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Hartshorne TC, McCollum CN, Earnshaw JJ, Morris J, Nasim A. Ultrasound measurement of aortic diameter in a national screening programme. Eur J Vasc Endovasc Surg 2011; 42:195-9. [PMID: 21439859 DOI: 10.1016/j.ejvs.2011.02.030] [Citation(s) in RCA: 68] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2010] [Accepted: 02/28/2011] [Indexed: 12/24/2022]
Abstract
OBJECTIVE Currently there is no universally accepted standard for ultrasound measurement of abdominal aortic aneurysm (AAA). The aim was to investigate the reliability and reproducibility of inner to inner (ITI) versus outer to outer (OTO) ultrasound measurement of AAA diameter. METHODS A prospective study design was used to collect 60 random images of aorta (1.4-7.1 cm). Inner and outer wall diameter measurements were then performed by 13 qualified AAA screening technicians and 11 vascular sonographers. RESULTS The mean (range) diameter for all 60 aortas by ITI was 3.91 cm (1.39-6.80) and by OTO was 4.18 cm (1.63-7.09), a significant mean difference of 0.27 cm (95% CI: 0.23-0.32 cm). The reproducibility coefficients for differences between technicians were 0.30 cm (95% CI: 0.24-0.36) for ITI and 0.42 cm (95% CI: 0.35-0.49) for OTO indicating significantly better repeatability using ITI. Finally, 15 images were measured twice in random order by all screeners and sonographers. For AAAs > 5 cm, repeatability was significantly better with ITI than OTO (0.14 vs. 0.21; p = 0.016). CONCLUSION There was the expected difference in AAA diameter between the two methods (0.27 cm). However, ITI wall method was measurably more reproducible.
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Sharpe R, Dennis M, Nasim A, McCarthy M, Sayers R, London N, Naylor A. Dual Antiplatelet Therapy Prior to Carotid Endarterectomy Reduces Post-operative Embolisation and Thromboembolic Events: Post-operative Transcranial Doppler Monitoring is now Unnecessary. Eur J Vasc Endovasc Surg 2010; 40:162-7. [DOI: 10.1016/j.ejvs.2010.04.004] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2009] [Accepted: 04/14/2010] [Indexed: 11/15/2022]
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Sharpe R, Dennis M, Nasim A, McCarthy M, Sayers R, London N, Naylor A. Dual Antiplatelet Therapy Prior to Carotid Endarterectomy Reduces Post-operative Embolisation and Thromboembolic Events: Post-operative Transcranial Doppler Monitoring is now Unnecessary. J Vasc Surg 2010. [DOI: 10.1016/j.jvs.2010.06.092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Nasim A. Commentary. Br J Surg 2009; 97:44. [PMID: 20013925 DOI: 10.1002/bjs.6933] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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Brown C, Sangal S, Stevens S, Sayers R, Fishwick G, Nasim A. The EVAR Trial 1: Has it led to a change in practice? Surgeon 2009; 7:326-31. [DOI: 10.1016/s1479-666x(09)80104-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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Salem M, Rayt H, Hussey G, Rafelt S, Nelson C, Sayers R, Naylor A, Nasim A. Should Asian Men be Included in Abdominal Aortic Aneurysm Screening Programmes? Eur J Vasc Endovasc Surg 2009; 38:748-9. [DOI: 10.1016/j.ejvs.2009.07.012] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2009] [Accepted: 07/21/2009] [Indexed: 10/20/2022]
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Babar ME, Nawaz M, Nasim A, Abdullah M, Imran M, Jabeen R, Chatha SA, Haq AU, Nawaz A, Mustafa H, Nadeem A. Prion Protein Genotypes in Pakistani Goats. ASIAN-AUSTRALASIAN JOURNAL OF ANIMAL SCIENCES 2008. [DOI: 10.5713/ajas.2008.70493] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Bhalli JA, Khan QM, Nasim A. DNA damage in Pakistani pesticide-manufacturing workers assayed using the Comet assay. ENVIRONMENTAL AND MOLECULAR MUTAGENESIS 2006; 47:587-93. [PMID: 16917935 DOI: 10.1002/em.20232] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
Abstract
The production and use of chemical pesticides has increased in recent years. Although the increased use of pesticides may benefit agriculture, they are also the potential source of environmental pollution, and exposure to pesticides can have negative consequences for human health. In the present study, we have assessed DNA damage in blood leukocytes from 29 Pakistani pesticide-factory workers and 35 controls of similar age and smoking history. The workers were exposed to various mixtures of organophosphates, carbamates, and pyrethroids. DNA damage was measured with the single cell gel electrophoresis (SCGE) assay or Comet assay, using the mean comet tail length (microm) as the DNA damage metric. Exposed workers had significantly longer comet tail lengths than the controls (mean +/- SD 19.98 +/- 2.87 vs. 7.38 +/- 1.48, P < 0.001). Of the possible confounding factors, smokers had significantly longer mean comet tail lengths than nonsmokers and exsmokers for both the workers (21.48 +/- 2.58 vs.18.37 +/- 2.28, P < 0.001) and the controls (8.86 +/- 0.56 vs. 6.79 +/- 1.31, P < 0.001), while age had a minimal effect on DNA damage (P > 0.05 and P < 0.05 for workers and controls, respectively). The results of this study indicate that occupational exposure to pesticides causes DNA damage.
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Bhalli JA, Khan QM, Haq MA, Khalid AM, Nasim A. Cytogenetic analysis of Pakistani individuals occupationally exposed to pesticides in a pesticide production industry. Mutagenesis 2006; 21:143-8. [PMID: 16540494 DOI: 10.1093/mutage/gel009] [Citation(s) in RCA: 49] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Although several cytogenetic biomonitoring studies on workers exposed to pesticides have been reported, there is only limited information on this topic from developing countries where pesticides have been widely used over the years. People in developing countries are at higher risk from exposure, due to poor working conditions and a lack of awareness of the potential hazards during manufacturing and application of the pesticides. The present study has assessed the genotoxic effects of pesticides on workers involved in the pesticide manufacturing industry. Subjects in the exposed group (29) were drawn from workers at a pesticide production plant in district Multan (Pakistan). The control group (unexposed) composed of 35 individuals from the same area but was not involved in pesticide production. Liver enzymes, serum cholinesterase (SChE), micronucleus assay and some haematological parameters were used as biomarkers in this study. A statistically significant (P < 0.001) increase in levels of alanine aminotransferase, aspartate aminotransferase and alkaline phosphatase was detected in exposed workers with respect to the control group. There was a significant (P < 0.001) decrease in the level of SChE in the exposed group. Exposed individuals exhibited cytogenetic damage with increased frequencies (P < 0.001) of binucleated cells with micronuclei and total number of micronuclei in binucleated lymphocytes in comparison with subjects of the control group. A decrease (P < 0.001) in cytokinesis block proliferation index similarly demonstrates a genotoxic effect due to pesticide exposure. The results indicate that the pesticide industry workers have experienced significant genotoxic exposure. This study highlights the risk to workers in the pesticide manufacturing industries of developing countries such as Pakistan and the need for implementation of suitable safety measures to prevent/limit exposure to harmful toxins.
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Awad S, Karkos CD, Serrachino-Inglott F, Cooper NJ, Butterfield JS, Ashleigh R, Nasim A. The impact of diabetes on current revascularisation practice and clinical outcome in patients with critical lower limb ischaemia. Eur J Vasc Endovasc Surg 2006; 32:51-9. [PMID: 16488631 DOI: 10.1016/j.ejvs.2005.12.019] [Citation(s) in RCA: 49] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2005] [Accepted: 12/23/2005] [Indexed: 12/15/2022]
Abstract
OBJECTIVE To compare current revascularisation practice and outcome in diabetic and non-diabetic patients presenting with critical limb ischaemia (CLI) to a single vascular surgeon. METHODS Data for 113 patients presenting with CLI were collected prospectively over a 3-year period. Forty-four (39%) were diabetic. Treatment was classified as percutaneous angioplasty, arterial reconstruction, primary major amputation, and conservative therapy. Main outcome measures were 30-day mortality, major amputation, survival, and amputation-free survival. RESULTS Diabetic patients were more likely to present with gangrene, give a history of angina, be treated with nitrates and statins, and have lower cholesterol levels. No significant differences were found in the initial treatment options between diabetics and non-diabetics: angioplasty 39 vs 26%, surgical revascularisation 34 vs 33%, primary major amputation 9% vs 17%, and conservative treatment 11 vs 19% (p = ns in all). There were eight deaths (7%) within 30-days. At follow-up (1-44 months, median 14 months), rates of major amputation and death for the entire population were 23 and 8%, respectively. The 12-month cumulative survival and amputation-free survival rates were 90 and 72%, respectively. When comparing diabetic to non-diabetic patients, there were no significant differences in the 30-day mortality (6.8 vs 7.2%, p = 0.4), cumulative survival (93 vs 89% at 12 months, log-rank test: 0.00, p = 0.9), amputation-free survival (71 vs 73% at 12 months, log-rank test: 0.00, p = 0.99), and major amputation rates (22.7 vs 23.1% at 12 months, p = 0.96). Similarly, there were no differences in limb salvage rates between diabetic and non-diabetic patients undergoing revascularisation procedures (78 vs 90% at 12 months, log-rank test: 2.04, p = 0.15). CONCLUSIONS In current practice, an aggressive multidisciplinary approach in diabetic patients presenting with CLI leads to similar limb salvage, amputation-free survival, mortality, and major amputation rates to those seen in non-diabetic patients. The presence of diabetes should not deter clinicians from attempting revascularisation by means of angioplasty or surgical reconstruction.
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Serracino-Inglott F, Awad S, Barclay A, Nasim A. The use of a cell saver during repair of ruptured abdominal aortic aneurysms increases early survival. Ann R Coll Surg Engl 2005; 87:475. [PMID: 16404778 PMCID: PMC1964136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/06/2023] Open
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Usman M, Burney I, Nasim A, Adil SN, Salam A, Siddiqui T, Khurshid M. Outcome of adult acute lymphoblastic leukemia: a single center experience. J PAK MED ASSOC 2003; 53:384-8. [PMID: 14620310] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/27/2023]
Abstract
OBJECTIVE To study the outcomes of adult patients with acute lymphoblastic leukemia. SETTING Tertiary care hospital. STUDY DESIGN Retrospective analysis. METHODS Fifty eight adult patients (age >14 years) diagnosed as cases of acute lymphoblastic leukemia were studied with respect to their clinical, morphological and immunopathological features at presentation and their relationship with treatment outcomes. RESULTS Forty five (77.5%) of the patients belonged to younger age group with male preponderance. The median age was 20 years and mean age was 25.1 years. Male to female ratio was 3:1. Common presenting signs were lymphadenopathy (17.2%), hepatomegaly (32.7%) and splenomegaly (62%). Laboratory features at presentation revealed: hemoglobin > or = 10 gm/dl in 18 (31%), WBC >50 x 10E9 / L in 18 (31%), LDH more than 1000 IU/L in 44 (75.8%) of patients. Morphology revealed that FAB L1 was seen in 21(37.2%) and L2 in 62 (32.7%). Immunophenotyping showed that 26 (61.9%) were early pre-B ALL, 6 (14.2%) were pre-B ALL and T-ALL were 10 (23.8%). Univariate analysis showed age more than 30 years, male gender, total leucocyte count >50 x 10(9)/L and hemoglobin more than 10 gm/dl to be risk factors for poor outcome. Multivariate analysis revealed age more than 30 years, male sex and total leucocyte count > 50 x 10(9)/L are independent risk factors for poor survival. Patients were treated according to the MRCUKX and XII adult protocols. Thirteen (22.4%) patients died during induction therapy secondary to sepsis and progressive disease whereas 42 (72.4%) patients achieved complete remission. Median survival was 18.6 months and 42% patients were alive at 5-years. CONCLUSION Overall survival and disease free survival were comparable to those reported in literature. However, age more than 30 years, male gender and total leucocyte count >50 x 10(9)/L had an adverse impact on overall survival.
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Daly KJ, Pearse A, Nasim A, Ray SG, McCollum CN. Paradoxical embolism in peripheral ischaemia: diagnosis of venous to arterial shunting by transcranial doppler. Eur J Vasc Endovasc Surg 2003; 26:219-20. [PMID: 12917842 DOI: 10.1053/ejvs.2002.1860] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Nasim A, Thompson MM, Naylor AR, Bell PRF, London NJM. Methicillin-resistant Staphylococcus aureus infection in vascular patients. Br J Surg 2002. [DOI: 10.1046/j.1365-2168.2000.01420-39.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Abstract
Background
The increasing prevalence of methicillin-resistant Staphylococcus aureus (MRSA) is a major threat in arterial surgery and poses a considerable therapeutic challenge. The aim of this study was to assess the prevalence of MRSA infection in patients treated in the vascular unit.
Methods
A retrospective case-note review was undertaken to identify the nature of the infection and the outcome.
Results
During 1993–1998, a total of 115 patients (4 per cent of the total) were positive for MRSA. Of these, 67 were colonized and 48 were infected by MRSA. The number of MRSA infections increased yearly (1 per cent in 1994 to 5 per cent in 1998). Of the 48 patients infected by MRSA, one had wound infection following brachial embolectomy which eventually resolved. Two patients had undergone carotid endarterectomy necessitating removal of an infected Dacron patch, one of whom developed a hemiparesis. Eleven patients had undergone elective abdominal aortic aneurysm (AAA) repair (five developed pneumonia, two septicaemia, two wound infection, one a false aneurysm at the site of insertion of an endovascular stent, and one developed crossover graft infection after endovascular AAA repair and died). Five patients had undergone ruptured AAA repair (two developed pneumonia, one wound infection and two developed graft infection and died). Four patients undergoing reconstruction for aortic occlusive disease developed MRSA infection, two of whom died. Twenty-five patients with MRSA infection had undergone lower limb procedures. Five of these had graft infection leading to amputation in three and death in two. One patient developed primary arterial infection following embolectomy resulting in arterial rupture.
Conclusion
These results suggest that the prevalence of MRSA infection in vascular patients is increasing. Infection of aortic grafts appears to be uniformly fatal and lower limb graft infection is associated with a high rate of limb loss.
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Molloy K, Nasim A, London NJM, Naylor AR, Bell PRF, Fishwick G, Bolia A, Thompson MM. Durability of angioplasty in treating severe leg ischaemia. Br J Surg 2002. [DOI: 10.1046/j.1365-2168.2000.01420-50.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Abstract
Background
Percutaneous transluminal angioplasty (PTA) has recently been accepted as a valuable therapeutic option in patients with severe limb ischaemia. However, despite the increasing use of this technique, there have been concerns that the long-term efficacy of PTA is inferior to that of surgical revascularization. This prospective study reports the outcome of an unselected cohort of patients who underwent balloon angioplasty for severe lower limb ischaemia in a single centre.
Methods
During 1997, 108 patients with 133 severely ischaemic legs were treated by PTA. The median age of the patients (49 per cent men) was 76 years. Symptoms were rest pain in 31 per cent, ischaemic ulceration in 56 per cent and gangrene in 13 per cent. The distribution of risk factors was typical: diabetes 32 per cent, ischaemic heart disease 18 per cent and stroke 16 per cent. Median (interquartile range) follow-up was 16 (12–19) months. There was a mean of 1·7 angioplasty sites per patient, distributed in the iliofemoral (14 per cent), superficial femoral (42 per cent), popliteal (18 per cent) and crural (26 per cent) arteries. PTA was performed luminally in 20 per cent of cases and subintimally in the remainder. Overall, 67 per cent of the lesions were complete occlusions with a median length of 20 (10–40) cm.
Results
Technical success was achieved in 104 limbs, with 29 failures. The outcome of patients with a failed angioplasty (29) was poor, with 14 requiring bypass surgery, 11 undergoing a major amputation and 32 per cent dying after the procedure. In contrast, patients having a technically successful angioplasty had a good outcome after a median follow-up of 16 (12–19) months. In this group there was a 30 per cent overall mortality rate during follow-up. However, 85 per cent of the patients had no symptoms of critical ischaemia and the limb salvage rate was 92 per cent.
Conclusion
PTA is an effective and durable procedure in patients with critical leg ischaemia, with results comparable to those of historical surgical controls. Technical failure of PTA is, however, associated with a dire outcome.
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Papavassiliou VG, Nasim A, Awad EM, Bell PRF. Adventitial cystic disease of the popliteal artery: diagnosis and treatment. A case report. THE JOURNAL OF CARDIOVASCULAR SURGERY 2002; 43:399-401. [PMID: 12055573] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/25/2023]
Abstract
Adventitial cystic disease of the popliteal artery (ACDPA) is an unusual cause of a unilateral progressive intermittent claudication in young or middle-aged men. In the case described here, ultrasound (US) examination provided the preoperative diagnosis. The lesion was dealt with by simple evacuation of the cyst and excision of the wall. This simple treatment is all that is required in the majority of cases and provides good long-term results.
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Nasim A, Thompson MM, Naylor AR, Bell PR, London NJ. The impact of MRSA on vascular surgery. Eur J Vasc Endovasc Surg 2001; 22:211-4. [PMID: 11506512 DOI: 10.1053/ejvs.2001.1429] [Citation(s) in RCA: 65] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVES To investigate the prevalence of MRSA infection in patients treated in a major vascular unit and examine its consequences. DESIGN AND METHODS A retrospective case-note review was performed. RESULTS During the period 1993 to 2000, a total of 172 patients (4.4% of total) were positive for MRSA. Of these 97 were colonised and 75 were infected by MRSA. The proportion of wound or graft infections caused by MRSA has increased (4% in 1994 to 63% in 2000). Three patients developed native artery infection (one following aortic stent insertion and 2 following embolectomy). All patients with aortic graft infection died. All patients with infected prosthetic infrainguinal bypass ended up with an amputation. CONCLUSION The prevalence of MRSA infection is increasing. Infection of aortic grafts appears to be uniformly fatal and lower limb graft infection is associated with high limb loss.
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Murphy GJ, Pararajasingam R, Nasim A, Dennis MJ, Sayers RD. Methicillin-resistant Staphylococcus aureus infection in vascular surgical patients. Ann R Coll Surg Engl 2001; 83:158-63. [PMID: 11432131 PMCID: PMC2503574] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/20/2023] Open
Abstract
BACKGROUND Methicillin-resistant Staphylococcus aureus (MRSA) infection is emerging as a major problem in vascular surgical practice. The aim of this study was to review the management of patients with MRSA infection complicating vascular surgical operations. METHODS Data were obtained from the vascular audit, case notes, intensive therapy unit (ITU) notes, high dependency unit (HDU) notes and microbiological records of patients who underwent either arterial reconstruction (n = 464) or limb amputation (n = 110) between April 1994 and October 1998. RESULTS Forty-nine vascular surgical patients developed clinical MRSA infection (9%). Clinical MRSA infection in patients who had undergone aorto-iliac reconstruction (n = 18) was associated with a 56% mortality (n = 10) and the most common infections were bacteraemia (55%) and pneumonia (50%). MRSA infection occurred in 17 patients who had undergone infra-inguinal bypass and was associated with a 29% mortality (n = 5). The most common site of MRSA infection was the groin wound (76%) leading to anastomotic dehiscence and death in one patient (11%) and necessitating wound debridement in 4 patients (22%). MRSA infection of the groin wound in the presence of a prosthetic graft (n = 3) led to anastomotic dehiscence in 2 patients, and graft excision in 2 patients. Similar complications were not observed in the presence of an underlying autogeneous long saphenous vein graft (n = 16). MRSA infection following major lower limb amputation (n = 14) was associated with death in 5 patients (36%). Wound infection in 10 amputees (71%) led to revision of the amputation to a higher level in 2 (14%) and wound debridement in 2 (14%). CONCLUSIONS MRSA infection has a high mortality in vascular surgical patients in general, and following aorto-iliac reconstruction in particular. Autogeneous vein may confer some protection against local complications following groin wound infection. Strategies aimed at reducing the incidence of infection, including strict adherence to infection control procedures, may reduce the severity of this problem.
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Molloy KJ, Nasim A, Payne D, Naylor AR, Thompson MM. Delayed presentation of ischaemic colon following repair of ruptured aortic aneurysm. Eur J Vasc Endovasc Surg 2000; 20:584-5. [PMID: 11136598 DOI: 10.1053/ejvs.2000.1222] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Molloy KJ, Nasim A, Payne D, Lloyd DM. Laparoscopic reduction of incarcerated Meckel's diverticulum following abdominal hysterectomy. JSLS 2000; 4:235-7. [PMID: 10987401 PMCID: PMC3113176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Laparoscopic techniques are increasingly being utilized to diagnose and successfully manage intestinal obstruction. CASE REPORT We describe a patient who presented with intestinal obstruction following a recent abdominal hysterectomy. The obstruction was caused by entrapment of a segment of small bowel containing a Meckel's diverticulum within a pouch formed by the peritoneal layer following mass closure of the abdominal wound. DISCUSSION We discuss the literature on the abdominal wound closure technique. The role of laparoscopy in dealing with intestinal obstruction is reviewed briefly. We have also summarized the management of an incidental Meckel's diverticulum found at laparoscopy.
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Hayes PD, Nasim A, London NJ, Sayers RD, Barrie WW, Bell PR, Naylor AR. In situ replacement of infected aortic grafts with rifampicin-bonded prostheses: the Leicester experience (1992 to 1998). J Vasc Surg 1999; 30:92-8. [PMID: 10394158 DOI: 10.1016/s0741-5214(99)70180-1] [Citation(s) in RCA: 137] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
PURPOSE Prosthetic graft infection after aortic aneurysm surgery is a life-threatening complication. Treatment options include total graft excision and extra-anatomic bypass grafting or in situ replacement of the graft. The latter option is gaining increasing popularity, but the long-term outcome remains uncertain, particularly in light of the increasing prevalence of methicillin-resistant Staphylococcus aureus (MRSA). We performed a prospective nonrandomized study to assess the outcome after graft excision and in situ replacement with a rifampicin-bonded prosthesis for the treatment of major aortic graft infection. METHODS In a 6-year period from January 1992 to December 1997, 11 patients (eight men, three women) with major aortic graft infection underwent total graft excision and in situ replacement with a rifampicin-bonded prosthesis. The median age of the patients was 66 years (range, 49 to 78 years). Four patients had a hemorrhage from an aortoenteric fistula, three had a retroperitoneal abscess, two had graft occlusion, one had a perigraft collection shown by means of computed tomography, and one had a ruptured suprarenal false aneurysm. Organisms were cultured from 10 patients. RESULTS MRSA was isolated in two patients, both of whom had originally undergone repair of a ruptured abdominal aortic aneurysm. Two patients died (18.2%) within 30 days, and three patients (27.6%) had nonfatal complications (peritoneal candidiasis, transient renal impairment, and profound anorexia). Two patients died late in the follow-up period. Seven patients remain alive and clinically free of infection. CONCLUSION The long-term results after total graft excision and in situ replacement with a rifampicin-bonded prosthesis appear to be favorable. However, MRSA aortic graft infection appears to be associated with a poor prognosis.
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Nasim A, Hayes P, London N, Barrie WW, Bell PR, Naylor AR. Vascular surgical society of great britain and ireland: In situ replacement of infected aortic grafts with rifampicin-bonded prostheses. Br J Surg 1999; 86:695. [PMID: 10361201 DOI: 10.1046/j.1365-2168.1999.0695a.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND: Prosthetic graft infection following abdominal aortic aneurysm (AAA) surgery is life threatening. Treatment options include total graft excision and extra-anatomic bypass or in situ replacement of the graft. The latter option is gaining popularity but the long-term outcome remains uncertain, particularly in light of the increasing prevalence of methicillin-resistant Staphylococcus aureus (MRSA) infection. A retrospective study was undertaken to assess the outcome after graft excision and in situ replacement with a rifampicin-bonded prosthesis for the treatment of major aortic graft infection. The prevalence of MRSA and its influence on outcome was also assessed. METHODS: Over 6 years between January 1992 and December 1997, 11 patients (eight men) with major aortic graft infection underwent total graft excision and in situ replacement with a rifampicin-bonded prosthesis. RESULTS: The median age was 66 (range 49-78) years. Four patients presented with haemorrhage from an aortoenteric fistula, three had retroperitoneal abscess, two had graft occlusion, one had a perigraft collection on computed tomography and one presented with a ruptured suprarenal false aneurysm. Organisms were cultured from ten patients. Staphylococcus epidermidis and Streptococcus faecalis were predominant. MRSA was isolated from two patients, both of whom had originally undergone ruptured AAA repair. Two patients died and three suffered non-fatal complications. Two patients died during follow-up, one from suspected ongoing MRSA infection and the other from recurrent graft infection. Seven patients remain alive and clinically free from infection, although two were lost to follow-up at 12 and 15 months. CONCLUSION: The long-term results following total graft excision and in situ replacement with a rifampicin-bonded prosthesis appear to be favourable. MRSA infection seems to be associated with a poor prognosis.
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Pararajasingam R, Nasim A, Sutton C, Dennis MJ, Bell PR, Sayers RD. The role of screening blood tests in patients with arterial disease attending vascular outpatients. Eur J Vasc Endovasc Surg 1998; 16:513-6. [PMID: 9894492 DOI: 10.1016/s1078-5884(98)80243-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To evaluate the benefits of a policy of performing screening blood tests in new patients with arterial disease referred to the vascular outpatients department. METHODS Clinical audit over a 12-month period of all new referrals with arterial disease to the vascular outpatients department at the Leicester General Hospital. RESULTS Two hundred and seventy-two patients had at least one blood test performed at their outpatient visit. All of these patients had a full blood count performed, of which 21 results (21%) were abnormal. Further investigation of patients with abnormal results revealed one case of bladder cancer, one case of leukaemia and one patient with polycythaemia. Urea and electrolytes were measured in 269 patients (99%). Of these, 26 (10%) were expectedly abnormal in patients with known renal impairment. A further 27 patients (10%) were identified to have some degree of unrecognised renal impairment. Serum non-fasting glucose was measured in 252 patients (93%). There were 11 unexpectedly raised results, but further investigation of these patients only diagnosed one of these patients as diabetic. Serum cholesterol was measured in 201 patients (74%). One hundred and thirty-two patients (66%) had an abnormally raised serum cholesterol level. Of these, only 12 patients (6%) were known to have hyperlipidaemia. CONCLUSIONS Screening new patients with arterial disease in vascular outpatients does identify significant abnormalities, in particular renal impairment and hyperlipidaemia. Correction of these abnormalities may reduce the morbidity associated with contrast induced nephrotoxic acute renal failure, and also contribute to secondary prevention of vascular events associated with raised lipids.
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Nasim A, Thompson MM, Sayers RD, Boyle JR, Maltezos C, Fishwick G, Bolia A, Bell PR. Is endoluminal abdominal aortic aneurysm repair using an aortoaortic (tube) device a durable procedure? Ann Vasc Surg 1998; 12:522-8. [PMID: 9841681 DOI: 10.1007/s100169900195] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Endoluminal repair of abdominal aortic aneurysm (AAA) is being adopted as a less invasive alternative to conventional open repair in many centers worldwide. Although the initial results are encouraging, the long-term durability of this procedure remains unknown. Endoluminal AAA repair in 29 patients using three different devices (EVT tube Endograft(R), aortouniiliac device, and Stentortrade mark bifurcated system) is described. Overall, 24 procedures (83%) were completed successfully. Complications included two deaths due to microembolization, five early conversions, two chest infections, three patients with buttock claudication, and three patients with trashed foot. Perigraft leaks were detected in four patients (three proximal, one distal) treated with the EVT tube Endograft. Continued aneurysm expansion was observed in three of the patients. One of the leaks was discovered at the 1-year follow-up. In this patient the aneurysmal process was not retarded by endoluminal repair. The findings in this patient may have implications for the durability of this technique. Therefore, careful long-term evaluation of this procedure is recommended prior to its widespread use.
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Ashkan K, Nasim A, Sayers RD, Dennis MJ. Arterial thrombosis: a complication of loop ileostomy. Eur J Gastroenterol Hepatol 1998; 10:795-6. [PMID: 9831276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Abstract
Restorative proctocolectomy has become the surgical treatment of choice in ulcerative colitis. Most commonly, this is performed as a staged procedure which includes formation of a defunctioning loop ileostomy. High output loop ileostomies are associated with both local and systemic complications. We describe two patients with loop ileostomies who developed acute arterial thrombosis, a complication not previously described, thus further emphasizing the importance of careful management and early reversal of high output ileostomies.
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