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Biomedical subjects

D Bouchier-Hayes

Publications and source records attributed to D Bouchier-Hayes.

At least 163 records · Page 9Linked to original sources
PubMed1980

Prophylactic antibiotics in vascular surgery. Topical, systemic, or both?

A prospective, randomized, blinded study was performed to determine whether prophylactic antibiotics would reduce the incidence of infection in peripheral vascular surgery and whether the route of antibiotic administration was important. Patients undergoing a vascular procedure with a groin incision were allocated to one of four groups with respect to prophylactic antibiotics. Group I received no antibiotic. Group II had topical cephradine instilled in their incisions prior to closure. Group III received a 24-hour perioperative course of intravenous cephradine, and Group IV received both topical and intravenous cephradine. Groin and abdominal incisional infections were significantly reduced (p < 0.01) among patients who received prophylactic antibiotics by either the topical, systemic, or combined routes of administration. No significant differences were noted among the three antibiotic groups. Profundoplasty, femoral embolectomy, and femoral aneurysm repair were each associated with an increased incidence of infection (p < 0.01). Other risk factors were only important in patients not receiving antibiotics. Either intraoperative topical antibiotics or perioperative systemic antibiotics prevent infection in peripheral vascular surgery, but antibiotic administration by both routes is unnecessary.

Anti-Bacterial Agents↗
PubMed1980

Complementary methods for evaluating carotid stenosis: a biophysical basis for ocular pulse wave delays.

Attempts to noninvasively estimate the significance of carotid arterial stenoses have resulted in a recent technological explosion. Ocular pulse wave timing [oculoplethysmography (OPG) pulse delay] has been strongly promulgated but also criticized on theoretical grounds and for lack of physiologic validation. Audiofrequency analysis of carotid bruits (carotid phonoangiography CPA) has been combined with OPG allegedly to improve accuracy. To evaluate these methods in a controlled model, we studied the effects of graded unilateral stenoses in the canine carotid artery on physiological parameters and associated OPG and CPA recordings. Arterial compliance was calculated from simultaneous diameter and pressure recordings distal to the stenosis. OPG time delay correlated directly with reductions in flow and pressure and with increasing arterial compliance (P less than 0.01). Thus, the delay is caused at least partially by a decreased pulse wave velocity, resulting from the increased compliance distal to stenoses associated with a significant pressure gradient. OPG is most discriminating for stenoses of higher grades. Because bruits arise from flow disturbances that occur even with moderate degrees of stenosis, CPA provides diagnostic information before profound flow reduction occurs. This study illustrates the value of complementary methods for analyzing complex hemodynamic phenomena and provides evidence to support use of the pulse delay concept to diagnose arterial disease.

Angiography↗
PubMed1979

The morbidity of carotid endarterectomy.

The results of 72 carotid endarterectomy operations carried out by three consultant surgeons were analysed. Thirty-eight operations (32.8 per cent) were performed in patients with mild or resolving stroke and 33 operations (45.9 per cent) in patients with transient ischaemic attacks and/or amaurosis fugax. Five patients (7 per cent) died in the early postoperative period, 2 as a result of strokes and the others from cardiac causes. Seventy-six per cent of patients had a satisfactory long term result, remaining free from storke, blindness or recurrent transient ischaemic attacks over the follow-up period of 1--7 years. There were 10 patients (13.8 per cent), including 2 who died, who developed early postoperative neurological deficits; 4 (5.5 per cent) had transient defects and 6 (8.3 per cent) had permanent deficits. Of these patients, 4 had proved occlusions of the reconstructed artery. In 3 patients, cerebral embolization during operation was suspected as the cause. There were, in addition, 2 asymptomatic patients whose reconstruction was shown to be occluded on follow-up postoperative angiography. The continued absence of symptoms, therefore, is no guarantee that the reconstruction is patent and some more objective method of assessment is necessary if the results of carotid endarterectomy are to be critically analysed. The incidence of neurological deficits could, it is believed, be reduced by greater experience with the operation, the routine use of peroperative intra-arterial shunting and peroperative angiography to confirm the patency of the reconstruction.

Adult↗
PubMedDate not supplied

Regulation of macrophage production of vascular endothelial growth factor (VEGF) by hypoxia and transforming growth factor beta-1.

BACKGROUND: Breast tumors contain high numbers of infiltrating macrophages. The role and function of these cells within the tumor remain unclear, but a number of studies have found an association between poor prognosis and macrophage content in human breast cancer. Both hypoxia and TGFbeta-1 have been shown to regulate VEGF in other cell types. We hypothesized that breast tumor-associated macrophages produce VEGF and that macrophage production of this factor is regulated by both hypoxia and TGFbeta-1. METHODS: Paraffin-embedded breast tumor sections were stained immunohistochemically with anti-VEGF, anti-CD68, and anti-cytokeratin. Monocytes were matured for 3 days in 20% autologous plasma and activated with 1000 U/mL interferon-gamma for 24 hours. Supernatants were assayed for VEGF protein by ELISA. Total RNA was isolated from cells and reverse transcribed to cDNA, which was used as a template in PCR reactions for VEGF and beta-actin. RESULTS: Both tumor cells and tumor macrophages produce VEGF in human breast tumors. Hypoxia increases VEGF protein and mRNA levels in monocyte-derived macrophages, whereas TGFbeta-1 increases VEGF protein but not mRNA under hypoxic growth conditions. CONCLUSIONS: Breast tumor-associated macrophages may contribute to the angiogenic activity of human breast tumors by producing VEGF. Macrophage production of VEGF is upregulated by hypoxia and TGFbeta-1, both of which occur in the tumor environment. Macrophage production of VEGF is regulated at both the mRNA and protein levels.

Breast Neoplasms↗
PubMedDate not supplied

Fractured penis: a clinical misnomer!

BACKGROUND: A 'fracture' of the penis refers to a tear in the deep layer of the tunica albuginea (Buck's fascia) and may be associated with a urethral injury. AIM: To describe a classical case of a 'fractured' penis and discuss the management options. METHOD: A case report of a 30-year-old man presented with a 'fractured' penis and who underwent surgical intervention. CONCLUSION: This rare occurrence represents a urological emergency and necessitates imaging and repair of the cavernosal defect in order to prevent poor functional outcome.

Adult↗
PubMedDate not supplied

The role of apoptotic cell death in cardiovascular disease.

BACKGROUND: Programmed cell death, or apoptosis, is a distinct, managed form of cell death. It is fundamentally different from necrosis. It is a genetically controlled, energy-dependent method of cellular deletion without inflammation. In the cardiovascular system, apoptosis occurs as a primary and secondary event in disease pathogenesis. This review addresses our current understanding of the initiation, propagation and significance of apoptosis in the cardiovascular system, as well as assessing therapeutic potentials arising therefrom. METHODS: A Medline search was performed and relevant publications reviewed. Further articles were obtained from the references of these publications. RESULTS: and conclusions Apoptotic cell death is a key element in the pathogenesis and progression of ischaemia-reperfusion (IR) injury, cardiac failure, myocardial infarction, atherosclerosis, endothelial dysfunction and the clinical syndromes which these situations produce. Our increased understanding of the role of apoptosis in the pathogenesis of cardiovascular disease offers potential to develop new therapeutic strategies.

Apoptosis↗
PubMedDate not supplied

Immunonutrition: the role of taurine.

Taurine is a sulfonated beta amino acid derived from methionine and cysteine metabolism. It is present in high concentrations in most tissues and in particular in proinflammatory cells such as polymorphonuclear phagocytes. Initial investigation into the multifaceted properties of this non-toxic physiologic amino acid revealed a link between retinal dysfunction and dietary deficiency. Since then a role for this amino acid has been found in membrane stabilization, bile salt formation, antioxidation, calcium homeostasis, growth modulation, and osmoregulation. Our own group has demonstrated a key role for taurine in modulation of apoptosis in a variety of cell types. This review summarizes our current knowledge of taurine in nutrition, host proinflammatory cell homeostasis, therapeutic applications, and its potential immunoregulatory properties. It is our belief that taurine, similar to arginine and glutamine, is now more than worthy of critical clinical analysis.

Homeostasis↗
PubMedDate not supplied

Nutritional, respiratory, and psychological effects of recombinant human growth hormone in patients undergoing abdominal aortic aneurysm repair.

BACKGROUND: Recombinant human growth hormone (rhGH) has been shown to have powerful anabolic effects and to reduce or even prevent nitrogen catabolism in stressed patients. The effects of rhGH on functional parameters are less clearly defined. The aim of this study was to assess the effects of perioperative rhGH on nutritional markers, skeletal muscle function, and psychological well-being in patients undergoing infrarenal, abdominal aortic aneurysm repair. METHODS: Thirty-three patients undergoing elective infrarenal abdominal aortic aneurysm repair were randomized to one of three groups: (1) control (n = 12): placebo for 6 days before and after surgery; (2) preop + postop (n = 10): rhGH (Genotropin; Pharmacia Ltd, Uppsala, Sweden) 0.3 IU/kg/d for 6 days before and after surgery; and (3) postop (n = 11): placebo for 6 days before and rhGH 0.3 IU/kg/d for 6 days after surgery. Patients were assessed on days -7 and -1 before surgery and days 7, 14, and 60 after surgery. RESULTS: Administration of rhGH resulted in increased insulin-like growth factor 1 levels, the increase being significantly more marked in the group given rhGH preoperatively. Preoperative and postoperative rhGH reduced the postoperative decrease in both serum transferrin and grip strength at day 7 by 30% and 70%, respectively. Postoperative respiratory function and arterial oxygenation also were improved, with significant differences in arterial oxygenation between rhGH-treated and untreated groups. No difference in mood was seen between groups after surgery, nor was there any difference between subjective assessment of fatigue scores between groups. CONCLUSIONS: This pilot study indicates that rhGH administered preoperatively has beneficial effects on skeletal muscle and respiratory function and may be more useful than postoperative rhGH administration alone.

Aged↗