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Biomedical subjects

J Collin

Publications and source records attributed to J Collin.

At least 91 records · Page 5Linked to original sources
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).

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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.

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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%.

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PubMed1989

How fast do very small abdominal aortic aneurysms grow?

Fifty patients with abdominal aortic aneurysms from 2.5 to 5.0 cm in anteroposterior diameter (median 3.1 cm, mean +/- S.E. 3.3 +/- 0.1 cm) were initially offered non-operative treatment. Two patients have subsequently undergone successful elective aneurysm resection because of increase in aneurysm size, and a third has died. The median annual growth rate of the aneurysm has been 0.22 cm and 77.8% increased in size between 6 monthly ultrasound examination. For aneurysms less than 4.0 cm the maximum 6 monthly increment in diameter was 0.7 cm. Even the smallest abdominal aortic aneurysms usually progressively increase in size and 6 monthly ultrasound remeasurement of aneurysm diameter is an essential component of non-operative management.

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PubMed1989

Hemangiosarcoma of the rectum after chronic anorectal ulceration.

A 37-year-old man with a 30-year history of recurrent anorectal ulceration developed a hemangiosarcoma of the rectum. This diagnosis was made based on histology and immunocytochemistry. We believe this is the fifth reported case of hemangiosarcoma of the rectum and is another example of a rare granulation tissue sarcoma.

Adult↗
PubMed1989

Two year prospective analysis of the Oxford experience with surgical treatment of abdominal aortic aneurysm.

During the two years from 1 November 1985 to 31 October 1987, 177 patients were admitted to a hospital in Oxford with the diagnosis of abdominal aortic aneurysm (AAA). The aneurysm had ruptured in 88 patients, of whom 75 underwent emergent surgical treatment, yielding an operative mortality rate of 36 per cent. Of the 13 patients who did not have surgical treatment, two died before transfer to the operating room; in the other 11 patients, a deliberate decision was made not to undertake surgical treatment--in ten patients, the reason was an age of 85 years or more and in one patient, severe debilitating Parkinson's disease. Emergent operations were done upon another 15 patients--11 who had acute aneurysm and four in whom symptoms were not caused by an aneurysm. Emergent operations for ruptured or acute aneurysms represented 55 per cent of all operations for AAA. This high proportion and large number of emergent operations is in marked contrast with the experience of comparable specialist vascular surgical units in the United States. The 24-fold difference in mortality rates between surgical procedures performed electively and for ruptured aneurysm suggests that a considerable impact on over-all mortality could be achieved by a substantial increase in referral of patients

Acute Disease↗
PubMed1988

Oxford screening programme for abdominal aortic aneurysm in men aged 65 to 74 years.

824 men aged 65 to 74 were invited for ultrasound screening of the aorta and 426 (51.7%) attended. An abdominal aortic aneurysm was discovered in 23 (5.4%), and in 10 (2.3%) the aneurysm was 4.0 cm or more in diameter. 2 other patients had a common iliac artery aneurysm. The 36 men who had objective evidence of occlusive arterial disease of the lower limbs were twice as likely to be tobacco smokers and accounted for 5 (20%) of the aneurysms discovered. Extension of this screening programme to England and Wales could be expected to identify 52,500 men with an abdominal aortic aneurysm. If elective surgical replacement of the aneurysm were to be accepted by 60% of those with aneurysms 4 cm or more in diameter, 6000 unnecessary deaths from aortic aneurysm rupture could be prevented.

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PubMed1988

Surgical care of patients over eighty: a predictable crisis at hand.

The number of people over the age of 80 in Britain will increase by around 30 per cent over the next 15 years. Little attention has been paid to the acute surgical services required to meet the surgical needs of this population. This study reviews 198 surgical admissions in 1 year of patients aged 80 years and over, of which 74.9 per cent were admitted as emergencies. The overall mortality was 10.1 per cent of all admissions and 41 per cent of admissions were accompanied by at least one serious complication. Eighty-eight patients underwent surgery with an operative mortality of 11.3 per cent. In only 63.5 per cent of cases could the patient be discharged directly home. By 2001, in Oxford, the proportion of acute surgical beds occupied by patients aged over 80 will increase to 9.2 per cent from the present 7.0 per cent. Unless additional resources are provided to meet this extra demand for acute surgical care of the old, elective surgery for younger patients will inevitably be curtailed.

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PubMed1988

Dietary fibre and gastrointestinal disease.

This review examines the evidence linking dietary fibre to gastrointestinal disease. Fibre increases stool weight, decreases whole gut transit time and lowers colonic intraluminal pressure. While it may be of benefit in the treatment of constipation, the irritable bowel syndrome and diverticular disease, its role in the prevention or treatment of other gastrointestinal disease has yet to be established.

Dietary Fiber↗
PubMed1988

A community screening programme for abdominal aortic aneurysms.

Three-hundred and sixty-nine unselected men aged 65-79 years were invited for screening for abdominal aortic aneurysm. One hundred and forty-one men were examined and 4 aneurysms detected. 43.2% of men aged 65-74 attended for examination in response to a single unsolicited letter of explanation with the date of an appointment, but only 29.1% of those aged 75-79 years. It is suggested that community mortality from ruptured aortic aneurysm could be reduced by ultrasound screening of the aorta in men aged 65-74 years and early selective aneurysm surgery.

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