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Biomedical subjects

A E Giddings

Publications and source records attributed to A E Giddings.

At least 19 recordsLinked to original sources
PubMed1995

A regional study of thyroidectomy: surgical pathology suggests scope to improve quality and reduce cost.

This study of thyroid histopathological data from hospitals in the South West Thames region was undertaken to assess current practice and the scope for improvement. Over a 6 month period, 186 thyroid operations were performed on 179 patients at eight hospitals serving almost 1.7 million people. The frequency of thyroidectomy in different hospitals varied from 13 to 35 per 100,000 per year and 6.4% of the operations were second thyroidectomies. Benign multinodular goitre was the most common histological finding (34%). A benign solitary nodule was found in 36% and malignancy in 8.4% of the specimens. Correlation of histological analysis and type of operation suggested that a variety of operations were performed for the same pathological condition and that some operations were diagnostic procedures only. Overall, 63 of the 186 operations (34%) might have been avoided by a firm preoperative diagnosis. Only 67 thyroid fine needle aspiration biopsies (FNAC) were performed at the eight hospitals during the study period. Only 15 (8%) of the patients who underwent thyroid operation had been investigated by FNAC. Reduction in thyroid surgery through more widespread use of FNAC could result in savings of 100,000 pounds per million population per year. Regional activity data show that more than 50 surgeons currently undertake a workload of less than 500 thyroidectomies each year. Increased subspecialisation may be required to reduce costs and raise standards.

Biopsy, Needle↗
PubMed1994

Idiopathic true aneurysm of the popliteal artery in childhood.

Non-traumatic arterial aneurysms in childhood are very uncommon and are usually associated with inflammatory or degenerative conditions. A case of idiopathic true aneurysm occurring in one popliteal artery of a 14-year-old girl is described. Geniculate artery branches arose from the sac and histological examination confirmed that it was a true aneurysm. Successful treatment by the insertion of a reversed vein graft was confirmed by follow-up years after the operation.

Adolescent↗
PubMed1993

Acute limb deterioration during intra-arterial thrombolysis.

Approximately 12 per cent of limbs undergoing intra-arterial thrombolysis (IAT) develop distal embolism or extension of thrombus during the procedure. These are usually of little clinical consequence and can be treated by increasing the rate of administration of the lytic agent. However, in some patients the clinical condition of the limb deteriorates rapidly. In an attempt to define the incidence of acute limb deterioration during IAT, information was collected from five centres in the UK with experience of the technique. A total of 866 treatments were recorded, with 20 limbs (2.3 per cent) undergoing acute deterioration. This complication was more common during the treatment of thrombosed popliteal aneurysm than during that of emboli or thrombosed atheromatous arteries or grafts (P < 0.001). The amputation rate associated with the complication was high, and operative intervention provided better results than continuation of lysis.

Aneurysm↗
PubMed1993

Long-term results of a single protocol for thrombolysis in acute lower-limb ischaemia.

In a prospective study, 78 of 157 patients with acute lower-limb ischaemia were considered suitable for thrombolysis. The immediate and 4-year results of 52 patients managed by a single protocol are reported. Of 34 patients alive at 4 years, 23 had limb salvage. Initial treatment produced effective lysis in 38 patients (73 per cent) with significant benefit in 35 (67 per cent); that benefit was sustained for a minimum of 4 years in 30 patients (58 per cent). Seven of the 18 deaths by 4 years occurred within 30 days. Amputation was carried out in six patients within 30 days and in five during the next 4 years. Delayed amputation followed persistent distal occlusion or progression of distal disease. No death or amputation was caused by complication of treatment. In selected patients the risks of thrombolysis can be reduced to an acceptable level by personal supervision and a strict protocol. In survivors, limb salvage is generally sustained for at least 4 years.

Acute Disease↗
PubMed1993

The diagnosis and management of arteritis.

Inflammatory arterial disease is often insidious and associated with a substantial morbidity and mortality. Early recognition is vital. Patients with arteritis (n = 106) were studied and divided into five groups. Two of these were subgroups of giant cell arteritis classified by site into either cranial arteritis (66), or upper limb arteritis (7). Three other groups were identified; chronic periaortitis (with or without inflammatory aortic aneurysm) (7), polyarteritis nodosa (14), and small vessel arteritis (12). Clinicians are not sufficiently aware of arteritis and its many atypical presentations. Delay in management is associated with a significant morbidity and mortality. In this district serving 200,000 people at least one patient per month is seriously at risk from the disease. Improved outlook depends on early recognition of the clinical syndromes and rapid appropriate treatment.

Arteritis↗
PubMed1992

Critical ischaemia of the upper limb.

Fifty-seven patients who presented to the Royal Surrey County Hospital, Guildford, with critical upper limb ischaemia between 1980 and 1989 were studied. Only 13 patients had emboli, while 23 presented with arteritis, seven involving large vessels and 16 with small vessel disease. Other causes included nine patients with trauma, six with atherosclerosis (of whom five were women), and four with vascular complications of thoracic outlet obstruction. Single examples of ischaemia due to radiation fibrosis and disseminated intravascular coagulation were also seen. Critical ischaemia of the upper limb remains an uncommon yet challenging problem. The review demonstrates that total limb arteriography should be performed in all patients, except the minority who present with direct arterial trauma or classical emboli.

Adult↗
PubMed1991

Towards an appropriate training for vascular surgeons.

The increasing demand for fully trained vascular surgeons in the UK has highlighted the need for urgent review of that training. Such a review must examine the number of trainees required and the number and role of teaching centres. Vascular surgical training should only take place where an integrated approach, including experience in interventional radiology and intensive care, is available. The relationship of vascular to general surgery must now be defined with training needs in mind if we are to provide an appropriate service within the next decade.

Curriculum↗
PubMed1990

Conservative management of asymptomatic popliteal aneurysm.

Historical review shows that the treatment of popliteal aneurysm has developed by trial and error and there is disagreement about the proper management of the symptomless patient. In 1981 a policy of conservative management for asymptomatic popliteal aneurysm was adopted in this unit. Since that time we have also managed nine patients with thrombosed popliteal aneurysms by arteriography and low-dose intra-arterial streptokinase. Six patients treated within 72 h of occlusion achieved significant (70-100 per cent) lysis, but streptokinase was ineffective in those treated 10 or more days after the thrombosis. Of the six patients with significant lysis, three were treated by elective reconstruction and two by anticoagulation. One patient who had significant lysis died. Vascular patency of all five successfully treated limbs was maintained and no limb loss occurred in those who presented late and failed to achieve significant lysis. These results reinforce the view that thrombolysis is the treatment of choice for thrombosed popliteal aneurysms. The low complication rate for asymptomatic popliteal aneurysms and the advent of safe, effective thrombolysis indicate that operation for symptomless popliteal aneurysm is no longer required.

Adult↗