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Papworth Everard, United Kingdom

Elsayed H.,Papworth Hospital NHS Foundation Trust | Elsayed H.,Ain Shams University
European Journal of Cardio-thoracic Surgery | Year: 2012

Mediastinoscopy is used for the staging of lung cancer and for the diagnosis of mediastinal lesions. It is a valuable diagnostic tool but, in a few cases, it could result in major complications. We describe a simple technique to avoid the development of a major complication - massive haemothorax - after a mediastinoscopy, which should be applied in cases of inadvertent injury of the pleura during the procedure. © The Author 2011. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.

Wilson R.,University College London | Cohen J.M.,University College London | Jose R.J.,University College London | De Vogel C.,Erasmus University Rotterdam | And 2 more authors.
Mucosal Immunology | Year: 2015

Streptococcus pneumoniae is a common cause of pneumonia and infective exacerbations of chronic lung disease, yet there are few data on how adaptive immunity can specifically prevent S. pneumoniae lung infection. We have used a murine model of nasopharyngeal colonization by the serotype 19F S. pneumoniae strain EF3030 followed by lung infection to investigate whether colonization protects against subsequent lung infection and the mechanisms involved. EF3030 colonization induced systemic and local immunoglobulin G against a limited number of S. pneumoniae protein antigens rather than capsular polysaccharide. During lung infection, previously colonized mice had increased early cytokine responses and neutrophil recruitment and reduced bacterial colony-forming units in the lungs and bronchoalveolar lavage fluid compared with control mice. Colonization-induced protection was lost when experiments were repeated in B-cell- or neutrophil-deficient mice. Furthermore, the improved interleukin (IL)-17 response to infection in previously colonized mice was abolished by depletion of CD4+ cells, and prior colonization did not protect against lung infection in mice depleted of CD4+ cells or IL17. Together these data show that naturally acquired protective immunity to S. pneumoniae lung infection requires both humoral and cell-mediated immune responses, providing a template for the design of improved vaccines that can specifically prevent pneumonia or acute bronchitis. © 2015 Society for Mucosal Immunology.

Slade M.,Papworth Hospital NHS Foundation Trust
Seminars in Respiratory and Critical Care Medicine | Year: 2014

Pneumothorax refers to the presence of air within the pleural cavity, which may arise from a spontaneous defect in the visceral pleural surface, or through iatrogenic or other thoracic trauma. The most common cause in the developed world is iatrogenic pneumothorax. Most frequently, it can be managed conservatively or through simple pleural aspiration or drainage. A persistent air leak, >2 days' duration, develops in one-third of patients. When patients are managed with chest drainage alone, the median time for resolution of air leak is longer in patients with a pneumothorax secondary to an underlying lung disease (11 vs. 7 days). Interventional pulmonology is not usually required for the resolution of simple pneumothorax, but offers important minimally invasive techniques for treating persistent air leak and bronchopleural fistula. Following assessment of the site of the air leak within the bronchial tree, techniques are described for the sealing of leak using tissue or fibrin glues, endobronchial devices of various kinds, and combination approaches. Bronchoscopic sealing of air leaks can often avoid the requirement for thoracic surgical intervention. They may prove life-saving in patients who are difficult to wean from mechanical ventilation or extracorporeal membrane oxygenation because of catastrophic air leaks. Copyright © 2014 by Thieme Medical Publishers, Inc.

Pilkington S.A.,Queen Elizabeth Hospital NHS Foundation Trust | Taboada D.,Pulmonary Vascular Disease Unit | Martinez G.,Papworth Hospital NHS Foundation Trust
Anaesthesia | Year: 2015

Pulmonary hypertension is a complex disorder of the pulmonary vasculature that leads to increased peri-operative morbidity and mortality. Non-cardiac surgery constitutes a significant risk in patients with pulmonary hypertension. The management of right ventricular failure is inherently challenging and fraught with life-threatening consequences. A thorough understanding of the pathophysiology, the severity of the disease and its treatment modalities is required to deliver optimal peri-operative care. This review provides an evidence-based overview of the definition, classification, pathophysiology, diagnosis and treatment of pulmonary hypertension and focuses on the peri-operative management and treatment of pulmonary hypertensive crises in a non-cardiac setting. © 2014 The Association of Anaesthetists of Great Britain and Ireland.

Fynn S.P.,Papworth Hospital NHS Foundation Trust
Current cardiology reviews | Year: 2015

Focal atrial tachycardias arise preferentially from specific locations within the atria. Careful analysis of the P wave can provide useful information about the chamber and likely site of origin within that chamber. Macro-reentrant atrial flutter also tends to occur over a limited number of potential circuits. In this case, the ECG usually gives a guide to the chamber of origin, but unless it shows a specific morphology it is less useful in delineating the circuit involved. Nonetheless, prior knowledge of the likely chamber of origin helps to plan the ablation strategy.

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