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1. Choices of stent and cerebral protection in the ongoing ACST-2 trial: a descriptive study

Author

D.D. de Waard, A. Halliday, G.J. de Borst, R. Bulbulia, A. Huibers, R. Casana, L.H. Bonati, V. Tolva, G. Fraedrich, B. Rantner, E. Gizewski, I. Gruber, J. Hendriks, P. Cras, P. Lauwers, P. van Scheil, F. Vermassen, I. Van Herzeele, M. Geenens, D. Hemelsoet, P. Lerut, B. Lambrecht, G. Saad, A. Peeters, M. Bosiers, E. da Silva, N. de Luccia, J.C. Sitrangulo, A.E.V. Estenssoro, C. Presti, I. Casella, J.A.T. Monteiro, W. Campos, P. Puech-Leao, V. Petrov, C. Bachvarov, M. Hill, A. Mitha, J. Wong, C.-W. Liu, L. Bao, C. Yu, I. Cvjetko, V. Vidjak, J. Fiedler, S. Ostry, L. Sterba, P. Kostal, R. Staffa, R. Vlachovsky, M. Privara, Z. Kriz, B. Vojtisek, P. Krupa, M. Reif, V. Benes, P. Buchvald, L. Endrych, V. Prochazka, M. Kuliha, D. Otahal, T. Hrbac, D. Netuka, M. Mohapl, F. Kramier, M. Eldessoki, H. Heshmat, F. Abd-Allah, V. Palmiste, S. Margus, T. Toomsoo, J.-P. Becquemin, P. Bergeron, T. Abdulamit, J.-M. Cardon, S. Debus, G. Thomalla, J. Fiehler, C. Gerloss, U. Grzyska, M. Storck, E. LaMacchia, H.H. Eckstein, H. Söllner, H. Berger, M. Kallmayer, H. Popert, A. Zimmermann, A. Guenther, C. Klingner, T. Mayer, J. Schubert, J. Zanow, D. Scheinert, U. Banning-Eichenseer, Y. Bausback, D. Branzan, S. Braünilch, J. Lenzer, A. Schidt, H. Staab, M. Ulirch, J. Barlinn, K. Haase, A. Abramyuk, U. Bodechtel, J. Gerber, C. Reeps, T. Pfeiffer, G. Torello, A. Cöster, A. Giannoukas, K. Spanos, M. Matsagkas, S. Koutias, S. Vasdekis, J. Kakisis, K. Moulakakis, A. Lazaris, C. Liapas, E. Brountzos, M. Lazarides, N. Ioannou, A. Polydorou, B. Fulop, E. Fako, E. Voros, M. Bodosi, T. Nemeth, P. Barzo, S. Pazdernyik, L. Entz, Z. Szeberin, E. Dosa, B. Nemes, Z. Jaranyi, S. Pazdernyia, P. Madhaban, A. Hoffman, E. Nikolsky, R. Beyar, R. Silingardi, A. Lauricella, G. Coppi, E. Nicoloci, N. Tusini, F. Strozzi, E. Vecchiati, M. Ferri, E. Ferrero, D. Psacharopulo, A. Gaggiano, A. Viazzo, L. Farchioni, G. Parlani, V. Caso, P. De Rangoy, F. Verzini, P. Castelli, M.L. DeLodovici, G. Carrafiello, A.M. Ierardi, G. Piffaretti, G. Nano, M.T. Occhiuto, G. Malacrida, D. Tealdi, S. Steghter, A. Stella, R. Pini, G. Faggioli, S. Sacca, M.D. Negri, M. Palombo, M.C. Perfumo, G.F. Fadda, H. Kasemi, C. Cernetti, D. Tonello, A. Visonà, N. Mangialardi, S. Ronchey, M.C. Altavista, S. Michelagnoli, E. Chisci, F. Speziale, L. Capoccia, P. Veroux, A. Giaquinta, F. Patti, R. Pulli, P. Boggia, D. Angiletta, G. Amatucci, F. Spinetti, F. Mascoli, E. Tsolaki, E. Civilini, B. Reimers, C. Setacci, G. Pogany, A. Odero, F. Accrocca, G. Bajardi, I. Takashi, E. Masayuki, E. Hidenori, B. Aidashova, N. Kospanov, S. Bakke, M. Skjelland, A. Czlonkowska, A. Kobayashi, R. Proczka, A. Dowzenko, W. Czepel, J. Polanski, P. Bialek, G. Ozkinis, M. Snoch-Ziólkiewicz, M. Gabriel, M. Stanisic, W. Iwanowski, P. Andziak, F.B. Gonçalves, V. Starodubtsev, P. Ignatenko, A. Karpenko, D. Radak, N. Aleksic, D. Sagic, L. Davidovic, I. Koncar, I. Tomic, M. Colic, D. Bartkoy, F. Rusnak, M. Gaspirini, P. Praczek, Z. Milosevic, V. Flis, A. Bergauer, N. Kobilica, K. Miksic, J. Matela, E. Blanco, M. Guerra, V. Riambau, P. Gillgren, C. Skioldebrand, N. Nymen, B. Berg, M. Delle, J. Formgren, T.B. Kally, P. Qvarfordt, G. Plate, H. Pärson, H. Lindgren, K. Bjorses, A. Gottsäter, M. Warvsten, T. Kristmundsson, C. Forssell, M. Malina, J. Holst, T. Kuhme, B. Sonesson, B. Lindblad, T. Kolbel, S. Acosta, L. Bonati, C. Traenka, M. Mueller, T. Lattman, M. Wasner, E. Mujagic, A. Von Hessling, A. Isaak, P. Stierli, T. Eugster, L. Mariani, C. Stippich, T. Wolff, T. Kahles, R. Toorop, F. Moll, R. Lo, A. Meershoek, A.K. Jahrome, A.W.F. Vos, W. Schuiling, R. Keunen, M. Reijnen, S. Macsweeney, N. McConachie, A. Southam, G. Stansby, T. Lees, D. Lambert, M. Clarke, M. Wyatt, S. Kappadath, L. Wales, R. Jackson, A. Raudonaitis, S. MacDonald, P. Dunlop, A. Brown, S. Vetrivel, M. Bajoriene, R. Gopi, C. McCollum, L. Wolowczyk, J. Ghosh, D. Seriki, R. Ashleigh, J. Butterfield, M. Welch, J.V. Smyth, D. Briley, U. Schulz, J. Perkins, L. Hands, W. Kuker, C. Darby, A. Handa, L. Sekaran, K. Poskitt, J. Morrison, P. Guyler, I. Grunwald, J. Brown, M. Jakeways, S. Tysoe, D. Hargroves, G. Gunathilagan, R. Insall, J. Senaratne, J. Beard, T. Cleveland, S. Nawaz, R. Lonsdale, D. Turner, P. Gaines, R. Nair, I. Chetter, G. Robinson, B. Akomolafe, J. Hatfield, K. Saastamoinen, J. Crinnion, A.A. Egun, J. Thomas, S. Drinkwater, S. D'Souza, G. Thomson, B. Gregory, S. Babu, S. Ashley, T. Joseph, R. Gibbs, G. Tebit, A. Mehrzad, P. Enevoldson, D. Mendalow, A. Parry, G. Tervitt, A. Clifton, M. Nazzel, R. Peto, H. Pan, J. Potter, R. Bullbulia, B. Mihaylova, M. Flather, A. Mansfield, D. Simpson, D. Thomas, W. Gray, B. Farrell, C. Davies, K. Rahimi, M. Gough, P. Cao, P. Rothwell, A. Belli, M. Mafham, W. Herrington, P. Sandercock, R. Gray, C. Shearman, A. Molyneux, A. Gray, A. Clarke, M. Sneade, L. Tully, W. Brudlo, M. Lay, A. Munday, C. Berry, S. Tochlin, J. Cox, R. Kurien, and J. Chester

Subjects
Plaque echolucency, Time Factors, medicine.medical_treatment, Practice Patterns, 030204 cardiovascular system & hematology, Severity of Illness Index, law.invention, 0302 clinical medicine, Randomized controlled trial, law, Risk Factors, Occlusion, Carotid artery stenosis, Carotid Stenosis, Practice Patterns, Physicians', Stroke, Endarterectomy, Plaque, Atherosclerotic, Endarterectomy, Carotid, Endovascular Procedures, Plaque, Atherosclerotic, Treatment Outcome, Cerebrovascular Circulation, Stents, Radiology, medicine.symptom, Cardiology and Cardiovascular Medicine, Carotid artery stenting, medicine.medical_specialty, Clinical Decision-Making, education, Cerebral protection devices, Stent design, Surgery, Prosthesis Design, Asymptomatic, Embolic Protection Devices, 03 medical and health sciences, Severity of illness, medicine, Humans, Carotid, Chi-Square Distribution, Physicians', business.industry, Patient Selection, Stent, METANÁLISE, medicine.disease, Asymptomatic Diseases, Cerebrovascular Disorders, Stenosis, business, 030217 neurology & neurosurgery
Abstract

Objectives Several plaque and lesion characteristics have been associated with an increased risk for procedural stroke during or shortly after carotid artery stenting (CAS). While technical advancements in stent design and cerebral protection devices (CPD) may help reduce the procedural stroke risk, and anatomy remains important, tailoring stenting procedures according to plaque and lesion characteristics might be a useful strategy in reducing stroke associated with CAS. In this descriptive report of the ongoing Asymptomatic Carotid Surgery Trial-2 (ACST-2), it was assessed whether choice for stent and use or type of CPD was influenced by plaque and lesion characteristics. Materials and methods Trial patients who underwent CAS between 2008 and 2015 were included in this study. Chi-square statistics were used to study the effects of plaque echolucency, ipsilateral preocclusive disease (90–99%), and contralateral high-grade stenosis (>50%) or occlusion of the carotid artery on interventionalists' choice for stent and CPD. Differences in treatment preference between specialties were also analysed. Results In this study, 831 patients from 88 ACST-2 centres were included. Almost all procedures were performed by either interventional radiologists (50%) or vascular surgeons (45%). Plaque echolucency, ipsilateral preocclusive disease (90–99%), and significant contralateral stenosis (>50%) or occlusion did not affect the choice of stent or either the use of cerebral protection and type of CPD employed (i.e., filter/flow reversal). Vascular surgeons used a CPD significantly more often than interventional radiologists (98.6% vs. 76.3%; p < .001), but this choice did not appear to be dependent on patient characteristics. Conclusions In ACST-2, plaque characteristics and severity of stenosis did not primarily determine interventionalists' choice of stent or use or type of CPD, suggesting that other factors, such as vascular anatomy or personal and centre preference, may be more important. Stent and CPD use was highly heterogeneous among participating European centres.

Published
2017

2. Haemodilutional Effect of Standard Fluid Management Limits the Effectiveness of Acute Normovolaemic Haemodilution in AAA Surgery—Results of a Pilot Trial

Author

Frank C T Smith, Roger N. Baird, PM Lamont, L Wolowczyk, and M Nevin

Subjects
Male, medicine.medical_specialty, Blood Loss, Surgical, Plasma Substitutes, Pilot Projects, Fluid management, Hydroxyethyl Starch Derivatives, Blood Transfusion, Autologous, Hemoglobins, Blood loss, Humans, Medicine, Blood Transfusion, Prospective Studies, Aged, Medicine(all), Aged, 80 and over, Hemodilution, Blood Volume, Blood conservation, business.industry, Pilot trial, Crystalloid Solutions, Middle Aged, Acute normovolaemic haemodilution, medicine.disease, Abdominal aortic aneurysm, Surgery, Fluid infusion, Anesthesia, Female, Isotonic Solutions, Cardiology and Cardiovascular Medicine, business, Aortic Aneurysm, Abdominal
Abstract

Objective: To evaluate the impact of standard fluid management on the effectiveness of ANH as a blood conservation method in elective open AAA repair. Design: Prospective randomised controlled study. Methods: Thirty-four patients undergoing elective AAA repair were randomised to have ANH (16) or act as controls (18). Intra-operative cell salvage was permitted in both groups. Haemoglobin (Hb) concentrations were determined at variable intervals peri-operatively. Blood loss and the use of heterologous blood were recorded. Results: The pre- and post-operative Hb concentrations, surgical blood loss and the use of cell salvage were similar in both groups. Hb concentration (median, range) decreased significantly from pre-operative to aortic clamping (with blood loss

Published
2003
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3. Erratum to 'Choices of Stent and Cerebral Protection in the Ongoing ACST-2 Trial: A Descriptive Study' [Eur J Vasc Endovasc Surg 53 (2017) 617–625]

Author

D.D. de Waard, A. Halliday, G.J. de Borst, R. Bulbulia, A. Huibers, R. Casana, L.H. Bonati, V. Tolva, G. Fraedrich, B. Rantner, E. Gizewski, I. Gruber, J. Hendriks, P. Cras, P. Lauwers, P. van Scheil, F. Vermassen, I. Van Herzeele, M. Geenens, D. Hemelsoet, P. Lerut, B. Lambrecht, G. Saad, A. Peeters, M. Bosiers, E. da Silva, N. de Luccia, J.C. Sitrangulo, A.E.V. Estenssoro, C. Presti, I. Casella, J.A.T. Monteiro, W. Campos, P. Puech-Leao, V. Petrov, C. Bachvarov, M. Hill, A. Mitha, J. Wong, C.-W. Liu, L. Bao, C. Yu, I. Cvjetko, V. Vidjak, J. Fiedler, S. Ostry, L. Sterba, P. Kostal, R. Staffa, R. Vlachovsky, M. Privara, Z. Kriz, B. Vojtisek, P. Krupa, M. Reif, V. Benes, P. Buchvald, L. Endrych, V. Prochazka, M. Kuliha, D. Otahal, T. Hrbac, D. Netuka, M. Mohapl, F. Kramier, M. Eldessoki, H. Heshmat, F. Abd-Allah, V. Palmiste, S. Margus, T. Toomsoo, J.-P. Becquemin, P. Bergeron, T. Abdulamit, J.-M. Cardon, S. Debus, G. Thomalla, J. Fiehler, C. Gerloss, U. Grzyska, M. Storck, E. LaMacchia, H.H. Eckstein, H. Söllner, H. Berger, M. Kallmayer, H. Popert, A. Zimmermann, A. Guenther, C. Klingner, T. Mayer, J. Schubert, J. Zanow, D. Scheinert, U. Banning-Eichenseer, Y. Bausback, D. Branzan, S. Braünilch, J. Lenzer, A. Schidt, H. Staab, M. Ulirch, J. Barlinn, K. Haase, A. Abramyuk, U. Bodechtel, J. Gerber, C. Reeps, T. Pfeiffer, G. Torello, A. Cöster, A. Giannoukas, K. Spanos, M. Matsagkas, S. Koutias, S. Vasdekis, J. Kakisis, K. Moulakakis, A. Lazaris, C. Liapas, E. Brountzos, M. Lazarides, N. Ioannou, A. Polydorou, B. Fulop, E. Fako, E. Voros, M. Bodosi, T. Nemeth, P. Barzo, S. Pazdernyik, L. Entz, Z. Szeberin, E. Dosa, B. Nemes, Z. Jaranyi, S. Pazdernyia, P. Madhaban, A. Hoffman, E. Nikolsky, R. Beyar, R. Silingardi, A. Lauricella, G. Coppi, E. Nicoloci, N. Tusini, F. Strozzi, E. Vecchiati, M. Ferri, E. Ferrero, D. Psacharopulo, A. Gaggiano, A. Viazzo, L. Farchioni, G. Parlani, V. Caso, P. De Rangoy, F. Verzini, P. Castelli, M.L. DeLodovici, G. Carrafiello, A.M. Ierardi, G. Piffaretti, G. Nano, M.T. Occhiuto, G. Malacrida, D. Tealdi, S. Steghter, A. Stella, R. Pini, G. Faggioli, S. Sacca, M.D. Negri, M. Palombo, M.C. Perfumo, G.F. Fadda, H. Kasemi, C. Cernetti, D. Tonello, A. Visonà, N. Mangialardi, S. Ronchey, M.C. Altavista, S. Michelagnoli, E. Chisci, F. Speziale, L. Capoccia, P. Veroux, A. Giaquinta, F. Patti, R. Pulli, P. Boggia, D. Angiletta, G. Amatucci, F. Spinetti, F. Mascoli, E. Tsolaki, E. Civilini, B. Reimers, C. Setacci, G. Pogany, A. Odero, F. Accrocca, G. Bajardi, I. Takashi, E. Masayuki, E. Hidenori, B. Aidashova, N. Kospanov, S. Bakke, M. Skjelland, A. Czlonkowska, A. Kobayashi, R. Proczka, A. Dowzenko, W. Czepel, J. Polanski, P. Bialek, G. Ozkinis, M. Snoch-Ziólkiewicz, M. Gabriel, M. Stanisic, W. Iwanowski, P. Andziak, F.B. Gonçalves, V. Starodubtsev, P. Ignatenko, A. Karpenko, D. Radak, N. Aleksic, D. Sagic, L. Davidovic, I. Koncar, I. Tomic, M. Colic, D. Bartkoy, F. Rusnak, M. Gaspirini, P. Praczek, Z. Milosevic, V. Flis, A. Bergauer, N. Kobilica, K. Miksic, J. Matela, E. Blanco, M. Guerra, V. Riambau, P. Gillgren, C. Skioldebrand, N. Nymen, B. Berg, M. Delle, J. Formgren, T.B. Kally, P. Qvarfordt, G. Plate, H. Pärson, H. Lindgren, K. Bjorses, A. Gottsäter, M. Warvsten, T. Kristmundsson, C. Forssell, M. Malina, J. Holst, T. Kuhme, B. Sonesson, B. Lindblad, T. Kolbel, S. Acosta, L. Bonati, C. Traenka, M. Mueller, T. Lattman, M. Wasner, E. Mujagic, A. Von Hessling, A. Isaak, P. Stierli, T. Eugster, L. Mariani, C. Stippich, T. Wolff, T. Kahles, R. Toorop, F. Moll, R. Lo, A. Meershoek, A.K. Jahrome, A.W.F. Vos, W. Schuiling, R. Keunen, M. Reijnen, S. Macsweeney, N. McConachie, A. Southam, G. Stansby, T. Lees, D. Lambert, M. Clarke, M. Wyatt, S. Kappadath, L. Wales, R. Jackson, A. Raudonaitis, S. MacDonald, P. Dunlop, A. Brown, S. Vetrivel, M. Bajoriene, R. Gopi, C. McCollum, L. Wolowczyk, J. Ghosh, D. Seriki, R. Ashleigh, J. Butterfield, M. Welch, J.V. Smyth, D. Briley, U. Schulz, J. Perkins, L. Hands, W. Kuker, C. Darby, A. Handa, L. Sekaran, K. Poskitt, J. Morrison, P. Guyler, I. Grunwald, J. Brown, M. Jakeways, S. Tysoe, D. Hargroves, G. Gunathilagan, R. Insall, J. Senaratne, J. Beard, T. Cleveland, S. Nawaz, R. Lonsdale, D. Turner, P. Gaines, R. Nair, I. Chetter, G. Robinson, B. Akomolafe, J. Hatfield, K. Saastamoinen, J. Crinnion, A.A. Egun, J. Thomas, S. Drinkwater, S. D'Souza, G. Thomson, B. Gregory, S. Babu, S. Ashley, T. Joseph, R. Gibbs, G. Tebit, A. Mehrzad, P. Enevoldson, D. Mendalow, A. Parry, G. Tervitt, A. Clifton, M. Nazzel, R. Peto, H. Pan, J. Potter, R. Bullbulia, B. Mihaylova, M. Flather, A. Mansfield, D. Simpson, D. Thomas, W. Gray, B. Farrell, C. Davies, K. Rahimi, M. Gough, P. Cao, P. Rothwell, A. Belli, M. Mafham, W. Herrington, P. Sandercock, R. Gray, C. Shearman, A. Molyneux, A. Gray, A. Clarke, M. Sneade, L. Tully, W. Brudlo, M. Lay, A. Munday, C. Berry, S. Tochlin, J. Cox, R. Kurien, and J. Chester

Subjects
medicine.medical_specialty, Surgery, Cardiology and Cardiovascular Medicine, business.industry, Published Erratum, medicine.medical_treatment, Physical therapy, medicine, MEDLINE, Stent, Descriptive research, business
Published
2017
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4. The Effect of Acute Normovolaemic Haemodilution on Blood Transfusion Requirements in Abdominal Aortic Aneurysm Repair

Author

Roger N. Baird, David R. Lewis, PM Lamont, L Wolowczyk, M Nevin, and Frank C T Smith

Subjects
Male, medicine.medical_specialty, Blood transfusion, medicine.medical_treatment, Abdominal aortic aneurysm repair, Blood Loss, Surgical, Plasma Substitutes, Blood volume, Blood Transfusion, Autologous, Aortic aneurysm, Aneurysm, Humans, Medicine, Blood Transfusion, Aged, Retrospective Studies, Aged, 80 and over, Medicine(all), Hemodilution, Blood Volume, Red Cell, business.industry, Retrospective cohort study, Middle Aged, Acute normovolaemic haemodilution, medicine.disease, Abdominal aortic aneurysm, Autologous blood transfusion, Surgery, Anesthesia, Female, Cardiology and Cardiovascular Medicine, business, Aortic Aneurysm, Abdominal, Abdominal surgery
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

Published
2001
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5. The Snuffbox Arteriovenous Fistula for Vascular Access

Author

Andrew J Williams, L. Wolowczyk, Kieron Donovan, and C.P. Gibbons

Subjects
Male, medicine.medical_specialty, medicine.medical_treatment, Fistula, Arteriovenous fistula, Anatomical snuffbox, Arteriovenous Shunt, Surgical, AV fistula, Renal Dialysis, medicine, Humans, Vascular Patency, Treatment Failure, Vein, Dialysis, Brachiocephalic Veins, Retrospective Studies, Medicine(all), business.industry, Thrombosis, Retrospective cohort study, Middle Aged, medicine.disease, Surgery, medicine.anatomical_structure, Radial Artery, Kidney Failure, Chronic, Female, Vascular access, Radiology, Cardiology and Cardiovascular Medicine, business
Abstract

Objectives to determine the applicability, patency rates and factors influencing patency of snuffbox arteriovenous fistulae for haemodialysis access. Design retrospective non-randomised study. Materials and methods patency was determined by reference to an ongoing database and dialysis records of 645 vascular access procedures between 1985 and 1997, including 210 snuffbox fistulae in 201 patients. Results snuffbox fistulae comprised 189/376 (50%) primary procedures. Records of 208 snuffbox fistulae were available for patency analysis by the life-table method. Twenty-two (11%) thrombosed within 24 hours of operation. After six weeks 80% were used for dialysis. Cumulative patency was 65% at 1 year and 45% at 5 years. After thrombosis of snuffbox fistulae, ipsilateral wrist fistulae could be constructed in 45%. Fistula patency was significantly better in men than women (p70 years, and the prior commencement of haemodialysis did not significantly affect fistula survival. Conclusions the snuffbox AV fistula gives a long segment of arterialised vein for needling and preserves proximal vessels. It is feasible in 50% of patients requiring primary access and has good long-term patency, especially in men. A more proximal fistula may be preferable in women with smaller vessels.

Published
2000
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6. Out-of-hours Demand For Vascular Radiology

Author

TA Beckitt, L Wolowczyk, Fct Smith, M Subramaniam, Roger N. Baird, and PM Lamont

Subjects
medicine.medical_specialty, Out of hours, Multidisciplinary approach, business.industry, Medicine, General Medicine, Radiology, business
Abstract

The Vascular Society of Great Britain and Ireland recognises the importance of interventional vascular radiology as part of the multidisciplinary approach to the provision of emergency vascular services. However, arranging emergency rotas for vascular radiolo gy is not easy because of the small numbers of interventional radiologists who may also be required to cover other specialities.

Published
2008
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7. A case of primary cutaneous B-cell lymphoma of the knee

Author

E J H, Turner, H, Tsim, J, Pawade, and L, Wolowczyk

Subjects
Aged, 80 and over, Heart Failure, Male, Leg Ulcer, Palliative Care, Pneumonia, Anuria, Prognosis, Amputation, Surgical, Fatal Outcome, Postoperative Complications, Atrial Fibrillation, Humans, Knee, Neoplasm Invasiveness, Lymphoma, Large B-Cell, Diffuse
Abstract

We report the case of a gentleman with a primary cutaneous B cell lymphoma of the leg who underwent an amputation and later died. This is an uncommon type of cutaneous lymphoma with poor prognosis and the case demonstrates how aggressive the tumor can become.

Published
2009

8. A case of primary cutaneous B cell lymphoma of the knee

Author

L Wolowczyk, E J H Turner, H Tsim, and J Pawade

Subjects
Poor prognosis, medicine.medical_specialty, Palliative care, business.industry, medicine.medical_treatment, Primary cutaneous B-cell lymphoma, Dermatology, General Medicine, medicine.disease, Cutaneous lymphoma, Lymphoma, Pneumonia, Amputation, immune system diseases, hemic and lymphatic diseases, medicine, Anuria, medicine.symptom, business
Abstract

We report the case of a gentleman with a primary cutaneous B cell lymphoma of the leg who underwent an amputation and later died. This is an uncommon type of cutaneous lymphoma with poor prognosis and the case demonstrates how aggressive the tumor can become.

Published
2009
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11. Randomized controlled trial of acute normovolaemic haemodilution in aortic aneurysm repair

Author

PM Lamont, L Wolowczyk, Roger N. Baird, Ahr Stewart, M Nevin, Richard Bulbulia, A. Day, and Frank C T Smith

Subjects
Creatinine, Blood transfusion, biology, business.industry, medicine.medical_treatment, Heterologous, Urine, medicine.disease, Abdominal aortic aneurysm, law.invention, Systemic inflammatory response syndrome, chemistry.chemical_compound, chemistry, Randomized controlled trial, law, Anesthesia, medicine, biology.protein, Surgery, Interleukin 6, business
Abstract

Background Previous studies have suggested that acute normovolaemic haemodilution (ANH) reduces the need for heterologous blood transfusion in abdominal aortic aneurysm (AAA) surgery and may thus improve postoperative outcome by reducing the systemic inflammatory response. Controlled studies are lacking. The aim of this randomized controlled trial was to evaluate the effects of ANH on the systemic inflammatory response, clinical outcome and use of bank blood after AAA repair. Methods Patients undergoing elective AAA repair were randomized to ANH (n = 16) or control (n = 18) groups. Intraoperative cell salvage and heterologous blood were used in both groups according to predetermined transfusion triggers. Inflammatory markers in serum and urine were measured to assess the acute-phase response. Clinical outcome was determined using mortality, morbidity and the incidence of the systemic inflammatory response syndrome (SIRS). Results There was no difference between the ANH and control group in serial measurements of median (range) white cell count (maximum at 2 days after operation: 11·9 (7·7–21·4) versus 10·3 (7·8–20·6) × 109 l−1; P = 0·25), serum C-reactive protein level (maximum at 3 days: 150 (1–274) versus 169 (7–238) mg ml−1; P = 0·76), interleukin 6 level (maximum at 6 h: 142 (32–793) versus 105 (29–509) pg ml−1; P = 0·89), total antioxidant capacity (lowest at 1 h: 0·83 (0·67–1·22) versus 0·83 (0·68–1·23) mmol l−1; P = 0·45) or urinary albumin/creatinine ratio (maximum at 30 min after clamp release: 41 (2–923) versus 124 (4–376) mg ml−1; P = 0·10). SIRS was observed in ten of 16 patients having ANH and in 11 of 18 control patients (P = 0·99). There was no significant difference in mortality and morbidity between the groups. Similarly, there was no difference in median (range) blood loss (ANH 1800 (400–12 000) ml versus control 1600 (500–7500) ml; P = 0·55), use of cell salvage (600 (0–4740) versus 520 (0–2420) ml; P = 0·60) or heterologous blood transfusion (2 (0–32) versus 2 (0–9) units; P = 0·68). Conclusion In the setting of a randomized controlled trial ANH added no additional benefit, when used in combination with cell salvage, in reducing the requirements for heterologous blood transfusion, and made no impact on systemic inflammatory response and clinical outcome after AAA repair.

Published
2001
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13. The Effect of Acute Normovolaemic Haemodilution on the Inflammatory Response and Clinical Outcome in Abdominal Aortic Aneurysm Repair—Results of a Pilot Trial

Author

Roger N. Baird, PM Lamont, A. Day, M Nevin, L Wolowczyk, and Frank C T Smith

Subjects
Male, Urinary system, Enzyme-Linked Immunosorbent Assay, Pilot Projects, Antioxidants, Perioperative Care, law.invention, Blood Vessel Prosthesis Implantation, Aortic aneurysm, Randomized controlled trial, law, medicine, Albuminuria, Humans, Aged, Retrospective Studies, Aged, 80 and over, Inflammation, Medicine(all), Hemodilution, Interleukin-6, business.industry, Clinical outcome, Inflammatory response, Retrospective cohort study, Middle Aged, medicine.disease, Acute normovolaemic haemodilution, Abdominal aortic aneurysm, Retinol-Binding Proteins, Systemic inflammatory response syndrome, Clinical trial, C-Reactive Protein, Treatment Outcome, Creatinine, Anesthesia, Absolute neutrophil count, Female, Surgery, Cardiology and Cardiovascular Medicine, business, Biomarkers, Aortic Aneurysm, Abdominal, Follow-Up Studies
Abstract

Objectives To determine the effect of acute normovolaemic haemodilution (ANH) on the inflammatory response and clinical outcome in elective open abdominal aortic aneurysm (AAA) repair. Design Randomised controlled clinical trial. Methods Thirty-six patients were randomised to undergo ANH or act as controls. Cell salvage was permitted in both groups. Heterologous blood was transfused according to pre-determined triggers. Outcome measures were markers of the systemic inflammatory response in serum and urine observed at multiple time points, and clinical recovery. Results Median 890 (range 670–1620) ml of blood was removed at ANH in 16 patients. There were no differences in peri-operative changes in neutrophil count ( P =0.13), serum C-reactive protein ( P =0.38), interleukin-6 ( P =0.50), total antioxidant capacity ( P =0.73), urinary secretion of albumin ( P =0.97) or retinol binding protein ( P =0.41). There were no differences in the mortality and morbidity rates, systemic inflammatory response syndrome, ITU or hospital stay. Conclusions ANH, when used in combination with cell salvage, made no impact on systemic inflammatory response and clinical outcome when compared to cell salvage alone after AAA repair. ANH cannot be recommended for routine use in patients undergoing abdominal aortic aneurysm surgery when cell salvage is available.

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14. Improving duplex ultrasound methods for diagnosing functional popliteal artery entrapment syndrome.

Author

Barrett DW, Carreira J, Bowling FL, Wolowczyk L, and Rogers SK

Subjects
Humans, Hemodynamics, Ultrasonography, Arterial Occlusive Diseases diagnostic imaging, Popliteal Artery Entrapment Syndrome, Peripheral Arterial Disease
Abstract

Objectives: Popliteal artery entrapment syndrome (PAES) is a rare condition where musculoskeletal structures compress the popliteal artery (POPA) leading to vascular compromise. This study investigates the effect of dynamic plantar- and dorsi-flexion loading on POPA hemodynamic parameters to develop a robust diagnostic ultrasound-based protocol for diagnosing functional PAES., Methods: Healthy individuals (n = 20), recreational athletes (n = 20), and symptomatic (n = 20) PAES patients were consented. Triplex ultrasound imaging of lower limb arteries was performed (n = 120 limbs). Proximal and distal POPA's in dorsi-/plantar-flexion, in prone and erect positions, were imaged at rest and flexion. Peak systolic velocities (cm/s) and vessel diameter (antero-posterior, cm) was measured., Results: Distal vessel occlusion was noted across all three groups whilst prone during plantar-flexion (62.7%). POPA occlusion was only noted in the proximal vessel within the patient group (15.8%). When prone, 50% of control (n = 40 limbs), 70% of athletes (n = 40 limbs), and 65% of patients (n = 40 limbs) had distal POPA occlusion in plantar-flexion. When prone, recreational athletes (5%), and patients (12.5%) had distal POPA compression under dorsi-flexion. POPA occlusions with the patient in erect position were only noted in the symptomatic patient group under both dorsi-flexion (15.8%) and plantar-flexion (23.7%)., Conclusion: Compression of the POPA on ultrasound should not be the sole diagnostic criteria for PAES. POPA compression exists in asymptomatic individuals, primarily under prone plantar-flexion. To reduce false positives, ultrasound-based protocols should focus on scanning patients in the erect position only to diagnose PAES, rather than asymptomatic POPA compression. A distinction should be made between the two., (© 2024 The Authors. Scandinavian Journal of Medicine & Science In Sports published by John Wiley & Sons Ltd.)

Published
2024
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15. The Importance of Patient Position When Defining Normal Versus Pathological Functionality in the Diagnosis of Popliteal Artery Entrapment Syndrome with Duplex Ultrasound.

Author

Barrett DW, Carreira J, Bowling FL, Wolowczyk L, and Rogers SK

Subjects
Humans, Ultrasonography, Doppler, Duplex, Popliteal Artery diagnostic imaging, Popliteal Artery surgery, Popliteal Artery pathology, Popliteal Artery Entrapment Syndrome, Arterial Occlusive Diseases diagnostic imaging, Arterial Occlusive Diseases surgery
Published
2023
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16. Right iliac fossa kidney: Differential diagnoses.

Author

Doherty DT and Wolowczyk L

Abstract

A right iliac fossa kidney is rarely encountered by the general clinician but multiple diagnoses should be considered., Competing Interests: DD and LW have no conflicts of interest to declare., (© 2021 The Authors. Clinical Case Reports published by John Wiley & Sons Ltd.)

Published
2021
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17. Surgical management of a symptomatic extracranial internal carotid artery aneurysm and coexisting carotid body tumor.

Author

Al-Jarrah Q, Ashrafi M, Oldbury J, Rogers S, Baguneid M, and Wolowczyk L

Abstract

Treatment of carotid body tumors and extracranial carotid artery aneurysms are well documented in the literature as separate entities. As distinct pathologies, they present technical difficulties with high complication rates. No patients with simultaneous carotid body tumors and extracranial internal carotid artery aneurysms have been reported. We report, to our knowledge, the first and subsequent surgical management of such a patient., (© 2015 The Authors.)

Published
2015
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18. A case of primary cutaneous B-cell lymphoma of the knee.

Author

Turner EJ, Tsim H, Pawade J, and Wolowczyk L

Subjects
Aged, 80 and over, Amputation, Surgical, Anuria etiology, Atrial Fibrillation complications, Fatal Outcome, Heart Failure etiology, Humans, Knee, Leg Ulcer surgery, Lymphoma, Large B-Cell, Diffuse complications, Lymphoma, Large B-Cell, Diffuse surgery, Male, Neoplasm Invasiveness, Palliative Care, Pneumonia etiology, Postoperative Complications, Prognosis, Leg Ulcer etiology, Lymphoma, Large B-Cell, Diffuse pathology
Abstract

We report the case of a gentleman with a primary cutaneous B cell lymphoma of the leg who underwent an amputation and later died. This is an uncommon type of cutaneous lymphoma with poor prognosis and the case demonstrates how aggressive the tumor can become.

Published
2009

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