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Bath, United Kingdom

Peden C.,Royal United Hospital Bath
Update in Anaesthesia

With an increasingly aged world population and rising expectations of the level of therapy offered for a wide range of illnesses, the ICU is a common place to die. The attitudes of patient,s relatives and medical staff vary greatly between countries, cultures and religions. This article provides and overview of the factors we should consider when managing patients with a critical illness, particularly concerning endof- life care. Source

Nolan J.P.,Royal United Hospital Bath | Pullinger R.,John Radcliffe Hospital Oxford
BMJ (Online)

The priority in treating haemorrhagic shock is to stop the bleeding. Before haemorrhage is controlled, fluid resuscitation should be individualised: the decision to give fluid is determined by the risk of organ ischaemia versus the risk of increasing the bleeding. Fluid resuscitation may be initiated with crystalloid and blood is given to achieve a haemoglobin concentration of 8-10 g/dL. Adequate warming of all fluid is essential and coagulopathy is common. In the presence of massive haemorrhage, early infusion of FFP and platelets, as well as blood, may increase survival. © 2014, BMJ Publishing Group. All rights reserved. Source

Woolf D.K.,Breast Research Unit | Beresford M.,Royal United Hospital Bath | Li S.P.,Breast Research Unit | Dowsett M.,Royal Marsden Hospital | And 8 more authors.
British Journal of Cancer

Background:[18 F]fluorothymidine (FLT) has been proposed as a positron emission tomography (PET)-imaging biomarker of proliferation for breast cancer. The aim of this prospective study was to assess the feasibility of FLT-PET-CT as a technique for predicting the response to neoadjuvant chemotherapy (NAC) in primary breast cancer and to compare baseline FLT with Ki-67.Methods:Twenty women with primary breast cancer had a baseline FLT-PET-CT scan that was repeated before the second cycle of chemotherapy. Expression of Ki-67 in the diagnostic biopsy was quantified. From the FLT-PET-CT scans lesion maximum and mean standardised uptake values (SUV max, SUV mean) were calculated.Results:Mean baseline SUV max was 7.3, and 4.62 post one cycle of NAC, representing a drop of 2.68 (36.3%). There was no significant association between baseline, post chemotherapy, or change in SUV max and pathological response to NAC. There was a significant correlation between pre-chemotherapy Ki-67 and SUV max of 0.604 (P=0.006).Conclusions:Baseline SUV max measurements of FLT-PET-CT were significantly related to Ki-67 suggesting that it is a proliferation biomarker. However, in this series neither the baseline value nor the change in SUV max after one cycle of NAC were able to predict response as most patients had a sizeable SUV max reduction. © 2014 Cancer Research UK. Source

Patel R.P.,Northwick Park Hospital | Katsargyris A.,Klinikum Nurnberg | Verhoeven E.L.G.,Klinikum Nurnberg | Adam D.J.,Heartlands Hospital | Hardman J.A.,Royal United Hospital Bath
CardioVascular and Interventional Radiology

The chimney technique in endovascular aortic aneurysm repair (Ch-EVAR) involves placement of a stent or stent-graft parallel to the main aortic stent-graft to extend the proximal or distal sealing zone while maintaining side branch patency. Ch-EVAR can facilitate endovascular repair of juxtarenal and aortic arch pathology using available standard aortic stent-grafts, therefore, eliminating the manufacturing delays required for customised fenestrated and branched stent-grafts. Several case series have demonstrated the feasibility of Ch-EVAR both in acute and elective cases with good early results. This review discusses indications, technique, and the current available clinical data on Ch-EVAR. © 2013 Springer Science+Business Media New York and the Cardiovascular and Interventional Radiological Society of Europe (CIRSE). Source

Foster J.D.,Yeovil District Hospital | Pathak S.,Royal United Hospital Bath | Smart N.J.,University of Bristol | Branagan G.,Salisbury District Hospital | And 3 more authors.
Colorectal Disease

Aim An improvement in oncological outcome has been reported following an extralevator approach to abdominoperineal excision (ELAPE) for low rectal carcinoma. A larger perineal defect following ELAPE and the impact of neoadjuvant radiotherapy are sources of considerable morbidity for patients. We report an evidence-based systematic review of published data on the outcome of perineal reconstruction following ELAPE for low rectal carcinoma, comparing the use of tissue flap and biological mesh techniques. Method A literature search was performed of electronic databases including the Medline, Embase and Scopus databases (1995-2011). Studies describing outcomes relating to the perineum following ELAPE were included for review. Results Eleven small cohort studies reported the outcome relating to the perineum following ELAPE. Pooled-analysis of 255 combined patients undergoing flap repair and 85 undergoing biological mesh repair showed no significant difference in the rates of perineal wound complications or perineal hernia formation. Conclusion There is little information on the optimal technique of perineal wound closure following ELAPE. With the limited data available, there was no significant difference in complication rates between biological mesh and flap repair. There is a need for high-quality prospective trials to compare methods of reconstruction to determine the long-term results, quality of life and function. © 2012 The Authors. Colorectal Disease © 2012 The Association of Coloproctology of Great Britain and Ireland. Source

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