The British journal of surgery
-
Comparative Study
Abdominal aneurysms in a black population: clinicopathological study.
With exclusion of vascular trauma 2182 patients (1302 black and 880 white) have been treated in our Vascular Service over a period of 3 years. Sixty black patients (4.6 per cent) and 260 white patients (29.5 per cent) presented with aneurysms of the aorta and its abdominal branches. The aneurysms in the black group were distributed as follows: 50 aortic (9 suprarenal, 41 infrarenal), 6 common iliac artery, 2 superior mesenteric and 2 renal artery aneurysms. ⋯ All aneurysms were treated along standard surgical lines, antituberculous treatment was initiated when appropriate. It was concluded that abdominal aneurysm is an uncommon disease in black patients. When it occurs a more heterogeneous pathology can be expected with an unusually high prevalence of aorto-arteritis compared with the white population.
-
Preservation of the knee joint is of paramount importance in lower limb amputation for ischaemia. Clinical predictors of healing are unreliable in patients with septic peripheral lesions due to ischaemia. Seventy-three patients in whom a below-knee amputation was considered likely to heal, based on the temperature and appearance of the skin and bleeding from skin and muscle flaps, were divided into two groups. ⋯ There was no significant difference in the overall operative mortality in Group A (6.7 per cent) compared with Group B (11.4 per cent) (P greater than 0.05). There was a significantly higher above-knee revision rate in Group A survivors (33.3 per cent) compared with Group B (7.7 per cent) (P less than 0.01) due to non-viability and uncontrolled sepsis of the BK amputation site. The presence or absence of a palpable femoral or popliteal pulse had no significant influence on healing in either group.
-
Comparative Study
Major amputation compared with graft occlusion as the end point for assessing results of bypass surgery in lower limb ischaemia.
Cumulative graft patency rates calculated using graft occlusion as the end point are the standard method of presenting results of bypass surgery for lower limb ischaemia. The problems of using graft occlusion as the end point are that this is not easily documented and it gives no indication of the condition of the patient's limb after the graft occludes. The date of amputation is a well defined end point and it means treatment has failed. ⋯ The cumulative survival of diabetics was 23 per cent (s.e.m. +/- 12 per cent) at four years, while for non-diabetics this was 55 per cent (s.e.m. +/- 15 per cent), (chi 2 = 10.6, P less than 0.001). Diabetic patients have such different limb salvage and survival rates compared with non-diabetic patients that their results should be presented separately. A better indication of patient progress following bypass surgery is obtained if limb salvage rates and survival rates are reported as well as graft patency rates.
-
A method of investigating the lymphatic system by radionuclide imaging in patients with chronic lower limb oedema is described. The clearance of 99mTc rhenium sulphur colloid from the interdigital space of 55 limbs and its appearance in the ilio-inguinal lymph nodes 30 min, 1, 2 and 3 h later has been measured using a gamma camera in 34 limbs (26 patients) with the clinical and radiological features of primary lymphoedema, 10 limbs (8 patients) with venous oedema and 12 control limbs (6 volunteers). ⋯ Estimation of the percentage uptake of the colloid in the ilio-inguinal lymph nodes at 1/2, 1, 2 and 3 h showed a markedly decreased lymph flow in the 34 lymphoedematous limbs and an increased flow in the 10 limbs with venous oedema. The results suggest that this technique can be used as a simple diagnostic outpatient technique in the investigation of chronic limb oedema.