Volume and outcome for major upper GI surgery in England.

BACKGROUND: The correlation between hospital or surgeon volume and outcome for complex surgical procedures has been the subject of several studies in recent years. In the UK, such studies have been used to strengthen the case for centralization of such procedures. The recent availability of easily accessible and fully independent data on hospital outcomes for surgical services in the UK has provided the opportunity to review any potential associations between volume and outcome in the UK. METHODS: Hospital Episode Statistic (HES) data were collected through Dr Foster for four different upper GI procedures (gastrectomy, esophagectomy, pancreaticoduodenectomy, and liver resection) for a 6-year period from 1999 to 2005. Data for each procedure were divided into volume-dependant quartiles to assess any differences in mortality outcome. RESULTS: Generally, mortality rates for all four procedures are lower than previously studies have suggested. A significant trend favoring high volume providers was noted for esophagectomy, with mortality rates varying from 7.8% to 4.0% for lowest to highest volume providers (p < 0.001). A similar but less clear-cut trend was noted for pancreaticoduodenectomy. There was no significant difference for gastric and liver resection between low- and high-volume providers. There was a 20% decrease in centers performing esophagectomy and 28% for centers performing pancreaticoduodenectomy. CONCLUSION: There is a volume outcome association for esophagectomy and pancreaticoduodenectomy. There is no association for gastrectomy or hepatectomy.

Complications following peripheral angioplasty.

BACKGROUND: Peripheral angioplasty is increasingly the first choice intervention in patients with peripheral vascular disease. The aim of the current study was to audit prospectively all major complications, especially the requirement for emergency surgical intervention. PATIENTS AND METHODS: A prospective audit of outcome after peripheral angioplasty in 988 patients undergoing 1377 interventional procedures between 1 October 1995 and 30 September 1998 at which 1619 vessel segments were angioplastied. RESULTS: Major medical morbidity (bronchopneumonia, stroke, renal failure, myocardial infarction) complicated 33/1377 procedures (2.4%). Emergency surgical intervention was required after 31/1377 procedures (2.3%) with the commonest aetiologies being acute limb ischaemia and haemorrhagic complications. The amputation rate following angioplasty was 0.6% and no patient presenting with claudication or graft complications underwent amputation. The amputation rate following angioplasty for critical limb ischaemia was 2.2%. Overall, the risk of death and/or major medical complication and/or requiring emergency surgical intervention was 3.5%. The rate of complications was no different for subintimal as opposed to transluminal angioplasties. CONCLUSIONS: Peripheral angioplasty is associated with a low risk of major medical and surgical complications.

Acute spontaneous haematoma of the rectum.

Gastrointestinal haematomata occur usually in the small intestine and may be secondary to anticoagulation. Spontaneous intramural haematoma of the rectum is rare. We report such a case which presented as acute abdominal pain and which was treated by simple drainage.

Simple and reliable method of doxycycline determination in human plasma and biological tissues.

Over recent years there has been a resurgence in the use of doxycycline in clinical practice, which does not depend on its antibacterial properties. This paper describes a method of determination of doxycycline in human plasma and atheromatous tissue using high-performance liquid chromatography (HPLC), and a cheap commercially available extraction system. Doxycycline is extracted in the mobile phase and injected directly into the HPLC system, avoiding time consuming drying up steps. A limit of detection of 0.125 microg/ml of plasma, and a relative standard deviation of 3% was achieved, making the method very reliable and useful for assays within the usual therapeutic range. The method has also been applied to the extraction of a mixture of tetracyclines from plasma and atherma with equal efficacy, making it useful for assays of this class of drugs in veterinary practice and assays of food contaminants.

Endovascular repair of an innominate artery false aneurysm following blunt trauma.

PURPOSE: To describe a case of endovascular graft exclusion of an innominate artery pseudoaneurysm arising from blunt trauma. METHODS AND RESULTS: A 21-year-old patient was admitted following a major road accident. Computed tomography (CT) and aortography on admission disclosed an isolated innominate artery pseudoaneurysm. The lesion was stable, so an elective endoluminal repair was undertaken once the patient was treated for his other injuries. The right carotid artery was exposed and controlled, and the aneurysm was excluded by transluminal implantation of a customized stent-graft consisting of predilated polytetrafluoroethylene graft material covering a balloon-expandable Palmaz stent. A CT scan at 1 month and duplex scans at 6-month intervals documented good stent-graft positioning and aneurysm exclusion over a period of 18 months. CONCLUSIONS: This case illustrates the potential durability of endoluminal repair of innominate artery lesions and highlights the potential role of this minimally invasive alternative to surgery in these clinical situations.