Rotherham, United Kingdom
Rotherham, United Kingdom

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Chawdhary G.,Open University Milton Keynes | Pankhania M.,Rotherham District General Hospital | Douglas S.,Rotherham District General Hospital | Bottrill I.,John Radcliffe Hospital
Acta Oto-Laryngologica | Year: 2017

Introduction: Necrotising otitis externa (NOE) is a rare infection causing skull base osteomyelitis. The evidence regarding NOE consists mostly of case series. Hence, there is a limited evidence base to guide decision-making. This survey aims to report the experience of 221 otolaryngologists in this condition. Materials and methods: Internet survey administered to the membership of the British Association of Otorhinolaryngology – Head and Neck Surgery (ENT UK). Results: Respondents’ detailed replies on diagnosis, treatment and follow up are presented. One third of respondents reported increasing incidence of NOE. Over 80% diagnosed NOE based on pre-existing risk factors, severe pain, non-resolution of infection and CT scan. Most respondents managed NOE with intravenous antibiotics (90%) and blood sugar control (82%). There was less agreement in certain aspects of management including the role of surgery and the nature and duration of follow up. Conclusions: Our survey provides a picture of NOE management in the UK. While there is consensus in some aspects of NOE management, other aspects attract widely differing answers. This may reflect the lack of strong evidence in the literature. Future work should aim to address this. © 2017 Acta Oto-Laryngologica AB (Ltd)


Garg S.,Rotherham District General Hospital | Thyssen J.P.,Copenhagen University | Uter W.,Friedrich - Alexander - University, Erlangen - Nuremberg | Schnuch A.,University of Gottingen | And 5 more authors.
British Journal of Dermatology | Year: 2013

Background Nickel allergy is common worldwide. It is associated with hand dermatitis, and sensitization is often induced by nickel-releasing jewellery. The European Union (EU) introduced legislation to control nickel content and release from jewellery and other consumer items through the EU Nickel Directive 1994, which came into force in 2001 and is now part of the REACH regulation. Objectives To examine the effects of the EU nickel regulations on the prevalence of nickel allergy in four European countries. Methods Nickel patch-test data from 180 390 patients were collected from national databases in Denmark, Germany, Italy and the U.K. from between 1985 and 2002 to 2010. Patients with suspected allergic contact dermatitis who had been patch tested with nickel sulfate 5% in petrolatum were included in the analysis. The main outcomes studied were the percentage of positive results to nickel patch tests, and changes in trends with time in an age- and sex-stratified analysis. Results A statistically significant decrease in nickel allergy was observed in Danish, German and Italian women aged below 30 years. In female patients in the U.K. this was observed between 2004 and 2010. In young men, a statistically significant decrease in nickel allergy was observed in Germany and the U.K., whereas a nonsignificant increase was observed in Italy. Conclusions There has been a reduction in the prevalence of nickel allergy in young women, contemporaneous with the introduction of the nickel regulation. A reduction is also suggested in men in Germany and the U.K. A causative effect of the regulatory intervention is the most likely explanation. What's already known about this topic? Nickel allergy affects 10-15% of women in the general population and is associated with hand eczema. Previous studies have shown a decrease in nickel allergy in young women in Denmark and Germany since regulations to control nickel release were implemented. What does this study add? Postregulation, a significant decrease in nickel allergy was seen in women with suspected dermatitis aged below 30 years in all four countries studied, and in men aged below 30 years in the U.K. and Germany, although an increase was seen in young Italian men. This study of 180 390 patients shows that the EU nickel regulations are starting to reduce nickel allergy in young men and women, although allergy remains prevalent and more work needs to be done to improve compliance with the regulations. © 2013 British Association of Dermatologists.


Tanweer F.,Queens Medical Center | Mahkamova K.,Royal Infirmary | Harkness P.,Rotherham District General Hospital
Journal of Laryngology and Otology | Year: 2013

Background: Nasolacrimal duct tumours are rare and are often found inadvertently during dacryocystorhinostomy. Anecdotal case reports have been published, mostly in ophthalmology journals. Since the era of endoscopic dacryocystorhinostomy, such cases are more frequently encountered by ENT surgeons. Method: This paper reports a retrospective chart review of patients who underwent endoscopic dacryocystorhinostomy over the last 10 years in our dedicated epiphora clinic. It also provides a systematic literature review of nasolacrimal duct tumour cases published in English over the last 16 years. Results: Four of 525 endoscopic dacryocystorhinostomy procedures exposed a tumour (inverted papilloma, oncocytoma, lymphoma and solitary fibrous tumour). The literature review revealed 118 published case reports. Papilloma was the most frequently reported benign tumour and lymphoma was the most common malignant tumour. Conclusion: Since the advent of endoscopic dacryocystorhinostomy, tumours are being diagnosed relatively early when smaller in size. Because of the rarity of this condition, it is advisable that such cases are managed through a dedicated epiphora service framework. Copyright © JLO (1984) Limited 2013.


PubMed | St Helens And Knowsley Hospital, Rotherham District General Hospital, Royal Wolverhampton Hospital NHS Trust, University of Manchester and 8 more.
Type: Journal Article | Journal: Central European journal of urology | Year: 2016

Our tips and tricks focuses on all aspects of upper tract endourology and we hope these will be of use to all trainees and consultants who perform ureteroscopy. We report an expert consensus view from experienced endourological surgeons, on all aspects of advanced ureteroscopic techniques, with a particular focus on avoiding and getting out of trouble while performing ureteroscopy. In this paper we provide a summary of placing ureteric access sheath, flexible ureteroscopy, intra renal stone fragmentation and retrieval, maintaining visual clarity and biopsy of ureteric and pelvicalyceal tumours.


PubMed | St Helens And Knowsley Hospital, Rotherham District General Hospital, Royal Wolverhampton Hospital NHS Trust, University of Manchester and 8 more.
Type: Journal Article | Journal: Central European journal of urology | Year: 2016

Ureteroscopy is fast becoming the first line treatment option for the majority of urinary tract stones. Ureteroscopy training can be performed in a variety of ways including simulation, hands on ureteroscopy courses and supervised operative experience. We report an expert consensus view from experienced endourological surgeons, on all aspects of basic ureteroscopic techniques, with a particular focus on avoiding and getting out of trouble while performing ureteroscopy. In this paper we provide a summary of treatment planning, positioning, cannulation of ureteric orifice, guidewire placement, rigid ureteroscopy and stone fragmentation.


PubMed | Northern General Hospital, Chesterfield Royal Hospital, Royal Infirmary, Rotherham District General Hospital and Royal Hallamshire Hospital
Type: Journal Article | Journal: Digestive and liver disease : official journal of the Italian Society of Gastroenterology and the Italian Association for the Study of the Liver | Year: 2014

Coeliac disease affects 1% of the population. Despite this high prevalence, the majority of individuals are undetected. Many patients present with subtle symptoms which may also contribute to under diagnosis. Our aim was to determine the relative importance of different presenting characteristics.Unselected gastroenterology patients referred to 4 hospitals in South Yorkshire were investigated for coeliac disease. Diagnosis was based on positive serology and the presence of villous atrophy. Odds ratios were calculated for presenting characteristics and multivariate analysis performed to identify independent risk factors.4089 patients were assessed (41.5% male, mean age 55.8 18.2 years); 129 had coeliac disease (3.2%, 95% CI 2.6-3.7%). Multivariate analysis of patients referred to secondary care showed family history of coeliac disease (OR 1.26, p < 0.0001), anaemia (OR 1.03, p < 0.0001) and osteoporosis (OR 1.1, p = 0.006) were independent risk factors for diagnosis of coeliac disease. When compared to population controls, diarrhoea (OR 4.1, p < 0.0001), weight loss (OR 2.7, p = 0.02), irritable bowel syndrome symptoms (OR 3.2, p = 0.005) thyroid disease (OR 4.4, p = 0.01) and diabetes (OR 3.0, p = 0.05) were also associated with increased coeliac disease risk.Coeliac disease accounts for 1 in 31 referrals in secondary care to unselected gastroenterology clinics. A low threshold for coeliac disease testing should be adopted.


Tyagi P.,Rotherham District General Hospital
International ophthalmology | Year: 2011

The glistening and delayed opacification of intraocular lenses (IOLs) has been reported in literature as a late and permanent change in the acrylic IOL due to temperature change. We report a case in which clouding and opacification of an IOL occurred intraoperatively within a few seconds of implantation into the capsular bag after routine phacoemulsification. This phenomenon occurred due to the sudden change in temperature of a very cold IOL being implanted into the eye at body temperature. The opaqueness lasted for about 3 h then cleared without any residual or permanent change to the IOL. This case highlights the effect of environmental factors on hydrophillic acrylic IOLs. It is particularly important in cold countries and during the winter months. It also reinforces the practice of storing the IOL at a correct temperature to avoid sudden fluctuations in its surrounding environment.


Hepatitis-associated aplastic anaemia (HAAA) is an uncommon but distinct variant of aplastic anaemia in which pancytopenia and bone marrow failure appears 2-3 months after an acute attack of hepatitis. Although bilateral vision loss may rarely be the initial presentation of aplastic anaemia, no such report is known in HAAA. Here the authors report such a case presenting with large premacular subhyaloid haemorrhages secondary to severe anaemia and thrombocytopenia. Anaemic hypoxic damage to the vessel wall together with increased cardiac output and low platelet counts are interacting causal factors in the development of bleeding. Though these haemorrhages are benign and usually improve spontaneously, the presence of blood may cause permanent macular changes before it resolves. Posterior hyaloidotomy enabled rapid resolution of premacular subhyaloid haemorrhage thereby restoring vision and preventing need for vitreo-retinal surgery. These patients should be advised to refrain from valsalva manoeuvres, ocular rubbing and vigorous exercise to prevent ocular morbidity.


Yates D.R.,Rotherham District General Hospital | Mehta S.S.,Rotherham District General Hospital | Spencer P.A.,Royal Hallamshire Hospital | Parys B.T.,Rotherham District General Hospital
BJU International | Year: 2010

Study Type - Therapy (case series) Level of Evidence 4 OBJECTIVE To evaluate our experience of treating complicated iatrogenic ureteric strictures with a combined antegrade and retrograde endoscopic retroperitoneal bypass technique, a modification of the so-called 'rendezvous' procedure. Patients and methods Seven patients presented to our institution between 2004 and 2008 after developing a complicated iatrogenic ureteric stricture, impassable with solitary antegrade or retrograde stenting techniques. In most cases there was a significant loss of ureteric continuity, with some strictures of up to 10-12 cm. After initial temporizing management with a percutaneous nephrostomy, each patient had a radiological 'rendezvous' procedure to insert a JJ stent and restore ureteric continuity. After 6 months, the JJ stents were removed and the patients evaluated by symptom assessment, serial measurements of serum creatinine and diuretic renography (F-15 mercaptoacetyl triglycine). RESULTS All seven 'rendezvous' procedures were successful and a ureteric stent was inserted across or around the stricture in all cases. Five of seven patients whose follow-up was >6 months had their stent removed successfully. At a median follow-up of 21 months, all patients are alive and none has required subsequent surgery. Six of the seven patients presented with significant symptoms and they are all currently symptom-free, which we consider to be a successful clinical outcome. No patient has developed significant renal impairment (estimated glomerular filtration rate (<30 mL/min) but we could only confirm successful unequivocal renographic drainage in one patient. CONCLUSION Combining antegrade radiological and retrograde endourological techniques, it is possible to restore ureteric continuity with a JJ stent, even in situations with extensive loss of the ureteric lumen. This reduces the need for morbid open surgical repair and offers a long-term solution to patients who might otherwise be consigned to less favourable conservative measures. © 2009 BJU INTERNATIONAL.


Wild J.R.L.,Northern General Hospital | Garner J.P.,Rotherham District General Hospital | Skinner P.P.,Northern General Hospital
Ostomy Wound Management | Year: 2011

Malignant neoplasms presenting on a stoma, as well as the development of colorectal adenocarcinoma after previous treatment for squamous cell carcinoma (SCC) of the anal canal, are rare. The unique case is presented of an 81-year-old woman with parastomal bleeding and ulceration found to have a primary colorectal adenocarcinoma arising de novo on a colostomy, formed after salvage abdominoperineal resection (APR) 3 years earlier for recurrent anal SCC. This is the first reported case of a colonic adenocarcinoma on a colostomy formed after an APR for anal SCC. Although stomal neoplasia is rare, the appearance of a friable bleeding lesion on the stoma should be investigated to exclude metastatic cancer or a second primary malignancy.

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