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Biomedical subjects

J Collin

Publications and source records attributed to J Collin.

At least 19 recordsLinked to original sources
PubMed1992

Avoiding amputation.

Explore the source record for details and available documents.

Amputation, Surgical↗
PubMed1992

Early reoperation after major vascular surgery: a four-year prospective analysis.

Between 1 January 1985 and 31 December 1988, 1176 major vascular operations were performed on 1040 patients by the Oxford Regional Vascular Service, of which 136 (12 per cent) were reoperations within 30 days of the initial procedure (110 patients). Sixty-seven (49 per cent) of the reoperations were attempted revascularizations, 43 (32 per cent) were amputations, and surgery for bleeding accounted for 18 (13 per cent). Of the first reoperations 71 (65 per cent) were successful, but among the remaining 39 patients, 17 underwent 26 further reoperations, 15 of which were reoperations for revascularization. The 30-day mortality rate for patients undergoing one reoperation was 13 per cent; this rose to 35 per cent if more than one reoperation was performed. Early reoperation after major vascular surgery is common and carries a high operative mortality. This should be borne in mind when obtaining the informed consent of the patient.

Adolescent↗
PubMed1992

Prosthetic vascular graft infection.

The aetiology, diagnosis and management of prosthetic vascular graft infection are reviewed. The importance of contamination at the time of surgery as the crucial aetiological factor is highlighted. Staphylococcus epidermidis is the causative organism in over 50 per cent of cases and the reasons for this are explored. Sound surgical technique, use of prophylactic antibiotics and the avoidance of a groin incision are emphasized as the most important factors in prevention of graft infection. Difficulties of diagnosis are highlighted and the diagnostic role of various imaging methods is assessed. Graft excision with extra-anatomic revascularization is presented as the conventional surgical solution, while the roles of less radical surgical solutions and non-operative management are discussed.

Blood Vessel Prosthesis↗
PubMed1992

Duodenal obstruction after abdominal aortic aneurysm repair.

Duodenal obstruction is a rare post-operative complication of abdominal aortic aneurysm repair. Out of only four previously reported cases, two were post-mortem findings and the other two were managed surgically by gastro-jejunostomy and duodeno-jejunostomy, respectively. We present here two further cases of duodenal obstruction after aneurysm repair, one due to intramural haematoma and the other due to the superior mesenteric artery syndrome. Both cases were managed conservatively with parenteral nutrition and an expectant policy, with a successful outcome in each case.

Aged↗
PubMed1991

Infra-inguinal aneurysms: outcome for patient and limb.

The outcome of conservative treatment of infra-inguinal (femoral and popliteal) aneurysms was compared with that following vascular reconstruction. Over a 12-year period up to December 1988, 43 femoral aneurysms and 35 popliteal aneurysms presented to the Oxford Regional Vascular Service; 88 per cent of the femoral and 60 per cent of the popliteal aneurysms were treated by vascular reconstruction. The outcome was assessed in terms of limb symptoms or preservation and patient survival at the most recent point of follow-up (median 4.5 years). At least 12 of the 13 initially asymptomatic femoral and popliteal aneurysms which were untreated remained asymptomatic. In contrast, six of the 26 limbs with asymptomatic femoral aneurysms and three of the 11 limbs with asymptomatic popliteal aneurysms developed significant distal ischaemia after vascular reconstruction; four limbs came to amputation after intervention. Aggressive surgical management of all asymptomatic infra-inguinal aneurysms is unjustified and dangerous.

Adult↗
PubMed1991

Cloning, sequencing and characterization of the Saccharomyces cerevisiae URA7 gene encoding CTP synthetase.

The URA7 gene of Saccharomyces cerevisiae encodes CTP synthetase (EC 6.3.4.2) which catalyses the conversion of uridine 5'-triphosphate to cytidine 5'-triphosphate, the last step of the pyrimidine biosynthetic pathway. We have cloned and sequenced the URA7 gene. The coding region is 1710 bp long and the deduced protein sequence shows a strong degree of homology with bacterial and human CTP synthetases. Gene disruption shows that URA7 is not an essential gene: the level of the intracellular CTP pool is roughly the same in the deleted and the wild-type strains, suggesting that an alternative pathway for CTP synthesis exists in yeast. This could involve either a divergent duplicated gene or a different route beginning with the amination of uridine mono- or diphosphate.

Amino Acid Sequence↗
PubMed1991

Gliomatosis peritonei with malignant transformation: a case report and review of the literature.

Gliomatosis peritonei is the implantation of glial tissue within the peritoneal cavity associated with ovarian teratomas. Previous reports have emphasized improved outcomes when these implants are found to be mature, even if the ovarian component is immature. A 16-year-old female with grade 3 immature teratoma was found on two subsequent laparotomies to have extensive peritoneal implantation of mature glial tissue. More than 5 years after the original surgery she was found to have a malignant abdominal glial neoplasm. This case illustrates a rare finding of malignant transformation of previously mature gliomatosis peritonei.

Adolescent↗
PubMed1991

Growth rates of subclinical abdominal aortic aneurysms--implications for review and rescreening programmes.

One hundred and six patients with abdominal aortic aneurysms (AAAs) of 2.5 to 3.9 cm in anteroposterior diameter were reexamined by ultrasound every 6 months for up to 3 years after diagnosis. Annual growth rates were 0.11 cm +/- 0.03 (mean +/- SE) for AAAs 2.5 to 2.9 cm and 0.29 cm +/- 0.08 for AAAs 3.5 to 3.9 cm (P = 0.002). In 73 patients (69%) the annual rate of increase in diameter was 0.2 cm or less and only 12 aneurysms (11%) grew at more than 0.5 cm per annum. We conclude that: (1) for AAAs less than 4.0 cm diameter remeasurement more often than every 6 months is unnecessary; (2) interval screening (rescreening) for AAAs more frequently than 5 yearly is unlikely to detect sufficient clinically significant aneurysms to be worthwhile.

Aorta, Abdominal↗
PubMed1990

Recent changes in the treatment of aortoiliac occlusive disease by the Oxford Regional Vascular Service.

Over the four years from 1 January 1985 to 31 December 1988, 192 patients were treated for aortoiliac occlusive disease by the Oxford Regional Vascular Service. The number of patients treated by percutaneous transluminal angioplasty increased from two in the first year of the study to 34 in the third year of the study. This increase was accompanied by a decrease in the proportion of patients treated by aortobifemoral bypass but the proportion of patients treated by extra-anatomic bypass remained constant at around 30 per cent. Twice as many patients were treated in the fourth year as in the first year of the study so that the number of surgical operations increased despite many patients being treated exclusively by percutaneous transluminal angioplasty. The number of patients requiring mandatory treatment for limb salvage increased by 109 per cent and optional treatment for intermittent claudication by 85 per cent. The introduction of percutaneous transluminal angioplasty in Oxford has coincided with an increase in the number of patients presenting with symptomatic aortoiliac occlusive disease and has allowed twice as many people to be treated while the number of aortobifemoral bypass operations has remained unchanged. It is concluded that the introduction of percutaneous transluminal angioplasty has not only generated its own workload but has also led to an increased demand for surgical reconstruction for aortoiliac occlusive disease.

Adult↗
PubMed1990

Is percutaneous transluminal angioplasty better than exercise for claudication? Preliminary results from a prospective randomised trial.

Percutaneous transluminal angioplasty (PTA) is a commonly performed procedure for the treatment of intermittent claudication despite the lack of controlled studies. The aim of this study was to compare PTA with supervised exercise therapy for patients with arterial occlusive disease judged suitable for PTA at angiography. Patients were assessed before treatment commenced and at three monthly intervals afterwards. Assessment included measurement of resting ankle brachial pressure indices (ABPI), and claudicating and maximum walking distances on a treadmill up a 10 degrees incline. Twenty patients were randomised to receive PTA and 16 exercise. The groups were similar in age, sex, smoking habits and arteriographic pattern of disease. In the PTA group two patients had angioplasties that were technically unsuccessful and two other patients subsequently required surgery. One patient in the exercise group subsequently had a PTA. After PTA, mean ABPI were significantly improved at 3, 6 and 9 months (P less than 0.01) without a corresponding significant increase in mean maximum walking distances. However in the exercise group despite no increase in mean ABPI, mean maximum walking distances increased progressively, with significant increases at 6, 9 and 12 months (P less than 0.01).

Aged↗
PubMed1990

Which deaths in vascular surgery are avoidable? A review of 150 consecutive deaths occurring on the Oxford regional vascular service.

One hundred and fifty consecutive deaths occurring on the Oxford regional vascular service were reviewed using data collected prospectively by weekly audit to determine which deaths were avoidable. During the period of study there were 2449 admissions to the vascular service and 1796 operations were performed. Of those who died 71 (47%) had aneurysmal disease and 76 (51%) occlusive disease. Most were elderly (89% were over 65 years) and died from their presenting disorder or associated conditions. Thirty-four deaths were considered to have been avoidable and were caused or hastened by errors in management. Twenty-one of these occurred in patients with a ruptured abdominal aortic aneurysm. In eleven cases delayed diagnosis (7) or inter hospital transfer (4) were implicated. Eighteen deaths were associated with surgical and three with anaesthetic errors which would have been undetected but for the weekly audit. Our experience suggests that while early diagnosis of ruptured abdominal aortic aneurysm and rapid transportation to a specialist vascular service would save some lives, technical management errors remain the major cause of avoidable deaths in vascular surgery.

Aged↗
PubMed1990

A community detection program for abdominal aortic aneurysm.

This study aimed to discover the prevalence of undiagnosed abdominal aortic aneurysm in the community in men aged sixty-five to seventy-four. All 1,392 men in this age group registered with twenty general medical practitioners were invited for free health screening at hospital and 746 attended. The abdominal aorta was imaged by ultrasound and its anteroposterior diameter measured. An abdominal aortic aneurysm was present in 6.3% and the aneurysm was 4.0 cm or more in diameter in 2%.

Aged↗