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1.
Ann R Coll Surg Engl ; 106(1): 70-77, 2024 Jan.
Article in English | MEDLINE | ID: mdl-36779452

ABSTRACT

INTRODUCTION: A robust and reproducible way of assessing training should optimise and standardise vascular surgical training. This study describes the methodology supporting the Vascular Surgery Specialty Advisory Committee regional quality assurance reports for vascular surgery training programmes in the UK. METHODS: A Delphi consensus exercise was performed to establish the domains of training that most appropriately assess the quality of a vascular surgery training programme. A total of 54 stakeholders were invited to participate, including trainees, training programme directors and members of the vascular speciality advisory committee (SAC), vascular society executive and education committees. RESULTS: A total of 39 stakeholders successfully completed the three-stage Delphi process over 15 weeks. The domains identified as most appropriate to assess the quality of a vascular training programme were: Joint Committee on Surgical Training (JCST) survey results, clinical experience, regional education programmes, radiology support, timetable, regional support for trainees, trainer support for trainees, opportunities for professional development, trainee-rated quality of consultant teaching and training, and trainee recommendation of the post. CONCLUSIONS: This study describes a method to identify and prioritise domains that are appropriate to assess the quality of a vascular training programme. The domains that were identified as appropriate to assess quality are transferable internationally and the Delphi methodology could be used by other training schemes to 'fine-tune' their own domains to review and optimise the quality of their own training programmes.


Subject(s)
Specialties, Surgical , Humans , Specialties, Surgical/education , Curriculum , Education, Medical, Graduate/methods , Vascular Surgical Procedures , Consensus , Clinical Competence
2.
Ann R Coll Surg Engl ; 101(1): 7-13, 2019 Jan.
Article in English | MEDLINE | ID: mdl-30421961

ABSTRACT

INTRODUCTION: Guidelines for peripheral vascular disease state that supervised exercise therapy (SET) programmes improve walking distance and quality of life in patients with intermittent claudication. This paper outlines the steps needed to implement a successful SET programme and discusses some of the challenges. METHODS: Edinburgh Leisure was approached to coordinate an exercise programme aimed at rehabilitation, run by level 4 members of the Register of Exercise Professionals. It is estimated to be cost effective at 500 referrals compared with physiotherapy referral. Success is measured by walking distance, reduction of symptoms and weight loss. Edinburgh Leisure also measures success with feedback and membership numbers at its health centres. RESULTS: Between 4 March 2014 and 25 January 2016, 155 patients were referred to the SET programme with a median age of 68 years (range: 39-95 years) and a male-to-female ratio of 1.2:1. Of these, 117 patients attended and 29 have completed the programme. The mean walking distance increased from 298.5m (range: 150-385m) to 360m (range: 195-482m), an improvement of 20%. Increasing class numbers and venues, and introducing evening classes to make the programme accessible to more patients has addressed initial patient engagement issues. CONCLUSIONS: Collaboration with motivated local authorities can help implement a successful healthcare intervention. Early analysis is necessary to improve the system and engage as many patients as possible. The SET programme discussed has shown similar results to those of previous studies but is available at no personal cost to regional patients with intermittent claudication.


Subject(s)
Exercise Therapy/methods , Peripheral Vascular Diseases/therapy , Adult , Aged , Aged, 80 and over , Exercise Therapy/organization & administration , Female , Humans , Male , Middle Aged , Peripheral Vascular Diseases/rehabilitation , Program Development , Referral and Consultation , Walking
3.
Vascular ; 23(2): 138-43, 2015 Apr.
Article in English | MEDLINE | ID: mdl-24875184

ABSTRACT

INTRODUCTION: Patients with incidentally discovered small abdominal aortic aneurysms (AAA) require assessment by a vascular surgery department for possible enrollment in a surveillance programme. Our unit implemented a vascular nurse-run AAA clinic in October 2010. The aim of this study was to assess the feasibility of a specialist nurse-run small AAA clinic. METHODS: Demographic and clinical data were collected prospectively for all patients seen in the new vascular nurse clinic between October 2010 and November 2012. A validated AAA operative mortality score was used to aid decision making by the vascular nurse. RESULTS: Some 250 patients were seen in the clinic. 198 (79.2%) patients were enrolled in surveillance, 40 (16%) declined enrollment and 12 (4.8%) were referred to a consultant clinic for further assessment. The majority of patients were male and the mean age was 73.7 years. Co-morbidities included hypertension, a history of cardiovascular disease, and hyperlipidaemia. The majority of referrals were considered to be low operative risk. No aneurysms ruptured whilst under surveillance. CONCLUSIONS: A nurse-run clinic that assesses patients with incidentally discovered small AAAs for inclusion in AAA surveillance is a feasible alternative to assessment of these patients in a consultant-run clinic.


Subject(s)
Aortic Aneurysm, Abdominal/surgery , Aortic Rupture/surgery , Cost-Benefit Analysis , Nurse Clinicians , Adult , Aged , Aged, 80 and over , Aortic Aneurysm, Abdominal/diagnosis , Aortic Rupture/diagnosis , Female , Humans , Male , Middle Aged , Nurse Clinicians/economics , Time Factors , Treatment Outcome
4.
J Wound Care ; 20(1): 35-7, 2011 Jan.
Article in English | MEDLINE | ID: mdl-21278639

ABSTRACT

OBJECTIVE: To determine the efficacy of negative pressure wound therapy (NPWT), when used in combination with compression bandaging, for healing chronic resistant venous ulcers. METHOD: In this pilot study, seven patients (with a total of 12 chronic resistant venous ulcers) received adjunctive NPWT and compression bandaging for 4 weeks. Their wounds were monitored for a total of 12 weeks. RESULTS: Dormant ulcers were seen to rapidly develop into healthy wounds, with a granulating base. CONCLUSION: This regimen may have a role in stimulating chronic venous ulcers into healing wounds, or in preparing them for skin grafting.


Subject(s)
Negative-Pressure Wound Therapy/methods , Stockings, Compression , Varicose Ulcer/therapy , Wound Healing , Aged , Aged, 80 and over , Chronic Disease , Clinical Nursing Research , Combined Modality Therapy , Female , Granulation Tissue , Humans , Male , Middle Aged , Negative-Pressure Wound Therapy/nursing , Pilot Projects , Skin Care/methods , Skin Care/nursing , Statistics, Nonparametric , Time Factors , Treatment Outcome , Varicose Ulcer/pathology
5.
Eur J Vasc Endovasc Surg ; 39(1): 5-10, 2010 Jan.
Article in English | MEDLINE | ID: mdl-19836276

ABSTRACT

AIM: To assess the attitude of patients to receiving a copy of vascular outpatient clinic letters. METHOD: 100 patients attending an outpatient vascular clinic at Christchurch Hospital were sent a copy of their outpatient letter along with a questionnaire. This gathered information on the content of the letter, their understanding of it, how useful they found it and whether they would want this practice to continue. RESULTS: The response rate was 68%. Ninety four percent of the responders believed receiving a copy of the letter was a good reinforcement of the information they received at the consultation. Ninety three percent of responders also found being copied into correspondence helpful and 96% understood the contents of the letters. Ninety seven percent wished to receive more letters in the future. CONCLUSION: These results suggest that vascular surgery patients both value and understand clinic letters, and that health professionals should consider adopting this practice into their vascular outpatient clinics.


Subject(s)
Ambulatory Care , Correspondence as Topic , Health Knowledge, Attitudes, Practice , Outpatients , Patient Education as Topic , Vascular Surgical Procedures , Adult , Aged , Aged, 80 and over , Ambulatory Care/psychology , Ambulatory Care/statistics & numerical data , Attitude of Health Personnel , Communication , Comprehension , Female , Health Care Surveys , Humans , Male , Middle Aged , New Zealand , Outpatients/psychology , Outpatients/statistics & numerical data , Patient Education as Topic/statistics & numerical data , Physician-Patient Relations , Referral and Consultation , Surveys and Questionnaires , Vascular Surgical Procedures/psychology , Vascular Surgical Procedures/statistics & numerical data , Young Adult
6.
Int J Tuberc Lung Dis ; 13(8): 1008-14, 2009 Aug.
Article in English | MEDLINE | ID: mdl-19723382

ABSTRACT

SETTING: The National Longitudinal Mortality Study (NLMS) offers the advantage of assessing mortality in a representative population of the United States. OBJECTIVE: To evaluate health disparities associated with lung cancer and chronic obstructive pulmonary disease (COPD) mortality in the United States and whether these associations are similar between these outcomes. DESIGN: The NLMS is a prospective study. Data from NLMS cohort years 1985, 1992, 1993, 1995 and 1996 were included, representing nearly 1.5 million person-years. Lung cancer and COPD mortality relative risks (RRs) from Cox regression analysis, including residential characteristics, marital status, education, health insurance and family income, were evaluated. RESULTS: By 1998, 1273 lung cancer deaths and 772 COPD deaths occurred. Lung cancer mortality rates were approximately two times higher than COPD mortality rates among race and ethnic groups. Cox regression analysis revealed that low education (RR = 1.77, significant, P = 0.01) and low family income (RR = 1.50, significant, P = 0.01) are associated with lung cancer and COPD mortality, controlling for age, race/ethnicity, sex and smoking status. CONCLUSIONS: COPD and lung cancer mortality have similar associations with health disparity indicators in the NLMS data, with some differences in the magnitude of the effect.


Subject(s)
Lung Diseases/mortality , Health Status Disparities , Humans , Lung Neoplasms/mortality , Pulmonary Disease, Chronic Obstructive/epidemiology , Pulmonary Disease, Chronic Obstructive/mortality , Regression Analysis , Smoking/epidemiology , Socioeconomic Factors , United States/epidemiology
7.
J Wound Care ; 18(4): 164-7, 2009 Apr.
Article in English | MEDLINE | ID: mdl-19349936

ABSTRACT

OBJECTIVE: To investigate the effect of topical negative pressure, delivered using Vacuum Assisted Closure (VAC, KCI), on the microbiology of chronic, non-infected venous leg ulcers (VLUs). METHOD: Patients receiving compression therapy for a chronic VLU were recruited into this prospective pilot study. The ulcer was swabbed and VAC was applied at 125mmHg continuous sub-atmospheric pressure on day 1 for six days. Standard methods for bacteriological sampling and measuring the wound surface area were applied at baseline and at the VAC dressing changes on days 3 and 6. Log median colony forming units (CFUs) per cm2 were used for statistical analyses. The bacterial species were identified. RESULTS: Seven patients were recruited into and completed the study. The median log10 CFU/cm2 on days 1, 3 and 6 were 3.5, 4.7 and 5.1 respectively. There was a significant increase in bacterial colonisation between days 1 and 6 (p<0.02). No change was observed in the identified microbiological species during therapy with VAC. CONCLUSION: This pilot study suggests that VAC therapy increases absolute numbers of bacteria colonising non-infected leg ulcers. DECLARATION OF INTEREST: KCI supplied the VAC equipment and ARANZ the SilhouetteMobile, but both had no other influence on the study.


Subject(s)
Bacterial Infections/etiology , Cross Infection/etiology , Negative-Pressure Wound Therapy , Varicose Ulcer , Wound Infection/etiology , Aged , Aged, 80 and over , Bacterial Infections/diagnosis , Bacterial Infections/prevention & control , Chronic Disease , Colony Count, Microbial , Cross Infection/diagnosis , Cross Infection/prevention & control , Female , Humans , Infection Control , Male , Middle Aged , Negative-Pressure Wound Therapy/adverse effects , Negative-Pressure Wound Therapy/methods , Pilot Projects , Prospective Studies , Risk Factors , Statistics, Nonparametric , Time Factors , Treatment Outcome , Varicose Ulcer/complications , Varicose Ulcer/therapy , Wound Healing , Wound Infection/diagnosis , Wound Infection/prevention & control
8.
Sci Total Environ ; 344(1-3): 185-99, 2005 May 15.
Article in English | MEDLINE | ID: mdl-15907517

ABSTRACT

A model of phosphorus (P) losses in a small dairy farm catchment has been set up based on a linkage of weather-driven field-scale simulations using an adaptation of the MACRO model. Phosphorus deposition, both in faeces from grazing livestock in summer and in slurry spread in winter, has been represented. MACRO simulations with both forms of P deposition had been calibrated and tested at the individual field scale in previous studies. The main contaminant transport mechanism considered at both field and catchment scales is P sorbed onto mobile colloidal faeces particles, which move through the soil by macropore flow. Phosphorus moves readily through soil to field drains under wet conditions when macropores are water-filled, but in dry soil the P carrying colloids become trapped so losses remain at a low level. In the catchment study, a dairy farm is assumed to be composed of fields linked by a linear system of ditches which discharge into a single river channel. Results from linked simulations showed reasonable fits to values of catchment outflow P concentrations measured at infrequent intervals. High simulated outflow P concentrations occurred at similar times of year to high measured values, with some high loss periods during the summer grazing season and some during the winter when slurry would have been spread. However, there was a lack of information about a number parameters that would be required to carry out a more exact calibration and provide a rigorous test of the modelling procedure. It was nevertheless concluded that through soil flow of colloid sorbed P by macropore flow represents a highly plausible mechanism by which P is transported to river systems in livestock farming catchments. This represents an alternative to surface runoff transport, a mechanism to which high P losses from livestock farming areas have often been attributed. The occurrence of high simulated levels of loss under wet conditions indicates environmental benefits from avoiding slurry spreading on wet soil or during rain, and from some forms of grazing management.


Subject(s)
Agriculture , Fresh Water/chemistry , Models, Theoretical , Phosphorus/analysis , Soil Pollutants/analysis , Water Pollutants, Chemical/analysis , Animals , Cattle , Environmental Monitoring , Manure , United Kingdom , Water Movements
9.
Water Res ; 38(14-15): 3215-24, 2004.
Article in English | MEDLINE | ID: mdl-15276737

ABSTRACT

Three alternative approaches to predicting delivery of faecal indicators from livestock sources to surface water in the catchment of the River Irvine, Ayrshire, Scotland, are described. These are a soil transport model which assumes all E. coli are transported through the soil, a regression model using observed E. coli concentrations in surface waters, and a distributed catchment model (PAMIMO). Each of these is linked to a simple group of equations describing inputs of E. coli from livestock to land, transport and inactivation in the river Irvine and mixing and inactivation in the sea. The models predict E. coli content of bathing water for Irvine beach. The regression model gives the best predictions of bathing water quality. The low values predicted by the soil transport model suggests that preventing surface runoff of faecal indicators from livestock would provide an adequate solution to the problem of bathing water contamination.


Subject(s)
Animals, Domestic/microbiology , Environmental Monitoring/methods , Escherichia coli/growth & development , Water Microbiology , Animals , Data Collection , Forecasting , Geography , Models, Theoretical , Rivers , Scotland
10.
Eur J Vasc Endovasc Surg ; 27(5): 456-65, 2004 May.
Article in English | MEDLINE | ID: mdl-15079767

ABSTRACT

BACKGROUND: Aspirin is effective at reducing the cardiovascular event rate in defined patient groups. The introduction of antiplatelet therapies other than aspirin and the concept of aspirin resistance have led to critical reappraisal of current treatment. This review aims to clarify the evidence for aspirin resistance in patients with atherosclerosis. METHODS: Medline search was performed to identify publications concerned with antiplatelet effects of aspirin and failure of aspirin therapy. Manual cross referencing was also performed. RESULTS AND CONCLUSION: Wide variations in the rate of aspirin resistance (5.5-75%) have been reported. The lack of consensus on an appropriate definition and the number of different tests used to investigate aspirin resistance needs to be addressed. There are few studies where the primary aim was to document aspirin resistance or aspirin non-response. Further work should aim to investigate if aspirin resistance is clinically important and, if it is, what treatments may be beneficial to the at risk patient.


Subject(s)
Arteriosclerosis/prevention & control , Aspirin/pharmacology , Platelet Aggregation Inhibitors/pharmacology , Aspirin/administration & dosage , Aspirin/therapeutic use , Drug Resistance , Humans , Platelet Aggregation Inhibitors/administration & dosage , Platelet Aggregation Inhibitors/therapeutic use
11.
Br J Surg ; 90(9): 1068-71, 2003 Sep.
Article in English | MEDLINE | ID: mdl-12945072

ABSTRACT

BACKGROUND: Diathermy smoke contains complex hydrocarbons and organic material, and may contain viable tumour cells or viral particles. These particles measure from 0.05 to more than 25 microm, and long-term exposure to such particles may have adverse effects on health. This study investigated whether a suction clearance device reduces the amount of smoke reaching the surgeon's mask. METHODS: This was a randomized clinical trial in which subjects were randomized to standard diathermy equipment (group 1) or a diathermy smoke extraction system (group 2). All patients underwent thyroid or parathyroid surgery with standard anterior cervical collar incision and division of the strap muscles. The difference in the amount of smoke reaching the level of the operator's mask was measured by means of an aerosol monitor. RESULTS: Fifteen patients were randomized to each group. The mean amount of smoke detected at the level of the operator's mask was 0.137 mg/m(3) in group 1 and 0.012 mg/m(3) in group 2 (P < 0.001). The maximum amount detected was 2.411 and 0.255 mg/m(3) respectively (P < 0.001). There were no significant differences between the groups in terms of incision time or background particles measured before and after surgery. There was no correlation between gland weight and incision time or amount of smoke detected. CONCLUSION: Suction clearance of the diathermy plume resulted in a significant reduction in the amount of smoke reaching the level of the operator's mask. Although the risk of diathermy smoke inhalation is currently unknown, use of such a system appears advisable.


Subject(s)
Diathermy/methods , Suction , Adult , Aged , Environmental Monitoring , Female , Humans , Male , Middle Aged , Occupational Exposure/analysis , Parathyroid Diseases/surgery , Smoke , Thyroid Diseases/surgery
12.
Eur J Vasc Endovasc Surg ; 25(6): 568-72, 2003 Jun.
Article in English | MEDLINE | ID: mdl-12787701

ABSTRACT

OBJECTIVES: this study investigates current practice of risk factor documentation in a vascular unit and compares variations in risk factor assessment between elective and emergency admissions. METHODS: one hundred and forty-four patients who underwent vascular surgical intervention for atherosclerotic disease during the year 2000 were retrospectively identified from computerised database. Case note review collated demographic details, data on risk factor assessment and the nature of surgery. Data were analysed using SPSS statistical software. RESULTS: the male to female ratio was 2.3:1 with a median (range) age of 73 (31-95) years. For 55 (38%) emergency admissions the following risk factors were not documented; ischaemic heart disease (8), diabetes mellitus (10), hypertension (10), smoking habit (13) and antiplatelet therapy (18). For 89 (62%) elective admissions the following risk factors were not documented; ischaemic heart disease (11), diabetes mellitus (9), hypertension (4), smoking habit (5) and antiplatelet therapy (19). Sixty-six (72.5%) routine admissions and 11 (20.8%) emergency admissions had estimations of serum cholesterol documented (chi(2) p < 0.001). There were no statistically significant differences in the documentation of other risk factors between the 2 groups. CONCLUSION: risk factors are not documented consistently for emergency vascular surgical admissions. Staff education should aim to improve risk factor assessment for elective and emergency admissions to reduce cardiovascular events and possibly improve surgical outcome in patients with atherosclerotic disease.


Subject(s)
Elective Surgical Procedures , Emergency Medical Services , Patient Admission , Vascular Surgical Procedures , Adult , Aged , Aged, 80 and over , Aortic Aneurysm, Abdominal/epidemiology , Aortic Aneurysm, Abdominal/therapy , Cholesterol/blood , Elective Surgical Procedures/statistics & numerical data , Female , Follow-Up Studies , Humans , Hypertension/epidemiology , Hypertension/therapy , Male , Middle Aged , Myocardial Ischemia/epidemiology , Myocardial Ischemia/therapy , Patient Admission/statistics & numerical data , Platelet Aggregation Inhibitors/therapeutic use , Risk Factors , Vascular Surgical Procedures/statistics & numerical data
13.
Eur J Vasc Endovasc Surg ; 22(4): 326-30, 2001 Oct.
Article in English | MEDLINE | ID: mdl-11563891

ABSTRACT

INTRODUCTION: exercise in patients with intermittent claudication causes systemic effects, the consequences of which are unknown. This study investigates whether successful PTA reverses the systemic effects. PATIENTS AND METHODS: ten patients with IC were recruited prior to PTA. Having emptied their bladders and rested for 1 h, pre-exercise blood and urine samples were collected. Patients underwent treadmill exercise to maximum walking time and blood samples were collected at 10, 20 and 30 min. A second urine sample was collected at 60 min. Total antioxidant capacity (TAC) and von Willebrands Factor (vWF) were measured in blood and albumin/creatinine ratio (ACR) and retinol binding protein/creatinine ratio (RBP/Cr) in urine. Patients were recalled 2 weeks after successful angioplasty and the protocol repeated. Following PTA patients walked for a maximum of 5 min. RESULTS: there was no significant change in vWF. Exercise in claudicants induced a significant increase in median ACR (pre/post exercise=0.85 p =0.03) and in median RBP/Cr (pre/post exercise=1.8 p =0.04). These changes were no longer evident after successful PTA. TAC was significantly different before and after angioplasty at all time intervals. CONCLUSION: successful PTA reverses glomerular effects of exercise in claudicants. Future work should investigate the use of PTA in conjunction with exercise in the treatment of peripheral vascular disease.


Subject(s)
Angioplasty, Balloon , Intermittent Claudication/metabolism , Adult , Aged , Aged, 80 and over , Antioxidants/metabolism , Creatinine/metabolism , Female , Humans , Intermittent Claudication/surgery , Male , Middle Aged , Physical Exertion , Retinol-Binding Proteins/metabolism , Serum Albumin/metabolism , von Willebrand Factor/metabolism
14.
Eur J Vasc Endovasc Surg ; 22(4): 361-4, 2001 Oct.
Article in English | MEDLINE | ID: mdl-11563898

ABSTRACT

OBJECTIVE: to evaluate the impact of acute normovolaemic haemodilution (ANH) on the blood transfusion requirements in elective abdominal aortic aneurysm (AAA) repair in a single vascular unit. METHODS: thirty-two patients underwent ANH during elective AAA repair between 1992 and 1997. The operation was performed by the same surgeon/anaesthetist team in 75% of cases. Their demographic details, type of aneurysm (infra-renal or supra-renal), preoperative blood cross match, use of intra-operative red cell salvage, blood loss, peri-operative bank blood requirements, pre-op and on-discharge haemoglobin levels and post-operative outcome were recorded. The results were compared to a group of 40 randomly selected patients (to represent the unit average) who underwent elective AAA repair by variable surgeon/anaesthetist teams without ANH in the same time period. RESULTS: there were more supra-renal AAA repairs in the ANH group (8/32) than in the non-ANH group (0/40, p<0.01). ANH patients required significantly less blood transfusion peri-operatively (median 2 units) than the non-ANH patients (median 3 units, p=0.02). There were no other significant differences between the variables measured. CONCLUSION: these results suggest that a dedicated team can achieve significant reductions in the use of heterologous blood transfusion compared to the vascular unit average experience by the effective use of ANH.


Subject(s)
Aortic Aneurysm, Abdominal/surgery , Blood Transfusion , Blood Volume , Hemodilution , Aged , Aged, 80 and over , Blood Loss, Surgical , Blood Transfusion, Autologous , Female , Humans , Male , Middle Aged , Plasma Substitutes/administration & dosage , Retrospective Studies
18.
Br J Surg ; 86(10): 1275-9, 1999 Oct.
Article in English | MEDLINE | ID: mdl-10540132

ABSTRACT

BACKGROUND: The role of fine-needle aspiration cytology (FNAC) in the diagnosis and management of discrete parotid swellings remains controversial. Controlled enucleation can be appropriate with accurate preoperative diagnosis. This study (1985-1995) reviewed the role of FNAC in the diagnosis and surgical management of adenolymphoma. METHODS: Review of cytological smears by two observers concentrated on the features of infarction and squamoid metaplasia. Sensitivity, interobserver and intraobserver variation were evaluated statistically in a two-run 'blinded' analysis of 80 cytological slides from a variety of lesions. RESULTS: Of 222 epithelial neoplasms of the parotid, 33 were adenolymphomas. FNAC was performed before operation in 32, producing 34 slides, and a correct cytological diagnosis was made in 21 patients. Retrospective review of the 34 slides, to examine specific features of squamoid metaplasia and infarction, improved diagnostic accuracy. The reliability and reproducibility of cytodiagnosis was confirmed by analysis of interobserver and intraobserver agreement. The sensitivity was high (0.76-0.88). Controlled enucleation was performed in 12 patients and superficial parotidectomy in 11. There were no tumour recurrences. CONCLUSION: Attention to the features of squamoid metaplasia and infarction improves cytological diagnosis and directs appropriate surgical management.


Subject(s)
Adenolymphoma/pathology , Parotid Neoplasms/pathology , Adenolymphoma/surgery , Adult , Aged , Biopsy, Needle/adverse effects , Biopsy, Needle/methods , Female , Follow-Up Studies , Humans , Male , Middle Aged , Observer Variation , Parotid Neoplasms/surgery , Sensitivity and Specificity
19.
Cardiovasc Surg ; 7(4): 398-401, 1999 Jun.
Article in English | MEDLINE | ID: mdl-10430520

ABSTRACT

BACKGROUND: Cardiopulmonary bypass has complex effects on drug pharmacokinetics, which is important when considering the use of once-daily aminoglycoside regimens during cardiac surgery. AIM: To study the effects of cardiopulmonary bypass on the pharmacokinetics of a single dose of gentamicin (4 mg/kg). PATIENTS AND METHODS: Nine patients undergoing valve replacement surgery were given a single dose of gentamicin (4 mg/kg) at induction of anaesthesia and blood was taken for assay at 0, O.5, 1, 1.5, 2, 2.5, 3, 4, 6, 10, 16, 22 and 24 h following administration. The mean (range) gentamicin Cmax was 18.7 (12.4-26.3) mg/litre. Three patients had concentrations of gentamicin after 24 h of > 1 mg/litre. During cardiopulmonary bypass, the mean (range) gentamicin half-life (t1/2) was 5.1 (2.0-15.1) h and post-bypass the t1/2 was 7.1 (3.0-13.9) h. CONCLUSION: There is significant correlation between the elimination t1/2 and length of cardiopulmonary bypass (r = 0.89, P < 0.01). These results suggest that gentamicin excretion is delayed following cardiopulmonary bypass so that with dose regimens of > 4 mg/kg there is a risk of toxicity.


Subject(s)
Antibiotic Prophylaxis/methods , Cardiopulmonary Bypass/methods , Gentamicins/administration & dosage , Gentamicins/pharmacokinetics , Aged , Area Under Curve , Dose-Response Relationship, Drug , Drug Administration Schedule , Female , Follow-Up Studies , Half-Life , Humans , Male , Middle Aged , Treatment Outcome
20.
J Gen Physiol ; 113(6): 909-18, 1999 Jun.
Article in English | MEDLINE | ID: mdl-10352038

ABSTRACT

A transferred-DNA insertion mutant of Arabidopsis that lacks AKT1 inward-rectifying K+ channel activity in root cells was obtained previously by a reverse-genetic strategy, enabling a dissection of the K+-uptake apparatus of the root into AKT1 and non-AKT1 components. Membrane potential measurements in root cells demonstrated that the AKT1 component of the wild-type K+ permeability was between 55 and 63% when external [K+] was between 10 and 1,000 microM, and NH4+ was absent. NH4+ specifically inhibited the non-AKT1 component, apparently by competing for K+ binding sites on the transporter(s). This inhibition by NH4+ had significant consequences for akt1 plants: K+ permeability, 86Rb+ fluxes into roots, seed germination, and seedling growth rate of the mutant were each similarly inhibited by NH4+. Wild-type plants were much more resistant to NH4+. Thus, AKT1 channels conduct the K+ influx necessary for the growth of Arabidopsis embryos and seedlings in conditions that block the non-AKT1 mechanism. In contrast to the effects of NH4+, Na+ and H+ significantly stimulated the non-AKT1 portion of the K+ permeability. Stimulation of akt1 growth rate by Na+, a predicted consequence of the previous result, was observed when external [K+] was 10 microM. Collectively, these results indicate that the AKT1 channel is an important component of the K+ uptake apparatus supporting growth, even in the "high-affinity" range of K+ concentrations. In the absence of AKT1 channel activity, an NH4+-sensitive, Na+/H+-stimulated mechanism can suffice.


Subject(s)
Arabidopsis Proteins , Plant Proteins/metabolism , Plant Roots/chemistry , Potassium Channels/metabolism , Potassium/pharmacokinetics , Quaternary Ammonium Compounds/pharmacokinetics , Sodium/pharmacokinetics , Arabidopsis , Biological Transport/drug effects , Biological Transport/physiology , Gene Expression Regulation, Plant/physiology , Membrane Potentials/drug effects , Membrane Potentials/physiology , Mutagenesis, Insertional/physiology , Plant Proteins/genetics , Plant Roots/cytology , Plant Roots/growth & development , Potassium Channels/genetics , Rubidium/pharmacokinetics
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