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Preston, United Kingdom

Chinnusamy R.,Lancashire Teaching Hospital
Techniques in Orthopaedics | Year: 2014

Posterior approach is widely used in hip replacement. Traditionally, a simple retractor such as a Hohmann has been used to retract the proximal femur anterior to the acetabulum. We describe a simple technique for a cost-effective retraction to improve the mechanical advantage of Hohmann and aid cup placement. After anterior retraction of femur with standard Hohmann, a second Hohmann is stacked and reinforced by wrapping a swab and securing with a Kocher. This technique helps in better exposure, aid in cup placement, and also lessens effort on retraction. This technique provides a cheaper alternative compared with specialist long retractors and is readily available within every institution. © 2014 by Lippincott Williams & Wilkins Source

Jackson E.,Blackpool Victoria Hospital | Stewart M.,Lancashire Teaching Hospital
BMJ Case Reports | Year: 2013

A patient presented with symptoms consistent with non-ST elevation myocardial infarction (NSTEMI) and was given appropriate antiplatelet and anticoagulant therapy. Despite treatment of the NSTEMI and fluid resuscitation the patient remained persistently hypotensive. Further imaging demonstrated an extensive Stanford type A dissection extending from the aortic root to the left common iliac artery. The patient was taken to theatre and had an emergency hemiarch replacement with repair of the aortic root. Post surgery the patient had an uneventful recovery. We present this case to highlight the importance of considering dissection as a differential in patients presenting with chest pain and the lack of symptoms a patient with such a severe dissection can display. Copyright 2013 BMJ Publishing Group. All rights reserved. Source

Aslam A.,Lancashire Teaching Hospital | Aslam A.,Clinical Research Fellow | Rajbhandari S.M.,University of Central Lancashire
Practical Diabetes | Year: 2013

Advances in medical treatment have resulted in prolonged survival of people with diabetes, with multiple complications. Vascular dementia is one of these and is increasingly seen due to a reduction in mortality from cardiovascular causes. People suffering from dementia are often not capable of weighing up the advantages and disadvantages of proposed treatment in order to give an informed decision. In most cases, this incapacity does not cause problems as patients and their carers agree with the recommendation made by their health care professionals. However, we encountered a challenging case where we had to apply for deprivation of liberty safeguards (DoLS) to treat in the patient's best interests. We report the case of a patient with vascular dementia who had repeated admissions with life-threatening diabetic ketoacidosis (DKA) as she refused to comply with the insulin treatment because of her lack of insight regarding her diabetes care. In order to prevent harm to her, an application was successfully made for DoLS. This allowed treatment with once-daily, long-acting analogue insulin under supervision even against her wishes. This prevented further admission to hospital with DKA. DoLS was introduced in the UK in April 2009 to safeguard some of the most vulnerable people in our society for their own safety. People with type 1 diabetes are increasingly surviving longer and may suffer from dementia. The majority will manage with some help from family or health care worker, but in a small proportion DoLS may be needed, as in our case, to prevent recurrent life-threatening complications. © 2013 JOHN WILEY and SONS. Source

Hatab H.,Lancashire Teaching Hospital
BMJ case reports | Year: 2010

We describe an unusual case of a 54-year-old woman who was diagnosed with a subacute Budd-Chiari syndrome due to membranous venous obstruction in the inferior vena cava. The unusual feature of this case was that she had been diagnosed with pulmonary emboli a few years earlier and was on lifelong warfarin with a therapeutic international normalised ratio. She was effectively treated by venoplasty. Source

Ahmmed A.U.,Lancashire Teaching Hospital | Ahmmed A.A.,Newcastle University | Bath J.R.,Lancashire Teaching Hospital | Ferguson M.A.,NIHR National Biomedical Research | And 2 more authors.
Ear and Hearing | Year: 2014

OBJECTIVES:: To identify the factors that may underlie the deficits in children with listening difficulties, despite normal pure-tone audiograms. These children may have auditory processing disorder (APD), but there is no universally agreed consensus as to what constitutes APD. The authors therefore refer to these children as children with suspected APD (susAPD) and aim to clarify the role of attention, cognition, memory, sensorimotor processing speed, speech, and nonspeech auditory processing in susAPD. It was expected that a factor analysis would show how nonauditory and supramodal factors relate to auditory behavioral measures in such children with susAPD. This would facilitate greater understanding of the nature of listening difficulties, thus further helping with characterizing APD and designing multimodal test batteries to diagnose APD. DESIGN:: Factor analysis of outcomes from 110 children (68 male, 42 female; aged 6 to 11 years) with susAPD on a widely used clinical test battery (SCAN-C) and a research test battery (MRC Institute of Hearing Research Multi-center Auditory Processing "IMAP"), that have age-based normative data. The IMAP included backward masking, simultaneous masking, frequency discrimination, nonverbal intelligence, working memory, reading, alerting attention and motor reaction times to auditory and visual stimuli. SCAN-C included monaural low-redundancy speech (auditory closure and speech in noise) and dichotic listening tests (competing words and competing sentences) that assess divided auditory attention and hence executive attention. RESULTS:: Three factors were extracted: "general auditory processing," "working memory and executive attention," and "processing speed and alerting attention." Frequency discrimination, backward masking, simultaneous masking, and monaural low-redundancy speech tests represented the "general auditory processing" factor. Dichotic listening and the IMAP cognitive tests (apart from nonverbal intelligence) were represented in the "working memory and executive attention" factor. Motor response times to cued and noncued auditory and visual stimuli were grouped in the "processing speed and alerting attention" factor. Individuals varied in their outcomes in different tests. Poor performance was noted in different combinations of tests from the three factors. Impairments solely related to the "general auditory processing" factor were not common. CONCLUSIONS:: The study identifies a general auditory processing factor in addition to two other cognitive factors, "working memory and executive attention" and "processing speed and alerting attention," to underlie the deficits in children with susAPD. Impaired attention, memory, and processing speed are known to be associated with poor literacy and numeracy skills as well as a number of neurodevelopmental disorders. Individuals with impairments in the "general auditory processing" tests along with tests from the other two cognitive factors may explain the co-occurrence of APD and other disorders. The variation in performance by individuals in the different tests noted was probably due to a number of reasons including heterogeneity in susAPD and less-than ideal test-retest reliabilities of the tests used to assess APD. Further research is indicated to explore additional factors, and consensus is needed to improve the reliability of tests or find alternative approaches to diagnose APD, based on the underlying factors. © 2014 by Lippincott Williams & Wilkins. Source

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