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Biomedical subjects

C V Ruckley

Publications and source records attributed to C V Ruckley.

At least 73 records · Page 4Linked to original sources
PubMed1997

Expansion rates of abdominal aortic aneurysm: current limitations in evaluation.

OBJECTIVES: Literature on the expansion rate of infrarenal aortic aneurysm is scant. This review was carried out to assess whether there is a normal rate of expansion for infrarenal aortic aneurysms. DESIGN AND METHODS: Review of literature relating to abdominal aortic aneurysm (AAA) measurement and expansion rates. Articles were identified from a search of the computerised Medline database from 1966 onwards. RESULTS: Nine studies produced expansion rates for 3.0-5.0 cm AAA ranging from 0.17 to 0.57 cm per year. Evaluation of these studies showed that they are not wholly comparable in terms of source population, sample size, disease definition and period of assessment. CONCLUSIONS: It is not possible to discuss with confidence the "normal" expansion rate of infrarenal aortic aneurysms at any diameter. To elucidate fully the behaviour of AAA, a clear and universal definition of AAA is required in order that it may be used within a large, multicentered prospective cohort study.

Aneurysm, Ruptured↗
PubMed1997

Changes in platelet count, coagulation and fibrinogen associated with elective repair of asymptomatic abdominal aortic aneurysm and aortic reconstruction for occlusive disease.

BACKGROUND: Mortality and morbidity following aortic surgery, particularly repair of ruptured abdominal aortic aneurysm (AAA), is frequently associated with the development of coagulopathy. OBJECTIVES: To examine changes in platelet count (PC), fibrinogen, and coagulation in patients undergoing elective repair of asymptomatic abdominal aortic aneurysm (AAA) and aortic surgery for occlusive disease. DESIGN: Prospective clinical study in a University Department of Vascular Surgery. PATIENTS: Thirty-three patients undergoing elective repair of asymptomatic AAA and 19 patients undergoing aortic surgery for occlusive disease. METHODS: Full blood count (FBC), clotting screen, and fibrinogen measured pre-operatively; 6, 12, 24, 48 h postoperatively; and thereafter as clinically indicated in 23 consecutive patient's undergoing AAA repair (Group 1). Pre- and postoperative PC measured weekly for 4 weeks following operation in a further 10 consecutive patients undergoing AAA repair (Group 2) and perioperative PC measured in 19 consecutive patients undergoing aortic surgery for occlusive disease (Group 3). RESULTS: Group 1: Preoperative haematological parameters were normal. There was no mortality. Postoperatively, 21 (91%) patients developed thrombocytopenia (PC < 150 x 10(9)/l). The postoperative fall in PC (median 90, range 12-160 x 10(9)/l) was significantly related to the duration of aortic cross-clamp (median 46, range 20-127 min, r2 = 0.33, p < 0.01). At 10 days all patients had developed thrombocytosis (PC > 350 x 10(9)/l) Postoperatively, by 48 h, 17 (74%) patients had developed hyperfibrinogenaemia. One patient suffered a myocardial infarction associated with a PC of 105 x 10(9)/l and a fibrinogen of 7.2 g/l. GROUP 2: In a further 10 patients undergoing AAA repair postoperative thrombocytosis was found to persist for several weeks in five of nine survivors. GROUP 3: Patients undergoing aortic surgery for occlusive disease had significantly higher preoperative PC than AAA patients (median 292, range 179-251 x 10(9)/l vs. median 204, range 140-293 x 10(9)/l, p < 0.01). CONCLUSIONS: Patients undergoing elective repair of AAA demonstrate similar, albeit less dramatic, changes in platelet count to those we have previously reported in patients undergoing repair of ruptured AAA. Aortic clamping leads to platelet sequestration and thrombocytopenia in the early postoperative period. Later, patients develop hyperfibrinogenaemia and thrombocytosis which may persist for several weeks. Similar changes are seen in patients undergoing aortic surgery for occlusive disease. These changes may represent a hypercoagulable state that predisposes these patients to thrombotic complications.

Aged↗
PubMed1997

Subfascial endoscopic perforator surgery is associated with significantly less morbidity and shorter hospital stay than open operation (Linton's procedure)

BACKGROUND: Subfascial endoscopic perforator surgery (SEPS) is the minimally invasive alternative to the open (Linton's) procedure. This new technique may allow perforating vein interruption with fewer complications and a shorter postoperative hospital stay. METHODS: This study was a case note review of 67 procedures: 30 SEPS and 37 Linton's. RESULTS: There were no significant differences between the two groups in age, sex and indication for surgery. SEPS was associated with a significantly reduced postoperative stay in hospital (median 2 (range 1-49) days) compared with the Linton's procedure (median 9 (range 3-36) days) (P < 0.01). Nine patients who had Linton's procedure suffered a calf wound complication compared with none who had SEPS. The presence of an open ulcer at the time of surgery did not prolong the duration of stay in either group, nor did it increase the incidence of calf wound complications. CONCLUSION: In patients undergoing calf perforator interruption for chronic venous insufficiency, SEPS is associated with significantly less morbidity and a shorter hospital stay than Linton's procedure. SEPS can be performed safely at the same time as skin grafting and in the presence of an open ulcer without any increase in wound complications.

Adult↗
PubMed1997

Socioeconomic impact of chronic venous insufficiency and leg ulcers.

Chronic venous insufficiency affects approximately 5% and chronic leg ulcer approximately 1% of the adult population of developed countries. Not only do recent quality of life studies highlight major disability and social impairment but, since this is a condition characterized by chronicity and relapse, it gives rise to massive health care expenditure amounting in the UK to around Pounds 400 million per annum. Venous disease consumes 1-2% of the health care budgets of European countries. Imprecise disease classifications and codings impede the acquisition of accurate data but there is a compelling need for better quality socioeconomic data concerning this long-neglected health care problem.

Adult↗
PubMed1997

Use of a fibrous dressing in exuding leg ulcers.

In a multicentre, prospective, randomised trial of 44 patients with exuding leg ulcers, a new hydrofibre dressing was compared with an alginate dressing in terms of dressing performance, patient comfort, safety and cost-effectiveness. The groups were well matched with regard to sex and age. A statistically significant difference between treatment groups was observed in mean wear time, with a longer wear time of four days observed in the hydrofibre dressing group compared to three days in the alginate group. The hydrofibre dressing group therefore demonstrated a significantly lower frequency of dressing changes required per week. Significantly more patients achieved a seven-day wear time with the hydrofibre dressing than with the alginate dressing. There was no difference with regard to percentage change in ulcer area. Cost-effectiveness was based on the cost of dressings, compression therapy and nursing time to achieve a healed wound. However, because of small patient numbers, it was difficult to make an accurate comparison. This study suggests that the hydrofibre dressing may have clinical benefits that merit further investigation with larger patient numbers.

Aged↗
PubMed1997

Twelve-year experience of the management of ruptured abdominal aortic aneurysm.

BACKGROUND: The operative mortality rate for elective repair of asymptomatic abdominal aortic aneurysm (AAA) is falling but the fate of patients with ruptured AAA may have changed little over the past decade. METHODS: This study was an analysis of a prospectively gathered computerized database. RESULTS: In the 12 years to 31 December 1994, 1144 patients underwent (attempted) repair of AAA. In 514 patients (44.9 per cent) who had an operation for ruptured AAA there was no significant change in the mean age, male:female ratio (418:96), or operative mortality rate (35.0 per cent) over the interval of the study. Forty-seven patients died before reaching the operating theatre, giving an 'intention to operate' mortality rate of 40.5 per cent. A further 68 patients (10.8 per cent of all patients who presented with a ruptured AAA) were not offered operation because of poor medical condition (n = 34) or extreme age (n = 34); three patients refused operation. A greater proportion of patients had surgery between 1989 and 1994 (276 of 323, 85.4 per cent) than between 1983 and 1988 (238 of 309, 77.0 per cent) (P < 0.01, chi2 test). CONCLUSION: The proportion of aneurysms operated on for rupture in this unit remains high (almost 50 per cent). The results of surgery for ruptured AAA have not improved in the past 12 years.

Aged↗
PubMed1997

Supervised training in carotid endarterectomy is safe.

BACKGROUND: The number of carotid endarterectomies (CEAs) performed in the UK, and thus the need to train surgeons in this operation, has increased markedly in recent years and may continue to do so. The aim of the present study was to assess the quality, clinical outcome and case-mix of supervised training in CEA in this unit. METHODS: The study was an analysis of a prospectively gathered database of all CEAs performed in this unit since 1975. RESULTS: Between 1 January 1975 and 31 December 1991, 247 CEAs were performed of which only 12 were done by supervised trainees. By contrast, between 1 January 1992 and 1 July 1996, 219 CEAs were performed, 92 (42 per cent) by supervised trainees (P < 0.0001). In cases performed since 1 January 1992, there was no significant difference between trainee and consultant operations with regard to age and sex of patient, smoking history, ischaemic heart disease, hypertension, diabetes, presence of preoperative infarction on computed tomography, indications for operation, degree of ipsilateral carotid stenosis, status of the contralateral carotid artery, use of a shunt or patch angioplasty. Since 1 January 1992, the total perioperative neurological event rate for supervised trainees was seven of 92 (7.6 per cent) of which one was fatal (cerebral infarction). The total neurological event rate for operations done by a consultant was nine of 127 (7.1 per cent), of which one was permanent and disabling and two were fatal (one cerebral infarction and one haemorrhage). CONCLUSION: Since 1991 there has been a tenfold increase in the proportion of CEAs being performed by supervised trainees. This has been accomplished without deterioration in clinical outcome. With adequate supervision, training in CEA can be safe, even when trainees are exposed to a true cross-section of low-, medium- and high-risk cases.

Consultants↗
PubMed1996

Use of ankle brachial pressure index to predict cardiovascular events and death: a cohort study.

OBJECTIVE: To determine whether a low ankle brachial pressure index is associated with an increased risk of cardiovascular events and death, and whether the prediction of such events could be improved by including this index. DESIGN: Cohort study. SETTING: 11 practices in Edinburgh, Scotland. SUBJECTS: 1592 men and women aged 55-74 years selected at random from the age-sex registers of 11 general practices and followed up for 5 years. MAIN OUTCOME MEASURES: Incidence of fatal and non-fatal cardiovascular events and all cause mortality. RESULTS: At baseline 90 (5.7%) of subjects had an ankle brachial pressure index < or = 0.7, 288 (18.2%) had an index < or = 0.9, and 566 (35.6%) < or = 1.0. After five years subjects with an index < or = 0.9 at baseline had an increased risk of non-fatal myocardial infarction (relative risk 1.38, 95% confidence interval 0.88 to 2.16), stroke (1.98, 1.05 to 3.77), cardiovascular death (1.85, 1.15 to 2.97), and all cause mortality (1.58, 1.14 to 2.18) after adjustment for age, sex, coronary disease, and diabetes at baseline. The ability to predict subsequent events was greatly increased by combining the index with other risk factors--for example, hypertensive smokers with normal cholesterol concentrations had a positive predictive value of 25.0%, increasing to 43.8% in subjects with a low index and decreasing to 15.6% in those with a normal index. CONCLUSION: The ankle brachial pressure index is a good predictor of subsequent cardiovascular events, and improves on predictions by conventional risk factors alone. It is simple and accurate and could be included in routine screening of cardiovascular status.

Aged↗
PubMed1996

Surgical research.

Explore the source record for details and available documents.

General Surgery↗
PubMed1996

Comparison of venous reflux in the affected and non-affected leg in patients with unilateral venous ulceration.

In 54 patients with unilateral leg ulceration of purely venous aetiology the only difference in venous reflux between affected and non-affected legs was with respect to the popliteal and crural veins. Deep and superficial venous reflux is common in legs without the skin changes typical of chronic venous insufficiency. The significance of venous reflux in an ulcerated leg cannot therefore be determined without reference to the contralateral, clinically normal, limb. Surgery should be directed at correcting reflux present in the ulcerated limb but not in the unaffected limb. In a minority of patients this entails superficial venous surgery alone, but in the majority such an approach would, ideally, entail correction of deep venous incompetence.

Aged↗
PubMed1996

Surveillance imaging of the operated artery does not alter clinical outcome following carotid endarterectomy.

Clinical outcome was studied in 243 patients undergoing 260 carotid endarterectomies; 166 of these patients underwent serial postoperative surveillance imaging. Including perioperative events, cumulative freedom from ipsilateral stroke was 86 and 82 per cent at 5 and 10 years respectively; the mean incidence of ipsilateral stroke was 1.8 per cent per annum. Twenty patients (8 per cent) suffered cerebral ischaemic events in the hemisphere of the operated side during follow-up: eight transient ischaemic attacks (TIA) and 12 strokes (only two preceded by TIA). Two symptomatic patients were found to have occluded the operated artery but the remainder had no evidence of significant recurrent disease. Cumulative freedom from occlusion or severe (greater than 70 per cent) recurrent stenosis was 87 and 78 per cent at 5 and 10 years respectively; the mean incidence of recurrence of significant disease was 2.2 per cent per annum. No revisional surgery was performed on the operated arteries. In its current format, neither clinical nor surveillance imaging could have prevented any of the strokes observed during follow-up.

Angiography, Digital Subtraction↗
PubMed1996

Still missing the boat with fatal pulmonary embolism.

Deaths from pulmonary embolism during 1994 among surgical inpatients in three Scottish regions were identified through the Scottish Audit of Surgical Mortality and reviewed to identify the risk factors for thromboembolic disease and the thromboprophylaxis received. Fifty-seven deaths were studied (3 per cent of total deaths); 25 (44 per cent) of the patients had received prophylaxis. Thirty-six patients were in a high-risk group, 19 were at moderate risk and two at low risk. Patients admitted as an emergency, those managed conservatively and those judged to be at moderate risk of thromboembolic disease were most likely not to have received thromboprophylaxis.

Adolescent↗