Incisional hernias in patients with aortic aneurysmal disease: the importance of suture technique. (49/70469)

OBJECTIVE: To study the rate of incisional hernia at 12 months in patients undergoing abdominal aortic aneurysm repair compared with others undergoing other surgery through midline incisions. METHODS: A prospective study of 1023 patients, 85 of these with aneurysmal disease. Wounds were continuously closed and the suture technique was monitored by the suture length to wound length ratio. RESULTS: Wound incisions were longer and operations lasted longer in aneurysm patients than in others. Incisional hernia was less common if closure was with a suture length to wound length ratio of at least four. Wounds were closed with a ratio of four or more in 39% (33 of 85) of aneurysm patients and in 59% (546 of 923) of others (p < 0.01). In aneurysm patients no wound dehiscence was recorded, the rate of wound infection was low and incisional hernia occurred in the same amount as in others. CONCLUSIONS: It is concluded that the rate of incisional hernia is similar in patients with abdominal aortic aneurysmal disease and others. Wounds are closed with a less meticulous suture technique in aneurysm patients.  (+info)

Age-related outcome for peripheral thrombolysis. (50/70469)

OBJECTIVES: To investigate the age-related outcome of peripheral thrombolysis and determine for which patient group this treatment is worthwhile. DESIGN AND METHODS: A combined retrospective and prospective analysis of consecutive patients undergoing thrombolysis for acute lower-limb ischaemia was made with respect to age-related outcome and other risk factors. RESULTS: One hundred and two patients underwent thrombolysis for acute limb ischaemia. In the under 60 age group there was a 40% amputation rate. Seventy-three per cent of this group smoked. In the over 80 age group, the amputation rate was 15% and only 8% were smokers. CONCLUSION: Advancing age is not an adverse risk factor for thrombolysis which appears to be safe and effective in this patient group. There is a high incidence of smoking in the younger age group (< 60 years), in whom failed thrombolysis frequently leads to amputation.  (+info)

Perceived health in a randomised trial of treatment for chronic venous ulceration. (51/70469)

STUDY OBJECTIVE: To observe changes in perceived health in patients during a clinical trial of treatments for venous leg ulceration. DESIGN: Randomised prospective factorial trial in patients with venous ulceration. Each patient randomised to a bandage, dressing and a drug. Perceived health assessed at entry and after 24 weeks. SETTING: Outpatient departments and patient's home. PATIENTS: Two hundred patients presenting to two vascular services in Falkirk and Edinburgh with chronic (duration > 2 months) non-healing venous ulceration. STATISTICAL ANALYSIS AND MAIN RESULTS: Analysis using the Nottingham Health Profile revealed that after 24 weeks there were significant improvements in all subscores (p < 0.01) with the exception of social isolation (p = 0.081). Patients with healed ulceration had improved in energy, pain, emotion, sleep and mobility compared with those whose ulceration failed to heal (p < 0.05). Patients randomised to four layer bandaging had significantly better energy (diff = 7.9, 95% CI 0.2, 15.6, p = 0.04) and mobility (diff = 4.5, 95% CI 0.0, 9.0, p = 0.046). This difference could be explained largely by the improved healing of patients randomised to this bandage system (67/97 vs. 50/103, OR = 2.37, 95% CI 1.31, 4.27). CONCLUSIONS: Improvements in perceived health were significantly greater in patients whose ulcers had completely healed. Methods of treatment which offer improved healing for patients with venous leg ulceration are likely to improve patients' perceived health status.  (+info)

Repair of ruptured thoracoabdominal aortic aneurysm is worthwhile in selected cases. (52/70469)

INTRODUCTION: The risks and benefits of operating on patients with ruptured thoracoabdominal aortic aneurysm (TAAA) have not been defined. The aim of the present study is to report this unit's experience with operations performed for ruptured TAAA over a 10-year period. METHODS: Interrogation of a prospectively gathered computerised database. PATIENTS: Between 1 January 1983 and 30 June 1996, 188 consecutive patients with TAAA were operated on, of whom 23 (12%) were operated for rupture. RESULTS: There were nine survivors (40%). Patients whose preoperative systolic blood pressure remained above 100 mmHg were significantly more likely to survive (4/8 vs. 13/15, p = 0.03 by Fisher's exact test). Survival was also related to Crawford type: type I (two of three survived); II (none of six); III (two of six); and IV (five of eight). All non-type II, non-shocked patients survived operation. Survivors spent a median of 28 (range 10-66) postoperative days in hospital, of which a median of 6 (range 2-24) days were spent in the intensive care unit. Survivor morbidity comprised prolonged ventilation (> 5 days) (n = 3); tracheostomy (n = 1); and temporary haemofiltration (n = 2). No survivor developed paraplegia or required permanent dialysis. CONCLUSIONS: Patients in shock with a Crawford type II aneurysm have such a poor prognosis that intervention has to be questioned except in the most favourable of circumstances. However, patients with types I, III and IV who are not shocked on presentation can be salvaged and, where possible, should be transferred to a unit where appropriate expertise and facilities are available.  (+info)

Randomized placebo-controlled trial of fluconazole prophylaxis for neutropenic cancer patients: benefit based on purpose and intensity of cytotoxic therapy. The Canadian Fluconazole Prophylaxis Study Group. (53/70469)

A randomized, double-blind trial comparing oral fluconazole (400 mg daily) with placebo as prophylaxis for adult patients receiving intensive cytotoxic therapy for acute leukemia or autologous bone marrow transplantation was conducted in 14 Canadian university-affiliated hospitals. Although fluconazole prophylaxis did not obviate the need for parenteral antifungal therapy compared with placebo (81 [57%] of 141 vs. 67 [50%] of 133, respectively), its use resulted in fewer superficial fungal infections (10 [7%] of 141 vs. 23 [18%] of 131, respectively; P = .02) and fewer definite and probable invasive fungal infections (9 vs. 32, respectively; P = .0001). Fluconazole recipients had fewer deaths attributable to definite invasive fungal infection (1 of 15 vs. 6 of 15, respectively; P = .04) and achieved more frequent success without fungal colonization (52 [37%] of 141 vs. 27 [20%] of 133, respectively; P = .004; relative risk reduction, 85%) than did placebo recipients. Patients benefiting the most from fluconazole prophylaxis included those with acute myeloid leukemia who were undergoing induction therapy with cytarabine plus anthracycline-based regimens and those receiving marrow autografts not supported with hematopoietic growth factors. Fluconazole prophylaxis reduces the incidence of superficial fungal infection and invasive fungal infection and fungal infection-related mortality among patients who are receiving intensive cytotoxic chemotherapy for remission induction.  (+info)

Role of intergenerational effects on linear growth. (54/70469)

Current knowledge on the role of intergenerational effects on linear growth is reviewed on the basis of a literature search and recent findings from an ongoing study in Guatemala. Fourteen studies were identified, most of which examined the intergenerational relationships in birth weight. Overall, for every 100 g increase in maternal birth weight, her child's birth weight increased by 10-20 g. The study samples were primarily from developed countries, and birth weight data were extracted from hospital records and/or birth registries. Among the few studies that examined associations between the adult heights of parents and their offspring, correlation coefficients of 0.42-0.5 were reported. None of the studies examined intergenerational relationships in birth length or linear growth patterns during early childhood, preadolescence and/or adolescence. Prospectively collected data from long-term studies being carried out in rural Guatemala provide the first evidence of intergenerational relationships in birth size in a developing country setting. Data were available for 215 mother-child pairs. Maternal birth size was a significant predictor (P < 0.05) of child's birth size after adjusting for gestational age and sex of the child and other potential confounders. Child's birth weight increased by 29 g/100 g increase in maternal birth weight which is nearly twice that reported in developed countries. Similarly, child's birth length increased by 0.2 cm for every 1 cm increase in mother's birth length. The effect of maternal birth weight remained significant even after adjusting for maternal adult size. More evidence from developing countries will help explain the underlying mechanisms and identify appropriate interventions to prevent growth retardation.  (+info)

Study of the effect of lactational bone loss on blood lead concentrations in humans. (55/70469)

Lactation and other clinical states of high bone turnover have been suggested to release lead (Pb) stored in bone into blood and tissues. Previous observations on the influences of lactation have been anecdotal, or at high blood Pb concentrations with varying past exposures, or complicated by postpartum fluid changes. A prospective observational study was performed to investigate possible changes in blood lead concentrations at multiple intervals during lactation for 6 months postpartum and to relate changes in blood lead concentrations to changes in bone density and other variables. Volunteer pregnant subjects (n = 58) were enrolled from a midwifery service at an academic public health hospital. Subjects were mostly Hispanic, recently immigrated, of low economic status, not receiving supplemental calcium, and had low blood Pb concentrations (2.35 +/- 2.05 microg/dl at enrollment). Bone density losses over 6 months for the group averaged -2.46 +/- 6.33% at the vertebral spine and -0.67 +/- 5.21% at the femoral neck. In predicting final bone density, apart from initial bone density only the total number of breast-feedings was a significant independent variable of the variables tested, accounting for an additional 12% of the variability. No changes in blood Pb concentrations were seen over the interval beyond 2 weeks postpartum (minimum detectable change was 0.4 microg/dl). There was no relation between the changes in bone density and changes in blood Pb or the integrated blood Pb over the 2-week to 6-month period. Normal (nonlactating) bone resorption rates contribute a large fraction of the Pb in blood during low-exposure circumstances. However, during lactation the increase in bone resorptive processes is probably relatively small with a larger decrease in deposition accounting for net bone loss, as suggested by other investigations. Thus, concomitant release of Pb from bones of lactating subjects with low blood lead concentrations on this background of high normal resorption was not large enough for detection.  (+info)

Echo derived variables predicting exercise tolerance in patients with dilated and poorly functioning left ventricle. (56/70469)

OBJECTIVE: To determine whether resting echo derived measurements predict exercise tolerance and its interrelation with heart rate response and ventilation drive in patients with systolic left ventricular disease. DESIGN: Prospective echocardiographic examination followed by cardiopulmonary exercise testing. SETTING: A tertiary referral centre for cardiac diseases. SUBJECTS: 21 patients (11 with coronary artery disease, 10 with idiopathic dilated cardiomyopathy) with end diastolic dimension > 6.4 cm, shortening fraction < 25%, and in sinus rhythm. There were 11 age matched normal controls. RESULTS: In the patients, peak oxygen consumption (mVo2) correlated with right ventricular long axis excursion (r = 0.62); 65% of the variance in mVo2 was predictable using a multivariate model with right ventricular long axis excursion and peak lengthening rate, and peak mitral atrial filling velocity as independent variables. Aetiology was not an independent predictor, although the right ventricular long axis excursion (mean (SD)) was greater in patients with idiopathic dilated cardiomyopathy than in those with coronary artery disease (2.4 (0.5) cm v 1.6 (0.5) cm, p < 0.001). Peak heart rate correlated with duration of mitral regurgitation (r = -0.52) and the slope of ventilation against CO2 production correlated with M mode isovolumic relaxation time (r = 0.61). CONCLUSIONS: In patients with systolic left ventricular dysfunction, more than half the variance in exercise tolerance can be predicted by factors measured on echocardiography at rest, particularly right ventricular long axis excursion.  (+info)