Newport, United Kingdom
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Kurdi H.,The Royal Gwent Hospital | Ershaid D.,The Royal Gwent Hospital | Evans P.,The Royal Gwent Hospital
Practical Diabetes | Year: 2017

Movement disorders are a rare but recognised manifestation of non-ketotic hyperglycaemic episodes on a background of poorly-controlled diabetes mellitus. The literature is otherwise sparse when it comes to an association between hemichorea-hemiballism and diabetic ketoacidosis (DKA). A patient with no past medical history of note was admitted with a sudden-onset involuntary movement disorder and was found to be in DKA during her inpatient stay. There was a delay in diagnosis and management as all efforts pointed in the direction of diagnosing the cause of the sudden-onset hemichorea-hemiballism as a potential cerebrovascular event. The movements subsided with treatment of the ketoacidosis and with the addition of tetrabenazine. Imaging revealed a hyperdensity of the left basal ganglia consistent with a metabolic cause and not an ischaemic event. Although the pathophysiology of movement disorders in diabetes is still unclear, this case highlights the importance in maintaining a wide list of differentials when faced with an atypical presentation of hemichorea-hemiballism, especially as DKA is a reversible emergency with high mortality rates if left untreated. Hemichorea-hemiballism as a consequence of DKA seems to be a multifactorial phenomenon. In this case, it began with non-ketotic hyperglycaemia and evolved into ketoacidosis. Confounding factors precipitating this included infection, and delayed diagnosis and management. Copyright © 2017 John Wiley & Sons. Copyright © 2017 John Wiley & Sons, Ltd.


Man W.Y.,The Royal Gwent Hospital | Monni T.,The Royal Gwent Hospital | Jenkins R.,The Royal Gwent Hospital | Roberts P.,The Royal Gwent Hospital
Cell and Tissue Banking | Year: 2016

Femoral head bone allografts have traditionally been used to provide mechanical stability to areas of bony deficiency, or for its osteoinductive and osteoconductive properties. Concerns have been raised over increased infection rates following the use of fresh-frozen graft tissue. This retrospective study aims to investigate the outcomes of fresh frozen femoral heads kept in a regulated, non-commercial bone bank at a university teaching hospital.The local bone bank database was used to identify released femoral heads during a 14 year study period (September 1999–December 2013) whereby a retrospective review of patient records was undertaken to determine clinical outcome. During the observed study period, 427 femoral heads were released from cold storage. Of these, 270 femoral heads had a mean follow-up of 347 days. 157 femoral heads were excluded due to insufficient follow-up data (n = 132) or discarded due to breaks in the cold chain prior to use (n = 25). Of the 270 included femoral heads, 231 (85.6 %) had no reported complications with good graft incorporation. In the remaining 39 with reported complications, only 5 (2.6 %) developed a postoperative infection. Our findings suggest that the use of fresh frozen allograft does not materially increase the risk of post-operative bacterial infection. Our reported post-operative infection rates are comparable with infection rates of other similar studies on fresh frozen allograft use. © 2016 Springer Science+Business Media Dordrecht


Hamilton P.D.,Addenbrookes Hospital | Hariharan K.,The Royal Gwent Hospital | Robinson A.H.N.,Addenbrookes Hospital
Foot and Ankle Surgery | Year: 2011

Background: The incidence of venous thromboembolism (VTE) is unknown in elective foot and ankle surgery. The National Institute for Health and Clinical Excellence (NICE) recently published guidelines on reducing the risk of venous thromboembolism in surgical patients. This includes patients undergoing elective foot and ankle surgery. Method: In March 2010 we surveyed the current practice in VTE prophylaxis in elective foot and ankle surgery amongst members of the British Orthopaedic Foot and Ankle Society (BOFAS). Results: The response rate was 84 (53%). The total number of elective foot and ankle operations performed by the surveyed group was 33,500 per annum. The estimated incidence of DVT, PE and fatal PE was 0.6%, 0.1% and 0.02%. In our study the number of patients needed to treat to prevent a single fatal PE is 10,000 although this figure is open to important bias. Conclusion: We question the applicability of the NICE guidelines to patients undergoing elective foot and ankle surgery. We consider that this data justifies the prospective study of the incidence of VTE in patients undergoing elective foot and ankle surgery, without the use of chemical thromboprophylaxis. © 2011 European Foot and Ankle Society.


PubMed | The Royal Gwent Hospital
Type: Journal Article | Journal: Cell and tissue banking | Year: 2016

Femoral head bone allografts have traditionally been used to provide mechanical stability to areas of bony deficiency, or for its osteoinductive and osteoconductive properties. Concerns have been raised over increased infection rates following the use of fresh-frozen graft tissue. This retrospective study aims to investigate the outcomes of fresh frozen femoral heads kept in a regulated, non-commercial bone bank at a university teaching hospital.The local bone bank database was used to identify released femoral heads during a 14year study period (September 1999-December 2013) whereby a retrospective review of patient records was undertaken to determine clinical outcome. During the observed study period, 427 femoral heads were released from cold storage. Of these, 270 femoral heads had a mean follow-up of 347days. 157 femoral heads were excluded due to insufficient follow-up data (n=132) or discarded due to breaks in the cold chain prior to use (n=25). Of the 270 included femoral heads, 231 (85.6%) had no reported complications with good graft incorporation. In the remaining 39 with reported complications, only 5 (2.6%) developed a postoperative infection. Our findings suggest that the use of fresh frozen allograft does not materially increase the risk of post-operative bacterial infection. Our reported post-operative infection rates are comparable with infection rates of other similar studies on fresh frozen allograft use.

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