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3. Preoperative Evaluation of a Vascular Patient

Author

Horrocks, Michael, Metcalfe, James, Arnold, Wolfgang, editor, Ganzer, Uwe, editor, Liapis, Christos D., editor, Balzer, Klaus, editor, Benedetti-Valentini, Fabrizio, editor, and Fernandes e Fernandes, José, editor

Published
2007
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16. Contributors

Author

Baird, Roger N., primary, Barros D'Sa, Aires A.B., additional, Beard, Jonathan D., additional, Bell, Peter R.F., additional, Campbell, W. Bruce, additional, Chamberlain, John, additional, Chant, Anthony D.B., additional, Clyne, Charles A.C., additional, Darke, Simon G., additional, Galloway, John M.D., additional, Harris, Peter L., additional, Horrocks, Michael, additional, Lieberman, Paul, additional, Murie, John A., additional, Parvin, Simon D., additional, Michael Perry, P., additional, Vaughan Ruckley, C., additional, Wilkins, Denis C., additional, Wilmshurst, Colin C., additional, and Wolfe, John H.N., additional

Published
1991
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19. GALA: an international multicentre randomised trial comparing general anaesthesia versus local anaesthesia for carotid surgery

Author

Dellagrammaticas Demosthenes, Torgerson David, Gough Moira, Banning Adrian P, Rothwell Peter M, Lewis Steff C, Colam Bridget, Horrocks Michael, Bodenham Andrew, Gough Michael J, Leigh-Brown Anne, Liapis Christos, and Warlow Charles

Subjects
Medicine (General), R5-920
Abstract

Abstract Background Patients who have severe narrowing at or near the origin of the internal carotid artery as a result of atherosclerosis have a high risk of ischaemic stroke ipsilateral to the arterial lesion. Previous trials have shown that carotid endarterectomy improves long-term outcomes, particularly when performed soon after a prior transient ischaemic attack or mild ischaemic stroke. However, complications may occur during or soon after surgery, the most serious of which is stroke, which can be fatal. It has been suggested that performing the operation under local anaesthesia, rather than general anaesthesia, may be safer. Therefore, a prospective, randomised trial of local versus general anaesthesia for carotid endarterectomy was proposed to determine whether type of anaesthesia influences peri-operative morbidity and mortality, quality of life and longer term outcome in terms of stroke-free survival. Methods/design A two-arm, parallel group, multicentre randomised controlled trial with a recruitment target of 5000 patients. For entry into the study, in the opinion of the responsible clinician, the patient requiring an endarterectomy must be suitable for either local or general anaesthesia, and have no clear indication for either type. All patients with symptomatic or asymptomatic internal carotid stenosis for whom open surgery is advised are eligible. There is no upper age limit. Exclusion criteria are: no informed consent; definite preference for local or general anaesthetic by the clinician or patient; patient unlikely to be able to co-operate with awake testing during local anaesthesia; patient requiring simultaneous bilateral carotid endarterectomy; carotid endarterectomy combined with another operation such as coronary bypass surgery; and, the patient has been randomised into the trial previously. Patients are randomised to local or general anaesthesia by the central trial office. The primary outcome is the proportion of patients alive, stroke free (including retinal infarction) and without myocardial infarction 30 days post-surgery. Secondary outcomes include the proportion of patients alive and stroke free at one year; health related quality of life at 30 days; surgical adverse events, re-operation and re-admission rates; the relative cost of the two methods of anaesthesia; length of stay and intensive and high dependency bed occupancy. Trial registration Current Controlled Trials ISRCTN00525237

Published
2008
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20. Waiting times for carotid endarterectomy in UK: observational study

Author

Halliday, Alison W., Lees, Tim, Kamugasha, Dora, Grant, Robert, Hoffman, Alex, Rothwell, Peter M., Potter, John F., Horrocks, Michael, Naylor, Ross, and Rudd, Anthony G.

Subjects
Endarterectomy -- Usage, Endarterectomy -- Health aspects, Stroke (Disease) -- Care and treatment, United Kingdom -- Health aspects
Published
2009

21. Impedance analysis to identify the at risk femorodistal graft

Author

Wyatt, Michael Graham, Muir, Rachel M., Tennant, William G., Scott, D. Julian A., Baird, Roger N., and Horrocks, Michael

Subjects
Graft occlusion, Vascular -- Diagnosis, Blood flow -- Measurement, Laser Doppler velocimeter -- Usage, Vascular grafts -- Evaluation, Health
Abstract

Vein grafts used in arterial bypass in the leg have a high failure rate, reported to be 20 to 50 percent after five years. Most of these failures occur during the first year. It is known that stenosis (narrowing) of the graft eventually results in failure. A program of graft surveillance is needed to identify those grafts at risk for failure before it occurs. A newly developed technique to perform this monitoring is computer-assisted impedance analysis. This noninvasive technique measures pulsatile blood flow; the pulsatile pressure within the thigh and calf is measured, and an impedance score is developed for the thigh and calf. The concept of impedance of blood flow is important in a pulsatile system because of fluid inertia and vessel compliance, in addition to viscous resistance. A retrospective review was undertaken of 50 femorodistal grafts; impedance analysis was compared with arteriography (X-ray of the arteries after injection of dye). Arteriography identified stenosis in 22 grafts at risk and 28 normal controls with grafts. Impedance scores were significantly higher in the at-risk group, compared with the controls. Impedance analysis was able to detect stenosis, not only in the graft itself, but also in the runoff vessels. These results suggest that impedance analysis may be useful in identifying at-risk vein grafts which require surgery. (Consumer Summary produced by Reliance Medical Information, Inc.)

Published
1991

22. Fate of patients undergoing transluminal angioplasty for lower-limb ischemia

Author

Jeans, William D., Armstrong, Susan, Cole, Susan E. A., Horrocks, Michael, and Baird, Roger N.

Subjects
Transluminal angioplasty -- Evaluation, Blood vessels, Ischemia -- Care and treatment, Extremities, Lower -- Blood-vessels, Health
Abstract

Percutaneous transluminal angioplasty (PTA) is a relatively new technique for treating narrowed or blocked blood vessels. It involves inserting a balloon-tipped catheter into the vessel and inflating the balloon to open the vessel. PTA has proven to be as effective as surgical reconstruction of blood vessels in the lower limbs, with fewer associated complications. This study examined the results from patients who underwent PTA, and examined the fate, or outcome, of patients in which it failed. The study involved following 370 patients who had undergone a total of 500 PTA treatments for ischemia (reduced blood flow) in the lower limbs. The success rate of the PTA treatments was 51 percent, with no significant difference between male and female success rates. One percent of the patients died within 30 days as a result of PTA. Most of the failed PTA treatments occurred within the first month. Thirteen percent of these patients underwent a second PTA treatment successfully. The others were given a variety of treatments. The successful PTA patients tended to be younger and to have less critical cases. This group was more likely to have normal calf vessels and to have narrowing in the femoropopliteal vessel, while the unsuccessful patients were more likely to have occlusions (blockages) in these vessels. Improvements in post-exercise ankle-brachial systolic pressure index (ABPI) were seen in patients successfully treated with PTA; ABPI is indicative of improvement in circulation. Failure of PTA can often be attributed to selection of an inappropriate patient. Unsuccessful PTA has dramatic effects on future treatment, often leading to bypass grafts or amputation. Patients with unsuccessful PTA treatments were twice as likely to die within five years of treatment as those with successful treatments. The results indicate that PTA can be a safe and effective treatment of first choice for the appropriate patient. (Consumer Summary produced by Reliance Medical Information, Inc.)

Published
1990

26. READERS SPEAK

Author

Horrocks, Michael

Subjects
MIS, Enterprise resource planning, Enterprise resource planning -- Usage, Management information systems -- Usage
Abstract

What are the bonuses and drawbacks of using an enterprise resource planning approach? The success of any all-encompassing software system depends on the cooperation of all parties to populate the […]

Published
2001

27. GALA: an international multicentre randomised trial comparing general anaesthesia versus local anaesthesia for carotid surgery

Author

Gough, Michael J. Bodenham, Andrew Horrocks, Michael Colam, Bridget Lewis, Steff C. Rothwell, Peter M. Banning, Adrian P. Torgerson, David Gough, Moira Dellagrammaticas, Demosthenes Leigh-Brown, Anne Liapis, Christos Warlow, Charles

Abstract

Background: Patients who have severe narrowing at or near the origin of the internal carotid artery as a result of atherosclerosis have a high risk of ischaemic stroke ipsilateral to the arterial lesion. Previous trials have shown that carotid endarterectomy improves long-term outcomes, particularly when performed soon after a prior transient ischaemic attack or mild ischaemic stroke. However, complications may occur during or soon after surgery, the most serious of which is stroke, which can be fatal. It has been suggested that performing the operation under local anaesthesia, rather than general anaesthesia, may be safer. Therefore, a prospective, randomised trial of local versus general anaesthesia for carotid endarterectomy was proposed to determine whether type of anaesthesia influences peri-operative morbidity and mortality, quality of life and longer term outcome in terms of stroke-free survival. Methods/design: A two-arm, parallel group, multicentre randomised controlled trial with a recruitment target of 5000 patients. For entry into the study, in the opinion of the responsible clinician, the patient requiring an endarterectomy must be suitable for either local or general anaesthesia, and have no clear indication for either type. All patients with symptomatic or asymptomatic internal carotid stenosis for whom open surgery is advised are eligible. There is no upper age limit. Exclusion criteria are: no informed consent; definite preference for local or general anaesthetic by the clinician or patient; patient unlikely to be able to co-operate with awake testing during local anaesthesia; patient requiring simultaneous bilateral carotid endarterectomy; carotid endarterectomy combined with another operation such as coronary bypass surgery; and, the patient has been randomised into the trial previously. Patients are randomised to local or general anaesthesia by the central trial office. The primary outcome is the proportion of patients alive, stroke free ( including retinal infarction) and without myocardial infarction 30 days post-surgery. Secondary outcomes include the proportion of patients alive and stroke free at one year; health related quality of life at 30 days; surgical adverse events, re-operation and re-admission rates; the relative cost of the two methods of anaesthesia; length of stay and intensive and high dependency bed occupancy.

Published
2008

32. GALA: an international multicentre randomised trial comparing general anaesthesia versus local anaesthesia for carotid surgery

Author

Gough, Michael J, primary, Bodenham, Andrew, additional, Horrocks, Michael, additional, Colam, Bridget, additional, Lewis, Steff C, additional, Rothwell, Peter M, additional, Banning, Adrian P, additional, Torgerson, David, additional, Gough, Moira, additional, Dellagrammaticas, Demosthenes, additional, Leigh-Brown, Anne, additional, Liapis, Christos, additional, and Warlow, Charles, additional

Published
2008
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37. Preoperative Evaluation of a Vascular Patient.

Author

Arnold, Wolfgang, Ganzer, Uwe, Liapis, Christos D., Balzer, Klaus, Benedetti-Valentini, Fabrizio, Fernandes e Fernandes, José, Horrocks, Michael, and Metcalfe, James

Abstract

The purpose of preoperative evaluation is to identify and, if necessary, implement measures to prepare higher risk patients for surgery. Preoperative evaluation can decrease the length of hospital stay as well as minimize postponed or cancelled surgeries [4]. With the high likelihood of un- derlying coronary artery disease and the high degree of haemodynamic cardiac stress with profound alteration in heart rate, blood pressure, vascular volume, bleeding and clotting tendencies, vascular surgery represents an inter- mediate (1-5%)to high (>5%)mortality risk. [ABSTRACT FROM AUTHOR]

Published
2007
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47. Seroprevalences of a typical respiratory infections, SeroCp ELISA reproducibility, electrocardiographic rhythm and ischaemic changes, socioeconomic deprivation and survival outcome in elderly stroke and control medical patients

Author

Ngeh, Joseph Kho Tong and Horrocks, Michael

Subjects
616.8, stroke, socioeconomic deprivation, electrocardiography, ELISA, seroprevalences, elderly, survival, atypical respiratory infections
Abstract

This thesis was based on a collection of my published works. Chapter 1 introduced the idea that infections, both acute and chronic, were risk factors for stroke. Various infections and micro-organisms associated with stroke were discussed. Specifically, the relationship between micro-organisms such as Cytomegalovirus, Helicobacter pylori, dental pathogens, and stroke were discussed. The theories of the pathogenesis of atherosclerosis were presented. Chapter 1 also reviewed the association between Chlamydia pneumoniae, an atypical respiratory pathogen, and atherosclerosis in detail. Chapter 2 introduced the ‘Chlamydia pneumoniae in elderly patients with stroke’ or ‘C-PEPS’ study from which published works in subsequent chapters of this thesis were based. The C-PEPS was a case-control study that investigated the seroprevalence of C pneumoniae in 100 elderly acute stroke and transient ischaemic attack (TIA) patients versus 87 control medical patients. The C-PEPS study showed a high seroprevalence (immunoglobulin IgG) of C pneumoniae infection in both cases and controls. There was no significant association between C pneumoniae seropositivity and stroke / TIA. Chapter 3 presented a study that investigated the reproducibility of a commercial enzyme linked immunosorbent assay (ELISA) kit (SeroCP, Savyon) used in the CPEPS study. The study concluded that SeroCP ELISA had a good reproducibility for the detection of C pneumoniae IgA and moderately good reproducibility for C pneumoniae IgG and IgM. In chapter 4, the ‘Mycoplasma pneumoniae in elderly patients with stroke’ or ‘MPEPS’ case-control study was based on the same cohort of patients as in the C-PEPS study. The M-PEPS study showed a high seroprevalence of M pneumoniae, another atypical respiratory pathogen, in the cohort. However, the study had ruled out M pneumoniae as a major risk factor for stroke / TIA. In chapter 5, the ‘Legionella pneumophila in elderly patients with stroke’ or ‘L-PEPS’ was another case-control study based on the same cohort of patients as in the C-PEPS 3 study. The L-PEPS study established that there was no statistical difference between the seroprevalence of L pneumophila, another atypical respiratory pathogen, in both the stroke / TIA patients and control medical patients. However, when the results of C-PEPS, M-PEPS and L-PEPS studies were analysed together, it appeared that the aggregate number or infectious burden of chronic atypical respiratory infections was associated with the risk of stroke / TIA. Chapter 6 presented a pilot study that investigated the seroprevalence of Coxiella burnetii, another atypical respiratory pathogen, in the same cohort of patients as in the C-PEPS study. Due to very low seropositivity and zero counts, a conclusion could not be made on any association between C burnetii seropositivity and stroke / TIA. Chapter 7 presented the electrocardiographic findings such as rhythms and ischaemic changes of the same cohort of patients as in the C-PEPS study. Atrial fibrillation was the commonest rhythm abnormality in both elderly stroke / TIA cases and medical controls. After adjusment for background history of ischaemic heart disease, there was a statistical trend to suggest an association between ischaemic elctrocardiographic changes and stroke / TIA. Chapter 8 presented a case-control study that investigated the relationsips between socioeconomic deprivation (SED) status, atypical respiratory infections and survival outcome in the same cohort of patients as in the C-PEPS study. The SED status of stroke / TIA cases and controls were similar. Although an association between acute atypical respiratory infection and SED was only found in the control medical patients, acute atypical respiratory infectious burden was found to associate with income deprivation in the whole cohort of elderly stroke / TIA and medical patients. SED on its own had only a modest effect on the association between chronic atypical respiratory infectious burden and stroke / TIA. Elderly patients’ duration of survival after an acute stroke / TIA appeared not to be affected by their background SED status. Chapter 9 was the concluding chapter. The main findings of the published works submitted for the thesis were summarised and discussed. Some directions for future research were also discussed.

Published
2008

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