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Ealing, United Kingdom

Shariff S.,Wexham Park Hospital | Bashir W.A.,Ealing Hospital
Skeletal Radiology | Year: 2010

We describe an unusual cause of an acquired cavo-varus foot deformity produced by progressive enlargement of an accessory calcaneal ossicle. A 13-year-old boy with constitutional plano-valgus flat feet noted a gradual change in foot shape associated with lateral ankle pain on ambulation following an inversion injury 2 years earlier. CT and MRI scans confirmed a large accessory calcaneal ossicle lying within the sinus tarsi, with associated marrow oedema. Following surgical excision of the ossicle, the foot returned to its original shape and the symptoms were alleviated. This is the fifth reported case of an accessory calcaneal ossicle, but the only case that has occurred in a flatfooted individual. We also present the first reported MRI images of the lesion confirming pathological marrow oedema as a response to mechanical stress. © ISS 2009.

Page V.J.,Intensive Care Unit | Page V.J.,Imperial College London | Davis D.,University of Cambridge | Davis D.,University of Edinburgh | And 7 more authors.
American Journal of Respiratory and Critical Care Medicine | Year: 2014

Rationale: Delirium is common in intensive care unit (ICU) patients and is a predictor of worse outcomes and neuroinflammation is a possible mechanism. The antiinflammatory actions of statins may reduce delirium. Objectives: To determine whether critically ill patients receiving statin therapy had a reduced risk of delirium than those not on statins. Methods: A prospective cohort analysis of data from consecutive ICU patients admitted to a UK mixed medical and surgical critical care unit between August 2011 and February 2012; the Confusion Assessment Method for ICU was used to determine the days each patient was assessed as being free of delirium during ICU admission. Measurements and Main Results: Delirium-free days, daily administration of statins, and serum C-reactive protein (CRP) were recorded. Four hundred and seventy consecutive critical care patients were followed, of whom 151 patients received statins. Using randomeffects multivariable logistic regression, statin administration the previous evening was associated with the patient being assessed as free of delirium (odds ratio, 2.28; confidence interval, 1.01-5.13; P , 0.05) and with lower CRP (b = 20.52; P , 0.01) the following day. When the association between statin and being assessed as free of delirium was controlled for CRP, the effect size became nonsignificant (odds ratio, 1.56; confidence interval, 0.64-3.79; P = 0.32). Conclusions: Ongoing statin therapy is associated with a lower daily risk of delirium in critically ill patients. An ongoing clinical trial, informed by this study, is investigating if statins are a potential therapy for delirium in the critically ill.Copyright © 2014 by the American Thoracic Society.

Griffin M.,Vascular Noninvasive Screening and Diagnostic Center | Nicolaides A.N.,Vascular Noninvasive Screening and Diagnostic Center | Nicolaides A.N.,Imperial College London | Nicolaides A.N.,University of Cyprus | And 3 more authors.
European Journal of Vascular and Endovascular Surgery | Year: 2010

Objectives: Electrical stimulation of calf muscles has been shown to be effective in prevention of DVT. The aim was to determine: (a) dependence of venous blood velocity and ejected volume on the rates of stimulated calf contractions: (b) clinical factors affecting efficacy in healthy individuals. Methods: The maximum intensity stimulus tolerated was applied to calfs of 24 volunteers. In popliteal veins, Peak Systolic Velocities (PSV), ejected volume per individual stimulus (Stroke Volume SV) and ejected Total Volume Flow per minute (TVF) of expelled blood were determined using ultrasound. Stimulation rates from 2 to 120 Beats Per Minute (bpm) were applied. Results: Mean baseline popliteal PSV was 10 cm/s. For stimulation rates between 2 and 8 bpm, the PSV was 10 times higher and reached 96-105 cm/s. Stroke volume (SV) per individual stimulus decreased in a similar fashion. With increasing rates of stimulation the TVF increased by a factor of 12 times (from 20 ml/min to 240 ml/min). Conclusion: Electrical stimulation is an effective method of activating the calf muscle pump. Enhancements of popliteal blood velocity and volume flow are key factors in the prevention of venous stasis and DVT. Further studies are justified to determine the stimulation rates in those with a compromised venous system.

Background and Purpose-Progression of asymptomatic carotid stenoses with >50% luminal narrowing is associated with an increased risk of stroke. The significance of the progression rate in these patients is unknown. The main aim of this study was to evaluate the rate of change of carotid luminal narrowing over 1 year, as a risk factor for ipsilateral ischemic events, in patients with a >50% asymptomatic carotid stenosis. Secondary aims were to establish the incidence of changes in carotid luminal narrowing and establish additional risk factors for ipsilateral neurological events. Methods- A retrospective analysis was conducted of data derived from the deferred endarterectomy arm of the Asymptomatic Carotid Surgery Trial. Patients were followed up for 5 years with serial carotid duplex examinations. Data were derived from information obtained at randomization and annual follow-up visits with carotid duplex examination. Potential risk factors for ipsilateral neurological events were analyzed in Poisson regression models. Results-Data from 1469 patients were included. Two hundred forty-four had ipsilateral events; 240 had ipsilateral carotid surgery; 370 died from nonstroke causes; and 82 had an asymptomatic carotid occlusion. The annual incidence of progression in the cohort as a whole was 5.2%. Ipsilateral events occurred in 17% of patients. Diabetes and previous contralateral symptoms showed a significant independent association with ipsilateral neurological events. Ipsilateral events were associated with high rates of progression over 1 year but not with low progression rates or regression. Conclusions-Fast rates of progression of carotid luminal narrowing should be interpreted as a sign of significantly increased risk of future ipsilateral neurological events.

Rivers L.,Ealing Hospital | Gaspar H.B.,University College London
Archives of Disease in Childhood | Year: 2015

Severe combined immunodeficiency (SCID) is a rare but important condition. Affected infants are born with profound abnormalities of immune cell function that lead to severe and recurrent infection that are almost always fatal in the first year of life without treatment. Infants with SCID are often initially seen by general paediatricians in the hospital care setting, and the recognition of the cardinal features of the disease and alertness to specific laboratory parameters are important in making an early diagnosis. There is also increasing interest in newborn screening for SCID, which has the potential to significantly improve outcome through early diagnosis and implementation of prophylactic medications. Definitive treatments such as haematopoietic stem cell transplantation and gene therapy have also made major advances over the last decade and again promise to improve the overall outcome for SCID with reduced long-term toxicities. In this review, we highlight some of the major advances in diagnosis and management of the disease, but we also want to emphasise the important role of the general paediatrician in making an early diagnosis and in ongoing management. © 2015, BMJ Publishing Group. All rights reserved.

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