ISSN:0007-1323    

DOI:10.1002/bjs.1800780402

出版商:John Wiley&Sons, Ltd.    

年代:1991

数据来源: WILEY

ISSN:0007-1323    

DOI:10.1002/bjs.1800780403

出版商:John Wiley&Sons, Ltd.    

年代:1991

数据来源: WILEY

摘要:

AbstractVenous insufficiency is a widespread condition, the prevalence of venous ulceration being 0·5–1·0 per cent in Western populations. A principal abnormality causing venous insufficiency is deep venous reflux, usually resulting from post‐thrombotic valve destruction. Patients undergoing treatment for venous insufficiency should have all venous abnormalities investigated, defined and corrected where possible. Although treatment for superficial and communicating vein incompetence is available, correction of deep vein reflux has been neglected until recently. Deep vein valve physiology, the selection of patients for deep vein valve surgery and methods of valve repair and replacement are rev

ISSN:0007-1323    

DOI:10.1002/bjs.1800780404

出版商:John Wiley&Sons, Ltd.    

年代:1991

数据来源: WILEY

摘要:

AbstractThe typical and atypical appearances of watermelon stomach (gastric antral vascular ectasia) during endoscopy, along with the treatments for it, are reviewed.

ISSN:0007-1323    

DOI:10.1002/bjs.1800780405

出版商:John Wiley&Sons, Ltd.    

年代:1991

数据来源: WILEY

摘要:

AbstractOf 309 questionnaires on carotid endarterectomy sent to all surgeons in Great Britain and Ireland who might use this technique, 298 (96 per cent) were returned. In all, 110 (37 per cent) of 298 surgeons performed at least one carotid endarterectomy in 1989; 67 performed10. In total, these 110 surgeons performed 1417 operations in 1989, a situation that has changed little over 5 years since the previous survey. Transient ischaemic attack and minor stroke remain the main indications for carotid endarterectomy; the operation was hardly ever performed for asymptomatic stenosis. By 1989 almost all surgeons initially assessed prospective patients using a technique less invasive than conventional angiography; duplex scanning was used ‘always’ or ‘sometimes’ by 70 per cent of surgeons. While 72 per cent of surgeons in 1984 ‘always’ required conventional angiograms before operation, by 1989 only 21 per cent did so, most now relying on less invasive techniques. During operation there was an increasing use of shunts, carotid sinus nerve blockade and patch closure of the arteriotomy. The overall number of carotid endarterectomies performed annually in Great Britain and Ireland has remained steady over the past 5 years and is relatively low for a population of 60 millions. An increase in the number of surgeons performing the operation is almost entirely accounted for by an increase in those performing<10 carotid endarterectomi

ISSN:0007-1323    

DOI:10.1002/bjs.1800780406

出版商:John Wiley&Sons, Ltd.    

年代:1991

数据来源: WILEY

摘要:

AbstractAmong 18403 male civil servants examined at age 40–64 years there were 99 deaths attributed to aortic aneurysm during 18 years of follow‐up. Each case was matched by age to ten controls who survived longer than the case. The risk of all types of fatal aneurysm was substantially increased for current smokers of manufactured cigarettes (rate ratio compared with lifelong non‐smokers—6·5; 95 per cent confidence interval 2·3–18·7), pipe or cigars (6·7; 1·7–26·5) and hand‐rolled cigarettes (25·0; 7·5–83·3). Diastolic blood pressure was strongly associated with dissecting aneurysm (rate ratio per 10 mmHg increase = 2·4; 95 per cent confidence interval 1·7–3·2) and abdominal aneurysm (1·5; 1·2–1·9) but not other aneurysms (1·0; 0·7–1·5). The independent effects of height, adiposity, plasma cholesterol, glucose intolerance, reported angina and intermittent claudication were not significant. Hypertension and smoking, particularly of hand‐rolled cigarettes, are confirmed as major and potentially remediab

ISSN:0007-1323    

DOI:10.1002/bjs.1800780407

出版商:John Wiley&Sons, Ltd.    

年代:1991

数据来源: WILEY

摘要:

AbstractNear‐infrared spectroscopy has been performed on the calf muscles of 38 subjects, 21 normal controls without vascular disease and 17 patients with peripheral vascular disease. Oxygen consumption was measured in the calf by calculating the rate of conversion of oxyhaemoglobin to deoxyhaemoglobin during a period of tourniquet‐induced ischaemia. Postischaemic reoxygenation was also measured. Median oxygen consumption in patients with peripheral vascular disease was 0·10 ml 100 g tissue−1min−1, while in the control group it was 0·20 ml 100 g tissue−1min−1(P<0·03, Mann—Whitney U test). The median time taken to reach maximum oxyhaemoglobin levels after ischaemia was 40 s in patients with peripheral vascular disease and 20 s in controls (P<0·02). The results indicate that oxygen consumption is reduced in peripheral vascular disease. Near infrared spectroscopy is a non‐invasive method for assessing metabolic improvement resulting from surgical or pharma

ISSN:0007-1323    

DOI:10.1002/bjs.1800780408

出版商:John Wiley&Sons, Ltd.    

年代:1991

数据来源: WILEY

摘要:

AbstractTwenty‐eight patients with acute lower limb ischaemia received low dose intra‐arterial thrombolytic therapy over a 2‐year period. Eighteen patients received streptokinase and ten patients received recombinant tissue plasminogen activator (rTPA). Indications included arterial thromboemboli and graft failures. Mean ischaemic times were similar in both groups. Treatment time to achieve lysis was significantly less with rTPA (P<0·01). Subsequent vascular procedures, including angioplasty or reconstruction, were undertaken in 36 per cent of patients. Arterial puncture site bleeding occurred in eight (29 per cent) patients. Three (11 per cent) patients suffered rethrombosis after initial successful lysis. All rethromboses were successfully lysed with rTPA. There were two major amputations. Five (18 per cent) patients died, all lytic failures in the streptokinase treatment group. There were no cerebral haemorrhagic events and no patient died as a result of thrombolytic therapy. Good clinical outcome was obtained in nine of 18 patients treated with streptokinase and in nine of ten patients treated with rTPA. Intra‐arterial thrombolysis provides effective therapy with high rates of limb salvage and a low mortality rate. This study suggests that rTPA may be a more effective agent, causing less morbidity, than strep

ISSN:0007-1323    

DOI:10.1002/bjs.1800780409

出版商:John Wiley&Sons, Ltd.    

年代:1991

数据来源: WILEY

摘要:

AbstractA total of 1290 patients were enrolled in a randomized multicentre double blind study in order to investigate the use of two doses of a new low molecular weight heparin, Logiparin®, in the prevention of deep vein thrombosis (DVT) in general surgery. Patients who were included had no contraindication to heparin therapy and had at least one of the recognized risk factors for DVT. Patients were randomized to receive unfractionated heparin (UH) 5000 units b.d., Logiparin 2500 units daily or Logiparin 3500 units daily. Each treatment was given subcutaneously 2h before surgery and continued for 7–10 days. Daily125I‐labelled fibrinogen uptake tests (FUTs) were performed from day 2 to day 7 to detect DVT, and phleboangiography was used to confirm the diagnosis. The wound was examined on a daily basis to check for haematoma formation, and all patients were followed up for 1 month after operation. All three treatment arms were well matched for age, sex, weight, diagnosis and type of operation performed. The three major inclusion criteria in the trial were malignancy, age over 60 years and a history of varicose veins. Positive FUTs (UH=4·2 per cent, Logiparin 2500 units daily = 7·9 per cent, Logiparin 3500 units daily = 3·7 per cent) and positive angiograms (UH=3·0 per cent, Logiparin 2500 units daily = 5·6 per cent, Logiparin 3500 units daily = 2·3 per cent) were significantly more common in the Logiparin 2500 units daily group than in the UH and Logiparin 3500 units daily groups. The rates of major complications (severe haemorrhage, death, pulmonary embolism, reintervention) were similar in the th

ISSN:0007-1323    

DOI:10.1002/bjs.1800780410

出版商:John Wiley&Sons, Ltd.    

年代:1991

数据来源: WILEY

摘要:

AbstractThin‐walled expanded polytetrafluoroethylene (ePTFE), woven Dacron® and gelatin‐impregnated Dacron (Gelseal®) vascular grafts were compared, the grafts being coated with three different matrices: collagen IV, fibronectin and preclot matrix. In addition, untreated ePTFE and Gelseal were examined. The graft segments, coated with these matrices, were incubated with radiolabelled adult human endothelial cells for 30, 60 and 90 min. Endothelial cell adherence was calculated from the ratio of radioactive counts in the grafts to counts in grafts plus supernatants. Endothelial cell attachment to untreated grafts was poor, but a suitable matrix significantly improved adherence. All three matrices tested gave good results, although preclot was best; 30–60 min incubation was sufficient for optimum cell attachment. Cell adherence to both Dacron and ePTFE was significantly better than to Gelseal. The type of prosthetic polymer and the substrate protein coating used to promote endothelial cell adherence are two important factors which may determine the ultimate success of endothelial seeding in the operati

ISSN:0007-1323    

DOI:10.1002/bjs.1800780411

出版商:John Wiley&Sons, Ltd.    

年代:1991

数据来源: WILEY