[Show abstract][Hide abstract] ABSTRACT: PURPOSE: Extra-levator abdominal perineal excision of rectum (eLAPE) for low rectal tumours is associated with a lower incidence of circumferential resection involvement. However, there is no consensus on the ideal technique for perineal reconstruction following eLAPE. We thereby conducted a 5-year review of perineal closure outcomes following eLAPE. METHODS: A systematic review of the literature was conducted between 2006 and July 2012. Perineal wound healing and complications in the post-operative period were examined. RESULTS: Original data following eLAPE were found in 27 studies involving 963 individuals to inform a qualitative synthesis. Pooled analysis revealed that investigators most commonly employed either biomesh closure (12 studies, n = 149), myocutaneous flap closure (9 studies, n = 201) and primary closure (4, n = 578). The incidence of minor and major wound complications and perineal hernias across the latter groups was (27.5, 13.4 and 2.7 %), (29.4, 19.4 and 0 %) and (17.1, 6.4 and 1.2 %), respectively. Two studies utilised synthetic mesh closure (n = 4) and omentoplasty (n = 31). Objective assessment of wound healing was strikingly deficient across most studies, largely due to low level retrospective evidence lacking randomised controls. Modest cohort sizes with short follow-up data were evident due to the relative novelty of eLAPE. CONCLUSION: The paucity of high quality data, suggests that a prospective, randomised trial is needed to determine the ideal technique for perineal reconstruction following eLAPE.
International Journal of Colorectal Disease 02/2013; · 2.24 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Spontaneous embolisation (SE) detected using Transcranial Doppler (TCD) after a Transient Ischaemic Attack (TIA)/Minor stroke is an independent predictor of recurrent stroke. There are, however limited data on the differential prevalence of SE in the first few days/weeks after onset of symptoms.
156 consecutive patients (symptomatic n = 123, asymptomatic n = 33) underwent Carotid Endarterectomy (CEA) during an 18 month period and had an accessible window permitting 30 min of pre-operative TCD monitoring. A prospective study was conducted with assessors blinded to clinical status.
Spontaneous embolisation was detected in 31 symptomatic patients (25%) of which 1/1 (100%), 14/35 (40%), 8/37 (22%) and in 8/50 (16%) patients presented within 48 h, 3-7 days, 8-14 days and >14 days respectively from the index clinical event. SE occurred in only 6% of asymptomatic patients. Out of 31 symptomatic patients with SE, seven (22.6%) suffered recurrent cerebrovascular events following admission as opposed to 11/92 patients (11.9%) who had no evidence of spontaneous embolisation after admission (OR 2.2 (95% CI 0.8-6.1))(P = 0.2)
Patients presenting for CEA in the hyperacute period after onset of TIA/Minor stroke have a high incidence of SE. Patients with SE had a 23% risk of recurrent cerebrovascular events. These data support the current drive towards expedited CEA in recently symptomatic patients.
European journal of vascular and endovascular surgery: the official journal of the European Society for Vascular Surgery 02/2011; 41(6):720-5. · 2.92 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Telomeres are specialised DNA-protein complexes which cap the ends of linear chromosomes serving to maintain DNA integrity during cell division. Telomere length naturally shortens with successive cell divisions and represents a cellular marker of biological age. This paper aims to provide an overview of telomere biology and review the evidence for any association between vascular surgical conditions and short telomere length.
A systematic review of the literature was performed using the search terms 'telomere' and 'vascular'.
Considerable associations between a shorter mean telomere length and coronary heart disease have been observed. This finding extends to vascular disease risk factors including age, sex, smoking, obesity, hypertension and diabetes. Vascular diseases including abdominal aortic aneurysm, peripheral vascular disease and carotid disease were also associated with shorter telomere lengths but evidence was limited to a small number of studies. There were no reports of short telomere length associated with varicose veins or arterio-venous malformations suggesting a novel area for further investigation.
Multiple associations between short telomere length and vascular disease characterised by atherosclerosis suggest a possible link between telomere attrition and disease mechanisms. Further studies are warranted to validate and define the role of telomeres in vascular disease pathogenesis.
European journal of vascular and endovascular surgery: the official journal of the European Society for Vascular Surgery 07/2010; 40(1):17-26. · 2.92 Impact Factor