Bucher T.A.,Royal Devon and Exeter Hospital |
Darcy P.,George Eliot Hospital |
Ebert J.R.,University of Western Australia |
Janes G.,Perth Orthopaedic and Sports Medicine Center
HIP International | Year: 2014
We describe an augmented surgical repair technique for gluteus minimus and medius tears, along with a supportive case series. A consecutive series of 22 patients presenting with clinical and radiological findings consistent with hip abductor tears, who had undergone failed prior conservative treatments, were prospectively recruited. Patients underwent open bursectomy, Y-iliotibial release, debridement of the diseased tendon, decortication of the trochanteric foot-plate and reattachment augmented with a LARS ligament through a trans-osseous tunnel, together with suture anchors. All patients were assessed pre- and postoperatively to 12 months with the Oxford Hip Score (OHS), the Short-Form Health Survey (SF-36) and a Visual Analogue Pain Scale (VAS), while a satisfaction scale was employed at 12 months. A statistically significant improvement (p<0.05) was observed for all patient reported outcome measures, while all patients were at least 'satisfied' with the procedure at 12 months. One patient reported some lateral hip discomfort at 10 months, and removal of the LARS interference screw provided immediate relief. One patient had a urological catheter-related complication. With no other complications and no clinical failures of the repair, we believe the technique to be safe and reliable, whilst reducing the incidence of re-tears as reported in the existing literature. © 2013 Wichtig Editore.
Baranidharan G.,Leeds Teaching Hospitals NHS Trust |
Simpson K.H.,Leeds Teaching Hospitals NHS Trust |
Dhandapani K.,George Eliot Hospital
Neuromodulation | Year: 2014
Background Spinal cord stimulation and dorsal column stimulation have been used successfully in the management of visceral pain for many years. A novel technique of ventral column stimulation has been used in our institute with good outcomes since 2007. We describe a retrospective series of 26 patients with visceral neuropathic pain who were treated with neuromodulation. Methods Patients with either dermatomal hyperalgesia or sympathetically mediated neuropathic abdominal pain who had been treated with spinal cord stimulation were assessed. An independent observer conducted a face-to-face interview with each patient to collect data including demography, electrode placement, electrode mapping, and outcomes. Results There was significant reduction in visual analog pain scores from a median 9 at baseline to 4 at 26 months (p ≤ 0.05). Reduction in opioid consumption was very significant from a baseline median oral morphine equivalent of 160 mg to 26 mg (p < 0.001). In addition, quality of life, activities of daily living, and patient global impression of change improved. Conclusion There is a need to further investigate the use of ventral stimulation for visceral pain syndromes. This would need multicenter trials to collect adequate numbers of patients to allow hypothesis testing to underpin recommendations for future evidence-based therapies. © 2014 International Neuromodulation Society.
Berth-Jones J.,Walsgrave Hospital |
Berth-Jones J.,George Eliot Hospital
Medicine (United Kingdom) | Year: 2013
Psoriasis affects approximately 1.5% of the population of the UK and is seen mainly in adults, with onset most frequently at around the age of 20. Psoriasis is regarded as an autoimmune disease in which genetic and environmental factors play a significant role. The most commonly affected sites are the scalp, elbows, knees, umbilicus, genitalia, sacrum and shins. Plaques may range in size from a few millimetres to a large part of the trunk or limb. The Köbner phenomenon, in which psoriatic lesions tend to develop at sites of trauma, is sometimes a helpful diagnostic feature. Disease activity fluctuates spontaneously over a variable timescale of months or years. The psychological impact and co-morbidity of psoriasis are often underestimated and can greatly impact on quality of life. First-line treatments are topical: emollients, dithranol, tar, deltanoids (vitamin D analogues), retinoids and corticoids (corticosteroids). Second-line treatments have more adverse effects and include phototherapy and systemic drugs: methotrexate, ciclosporin, acitretin, hydroxycarbamide (hydroxyurea) and fumarates. Biological therapies are costly and demonstrate immunosuppressant activity, and are currently reserved for patients unable to benefit from first- and second-line modalities. Severe forms of psoriasis such as erythrodermic and generalized pustular psoriasis can be life-threatening and may require urgent treatment in hospital. © 2013 Elsevier Ltd. All rights reserved.
Hunter J.P.,University of Leicester |
Saratzis A.,George Eliot Hospital |
Froggatt P.,Coventry University |
Harmston C.,Coventry University
Colorectal Disease | Year: 2012
Aim Guaiac-based faecal occult blood tests (gFOBTs) are used in the colorectal cancer screening programme. Recent data suggested that the immunological faecal occult blood test illustrated a variation in positivity according to season and ambient temperature. Our aim was to assess the effect of season and ambient temperature on the positivity rates of the gFOBT during pilot screening for colorectal cancer. Method Data from the first year of round 1 of the pilot screening programme in Coventry and Warwickshire were analysed. Patients with positive and negative gFOBT samples were included. Patients with spoilt samples or incomplete data were excluded. Of the total of 59513 patients, 30311 were men and 29202 women. Mean age was 56 years. Daily temperature data were provided by the meteorological office. Results Median exposure of the gFOBT test card was 6 days (range 1-17). Median daily maximum temperature was 14°C. Spring and summer illustrated significantly decreased positivity rates compared with autumn and winter (Pearson's chi-squared test, P<0.001). Mean daily maximum temperature for the test card exposure showed no significant difference in positivity rates (P=0.53). Subgroup analysis revealed a significant reduction in positive samples in the >25°C subgroup (P=0.045). Conclusions There is a seasonal variation in positivity rates of gFOBTs with increased positivity in spring and summer months. There is no difference in positivity rates in relation to ambient temperature except in subgroup analysis where there is a significant reduction in positivity rates above 25°C. © 2011 The Authors. Colorectal Disease © 2012 The Association of Coloproctology of Great Britain and Ireland.
Alsafadi H.,George Eliot Hospital |
Goodwin W.,Coventry University |
Syed A.,Coventry University
Clinical Medicine, Journal of the Royal College of Physicians of London | Year: 2011
Keeping well during Hajj is a challenge for people with diabetes. However, with proactive planning and education, it may prove to be an excellent opportunity for reviewing management and enhancing diabetes education to reduce diabetes-related short- and long-term problems. People with diabetes should have enough time to consider a management plan. It is important that healthcare professionals are well informed regarding the effects of Hajj on diabetes and are able to offer advice, guidance and change of medications as required during pre-Hajj counselling to enable patients to stay healthy. © Royal College of Physicians, 2011. All rights reserved.
Billingham M.J.,George Eliot Hospital |
Basterfield S.J.,Coventry University
European Journal of Pediatric Surgery | Year: 2010
Introduction: The laparoscopic treatment of pediatric populations remains controversial. This review was conducted to compare the clinical and cost effectiveness of laparoscopic and open surgical approaches for a variety of surgical indications in pediatric populations. Method/Design: A computerized comprehensive search supplemented by a manual review of the literature was performed for all peer-reviewed publications comparing laparoscopic and open appendectomy, fundoplication and hernia repair cohorts. Outcomes of interest were length of stay (LOS), operating room (OR) time, complication rates and total hospital costs; aggregation of outcome rates was performed with the Mantel-Haenszel method. Results: A total of 24 articles were identified that met the search and inclusion criteria. LOS was found to be significantly reduced in favor of the laparoscopic approach, with a weighted mean difference of 1.44 days, although the OR time was significantly increased, with a weighted mean difference of +12.8min. Laparoscopic intervention was associated with a significantly reduced complication rate compared to the open approach (10.6 vs. 15.6%). Total hospital costs of the laparoscopic approaches were found to be insignificantly increased compared to the open techniques. Conclusion: This review further supports the use of minimally invasive surgery (MIS) in pediatric populations, demonstrating that the three types laparoscopic procedures reviewed resulted in better patient outcomes compared to open procedures, in the form of reduced LOS and overall complication rates. Increased utilization of this approach may prove beneficial to pediatric patients. © Georg Thieme Verlag KG Stuttgart - New York.
Wilkinson A.,George Eliot Hospital
BMJ Case Reports | Year: 2011
A 57-year-old man presenting with profound visual hallucinations was found to have severe hypomagnesaemia and hypocalcaemia with a normal level of parathyroid hormone (PTH). Magnesium is essential to the release of PTH so the suspected pathophysiology was thought to be: low Mg → inappropriately low PTH → low Ca. He commenced supplementation and his symptoms resolved. Causes of hypomagnesaemia are discussed.
Aminu S.,George Eliot Hospital
African Journal of Urology | Year: 2015
Bladder pain is a cause of chronic pelvic pain, which constitutes a common presentation in urology out-patient consultation, especially among females. Some endoscopic features of the trigone observed during cystoscopy was correlated with mild to moderately bothersome bladder pain, termed trigonalgia. This is due to peculiarity of the trigonal anatomy from the rest of bladder, especially with the highest concentration of afferent nerves. Research focused on the trigone is worthwhile. © 2015 Pan African Urological Surgeons' Association.
Al-Azzawi F.,University of Leicester |
Wahab M.,George Eliot Hospital
Annals of the New York Academy of Sciences | Year: 2010
The increased interest in phytoestrogens in the management of menopausal symptoms followed the publication of the Women's Health Initiative study. A wide-spread perception that these plant-derived compounds are equivalent to estrogen was established. These compounds evolved to fulfill the needs of plant physiological processes and are natural for the plant cells but not natural to the human cell. Epidemiological data suggest a possible protective effect of phytoestrogen if consumed during adolescence, but later on in life this effect is not clear. The utility of phytoestrogen as a "natural and safe" alternative to estrogen in alleviating vasomotor symptoms has failed the test in randomized clinical trials. Because many breast cancer sufferers seek in phytoestrogen a relief of estrogen deficiency symptoms, the possible interaction of such remedies with risk of recurrence of breast cancer or interference with tamoxifen action should not be overlooked. © 2010 New York Academy of Sciences.
Bhangu A.,George Eliot Hospital |
Hartshorne G.,George Eliot Hospital
Clinical Teacher | Year: 2011
Background: The introduction of the European Working Time Directive has resulted in the on-call general surgery junior doctor regularly missing consultant-led post-take ward rounds (PTWRs). This study aimed to determine the frequency with which the admission diagnosis was changed on the PTWR, and thus whether an educational opportunity for trainees is missed. Methods: Prospective observational study of consecutive admissions to a general surgery department over a 4-week period was conducted. Patients with exacerbations of known conditions were excluded. Results: Fifty-two included patients were admitted by seven general surgery juniors, and 27percent (14/52) of diagnoses were changed on the PTWR. There were two 'major' diagnostic changes: peritonitis and ischaemic bowel. Patients whose diagnoses were changed by the consultant were no more likely to be older (p=0.575) or have differing white cell counts (p=0.471), C-reactive proteins (CRPs; p=0.643) or amylase levels (p=0.666) than those whose initial diagnosis was agreed with. Thirty-five per cent of patients (18/52) had further investigations ordered at the PTWR. These included nine ultrasound scans, four computed tomography scans, three abdominal or chest X-rays, two flexible sigmoidoscopies and one barium enema. In one case, a serum amylase was ordered. Conclusions: The rate of incorrect diagnoses by on-call surgical juniors is high, and educational feedback to these doctors is important. The PTWR represents a strong educational opportunity that is missed if admitting junior doctors are not present. These results should be taken into account for any specialty that uses junior doctors to admit patients who are then reviewed by a consultant on a PTWR. © Blackwell Publishing Ltd 2011.