Macclesfield, United Kingdom
Macclesfield, United Kingdom

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Tonus C.,Asklepios Hospital North | Sellinger M.,Medical Practice for Gastroenterology Lusanum | Koss K.,Macclesfield District General Hospital | Neupert G.,Asklepios Hospital North
World Journal of Gastroenterology | Year: 2012

AIM: To present a critical discussion of the efficacy of the faecal pyruvate kinase isoenzyme type M2 (faecal M2-PK) test for colorectal cancer (CRC) screening based on the currently available studies. METHODS: A literature search in PubMed and Embase was conducted using the following search terms: fecal Tumor M2-PK, faecal Tumour M2-PK, fecal M2-PK, faecal M2-PK, fecal pyruvate kinase, faecal pyruvate kinase, pyruvate kinase stool and M2-PK stool. RESULTS: Stool samples from 704 patients with CRC and from 11 412 healthy subjects have been investigated for faecal M2-PK concentrations in seventeen independent studies. The mean faecal M2-PK sensitivity was 80.3%; the specificity was 95.2%. Four studies compared faecal M2-PK head-to-head with guaiac-based faecal occult blood test (gFOBT). Faecal M2-PK demonstrated a sensitivity of 81.1%, whereas the gFOBT detected only 36.9% of the CRCs. Eight independent studies investigated the sensitivity of faecal M2-PK for adenoma (n = 554), with the following sensitivities: adenoma < 1 cm in diameter: 25%; adenoma > 1 cm: 44%; adenoma of unspecified diameter: 51%. In a direct comparison with gFOBT of adenoma > 1 cm in diameter, 47% tested positive with the faecal M2-PK test, whereas the gFOBT detected only 27%. CONCLUSION: We recommend faecal M2-PK as a routine test for CRC screening. Faecal M2-PK closes a gap in clinical practice because it detects bleeding and non-bleeding tumors and adenoma with high sensitivity and specificity. © 2012 Baishideng.


Metcalfe C.,Macclesfield District General Hospital
Journal of Diabetes Nursing | Year: 2016

Some evidence exists that suggests that residential camps and events for children and young people with diabetes are an excellent way of bringing together young people and healthcare professionals in an informal and fun environment. Although there is a lack of evidence for the impact of these events on outcomes, such as glycaemic control and adherence to medications, anecdotal evidence from healthcare professionals and the young people who attend the events suggests that the young people benefit greatly from being around other young people with diabetes. They grow in confidence and are able to talk to healthcare professionals in informal surroundings. Healthcare professionals also report that involvement in these events changes their clinical practice for the better as they are able to interact with young people in some real-life situations, rather than in a clinic setting. This article describes the care events run by Diabetes UK and discusses the benefits for all involved.


Morapudi S.P.,Macclesfield District General Hospital
Journal of orthopaedic surgery (Hong Kong) | Year: 2012

To report outcomes of 21 total wrist arthroplasties (TWA) using the Universal 2 prosthesis. Five men and 14 women aged 44 to 82 (mean, 62) years underwent 21 total wrist arthroplasties for rheumatoid arthritis (n=19) and post-traumatic arthritis (n=2) by a single surgeon using the Universal 2 prosthesis. Pre- and post-operative pain and function were assessed by a single surgeon using the Disabilities of the Arm, Shoulder and Hand (DASH) score and the patient-rated wrist evaluation (PRWE) score. Range of motion, stability, dislocation rate, and neurovascular status were also assessed. Radiographs were evaluated for implant alignment and fit, screw positioning, and implant loosening. The mean time to assessment of the range of motion was 3.1 (range, 1.8-3.9) years, and the mean time to assessment of the PRWE score was 4.8 (range, 2.1-7.3) years. The range of motion in each direction and the mean DASH and PRWE scores improved significantly following TWA. Two patients had restricted range of motion, which was treated by manipulation under anaesthetic (after 6 months in one and 8 weeks in the other). One patient underwent excision of a palmar bony bridge. One patient endured extensor pollicis longus rupture and underwent tendon transfer after 5 months. Radiographs revealed no evidence of implant loosening, migration, or malalignment. There was no sign of osteonecrosis in the remaining carpals or metacarpals. The Universal 2 TWA achieved significant improvement in range of motion and functional outcome of the wrist, with reduced rates of early joint instability, dislocation, and implant loosening, compared to previous implants. The small implant size and cementless design reduce bone loss and osteonecrosis.


Haider S.,Macclesfield District General Hospital | Wright D.,Macclesfield District General Hospital
BMJ Case Reports | Year: 2013

Panton-Valentine leukocidin (PVL) toxin producing strains of Staphylococcus aureus are known to cause skin and soft tissue infection. They can also cause necrotising pneumonia in otherwise healthy individuals. Here we report a case of severe, necrotising, haemorrhagic pneumonia in a 12-year-old boy who presented with a four-day history of a sore throat and fever. During his admission he deteriorated and needed full ventilatory support but despite all efforts he died. Postmortem examination lung swabs confirmed the presence of PVL-associated S aureus. There is a need to improve awareness of this disease among medical practitioners as early diagnosis and appropriate management can save lives. Copyright 2013 BMJ Publishing Group. All rights reserved.


Loughran C.,Macclesfield District General Hospital | Keeling C.R.,Macclesfield District General Hospital
British Journal of Radiology | Year: 2011

Needle biopsy of the breast is widely practised. Image guidance ensures a high degree of accuracy. However, sporadic cases of disease recurrence suggest that in some cases the procedure itself may contribute to this complication. This article reviews evidence relating to needle biopsy of the breast and the potential for tumour cell migration into adjacent tissues following the procedure. A literature search was undertaken using Medline, Embase and the Cochrane Library. Results are grouped under three categories: histological evidence of spread, clinical evidence of recurrent disease and the likelihood of seeding dependent upon tumour type. There is histological evidence of seeding of tumour cells from the primary neoplastic site into adjacent breast tissue following biopsy. However, as the interval between biopsy and surgery lengthens then the incidence of seeding declines, which suggests that displaced tumour cells are not viable. Clinical recurrence at the site of a needle biopsy is uncommon and the relationship between biopsy and later recurrence is difficult to confirm. There is some evidence to suggest that cell seeding may be reduced when vacuum biopsy devices are deployed. © 2011 The British Institute of Radiology.


Hunter J.D.,Macclesfield District General Hospital | Doddi M.,Macclesfield District General Hospital
British Journal of Anaesthesia | Year: 2010

Septic shock, the most severe complication of sepsis, accounts for ∼10 of all admissions to intensive care. Our understanding of its complex pathophysiology remains incomplete but clearly involves stimulation of the immune system with subsequent inflammation and microvascular dysfunction. Cardiovascular dysfunction is pronounced and characterized by elements of hypovolaemic, cytotoxic, and distributive shock. In addition, significant myocardial depression is commonly observed. This septic cardiomyopathy is characterized by biventricular impairment of intrinsic myocardial contractility, with a subsequent reduction in left ventricular (LV) ejection fraction and LV stroke work index. This review details the myocardial dysfunction observed in adult septic shock, and discusses the underlying pathophysiology. The utility of using the regulatory protein troponin for the detection of myocardial dysfunction is also considered. Finally, options for the management of sepsis-induced LV hypokinesia are discussed, including the use of levosimendan.


Banks D.S.,Macclesfield District General Hospital
Journal of the Intensive Care Society | Year: 2011

Acute kidney injury in the intensive care unit (ICU) requiring renal replacement therapy (RRT) is common and mortality is high. The dose delivered is important and is usually inadequate. Evidence for dose is quoted as clearance, but RRT is usually prescribed as pump flow rates. Accurately delivering an evidence-based dose to a patient is difficult because of inefficiencies of RRT, the complexity of its mathematics and poor understanding. Inadequate dose can result from inadequate prescribing, which should be by ideal body weight and possibly by indication. Inadequate delivery of a prescription can occur because the delivered dose depends not only on the dialysate and ultrafiltrate pump flow rates, but also blood flow rate, predilution inefficiency, fluid removal rate and downtime. To investigate the feasibility of using a web-based calculator to make prescribing by clearance easy and to predict and compensate for these factors, a web page with a RRT calculator using JavaScript was used. Data were collected from 19 treatments before the introduction of the calculator and 20 after. Results showed that dose delivery was significantly improved (p<0.001). There was an improvement in prescribing an evidence-based dose which did not reach statistical significance (p=0.056) but the standard deviation was significantly smaller, indicating more rational prescribing. The calculator significantly improved prescribing and delivery of RRT in our ICU. © The Intensive Care Society 2011.


Akram Q.,Macclesfield District General Hospital | Knight S.,Macclesfield District General Hospital | Saravanan R.,Macclesfield District General Hospital
Clinical Rheumatology | Year: 2015

Giant cell arteritis (GCA) is a medium to large vessel vasculitis of unknown aetiology. Commonly, it affects the temporal arteries and is known as temporal arteritis. It has an association with polymyalgia rheumatica and can result in severe complications such as loss of vision and rarely scalp necrosis. There are approximately 100 cases of scalp necrosis in patients with GCA published in the literature to date. We report a case of a man who presented with a 4-week history of bilateral scalp necrosis associated with headache, jaw claudication, temporal artery tenderness, and raised inflammatory markers. He did not have any visual loss. A diagnosis of GCA was made and he was started on high-dose steroids immediately. The scalp lesions did improve and his symptoms resolved without any visual loss but, sadly he died due to severe sepsis. This case report is important as it describes a rare but severe complication of a common large vessel vasculitis seen by both primary care physicians and rheumatologists. Prompt recognition and early treatment by the physician are crucial to the patient to prevent visual loss or a fatal stroke. It also highlights complications associated with steroids which are the mainstay of treatment for this condition. © 2014, International League of Associations for Rheumatology (ILAR).


Yates J.,Macclesfield District General Hospital | Choudhry M.,Macclesfield District General Hospital | Keys G.,Macclesfield District General Hospital
Journal of Clinical Pharmacy and Therapeutics | Year: 2013

Summary What is known and Objective: Rivaroxaban is an oral anticoagulant, currently licensed for use as a venous thromboembolism (VTE) prophylaxis, and recommended by the National Institute for Clinical Excellence (NICE) for all patients undergoing elective hip and knee replacement surgery in the UK. We present the first case of a suspected hypersensitivity to rivaroxaban. Case summary: A 57-year-old man with no previous allergies underwent an uncomplicated, elective partial knee replacement, after which he was prescribed a routine 2-week course of rivaroxaban 10 mg. He developed an allergic response requiring readmission for assessment and treatment 7 days post-operatively. What is new and Conclusion: We believe this to be the first published case of hypersensitivity associated with rivaroxaban. More research is needed to determine this association. At the same time, given the growing range and increasing use of anticoagulants, particular vigilance is required regarding potential side effects so that these may be managed quickly and effectively in the early stages. © 2012 Blackwell Publishing Ltd.


Singh J.,Macclesfield District General Hospital
Journal of orthopaedic surgery (Hong Kong) | Year: 2010

To assess the effects of tranexamic acid (TA) in patients undergoing total hip arthroplasty (THA) for osteoarthritis. 42 patients underwent primary THA for osteoarthritis by a single surgeon. 10 men and 11 women who did not receive TA were controls, whereas 9 men and 12 women who received TA constituted the treatment group. Both groups were matched for age, gender, body mass index, and American Society of Anesthesiologists grading. The type of prosthesis used (cemented or uncemented) was based on the surgeon's preference and patient age, activity level and demands. No hybrid prosthesis was used. 10 minutes prior to incision, a single dose of intravenous TA (10 mg per kg body weight) was given to patients in the treatment group. Comparison was made between both groups with regard to intra-operative blood loss, postoperative reduction in haemoglobin and haematocrit levels, blood transfusion, incidence of deep vein thrombosis, and the length of hospital stay. The mean intra-operative blood loss (489 [SD, 281] vs. 339 [SD, 184] ml, p = 0.048) and the decrease in haemoglobin level (38 [SD, 12] vs. 29 [SD, 10] g/l, p=0.014) were significantly higher in the control than the treatment group. Two patients among the controls received a transfusion, compared to none in the TA group (p = 0.49, Fisher's exact test). The 2 patients who needed blood transfusion had blood losses of 600 and 690 ml, compared to a mean of 489 ml in the whole group. No patient in either group developed deep vein thrombosis or pulmonary embolism up to 3 months. A single dose of intravenous TA (10 mg per kg body weight) given 10 minutes prior to THA is a cost-effective and safe means of minimising blood loss and reduction in haemoglobin concentrations as well as the need for allogenic blood transfusion, without increasing the risk of thromboembolic events.

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