Jonathan Ghosh - Academia.edu (original) (raw)

Papers by Jonathan Ghosh

European Journal of Vascular and Endovascular Surgery, 2000

Objectives: to investigate the method of discovery of abdominal aortic aneurysms (AAA) in a distr... more Objectives: to investigate the method of discovery of abdominal aortic aneurysms (AAA) in a district general hospital setting. Design: retrospective study. Materials and methods: we analysed 198 patients with an AAA who presented to our unit over a 3-year period. The method of initial diagnosis, size of the AAA and whether this was palpable, irrespective of the method of detection, were recorded. Results: ninety-five (48%) were discovered clinically, 74 (37.4%) during a radiological investigation, and 29 (14.6%) at laparotomy. Of the 74 AAAs first detected radiologically, subsequent physical examination showed that 28 (37.8%) were in fact palpable and missed at presentation. The average size of those discovered clinically (6.48±1.32 cm) was larger than those found radiologically (5.37±1.44 cm, p<0.001) or at operation (5.43±1.48 cm, p=0.039). The average diameter of the palpable AAAs was also greater than that of the non-palpable AAAs (6.42±1.24 cm vs. 4.86±1.38 cm, p<0.001).

Thrombosis Research, 2015

Despite NICE guidelines, the early management of deep vein thrombosis (DVT) in UK hospitals varie... more Despite NICE guidelines, the early management of deep vein thrombosis (DVT) in UK hospitals varies widely. We investigated the variation in clinical pathways used in NHS hospitals in North West England. A detailed questionnaire was sent to seventeen University or District General hospitals with an Accident and Emergency department. Copies of protocols or patient pathways were requested. 15 hospitals responded despite our repeated requests for information. Of those, four hospitals did not provide any DVT protocol, guideline or service for DVT. In seven (63.6%) hospitals, possible DVT patients were assessed in A&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;E, and four (36.4%) in Acute Medical Admission Units. During the day, initial assessment was by a Specialist Nurse (SN)/Advance Nurse Practitioner (ANP) in 4 (36.4%) hospitals, by a doctor in 5 out of 11 hospitals (45.5%) and a combination of ANP and doctors in 2 out of 11 (18.2%) hospitals. Out of hours assessment was conducted by a doctor in all 11 hospitals (100%). Two (18.2%) hospitals used the 2003 Wells score, three (27.3%) used the 1997 Wells score and six (54.5%) hospitals used &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;in house&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; modified Wells score. The score required to trigger further investigation varied between different hospitals. Only four (36.4%) hospitals could arrange US imaging within four hours of presentation. This lack of co-ordinated services for the management of DVT in the North West England is likely to reflect national practice. A national programme is urgently needed to ensure patients with suspected DVT are managed using standardised and consistent protocols.

BMJ case reports, 2013

We report the use of a spinal cord stimulator (SCS) for non-surgical management of superior mesen... more We report the use of a spinal cord stimulator (SCS) for non-surgical management of superior mesenteric artery thrombosis. A 59-year-old woman with polycythaemia rubra vera presented with extensive superior mesenteric artery thrombosis not amenable to surgical or endovascular revascularisation. A SCS was implanted for analgesia thereby allowing enteral feeding to be tolerated during the acute period. Four months later the patient developed a focal ischaemic jejunal stricture and underwent resection of a short segment of small bowel with primary anastomosis that healed without complication. Spinal cord stimulation can facilitate non-surgical management of mesenteric ischaemia.

BMJ case reports, 2013

Dissection of the aorta is a rare yet potentially serious complication following endovascular abd... more Dissection of the aorta is a rare yet potentially serious complication following endovascular abdominal aortic aneurysm (EVAR). These can lead to visceral branch hypoperfusion, compromise of aneurysm exclusion, arterial dilation or rupture. Intimal injury and dissection in the context of EVAR may be associated with a number of risk factors that include adverse infrarenal neck morphology, device oversizing, barbed fixation and wire manipulation in the proximal aorta. Herein, we describe three cases of type B aortic dissection following EVAR and discuss possible causes. As the applicability of endovascular technology widens, clinicians are reminded of the importance of early recognition and detection of unusual sequelae following EVAR.

Vascular and Endovascular Surgery, 2011

Soft tissue malignancy encasing axial vessels presents a surgical challenge when the goal is limb... more Soft tissue malignancy encasing axial vessels presents a surgical challenge when the goal is limb-preserving radical excision. We describe a case where limb-preserving resection of a myxoid liposarcoma involving the femoral vessels was successfully performed in the absence of autologous superficial vein for vascular reconstruction. The proximal ipsilateral superficial femoral artery was harvested as an autograft for venous reconstruction, with the arterial defect bridged using a polytetrafluoroethylene interposition graft. This technique may be selectively extended to other indications where limb viability is dependent upon availability of a high-quality graft, and conventional conduits are either unavailable or unreliable.

Case Reports in Vascular Medicine, 2015

Prosthetic vascular graft infection (PVGI) is a rare but significant complication of arterial rec... more Prosthetic vascular graft infection (PVGI) is a rare but significant complication of arterial reconstructive surgery. Although the relative risk is low, the clinical consequences can be catastrophic. Microbiological data on causative bacteria are limited. We present four cases of late-onset PVGI. Using a culture-independent nucleic acid amplification method for analysis of intraoperative samples, the presence of bacteria highly suggestive of an oral source was reported. Examination by an oral health specialist confirmed the presence of chronic periodontal disease. We hypothesize that chronic oral infection may be a previously unreported risk factor for the development of late-onset PVGI.

Cardiovascular pathology : the official journal of the Society for Cardiovascular Pathology

The transforming growth factor beta (TGFbeta) family of cytokines exert pleiotropic effects upon ... more The transforming growth factor beta (TGFbeta) family of cytokines exert pleiotropic effects upon a wide variety of cell types. TGFbeta1 has been demonstrated to be of fundamental importance in the development, physiology and pathology of the vascular system. As the role of TGFbeta1 in these processes becomes clearer, influencing its activity for therapeutic benefit is now beginning to be investigated. This review presents an overview of the role of TGFbeta1 in the vasculature. The cellular and extracellular biology of the TGFbeta family is first addressed, followed by an overview of the function of TGFbeta1 during vascular development, atherogenesis, hypertension, and vessel injury.

Annals of vascular surgery, 2006

We report on a 52-year-old male who developed late stent graft infection resulting in infective a... more We report on a 52-year-old male who developed late stent graft infection resulting in infective aneurysm formation with systemic septic embolization and aortoduodenal fistulation 9 months following endoluminal repair of an abdominal aortic aneurysm. Although endoluminal stent graft infection and erosion into surrounding viscera is rare, we highlight the need for awareness of this potentially catastrophic complication.

Journal of Vascular Surgery, 2009

We present the case of a 61-year-old man with a 5.8 cm infrarenal aortic aneurysm with extensive ... more We present the case of a 61-year-old man with a 5.8 cm infrarenal aortic aneurysm with extensive iliac disease that did not permit conventional EVAR, who was also judged to be too high risk for open surgery. Despite these factors, the aneurysm was still successfully repaired using endovascular means and an alternative access technique. This involved a specially commissioned Zenith aorto-uniliac endograft reverse mounted onto a TX2 delivery device, delivered via the carotid artery. ( J Vasc Surg 2009;49:763-6.)

Journal of Vascular Surgery, 2006

The transforming growth factor (TGF)-␤ family of cytokines exerts pleiotropic actions on vascular... more The transforming growth factor (TGF)-␤ family of cytokines exerts pleiotropic actions on vascular smooth muscle cell phenotype, proliferation, and extracellular matrix synthesis. This in vivo study assessed the use of TGF-␤3 in attenuating the development of postanastomotic smooth muscle cell proliferation. Methods: Under general anesthesia, 10 adult goats underwent transection and reanastomosis of both common carotid arteries. After reanastomosis, one artery was infiltrated with 50 ng of TGF-␤3 in 100 L of pH buffer around the anastomosis, and the other side was infiltrated with buffer only. After surgery, each animal received 150 mg of aspirin daily. The arteries were explanted after 3 months for histologic examination. Results: Vessel wall thickness surrounding the anastomosis was reduced by 30% after TGF-␤3 treatment compared with placebo (P ‫؍‬ .003), with a 20% (P ‫؍‬ .002) reduction in cellular content. Although total collagen content was not significantly different between TGF-␤3 and placebo, collagen type VIII content was reduced around the TGF-␤3 anastomoses (P ‫؍‬ .011). A reduction in the total elastin content (P ‫؍‬ .003) and number of elastic fiber lamellae (P ‫؍‬ .042) was found surrounding TGF-␤3-treated anastomoses, but not placebo-treated anastomosis. A 29% increase in vasa vasorum (P ‫؍‬ .044) was present around TGF-␤3-treated anastomoses. No differences in inflammatory cell infiltration were seen between sides.

European Journal of Cardio-Thoracic Surgery, 2006

Objective: Facial blushing and hyperhidrosis, particularly in the facial, axillary or palmar dist... more Objective: Facial blushing and hyperhidrosis, particularly in the facial, axillary or palmar distribution, are socially, professionally, and psychologically debilitating conditions. Endoscopic thoracic sympathectomy can be carried out through multiple ports or by using a single port and a modified thoracoscope with integrated electrocautery. We reviewed our own experience to compare outcomes between these methods. Methods: One hundred and nine consecutive endoscopic thoracic sympathectomies performed on 96 patients (M:F, 30:66) were examined with respect to operative method, symptom control, and patient satisfaction. Complete follow-up was available on 144 treated sides in 77 patients (80.2%), 38 treated with two ports, 39 performed by a one-port procedure. Mean age was 32.6 years (range 18-63) with a median follow-up of 25 months (range 5-85). Pooled data showed that the mean duration hospital stay was 1.6 nights with no deaths, conversions, or neurological injuries. Results: The one-port group showed superior outcomes in terms of hospital stay, rate of postoperative pneumothorax, and the need for chest drain insertion; however, there was no correlation between number of ports and patient satisfaction. The mean overall satisfaction rating out of 5 was 3.3 with 76.6% of patients rating the outcome as 3 or more. 90.9% had an initial improvement in symptoms, although 21 patients (27.3%) described a late return of symptoms. Conclusion: Endoscopic thoracic sympathectomy can be safely and effectively carried out using a single port with similar results to the traditional two-port procedure. The one-port procedure may allow for a shorter duration of stay and lower complication rate. #

Cardiovascular Pathology, 2004

Cardiovascular Pathology, 2005

The transforming growth factor beta (TGFbeta) family of cytokines exert pleiotropic effects upon ... more The transforming growth factor beta (TGFbeta) family of cytokines exert pleiotropic effects upon a wide variety of cell types. TGFbeta1 has been demonstrated to be of fundamental importance in the development, physiology and pathology of the vascular system. As the role of TGFbeta1 in these processes becomes clearer, influencing its activity for therapeutic benefit is now beginning to be investigated. This review presents an overview of the role of TGFbeta1 in the vasculature. The cellular and extracellular biology of the TGFbeta family is first addressed, followed by an overview of the function of TGFbeta1 during vascular development, atherogenesis, hypertension, and vessel injury.

CardioVascular and Interventional Radiology, 2011

Critical Care Medicine, 2005

European Journal of Vascular and Endovascular Surgery, 2000

Objectives: to investigate the method of discovery of abdominal aortic aneurysms (AAA) in a distr... more Objectives: to investigate the method of discovery of abdominal aortic aneurysms (AAA) in a district general hospital setting. Design: retrospective study. Materials and methods: we analysed 198 patients with an AAA who presented to our unit over a 3-year period. The method of initial diagnosis, size of the AAA and whether this was palpable, irrespective of the method of detection, were recorded. Results: ninety-five (48%) were discovered clinically, 74 (37.4%) during a radiological investigation, and 29 (14.6%) at laparotomy. Of the 74 AAAs first detected radiologically, subsequent physical examination showed that 28 (37.8%) were in fact palpable and missed at presentation. The average size of those discovered clinically (6.48±1.32 cm) was larger than those found radiologically (5.37±1.44 cm, p<0.001) or at operation (5.43±1.48 cm, p=0.039). The average diameter of the palpable AAAs was also greater than that of the non-palpable AAAs (6.42±1.24 cm vs. 4.86±1.38 cm, p<0.001).

Thrombosis Research, 2015

Despite NICE guidelines, the early management of deep vein thrombosis (DVT) in UK hospitals varie... more Despite NICE guidelines, the early management of deep vein thrombosis (DVT) in UK hospitals varies widely. We investigated the variation in clinical pathways used in NHS hospitals in North West England. A detailed questionnaire was sent to seventeen University or District General hospitals with an Accident and Emergency department. Copies of protocols or patient pathways were requested. 15 hospitals responded despite our repeated requests for information. Of those, four hospitals did not provide any DVT protocol, guideline or service for DVT. In seven (63.6%) hospitals, possible DVT patients were assessed in A&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;E, and four (36.4%) in Acute Medical Admission Units. During the day, initial assessment was by a Specialist Nurse (SN)/Advance Nurse Practitioner (ANP) in 4 (36.4%) hospitals, by a doctor in 5 out of 11 hospitals (45.5%) and a combination of ANP and doctors in 2 out of 11 (18.2%) hospitals. Out of hours assessment was conducted by a doctor in all 11 hospitals (100%). Two (18.2%) hospitals used the 2003 Wells score, three (27.3%) used the 1997 Wells score and six (54.5%) hospitals used &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;in house&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; modified Wells score. The score required to trigger further investigation varied between different hospitals. Only four (36.4%) hospitals could arrange US imaging within four hours of presentation. This lack of co-ordinated services for the management of DVT in the North West England is likely to reflect national practice. A national programme is urgently needed to ensure patients with suspected DVT are managed using standardised and consistent protocols.

BMJ case reports, 2013

We report the use of a spinal cord stimulator (SCS) for non-surgical management of superior mesen... more We report the use of a spinal cord stimulator (SCS) for non-surgical management of superior mesenteric artery thrombosis. A 59-year-old woman with polycythaemia rubra vera presented with extensive superior mesenteric artery thrombosis not amenable to surgical or endovascular revascularisation. A SCS was implanted for analgesia thereby allowing enteral feeding to be tolerated during the acute period. Four months later the patient developed a focal ischaemic jejunal stricture and underwent resection of a short segment of small bowel with primary anastomosis that healed without complication. Spinal cord stimulation can facilitate non-surgical management of mesenteric ischaemia.

BMJ case reports, 2013

Dissection of the aorta is a rare yet potentially serious complication following endovascular abd... more Dissection of the aorta is a rare yet potentially serious complication following endovascular abdominal aortic aneurysm (EVAR). These can lead to visceral branch hypoperfusion, compromise of aneurysm exclusion, arterial dilation or rupture. Intimal injury and dissection in the context of EVAR may be associated with a number of risk factors that include adverse infrarenal neck morphology, device oversizing, barbed fixation and wire manipulation in the proximal aorta. Herein, we describe three cases of type B aortic dissection following EVAR and discuss possible causes. As the applicability of endovascular technology widens, clinicians are reminded of the importance of early recognition and detection of unusual sequelae following EVAR.

Vascular and Endovascular Surgery, 2011

Soft tissue malignancy encasing axial vessels presents a surgical challenge when the goal is limb... more Soft tissue malignancy encasing axial vessels presents a surgical challenge when the goal is limb-preserving radical excision. We describe a case where limb-preserving resection of a myxoid liposarcoma involving the femoral vessels was successfully performed in the absence of autologous superficial vein for vascular reconstruction. The proximal ipsilateral superficial femoral artery was harvested as an autograft for venous reconstruction, with the arterial defect bridged using a polytetrafluoroethylene interposition graft. This technique may be selectively extended to other indications where limb viability is dependent upon availability of a high-quality graft, and conventional conduits are either unavailable or unreliable.

Case Reports in Vascular Medicine, 2015

Prosthetic vascular graft infection (PVGI) is a rare but significant complication of arterial rec... more Prosthetic vascular graft infection (PVGI) is a rare but significant complication of arterial reconstructive surgery. Although the relative risk is low, the clinical consequences can be catastrophic. Microbiological data on causative bacteria are limited. We present four cases of late-onset PVGI. Using a culture-independent nucleic acid amplification method for analysis of intraoperative samples, the presence of bacteria highly suggestive of an oral source was reported. Examination by an oral health specialist confirmed the presence of chronic periodontal disease. We hypothesize that chronic oral infection may be a previously unreported risk factor for the development of late-onset PVGI.

Cardiovascular pathology : the official journal of the Society for Cardiovascular Pathology

The transforming growth factor beta (TGFbeta) family of cytokines exert pleiotropic effects upon ... more The transforming growth factor beta (TGFbeta) family of cytokines exert pleiotropic effects upon a wide variety of cell types. TGFbeta1 has been demonstrated to be of fundamental importance in the development, physiology and pathology of the vascular system. As the role of TGFbeta1 in these processes becomes clearer, influencing its activity for therapeutic benefit is now beginning to be investigated. This review presents an overview of the role of TGFbeta1 in the vasculature. The cellular and extracellular biology of the TGFbeta family is first addressed, followed by an overview of the function of TGFbeta1 during vascular development, atherogenesis, hypertension, and vessel injury.

Annals of vascular surgery, 2006

We report on a 52-year-old male who developed late stent graft infection resulting in infective a... more We report on a 52-year-old male who developed late stent graft infection resulting in infective aneurysm formation with systemic septic embolization and aortoduodenal fistulation 9 months following endoluminal repair of an abdominal aortic aneurysm. Although endoluminal stent graft infection and erosion into surrounding viscera is rare, we highlight the need for awareness of this potentially catastrophic complication.

Journal of Vascular Surgery, 2009

We present the case of a 61-year-old man with a 5.8 cm infrarenal aortic aneurysm with extensive ... more We present the case of a 61-year-old man with a 5.8 cm infrarenal aortic aneurysm with extensive iliac disease that did not permit conventional EVAR, who was also judged to be too high risk for open surgery. Despite these factors, the aneurysm was still successfully repaired using endovascular means and an alternative access technique. This involved a specially commissioned Zenith aorto-uniliac endograft reverse mounted onto a TX2 delivery device, delivered via the carotid artery. ( J Vasc Surg 2009;49:763-6.)

Journal of Vascular Surgery, 2006

The transforming growth factor (TGF)-␤ family of cytokines exerts pleiotropic actions on vascular... more The transforming growth factor (TGF)-␤ family of cytokines exerts pleiotropic actions on vascular smooth muscle cell phenotype, proliferation, and extracellular matrix synthesis. This in vivo study assessed the use of TGF-␤3 in attenuating the development of postanastomotic smooth muscle cell proliferation. Methods: Under general anesthesia, 10 adult goats underwent transection and reanastomosis of both common carotid arteries. After reanastomosis, one artery was infiltrated with 50 ng of TGF-␤3 in 100 L of pH buffer around the anastomosis, and the other side was infiltrated with buffer only. After surgery, each animal received 150 mg of aspirin daily. The arteries were explanted after 3 months for histologic examination. Results: Vessel wall thickness surrounding the anastomosis was reduced by 30% after TGF-␤3 treatment compared with placebo (P ‫؍‬ .003), with a 20% (P ‫؍‬ .002) reduction in cellular content. Although total collagen content was not significantly different between TGF-␤3 and placebo, collagen type VIII content was reduced around the TGF-␤3 anastomoses (P ‫؍‬ .011). A reduction in the total elastin content (P ‫؍‬ .003) and number of elastic fiber lamellae (P ‫؍‬ .042) was found surrounding TGF-␤3-treated anastomoses, but not placebo-treated anastomosis. A 29% increase in vasa vasorum (P ‫؍‬ .044) was present around TGF-␤3-treated anastomoses. No differences in inflammatory cell infiltration were seen between sides.

European Journal of Cardio-Thoracic Surgery, 2006

Objective: Facial blushing and hyperhidrosis, particularly in the facial, axillary or palmar dist... more Objective: Facial blushing and hyperhidrosis, particularly in the facial, axillary or palmar distribution, are socially, professionally, and psychologically debilitating conditions. Endoscopic thoracic sympathectomy can be carried out through multiple ports or by using a single port and a modified thoracoscope with integrated electrocautery. We reviewed our own experience to compare outcomes between these methods. Methods: One hundred and nine consecutive endoscopic thoracic sympathectomies performed on 96 patients (M:F, 30:66) were examined with respect to operative method, symptom control, and patient satisfaction. Complete follow-up was available on 144 treated sides in 77 patients (80.2%), 38 treated with two ports, 39 performed by a one-port procedure. Mean age was 32.6 years (range 18-63) with a median follow-up of 25 months (range 5-85). Pooled data showed that the mean duration hospital stay was 1.6 nights with no deaths, conversions, or neurological injuries. Results: The one-port group showed superior outcomes in terms of hospital stay, rate of postoperative pneumothorax, and the need for chest drain insertion; however, there was no correlation between number of ports and patient satisfaction. The mean overall satisfaction rating out of 5 was 3.3 with 76.6% of patients rating the outcome as 3 or more. 90.9% had an initial improvement in symptoms, although 21 patients (27.3%) described a late return of symptoms. Conclusion: Endoscopic thoracic sympathectomy can be safely and effectively carried out using a single port with similar results to the traditional two-port procedure. The one-port procedure may allow for a shorter duration of stay and lower complication rate. #

Cardiovascular Pathology, 2004

Cardiovascular Pathology, 2005

The transforming growth factor beta (TGFbeta) family of cytokines exert pleiotropic effects upon ... more The transforming growth factor beta (TGFbeta) family of cytokines exert pleiotropic effects upon a wide variety of cell types. TGFbeta1 has been demonstrated to be of fundamental importance in the development, physiology and pathology of the vascular system. As the role of TGFbeta1 in these processes becomes clearer, influencing its activity for therapeutic benefit is now beginning to be investigated. This review presents an overview of the role of TGFbeta1 in the vasculature. The cellular and extracellular biology of the TGFbeta family is first addressed, followed by an overview of the function of TGFbeta1 during vascular development, atherogenesis, hypertension, and vessel injury.

CardioVascular and Interventional Radiology, 2011

Critical Care Medicine, 2005