 legs and distal bypass was completed after 1–9 days, using local anaesthesia without femoral re-exposure. One patient died at 15 days and 13 grafts were patent on discharge from hospital.

Results
In 12 legs in 11 patients, limb perfusion was deemed adequate after operation. Four patients (five legs) died in hospital and seven were discharged. No further procedure was required in five and the proximal long saphenous vein presumably thrombosed. In two legs the whole long saphenous system had become pulsatile at 7 and 8 months, and a distal bypass was completed. No amputations were required in this series.

Conclusion
Staged in situ bypass can avoid prolonged and complex reconstructions in frail patients and facilitates the use of local anaesthesia, where necessary.
Randomized prospective study comparing pre-emptive epidural and intraoperative perineural analgesia for the prevention of postoperative stump and phantom limb pain following major amputation
Authors: Lambert A W , Dashfield A , Cosgrove C , Wilkins D C , Walker A J , Ashley S 
Published: July 2002

Abstract

Background
The reported incidence of phantom limb pain (PLP) following amputation is up to 85 per cent. This study was designed to compare the efficacy of two perioperative analgesic techniques with respect to postoperative stump pain (POSP) and PLP.

Methods
Patients were randomized prospectively. Group 1 received a pre-emptive epidural for a minimum of 24 h before surgery which was continued after operation. Group 2 had intraoperative placement of a perineural catheter for the administration of local anaesthetic by infusion after operation. All amputations were performed under general anaesthesia. POSP was assessed by visual analogue score (VAS), ranging from 0 to 10. The presence of PLP was assessed 6 and 12 months after operation.

Results
A total of 30 patients were recruited, 12 men and 18 women, of median age 74 (range 47–93) years. Each group was well matched for concurrent cardiovascular disease and the level of amputation. VAS at 6 h, 1, 2 and 3 days after operation was significantly less in group 1 than group 2 (P &lt; 0·05, two-sample t test). Six patients died in each group and one was lost to follow-up. The overall incidence of PLP was 75 per cent at 6 months and 44 per cent at 12 months, with no significant difference between the two groups.

Conclusion
In this series, pre-emptive epidural analgesia significantly reduced the severity of POSP. The incidence of PLP remains disappointingly high regardless of the analgesic technique used.
Impact of a lifestyle clinic on vascular workload: analysis of factors predicting a successful outcome
Authors: Olojugba D H , Vallabhaneni R , McCormick S , Reilly D T , Blair S D , Greaney M G 
Published: July 2002

Abstract

Background
Regular exercise and risk factor control has been shown to treat patients with intermittent claudication effectively; however, patients are often non-compliant and never achieve the full benefits of a conservative approach. In this vascular unit, a nurse-led lifestyle intervention clinic has been established with the aim of optimizing the conservative management of such patients. The aim of this study was to assess the short-term impact of this strategy on radiological and operative vascular workload since its introduction in 1997, and to identify factors predictive of a successful conservative outcome.

Methods
The number of operative and radiological lower limb interventional procedures performed between January 1996 and January 1999 was obtained from departmental databases. The details of 145 consecutive referrals to the claudication clinic were also retrieved. These details were entered into a separate database for analysis. The factors analysed included age, sex, duration of symptoms, ankle: brachial pressure index and maximal walking distance at the start of the programme, co-morbid problems, smoking history and attendance. The outcome was change in claudication distance after 3 months of therapy. Analysis was performed using logistic and multiple linear regression models.

Results
Open revascularization procedures reduced from 104 in 1996 to 52 in 1998, femoral-to-popliteal bypass procedures reduced from 66 to 18. Iliac and lower limb angioplasties reduced from 133 to 101, and there were 53 major lower limb amputations in 1996 compared with 58 in 1998. The lifestyle clinic achieved a 36 per cent smoking cessation rate. Change in claudication distance ranged from −51 to 3100 (median 126) per cent. None of the factors analysed could significantly predict a successful outcome.

Conclusion
Lifestyle management is an effective strategy in management of claudicants. It can also reduce interventional vascular workload. The prediction of a successful outcome in individual patients may not be possible.
Modelling the effects of the reorganization of vascular services
Authors: Michaels J , Palfreyman S , Shackley P , Slack R , Brazier J 
Published: July 2002

Abstract

Background
Vascular services are currently in a state of evolution in many areas. A study has been carried out to model the economic and outcome implications of possible reconfiguration of vascular services.

Methods
Computer modelling was carried out based on an urban area with a teaching hospital (TH) and four surrounding district hospitals (DGHs) serving a population of 1·8 million. Data for the model were derived from a number of sources including local activity analysis, record linkage for cross-boundary flows, local audit, prospective surveys and systematic literature reviews.

Results
Analysis demonstrated a number of key differences in service provision between the TH and DGHs which were consistent with findings from literature reviews. These included differences in the use of endovascular treatments and femorodistal bypass, differences in case-mix and rates of particular procedures, and differences in outcome as measured by mortality and amputation rates. Computer modelling examined a number of options for the reconfiguration of services, including variations on fully centralized and hub and spoke arrangements. Cost estimates suggested that centralization and hub and spoke would result in an increased cost of £1 240 000–1 430 000 per year for the entire service, with over 80 per cent of these costs being related to expected increases in activity. Consideration of a number of key areas suggested that the resultant changes would save approximately 20 lives, 65 amputations and seven strokes per year for the population under consideration.

Conclusion
Reconfiguration of vascular services is likely to be highly cost effective. There is little difference in expected cost and outcomes between fully centralized and hub and spoke arrangements but the latter is preferred on the basis of decreased shift of resources and strong patient preference for local services.
Comparison of cognitive function and quality of life after endovascular or conventional aortic aneurysm repair
Authors: Lloyd A J , Boyle J , Bell P R F , Thompson M M 
Published: July 2002

Abstract

Introduction
The long-term effects of endovascular aortic aneurysm repair on cognitive function and quality of life are not known.

Methods
The cognitive function and quality of life of 82 patients undergoing aortic aneurysm repair (34 endovascular and 48 conventional procedures) were assessed before and 6 months after operation. Cognitive function was quantified using a battery of psychometric tests. Quality of life was assessed with the Medical Outcomes Short Form 36 (SF-36) questionnaire.

Results
Data at 6 months were available for 78 per cent of patients. As a group the patients showed a significant decline on one cognitive function test (visual search) and on two domains of the SF-36 (physical function and vitality) when they were reassessed. There were no significant differences between patients undergoing endovascular or conventional aneurysm repair after 6 months in cognitive function or quality of life.

Conclusion
Endovascular aneurysm surgery had a similar impact on health-related quality of life and cognitive function compared with conventional aneurysm repair. Patients in both groups demonstrated a significant decline in cognitive function.