-
[show abstract]
[hide abstract]
ABSTRACT: The correlation between hospital or surgeon volume and outcome for complex surgical procedures has been the subject of several studies in recent years. In the UK, such studies have been used to strengthen the case for centralization of such procedures. The recent availability of easily accessible and fully independent data on hospital outcomes for surgical services in the UK has provided the opportunity to review any potential associations between volume and outcome in the UK.
Hospital Episode Statistic (HES) data were collected through Dr Foster for four different upper GI procedures (gastrectomy, esophagectomy, pancreaticoduodenectomy, and liver resection) for a 6-year period from 1999 to 2005. Data for each procedure were divided into volume-dependant quartiles to assess any differences in mortality outcome.
Generally, mortality rates for all four procedures are lower than previously studies have suggested. A significant trend favoring high volume providers was noted for esophagectomy, with mortality rates varying from 7.8% to 4.0% for lowest to highest volume providers (p < 0.001). A similar but less clear-cut trend was noted for pancreaticoduodenectomy. There was no significant difference for gastric and liver resection between low- and high-volume providers. There was a 20% decrease in centers performing esophagectomy and 28% for centers performing pancreaticoduodenectomy.
There is a volume outcome association for esophagectomy and pancreaticoduodenectomy. There is no association for gastrectomy or hepatectomy.
Journal of Gastrointestinal Surgery 02/2008; 12(2):353-7. · 2.83 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: Background:Percutaneous transluminal angioplasty has firmly established itself as a useful adjunct to surgery in the management of patients with peripheral vascular disease. A large series has been reviewed to assess the impact of the increase in the number of procedures performed as well as the improvements in technique on the complication rate of the procedure.Methods:The complications of all percutaneous transluminal angioplasty procedures carried out between 2 October 1995 and 29 September 1998 were recorded and analysed prospectively.Results:There were 1379 procedures carried out on 988 patients. There were 551 men (55·8 per cent) and 437 women (44·2 per cent), with a mean age of 62·5 years. A total of 1756 vessel segments were dilated. The indications for angioplasty included claudication (620 patients, 62·8 per cent), critical ischaemia (270, 27·3 per cent) and bypass graft complications (98, 9·9 per cent). The major complications were retroperitoneal bleed (0·2 per cent), false aneurysm (0·2 per cent), myocardial infarction (0·4 per cent), acute limb ischaemia (1·5 per cent), pulmonary embolism (0·1 per cent), renal failure (0·4 per cent), stroke and transient ischaemic attack (0·4 per cent) and respiratory failure (1·0 per cent). Minor complications were haematoma in 0·9 per cent, perforation in 1·7 per cent, wound infection in 1·0 per cent and catheter complications in 0·6 per cent. The overall rate of significant complications was 4·2 per cent and that of minor complications was 4·2 per cent. The overall incidence of complications needing surgical intervention was 2·2 per cent. The overall amputation rate due to complications was 0·6 per cent.Conclusion:The sharp rise in the number of angioplasties in recent years has not been accompanied by a similar rise in the number of complications, despite broadening of the referral spectrum. © 2000 British Journal of Surgery Society Ltd
British Journal of Surgery 12/2002; 87(4):510 - 510. · 4.61 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: Peripheral angioplasty is increasingly the first choice intervention in patients with peripheral vascular disease. The aim of the current study was to audit prospectively all major complications, especially the requirement for emergency surgical intervention.
A prospective audit of outcome after peripheral angioplasty in 988 patients undergoing 1377 interventional procedures between 1 October 1995 and 30 September 1998 at which 1619 vessel segments were angioplastied.
Major medical morbidity (bronchopneumonia, stroke, renal failure, myocardial infarction) complicated 33/1377 procedures (2.4%). Emergency surgical intervention was required after 31/1377 procedures (2.3%) with the commonest aetiologies being acute limb ischaemia and haemorrhagic complications. The amputation rate following angioplasty was 0.6% and no patient presenting with claudication or graft complications underwent amputation. The amputation rate following angioplasty for critical limb ischaemia was 2.2%. Overall, the risk of death and/or major medical complication and/or requiring emergency surgical intervention was 3.5%. The rate of complications was no different for subintimal as opposed to transluminal angioplasties.
Peripheral angioplasty is associated with a low risk of major medical and surgical complications.
Annals of The Royal College of Surgeons of England 02/2002; 84(1):39-42. · 1.23 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: Over recent years there has been a resurgence in the use of doxycycline in clinical practice, which does not depend on its antibacterial properties. This paper describes a method of determination of doxycycline in human plasma and atheromatous tissue using high-performance liquid chromatography (HPLC), and a cheap commercially available extraction system. Doxycycline is extracted in the mobile phase and injected directly into the HPLC system, avoiding time consuming drying up steps. A limit of detection of 0.125 microg/ml of plasma, and a relative standard deviation of 3% was achieved, making the method very reliable and useful for assays within the usual therapeutic range. The method has also been applied to the extraction of a mixture of tetracyclines from plasma and atherma with equal efficacy, making it useful for assays of this class of drugs in veterinary practice and assays of food contaminants.
Journal of chromatography. B, Biomedical sciences and applications 08/2000; 744(2):359-65.
-
[show abstract]
[hide abstract]
ABSTRACT: Gastrointestinal haematomata occur usually in the small intestine and may be secondary to anticoagulation. Spontaneous intramural haematoma of the rectum is rare. We report such a case which presented as acute abdominal pain and which was treated by simple drainage.
International Journal of Clinical Practice 55(1):66-7. · 2.41 Impact Factor
