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Ninewells, United Kingdom

Irving J.,Ninewells Hospital
Current Cardiology Reviews | Year: 2014

Chronic total occlusion (CTO) pathophysiology has been described in a few, small studies using post mortem histology, and more recently, in vivo intravascular ultrasound (IVUS) to analyse the constituents of occluded segments. Recent improvements in equipment and techniques have revealed new insights into physical characteristics of occluded coronaries, which in turn enable predictable procedural success. The purpose of this review is to consider the published evidence describing CTO pathophysiology from the perspective of the hybrid algorithm approach to CTO PCI. Methods: Literature searches using “Chronic Occlusion”, “angioplasty”, and” pathology” as keywords. Further searches on “coronary” “collateral”, “Viability”. Bibliographies were scrutinised for further key publications in an iterative process. Papers describing animal models were excluded. © 2014 Bentham Science Publishers. Source

This review is aimed at summarizing the current state of knowledge regarding parasomnias, which have been implicated in medicolegal cases as well as providing guidance to those working within common-law jurisdictions regarding the technical aspects of the law. Sleepwalking and sexsomnia as a defence are being raised more frequently in criminal cases and there has been public debate on their validity. Unfortunately, expert evidence on forensic sleep disorders continues to be heavily opinion-based with the potential for miscarriages of justice seen in recent highly publicized cases. There is an apparent inertia in research into violent sleep disorders. We review the current state of forensic sleep science in the United Kingdom (UK) and abroad and discuss the need to formulate guidelines based on available evidence. We also highlight the pressing necessity for more research in this area as well as the need to reform the law, which is the subject of a recent Criminal Law Commission report in the United Kingdom. In time, this will facilitate the efficient, proportionate, and just disposal of violence arising from sleep, thus benefitting both society and the individual sufferer. Copyright © 2013 Elsevier Ltd. All rights reserved. Source

Quaba O.,Ninewells Hospital | Quaba A.,Spire Murrayfield Hospital
Journal of Plastic, Reconstructive and Aesthetic Surgery | Year: 2013

Introduction To determine the true rupture rates of PIP implants from a large single surgeon cohort and to assess whether rupture rates varied depending on time of implant insertion. In addition, the efficacy of ultra sound scanning (USS) in determining rupture is examined. Design Predominantly prospectively based analysis of patient records, investigations and surgical findings. Participants 338 patients (676 implants) were included in the study and they all had removal of their implants. The senior author operated on all patients at some stage of their treatment. 160 patients were imaged pre-operatively with USS. Patients had implants inserted between 1999 and 2007 for cosmetic breast augmentation. Results A total of 144 ruptured implants were removed from 119 patients, giving a rupture rate of 35.2% per patient and 21.3% per implant over a mean implantation period of 7.8 years. A statistical difference (P < 0.001) in rupture rates between implants inserted prior to 2003 and those inserted from 2003 was demonstrated, with higher failure rates in the latter group. There was a significant difference in rupture rates depending on pocket placement of the implants. The sensitivity and specificity of USS at detecting rupture was 90.6% and 98.3% respectively. A proportion of patients (29.4%) demonstrated loco-regional spread of silicone to the axilla on scanning. Conclusions Our paper has confirmed high rates of PIP implant failure in the largest published series to date. The significant difference in rupture rates between implants inserted prior to 2003 and those after this time supports the view that industrial silicone was used in the devices after 2003. Implants are more likely to rupture if inserted in the sub muscular plane compared to the sub glandular plane. USS is highly effective at detecting rupture in PIP implants and loco-regional spread is high compared to other devices. We believe this paper provides hard data enabling more informed decision making for patients, clinicians and providers in what remains an active issue affecting thousands of women. © 2013 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved. Source

Gifford A.M.,Ninewells Hospital | Chalmers J.D.,University of Dundee
Current Opinion in Hematology | Year: 2014

PURPOSE OF REVIEW: Neutrophils are known to dominate the pulmonary inflammatory process observed in cystic fibrosis (CF). An enduring paradox is how these large numbers of neutrophils fail to eradicate colonizing bacteria. Major advances in our understanding of neutrophil dysfunction in CF and its effect on the innate immune system are leading to advances in our understanding of the pathophysiology and leading directly to new therapies. RECENT FINDINGS: New mechanisms of neutrophil dysfunction have been described in CF including disabled cystic fibrosis transmembrane conductance regulator recruitment to phagosomes and novel mechanisms of protease-induced neutrophil dysfunction. Neutrophil elastase has been shown to be present in the airway very early in life in CF patients, and appears a biomarker of disease progression, predicting lung function decline and bronchiectasis. Elastase has also been shown to induce a pro-inflammatory state of senescence in bronchial epithelial cells in vitro and potentially in vivo. Inhibitors of neutrophil elastase are now entering clinical trials with promising results. New avenues of CF therapeutics are being explored including novel macrolides, CXCR2 antagonists and exogenous opsonins. SUMMARY: This article reviews the past 12 months of research that contributes to our understanding of the role of neutrophils and immune dysfunction in CF. © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins. Source

Lowrie A.G.,Ninewells Hospital | Lees V.C.,Wythenshawe Hospital
Journal of Hand Surgery: European Volume | Year: 2014

The use of the digital flexor sheath to reconstruct damaged structures in the fingers is an intriguing but under-investigated subject. The sheath is anchored firmly to the phalanges and palmar plates and has well-vascularized outer and synovial inner layers. The middle layer is strong and fibrous and not all of it is required for its main biomechanical function of maintaining the moment arm of the flexor tendons. These characteristics have led to several descriptions of different reconstructive uses. In sheath reconstruction, flaps can be used to repair damaged A2 and A4 pulleys. As an anchor, the sheath is useful for tenodeses and tendon transfers. It has been used in the correction of ulnar claw and swan neck deformities. In ligament reconstruction, the A1 pulley has been used to reconstruct the transverse intermetacarpal ligament in cleft hand and ray amputations. The sheath has also been used to cover tendon repairs and periosteal defects with the aim of decreasing adhesions. There is potential for further use of the flexor sheath in reconstructive surgery.The digital flexor sheath can be used to restore various finger functions providing its physiological roles are recognized and preserved. This review considers the different techniques described and their potential uses. © The Author(s) 2013. Source

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