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Shulgina L.,University of East Anglia | Cahn A.P.,Bedford Hospital NHS Trust | Clark A.B.,University of East Anglia | Wilson E.C.F.,University of East Anglia | And 6 more authors.
Thorax | Year: 2013

Background: Idiopathic pulmonary fibrosis (IPF) is a fatal condition with limited treatment options. However, in a previous small study, co-trimoxazole was found to be beneficial. Methods: In a double-blind multicentre study, 181 patients with fibrotic idiopathic interstitial pneumonia (89% diagnosed as definite/probable IPF) were randomised to receive co-trimoxazole 960 mg twice daily or placebo for 12 months in addition to usual care. Measurements were made of forced vital capacity (FVC) (primary endpoint), diffusing capacity of carbon monoxide (DLCO) and EuroQol (EQ5D)-based utility, 6-minute walk test (6MWT) and Medical Research Council (MRC) dyspnoea score (secondary endpoints). All-cause mortality and adverse events were recorded (tertiary endpoints). Results: Co-trimoxazole had no effect on FVC (mean difference 15.5 ml (95% CI -93.6 to 124.6)), DLCO (mean difference -0.12 mmol/min/kPa (95% CI 0.41 to 0.17)), 6MWT or MRC dyspnoea score (intention-to-treat analysis). The findings of the per-protocol analysis were the same except that co-trimoxazole treatment resulted in a significant improvement in EQ5D-based utility (mean difference 0.12 (95% CI 0.01 to 0.22)), a reduction in the percentage of patients requiring an increase in oxygen therapy (OR 0.05 (95% CI 0.00 to 0.61)) and a significant reduction in all-cause mortality (co-trimoxazole 3/53, placebo 14/65, HR 0.21 (95% CI 0.06 to 0.78), p=0.02)) compared with placebo. The use of co-trimoxazole reduced respiratory tract infections but increased the incidence of nausea and rash. Conclusions: The addition of co-trimoxazole therapy to standard treatment for fibrotic idiopathic interstitial pneumonia had no effect on lung function but resulted in improved quality of life and a reduction in mortality in those adhering to treatment.


Muttalib M.,Bedford Hospital NHS Trust | Ibrahem R.,University of Nottingham | Khashan A.S.,University College Cork | Hajaj M.,Kettering General Hospital Foundation Trust
Clinical Radiology | Year: 2014

Aim To evaluate the performance of breast magnetic resonance imaging (MRI) in determining the size of invasive lobular carcinoma (ILC) compared to histopathology, and its influence on breast surgical management. Materials and methods Prospective evaluation was undertaken of standardized contrast-enhanced MRI images of 51 consecutive women over an 18 month period with pure ILC or with lobular features as the dominant subtype on breast core biopsy. Image interpretation was performed by one consultant radiologist (M.H.). The lesion size at MRI was compared with the size at final histopathology after surgical excision using a Bland-Altman agreement plot. Results Of the 51 prospectively imaged consecutive women, seven were excluded as they had diffuse ILC. The remaining 44 patients had a mean histological tumour size of 34.9 mm (range 4-77 mm). MRI underestimated tumour size in 26 (59.1%) cases. In 21 (47.7%) patients, this discrepancy was small, ranging up to 16 mm. The largest underestimation occurred in five (11.4%) cases with a difference ranging between 31 and 48 mm. Fifteen (34.1%) tumours were overestimated by MRI where the discrepancy ranged up to 22 mm. In three (6.8%) patients MRI and histological size matched. The Bland-Altman agreement plot demonstrated that in 95% of cases the size at histopathology will be between 0.36 and 2.31 times the MRI size at extremes. MRI correlated better with histopathology in tumours up to T2 (<5 cm) size leading to a change in surgical management for nine of the 44 (20.5%) patients. Conclusion MRI enables surgical management decisions to be made with increased confidence in patients with ILC up to T2 size. © 2013 The Royal College of Radiologists. Published by Elsevier Ltd. All rights reserved.


Wassif W.S.,Bedford Hospital NHS Trust | Ross A.R.,Assiut University
Vitamins and Hormones | Year: 2013

Few organ systems are spared the progressive deterioration seen in critically ill patients with anorexia nervosa. Most of the endocrine disturbances discussed are due to starvation and represent appropriate metabolic adaptation of the body to food restriction and negative energy balance. In a starving patient, a lowered metabolic rate, increased cortisol and growth hormone level and reduced fertility are all appropriate adaptations to an abnormal and highly stressful state. Most metabolic abnormalities can be reversed with a well-planned refeeding program and nutritional recovery. © 2013 Elsevier Inc.


Chaudhuri A.,Bedford Hospital NHS Trust | York A.,Bedford Hospital NHS Trust | Dey R.,Northampton General Hospital
European Journal of Vascular and Endovascular Surgery | Year: 2014

Objectives: Small published series suggest a higher failure rate for Angio-Seal vascular closure device (VCD) deployment after antegrade femoral puncture, despite the need for shorter haemostasis times, early discharge, and possibly higher turnover. We seek to compare the deployment efficacy and complications of the Angio-Seal VCD between antegrade and retrograde femoral arterial deployments. Methods: Radiological data was retrospectively analysed from prospective databases from the hospitals' Computerised Radiology Information System (CRIS) over 2010-2012. Angio-Seal gauge, Rutherford class (as applicable), puncture mode (used to classify deployment as antegrade/ retrograde), sheath sizes, and deployment success/failures were recorded. Numerical/statistical analyses were undertaken using Microsoft Excel 10/SISA software. Results: A total of 519 Angio-Seal VIP VCDs were deployed in 470 patients over 2010-2012 (13 other patients could not be analysed due to incomplete data). Sheath sizes for antegrade/retrograde femoral puncture were 5F, n = 22/9; 6F, n = 244/223; 7F, n = 1/5; 9F, n = 4/0. 8F Angio-Seal VIPs were used for 9F punctures only, 6F for the remainder. The overall deployment success rate was 93.7%. In total, 247 (91.1%) successful antegrade deployments were undertaken with 24 (8.9%) failures, compared with 229 (96.6%) successful retrograde deployments with eight (3.4%) failures. Antegrade/retrograde failures were classed as failure to deploy, n = 15/5; bleeding despite successful deployment requiring supplementary compression, n = 6/1; haematoma formation, n = 2/1; groin pain, n = 0/1; vessel stenosis, n = 1/0. Higher deployment failures were noted with antegrade deployment (p <.02, chi-square test). Conclusions: Angio-Seal deployment is successful for both antegrade/retrograde femoral punctures albeit with a higher antegrade failure rate. © 2014 European Society for Vascular Surgery.


Schreiber B.E.,Royal Free Hampstead NHS Trust | Noor N.,Bedford Hospital NHS Trust | Juli C.F.,Imperial College London | Haskard D.O.,Imperial College London
Seminars in Arthritis and Rheumatism | Year: 2011

Introduction: We describe the successful treatment of pulmonary arterial aneurysms in Behçet's syndrome using a tumor necrosis factor (TNF) inhibitor. Methods: A case is reported of Behçet's syndrome complicated by pulmonary arterial aneurysms that responded to anti-TNF therapy. This is accompanied by a literature review of previously published cases. We searched the English language medical literature using the PubMed and Medline search terms: "Behçet's," "Pulmonary aneurysms," and "infliximab," "etanercept," or "adalimumab.". Results: A 43-year-old man with a 6-month history of oral and genital ulcers, weight loss, and fatigue developed arterial aneurysms in the common carotid and common iliac arteries and thromboses in a femoral vein and pulmonary arteries. Treatment with high-dose oral corticosteroids and pulsed intravenous cyclophosphamide was initiated but while on treatment he developed pulmonary arterial aneurysms with hemoptysis. His treatment was changed to intravenous infliximab with methotrexate to which he showed a good response with marked clinical improvement, reduction in his inflammatory markers, and regression of the pulmonary arterial aneurysms. The review of the literature identified 3 reported cases of treatment of pulmonary arterial aneurysms in Behçet's syndrome with anti-TNF therapy, with good outcomes in each case. Conclusions: Pulmonary artery aneurysms are important complications of Behçet's syndrome. Anti-TNF inhibitors should be considered in patients who do not respond to treatment with corticosteroids and cyclophosphamide. © 2011 Elsevier Inc.


Kent M.,Norwich University | Rachha R.,Bedford Hospital NHS Trust | Sood M.,Bedford Hospital NHS Trust
International Orthopaedics | Year: 2010

We describe an inexpensive method of producing a reinforced articulating cement spacer using a commercially available hip cement mould. We have a cohort of 15 consecutive patients in whom this novel cement spacer has been used. All patients were able to at least partially weight bear and none of the spacers fractured. Thirteen have been explanted at second stage operation after a minimum of eight weeks in situ. Two patients have been unable to undergo a second stage due to unrelated death and medical problems precluding further surgery. The articulating cement spacer described is produced using a technique that is simple, reproducible and allows a reinforced spacer to be created inexpensively without the need for special equipment. © 2009 Springer-Verlag.


Arvinte D.,Bedford Hospital NHS Trust | Sood M.,Bedford Hospital NHS Trust
Journal of Arthroscopy and Joint Surgery | Year: 2015

This article describes the case of a patient with a periprosthetic femoral fracture. The risk factors and possible reasons for the increasing incidence of this type of fracture in current orthopaedic practice are discussed. A classification is presented and the correct approach to management, with direct application to the case described, is presented. © 2015 International Society for Knowledge for Surgeons on Arthroscopy and Arthroplasty.


Introduction We present a 'post-close' technique using the Angio-Seal VIP vascular closure device (VCD) after percutaneous endovascular aneurysm repair (p-EVAR) using an ultra-low-profile (ULP) device. Technique Following percutaneous using an ULP device (here the Ovation Prime system, Trivascular, Eysins, Switzerland), contralateral femoral hemostasis is achieved by using an 'undersized' application of an 8F Angio-Seal VIP vascular closure device (VCD) for all punctures wherein upto 12F sheaths have been applied for access. On the ipsilateral side, following 'double-wire' preparation, synchronous deployment of an 8F and 6F Angio-Seal VIP VCDs achieves hemostasis. Procedural heparin is reversed as an adjunct, pressure dressings are applied and the patient kept flat for 2 hours. Discussion Double-wire VCD deployments, and 'post-close' techniques have not been described in the context of femoral hemostasis after p-EVAR. This technique is easy to apply and saves time (and potentially cost) used to set up 'pre-close' devices, as is typically used these days. © 2015 The Author. Published by Elsevier Ltd.


John H.E.,Bedford Hospital NHS Trust | Mahaffey P.J.,Bedford Hospital NHS Trust
Journal of Surgical Oncology | Year: 2014

Both laser therapy and cryotherapy have been used with good results in the ablation of cutaneous melanoma metastases. There is less literature evidence in support of cryotherapy. Carbon dioxide laser therapy is a simple, low cost, patient-friendly technique, effective for palliation of individual lesions. There is evidence of a more profound regional effect, with unexplained absences of recurrence at treated sites and reported complete remissions, which demands further investigation. J. Surg. Oncol. 2014 109:296-300. © 2013 Wiley Periodicals, Inc. © 2013 Wiley Periodicals, Inc.


Thakar T.,Bedford Hospital NHS Trust | Chaudhuri A.,Bedford Hospital NHS Trust
Journal of Endovascular Therapy | Year: 2013

Purpose: To present a preliminary experience using a multilayer flow-modulating stent for trans/infragenicular popliteal endovascular aneurysm repair. Methods: Five men (mean age 76 years, range 62-86) with 6 popliteal artery aneurysms (PAAs) measuring 22 to 39 mm in diameter (mean 30) underwent endovascular repair using the Cardiatis Multilayer Aneurysm Repair System (MARS) between June and August 2011. Radiological assessments post procedure using duplex ultrasonography and biplanar knee radiographs (additional contrast studies as necessary) sought evidence of aneurysm exclusion, graft patency, and preservation of branches and runoff vessels. Results: Technical success was achieved in each case. There was one symptomatic stent occlusion requiring thrombectomy at 4 days, with reocclusion, and one leak via the stent struts into the sac with no branch outflow identified. Two further symptomatic stent occlusions were identified within a 6-week follow-up period, totaling 3 occlusions among the 6 devices deployed. Conclusion: No firm conclusion can be reached on the efficacy of the MARS in PAAs due to the inherent limitations of this small series, although a 50% thrombosis rate is a poor outcome. The risk of early thrombosis in flow-modulating stents deployed in the popliteal artery exists, as it does with earlier generation stent-grafts. Larger prospective trials and the influence of more aggressive antithrombotic/anticoagulant therapy should be considered to enable accurate evaluation of this device in popliteal artery aneurysms. © 2013 by the International Society of Endovascular Specialists.

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