Staff Publication

Fistula formation between the external iliac artery and ileal conduit following a radical cystoprostatectomy: a rare complication with prewarning signs of haemorrhage (2015)

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Type of publication:
Journal article

Author(s):
*Anisha Sukha, *Niamh Smyth

Citation:
BMJ Case Reports 2015:published online 27 March 2015

Abstract:
A 76-year-old man was admitted with bleeding perurostomy following a collapse at home. Three weeks prior to the admission, he had undergone a radical cystoprostatectomy and formation of ileal-conduit for an extensive bladder carcinoma. A CT angiogram revealed a possible small source of bleeding within the ileal-conduit itself, which settled with conservative management. However, prior to discharge he developed profuse fresh bleeding from the urostomy, which could not be controlled. The patient underwent an emergency endoscopy of the conduit and laparotomy, which revealed a fistula between the right external iliac artery and the proximal end of the ileal-conduit. The right iliac artery was ligated and an emergency left-to-right femoral-femoral crossover bypass was performed. The right ureter was stented and rediverted through the ilealconduit and the left ureter was stented at a later date. He unfortunately had a stormy postoperative recovery with further episodes of per-urostomy bleeding and no identified source.

Link to full-text: http://casereports.bmj.com/content/2015/bcr-2014-208914.short?rss=1

 

UK consensus position on the management of homozygous familial hypercholesterolaemia and the introduction of new agents (2014)

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Type of publication:
Conference abstract

Author(s):
R. Cramb, H. Soran, *N. Capps, A. Rees, K. Ray, W. Madira, J. Deanfield, G. Thompson

Citation:
Atherosclerosis, August 2014, vol./is. 235/2(e252-e253), 0021-9150 (August 2014)

Abstract:
Objectives: To provide a consensus position on the potential use of new therapies in the management of homozygous familial hypercholesterolaemia (HoFH) based on a review of the current standards of care, unmet medical need and new clinical evidence. The term HoFH is used to include compound heterozygous familial hypercholesterolamia as defined in the National Institute for Clincal Excellence guidelines. Methods: Participants in this discussion included clinicians managing HoFH in specialist centres, clinicians from lipid clinics and cardiologists with an interest in lipid disorders. Results: HoFH is a rare inherited disorders of cholesterol metabolism with a historical reported prevalence of 1/1,000,000. A survey in the United Kingdom (UK) identified 43 patients with a diagnosis of HoFH who receive care in one of 8 UK specialist centres. Conventional lipid lowering agents have a limited variable effect on low density lipoprotein cholesterol (LDLC) levels in HoFH. The current standard of care is by the use of lipoprotein apheresis that provides a temporary reduction in LDL-C with repeat apheresis at weekly or fortnightly intervals. Some of these patients are unable to tolerate regular apheresis, a high proportion may not achieve the European Athereosclerosis Society LDL-C targets for apheresis and there is uncertainty whether regular apheresis will prevent progression of disease. With the advent of new therapeutic approaches, the first of these being a microsomal transfer protein (MTP) inhibitor, UK clinicians have considered adopting a potentital management pathway to enhance care of patients with HoFH. Conclusion: HoFH are rare but life-threatening conditions, that require specialist therapeutic options. We describe a management pathway for patients with HoFH that considers current therapeutic options and directs the indications for new treatments to ensure maximum clinical benefit.

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Calcaneus osteotomy (2014)

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Type of publication:
Journal article

Author(s):
Tennant J.N., *Carmont M., Phisitkul P.

Citation:
Current Reviews in Musculoskeletal Medicine, 2014, vol./is. 7/4(271-276), 1935-973X;1935-9748 (2014)

Abstract:
Calcaneal osteotomy is an extra-articular, joint-sparing procedure that is used in the correction of cavovarus and planovalgus foot deformity. Careful indications and contraindications for the procedure, with meticulous surgical technique, should be followed to avoid complications and to achieve optimal outcomes. Multiple options of osteotomies exist, including translational (medializing and lateralizing calcaneal osteotomy, with ability to slide proximally or distally, closing wedge (Dwyer), and rotational type osteotomies (Evans, Z-osteotomy). Future directions for innovation include developments of both implants and surgical techniques.

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Success rate of cold coagulation for the treatment of cervical intraepithelial neoplasia: a retrospective analysis of a series of cases (2015)

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Type of publication:
Journal article

Author(s):
*Parry-Smith W, *Underwood M , De Bellis-Ayres S, *Bangs L, Redman CW, *Panikkar J.

Citation:
Journal of Lower Genital Tract Disease, January 2015, vol./is. 19/1(17-21), 1089-2591;1526-0976 (13 Jan 2015)

Abstract:
OBJECTIVE: To establish the cure rate at 1 year of patients who have undergone cold coagulation for the treatment of cervical intraepithelial neoplasia (CIN).DESIGN: Retrospective review of data for all patients at Shrewsbury and Telford NHS Trust who had undergone cold coagulation as part of their treatment for CIN between 2001 and 2011. Follow-up data up to December 2012 were analyzed. SETTING: Colposcopy Department, Shrewsbury and Telford NHS Trust, United Kingdom.POPULATION: Women undergoing cold coagulation for the treatment of CIN between 2001 and 2011, with cytologic follow-up until December 2012. METHODS: Patients were identified using a local colposcopy database. Data were obtained via the local histopathology reporting systems. Statistical analyses were performed using Stata/IC 10.1 software. MAIN OUTCOME MEASURES: Posttreatment cytology and whether subsequent treatment was required, with histology results. RESULTS: Data on 557 patients were collected and analyzed. Pre-cold coagulation treatment histologic findings were CIN 1 in 156 patients (28.01%), CIN 2 in 260 patients (46.68%), and CIN 3 in 141 patients (25.31%). The median length of time between cold coagulation treatment and first follow-up smear, used to calculate cure rates at around 1 year, was 406 days (interquartile range 123 days, range 169-3,116 days). The cure rate after cold coagulation was 95.7% at around 1 year. CONCLUSIONS: Cold coagulation has a cure rate comparable to that of excisional treatments such as large loop excision of the transformation zone and should be considered more widely in patients undergoing primary treatment for CIN, where there is no suspicion of invasive disease on history, examination and cytologic results.

 

Descemet's membrane endothelial keratoplasty (DMEK): first UK prospective study of 1-year visual outcomes, graft survival and endothelial cell count (2015)

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Type of publication:
Journal article

Author(s):
*Robert A Reid, *Ewan A Craig, *Hanif Suleman

Citation:
British Journal of Ophthalmology, February 2015, vol./is. 99/2(166-169), 0007-1161;1468-2079 (01 Feb 2015)

Abstract:

Aim: To evaluate the clinical outcomes of Descemet’s membrane endothelial keratoplasty (DMEK) in the treatment of patients with Fuchs’ endothelial dystrophy.

Methods: This prospective study involved 16 consecutive patients who had DMEK done and who were evaluated over a year. Measurements included best corrected visual acuity (BCVA), endothelial cell count, and central corneal thickness.

Results: Two patients had failed grafts. Of the remaining 14 patients with successful grafts, after 12 months, 79% had BCVA of 6/6 or better, and all patients had a BCVA of 6/9 or better. Median endothelial cell count was 1567 cells per mm2 (range=900–2359) representing a 40% reduction compared with preoperative counts. Median central corneal thickness was 498 µm (range 445–567 µm) compared with a median of 649 µm (range 548–740 µm) preoperatively. All patients attained total visual rehabilitation without further surgical intervention.

Conclusions: In our experience, DMEK has the potential to become the primary procedure for treating Fuchs’ endothelial dystrophy and endothelial disease as it produces rapid total visual rehabilitation with few complications, and an easy follow-up and management regimen. Donor preparation and graft insertion, however, remain important challenges.

Perineal support and risk of obstetric anal sphincter injuries: a Delphi survey (2015)

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Type of publication:
Journal article

Author(s):
Ismail KM, Paschetta E, *Papoutsis D, Freeman RM

Citation:
Acta Obstetricia Et Gynecologica Scandinavica 2015 Feb; Vol. 94 (2), pp. 165-74. Date of Electronic Publication: 2014 Dec 30.

Abstract:
Objective: To explore the views of a multidisciplinary group of experts and achieve consensus on the importance of perineal support in preventing obstetric anal sphincter injuries (OASIS).
Design: A three-generational Delphi survey.
Setting: A UK-wide survey of experts.
Population: A panel of 20 members consisting of obstetricians, midwives and urogynecologists recommended by UK professional bodies.
Methods: A 58-item web-based questionnaire was sent to all participants who were asked to anonymously rate the importance of each item on a six-point Likert scale. They were asked to rate their level of agreement on statements related to hands-on/hands-poised techniques, the association of hands-poised/hands-off approach with OASIS, the need to implement perineal support and the need to improve the evidence to support it. Systematic feedback of responses from previous rounds was provided to participants.
Main Outcome Measures: To achieve consensus on key areas related to perineal support.
Results: The response rate was 100% in all three iterations. There was consensus that current UK practice regarding perineal protection was not based on robust evidence. The respondents agreed that hands-poised/hands-off and OASIS are causally related and that hands-poised was misinterpreted by clinicians as hands-off. Although 90% of experts agreed that some form of randomized trial was required and that all would be prepared to take part, there was also consensus (75%) that in the meantime, hands-on should be the recommended technique.
Conclusions: Our results highlight the current lack of evidence to support policies of perineal support at time of birth and the need to address this controversial issue.

The Telford tonsillectomy tie trainer: an AirSim model modification (2014)

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Type of publication:
Journal article

Author(s):
*Douglas, JA; *Senior, AJ; *Scott, A

Citation:
Annals of The Royal College of Surgeons of England, Volume 96, Number 8, November 2014, pp. 634-634(1)

Abstract:

Link to more details or full-text: http://www.ingentaconnect.com/content/rcse/arcs/2014/00000096/00000008/art00042

Abdominal cocoon (2014)

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Type of publication:
Journal article

Author(s):
*Christian B S Katz, *Robert T Diggory, Abdus Samee

Citation:
BMJ Case Reports 2014; doi:10.1136/bcr-2013-203102

Abstract:
Intestinal obstruction secondary to cocoon formation is not common. We report a case of a patient who had presented with abdominal pain and distension accompanied by vomiting. Investigations, laparotomy and histology together revealed primary peritoneal carcinoma as the cause of the patient’s symptoms.

Link to more details or full-text: http://casereports.bmj.com/content/2014/bcr-2013-203102.full.pdf+html

The stages of extrication: A prospective study (2014)

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Type of publication:
Journal article

Author(s):
Nutbeam T., *Fenwick R. , Hobson C., Holland V., Palmer M.

Citation:
Emergency Medicine Journal, December 2014, vol./is. 31/12(1006-1008), 1472-0205;1472-0213 (01 Dec 2014)

Abstract:
Background: Many patients will require extrication following a motor vehicle collision (MVC). Little information exists on the time taken for the various stages of extrication. Objective: To report the time taken for the various stages of extrication. Methods: A prospective, observational study carried out in the West Midland Fire Service’s metropolitan area. Time points related to extrication were collected ’live’ by two-way radio broadcast. Any missing data were actively gathered by fire control within 1 h of completion of extrication. This paper reports an interim analysis conducted after 1 year of data collection following a 3-month run-in and training period: data were analysed from 1 January 2011 to 31 December 2011 inclusive. Results: During the study period 228 incidents were identified. Seventy-nine were excluded as they met the predetermined exclusion criteria or had incomplete data collection. This left 158 extrications that were suitable for analysis. The median time for extrication was 30 min, IQR 24-38 min. Conclusions: In patients requiring extrication following an MVC a median time of 8 min is typically required before initial limited patient assessment and intervention. A further 22 min is typically required before full extrication. Prehospital personnel should be aware of these times when planning their approach to a trapped patient.

Link to more details or full-text: http://emj.bmj.com/content/31/12/1006.abstract

 

Comparison of approaches and measurement of continuing professional development for specialists in laboratory medicine within four European countries (2014)

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Type of publication:
Journal article

Author(s):
Martin J, Gasljevic V, Sálek T, Horvath A, Borg C, Flegar-Meštrić Z, Jakovcic M, Silhavik J, Adonics A, Szlamka Z, Brincat I, Buttigieg D, Ciantar N, Sciortino AL, Mifsud A, Adkins A, *Bennett T, Rice K, Taylor Y.

Citation:
Clin Chem Lab Med. 2015 Jan 1;53(1):35-44

Abstract:
Abstract Background: This study investigated approaches to continuing professional development (CPD) for specialists in laboratory medicine within four European countries: Croatia, the Czech Republic, Malta and the UK.

METHODS:

The research questions focussed on ascertaining if continued registration/licence was linked to CPD and if so, were there requirements for certain amounts and types of CPD and for CPD activities to meet specified accreditation criteria. The Professional Associations Research Network (PARN) model of CPD measurement was applied to each country’s registration/licencing body’s CPD requirements.

RESULTS:

Our results indicate a spectrum of approaches to CPD within participating countries.

CONCLUSIONS:

It will be necessary for European employers to be familiar with these differences and to take them into account for this increasingly mobile European workforce.

Link to more details or full-text: http://search.ebscohost.com/login.aspx?direct=true&db=mnh&AN=25060347&athens.asp&site=ehost-live