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Shaikh I.,Royal Infirmary | Shaikh I.,Queen Elizabeth Queen Mother Hospital | Willder J.M.,Royal Infirmary | Kumar S.,Royal Infirmary
Hernia | Year: 2013

Aims: The aims of this study were to compare same day discharges and early complications after open and laparoscopic primary paraumbilical hernia (PUH) repair, including the procedures performed by surgical trainees (STs). Methods: All patients who had open (suture or mesh) and laparoscopic repair of primary PUH in the Day Surgery Unit (DSU) between January 2007 and June 2009 were identified from the hospital database. The database was questioned regarding the grade of operating surgeon, type of surgical repair, day of admission and discharge from the DSU, and a patient's return to surgical services. Data were stored in Microsoft Excel® (TM 2007). Statistical significance was determined using Fisher's exact test. Results: PUH was repaired in 337 patients: 252/337 (74.8 %) had open and 85/337 (25.2 %) had laparoscopic repair. Significantly, more patients were discharged home on the day of surgery after an open repair compared to the laparoscopic repair: open repair 187/252 (74.2 %), laparoscopic repair 35/85 (41.17 %), P = 0.0001. Overall early complications such as wound complications and hospital re-visits were similar in both groups: open repair 6.3 % (16/252), laparoscopic repair 11.7 % (10/85), P = 0.1554. STs performed 142/337 (42.1 %) of the PUH repairs with similar same day discharges from the DSU: STs 64.7 % (92/142), consultant surgeons 66.7 % (130/195), P = 0.7285. The difference in hernia recurrence between open repair 7/252 (2.78 %) and laparoscopic group 0/85 was not significant (P = 0.1985). Conclusion: Patients with PUH repair were more likely to go home on the day of surgery after open than after laparoscopic repair. This was not affected by the grade of the operating surgeon. Early complications were similar following open and laparoscopic repair of primary PUH. © 2013 Springer-Verlag France.


D'Silva A.,Conquest | Jassim I.,Queen Elizabeth Queen Mother Hospital | Greenwood J.,Leeds General Infirmary | Grosser K.,Queen Elizabeth Queen Mother Hospital
BMJ Case Reports | Year: 2013

A case study of a patient presenting with acute pulmonary oedema, dynamic ECG changes and a rise in cardiac biomarkers with no evidence of myocardial infarction. The clinical course followed a dynamic and inflammatory disease process with evidence of sarcoidosis on tissue histology. The patient had an excellent clinical response to corticosteroid therapy with minimal evidence of hyperenhancement (focal fibrosis) on cardiac MRI at 6 months. The case highlights the challenges in making a new diagnosis of sarcoidosis where involvement appears limited to the heart and lymphatic system.


Meadows S.,University of Kent | Woolf-May K.,Canterbury Christ Church University | Kearney E.,Queen Elizabeth Queen Mother Hospital
Journal of Exercise Physiology Online | Year: 2013

The current compendium regarding resting metabolic equivalents (METs) is based on 1 MET, which is defined as an oxygen uptake (VO2) value of 3.5mL·kg-1·min-1 to understand energy expenditure, aerobic capacity, and exercise intensity in cardiac populations. Yet, a field test has indicated it is not sufficiently accurate and may lend itself to implications that are potentially hazardous. The purpose of this study was to determine METs in post-MI males during a controlled graded treadmill walking test (GTWT) using a comparative controlled study design. Seventeen male post-myocardial infarction (MI) subjects (mean ± SD, 63.0 ± 8.5, range 48 to 77 yrs) and 17 healthy male controls (51.9 ± 7.7, range 41 to 66 yrs) participated as subjects in this study. All subjects performed a GTWT at speeds 2.0 to 4.4 m·hr-1. Throughout the testing, the subjects' VO2, heart rate, and rating of perceived exertion (RPE) were measured. Analysis comparing lines of regression showed that the METs were significantly higher (P<0.05) for post-MIs vs. the controls. METs differed significantly for post-MIs vs. current compendium METs (P<0.01), and controls vs. current compendium METs (P<0.01). Given that both post-MIs and controls showed significantly higher METs vs. the current compendium values during a GTWT, these findings bring into question the appropriateness of the standard use of the current METs in this context.


Boshnaq M.,Queen Elizabeth Queen Mother Hospital | Thakrar A.,Queen Elizabeth Queen Mother Hospital | Martini I.,Queen Elizabeth Queen Mother Hospital | Doughan S.,Queen Elizabeth Queen Mother Hospital
BMJ Case Reports | Year: 2016

An 83-year-old woman presented to the emergency department with sudden onset of severe abdominal pain. She had a background of ulcerative colitis managed surgically at the age of 18 years with panproctocolectomy and permanent ileostomy. On admission, clinical assessment suggested a visceral perforation and an urgent CT scan demonstrated a perforated prepyloric ulcer. Emergency laparotomy was performed and confirmed a 3 cm perforated pre-pyloric ulcer. Repair of the defect was challenging due to the absence of omental fat to patch the perforation. A modification to the standard technique was therefore performed: the falciform ligament was mobilised and its free end used as a patch to repair the defect. The patient made a good postoperative recovery. This case report highlights an alternative operative technique for the treatment of perforated gastric/duodenal ulcers in patients who lack omentum, or when omentum cannot be used to cover perforated gastroduodenal ulcers. © Copyright 2016 BMJ Publishing Group. All rights reserved.


Boshnaq M.,Queen Elizabeth Queen Mother Hospital | Phan Y.C.,Queen Elizabeth Queen Mother Hospital | Akhtar M.,Queen Elizabeth Queen Mother Hospital | Hamade A.,Queen Elizabeth Queen Mother Hospital
BMJ Case Reports | Year: 2016

A 61-year-old man presented to the emergency department, with a 2-week history of a painful lump on his right groin. A diagnosis of an irreducible right femoral hernia was made. As such, an urgent operation was carried out on the same day, and the patient was found to have a rare prevascular femoral hernia in which the sac was lying over the femoral vessels and split by the inferior epigastric vessels into 2 components resembling 2 trouser limbs. The hernia sac presented in a different and challenging way that necessitated meticulous dissection and full orientation of the anatomy of the femoral triangle. Complete dissection and control of the inferior epigastric vessels, and complete reduction of the sac followed by repair with a prosthetic mesh plug were performed successfully. The patient was discharged home the next day. Copyright 2016 BMJ Publishing Group. All rights reserved.


PubMed | Queen Elizabeth Queen Mother Hospital
Type: | Journal: BMJ case reports | Year: 2016

An 83-year-old woman presented to the emergency department with sudden onset of severe abdominal pain. She had a background of ulcerative colitis managed surgically at the age of 18years with panproctocolectomy and permanent ileostomy. On admission, clinical assessment suggested a visceral perforation and an urgent CT scan demonstrated a perforated prepyloric ulcer. Emergency laparotomy was performed and confirmed a 3cm perforated pre-pyloric ulcer. Repair of the defect was challenging due to the absence of omental fat to patch the perforation. A modification to the standard technique was therefore performed: the falciform ligament was mobilised and its free end used as a patch to repair the defect. The patient made a good postoperative recovery. This case report highlights an alternative operative technique for the treatment of perforated gastric/duodenal ulcers in patients who lack omentum, or when omentum cannot be used to cover perforated gastroduodenal ulcers.


PubMed | Queen Elizabeth Queen Mother Hospital
Type: | Journal: BMJ case reports | Year: 2016

A 61-year-old man presented to the emergency department, with a 2-week history of a painful lump on his right groin. A diagnosis of an irreducible right femoral hernia was made. As such, an urgent operation was carried out on the same day, and the patient was found to have a rare prevascular femoral hernia in which the sac was lying over the femoral vessels and split by the inferior epigastric vessels into 2 components resembling 2 trouser limbs. The hernia sac presented in a different and challenging way that necessitated meticulous dissection and full orientation of the anatomy of the femoral triangle. Complete dissection and control of the inferior epigastric vessels, and complete reduction of the sac followed by repair with a prosthetic mesh plug were performed successfully. The patient was discharged home the next day.

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