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Biomedical subjects

R B Galland

Publications and source records attributed to R B Galland.

At least 91 records · Page 5Linked to original sources
PubMed1997

Cumulative risk of bypass, amputation or death following percutaneous transluminal angioplasty.

OBJECTIVE: To define cumulative risk of reconstruction, amputation or death following percutaneous transluminal angioplasty (PTA). DESIGN: Non-randomised observational study. PATIENTS AND METHODS: Two hundred and thirty-four PTAs in 212 patients. Minimum follow-up 6 months. Examination of data collected prospectively on manual card index. Examination of radiology and theatre ledgers over 2.5-year period. District Information System (Dis Data). Life-table analysis. RESULTS: The cumulative risks of reconstruction at 12 months were 14.9% and 6.7%, respectively, following angioplasties below and above the inguinal ligament. Major and minor amputations were more common if the original lesions were below the inguinal ligament (relative risk (RR) 3.32, confidence interval (CI) CI 0.42-26.26 and RR 4.24, CI 0.055-32.9, respectively). They were also more likely in diabetic compared with non-diabetic patients (RR 9.95, CI 2.85-34.47 and RR 3.66, CI 1.28-10.44, respectively). No patient who presented with claudication underwent amputation. Death was more common in patients originally presenting with rest pain or gangrene than claudication (RR 3.94, CI 1.51-10.31). CONCLUSION: This study confirms the poor outlook of diabetic patients with peripheral vascular disease or those presenting with rest pain, ulceration or gangrene. Percutaneous transluminal angioplasty was associated with approximately 80% limb salvage rate in those patients during the duration of the study.

Adult↗
PubMed1997

A traumatic deterioration in general surgeons access to emergency theatre.

An audit has been carried out of general surgical emergency theatre usage before and after the allocation of some of the emergency theatre time for trauma lists. The median delay between decision to operate and operation starting rose from 1 hour 15 minutes to 2 hours 30 minutes. There was a fall in the number of operations carried out during the day (p < 0.001) and a corresponding increase in the number of procedures performed after midnight (p < 0.005). Emergency theatre usage provides advantages to patient and surgeon alike. However, by its nature it will not be fully occupied all of the time. There is always likely to be a temptation to use some of the "free time' for non-emergency cases. This results in the advantages of the emergency theatre being lost.

Abscess↗
PubMed1997

Prospective randomized trial of high-dose bolus versus low-dose tissue plasminogen activator infusion in the management of acute limb ischaemia. Thrombolysis Study Group.

INTRODUCTION: Accelerated thrombolysis with high-dose bolus tissue plasminogen activator (tPA) may enable patients with more severe acute leg ischaemia to be treated without recourse to surgery. This study was a randomized comparison of two thrombolytic regimens. METHODS: One hundred patients with acute leg ischaemia of less than 30 days' duration were randomized to receive either high-dose bolus tPA (three doses of 5 mg over 30 min, then 3.5 mg/h for up to 4 h, then 0.5-1.0 mg/h) or conventional low-dose tPA (0.5-1.0 mg/h). The groups were well matched for age, cardiovascular risk factors, duration and severity of ischaemia, site, cause and length of arterial occlusion. RESULTS: The median duration of infusion in the high-dose group was 4.0 (range 0.25-46) h compared with 20 (range 2-46) h for low-dose infusion (P < 0.0001). Successful thrombolysis was achieved in 45 of 49 high-dose and 39 of 44 low-dose infusions but significantly more adjunctive procedures were required following high-dose bolus infusion (26 versus 16 patients) (P = 0.002). Thirty days after treatment was commenced, limb salvage was achieved in 39 of 49 patients in the high-dose group compared with 37 of 44 who had a low-dose infusion of tPA. Six and two patients respectively required amputation. Four patients in the high-dose group and five in the low-dose group died. Three patients in each group suffered a major haemorrhage and one in the low-dose group had a stroke. CONCLUSION: High-dose bolus therapy significantly accelerated thrombolysis with tPA without compromising outcome. Some 50 per cent of patients were treated within 4 h enabling thrombolysis to be used as primary therapy for patients with acute critical ischaemia.

Acute Disease↗
PubMed1997

Varicose vein clinics: modelling the effects of seasonal variation in referrals.

Data have been collected prospectively on patients referred to a specialist varicose vein clinic between January 1991 and December 1994. A seasonal variation in referral pattern of patients is demonstrated, with more patients being referred in the summer months. Similar fluctuations are seen in the number of patients waiting for first appointment, and the average waiting time for first appointment. Such fluctuations in referral patterns can lead to difficulties in planning. A computer model has been constructed and used to predict future referrals and the effects of seasonal variations upon waiting times for appointments and on efficiency of clinic usage. The computer model accurately predicts numbers of future referrals. The average waiting time for first appointment could be kept constant by arranging more varicose vein clinics in summer than in winter but keeping the overall number of clinics during the year constant. The computer model could be important in planning of specialist clinics, and may play a role when negotiating future contracts. If flexibility can be achieved by exchanging clinics with different seasonal patterns, it may be possible to reduce waiting times within existing resources.

Ambulatory Care Facilities↗
PubMed1996

Phlegmasia caerulea dolens and venous gangrene.

Phlegmasia caerulea dolens and venous gangrene are rare conditions that tend to occur in association with malignancy. They are characterized by total or near-total occlusion of the venous drainage of the limb, including the microvascular collaterals. Associated mortality and morbidity rates are high, especially when progression to venous gangrene has occurred. Treatment options are limited; elevation and anticoagulation are recommended as first-line management. Experience with thrombolysis has been disappointing although intra-arterial administration of thrombolytic agents may improve results. Thrombectomy cannot be advocated routinely. Little advance in management, or in life and limb salvage, has been made in the past 30 years.

Female↗
PubMed1996

General surgery with a special interest in vascular surgery: changing patterns of workload.

Prospective surveys of workload were carried out during 1989, 1990 and 1995. Analysis of outpatient referrals, inpatients and operations performed over periods of 3 months was undertaken and the changing patterns of general surgical and vascular surgical workload noted. The number of outpatient referrals rose throughout the study period because of a significant increase in the number of patients with both varicose veins and other vascular problems. There was an increase in the number of emergency admissions for vascular disease. The number of patients having general surgical operations fell; there was a corresponding increase in the number for arterial and venous disease. The general surgical component of a general surgical unit with a vascular interest is gradually declining, as increased numbers of patients with vascular problems are being referred and managed.

Ambulatory Surgical Procedures↗
PubMed1996

Changing patterns in aortoiliac reconstruction: a 7-year audit.

A prospective vascular audit was performed in this hospital between 1988 and 1994. There was a substantial increase in the number of vascular reconstructions (78 in 1988; 141 in 1994). Aortobifemoral grafts for occlusive disease comprised 18 per cent of the operations in 1988 and 0.7 per cent in 1994 (95 per cent confidence interval 0.086-0.259). There was a corresponding increase in the number of extra-anatomic grafts (from 3 to 20.6 per cent). There was a threefold increase in the number of percutaneous angioplasties performed for iliac occlusive lesions (14 in 1988; 41 plus 13 iliac stent procedures in 1994). This had no impact on the total rate of surgical intervention for aortoiliac disease, although it probably aided the shift to extra-anatomic reconstruction by dilatation of the donor side. To investigate whether this change is national, rather than local, graft sales figures were obtained from two vascular graft companies; these confirmed a national trend away from aortobifemoral grafting and provide some evidence to support an increase in extra-anatomic bypass grafting.

Angioplasty↗
PubMed1996

A prospective study to define the optimum rescreening interval for small abdominal aortic aneurysm.

A prospective study of 99 patients with small abdominal aortic aneurysms was undertaken using serial ultrasound to assess the optimum screening interval. Fifty-three patients had aneurysms measuring 2.5-3.9 cm and 46 patients aneurysms of 4.0-4.9 cm. Aneurysms measuring 2.5-3.9 cm were screened annually and those > 4.0 cm every 6 months. There were eight deaths in the 2.5-3.9 cm group, none attributable to a ruptured aneurysm and five patients have had their aneurysm repaired. Nine patients died in the 4.0-4.9 cm group, one with a ruptured aneurysm measuring 5.6 cm at her previous screening visit and who was unfit for operation. No other patient had an aneurysm which ruptured between scans. There were seven elective repairs in this group. No patient died following elective operation in either group. The mean growth rate of aneurysms in the 2.5-3.9 cm group was 2.2 mm in the first year, 2.8 mm in the second and 1.8 mm in the third. Corresponding growth rates in the 4.0-4.9 cm group were 2.7 mm, 4.2 mm and 2.2 mm. This study supports a policy of annual screening for aneurysms measuring 2.5-3.9 cm and 6-monthly screening for those > or = 4.0 cm.

Aged↗
PubMed1996

Quality of life following percutaneous transluminal angioplasty for claudication.

OBJECTIVE: To determine quality of life in claudicants before and after percutaneous transluminal angioplasty (PTA). DESIGN: Prospective study using EuroQuol questionnaire and visual analogue scales. SETTING: District general hospital. MATERIAL: Twenty-nine patients undergoing successful PTA. RESULTS: Before PTA patients showed a significantly lower EuroQuol score compared with the normal population. There was also marked impairment of patients usual activities, mobility and perceived health state. Following successful PTA the EuroQuol score, perceived health state, mobility, usual activities, pain and discomfort and mental state were all significantly improved. CONCLUSIONS: Intermittent claudication impairs quality of life. Following successful PTA there is significant improvement in symptoms and in general health.

Aged↗
PubMed1996

A survey of methods used for cardiac risk assessment prior to major vascular surgery.

OBJECTIVES: To assess the frequency with which various methods of cardiac risk assessment are used prior to major vascular surgery and the way in which patients considered to the "high" risk are managed. DESIGN: Questionnaire survey. SETTING: Great Britain and Northern Ireland. MATERIALS: Vascular Surgeons who are current members of the Vascular Surgical Society of Great Britain and Northern Ireland. CHIEF OUTCOME MEASURES: Number of respondents reporting routine or frequent use of particular investigations and methods of management. MAIN RESULTS: Of 246 respondents, 52% had access to a high dependency unit and 77% used intensive therapy units routinely following aortic reconstruction. Some measure of ejection fraction was the most common investigation and was used routinely prior to aortic reconstruction by 35% and often by 33% of respondents, this being more frequent in respondents from teaching hospitals and those carrying out a greater number of reconstructions. Calculated clinical risk indices were rarely used. The identification of high risk patients led to referral to a cardiologist for 90% of respondents and influenced the choice of anaesthetist for 50%. CONCLUSIONS: It is concluded that there is considerable variation in practice, but that those who carry out more vascular surgery are more aggressive in their assessment of cardiac risk prior to reconstruction.

Aorta↗
PubMed1996

Assessment of peritonism in appendicitis.

The aim of this study was to evaluate the accuracy of different methods of demonstrating right iliac fossa peritonism in appendicitis. The methods used were cat's eye symptom (pain on going over a bump in the road), cough sign, right iliac fossa tenderness, percussion tenderness, rebound tenderness and guarding. A series of 100 consecutive patients with a median age of 25 years (range 4-81 years), presenting with right iliac fossa pain were studied prospectively; the male:female ratio was 39:61. In all, 58 patients underwent operation, 44 had appendicitis confirmed on histology. Fourteen patients had a normal appendix removed; 11 were women aged between 16 and 45 years. Cat's eye symptom and cough sign were sensitive indicators of appendicitis (sensitivity 0.80 and 0.82, respectively), but were not specific (specificity 0.52 and 0.50, respectively) and therefore inaccurate (accuracy 64%). Percussion tenderness was less sensitive (sensitivity 0.57) but more specific (specificity 0.86). Rebound tenderness proved to be sensitive (sensitivity 0.82), specific (specificity 0.89) and accurate (accuracy 86%). Thus, rebound tenderness had a positive predictive value of 86% compared with 56% and 57% for cough sign and cat's eye symptom, respectively. In the difficult diagnostic group of young women, the positive predictive value of rebound tenderness was 88% compared with 58% and 56% for cat's eye symptom and cough sign. Appendicitis remains a difficult diagnosis, particularly in young women. Rebound tenderness still has an important role to play in clinical assessment.

Abdominal Pain↗
PubMed1996

Magnetic resonance imaging in the management of diabetic foot infection.

A prospective study was carried out of 22 patients admitted with 25 diabetic foot infections. All had cellulitis, 12 had discharging ulcers and eight had digital gangrene. In one case magnetic resonance imaging (MRI) was unhelpful owing to patient movement. Thirteen scans suggested deep-seated infection, including abscess (ten), osteomyelitis (seven) and ankle effusion (one). Overall, imaging provided a specificity of 77 per cent, a positive predictive value of 77 per cent, a sensitivity of 91 per cent and a negative predictive value of 91 per cent. MRI is valuable in determining the presence and extent of infection, which allows appropriate planning of surgical intervention.

Adult↗
PubMed1996

A prospective audit of cholecystectomy in a single health district.

Laparoscopic cholecystectomy is becoming the treatment of choice for patients presenting with gallstones. A prospective audit of all patients undergoing cholecystectomy in a single health district over a six-month period was carried out. The aim was to define those patients not having laparoscopic cholecystectomy and determine the morbidity and mortality associated with open and laparoscopic procedures. Cholecystectomy was performed on 173 patients; 149 operations were attempted laparoscopically, of which 134 were successful, giving a conversion rate of 10%. Elective open cholecystectomy was performed on 24 patients. Twenty of these patients were under the care of a consultant who only performs open cholecystectomy and the others were not offered a laparoscopic procedure because of previous abdominal operations. The median time taken for open cholecystectomy was significantly shorter (P < 0.05) than for laparoscopic cholecystectomy or for converted procedures. Laparoscopic cholecystectomy resulted in bile duct injury in one patient (0.7%). This study shows that the majority of patients with gallstones are being offered laparoscopic cholecystectomy, although some patients will undergo open cholecystectomy. The latter include patients under the care of surgeons not performing laparoscopic cholecystectomy, those presenting as an emergency where laparotomy is performed and those where laparoscopy is contra-indicated. The findings of this study are probably representative of other health districts where a similar mix of surgical practice exists.

Adult↗
PubMed1995

Lysis-assisted angioplasty in the treatment of lower-limb arterial thrombosis.

This study examined the results in 30 patients treated with lysis-assisted angioplasty and compared them with the results of 30 patients with simple stenotic disease treated by angioplasty alone. One patient died on the day of treatment with lysis-assisted angioplasty from arterial perforation and haemorrhage. Of the remaining 29 patients 16 (55 per cent) were symptomatically improved and 13 had early reocclusion. Six patients developed major complications (two deaths, two major haemorrhage, two cerebrovascular accident). The late results were comparable to those for patients undergoing angioplasty alone. The best outcome was obtained in patients with proximal disease (P < 0.01); poor run-off or critical ischaemia did not preclude a good outcome.

Adult↗