Type of publication:
Conference abstract
Author(s):
Paramita Baruah and *Duncan Bowyer
Citation:
The Journal of Laryngology and Otology, Volume 130, Issue S3 (Abstracts for the 10th International Conference on Cholesteatoma). May 2016, pp. S154-S155
Link to more details or full-text: https://www.cambridge.org/core/journals/journal-of-laryngology-and-otology/article/div-classtitleendoscopic-ear-surgery-and-its-impact-on-the-operating-theatre-teamdiv/9BC11266B24CA333FE8F8C24DB660A32#
Type of publication:
Conference abstract
Author(s):
*Mohamed Rizny Sakkaff and *Duncan Bowyer
Citation:
The Journal of Laryngology and Otology, Volume 130, Issue S3 (Abstracts for the 10th International Conference on Cholesteatoma). May 2016, pp. S207-S208
Link to more details or full-text: https://www.cambridge.org/core/journals/journal-of-laryngology-and-otology/article/div-classtitlea-comparison-of-operative-time-outcomes-in-endoscopic-and-open-tympanomastoid-surgerydiv/260FA9CCDD529CE5E41661ECB229FE81
Type of publication:
Conference abstract
Author(s):
*Mikrou P.; *Kannivelu A.
Citation:
European Journal of Pediatrics; 2016; vol. 175 (no. 11); p. 1480-1481
Abstract:
Background and aims Syncope is a common presentation in Paediatrics. Although cardiac syncope is rare, identifying the red flags that could signify an underlying cardiac cause (see chart 1) is an essential skill for all Paediatricians. Methods We conducted a retrospective audit of children with presentation of syncope/presyncope in our local District General Hospital. We based our standards on the Department of Health and Arrhythmia Alliance Primary Care pathway, NICE and European Society of Cardiology guidance on Transient Loss of Consciousness in young people and adults. Results A total of 33 patients were analysed, in two different subgroups: Paediatric Assessment Unit (PAU) group (n=23) and Outpatient group (n=10). In the PAU subgroup, only 70% of patients had a 12-lead ECG (44% had a manual QTC calculated). Family history of sudden death was not documented in 48% of cases. In the outpatient subgroup a significantly higher number of investigations were performed (100% had 12-lead ECGs, 70% Holter monitors and 30% echocardiograms). There was felt to be a selection bias (clinic being run by a Paediatrician with Cardiology expertise). Conclusions A standard operating procedure pathway was formulated to guide clinicians in the Emergency Department and PAU for the management of children presenting with syncope. Key points are that all children presenting with syncope should have a 12-lead ECG and 'red flags' explored in history (e.g. family history of sudden unexplained death, exercise induced symptoms, palpitations). We hope that the pathway implementation will lead to improved patient care outcomes.
Type of publication:
Journal article
Author(s):
Antonakou A.; *Papoutsis D.
Citation:
Journal of Clinical and Diagnostic Research; Dec 2016; vol. 10 (no. 12)
Abstract:
Introduction: There is increasing evidence of a gender-related phenomenon where the presence of a male fetus may have an adverse effect on the outcome of pregnancy. Aim: The aim of this study was to investigate the effect of fetal gender on the delivery outcome in primigravidae women with induced labours. Materials and Methods: This was an observational cohort study of primigravidae women who had Induction Of Labour (IOL) for all indications during a two-year period. Women with breech vaginal deliveries, stillbirths, multiple pregnancies and elective Caesarean Section (CS) were excluded. Results: Of the 936 eligible patients identified, 493(52.6%) gave birth to male neonates and 443(47.4%) to female neonates. Age, ethnicity, Body Mass Index (BMI) and smoking were similar between women that delivered male and female neonates. More than half of all women were induced for post-date pregnancies. In women who gave birth to male neonates, the CS delivery rate was higher than in those with female neonates (23.7% vs 17.8%; p=0.029). Though emergency admission rates to the neonatal Intensive Care Unit (ICU) and arterial/venous pH from umbilical cord sampling immediately after birth were similar between male and female neonates, nevertheless male neonates had lower Apgar scores of <7 at 1 minute after birth (p=0.02). Conclusions: This study has shown that, male gender fetuses have a higher CS delivery rate in primigravidae women undergoing IOL and may be more vulnerable to fetal compromise when in labour.
Link to more details or full-text: http://www.jcdr.net/articles/PDF/9104/22099_CE[Ra1]_F(GH)_PF1(PI_RK)_PFA(AK)_PF2(PAG).pdf
Type of publication:
Conference abstract
Author(s):
*Sandhu B.; *Mihalache G.; *Bhatia S.
Citation:
British Journal of Oral and Maxillofacial Surgery; Dec 2016; vol. 54 (no. 10)
Abstract:
Controversy still surrounds the use of tracheosteomies in maxillofacial oncology surgery with free flaps. Many surgeons place tracheostomies in patients for airway protection post-operatively due to suspected swelling, removing the tube at approximately 10 days. However, patients undergoing this extensive surgery may not require routine tracheostomy and few maxillofacial units across the UK employ this principle. The aim of this study was to determine tracheostomy need within maxillofacial free flap surgery, and the associated complications, including extended recovery.A retrospective study was carried out of 40 patients whom underwent excision of tumours with free flap reconstruction from January 2013 to December 2015, with comparison to 2010-2012 where tracheostomies were routinely used. Analysis was made of hospital stay duration and post-operative complications.From the results of this study we can see that only 5% of cases underwent tracheostomies compared to 75% of the previous three years. All tracheostomy cases of 2013-2015 experienced chest or tracheostomy wound infections, compared to 31% of the 2010-2012 cases. The average hospital stay for those with temporary tracheostomies was 15-16 days and those without was 10 days for across the six years. There have been no reported cases of airway obstruction post-operatively in those cases where tracheostomies have not been placed following free flap surgery, including fibula free flaps. As a unit it has been concluded to avoid placing a temporary tracheostomy in all cases where possible. This is to avoid postoperative complications, reduce hospital stay and improve the quality of recovery from the patient's perspective.
Type of publication:
Conference abstract
Author(s):
*Sandhu B.; *Messahel A.
Citation:
British Journal of Oral and Maxillofacial Surgery; Dec 2016; vol. 54 (no. 10)
Abstract:
Facial injuries can lead to extensive scarring, causing physical discomfort, anxiety and social isolation for patients. The optimum method of wound healing would be primary closure, however in cases where this is not possible other options must be explored. This case report involves a 40 year old female who sustained a severe scalp wound following a road traffic accident, causing partial ejection from the vehicle. The patient was transferred to our care seven days after receiving treatment to the affected area by an emergency department. Examination revealed an 8 cm right frontal scalp region wound present, which was clearly acutely infected with areas of full thickness skin necrosis and generalised overlying slough across the defect. The lower region of the wound involved an area of 2.5 cm exposed bone. There was also weakness noted of the temporal branch of the right facial nerve with reduced brow movement. Following thorough debridement and lavage, combination treatment consisting of negative pressure vacuum therapy and allogenic skin spray application was instigated. Negative pressure allowed for contraction of the wound edges for granulation, and reduced dehiscence risk. It also increased vascularisation of the exposed bone region inferiorly and significant reduction in wound size. Fresh allogenic human keratinocyte suspension allowed for complete healing of the defect. This involved epithelisation of the superficial layer of the wound, with no remaining exudate and complete bone coverage.This successful result is exemplary of a non-surgical therapy for extensive wounds in aesthetically challenging areas.
Type of publication:
Journal article
Author(s):
*Pickstock, Shirley
Citation:
Journal of Community Nursing, 2016, vol./is. 30/6(36-40)
Type of publication:
Journal article
Author(s):
*Shehovych, A, *Salar, O, *Meyer, Cer, *Ford, D J
Citation:
Annals of the Royal College of Surgeons of England, Nov 2016, vol. 98, no. 8, p. 525-531
Abstract:
Classification systems should be tools for concise communication, which ideally can predict prognosis and guide treatment. They should be relevant, reproducible, reliable, properly validated and most importantly simple to use and understand. There are 15 described distal radius classification systems present in the literature in the past 70 years, of which 8 are discussed in this paper. For each classification, we give an insight into its history, strengths and weaknesses, and provide evidence from the literature on reliability and reproducibility. Sadly, on completion of this paper we have not found a distal radius fracture classification that proved to be useful. Failings range from poor reproducibility and reliability, and over-complexity mainly emanating from the inability to classify this spectrum of injury in all of its manifestations. Consequently, we would suggest that classification systems for acute adult distal radius fractures are not useful clinical knowledge but mainly historical and/or research tools. Moreover, we would discourage trainees from spending time learning these classifications, as they serve not as essential clinical knowledge but more as forms of abstract memory testing.
Type of publication:
Journal article
Author(s):
*Fussey, J M, *Ahsan, F
Citation:
Annals of the Royal College of Surgeons of England, Nov 2016, vol. 98, no. 8, p. e152
Abstract:
The left recurrent laryngeal nerve is at increased risk of compression by oesophageal pathology due to its long course through the neck and thorax. Here we report a case of left vocal cord palsy secondary to displacement of a gastric band, resulting in oesophageal dilatation and neuropraxia of the left recurrent laryngeal nerve. Vocal cord function partially improved following removal of the gastric band.
Type of publication:
Conference abstract
Author(s):
*Pettit L., *Welsh A., *Puzey-Kibble C., *Williams M., *Santos J., *Wardle G., *Khanduri S.
Citation:
Radiotherapy and Oncology, April 2016, vol./is. 119/(S558)
Abstract:
Purpose or Objective: There has been recent move within the U.K. to contour the nodal CTV for patients receiving adjuvant radiotherapy for breast cancer. Axillary radiotherapy (ART) following a positive sentinel lymph node biopsy is becoming more common for certain groups of patients. Organs at risk (OAR) should be delineated and considered during the planning process. Body mass index (BMI) has been shown to impact upon spinal cord and brachial plexus doses in irradiation of the supraclavicular fossa. The impact upon the OAR in the axilla has not yet been well documented. Material and Methods: Patients undergoing ART between 01/04/15-01/10/15 were identified. Non – contrast radiotherapy planning CT scans were taken. External beam radiotherapy was planned with extended tangents using a field in field approach with an additional low weighted anterior oblique field if deemed appropriate for adequate dose coverage. Dose delivered was 40.05 Gy in 15 fractions. BMI was calculated by: weight(kg)/height (m)2. CTV's were contoured in accordance with the RTOG contouring atlas. OAR including ipsilateral lung, humeral head and brachial plexus were delineated. Results: Fifteen patients were identified. Six patients had a BMI between 20-25, 3 between 25-30, 5 between 30-40 and 1 BMI>40. Mean ipsilateral lung V12 was 10.44% (range 2.3%- 14.33%). Mean V12 did not vary with BMI (BMI 20-25;mean V12=9.33%, BMI 25-30; mean V12=8.52%, BMI 30-40;mean V12=9.51%, BMI>40 mean V12=6.38%, p=0.55 Chi-Squared). The mean humeral head maximum dose was 35.2 Gy (range 1.2-41.5 Gy). Mean humeral head maximum dose did not vary with BMI (BMI 20-25; mean=34.2Gy, BMI 25-30;mean=27.8Gy, BMI 30-40; mean=40.3Gy, BMI>40; mean=38.2Gy, p=0.49 ttest). The ipsilateral brachial plexus D2 mean was15.6Gy (range 1.2-37.4 Gy). Mean ipsilateral brachial plexus D2 dose did not vary with BMI(p=0.21 t-test). Conclusion: BMI did not significantly impact upon OAR dosage although this series is limited by a small sample size. Ipsilateral lung and brachial plexus were comfortably within departmental tolerance. A planning risk volume of 10 mm around the humeral head has now been adopted within the department. It is recognised that intravenous contrast provides better quality images for delineating OAR in particular for the brachial plexus. However, this impacts upon resources in terms of radiographer scanning time. Adequate time needs to be allocated in consultant and physics teams job plans to enable high quality delineation and subsequent radiotherapy plans to be produced.
Link to more details or full-text: https://user-swndwmf.cld.bz/ESTRO-35/ESTRO-35-Abstract-book3/584
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