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Stickler D.J.,University of Cardiff | Feneley R.C.L.,North Bristol NHS Trust
Spinal Cord

Objectives: To review the literature showing that understanding how Foley catheters become encrusted and blocked by crystalline bacterial biofilms has led to strategies for the control of this complication in the care of patients undergoing long-term indwelling bladder catheterization. Methods: A comprehensive PubMed search of the literature published between 1980 and December 2009 was made for relevant articles using the Medical Subject Heading terms biofilms, urinary catheterization, catheter-associated urinary tract infection and urolithiasis. Papers on catheter-associated urinary tract infections and bacterial biofilms collected during 40 years of working in the field were also reviewed.Results: There is strong experimental and epidemiological evidence that infection by Proteus mirabilis is the main cause of the crystalline biofilms that encrust and block Foley catheters. The ability of P. mirabilis to generate alkaline urine and to colonize all available types of indwelling catheters allows it to take up stable residence in the catheterized tract in bladder stones and cause recurrent catheter blockage.Conclusion:The elimination of P. mirabilis by antibiotic therapy as soon as it appears in the catheterized urinary tract could improve the quality of life for many patients and reduce the current expenditure of resources when managing the complications of catheter encrustation and blockage. For patients who are already chronic blockers and stone formers, antibiotic treatment is unlikely to be effective owing to the resistance of cells in the crystalline biofilms. Strategies such as increasing fluid intake with citrated drinks could control the problem until bladder stone removal can be organized. © 2010 International Spinal Cord Society All rights reserved. Source

Livingstone C.,North Bristol NHS Trust
Emergency Nurse

In the UK, care for people with major injuries has improved since the introduction of trauma networks and major trauma centres, and since ambulance services began to use specific triage tools to identify major trauma. The advent of consultant-led trauma teams in emergency departments and implementation of the relevant protocols have also raised the standard of trauma care. One such protocol governs the use of tranexamic acid (TXA), which is used to control bleeding. This drug is cheap and widely available, and can save lives if administered within three hours of injury. This article reviews two recent major studies of the effects of TXA on trauma patients © 2013 RCN Publishing Ltd. All rights reserved. Source

Kelly M.D.,North Bristol NHS Trust
ANZ Journal of Surgery

Background: Laparoscopic bile duct exploration (LBDE) is well established although the results via choledochotomy are relatively poorly documented. This report evaluates the results achieved by a single surgeon operating in one institution on an unselected group of patients using modern instrumentation. Methods: Over a 3-year period, 56 consecutive patients underwent LBDE via choledochotomy utilizing flexible choledochoscopy. Results: The median age was 61 years (range 20-90) and the mean body mass index was 29 (21-47). There were 15 patients (27%) who had emergency operations for jaundice with a mean preoperative bilirubin level of 108 umol/L (41-248). Fourteen patients (25%) had undergone failed preoperative endoscopic retrograde cholangiopancreatography. Contact electrohydraulic lithotripsy was used in 8 patients (14%) and t-tubes were inserted in 6 patients (11%) with the remainder having primary closure. There was major morbidity in 6 patients (11%) including conversion to open surgery in 1 and relaparoscopy in 3. Three patients had positive t-tube cholangiograms giving a laparoscopic clearance rate of 93% (52 patients). The median postoperative length of stay was 2.5 days (1-15). The median follow-up was 56.1 weeks (interquartile range 23.4-110.7) with no recurrent stones, strictures or late gallstone abscess. Conclusions: LBDE via choledochotomy is safe and effective but there is a definite morbidity rate. It requires significant investment in equipment, and skill with flexible endoscopy and laparoscopic suturing. © 2010 The Author. ANZ Journal of Surgery © 2010 Royal Australasian College of Surgeons. Source

Hounsome L.S.,Public Health England | Verne J.,Public Health England | McGrath J.S.,Exeter Surgical Health Services Research Unit | Gillatt D.A.,North Bristol NHS Trust
European Urology

Background The Improving Outcomes in Urological Cancers guidelines recommended centralisation of cystectomy services to improve outcomes for bladder cancer (BCa) patients. Objective To investigate trends in all-cause and cause-specific survival to see if there was an improvement in survival after centralisation was implemented. To analyse trends in the number of acute hospital trusts undertaking cystectomy. Design, setting, and participants We used routine data to capture information on radical cystectomy (RC) in BCa patients aged 20 yr and older between 1998 and 2010 (n = 16 033). Outcome measurements and statistical analysis We calculated 30-d and 90-d mortality, and 30-d, 90-d, 1-yr, and 5-yr survival. The average number of RCs per trust was derived. Trends were identified using regression analysis. Results and limitations The 30-d crude mortality decreased from 5.2% to 2.1% (p < 0.001) and 90-d crude mortality decreased from 10.3% to 5.1% (p < 0.001). There was an increase in 30-d relative survival from 96% to 98% (p < 0.001), in 90-d relative survival from 91% to 96% (p < 0.001), in 1-yr relative survival from 71% to 80% (p < 0.001), and in 5-yr relative survival from 49% to 56% (2004-2006 data; p < 0.001). The mean number of RCs performed by trusts in England increased from six to 24 (p < 0.001). Smoking status and stage at diagnosis were not available. Conclusions Survival after RC has increased alongside decreases in short-term mortality. There is little evidence of a cohort effect. The trends in survival are linear and we conclude that the continued survival improvements are a result of a combination of service improvements that include service reconfiguration, improved surgical training, neoadjuvant chemotherapy, enhanced recovery principles, and continued improvements in perioperative care. Patient summary We analysed routinely collected hospital data. Outcomes for patients who undergo cystectomy have improved for all age groups. This is likely to be due to a combination of changes in practice. © 2014 European Association of Urology. Published by Elsevier B.V. All rights reserved. Source

White E.,North Bristol NHS Trust
British Journal of Neurosurgery

Molecular neurosurgery involves the use of vector-mediated gene therapy and gene knockdown to manipulate in vivo gene expression for the treatment of neurological diseases. These techniques have the potential to revolutionise the practice of neurosurgery. However, significant challenges remain to be overcome before these techniques enter routine clinical practice. These challenges have been the subject of intensive research in recent years and include the development of strategies to facilitate effective vector delivery to the brain and the development of both viral and non-viral vectors that are capable of efficient cell transduction without excessive toxicity. This review provides an update on the practice of molecular neurosurgery with particular focus on the practical neurosurgical aspects of vector delivery to the brain. In addition, an introduction to the key vectors employed in clinical trials and a brief overview of previous gene therapy clinical trials is provided. Finally, key areas for future research aimed at increasing the likelihood of the successful translation of gene therapy into clinical trials are highlighted. © 2012 The Neurosurgical Foundation. Source

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