Methicillin Resistant Staphylococcus aureus in Patients Undergoing Major Amputation

AbstractObjectives: to examine the impact of MRSA infection on patients undergoing major amputation. Setting: District General Hospital. Methods: patients having had major amputation and positive MRSA cultures January 1995–December 1999 were included. Outcome was compared with a randomly chosen group of patients having major amputation but no positive MRSA culture from the same time period. Results: overall 21% of patients undergoing amputation were MRSA positive. Some 28 patients (30 amputations) with MRSA positive cultures were compared with 44 patients (54 amputations) who did not have positive cultures for MRSA. MRSA was isolated from the wound in 17 of 30 amputations. More patients in the control group had a below knee amputation (38 of 54 compared with 12 of 30, p<0.02). Mortality in MRSA positive patients was higher than controls, (12 of 28, 43%, versus 4 of 44, 9%, p<0.01). Primary healing was achieved in only 4 of 17 (24%) amputations where MRSA was isolated from the wound. This compared with 31 of 54 (57%) controls (p<0.05). Delayed healing due to chronic infection was also more likely in MRSA positive patients (p<0.01). Conclusion: in view of the high morbidity and mortality in patients with MRSA positive isolates specific antibiotic prophylaxis against MRSA should be considered in patients undergoing major amputation

The current role of intra-arterial thrombolysis

AbstractBackground: the role of intra arterial thrombolysis (IAT) in the management of peripheral vascular disease has come under scrutiny. This study aims to assess current usage and indications for IAT in the U.K. Method: the use of IAT was assessed at our own centre and a questionnaire was sent to all centres that provide data for the U.K. “Thrombolysis Study Group”. Results: there has been a steady decline in the use of IAT at our centre from a peak of 40 cases per annum to zero. Response was received from 22 of 24 centres (92%). Nineteen (86%) reported a decline in IAT use. Main reasons were concerns over lack of efficacy (74%) and complication rate (63%). Most centres would use IAT for acute limb ischaemia (86%). However, for acute thrombosis in specific indications the results varied; synthetic graft (82%), vein graft (54%), supra-inguinal graft (54%) and thrombosed popliteal artery aneurysm (54%). When asked what their commonest usage for IAT was, the results again varied; acute limb ischaemia (40%), graft thrombosis (40%), embolism post radiological intervention (12%), other (8%). Conclusion: there has been a significant decrease in IAT use. Concerns exist as to efficacy and complication rate. There is no clear consensus on indications.Eur J Vasc Endovasc Surg 26, 166-169 (2003

Prospective evaluation of quality of life after conventional abdominal aortic aneurysm surgery

Objectives:To evaluate the changes in quality of life following conventional abdominal aortic aneurysm repair.Design:Prospective study.Materials and methods:Fifty-nine consecutive patients (50 men; nine women) in two surgical centres were investigated preoperatively, and at 6 weeks, 3 months and 6 months postoperatively. Quality of life was measured using the Short Form 36 (SF 36) questionnaire and the York Quality of Life questionnaire, from which the Rosser index was calculated.Results:Rosser index assessment showed restoration of quality of life to preoperative levels by 3 months, and significant improvement at 6 months. Changes in the SF 36 revealed significant improvement in mental health, and physical role limitation at all times postoperatively. Social function worsened at 6 weeks but improved to preoperative levels by 3 and 6 months after surgery.Conclusions:Quality of life was improved after open aortic aneurysm repair. The time course of recovery shows a predominant improvement between 6 weeks and 3 months postoperatively

Popliteal Aneurysms: Distortion and Size Related to Symptoms

AbstractObjectivesTo examine size and distortion of popliteal aneurysms (PA) in relation to symptoms produced at presentation.MethodsA prospective study of all PA presenting to a single unit 1988–1994. Wherever possible patients underwent angiography, duplex scanning and measurement of both PA diameter and the most proximal angle of distortion. Symptoms and measurements were noted at the time of first presentation.ResultsSeventy-three patients presented with 116 PA. At initial diagnosis 44 PA (38%) were asymptomatic and 39 (34%) produced acute ischaemia. As the PA increased in diameter so did the degree of distortion (p<0.0001). Size and distortion were greater in PA producing acute ischaemia or acute thrombosis than in asymptomatic PA (p<0.01). Degree of distortion differentiated symptomatic from asymptomatic PA (p=0.0066). Size was not significantly different between these two groups. For PA 3cm or larger in diameter with greater than 45° distortion sensitivity, specificity and positive and negative predictive values for thrombosis were 90, 89, 83 and 94%, respectively.ConclusionDistortion and size can differentiate between PA producing different symptoms. Combining the two provides a reliable method of differentiating PA which should be managed by early elective repair