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Biomedical subjects

R B Galland

Publications and source records attributed to R B Galland.

At least 55 records · Page 3Linked to original sources
PubMed2000

Maintenance of patency following remote superficial femoral artery endarterectomy.

BACKGROUND: Remote superficial femoral artery endarterectomy (RSFE) is a minimally invasive means of superficial femoral artery revascularisation. It comprises a single groin incision and securing of the distal cut end of atheroma with an intraluminal stent. AIM: To determine medium-term results of RSFE, with particular reference to costs of maintaining patency. METHODS: Stenosis development, and patency of 25 RSFE were compared with 25 randomly selected in situ vein bypasses with similar follow-up (18-33 months). RESULTS: Following RSFE 17 stenoses were identified by duplex surveillance. Half of those arteries patent at 1 yr had stenoses. Angioplasty (PTA) was carried out for 11 stenoses. Four stenoses developed more than 12 months following RSFE. One patient died and nine arteries occluded during follow-up. Primary and primary- assisted patency at 18 months were 31 and 63% respectively. By contrast six stenoses were identified in 25 in situ grafts, all within one year. Four PTAs were carried out. Three grafts occluded. Excluding cost of three monthly duplex surveillance the cost of maintaining RSFE patency was approximately five times that of maintaining in situ bypass patency. CONCLUSION: The initial cost advantage of RSFE is offset by the increased costs of maintaining patency. Duplex surveillance probably needs to be continued indefinitely.

Aged↗
PubMed2000

The effect of intraoperative autotransfusion on antibiotic pharmacokinetics during elective abdominal aortic aneurysm repair.

AIM: Blood loss during aortic surgery has been reduced by the use of cell-salvage techniques (CS). Antibiotics are used routinely to prevent prosthetic graft infection. The influence of CS on antibiotic levels is unknown. This study measured antibiotic levels in serum and cell-salvage fluid during aortic reconstruction. METHODS: Teicoplanin, a glycopeptide with activity against gram positive bacteria was the antibiotic studied. Serial blood levels were measured after a single intravenous dose (400 mg) in five patients undergoing elective aortic aneurysm repair. Patient ages ranged from 67 to 82 yr. Cell-salvage (Dideco compact A75171) fluid was also assayed. SETTING: District General Hospital RESULTS: Serum teicoplanin levels peaked at mean 67.8 mg/l (SD 8.9 mg/l) 5 min after administration, and fell to mean 2.88 mg/l (SD 0.4 mg/l) at 720 min. This is less than levels in healthy volunteers but above the MIC90 for most Gram positive bacterial pathogens encountered in aortic surgery. Teicoplanin levels in discarded CS fluid at the end of the procedure were 0.56 mg/l (SD 0.71 mg/l). CONCLUSIONS: Teicoplanin blood levels are reduced during aortic surgery. Levels remain adequate for antibacterial prophylaxis for 12 h postoperatively other than for methicillin-resistant staphylococcus epidermidis (MRSE). Compared with patients undergoing arterial reconstruction without the use of a cell-salvage device there is no significant loss due to CS use.

Aged↗
PubMed2000

Carotid duplex imaging: variation and validation.

BACKGROUND: Duplex imaging is increasingly used as the only investigation before carotid endarterectomy, but many different criteria exist in the literature for the detection of a severe (70-99 per cent) carotid stenosis. This study aimed to investigate current practice in carotid duplex imaging in Great Britain and Ireland. METHODS: A postal questionnaire was sent to 86 vascular surgical units. RESULTS: The median number of scans performed per year was 450 (range 60-4500). Thirty-six per cent of units who responded used peak systolic : end diastolic velocity ratio to calculate carotid stenosis. Overall, nine different major duplex criteria were used to grade carotid stenosis in 14 different systems of percentage bands. Only 51 per cent of units verified their duplex criteria against angiography. Eighteen per cent of units used two or more different types of duplex scanner and applied the same diagnostic criteria to each machine. CONCLUSION: A wide variation in diagnostic duplex criteria and methods of grading stenosis exists among vascular units. Internal validation is not performed routinely. Standardization of duplex criteria would ensure greater consistency, but would not replace the need for validation of results within each unit.

Carotid Artery, Internal↗
PubMed2000

Remote superficial femoral artery endarterectomy: medium-term results.

BACKGROUND: the aim of this study is to determine the medium-term results following successful remote superficial-femoral endarterectomy (RSFE). SETTING: district general hospital in United Kingdom. METHODS: RSFE comprises a single incision over the origin of the superficial femoral artery. The endarterectomy is carried out in a closed fashion from above. The cut end of distal atheroma is secured with a stent. Twenty-five limbs were followed up with three monthly duplex scans and angiography if any abnormality was suggested. All patients presented with intermittent claudication; in addition three had rest pain and three ulceration or gangrene. The length of atheromatous core removed was 10-30 cm. RESULTS: all patients had a follow-up of at least one year (range 12-27 months). Eleven arteries developed 14 stenoses. Nine became apparent within nine months of RSFE. The cumulative risk of stenoses developing in patent arteries was 24% at 6 and 63% at 12 months. Eleven angioplasties (PTA) of these stenoses were undertaken. Nine of these remain patent at a median of 12 months after PTA. At one year primary patency was 10 of 25 (40%), primary-assisted patency 18 of 25 (72%) and secondary patency 19 of 25 (76%) and at two years 29%, 57% and 57% respectively. CONCLUSIONS: RSFE is worth considering for superficial femoral artery occlusive disease, particularly in high-risk patients without suitable vein and with limited life expectancy. Careful duplex surveillance is important. Until stenoses can be prevented, the widespread use of RSFE cannot be recommended.

Aged↗
PubMed2000

Iliac occlusions: stenting or crossover grafting? An examination of patency and cost.

OBJECTIVES: Percutaneous transluminal angioplasty with stenting is perceived to be a less invasive and cheaper option for the treatment of iliac artery occlusion than surgical reconstruction. We have carried out a prospective observational study of all patients undergoing an iliac stent or femorofemoral crossover graft for iliac artery occlusion to assess the cost effectiveness of the two approaches in a district general hospital. METHODS: Fifty-one patients underwent primary angioplasty with stenting and 87 patients crossover grafting. Patients were all assessed 2 months after their procedure and then at intervals over the following years. RESULTS: In 13 cases, it was impossible to place the stent successfully. In a further 10 patients, major complications occurred which were mainly thromboembolic. Fifteen patients underwent crossover grafting after failure to insert a stent, or after stent occlusion. No major complications occurred following crossover grafting. The median length of stay following successful stenting was 1 day; the following crossover grafting was 4 days. The mean stay was higher in each group (2.5 and 5.8 days) and is a more accurate parameter for estimation of cost, which for iliac stenting is estimated at pound1912 versus pound3072 for crossover grafting. The mean additional cost of those patients sustaining complications after stenting was pound2481. On an <<< >>> basis, patency following stent insertion at 6 months was 52%; patency after bypass was 100% (p <0.0001). If any complication occurs after stenting, the cost advantage of the procedure is lost. In those patients without complication, the initial cost benefit of iliac stenting is lost within 6 months, as patients require further intervention, usually as a crossover graft, when the stent occludes. Crossover grafting is a durable low-risk procedure. CONCLUSIONS: We suggest that stenting of occluded iliac arteries should be reserved for those patients with limited life expectancy. Patients who are younger and fitter should be offered femorofemoral crossover grafting as a primary procedure until research enables identification of those patients who are most likely to maintain long-term patency after stenting.

Aged↗
PubMed2000

Varicose veins on the internet.

OBJECTIVES: to evaluate the quality of information on the Internet concerning varicose veins. DESIGN: review of retrieved pamphlets and their scoring for educational value. MATERIALS: a sample of 41 documents were retrieved from the Internet using four "search engines". METHODS: characteristics, including country of origin, authorship, length, and presence of references were recorded. Based on factors such as disease summary, treatment options and complications a weighted score was created by two independent observers. RESULTS: eleven documents were published by an academic institution or professional organisation. Twenty-seven documents originated from private practice groups, the source of three was unidentifiable. The median weighted score was 21.5 (interquartile range: 7.5-48.5). Scores originating from non-profit making organisations were significantly higher than those from private practice groups (44.5 vs 13, p=0.04). The length of the document showed a significant positive correlation with its educational quality as measured by the information score (r=0.82, p<0.001). CONCLUSION: there is a plethora of data concerning varicose veins on the Internet. Some documents offer comprehensive information but many are confusing or misleading. Longer pamphlets and information presented by non-profit making organisations are more reliable than short documents and information offered by private medical groups.

Female↗
PubMed2000

Can changes to junior surgical jobs improve training and make a career in surgery more attractive?

Surgical training has been extensively revised in recent years and new challenges are emerging due to a shorter length of training with fewer opportunities for hands-on experience. Junior doctors' hours are likely to be reduced further, some even advocate shift systems. How do junior surgical jobs affect the desire of young doctors to become surgeons? How can further improvements be made to make surgical training more attractive and effective? This study aims to answer these questions by asking the junior doctors concerned.

Attitude of Health Personnel↗
PubMed2000

Regional variation in varicose vein operations in England 1989-1996.

AIM: To determine accuracy of Office of Population Censuses and Surveys (OPCS) codes for varicose vein (VV) operations and differences in regional activity over 7 years. METHODS: OPCS codes were obtained for VV operations (L85, L87) for the 8 English regions 1989/90-1995/96. Data were also obtained for the 4 districts of the old Oxford Region. Centrally collected codes for one hospital were compared with audit data from the same hospital. RESULTS: There was a marked inter-regional variation in VV activity, e.g. in 1995/96 the range of operations/100,000 population was 102 (Anglia & Oxford) to 138 (West Midlands). There was a gradual increase in the number of operations carried out nationally from 98/100,000 in 1989/90 to 121/100,000 in 1995/96. The numbers peaked in 1991/92, coinciding with a 'waiting list initiative'. When compared with audit data, accuracy of coding improved throughout the study period. There was a 55% inaccuracy in 1989/90 compared with 2% in 1995/96. In each year, codes overestimated the volume of work actually carried out. CONCLUSION: OPCS codes broadly reflect VV activity. Difference in VV activity in different parts of the country are apparent.

Documentation↗
PubMed2000

Surgeons have little control over general surgical waiting lists.

AIM: This study describes changes in the general surgical waiting list over a 13-year period. We have also attempted to define the factors affecting the size of the waiting list. METHODS: The number of patients on the waiting list was obtained from Hospital Activity Analysis data. Available surgical beds and theatre sessions were recorded prospectively over 13 years. RESULTS: As the number of beds and theatre sessions decreased, the general surgical waiting list increased. The total number of patients waiting rose from 301 in 1985 to 1,253 by 1990. The number of patients waiting for more than one year rose from 37 to 251. During that time the total number of available beds fell from 143 to 99 and theatre sessions from 21 to 17.5. Despite theatre sessions subsequently increasing to 21.5, the waiting list continued to rise, as these sessions were not matched with an increase in available beds. The introduction of a waiting list initiative that made extra resources available resulted in a fall in the number of patients waiting to 702 by 1993. Only 45 of those patients had been waiting for more than a year. When the waiting list initiative ended, there was a further steady rise in the waiting list, reaching 1,242 by the end of 1997. At this point, further waiting list initiative facilities were made available. We also noticed that during winter months there was a disproportionate number of patients added to the waiting list when surgical beds were 'blocked' by medical patients. CONCLUSIONS: This study shows that external factors, particularly available resources, influence the number of patients on a surgical waiting list. The main factors are lack of beds and theatre sessions. Furthermore, an imbalance between them will result in insufficient beds being available to fill those theatre sessions that do exist. Surgeons have little control over their routine waiting lists.

Consultants↗
PubMed2000

Emergency surgical admissions in patients aged more than 80 years: a study over four decades.

BACKGROUND: The proportion of older patients in the community is rising. The aim of this study was to determine the trend in emergency surgical admissions in patients over 80 years of age in 1997 compared with the previous three decades. PATIENTS AND METHODS: Data were obtained on all patients over 80 years of age admitted as general surgical emergencies in 1997 to the Royal Berkshire and Battle Hospitals, Reading, UK. Reasons for admission, management, mortality and duration of hospital stay were recorded and compared with results from 1966, 1976 and 1989. RESULTS: During 1997, 4807 patients over the age of 80 years were admitted as emergencies to all specialities. Of these, 447 (9.3%) were surgical. This compares with 122 in 1966, 248 in 1976 and 339 in 1989. Emergency surgical workload in patients over 80 years of age had increased from 6.2% in 1966 to 12% in 1997. A random sample of 261 patients was analysed. In-patient mortality was 13.8% in 1997 compared with 21.8% for 1976 and 22.4% for 1989. Median length of stay was 8 days (range, 0-41 days) for 1997 and 1989 compared with 14 days in 1976. Twenty-four patients either needed admission to other specialities or need not have been admitted as emergencies at all and were classified as inappropriate admissions to the general surgical ward. CONCLUSIONS: The trend of increased number of patients over the age of 80 years being admitted as emergencies to general surgery continues through four decades. There has been a decrease in mortality and length of stay since 1966, but no decrease in length of stay in 1997 compared with 1989. Avoiding inappropriate admissions would result in a significant improvement in bed utilisation for elective surgery and help to reduce waiting lists.

Aged↗
PubMed2000

Smoking--do vascular surgeons practise what they preach?

Smoking is a major health problem in Great Britain and cigarette consumption is rising. Although there are studies concerning the smoking habits of hospital physicians, nurses and oral and maxillofacial surgeons, little is known about the smoking habits of vascular surgeons and the advice given by them to their patients. A questionnaire survey was conducted involving 422 members of the Vascular Surgical Society of Great Britain and Ireland. The response rate was 74%. The median age of responders was 51 years (range, 32-69 years) of whom 98% were men. Of responders, 98% routinely advise patients to stop smoking, 10% advise nicotine gum/patch, 39% provide antismoking information sheets, 11% are involved in an antismoking clinic/group and 74% check to see whether patients continue to smoke. The majority of responders would be prepared to offer revascularisation in patients who continue to smoke. Only 8 surgeons (3%) would not advise revascularisation in this group of patients. Only 10% of respondents were current smokers, 37% were ex-smokers and 53% had never smoked. Vascular surgeons, therefore, seem to practise what they preach.

Adult↗
PubMed1999

Assessing arterial inflow before infra-inguinal bypass grafting: a survey of the members of the Vascular Surgical Society of Great Britain and Ireland.

The optimal assessment of arterial inflow is controversial. We investigated current preferences of inflow assessment prior to infra-inguinal bypass grafting. A questionnaire was sent to 364 members of the Vascular Surgical Society of Great Britain and Ireland asking about inflow assessment in different clinical situations, access to resources, size of hospital and number of grafts performed each year. Questionnaires analysed = 169. Angiography was used by 89.5%, most single view. Two views angiography was used more often by surgeons performing more than 20 femoro-distal grafts each year (79.3 versus 37.6%). Routine use of iliac duplex was < 20%; poor femoral pulse increased this to near 30%. About 90% of respondents had access to colour flow duplex. Most respondents use single-plane angiography to assess inflow before infra-inguinal grafting. Two views and functional tests are used more commonly by surgeons working in larger or teaching hospitals and those performing more grafts.

Arterial Occlusive Diseases↗
PubMed1999

Reconstruction for lower limb occlusive disease in the elderly.

OBJECTIVES: To determine the acceptability of performing distal limb bypass for occlusive vascular disease in the over 75's. METHOD: Patients undergoing surgery between January 1988 and December 1996 were included. Data were obtained from a card system, operating ledgers, admission diaries and hospital notes. RESULTS: A total of 166 patients were identified. There were 69 women and 97 men, 79 were aged 75-79 years, 81 were 80-89 years and six older than 90 years. A total of 171 procedures were performed: infrainguinal bypass in 131 (77%), aorto-femoral bifurcation grafts in 10 (6%) and extra-anatomic bypass in 30 (17%). This represents 28.1% of all reconstructions for occlusive disease during this time. Nine patients (5.4%) died within 30 days and one (0.6%) required a major amputation. During the follow-up period (median 12 months), 14 major and 10 minor amputations were required. Ten patients underwent a second successful reconstructive procedure. CONCLUSION: Reconstruction in this group of older patients can be carried out with acceptable 30-day mortality and limb salvage rates.

Aged↗
PubMed1999

Variation in vascular activity in the United Kingdom: an analysis of five regions.

BACKGROUND: The aim of this study was to define variations in vascular activity that may exist between different demographic regions of the UK. METHODS: Five regions were studied. Data were obtained on OPCS codes for vascular surgery 1994-95 from the Department of Health or Welsh Office. Mortality and cause of death statistics were calculated for each region from OPCS data. RESULTS: Ranges of vascular reconstruction, iliac and superficial femoral artery angioplasty and major amputation were 26.2-44, 10.5-23.0 and 11.5-15.7 per 100,000 population, respectively. The highest rates of amputation were seen in areas of high standard mortality and highest death rate from atheroma and ischaemic heart disease. Rates of amputation also rose in proportion to the number of men in the population aged > 60 years. CONCLUSION: Variations exist in vascular activity between different regions. This may be caused by demographic differences in the population. It needs to be considered when calculating the number of vascular surgeons required in different areas of the country.

Amputation, Surgical↗
PubMed1999

The effect of autoclave resterilisation on polyester vascular grafts.

OBJECTIVES: polyester grafts are expensive, single-use items. Some manufacturers of uncoated, woven grafts include instructions for autoclave resterilisation to be performed at the surgeon's own request. Others warn against such manipulation. Theoretically, the glass transition point of polyester at 70-80 degrees C and the possible acceleration of hydrolysis suggest that autoclave resterilisation at 135 degrees C might be a problem. MATERIALS AND METHODS: a DeBakey Soft Woven Dacron Vascular Prosthesis (Bard) and a Woven Double Velour Dacron Graft (Meadox) were autoclave-resterilised 0 to 20 times, having been weighed before and after sterilisation. Tactile testing was performed. Mechanical properties were examined by probe puncture and single-filament testing, the surface was examined by scanning electron microscopy and the degree of hydrolysis by infra-red spectroscopy. RESULTS: tactile testing revealed a change of feeling with increasing cycles of resterilisation. Investigation of weight, textile strength, single-filament strength, electron microscopy of the surface and infra-red spectroscopy showed no change of the material. CONCLUSIONS: changes felt are presumably a surface phenomenon, not measurably affecting strength or chemistry of material after autoclave resterilisation. We therefore feel that it is safe to use once-autoclave-resterilised surplus uncoated polyester grafts, provided that sterility is guaranteed.

Blood Vessel Prosthesis↗