Pulmonary embolism following placement of a Greenfield Filter.
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Adult↗
Biomedical subjects
P M Charlesworth
Publications and source records attributed to P M Charlesworth.
Prophylaxis in appendicectomy with cefoxitin or ceftriaxone.
Two hundred and forty adults undergoing acute appendicectomy were randomised to receive either cefoxitin or ceftriaxone 1 g intravenously at induction of anaesthesia. Patients were monitored daily while in hospital, and at least 4 weeks after discharge for evidence of wound, urinary or lower respiratory tract infection. We evaluated 167 patients at follow up and found no significant difference in infection rates between the two antibiotic groups. Thirty-four had normal appendices and 1 of 16 (6.3%) given cefoxitin and 2 of 18 (11.1%) given ceftriaxone developed wound infections. Ninety-seven had acute appendicitis and 3 of 48 (6.3%) given cefoxitin and 3 of 49 (6.1%) given ceftriaxone developed infections including 2 wound infections in each group. Thirty-six had gangrenous perforated or abscessed appendices: 31 were given additional antibiotics postoperatively, and 4 of 18 (22.2%) in each prophylactic antibiotic group developed infections, including wound infection in 3 given cefoxitin and in 4 given ceftriaxone. None of the infections were serious. Sixty-one percent presented after discharge from hospital. The mean hospital stay was 4.6 days for each antibiotic group. Neither antibiotic caused adverse effects.
Abscess↗
The fate of polytetrafluoroethylene grafts in lower limb bypass surgery: a six year follow-up.
The success of lower limb bypass surgery depends, in the major part, on the availability of autologous saphenous vein as the most satisfactory arterial substitute known to date. Although various prosthetic conduits, used in the absence of saphenous vein, have shown promising success on short term follow-up, more long-term comparative data are required for adequate assessment. This study analyses, by life table method, the results of 134 infra-inguinal bypass grafts using polytetrafluoroethylene (PTFE) over a 6 year period. The results reconfirm the superior long-term patency of vein bypasses compared with such prosthetic grafts. Analysis suggests that, while PTFE may give acceptable results in the immediate and short-term follow-up period, 6 year patencies approach 20-30 per cent.
Arteries↗
Isolated popliteal segment v tibial bypass. Comparison of hemodynamic and clinical results.
Clinical and hemodynamic results of isolated popliteal segment, tibial, and sequential bypass grafts were compared in a retrospective review. Results were good with vein grafts to either an isolated segment or infrapopliteal vessel, with five-year patency rates of 71% and 72%, respectively. Prosthetic grafts performed poorly in both groups, and sequential grafts appeared advantageous in such circumstances. Average ankle pressure increased 49 mm Hg following successful isolated segment grafts. Although less than with patent tibial or sequential grafts, improvement was sufficient to relieve rest pain in all instances and heal ischemic lesions or local amputations in all but four patients. If an adequate vein is available and a good tibial vessel exists, distal grafting may be elected, particularly if advanced ischemic lesions demand restoration of pulsatile flow to the foot. If such conditions are not present, isolated segment grafting will give highly satisfactory results.
Aged↗
Renal artery injury from a Fogarty balloon catheter.
A variety of complications secondary to thromboembolectomy with balloon catheters have been described. The present report describes an unusual and previously unreported complication following retrograde thrombectomy of an occluded limb of an aortofemoral graft. The variety of arterial injuries and technical misadventures attributable to balloon catheters are briefly discussed, and suggestions are made for avoiding the particular problem encountered in the patient described.
Blood Vessel Prosthesis↗
Nutrients and ventilation.
Nutritional support of the patient with respiratory failure may play a key role in recovery. Nutritional intake not only indirectly influences lung function by altering body composition and most defense mechanisms but interacts directly with respiratory function in a variety of ways. This review will focus on 2 such interactions; the effect of glucose on CO2 production and the effect of protein on ventilatory drive. Glucose administration results in increases in CO2 production via 2 mechanisms; 1) a thermogenic effect and 2) an increase in the respiratory quotient (RQ). In the hypermetabolic, acutely ill patient, both the thermogenic effect and the rise in the RQ contribute to the rise in CO2 production. In the malnourished patient, a rise in the RQ is the primary mechanism for the increase. In either case, the increased need for CO2 elimination results in an increase in ventilatory demand which may precipitate respiratory distress in a patient with previously compromised pulmonary function. Infusions of amino acids, either alone or as a part of a complete nutritional support regimen, results in an enhanced ventilatory response to CO2. This seems to be a result of the thermogenic effect of protein and an increase in the ratio of the plasma concentration of the large amino acids to tryptophan. We postulate that brain uptake of tryptophan which is a precursor to serotonin (a known respiratory inhibitor) is reduced by the presence of increased amounts of the large neutral amino acids that compete with tryptophan for transport across the blood brain barrier, thereby resulting in respiratory stimulation.
Amino Acids↗
Assessment of nutritional depletion and immune competence: a comparison of clinical examination and objective measurements.
The ability of two surgeons to assess accurately nutritional depletion and immune state in surgical patients by clinical examination has been studied. The clinical status of all the surgical patients (198) in a large teaching hospital was assessed by two surgeons without knowledge of the results of objective testing. One of the surgeons had had a formal training in nutritional assessment techniques, the other had not. Each was asked to make two clinical assessments, one of nutritional depletion the other of immune competence. On the same day each patient also had an objective assessment of nutritional depletion (relative weight index) and immune competence (delayed hypersensitivity skin testing to four antigens). While the two surgeons identified more than 80% of the patients objectively assessed as being not depleted, they could pick only 40% of the patients who were depleted. Similarly, they identified 60% of the patients who reacted normally to the skin tests but they picked only 31% of the patients with impaired reactivity. The surgeon with nutritional training performed better than the untrained surgeon. This study suggests that malnourished patients cannot be adequately identified by clinical examination
Adult↗