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Norwich, United Kingdom

Leese G.P.,Ninewells Hospital and Medical School | Stratton I.M.,Gloucestershire Eye Unit | Land M.,Landmark Health Consulting | Bachmann M.O.,Norwich Medical School | And 4 more authors.
Diabetes Care | Year: 2015

OBJECTIVE This study aimed to follow the natural progression of retinal changes in patients with diabetes. Such information should inform decisions with regard to the screening intervals for such patients. RESEARCH DESIGN AND METHODS An observational study was undertaken linking the data from seven diabetes retinal screening programs across the U.K. for retinal grading results between 2005 and 2012. Patients with absent or background retinopathy were followed up for progression to the end points referable retinopathy and treatable retinopathy (proliferative retinopathy). RESULTS In total, 354,549 patients were observed for up to 4 years during which 16,196 patients progressed to referable retinopathy. Of patients with no retinopathy in either eye for two successive screening episodes at least 12 months apart, the conditions of between 0.3% (95% CI 0.3-0.8%) and 1.3% (1.0-1.6%) of patients progressed to referable retinopathy, and rates of treatable eye disease were <0.3% at 2 years. The corresponding progression rates for patients with bilateral background retinopathy in successive screening episodes were 13-29% and up to 4%, respectively, in the different programs. CONCLUSIONS It may be possible to stratify patients for risk, according to baseline retinal criteria, into groups with low and high risk of their conditions progressing to proliferative retinopathy. Screening intervals for such diverse groups of patients could safely be modified according to their risk. © 2015 by the American Diabetes Association.

Minhas J.S.,Norwich Medical School | Igali L.,Norwich University
International Journal of Surgical Pathology | Year: 2011

Lymph node yield is a key factor in enabling the accurate determination of prognosis in colorectal cancer patients. The Royal College of Pathologists guidelines state a "minimum" recommended mean number of 12 lymph nodes. In this study of 391 patients, the authors aim to determine the optimal node counts in patients with colorectal cancer, examine for correlations between maximum tumor diameter and lymph node yield, and examine for correlations between lymph node yield and involved node numbers. Furthermore, the authors aim to examine the impact of specimen type on the harvested node numbers and assess whether the personal differences between surgeons and pathologists have significant influence on node yield. A moderate positive correlation between maximum tumor diameter and final lymph node yield was noted (Spearman's correlation coefficient =.328, P =.0001). There was significant variation shown by pathologists (Kruskal-Wallis test P =.001) and by differing specimen type (Kruskal-Wallis test P =.029) on the lymph node yield. © The Author(s) 2011.

Scanlon P.H.,Gloucestershire Retinal Research Group | Stratton I.M.,Gloucestershire Retinal Research Group | Leese G.P.,Ninewells Hospital and Medical School | Bachmann M.O.,Norwich Medical School | And 3 more authors.
Diabetic Medicine | Year: 2016

Aims: To report on the relationships between age at diagnosis of diabetes, time from registration with the screening programme to first diabetic eye screening and severity of diabetic retinopathy. Methods: Data were extracted from four English screening programmes and from the Scottish, Welsh and Northern Irish programmes. Time from diagnosis of diabetes to first screening and age at diagnosis were calculated. Results: Time from registration with the screening programme to first screening episode is strongly related to age at registration. Within 18 months of registration 89% of 3958 young people under 18 years of age and 81% of 391 293 people over 35 years of age were seen. In 19 058 people between 18 and 34 years of age, 80% coverage was not reached until 2 years and 9 months. The time from diagnosis of diabetes to first screening is positively associated with severity of disease (P < 0.0001). Conclusions: This report is the first that to demonstrate that those in the 18–34 year age group are least likely to attend promptly for screening after registration with a higher risk of referable diabetic retinopathy being present at the time of first screen. Date of diagnosis should be recorded and prodigious efforts made to screen all people promptly after diagnosis. Screening programmes should collect data on those who have not attended within one year of registration. © 2015 The Authors. Diabetic Medicine published by John Wiley & Sons Ltd on behalf of Diabetes UK.

Reid I.R.,University of Auckland | Lyles K.,Duke University | Su G.,Novartis | Brown J.P.,University of Quebec | And 7 more authors.
Journal of Bone and Mineral Research | Year: 2011

Two trials have shown that a single 5-mg infusion of zoledronic acid achieves much higher response rates in Paget disease of bone than risedronate. The duration of this effect is unknown. We have conducted an open follow-up of responders from the two trials (152 originally treated with zoledronic acid, 115 with risedronate) out to 6.5 years without further intervention. Endpoints were times to relapse (ie, return of serum total alkaline phosphatase activity to within 20% of the pretreatment value) or loss of response (response= normalization of alkaline phosphatase or 75% or greater reduction in its excess). Bone turnover markers were lower in the zoledronic acid group throughout follow-up, with mean alkaline phosphatase (ALP) remaining within the reference range in these patients, whereas the mean in the risedronate group was above normal from 1 year. Relapse rates were substantially greater in the risedronate group (23 of 115, 20%) than in those treated with zoledronic acid (1 of 152, 0.7%, p<.001), and loss of response occurred in 19 (12.5%) zoledronic acid patients compared with 71 (62%) risedronate patients (p<.0001). Risk ratios for relapse and loss of response in zoledronic acid patients were 0.02 [95% confidence interval (CI) 0.00-0.18] and 0.12 (95% CI 0.07-0.19), respectively. Changes from baseline in quality of life, assessed using SF-36 scores, were more positive in the zoledronic acid group across the follow-up period (p=.01). Bone markers at 6 months were predictive of response duration. These data demonstrate an unprecedented duration of remission of Paget disease following treatment with zoledronic acid, accompanied by an improved quality of life. © 2011 American Society for Bone and Mineral Research.

Watt D.C.,Norwich Medical School
BMJ case reports | Year: 2011

The authors describe two patients who underwent transfemoral endovascular procedures followed by the use of the Angio-seal arterial percutaneous closure device. In the first patient, distal migration of the device occurred with consequent occlusion of the ipsilateral popliteal artery 2 days post procedure. In the second patient, thrombotic occlusion of the femoral artery occurred and the patient presented with acute leg ischaemia 3 weeks post procedure. Surgical removal of the closure device with consequent revascularisation of the affected leg was achieved in both patients. This report aims to alert clinicians to the possibility of device-induced arterial occlusion, dislodgment and their sequelae.

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