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Bristol, United Kingdom

Virgo P.F.,Southmead Hospital | Gibbs G.J.,Musgrove Park Hospital
Annals of Clinical Biochemistry | Year: 2012

Flow cytometry has had an impact upon all areas of clinical pathology and now, in the 21st century, it is truly coming of age. This study reviews the application of ow cytometry within clinical pathology with an emphasis upon haematology and immunology. The basic principles of ow cytometry are discussed, including the principles and considerations of the ow-cell and hydrodynamic focusing, detector layout and function, use of uorochromes and multicolour ow cytometry (spectral overlap and colour compensation), alongside the strategies available for sample preparation, data acquisition and analysis, reporting of results, internal quality control, external quality assessment and ow sorting. The practice of ow cytometry is discussed, including the principles and pitfalls associated with leukocyte immunophenotyping for leukaemia and lymphoma diagnosis, immune deciency, predicting and monitoring response to monoclonal antibody therapy, rare event detection and screening for genetic disease. Each section is illustrated with a case study. Future directions are also discussed. Source

Wong N.A.C.S.,Royal Infirmary | Melegh Z.,Southmead Hospital
Histopathology | Year: 2011

Gastrointestinal stromal tumours can express CD10 and epithelial membrane antigen but not oestrogen receptor or HMB45 Aims: Gastrointestinal stromal tumour (GIST) may share morphological and/or immunohistochemical features with various intra-abdominal neoplasms, including endometrial stromal sarcoma, perivascular epithelioid cell tumour (PEComa), melanoma and synovial sarcoma. Each of these various neoplasms has characteristic immunohistochemical markers, including epithelial membrane antigen (EMA), CD10, oestrogen receptor alpha (ERa) and/or HMB45, and therefore the primary aim of this study was to determine whether these markers are also expressed by GISTs. Methods and results: Standard size sections of 52 GISTs were immunostained for EMA, CD10, ERa and a melanoma marker cocktail (targeting HMB45 and melan-A). Ten GISTs (19%) showed CD10 immunopositivity. This positivity was confined almost completely to small intestinal GISTs, and was seen among spindle cell GISTs but not epithelioid or mixed cell-type GISTs. Five of the 52 GISTs (9.6%) showed EMA immunopositivity. This positivity was always focal and usually seen in a perivascular location. None of the GISTs showed immunopositivity for ERa or the melanoma marker cocktail. Conclusions: GISTs occasionally show CD10 immunopositivity (especially small intestinal spindle cell GISTs), and infrequently show focal EMA positivity. GISTs do not show immunopositivity for ERa or HMB45. © 2011 Blackwell Publishing Limited. Source

Davis C.R.,Southmead Hospital
Annals of the Royal College of Surgeons of England | Year: 2010

INTRODUCTION Healthcare-associtated infections cost the UK National Helth Service £ billon per annum. Poor hand hygiene is the main route of transmission for methicillin-resistant Staphylococcus aureus (MRSA), leading to increased mortality and morbidity for infected patients. This studay aims to quantify MRSA infection rates and compliance of alcohol get application at the entrance to a surgical ward and assess how a simple intervention affects compliance. SUBJECTS AND METHODS Compliance was assessed via a discretely positioned close-surveillance camera at the ward entrance. Footage was reviewed to monitor compliance of all persons entering the ward over a 12-month period. RESULTS For the initinal 6 months, men alocohol get compliance was 24% for all persons entering the ward. After this period, a conspicuous strip of bright red tape was positioned along the corridor approaching the ward entrance. The red line continued up the wall to the two alcohol gel dispensers on the wall. Mean compliance over the subsequent 6 months significantly improved to 62%(p<0.0001); compliance improved for all persons entering the ward as follows (before-after, singificance): Doctors(0%-54%, p<0.01); nurse(24%-75%, p<0.05); porters(21%-67%, p<0.05); visitors(35%-68%, p<); patients(23%-44%. p>). There were two cases of MRSA bacteraemia in the initial 6 months and no cases in the followoing 6 months with the red line in situ. CONCLUSIONS This study demonstrates how a simple intervention sigificantly improves hand-hygienne compliance with associated eradication of MRSA. Source

Nolan J.P.,Royal United Hospital | Soar J.,Southmead Hospital
Current Opinion in Critical Care | Year: 2010

PURPOSE OF REVIEW: The purpose of this study is to discuss recent data relating to the treatment of cardiac arrest survivors. This is a rapidly evolving component of resuscitation medicine that impacts significantly on the quality of survival after cardiac arrest. RECENT FINDINGS: The postcardiac arrest syndrome comprises postcardiac arrest brain injury, postcardiac arrest myocardial dysfunction, the systemic ischaemia/reperfusion response, and the persistent precipitating disease. Primary percutaneous coronary intervention is the preferred method for restoring coronary perfusion when cardiac arrest has been caused by an ST-elevation myocardial infarction. Many cardiac arrest survivors with non-ST-elevation myocardial infarction may also benefit from urgent percutaneous coronary intervention. Comatose cardiac arrest survivors should be managed with a moderate blood glucose target range of below 10 mmol/l (180 mg/dl). Therapeutic hypothermia is now generally accepted as part of a treatment strategy for comatose survivors of cardiac arrest, but its use may render conventional methods of prognostication unreliable. SUMMARY: Survivors from cardiac arrest develop a postcardiac arrest syndrome. Postresuscitation care, including primary percutaneous coronary intervention, therapeutic hypothermia, and control of blood sugar, improves survival and neurological outcome in cardiac arrest survivors. Completely reliable prognostication in comatose survivors of cardiac arrest is difficult to achieve. © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins. Source

Bradley M.,Southmead Hospital
Clinical Radiology | Year: 2012

Aim: To outline the pitfalls for image-guided percutaneous removal of foreign bodies (FBs). Materials and methods: Three hundred and fifty prospective patients were referred for ultrasound imaging for FB diagnosis and percutaneous removal during 2008-2010. Those patients with suitable FBs were offered guided percutaneous removal. The procedural methods and difficulties were recorded and all outcomes were noted, including surgical success and complications. Results: Sixty-three patients had a negative ultrasound for FB and they were discharged with no subsequent attendances. Of the remaining 287 patients, 12 were deemed unsuitable for percutaneous removal, 15 attempted percutaneous removals failed, and eight were not attempted due to lack of symptoms. The remaining 252 patients underwent successful retrieval and there were no procedural complications. The procedural limitations were mainly related to the anatomical site, type of FB, instrumentation, bubbles, ultrasound beam width, and mobility of the FB. Conclusion: Ultrasound-guided percutaneous removal of FBs is a safe and viable approach to the management of FBs achieving at least 88% success overall and with attention to the pitfalls, the learning curve should improve the success rate. © 2011 The Royal College of Radiologists. Published by Elsevier Ltd. All rights reserved. Source

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