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Biomedical subjects

A J Walker

Publications and source records attributed to A J Walker.

At least 37 records · Page 2Linked to original sources
PubMed1995

The early morbidity of varicose vein surgery.

The early outcome and morbidity associated with varicose vein surgery were assessed at six months post operation by postal questionnaire. Most cases underwent sapheno-femoral ligation, above-knee stripping of the long saphenous vein and multiple stab avulsions. A 73.8% response rate resulted in 155 replies, and revealed a high incidence (65.8%) of perceived complications within the first two weeks after surgery. The commonest of these were bruising, pain and numbness. Over a third of patients consulted their general practitioner (GP) postoperatively. Half of these required further management or treatment and the rest, reassurance alone. At six months 79.4% were satisfied with the outcome of their surgery, although some still claimed problems with residual veins, skin discoloration, numbness, and ankle or foot discoloration. Eleven percent were referred to hospital for further opinion, mostly because of perceived residual varicose veins. The difference between residual and recurrent varicose veins is discussed. No patient felt that the standard 2.5 day admission was too long, and 12.9% thought it too short. Day case surgery is not a popular option in this population group. Despite high satisfaction rates, there is a considerable morbidity attached to varicose vein surgery. We believe that good pre- and perioperative communication, augmented by a comprehensive information sheet, is important to prepare patients for those postoperative problems and thus reduces their perceived importance.

Adult↗
PubMed1994

Experimental experience with a temporary intraluminal heparin-bonded polyurethane arterial shunt.

After vascular injury, intraluminal arterial shunting may be employed if definitive surgery must be delayed. This paper describes use of a heparin-bonded polyurethane shunt to restore distal circulation after ligation of the femoral artery in sheep. In studies to determine tissue viability for 12 h after insertion into the femoral artery, five of seven shunts remained patent. In another series of experiments to study tissue viability after limb ischaemia, the femoral artery was ligated and a tight Esmarch bandage applied to the limb for 6 h before shunt insertion. The shunt remained patent for 12 h in five of six cases. Nearly all shunt failures occurred shortly after placement and were attributable to intimal damage arising from difficulties during insertion.

Anastomosis, Surgical↗
PubMed1994

Recurrent varicose veins: assessment of the saphenofemoral junction.

Thirty-six consecutive unselected patients, who had apparently previously undergone saphenofemoral ligation for primary uncomplicated long saphenous varicosities and who had then re-presented with recurrent thigh varices emanating from the groin, underwent preoperative clinical assessment, hand-held Doppler and duplex ultrasonographic examination and varicography to establish the presence or absence of saphenofemoral incompetence as the cause of recurrence. All patients underwent reexploration of the saphenofemoral junction (SFJ) via a lateral approach. Twenty-six patients had an intact SFJ (type I recurrence) and ten had varices arising from either a thigh perforator, or from abdominal or perineal veins (type II recurrence). Clinical examination alone was poor at distinguishing type I from type II recurrence. Doppler ultrasonography was sensitive (88 per cent) but non-specific (40 per cent). In contrast, duplex scanning was insensitive (42 per cent) but extremely specific (100 per cent) and accurate, with a positive predictive value of 100 per cent. Varicography also had a specificity and positive predictive value of 100 per cent, a sensitivity of 73 per cent and in addition provided a precise anatomical 'road-map'. A combination of clinical examination and hand-held Doppler ultrasonography seems to be the most appropriate first-line method of preoperative assessment in these patients. Duplex ultrasonography, if available, will provide additional useful information about both the SFJ and the presence of thigh perforators. Contrast examination may be reserved for patients who have equivocal results on non-invasive investigations, who have had more than one previous groin operation or who have, in addition, deep venous disease.

Adult↗
PubMed1993

Abdominal aortic aneurysm: still missing the message.

Over a 7-month period 50 patients presented to the vascular unit with a ruptured or acute symptomatic abdominal aortic aneurysm (AAA). Information regarding the 24 months before acute presentation was obtained from the patient, family doctor and relevant case records to determine whether an asymptomatic aneurysm had previously been diagnosed but the patient not referred to the vascular service, or whether the patient had undergone an examination at which an aneurysm might reasonably have been expected to be diagnosed. Thirteen patients (26 per cent) had previously had an AAA diagnosed but only five had been referred. Thirteen patients (26 per cent) had had a total of 16 inpatient hospital admissions without an asymptomatic aneurysm being diagnosed. Six patients (12 per cent) underwent abdominal examination for an unrelated complaint by the family doctor without an asymptomatic aneurysm being diagnosed. A significant impact on overall mortality from aortic aneurysm may be made by increasing the number of patients undergoing elective aneurysm repair. All doctors should assess aortic diameter in all patients over 50 years of age who undergo abdominal examination for whatever reason. All patients diagnosed as having an asymptomatic AAA should be referred to a vascular surgeon for assessment.

Acute Disease↗
PubMed1993

Evaluation of the Colin STBP-680 at rest and during exercise: an automated blood pressure monitor using R-wave gating.

The application of automated blood pressure measurement during exercise has been limited by inaccuracies introduced by the effects of accompanying motion and noise. We evaluated a newly developed automated blood pressure monitor for measuring exercise blood pressure (Colin STBP-680; Colin, San Antonio, Texas, USA). The STBP-680 uses acoustic transduction with the assistance of the electrocardiogram R-wave to trigger the sampling period for blood pressure measurement. The automated monitor readings were compared with simultaneous technician mercury sphygmomanometric readings in the same arm. Blood pressure was measured in 18 men at rest and during exercise at 40% VO2 peak, (low intensity), 70% VO2 peak (moderate intensity) and VO2 peak (high intensity) on the cycle ergometer. Mean(s.d.) systolic blood pressure difference between the automated monitor and mercury manometer readings at rest and during exercise at low, moderate and high work intensities were 3(0) mmHg, 3(2) mmHg, 1(1) mmHg, and 0(11) mmHg respectively (analysis of variance; P > 0.05). Resting diastolic blood pressure obtained with the STBP-680 was similar to the mercury manometer readings (78(10) versus 81(7) mmHg (P > 0.05). Exercise diastolic pressure at the low level of work intensity was almost identical between the automated monitor and mercury manometer readings (64(8) versus 65(10) mmHg (not significant)). Diastolic blood pressure readings between the STBP-680 and mercury manometer showed a greater difference at the moderate and high workloads (11 mmHg and 9 mmHg, respectively), but this difference was not significant (P > 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1992

Racial differences in maximal vasodilatory capacity of forearm resistance vessels in normotensive young adults.

This study was performed to determine whether alterations in vascular structure exist in a biracial population of young (age 22.3 +/- 0.6 yrs [mean + SE]) normotensive men. We examined maximal vasodilatory capacity in 21 blacks and 20 whites (average blood pressure = 122/75 and 118/72 mm Hg, respectively). Forearm blood flow was determined at rest and after 10 min of ischemic handgrip exercise using venous occlusion plethysmography. Forearm vascular resistance was computed from blood flow and mean arterial blood pressure determined by auscultation. Minimum forearm vascular resistance was 23% higher in blacks (2.60 +/- 0.60) than in whites (2.11 +/- 0.41) (P = .005), and was unrelated to parental history of hypertension. The regression equation for minimum forearm vascular resistance (Y) and casual blood pressure (X) for blacks was Y = -1.782 + 0.0487X (r = 0.522); for whites it was Y = -1.165 + 0.0367X (r = 0.418). When the data were covaried on resting mean arterial blood pressure, blacks still had a higher minimum forearm vascular resistance (P = .014). The results suggest a racial difference in the vascular structure of the forearm resistance vessels.

Adult↗
PubMed1992

The benefits and costs of caregiving and care receiving for daughters and mothers.

In accordance with social exchange theory (Thibaut and Kelley, 1959), this study examined the outcomes of caregiving for elderly mothers and their caregiving daughters (N = 141 pairs). Data were gathered through face-to-face interviews. Principal components factor analyses revealed three factors for mothers: Helplessness, Feeling Loved, and Anger; and three factors for daughters: Insufficient Time, Frustration, and Anxiety. Block regressions with an initial block of demographic variables and a second block of situational variables were performed to determine the relative influence of these two sets of independent variables on caregiving outcomes. The regressions revealed limited influence of demographic variables and significant influence of situational variables. Of particular importance for daughters is the role of perceived intimacy with the mother: Daughters with better relationships experience fewer caregiving costs. Mothers' health plays a critical role in the outcomes of care receiving: Mothers in poorer health experience greater helplessness and are less likely to feel loved.

Aged↗
PubMed1992

The antibacterial activity of Virkon measured by colony growth and bioluminescence of lux recombinant Listeria monocytogenes.

Concentration exponents for the broad spectrum antimicrobial Virkon were determined for Listeria monocytogenes using both plate counts and bioluminescence measurements; the values of 3.15 and 2.6 indicate a close equivalence between these two measurement procedures. Virkon is an effective biocide for L. monocytogenes at the manufacturer's in-use concentration of 1%.

Colony Count, Microbial↗
PubMed1992

Cardiovascular and plasma catecholamine responses to exercise in blacks and whites.

The purpose of the present study was to assess possible racial differences in cardiovascular and plasma catecholamine responses to dynamic exercise. A biracial group of normotensive college-age men (15 blacks, 15 whites) were tested for maximal oxygen uptake, resting blood pressure, and heart rate. Subjects then rode a cycle ergometer at 25%, 50%, and 75% of peak oxygen uptake (6 minutes at each stage). Blood pressure and heart rate were measured during supine rest, seated rest, and at each stage of exercise with an automated blood pressure monitor. At each stage, venous blood was sampled to allow determination of plasma norepinephrine and epinephrine, and cardiac output was measured with the carbon dioxide rebreathing technique. The results indicated that resting blood pressure was similar for blacks and whites (114/68 versus 115/68 mm Hg, respectively). Blacks exhibited greater systolic and diastolic blood pressures during submaximal dynamic exercise. However, blacks also showed a trend toward a positive parental history of hypertension, which has been associated with an increased pressor response. Racial differences did not exist for heart rate or cardiac output, but blacks had higher values for total peripheral resistance both at rest and during exercise. Although no overall racial differences were seen for plasma catecholamine concentrations at rest, blacks had significantly lower levels of norepinephrine (1,275 versus 1,556 pg/ml) and higher levels of epinephrine (306 versus 216 pg/ml) than whites at the highest work rate. The current study confirms the increased pressor response to exercise in normotensive blacks. Blacks had an elevation in total peripheral resistance that was not accompanied by an increase in plasma norepinephrine levels.

Black or African American↗
PubMed1991

Medicare: a strategy for quality assurance, III: Beneficiary and physician focus groups.

The third of a series on the Institute of Medicine study on a quality review and assurance program for Medicare, this article describes findings on two separate series of focus groups held with Medicare beneficiaries and with physicians in private practice. The respondents' perceptions of quality of care, understanding of the Medicare program and QA activities, and recommendations for improvement are reported directly and examined for implications for designing a coherent QA strategy. A surprising finding is that both beneficiaries and physicians define quality of care in terms of the "art of care" as well as in technical and clinical terms.

Attitude of Health Personnel↗
PubMed1991

Relationships between caregiving daughters and their elderly mothers.

In this qualitative study of 29 pairs of widowed mothers and their caregiving daughters, we employ social exchange theory to identify three relationship types: intrinsic (45%), ambivalent (34%), and conflicted (21%). These types differ in the extent to which the women receive rewards from interacting with their partner, experience costs in their interaction, handle conflicts that arise in their relationship, and express feelings of concern for each other. They also differ in that daughters in intrinsic pairs have fewer children and shorter caregiving histories than daughters in ambivalent or conflicted pairs.

Aged↗
PubMed1991

Obesity in indigent elderly rural African women: effects on hypertension, hyperlipidaemia and hyperglycaemia.

To learn more of the sequelae of obesity in South African elderly rural indigent black women (aged 58-85 years), studies were made on 40 women with BMI greater than or equal to 30, and on 50 non-obese women with BMI of 25 or less, all in outward good health. In the two groups, hypertension (greater than or equal to 160/95 mm Hg) was present in 9 and 5 women (22% and 10%), hypercholesterolaemia (greater than or equal to 5.2 mmol/l) in 28 and 26 women (70% and 52%), hypertriglyceridaemia (greater than or equal to 1.8 mmol/l) in 20 and 16 (50% and 32%), and hyperglycaemia (greater than or equal to 6.7 mmol/l) in 8 and 7 women (20% and 14%). Differences between the obese and non-obese attained significance with blood pressure and serum lipids (P less than 0.01), although not with blood glucose. Both groups were habituated to a low fat high fibre diet. In this context, obesity appeared less evocative of adverse sequelae than prevails in a white population. However, for appropriate validation, longitudinal studies are required.

Aged↗
PubMed1991

Trans-endoscopic balloon dilatation of benign oesophageal strictures: a prospective study as an out-patient procedure.

Over an 18-month period 70 consecutive patients underwent 100 oesophageal balloon dilatations of their benign peptic strictures by the trans-endoscopic route. All procedures were performed as an out-patient under intravenous sedation. One patient developed respiratory depression from over-sedation. No other complications were seen in this series. The first 50 patients were reviewed by postal questionnaire. The majority (91%) of patients were swallowing normally and all patients except one were happy with the procedure and content to undergo further dilatation should it prove necessary. A cost analysis was performed comparing balloon dilatation with conventional bougienage which is also practised at our hospital. Balloon dilatation as an out-patient procedure is a more cost-effective technique when compared to bougienage and has the potential of saving the health service many thousands of pounds per annum.

Adult↗
PubMed1991

Serum albumin levels in elderly rural Africans.

Reports on white populations indicate an inverse relationship between serum albumin level and total death rate, also death rates from cardiovascular diseases (CHD) and cancer. Among rural African blacks, CHD is absent, and diet-related cancers rare, so that albumin levels in the elderly would be expected to be elevated. Studies on 50 men and 50 women, representative elderly rural blacks, revealed mean values to be high, 47.6 +/- 4.9 g/l and 48.2 +/- 4.2 g/l. Levels were not significantly associated with Body Mass Index, blood pressure, serum cholesterol level, nor blood glucose level. Hence, in the setting described, even elevated levels of these variables appear less noxious to health than is the case in white populations, since such levels are consistent with low mortality from the diseases mentioned. Explanation of the relationship between serum albumin and life expectancy is unknown. Longitudinal studies are necessary to clarify the situation.

Aged↗
PubMed1991

Comparison between Eusol and Silastic foam dressing in the postoperative management of pilonidal sinus.

Seventy-five consecutive patients with pilonidal sinus disease were randomized to receive either Eusol dressings or Silastic foam dressings. Patients were divided into those with pilonidal sinus and pilonidal abscess. There was no significant difference between time to hospital discharge or time to full healing in either group. The cost benefits and simplicity of Silastic foam dressing are discussed.

Abscess↗