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Biomedical subjects

C P Gibbons

Publications and source records attributed to C P Gibbons.

At least 19 recordsLinked to original sources
PubMed2006

Pancreatic abscess involving the aortic graft following repair of a ruptured aortic aneurysm: successful replacement with femoro-popliteal vein.

Acute pancreatitis is a rare complication after aortic surgery and carries a high mortality. We report the successful management of an infected aortic graft secondary to complicated severe pancreatitis in a 77-year-old man by open drainage of the abscess and replacement of the prosthetic graft with superficial femoro-popliteal vein (SFPV). The patient remains free from infection with a patent graft 8 months later.

Abscess↗
PubMed2005

Primary vascular access.

Primary vascular access is usually achievable by a distal autogenous arterio-venous fistula (AVF). This article describes the approach to vascular access planning, the usual surgical options and the factors affecting patency.

Arm↗
PubMed2003

Treatment of steal syndrome complicating a proximal arteriovenous bridge graft fistula by simple distal artery ligation without revascularization using intraoperative pressure measurements.

This case report describes the treatment of a patient with a steal syndrome complicating a brachioaxillary prosthetic bridge graft AV fistula by simple ligation of the brachial artery beyond the fistula. Intraoperative pressure measurements showed concomitant distal revascularization to be unnecessary.

Adult↗
PubMed2003

Ileitis due to Yersinia pseudotuberculosis in Crohn's disease.

We present the case of a young woman with fulminating terminal ileitis due to Yersinia pseudotuberculosis, in whom Crohn's disease was subsequently diagnosed. Serological testing was prompted by radiological, macroscopic and histological changes which were atypical of Crohn's disease. We speculate that Y. pseudotuberculosis ileitis may occasionally produce an acute exacerbation of Crohn's disease, but that its occurrence may not be diagnosed if the atypical features are not recognised. In this case, the classical features of Y. pseudotuberculosis may have been modified by pre-existing Crohn's disease. We propose that, because of defects in mucosal barrier function and immunological function, patients with Crohn's may have increased susceptibility to infection by Yersinia sp.

Adult↗
PubMed2003

Experience with femoro-popliteal vein as a conduit for vascular reconstruction in infected fields.

OBJECTIVE: to review the outcome of femoro-popliteal vein grafts for arterial reconstruction in the presence of sepsis. PATIENTS AND METHODS: twenty-six patients underwent 27 arterial reconstructions with femoro-popliteal vein in the presence of infection. Five had mycotic aneurysms (3 aortic, 1 iliac and 1 femoral), 21 had prosthetic graft infections (9 aortic, 8 femoro-femoral, 2 axillo-femoral, 1 ilio-femoral and 1 femoral dacron patch) and one underwent superior mesenteric artery reconstruction following ischaemic small bowel perforation.Arterial reconstruction followed debridement of infected tissue, removing any infected graft, povidone iodine washout and appropriate antibiotic cover. Where possible, new grafts were placed in a clean field or wrapped in omentum. Four femoral anastomoses were covered by rectus femoris flaps. RESULTS: there was one early postoperative death (4%) and no limb loss. All others remained free from infection with patent grafts at 1 month to 5 years (median 22 months). Three major wound infections healed without exposing the graft. One infarcted rectus femoris flap required removal. Donor limb swelling was transient. Five required percutaneous angioplasty and one underwent open profundaplasty within 3 months. CONCLUSION: femoro-popliteal vein reconstruction with debridement and appropriate antibiotic therapy is recommended for the treatment of arterial or graft infections.

Aged↗
PubMed2001

Completion angioscopy following carotid endarterectomy by the eversion technique or the standard longitudinal arteriotomy with patch closure.

INTRODUCTION: Technical defects are a potential cause of peri-operative strokes following carotid endarterectomy (CEA) by either the eversion technique or the standard method of longitudinal arteriotomy with or without patch closure. AIM: A non-randomised retrospective study was undertaken to assess the value of angioscopy for the identification of technical errors following CEA and to compare those detected following eversion and standard endarterectomy with patch closure. MATERIALS AND METHODS: Intra-operative completion angioscopy was performed following 110 CEAs (56 eversion, 54 standard). Angioscopy was omitted in 5 patients because of technical problems (2) or extreme shunt dependency (3). RESULTS: Significant technical defects were identified and corrected in 10 cases (9%) and were equally distributed between the eversion and standard procedures. There was no peri-operative stroke or death in this series. CONCLUSIONS: Significant residual defects may occur after CEA by either technique. Angioscopy allows their correction peri-operatively and has the potential to reduce peri-operative stroke.

Adult↗
PubMed2000

Use of superficial femoropopliteal vein for suprainguinal arterial reconstruction in the presence of infection.

BACKGROUND: Conventional treatment of mycotic aneurysms or graft infections of the aortoiliac segment by in situ or extra-anatomic prosthetic reconstruction has a high mortality and morbidity rate, with a substantial risk of persistent graft infection. The use of autologous vein may reduce this. METHODS: Eleven patients with suprainguinal arterial infections including two with mycotic aortic aneurysms, four with aortic graft infections, four infected femorofemoral grafts and an infected axillofemoral graft were treated by debridement and in situ reconstruction with autologous superficial femoropopliteal vein. All patients received appropriate antibiotic therapy and were followed by regular postoperative duplex imaging. Preoperative femoral vein duplex imaging was performed in eight of the 11 patients. RESULTS: Ten of the 11 patients survived with a functioning graft and without limb loss or evidence of infection at 4-33 months. One patient died from myocardial infarction after operation. Three patients had minor swelling of one leg. Four patients required subsequent angioplasty of anastomotic stenoses detected by duplex surveillance. CONCLUSION: Superficial femoropopliteal vein is an excellent conduit for suprainguinal reconstruction in the presence of infection. Duplex imaging is useful for confirming the suitability of deep veins for use as a graft and for postoperative surveillance.

Aged↗
PubMed2000

The snuffbox arteriovenous fistula for vascular access.

OBJECTIVES: to determine the applicability, patency rates and factors influencing patency of snuffbox arteriovenous fistulae for haemodialysis access. DESIGN: retrospective non-randomised study. MATERIALS AND METHODS: patency was determined by reference to an ongoing database and dialysis records of 645 vascular access procedures between 1985 and 1997, including 210 snuffbox fistulae in 201 patients. RESULTS: snuffbox fistulae comprised 189/376 (50%) primary procedures. Records of 208 snuffbox fistulae were available for patency analysis by the life-table method. Twenty-two (11%) thrombosed within 24 hours of operation. After six weeks 80% were used for dialysis. Cumulative patency was 65% at 1 year and 45% at 5 years. After thrombosis of snuffbox fistulae, ipsilateral wrist fistulae could be constructed in 45%. Fistula patency was significantly better in men than women (p<0.001) and for left- than right-sided fistulae (p<0.001). Diabetes, age >70 years, and the prior commencement of haemodialysis did not significantly affect fistula survival. CONCLUSIONS: the snuffbox AV fistula gives a long segment of arterialised vein for needling and preserves proximal vessels. It is feasible in 50% of patients requiring primary access and has good long-term patency, especially in men. A more proximal fistula may be preferable in women with smaller vessels.

Arteriovenous Shunt, Surgical↗
PubMed1988

Role of constipation and anal hypertonia in the pathogenesis of haemorrhoids.

The hypothesis that haemorrhoids result from chronic constipation was investigated by studying bowel habit, anal pressure profiles and anal compliance in 13 men and 10 women with prolapsing haemorrhoids, 12 women with severe constipation and 14 male and 11 female control subjects. Defaecation was less frequent in women than in men (P less than 0.01) but was independent of the presence of haemorrhoids. Patients with haemorrhoids and control subjects reported similar stool consistency and rarely admitted to straining. Severely constipated women complained of infrequent defaecation, straining at stool and hard motions, but none had prolapsing haemorrhoids. Haemorrhoids were associated with significantly longer anal high-pressure zones and significantly greater maximum resting pressures at all levels of anal distension (P less than 0.01), but minimum residual pressure during rectal distension and maximum squeeze pressure were not significantly different from control subjects. Maximum resting pressure was increased in patients of both sexes with haemorrhoids, but this reached statistical significance only in men (P less than 0.001). Constipated women had normal anal pressure profiles and maximum anal pressures. These data show that patients with haemorrhoids are not necessarily constipated but tend to have abnormal anal pressure profiles and anal compliance. Chronically constipated women do not necessarily have haemorrhoids but have normal anal pressure profiles and compliance. This casts doubt upon the hypothesis that haemorrhoids are caused by constipation.

Adult↗
PubMed1988

The mechanics of the anal sphincter complex.

The anal sphincter complex consists of circumferentially arranged muscle fibres, which surround a relatively thick anal lining. This apparatus was modelled mechanistically as two concentric homogeneous isotropic linear elastic cylinders. The inner cylinder (anal lining) was considered to be thick walled, while the outer (the circular muscle) was assumed to be thin walled. The model predicts that the anal sphincter tension varies linearly with luminal diameter. This prediction was confirmed experimentally under normal conditions as well as during external sphincter contraction and internal sphincter relaxation. Under conditions of negligible hoop stress in the anal lining the model also predicts that the intra-luminal pressure falls to zero before the luminal diameter reaches zero. Hence, an autoregulatory mechanism of anal cushion thickening, as the luminal pressure falls to zero, to produce anal closure was proposed. Deficiencies in this autoregulation mechanism may explain anal incontinence and the obstructed defaecation often found in subjects with haemorrhoids.

Adult↗
PubMed1987

Cortical and vascular prostaglandin synthesis during renal allograft rejection in the rat.

Alterations in local prostacyclin and thromboxane synthesis could mediate the changes in vascular perfusion and platelet deposition in acutely rejecting renal allografts and prostaglandin E2 (PGE2) has been implicated in the regulation of the immune response. 6-Keto-prostaglandin F1 alpha (6 KetoPGF1 alpha), thromboxane B2 (TxB2) (the stable degradation products of prostacyclin and thromboxane A2 [TxA2], respectively) and PGE2 were measured in incubates of cortical slices taken from rat renal allografts or isografts one to seven days after transplantation. 6 KetoPGF1 alpha and TxB2 synthesis was also measured in incubates of blood vessels supplying and transplanted with the kidney in these animals. During the phase of cellular rejection (3-5 days), TxB2 synthesis was selectively elevated in allografted renal cortex, renal artery, renal vein, and abdominal aorta in comparison with isografted tissues. There was also a small but significant rise in cortical PGE2 synthesis at this time, but vascular and cortical 6 KetoPGF1 alpha production remained unchanged. Renal infarction, occurring 7 days after transplantation, was accompanied by a nonspecific rise in the synthesis of all three prostaglandins by renal cortical slices. Increased tissue TxA2 synthesis may contribute to local thrombosis and decreased graft perfusion during acute rejection, thereby potentiating graft destruction.

6-Ketoprostaglandin F1 alpha↗