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Biomedical subjects

A D Chant

Publications and source records attributed to A D Chant.

At least 73 records · Page 4Linked to original sources
PubMed1985

Oxygen tension on the skin of the gaiter area of limbs with venous disease.

We examined the levels of oxygen on the skin of the gaiter areas of limbs with venous disease using a Roche Transcutaneous pO2 Monitor to determine whether hypoxia contributes to the skin changes and ulceration associated with severe venous disease. We studied patients with superficial varicose veins and no skin changes (Group 1: n = 25), patients with skin changes and healed ulcers (Group 2: n = 15), and an age matched normal control group (controls: n = 25). TcpO2 measurements were taken 5 cm above the medial malleolus with the limb both horizontal and vertical using a Roche Transcutaneous pO2 Monitor. A standard heel-raising test using a Medisonics Photoplethysmograph indicated the degree of venous insufficiency present. Results show that Group 1 patients and controls have similar skin oxygen levels (Group 1: TcpO2 66.48 + 14.12 mmHg; controls: TcpO2 61.60 +/- 11.02 mmHg) whereas those with skin changes and ulceration have significantly lower oxygen levels (Group 2: TcpO2 46.57 +/- 9.70 mmHg, t = 4.29, P less than 0.001). Group 2 patients did not show a significant rise in TcpO2 levels in the standing position whereas Group 1 patients and controls did (t = 2.6, P less than 0.02). PPG post-exercise recovery times confirmed differences between the three groups. These findings show that significant skin hypoxia occurs on the gaiter area of limbs with severe venous disease and support the concept of an oxygen diffusion block.

Acute Disease↗
PubMed1985

The reliability of Doppler ultrasound techniques in the assessment of carotid disease.

The reliability of continuous wave (CW) Doppler imaging and Duplex scanning in the assessment of carotid artery disease has been evaluated prospectively in comparison with biplanar angiography. Of 130 comparisons the sensitivity of Doppler imaging was 89% and specificity 99% in the detection of greater than or equal to 50% internal carotid stenosis, and 87% and 99% respectively in the diagnosis of internal carotid occlusion. Of 118 comparisons the sensitivity of Duplex scanning was 93% and specificity 98% in the detection of greater than or equal to 50% internal carotid stenosis, and 93% and 99% respectively in the diagnosis of internal carotid occlusion. CW Doppler imaging and Duplex scanning are accurate techniques in the diagnosis and categorisation of internal carotid artery disease. CW Doppler imaging is an effective screening technique for the presence of greater than or equal to 50% internal carotid artery stenosis. Duplex scanning also has the potential for improved detection of early internal carotid artery disease and study of the natural history of atherosclerosis.

Adolescent↗
PubMed1984

Prediction of amputation wound healing: the role of transcutaneous pO2 assessment.

With the recent trend towards more distal lower limb and below-knee amputation for peripheral vascular disease, failure of amputation healing remains a common clinical problem. There is an urgent need for more objective measures of selecting the most appropriate distal amputation level compatible with healing. Oxygen availability is the final arbiter of tissue viability and healing potential, and we have shown that the measurement of transcutaneous pO2 (TcpO2) accurately reflects the degree of ischaemia in the lower limb. In 59 patients having 62 amputations for peripheral vascular disease significantly lower TcpO2 levels were related to amputation failure. Below-knee amputations with a pre-operative below-knee TcpO2 of above 35 mmHg always healed, and failures had levels of 35 mmHg or less. Nine out of sixteen patients having above-knee amputations had pre-operative below-knee TcpO2 values well above 35 mmHg, suggesting that they may possibly have undergone successful below-knee amputation. No correlation between ankle systolic pressure and amputation healing was found. TcpO2 measurement is simple, non-invasive and reliable and offers an exciting research advance in the assessment of effective tissue perfusion.

Amputation Stumps↗
PubMed1984

Metronidazole v ampicillin: differing effects on the postoperative recovery.

One hundred and eight adult patients undergoing appendicectomy (37 advanced appendicitis and 71 early appendicitis or normal appendices) were randomised into a trial comparing the effects of ampicillin (anti-aerobic) and metronidazole (anti-anaerobic) based regimes. Although there were less wound infections amongst those patients receiving metronidazole (14%) as compared to ampicillin (27%) this difference failed to reach statistical significance. However, ampicillin appears to be superior in shortening the length of postoperative fever, 3.0 compared to 3.5 d for those patients receiving metronidazole. There is some suggestion that this advantage is reversed amongst those patients with wound infections. Further study is required to clarify this point. Our study suggests further evidence of differing clinical action of these drugs in appendicectomy.

Adolescent↗
PubMed1983

The effect of cephradine prophylaxis on wound infection after arterial surgery through a groin incision.

Cephradine administered prophylactically to a group of 35 patients undergoing reversed saphenous vein femoro-popliteal bypass, iliofemoral endarterectomy or profundaplasty through a groin incision, resulted in a significant reduction in the incidence of wound infection (P = 0.025; exact probability test). One gram of cephradine was given at induction of anaesthesia, followed by three postoperative doses of one gram at 6 hourly intervals. The overall wound infection rate at 7 days, as assessed by frank purulent discharge, was 15%. After cephradine prophylaxis, no infections were noted as judged on this basis, but erythema of the suture line was seen in equal numbers (40% of each group). Where the indication for operative intervention was rest pain or gangrene, the incidence of wound infection was very much increased, 80% of the infected cases being from this group.

Aged↗
PubMed1982

Operative cholangiography reassessed.

This study compares a surgeon's clinical impression of the common bile duct (CBD) at the time of operation with his assessment of it following an operative cholangiogram. It also compares the accuracy of the surgeon's radiological assessment with that of a consultant radiologist. In a series of 100 consecutive cholecystectomies 92 patients had operative cholangiograms. In the remaining eight cases no cholangiogram was performed for technical reasons in five and the presence of large stones in three. In the 92 patients who did have cholangiograms, there was clinical and radiological agreement on the state of the CBD in 80 patients. On the basis of the surgeon's interpretation there were six clinical false negatives and six radiological false positives, but only one false negative and one false positive when the films were reported by a radiologist. It is concluded that unless operative cholangiography is interpreted with the help of a radiologist the technique adds very little information regarding the CBD than has already been gained by pre-operative investigations and laparatomy.

Adolescent↗
PubMed1982

Smoking, ignorance, and peripheral vascular disease.

The effect of the surgeon's advice to give up smoking was studied in a group of 43 patients with peripheral vascular disease (PVD), using blood carboxyhemoglobin levels to detect deception. Only seven of 40 patients (17.5%) actually stopped smoking, but the remainder appeared fairly honest in reporting their continued habits. Few patients were aware of the possible harmful effect of smoking on the peripheral arteries. The 43 patients with PVD who smoked had significantly higher carboxyhemoglobin levels than a group of 25 smokers without PVD although their cigarette consumption was the same. This suggests that carboxyhemoglobin levels may provide a better indication of the risk of smoking than overall cigarette consumption alone in the development of PVD.

Adult↗
PubMed1982

Oxygen tension of the skin of ischemic legs.

Using a Kontron Roche Transcutaneous Oxygen Monitor, we measured oxygen tension on the skin of the legs at three sites in patients with peripheral vascular disease and group of controls. Significant decreases in oxygen tension occurred in the patient groups, which correlated well with ankle systolic pressure, with differences between those with claudication and those with rest pain. These results suggest that in limbs with claudication, significant skin hypoxia may exist during rest in spite of reportedly normal skin and muscle blood flow. The progressive decrease in skin oxygen tension down a limb with occlusive vascular disease may play a significant role in skin healing.

Aged↗
PubMed1982

Detection of arterial dilatation in the distal aorta--lower limb arteries using continuous wave Doppler ultrasound.

Continuous wave Doppler ultrasound techniques were used to obtain signals from the common femoral, popliteal, posterior tibial and dorsalis pedis arterial sites and the ankle systolic pressure indices in 54 patients with arteriographic, ultrasound "B"-Scan or surgical confirmation of arterial dilatation. The Doppler-shifted signals were spectrum-analysed and processed using a maximum frequency detector. The maximum frequency envelopes were examined retrospectively to determine whether there were any characteristics of the signals which could be used as diagnostic indicators of arterial dilatation. Ankle systolic pressure indices (ASPI), pulsatility index (PI), and delta, derived from the Laplacian transform method, were used in an attempt to quantify any changes produced by dilatation. The results indicate that characteristic and distinctive maximum frequency envelope signatures can be identified with arterial dilatation but that parameters such as ASPI and PI cannot distinguish these changes from the normal state and the Laplacian transform parameter "delta" places the dilatation cases in the minor stenosis category. However, generalised dilatation can be detected with a sensitivity of 85% if pattern recognition techniques are used.

Aged↗
PubMed1978

Treatment of early breast cancer.

The early follow-up of patients treated by simple mastectomy alone or simple mastectomy combined with radical radiotherapy is presented. Both groups were well matched for age, menopausal status, duration of symptoms, size of tumour, and lymph-node involvement. There was no significant difference in survival of patients in the two groups at three years, but local recurrence was significantly more frequent (28%) in the mastectomy-alone patients. Early survival was not adversely affected by radiotherapy.

Age Factors↗
PubMed1978

Varicose veins: A comparison of surgery and infection/compression sclerotherapy. Five-year follow-up.

A randomised controlled trial was carried out to compare the clinical outcome 5 years after inpatient surgery and outpatient injection/compression sclerotherapy. 91.3% of those originally treated by injection/compression sclerotherapy and 93.9% of those originally treated surgically were seen at follow-up. 40% of patients treated initially by injection/compression sclerotherapy and 24.2% of those treated surgically were given further treatment. The probability of having no further treatment is significantly greater for those treated surgically. The improved outcome after surgery increased with age, being most striking in those aged over 45. The implications of the 5-year follow-up findings for the long-term cost of treatment are discussed.

Adolescent↗
PubMed1978

Ruptured abdominal aortic aneurysms.

The results of operation in 76 patients with a ruptured abdominal aortic aneurysm are presented with an analysis of the cause of operative death. Overall mortality was 58 per cent and preoperative hypotension significantly increased mortality; deterioration while awaiting operation made a successful outcome particularly unlikely. No group could be identified, however, in which operation was without hope of saving life, and age alone should not contraindicate surgery.

Aged↗