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Biomedical subjects

P J Kent

Publications and source records attributed to P J Kent.

25 records · Page 2Linked to original sources
PubMed1998

Prospective analysis of quality of life in patients following infrainguinal reconstruction for chronic critical ischaemia.

BACKGROUND: The aims of this prospective study were to analyse the health-related quality of life (QOL) changes associated with infrainguinal arterial reconstruction for chronic critical limb ischaemia (CLI) and to assess the impact of graft patency and limb salvage. METHODS: Fifty-five consecutive patients, 28 women and 27 men of median age 71 (range 41-86) years, undergoing infrainguinal arterial reconstruction for CLI, consented to participate in the study. QOL was assessed using the Short Form 36 (SF36) health survey questionnaire, which was completed before and at 1, 3, 6 and 12 months following surgery. Graft patency was assessed by duplex imaging at the same postoperative intervals. RESULTS: CLI severely impaired QOL. Cumulative graft patency at 1, 3, 6 and 12 months after surgery was 82, 78, 76 and 64 per cent respectively. Reconstruction resulted in significant improvements in the SF36 domains Physical Functioning, Pain, Vitality and Social Functioning (P< 0.01). With a patent graft these improvements began soon after surgery and were maintained for the 12 months studied. Following irredeemable graft occlusion, patients who had secondary amputation also described some QOL improvements. CONCLUSION: A patent graft following infrainguinal arterial reconstruction for critical ischaemia results in an immediate and lasting improvement in health-related QOL.

Activities of Daily Living↗
PubMed1998

Duplex scanning may be used selectively in patients with primary varicose veins.

Reflux was assessed using hand-held Doppler (HHD) and duplex scanning in 72 patients with primary, previously untreated varicose veins (108 limbs). The aims of the study were (i) to compare the accuracy of HHD assessment with duplex scanning, (ii) to assess the benefit of tourniquet testing and (iii) to identify patients who would benefit from a policy of selective duplex scanning. HHD accurately assesses the saphenofemoral junction (SFJ) and long saphenous vein (LSV) reflux. HHD assessment of the saphenopopliteal junction (SPJ) reflux has a low positive predictive value. A high negative predictive value reflects absent SPJ reflux assessed using HHD accurately. Tourniquet testing is not helpful. Selective duplex scanning of limbs with suspected SPJ reflux, no identifiable site of reflux or posterior thigh perforator reflux on HDD (39% of limbs), would result in the appropriate surgical procedure being performed in 102 (94%) limbs, excessive surgery in 5 (5%) limbs and inadequate surgery in only 1 (1%) limb. The use of selective criteria for duplex scanning would reduce the workload of the vascular laboratory without compromising patient care.

Adult↗
PubMed1997

Mammographic assessment of the symptomatic nonsuspicious breast.

BACKGROUND: Evidence from breast screening programs demonstrates the value of mammography in the detection of asymptomatic breast cancer. METHODS: This study prospectively assessed the role of mammography in the management of 585 patients presenting to a breast clinic, over a 1-year period, with symptomatic breast disease and without clinical or cytological evidence of malignancy. RESULTS: Eighteen (3%) of these patients had breast cancer. Eight patients presenting with nonspecific nodularity had carcinoma. All patients had relatively early disease. CONCLUSIONS: This study suggests that patients with symptomatic disease presenting to a breast clinic represent a group at higher risk of malignancy than screened asymptomatic patients, and that symptomatic women over 40 years of age should have bilateral mammography before being discharged from the breast clinic.

Adult↗
PubMed1996

Argon-enhanced cutting and coagulation confers advantages over conventional electrocautery for mastectomy.

In this prospective randomized study we have compared argon-enhanced electrosurgery with conventional diathermy in a consecutive series of 50 patients undergoing mastectomy. The groups were comparable in age, menopausal status, tumour size, stage and specimen size. Patients undergoing mastectomy using argon diathermy had significantly less blood loss intraoperatively (521 (67)ml vs 824 (59)ml; P<0.001) and a significantly lower transfusion requirement post-operatively. There were no significant differences in post-operative drainage (1350 (160) ml vs 1527 (169) ml; P=NS), length of hospital stay, incidence of seromas or other complications. Argon diathermy significantly reduces intraoperative blood loss and should be considered as the method of choice in patients undergoing mastectomy.

Argon↗
PubMed1995

A prospective evaluation of CA15-3 in stage I carcinoma of the breast.

BACKGROUND: Carcinoma of the breast is characterized by a variable course with prognosis dependent on disease stage at presentation. Paradoxically, some patients with early malignancy demonstrate disease progression within a short time. The role of tumor markers in the management of carcinoma of the breast is controversial. While CA15-3 is the most widely used tumor marker in carcinoma of the breast, its role in the management of patients with early disease is controversial. STUDY DESIGN: Since 1986, all patients presenting to our unit with carcinoma of the breast have had serial CA15-3 levels measured. This study evaluates the role of serial CA15-3 levels in the management of a consecutive series of 168 patients with Stage I disease at presentation. RESULTS: The mean preoperative CA15-3 levels at presentation were significantly elevated in patients with Stage I disease compared with patients with benign disease. Sixteen patients had either locoregional (five patients) or metastatic recurrence (11 patients). CA15-3 levels were not elevated in patients with locoregional disease and were significantly elevated in patients with bony metastases and gave a mean lead time of 6.3 months over bone scintigraphy. CONCLUSIONS: Serial CA15-3 measurements are an efficient and cost-effective method of monitoring disease progression and have advantages over conventional investigations in patients with early carcinoma of the breast.

Adult↗
PubMed1994

Platelet activation during hand vibration.

The level of beta-thromboglobulin, the circulating platelet aggregate ratio and platelet sensitivity to aggregation with adenosine 5'-diphosphate (ADP) and collagen were assessed in 12 control subjects, 16 patients with vibration white finger (VWF) and 15 patients with primary Raynaud's disease; this was done before and after a 1-min exposure to hand vibration. The beta-thromboglobulin level increased significantly in controls, from a median (interquartile range) of 35.5 (22-47) to 47.5 (27-52) ng/ml, and in the VWF group from 44.0 (39-60) to 47.5 (42-109) ng/ml (P < 0.005). Vibration had no effect on circulating platelet aggregate ratio in any group. The platelets of normal subjects tended to be more sensitive to aggregation with low-dose ADP (1 mmol/l) than those of patients with VWF or primary Raynaud's disease. Significant change occurred in the lag phase of the aggregation response to vibration in the control group at an ADP concentration of 2 and 5 mmol/l. These results indicate that intravascular platelet aggregation occurs as a result of exposure to vibration. Platelet sensitivity to aggregation with ADP may be decreased in patients with VWF or established Raynaud's disease.

Adenosine Diphosphate↗