Variation in vascular activity in the United Kingdom: an analysis of five regions.

BACKGROUND: The aim of this study was to define variations in vascular activity that may exist between different demographic regions of the UK. METHODS: Five regions were studied. Data were obtained on OPCS codes for vascular surgery 1994-95 from the Department of Health or Welsh Office. Mortality and cause of death statistics were calculated for each region from OPCS data. RESULTS: Ranges of vascular reconstruction, iliac and superficial femoral artery angioplasty and major amputation were 26.2-44, 10.5-23.0 and 11.5-15.7 per 100,000 population, respectively. The highest rates of amputation were seen in areas of high standard mortality and highest death rate from atheroma and ischaemic heart disease. Rates of amputation also rose in proportion to the number of men in the population aged > 60 years. CONCLUSION: Variations exist in vascular activity between different regions. This may be caused by demographic differences in the population. It needs to be considered when calculating the number of vascular surgeons required in different areas of the country.

Accuracy of centrally recorded OPCS codes for vascular surgery in the United Kingdom.

AIM: Centrally recorded OPCS codes are based upon district returns. The aim of this study is to determine the accuracy of this system with regard to vascular surgery. METHODS: Prospectively recorded audit data for vascular and endovascular procedures were compared with those obtained from the Department of Health and Welsh Office. Five U.K. hospitals were involved in the study. Data were obtained for the twelve months, 1 April 1994-30 March 1995 (these being the most up to date figures available). RESULTS: The total number of arterial reconstructions based on audit data was 1082. Those recorded by the OPCS codes were 743. This represents a discrepancy of -31.3% (range for the five hospitals: -13.1% to -63.8%). When examining specific codes similar discrepancies were seen. For example, in one hospital 38 AAA repairs were carried out but only two were centrally recorded. However, examination of ICD9 codes (relating to hospital admissions) for that hospital showed that 38 patients with AAA were admitted. A similar wide variation was seen when examining iliac and superficial femoral artery endovascular procedures. Despite the discrepancies of audit and OPCS data, the codes for reconstructions did reflect relative workload of the different hospitals. CONCLUSION: This study shows that there is a marked underestimate of vascular workload when comparing central recorded data with that obtained from local audit. Marked variation is seen in the accuracy of data submitted from different hospitals.

Angiosarcoma in congenital hereditary lymphoedema (Milroy's disease)--diagnostic beacons and a review of the literature.

In cases of congenital lymphoedema the finding of ulceration, violaceous nodules or papules, or apparent traumatic ecchymoses should act as a diagnostic beacon warning of dangers. A case is reported of a high-grade angiosarcoma developing in a patient with congenital hereditary lymphoedema (Milroy's disease). This is the second paper to report this complication, the third case report and the first case in which the diagnosis is substantiated by immunohistochemistry and lectin histochemistry. A review of cases of angiosarcoma complicating congenital hereditary and non-hereditary lymphoedema is also presented.

Contraction of canine stomach and small bowel by intravenous administration of serotonin. A physiologic response?

Serotonin is found in large quantities in the gastrointestinal tract, where it can increase gastrointestinal motility. Whether this response represents a physiologic event has not previously been shown. In our investigation eight conscious dogs were fitted with strain gauges to monitor motility responses to serotonin. When infused intravenously, serotonin significantly increased the contraction rate and force of canine stomach, small bowel, and isolated Thirty-Vella loops. Whole blood serotonin levels monitored by radioimmunoassay showed no significant increase in levels during these infusions. Serotonin may have a physiologic function in the mediation of gastrointestinal motility.

Perforation of the acalculous gallbladder following renal transplantation.

Two acalculous renal transplant patients, of more than 1,000 performed at this center, suffered early infarction and perforation of the gallbladder following operation. This rare complication may be related to both postoperative stress and the immunocompromising drugs given to renal transplant patients.

Identification of accessory bile ducts at cholecystectomy.

The presence of accessory channels between the liver and extrahepatic bile ducts has long been recognised by anatomists and the division of such ducts may be a cause of bile leakage following cholecystectomy. However, visualisation of accessory bile ducts at operation is difficult as they are often small and sometimes less than 1 mm in diameter. Cholangiography has been used to help in the identification of accessory ducts in 50 patients included in a prospective trial. X-rays were taken after dissection of the gall bladder from its bed and extravasation of contrast was seen on five occasions (10%) suggesting leakage from divided accessory ducts. The identification of damage to accessory bile ducts in 10% of patients suggests that this may occur more frequently than previously supposed.