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Biomedical subjects

B R Hopkinson

Publications and source records attributed to B R Hopkinson.

At least 127 records · Page 7Linked to original sources
PubMed1986

Non-invasive investigation of lower limb revascularisation using resting thallium peripheral perfusion imaging.

Resting thallium thigh and calf imaging was performed in 11 patients with lower limb ischaemia before and after revascularisation. Eight patients had successful revascularisation but in the other three the procedure failed to improve the circulation. Despite symptomatic improvement and increases in ankle systolic pressures after successful revascularisation there was no change in thallium uptake. Thallium imaging was compared with radionuclide angiography and blood pool imaging in six patients. Radionuclide angiograms confirmed the presence of well developed collateral circulation in some patients with increased thallium uptake in the symptomatic limb and in all cases the angiograms were clinically useful. There was no correlation between thallium and blood pool images. Resting lower limb blood flow did not change after revascularisation and thallium peripheral perfusion imaging did not aid the assessment of the response to lower limb revascularisation.

Adult↗
PubMed1986

A review of 155 extra-anatomic bypass grafts.

Extra-anatomic bypass grafting has been used as treatment for patients with aorto-iliac disease who were considered unfit for aortic surgery. Eighty five percent of the patients had ischaemic pain at rest or skin necrosis. One hundred and three femorofemoral (FF) grafts, 40 axillounifemoral and 12 axillobifemoral grafts were performed. Femoropopliteal extension grafts were performed in 39 cases. The three year cumulative graft patency rate was 69% for FF grafts and 48% for both types of axillofemoral (AF) graft, falling to 61% for FF grafts and 32% for AF grafts at five years. The long term patient survival rate was poor, particularly for AF grafts, 27% at five years, reflecting the poor general condition of these patients. In addition almost a quarter of AF grafts required declotting at some stage. However, worthwhile limb salvage rates were obtained with both types of grafts, 69% for FF and 72% for AF at three years and 61% for FF and 65% for AF at five years, suggesting that these grafts should be employed as a means of avoiding amputation in poor risk patients.

Adult↗
PubMed1985

Five year experience using PTFE vascular grafts for lower limb ischaemia.

The 5 year results using polytetrafluoroethylene (PTFE-Gore-Tex) grafts mainly for superficial femoral occlusion have been reviewed. The majority of these grafts were inserted in an elderly poor risk group of patients with critical ischaemia of the lower limb. The overall cumulative patency at 2 years was 29% falling to 18% at 5 years. Further analyses were performed to take into account risk factors, namely, patient's age, diabetes, hypertension, continuation of smoking, peroperative angiographic findings and the site of the distal graft anastomosis. Peroperative angiographic run off was found to be the only risk factor significantly affecting the cumulative graft patency. The presence of diabetes was found to have a significant detrimental effect on limb salvage.

Aged↗
PubMed1984

A comparison of nuclear magnetic resonance and intravenous xeroangiography with conventional arteriography in popliteal artery imaging.

Twenty-nine patients with peripheral vascular disease had the popliteal artery segment assessed by xeroangiography and nuclear magnetic resonance (NMR) scanning. The result of each test was compared with conventional contrast arteriography. Nuclear magnetic resonance and xeroangiography correctly predicted popliteal artery patency in 97% and 100% of limbs, respectively, and occlusion was correctly predicted in 44% and 63% of limbs. The ability of xeroangiography to define the state of the popliteal artery accurately makes this a useful method in high-risk patients. The potential for NMR imaging appears very promising but more work is required to define its future clinical application.

Adult↗
PubMed1983

Unoperated abdominal aortic aneurysm: presentation and natural history.

The natural history of abdominal aortic aneurysm (AAA) is death from rupture unless the patient dies from another cause prior to rupture. Elective aortic grafting is the treatment of choice. Following rupture, emergency operation is the only treatment which will prolong the patient's survival. Controversy still exists as to the optimum management in poor risk patients and in those with a small aneurysm. This paper describes the presentation and natural history of 65 patients presenting with a ruptured abdominal aortic aneurysm who did not have an emergency operation, and a further 27 patients in whom the diagnosis of intact AAA was made who did not have an elective aortic replacement graft. The correct diagnosis was made at the time of admission in only 43 of the 65 patients with ruptured aneurysms. The diagnostic errors and appropriate investigations in cases of doubt are discussed. The mean time from admission to hospital to death was 8 hours. The reasons for not performing an elective operation in the 27 patients known to have AAA are given. Nine have subsequently died from rupture. There have been 7 deaths from other causes.

Aged↗
PubMed1983

A modified Gritti-Stokes amputation: its place in the management of peripheral vascular disease.

A modified technique for performing the Gritti-Stokes amputation is described and the results obtained in 247 cases are presented. The mortality rate was 9.3% and healing occurred in 87% of survivors. Using this modified technique the frequently cited criticisms of non-union of the patella and painful stumps were not found to be major problems. The prosthetic problems of amputation at this level are discussed in relation to recent developments in the design of artificial limbs.

Adult↗
PubMed1982

Popliteal artery aneurysm.

Fourteen patients with atherosclerotic aneurysms of the popliteal artery, which were bilateral in 13, have been managed in a vascular unit where ultrasound, xerography, and isotope angiography are available for investigation. Although these methods are useful in confirming a suspected diagnosis, they cannot replace an awareness of the condition and clinical methods of examining the ischaemic lower limb. Reconstructive vascular surgery was effective in preserving the presenting leg in 5 cases and amputation was needed in 6, while no operation was needed in 3. Elective arterial surgery was carried out on the asymptomatic contralateral leg in 7 cases with good results and this active approach to treatment is recommended.

Aged↗
PubMed1981

Restoration of the absent femoral pulse.

One hundred and eighty-three consecutive operations for ischemia of the lower limb were performed to restore an absent femoral pulse. Ninety-seven patients considered to be fit had an aortofemoral or iliofemoral bypass graft and 86 high risk patients had a femorofemoral or axillofemoral graft. The best results were obtained in those with the aortofemoral or iliofemoral grafts, but superficial grafts were a satisfactory alternative even in the unfit patients with critical ischemia.

Aged↗
PubMed1980

Silicone rubber band treatment of rectal prolapse.

Fifty-two patients with rectal prolapse have been treated by the silicone rubber band perianal suture technique and satisfactory results have been obtained in 46 (89%). Eleven patients required reoperation to achieve this result. The procedure is a minor one, with little morbidity and no mortality. Provided that faecal impaction can be avoided in patients having this operation a successful outcome, can be expected. It is recommended especially for the frail and elderly with rectal prolapse.

Adult↗
PubMed1978

The Gritti-Stokes amputation in ischaemia: a review of 134 cases.

The results of 134 Gritti-Stokes amputations for ischaemia are presented. The mortality rate was 11% and healing occurred in 88%, reaffirming the good results already reported for this operation. The long term results are reviewed in an attempt to decide whether the most frequently cited criticisms of this procedure are justified. Stump pain and mobility of the patella were not major problems. The difficulties in fitting a suitable prosthesis are discussed and attention is drawn to the advantages of a new prosthesis that has been developed for this amputation.

Adult↗
PubMed1978

Clinical experience with silicone rubber grafts as shunts in portal hypertension.

We report the use of a woven silicone rubber graft as an alternative prosthesis for a shunt in 8 patients with portal hypertension. Four patients were operated on as emergencies and 4 electively. In 4 cases the graft was used as a standard mesocaval H graft, in 2 as a portocaval H graft and in 2 cases it was used to simplify the Warren selective distal splenorenal shunt. The material has properties which make it a superior graft to existing prostheses and autogenous vein. Our results confirm the experience of others, that the poor risk patients do badly whatever form of shunt is performed, and of those who survive, the total portal shunt carries the risk of postoperative encephalopathy.

Adolescent↗
PubMed1977

Anal incontinence.

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Chronic Disease↗