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Raj A.,Birmingham and Midland Eye Center | Williams G.P.,Birmingham and Midland Eye Center | Hawksworth N.R.,Royal Glamorgan Hospital
Journal of Ocular Pharmacology and Therapeutics | Year: 2012

Purpose: To describe a case of 68-year-old male industrial chemist who received a chemical injury after a gold/amine compound exploded causing bilateral eye injuries. No apparent long-term problems were anticipated. After cataract extraction 40 years later, he developed a localized ulcerative keratitis adjacent to embedded gold in the cornea. Methods: To describe the clinical features, management, and outcomes. Results: Successful treatment with topical hydrocortisone was achieved. Subsequently, 3 further episodes of ulcerative keratitis were treated with topical steroid therapy without need for systemic immunosuppression. A systemic vasculitic/autoimmune screen was normal. Discussion: Ocular chrysiasis is well recognized after systemic gold administration and is normally considered inert, but in this case exogenous gold deposition might have been a contributing factor to very localized and repeated episodes of stromal erosion in this man, many years after the original injury. To the best of our knowledge this is the first such reported case. © Copyright 2012, Mary Ann Liebert, Inc. 2012. Source

Sheikh A.S.,Royal Glamorgan Hospital | Ranjan K.,University of London
Clinical Medicine, Journal of the Royal College of Physicians of London | Year: 2014

Brugada syndrome is an example of a channelopathy caused by an alteration in the transmembrane ion currents that together constitute the cardiac action potential. Approximately 20% of the cases of Brugada syndrome have been shown to be associated with mutations in the gene coding for the sodium ion channel in the cell membranes of the muscle cells of the heart. Patients with Brugada syndrome are prone to develop ventricular tachyarrhythmias that may lead to syncope, cardiac arrest or sudden cardiac death. Many clinical situations have been reported to unmask or exacerbate the electrocardiography (ECG) pattern of Brugada syndrome. Genetic testing for Brugada syndrome is clinically available. Here we report two cases of Brugada syndrome followed by a comprehensive review of the literature. © Royal College of Physicians 2014. All rights reserved. Source

Williamson J.S.,Royal Gwent Hospital | Ingrams D.,Royal Gwent Hospital | Jones H.,Royal Glamorgan Hospital
Annals of the Royal College of Surgeons of England | Year: 2011

Introduction: Laryngeal cancer treatment inherently affects life's most basic functions and significantly affects quality of life (QOL). We aimed to identify which aspects of QOL and which patients are most affected by the various treatment options. Methods: The University of Washington Quality of Life (UW-QOL) questionnaire was administered to all patients with laryngeal cancer treated at a single institution over a seven-year period (2003.2010). Results: In total, 41 patients responded. All had been treated for squamous cell carcinoma of the larynx. Questionnaires were completed at a median of 18.5 months after treatment. The overall quality of life was 81.1/100 as assessed by the UW-QOL scale, with only 4.9% reporting 'poor'f or worse QOL. Neither patient age nor time after treatment significantly affected any aspect of QOL. Patients undergoing primary radiotherapy reported the best QOL. Those undergoing chemoradiotherapy or combined surgical treatment and chemoradiotherapy reported the worst QOL, particularly in terms of social eating, taste and saliva production. Patients with a T stage ≥2 and those with nodal metastases reported a significantly worse QOL. Conclusions: Overall, QOL in our patients was good. This study highlights the aspects of QOL most affected by various treatments for laryngeal cancer and identifies areas in which therapeutic intervention may be focused. It also provides information to guide clinicians when assisting patients to make informed decisions regarding treatment of their head and neck cancer. Source

Loughran D.,Royal Glamorgan Hospital
Journal of Medical Ethics | Year: 2015

As the law around surgical consent continues to evolve, surgeons and those in training risk being caught redfaced and defenceless. Despite repeated concerns regarding surgical consent being raised by the General Medical Council of the UK, how much is changing on the National Health Service shop floor? This report investigates the variation between consenting practices for six common general surgical operations in 123 individual operations. Results showed that only 20% of mentioned operative complications for each operation were being documented on >75% of consent forms. The vast majority of mentioned complications were mentioned inconsistently, leading to patients being given grossly varying information preoperatively. Reassuringly, only 4.1% of consent procedures were done by those not in core surgical training ( junior resident) or above, but nonetheless significant omissions were observed. When consenting a patient for an emergency exploratory laparotomy, an operation carrying a 14% chance of death, a risk of death was only documented in 28% of cases. Trainees failed to document the possibility of an orchidectomy in 30% of scrotal exploration cases. Data showed that complication incidences were only documented for 0.004% of the 721 complications mentioned in total, and a consent process was documented in the chronological notes in only 38% of cases. Seventy-seven per cent of surgical trainees surveyed across four UK deaneries stated that they would strongly support an online and mobile consenting resource detailing the recommended mentionable risks and incidences. Is it time for the traditional consenting approach to give way to an evidence-based gold standard? Source

Sanjay P.,Ninewells Hospital and Medical School | Marioud A.,Auckland City Hospital | Woodward A.,Royal Glamorgan Hospital
Hernia | Year: 2013

Purpose: There is paucity of data regarding patient selection criteria, anaesthetic preferences and outcomes of elective inguinal hernia repair in public and private sector in the UK. This study aimed to compare such outcomes. Methods: Five hundred and fifty-five consecutive inguinal hernia repairs performed by one consultant surgeon in public and private sector were reviewed from a prospectively maintained database. The patient demographics, anaesthetic choice, day case rates and early and long-term morbidity were analysed. Results: The median age of the study group was 59 years (range 16-96 years) with a male/female ratio of 21:1. A total of 436 (78 %) patients underwent surgery in the public sector and 119 (22 %) patients in the private sector. The patients undergoing surgery in the private sector were younger compared to public sector (55 vs. 60 years, p = 0.03). The number of patients with ASA grades III and IV was higher in public sector (28.6 %) compared to private sector (p = 0.0001). General anaesthesia was the preferred anaesthetic technique in the private sector (52 %) and local anaesthesia in the public sector (66 %) (p = 0.0002). The day case rates were higher than in the private sector compared to public sector (78 vs. 66.5 %, p = 0.01). No significant difference was noted in the incidence of post-operative complications, recurrence, groin pain and satisfaction rate between the two groups. Conclusion: Patients undergoing surgery in the private sector are younger, healthier, prefer general anaesthesia and have higher day case rates compared to public sector. The short- and long-term outcomes are similar between public and private sectors. © 2012 Springer-Verlag France. Source

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