ABSTRACT
Autologous vein is preferable for use in lower limb arterial bypass rather than synthetic graft material. Suitable vein for grafting is often limited, particularly in patients who have had previous cardiac bypass grafting or varicose veins surgery. This case report describes the use of arteriovenous fistula formation to cultivate an arm vein of a suitable diameter for use in femorotibial bypassing.
ABSTRACT
AIMS: To determine the effect of pathological severity of cirrhosis on survival in patients with alcohol-related cirrhosis. DESIGN: Liver biopsies from 100 patients were scored for Laennec score of severity of cirrhosis, and medical notes were reviewed to determine various clinical factors, including drinking status. Up-to-date mortality data were obtained using the National Health Service Strategic Tracing Service. SETTING: Southampton General Hospital between 1 January 1995 and 31 December 2000. PARTICIPANTS: A total of 100 consecutive patients with biopsy proven alcohol-induced liver cirrhosis. MEASUREMENTS: Laennec score of severity of cirrhosis and mortality. FINDINGS: Most surprisingly, the severity of cirrhosis on biopsy had little impact on survival; indeed, early death was more likely in patients with the least severe cirrhosis. Abstinence from alcohol at 1 month after diagnosis of cirrhosis was the more important factor determining survival with a 7-year survival of 72% for the abstinent patients versus 44% for the patients continuing to drink. CONCLUSIONS: It is never too late to stop drinking, even with the most severe degrees of cirrhosis on biopsy. Early drinking status is the most important factor determining long-term survival in alcohol-related cirrhosis.
Subject(s)
Liver Cirrhosis, Alcoholic/mortality , Severity of Illness Index , Adult , Aged , Female , Humans , Liver Cirrhosis, Alcoholic/pathology , Male , Middle Aged , Prognosis , Survival Analysis , Time Factors , Young AdultABSTRACT
Sudden arrhythmic cardiac death can occur in chronic misusers of alcohol. The only findings at post mortem are fatty liver and a negative or low blood alcohol. This is an under-recognized entity. Coroner's post mortems in a typical UK city were studied. Seven out of 1,292 (0.5%) post mortems were deemed to have died of alcohol associated arrhythmic death. Applying this study to the UK as a whole, alcohol related arrhythmic death or as we have termed it SUDAM (Sudden Unexpected Death in Alcohol Misuse) probably accounts for around 1,000 deaths, many of which are misattributed to other causes.