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Couch D.G.,Derriford Hospital PHNT | Couch D.G.,Northampton General Hospital NHS Trust | Bullen N.,Derriford Hospital PHNT | Ward-Booth S.E.,Torbay Hospital SDHNFT | Adams C.,Derriford Hospital PHNT
Colorectal Disease | Year: 2013

Aim Colonoscopic follow-up after colorectal cancer resection (CRC) is recommended to screen for anastomotic recurrence and metachronous neoplasia, although guidelines vary in the timings of the first investigation. We aimed to quantify current practice and yield of neoplasia at first colonoscopy in relation to time from original resection. Method We conducted a retrospective case note study of all CRCs treated with curative intent within our hospital between two time periods: 2001-2003 and 2006-2007. Variables collected were the extent of preoperative luminal imaging, tumour site, procedure, timing and findings of initial colonoscopy, postoperative CT findings and mortality. The first follow-up colonoscopy findings including neoplasia formation and recurrence rates were matched with rates of complete preoperative luminal imaging. Two-year and 5-year outcomes were sought. Results A total of 863 patients underwent CRC with curative intent within these two time periods (518 vs 345). Colonoscopic follow-up rates by 2years were 32.8%vs 54.1%. Within the first cohort 63.5% of patients underwent colonoscopy by 5years. Significant volumes of neoplasia and resectable recurrences were found before 2years within these groups. Earlier detection of recurrent malignancy was associated with an improved patient outcome. Complete preoperative screening of the bowel was not associated with a lower incidence of neoplasia at first postoperative colonoscopy. Conclusion Our study demonstrates significant colonoscopic detection rates of neoplasia within 2years of CRC. Patient outcomes were improved with earlier detection. We would therefore suggest an interval of no more than 2years between resection and first surveillance colonoscopy. © 2012 The Association of Coloproctology of Great Britain and Ireland.


Joseph J.,Northampton General Hospital NHS Trust | Lim K.,Leeds Teaching Hospitals NHS Trust | Ramsden J.,University of Oxford
Annals of the Royal College of Surgeons of England | Year: 2012

Introduction: Investigation of the anterior midline neck lump has been debated over the years with little agreement on best practice. Thyroglossal duct cysts (TDCs) are the most common aetiology. A TDC may contain ectopic thyroid tissue, which may affect the decision to excise. Methods: A computerised survey was sent to a representative sample of UK-based ENT surgeons to determine current practice in investigation of presumed TDCs and the incidence of ectopic thyroid tissue. Results: Overall, 95% of those surveyed use ultrasonography, with 32% also arranging thyroid function tests. Fifteen per cent had encountered absent normal thyroid tissue in the presence of a midline neck swelling. In 64% of cases this represented the only functioning thyroid tissue. Thyroid function tests were normal in all but two cases. Conclusions: The results show a significant change in practice over the last decade. All surgeons would arrange some form of investigation of a presumed TDC, with the vast majority using ultrasonography. Radioisotope scanning should only be used if the ultrasonography or thyroid function tests are abnormal. The incidence of ectopic thyroid tissue in this survey was higher than previously calculated, with a 0.17% prevalence of midline neck lumps representing the only functioning thyroid tissue.


McGowan S.E.,University of Cambridge | Greaves C.D.,University of Leicester | Evans S.,Northampton General Hospital NHS Trust
Nuclear Medicine Communications | Year: 2012

BACKGROUND: In SPECT images truncation artefacts may occur when the object does not remain in the field of view (FOV). This truncation may lead to distortions in the transmission map (μ map), which would affect the attenuation correction (AC) and possibly the final image. Our aim was to investigate this distortion on our dedicated small FOV cardiac camera and evaluate the efficacy of the truncation correction. METHODS: Using a phantom, transmission data were acquired with our cardiac camera using arrays of Gd sources. The width of the phantom was varied by adding attenuating material. AC and non-AC images were analysed. RESULTS: The results showed that distorted μ maps were produced, which remained distorted even after the application of correction algorithms for chest width measurements greater than 43±1 cm. This distortion was observed to worsen with increasing chest width measurements. Artefacts were not seen for chest width measurements smaller than 43 cm, even when significant anterior attenuation was modelled. CONCLUSION: Our findings demonstrate that AC-corrected images acquired with our dedicated small FOV cardiac camera are not suitable for patients with chest width measurements greater than 43 cm. © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins.


Hickey F.,Northampton General Hospital NHS Trust | Finch J.G.,Northampton General Hospital NHS Trust | Khanna A.,Northampton General Hospital NHS Trust
Hernia | Year: 2011

Purpose: Diastasis or divarication of the rectus abdominus muscles describes the separation of the recti, usually as a result of the linea alba thinning and stretching. This review examines whether divaricated recti should be repaired and tries to establish if the inherent co-morbidity associated with surgical correction outweighs the benefits derived. Methods: EMBASE, MEDLINE and the Cochrane library were searched for ('divarication' OR 'diastasis') AND ('recti' OR 'rectus'). A standard data extraction form was used to extract data from each text. Due to the lack of randomised control trials, meta-analysis was not possible. Results: Seven studies report that patient satisfaction was high following surgery. The most common complication seen was the development of a seroma. Other common complications included haematomas, minor skin necrosis, wound infections, dehiscence, post-operative pain, nerve damage and recurrence, the rate of which may be as high as 40%. Conclusions: Further studies are required to compare laparoscopic and open abdominoplasty techniques. Patients and physicians should be advised that correction is largely cosmetic, and although divarications may be unsightly they do not carry the same risks of actual herniation. Progressive techniques have resulted in risk reduction with no associated surgical mortality. However, the outcomes may be imperfect, with unsightly scarring, local sepsis and the possibility of recurrence. © 2011 Her Majesty the Queen in Right of United Kingdom.


Khanna A.,Northampton General Hospital NHS Trust | Sezen E.,Northampton General Hospital NHS Trust | Barlow A.,Northampton General Hospital NHS Trust | Rayt H.,Northampton General Hospital NHS Trust | Finch J.G.,Northampton General Hospital NHS Trust
British Journal of Surgery | Year: 2013

Background Shoulder tip and abdominal pain following laparoscopic procedures are well recognized causes of postoperative morbidity. In this double-blind randomized clinical trial attempts were made to reduce postoperative pain in patients undergoing laparoscopic surgery by implementing a simple intraoperative technique. Methods Patients undergoing elective laparoscopic cholecystectomy or laparoscopic transabdominal preperitoneal inguinal hernia repair were randomized to receive either the current standard treatment (control group) or an intervention to remove residual carbon dioxide. In the intervention group, the pneumoperitoneum was removed at the end of the operation by placing the patient in the Trendelenburg position and utilizing a pulmonary recruitment manoeuvre consisting of two manual inflations to a maximum pressure of 60 cmH2O. In the control group, residual pneumoperitoneum was evacuated at the end of the procedure by passive decompression via the open operative ports. Results Seventy-six randomly assigned patients, 37 in the intervention group and 39 in the control group, were recruited. Overall postoperative pain scores were significantly lower in the intervention group (P = 0·001). Median (interquartile range) pain scores were significantly lower in the intervention group compared with the control group at both 12 h (3·5 versus 5; P < 0·010) and 24 h (3 versus 4·5; P < 0·010). Conclusion Active evacuation of residual pneumoperitoneum following laparoscopic procedures, by means of two pulmonary recruitment manoeuvres in the Trendelenburg position, reduces postoperative pain significantly. This simple and safe technique can be implemented routinely after abdominal laparoscopy. Registration number: NCT01720433 (http://www.clinical trials.gov). Simple techniques to reduce pain © 2013 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd.


Pickering W.,Northampton General Hospital NHS Trust
Journal of Renal Care | Year: 2013

Background: Home dialysis (peritoneal or haemodialysis) in any reasonable guise offers potential benefits compared with in-centre dialysis. Benefits may be overtly patient centred (independence, quality of life), outcome oriented (survival, resolution of left ventricular hypertrophy) or resource friendly (savings on staff costs). The priority placed on each of these areas is likely to vary from patient to patient, and possibly provider to provider. This is the one strength of home haemodialysis (HHD) rather than being viewed as a weakness, as it can offer different benefits to different people. Intuitively, more haemodialysis is better than less, and this is most realistically achieved at home. Indications are that both long nocturnal dialysis and short daily dialysis can offer real objective benefits. Literature review: Critics argue correctly that there is a paucity of robust randomised controlled study data. The complexity of HHD regimens and practice and in-homogeneity of patients means such firm data are unlikely to be forthcoming. However, the positive reports both subjective and objective of patients dialysing at home, and results from the available research suggest that advantages may be seen purely with changing the location of dialysis to home, and independently with enhancing dialysis schedules. Conclusion: The logical conclusion is that patients undertaking haemodialysis at home should have at least the recommended minimum of four hours three times per week (or equivalent), preferably avoiding the long inter-dialytic interval, but beyond that rigid adherence to a schedule as dogma should be subjugated to patient choice and flexibility, albeit by prior agreement with supervising medical and nursing staff. © 2013 European Dialysis and Transplant Nurses Association/European Renal Care Association.


Davies E.,Northampton General Hospital NHS Trust | Yeoh K.-W.,Churchill Hospital
British Journal of Cancer | Year: 2012

BACKGROUND: Reliable information can improve patients' knowledge of chemotherapy. As internet chemotherapy information (ICI) is increasingly viewed as a valuable patient education tool, we investigated the impact of ICI on patient care and analysed health professionals' (HPs') attitudes towards ICI. METHODS: The following questionnaires were distributed: (1) self-administered questionnaire randomly given to 261 patients receiving chemotherapy (80% returned); and (2) separate questionnaire given to 58 HPs at the same UK Oncology Centre (83% returned). RESULTS: Just over half of the patient respondents accessed the internet regularly. They were younger, with higher incomes and qualifications. Key search topics included chemotherapy modes of action, symptom management and treatment success, and most considered ICI useful. More than half wanted to discuss ICI with HPs but most did not get the opportunity. Although the majority of HP respondents supported the need for patients to retrieve ICI, most questioned the accuracy of ICI and did not routinely recommend its use. CONCLUSION: This study has shown that ICI is generally perceived by patients to be a valuable information resource. Given the potential impact of ICI, the following should be addressed in future studies: (1) inequalities in accessing ICI; (2) maintaining the quality of ICI (with clear guidance on recommended websites); (3) bridging the gap between the perception of ICI by patients and HPs; (4) integration of ICI with traditional consultation models. © 2012 Cancer Research UK. All rights reserved.


Barnes N.,Northampton General Hospital NHS Trust
Progress in Neurology and Psychiatry | Year: 2012

In the first of a new series on managing neurological and psychiatric conditions in children and adolescents, Dr Nick Barnes discusses the presentation, diagnosis and treatment of paediatric migraine. © 2012 John Wiley & Sons, Ltd.


Zochios V.A.,Papworth Hospital NHS Trust | Wilkinson J.,Northampton General Hospital NHS Trust | Dasgupta K.,University of Nottingham
Journal of Vascular Access | Year: 2014

Objective: To review the evidence behind Ultrasound (US) guided placement of arterial cannulae and its use in the critically ill population. Data sources: We performed a computer-aided literature search using set search terms and electronic data bases of PubMed and EMBASE from their commencement date through the end of July 2013. Summary of review: Insertion of intra-arterial catheters is a commonly performed invasive procedure in the peri-operative and intensive care setting that facilitates invasive blood pressure and cardiac output monitoring as well as frequent blood sampling. Arterial catheterization can be particularly challenging in critically ill and high-risk surgical patients with circulatory collapse, low cardiac output state and peripheral edema, all of which can limit the ability to successfully palpate and cannulate the artery. There is a convincing body of evidence suggesting a decrease in complication rate and first-pass success rate in US guided central venous catheter (CVC) insertion compared with the landmark technique. While most intensivists and peri-operative physicians are familiar with US guided CVC placement, fewer use US to guide arterial access. Conclusions: Most studies have demonstrated a higher success rate when using US guidance for arterial cannulation. Moreover, the technique permits more rapid access and establishment compared with the conventional palpation technique. However, there is evidence opposing the routine use of US to guide arterial cannula insertion. Further studies are required to ascertain the benefits and cost effectiveness of US guided arterial catheterization in peri-operative and critical care. © 2013 Wichtig Editore.


The development of specialist nursing practice has blurred the boundaries between medicine and nursing. This mainly qualitative study compares the structure of epilepsy specialist nurse (ESN) and consultant neurologist (CN) clinical interviews at first seizure presentation and opinion on diagnosis. Twenty patients with a suspected first seizure were randomly allocated for clinical review with an ESN and then a CN, or vice versa. Clinical interviews were unstructured and audio-recorded. The ESN and CN reached an independent diagnosis for each patient. Audiotapes were transcribed verbatim. Emergent themes were identified, catalogued and grouped into major thematic areas. Annotated audio recordings, medical notes and dictated clinic letters were used to validate findings. Statistical analysis of inter-rater agreement of diagnosis was evaluated using Kappa. The clinical interviews of CN and ESN were similar in structure. Differences demonstrated CNs concentrated on the prodrome to events and expressed less diagnostic uncertainty. ESNs concentrated on post-ictal recovery and used more investigations. Complete disagreement on diagnosis occurred in 5 (25%) patients. Kappa score = 0.510, demonstrating a moderate level of inter rater agreement on diagnosis between the CN and ESN. © 2011 British Epilepsy Association.

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