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Biomedical subjects

Mark Jackson

Publications and source records attributed to Mark Jackson.

At least 37 records · Page 2Linked to original sources
PubMed2004

Limitations of additive EuroSCORE for measuring risk stratified mortality in combined coronary and valve surgery.

OBJECTIVE: To study the use of the additive and logistic European System for Cardiac Operative Risk Evaluation (EuroSCORE) to predict mortality following adult combined coronary artery bypass grafting (CABG) and valve surgery. METHODS: Data were collected prospectively, from all four centres providing adult cardiac surgery in the north west of England, on 1769 consecutive patients undergoing combined CABG and valve surgery between April 1997 and March 2002. Observed in-hospital mortality was compared to predicted mortality as determined by both additive and logistic EuroSCORE. RESULTS: Observed mortality for simultaneous CABG and valve surgery was 8.7%, compared to 6.7% (additive) and 9.4% (logistic). Sixty-five percent of patients were classified as high-risk (additive EuroSCORE >5); the observed mortality was 11.5%, compared to 8.1% (additive) and 12.8% (logistic). Discrimination was similar in both systems as measured by the C statistic (additive 0.73, logistic 0.73). CONCLUSIONS: The logistic EuroSCORE is more accurate at predicting mortality in simultaneous CABG and valve surgery, as the additive EuroSCORE significantly under-predicts in this high-risk group.

Adult↗
PubMed2004

Spinal cord stimulation in a patient with persistent oesophageal pain.

This study describes a man with a long history of oesophageal pain that led to inability to swallow food and drink. Over a period of 8 years, he had multiple oesophageal operations that were unsuccessful. He presented, to the pain management team, with persistent oesophageal pain and required jejunostomy tube feeding to maintain nutrition. Conservative pain management strategies failed. Spinal cord stimulation (SCS) was suggested, and after counseling, an electrode was placed in the high thoracic region. Stimulation covered the area of the chest pain. He achieved immediate reduced pain on swallowing water. A permanent system was implanted. In this case, SCS resulted in a significant improvement in pain on swallowing liquids. The patient can now also eat certain foods occasionally and enjoy the social aspect of eating; this was impossible previously. He feels that SCS has been worthwhile. The authors discuss the rationale for this treatment. The decision was based on the use of SCS for refractory angina, and the idea that the neural mechanisms that generate both these pain states may be similar.

Adult↗
PubMed2004

'A menace to the good of society': class, fertility, and the feeble-minded in Edwardian England.

During debates on the Feeble-Minded Persons (Control) Bill in 1912, Josiah Wedgwood expressed concerns that legislative provisions to compulsorily detain the feeble-minded would be used primarily to restrict the liberty of women and the working classes. Wedgwood's objections to legislation proved futile. In 1913, the Mental Deficiency Act invested local authorities with the powers to confine mental defectives in certain circumstances. In spite of contemporary efforts to expose the class and gender assumptions evident in the legislation, historians have paid relatively scant attention to the impact of class and gender (or the interaction between the two) on debates about mental deficiency. The aim of this chapter is to redress this imbalance by unravelling the complex interplay of class and gender in framing Edwardian understandings of feeble-mindedness. Focusing on a particular set of exchanges that took place in Manchester in 1911, this chapter highlights and analyses crucial incongruities in the logic of Edwardian reformers and exposes the conflict between the rhetoric and practice of pioneers of segregation.

England↗
PubMed2004

Bacteremia following complex percutaneous coronary intervention.

BACKGROUND AND OBJECTIVE: Complex percutaneous coronary intervention (PCI) often requires introduction of numerous devices into and out of the arterial circulation and this may result in an increased risk of bacteraemia or even septicaemia. This study was undertaken to detect the frequency of bacteraemia that may be associated with such procedures. METHODS: 147 patients undergoing complex PCI had blood culture tests immediately after and 12 hours after the procedure. RESULTS: Of 147 patients, 26 (17.7%) had detectable bacteraemia immediately after PCI. Coagulase-negative staphylococcus was isolated most commonly. An additional 12% of patients yielded positive blood cultures in the next 12 hours with femoral sheaths still in-situ. There were no associated clinical sequelae. CONCLUSIONS: Uncomplicated bacteraemia is not uncommon as a result of complex PCI procedures. Although there are usually no clinical sequelae, these findings are important for those patients who are considered to be at moderate or high risk of infective endocarditis who require an invasive procedure such as PCI. This paper emphasizes the need for maximum sterility during PCI procedures if infective complications and stent infection are to be avoided.

Adult↗
PubMed2003

Surgeon specific mortality in adult cardiac surgery: comparison between crude and risk stratified data.

OBJECTIVE: As a result of recent failures in clinical governance the government has made a commitment to bring individual surgeons' mortality data into the public domain. We have analysed a database to compare crude mortality after coronary artery bypass surgery with outcomes that were stratified by risk. DESIGN: Retrospective analysis of prospectively collected data. SETTING: All NHS centres in the geographical north west of England that undertake cardiac surgery in adults. PARTICIPANTS: All patients undergoing isolated bypass graft surgery for the first time between April 1999 and March 2002. MAIN OUTCOME MEASURES: Surgeon specific postoperative mortality and predicted mortality by EuroSCORE. RESULTS: 8572 patients were operated on by 23 surgeons. Overall mortality was 1.7%. Observed mortality between surgeons ranged from 0% to 3.7%; predicted mortality ranged from 2% to 3.7%. Eighty five per cent (7286) of the patients had a EuroSCORE of 5 or less; 49% of the deaths were in this lower risk group. A large proportion of the variability in predicted mortality between surgeons was due to a small but differing number of high risk patients. CONCLUSIONS: It is possible to collect risk stratified data on all patients undergoing coronary bypass surgery. For most the predicted mortality is low. The small proportion of high risk patients is responsible for most of the differences in predicted mortality between surgeons. Crude comparisons of death rates can be misleading and may encourage surgeons to practise risk averse behaviour. We recommend a comparison of death rates that is stratified by risk and based on low risk cases as the national benchmark for assessing consultant specific performance.

Adult↗
PubMed2003

Valvular heart operation is an independent risk factor for acute renal failure.

BACKGROUND: Acute renal failure (ARF) after cardiac operation with cardiopulmonary bypass is associated with a high mortality rate. The purpose of this study was to determine and quantify whether valvular heart operation is an independent risk factor for developing ARF. METHODS: We retrospectively analyzed 5,132 consecutive patients who underwent cardiac operation involving cardiopulmonary bypass between April 1997 and March 2001. Patients with significant renal impairment (preoperative serum creatinine > 200 micromol/L) were excluded. A multivariable logistic regression model was constructed to identify independent risk factors for the postoperative development of ARF. RESULTS: In 151 (2.9%) patients ARF developed before hospital discharge. The crude incidence of ARF for isolated coronary artery bypass grafting, isolated valve(s) operation, and valve(s) with coronary artery bypass grafting operation was 1.9%, 4.4%, and 7.5%, respectively (p < 0.001). The results of the logistic regression analysis found that valve operation with or without coronary artery bypass grafting was an independent risk factor for the development of postoperative ARF (odds ratio 2.68, 95% confidence interval 1.89 to 3.79; p < 0.001). Other independent predictors of ARF were increased preoperative serum creatinine levels, urgent or emergent operation, insulin-dependent diabetes, and increased cardiopulmonary bypass time. CONCLUSIONS: Valve operation is an independent risk factor for postoperative ARF. This risk is further increased by prolonged cardiopulmonary bypass.

Acute Kidney Injury↗
PubMed2003

Calcaneal fractures in adolescents. CT classification and results of operative treatment.

The morphology of calcaneal fractures in 9 adolescents (mean age 13.4 years) with 10 fractures were classified using plain films and computed tomography scans. The patterns were found to be similar to those in adults. All except one of the fractures (which was not significantly displaced) were treated with open reduction and internal fixation. In all cases it was possible to achieve anatomic reduction and rigid internal fixation. Seven patients had 'excellent' long-term clinical results. One patient with pending litigation scored 'good', and one patient with an ipsilateral fracture of the talar neck scored 'fair'. This patient had mild limitation of ankle movement, all others had full ankle movement. Five had unrestricted subtalar movement, in two it was mildly limited and in three it was moderately limited (50-80%). There was no evidence of abnormality of the physes on follow up X-rays. We conclude that operative treatment of this fracture yields good results.

Adolescent↗
PubMed2003

Respiratory function after unilateral percutaneous cervical cordotomy.

Percutaneous cervical cordotomy (PCC) is a recognized procedure for control of pain due to thoracic malignancies. Caution with PCC in those with precarious lung function has previously been advised. Thirty-five patients were studied in a prospective study of respiratory function before and after PCC for control of pain from pleural mesothelioma or other thoracic malignancy using standard, easily applied tests. Mean duration of survival was 83 days (range 3-360 days). FEV1.0 and FVC did not alter significantly after the procedure. There was no relationship between any of the respiratory function variables measured and survival. Transient nocturnal hypoxemia occurred during the night immediately following PCC in 6 patients. Unilateral PCC does not worsen respiratory function in patients with pleural mesothelioma or other thoracic malignancies. Poor respiratory function before PCC does not predict survival or complications. It should not be a barrier to use of PCC.

Adult↗
PubMed2003

Fine wire frame-assisted intramedullary nailing of the tibia.

Intramedullary nailing is accepted as the technique of choice for treatment of unstable tibial diaphyseal fractures. Indirect closed reduction must first be obtained to allow passage of the guide wire and reamers. We describe the use of a simple frame that allows precise reduction, control of rotation and easy imaging access, without increasing operating or screening time.

Bone Nails↗
PubMed2002

Long term results of diaphragmatic plication for unilateral diaphragm paralysis.

OBJECTIVES: To examine whether diaphragmatic plication is an effective and lasting treatment option for non-malignant diaphragmatic paralysis. METHODS: Nineteen patients who had undergone diaphragm plication (1983-1990) were recalled for interview, pulmonary function testing and chest X-ray. RESULTS: There were 13 men and six women aged 24-73 (mean 55). Diaphragm paralysis was idiopathic (n=9), postsurgical (n=3), related to cervical spondylosis (n=4) and neck injury (n=2). Patients presented with breathlessness (18/19) or orthopnoea (1/19). Symptoms had lasted 3-60 months (mean 24 months). All patients had a raised hemidiaphragm on chest X-ray with paradoxical movement on ultrasound. Mean preoperative FVC was 71% predicted (range 38-93, SD 12.9) and mean FEV(1) was 67% predicted (range 33-90, SD 10.8). Supine lung volumes were 81% (mean) of sitting values. There were six right plications and 13 left. There were no postoperative deaths. One patient required re-plication. Follow-up (18/19 of original operated patients) ranged from 7-14 years (mean 10 years). Three patients had died of unrelated causes and one patient failed to attend long term follow-up, leaving 15 patients of the original 19 operated on. Positional change in lung volumes was not affected by surgery at early (6 week) or late (>5 year) follow-up. FVC, FEV(1), FRC and TLC improved by 10.1*, 11.8*, 16.9* and 9.2*%, respectively, at early follow-up and 11.8*, 15.4*, 26 and 13.3*% at late follow-up (*P<0.005 signed rank). Dyspnoea scores at long term follow-up improved 1 point (n=5), 2 points (n=5) and 3 points (n=2), remained unchanged (n=1) or dropped 1 point (n=2). Of the 15 patients followed up all but one who had been employed returned to work. 14/15 patients expressed satisfaction with their surgery. CONCLUSION: Diaphragm plication is an effective procedure with lasting results.

Adult↗
PubMed2002

Disease and diversity in history. (Reviews of: Cartwright, FF, Biddiss, M. Disease and history. Gloucestershire: Sutton Publishing Limited, 2000; Rotberg RI, ed. Health and disease in human history. Cambridge, MA: MIT Press, 2000; Cliff, A., Haggett, P., Smallman-Raynor, M. Deciphering global epidemics: analytical approaches to the disease records of world cities, 1888-1912. Cambridge: Cambridge University Press, 1998; Riley, JC. Rising life expectancy: a global history. Cambridge: Cambridge University Press, 2001; McMichael, T. Human frontiers, environments and disease: past patterns, uncertain futures. Cambridge: Cambridge University Press, 2001).

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Disease↗
PubMed2002

The treatment of nonunion after intracapsular fracture of the proximal femur.

Nonunion is a frequent complication of displaced intracapsular fractures of the femoral neck and occurs in as many as 43% of patients. The incidence can be reduced by prompt anatomic reduction and stable fixation. The treatment of an established nonunion depends on numerous factors including the age of the patient, the vascularity and sphericity of the femoral head, alignment of the neck and shaft, and potential limb length discrepancy. An algorithm constructed from literature-based evidence of the results of available procedures for treatment of nonunion is presented and the roles of refixation, osteotomy, grafting, and prosthetic replacement are considered.

Adolescent↗
PubMed2002

Health status and clinical diagnoses of 3000 UK Gulf War veterans.

Up to June 2001, 3000 British veterans of the Gulf War had sought advice from a special medical assessment programme established because of an alleged Gulf War syndrome. After assessment those attending were classified as completely well, well with symptoms, well with incidental diagnoses treated or controlled, or unwell (physically or mentally). Mental illness was confirmed by a psychiatrist. The first 2000 attenders have been reported previously. The present paper summarizes findings in all 3000. 2252 (75%) of those attending were judged "well", of whom 303 were symptom-free. Medical diagnoses were those to be expected in such an age-group (mean age 34 years, range 21-63). No novel or unusual condition was found. In 604 of the 748 unwell veterans, a substantial element of the illness was psychiatric, the most common condition being post-traumatic stress disorder. The healthcare requirements of the Gulf veterans seen in this programme can therefore be met by standard National Health Service provision.

Adult↗