D'Souza N.,Poole Hospital |
Sunthareswaran R.,Stoke Mandeville Hospital
International Journal of Surgery | Year: 2013
Introduction: Every investigation that can contribute towards a diagnosis of appendicitis is valuable to the emergency general surgeon. Previous research has suggested that hyperbilirubinaemia is a more specific marker for both simple and perforated appendicitis than WBC (white blood count) and CRP (C-reactive protein), but this investigation is not commonly used to help diagnose appendicitis. Aims: This study investigated whether there is an association between hyperbilirubinaemia and appendicitis. We also reviewed the diagnostic value of bilirubin in perforated vs simple appendicitis, and compared it with the serum C-reactive protein (CRP) and white blood cell count (WBC). Methods: This single centre, prospective observational study included all patients admitted with right iliac fossa (RIF) pain who had liver function tests performed. Statistical analysis was performed using Fisher's exact test to compare bilirubin, WBC and CRP levels for normal appendices, simple appendicitis, and perforated appendicitis. Results: 242 patients were included in this study, of whom 143 were managed operatively for RIF pain.Hyperbilirubinaemia was significantly associated with appendicitis vs RIF pain of other aetiologies (p<0.0001). Bilirubin had a higher specificity (0.96), than WBC (0.71) and CRP (0.62), but a lower sensitivity (0.27 vs 0.68 and 0.82 respectively).Hyperbilirubinaemia was associated with perforated appendicitis vs simple appendicitis with statistical significance (p<0.0001). Bilirubin had a higher specificity (0.82) than both WBC (0.34) and CRP (0.21), but a lower sensitivity (0.70 vs 0.80 and 0.95 respectively). Conclusion: Our findings confirm that hyperbilirubinaemia has a high specificity for distinguishing acute appendicitis, especially when perforated, from other causes of RIF pain, particularly those not requiring surgery. © 2013 Surgical Associates Ltd.
Silver J.R.,Stoke Mandeville Hospital
BJU International | Year: 2011
Historical review of the management of the bladder in patients with spinal injuries. Spinal injury patients - literature review - personal experience at Stoke Mandeville Hospital. Review of the different methods of catheterisation from the 19th century to today. Methods learned from the management of the bladder of spinal injuries patients were adopted into mainstream urology. © 2011 BJU INTERNATIONAL.
Goutos I.,Stoke Mandeville Hospital
Burns | Year: 2010
Pruritus is a universal symptom associated with burns healing. Little research has been conducted to assess physicians' attitudes and management principles in specialist units. A survey of UK burn units has identified a variety of opinions on the importance of various factors affecting the incidence of pruritus and a lack of a systematic approach in the assessment and treatment of this distressing symptom. A clear pattern emerged favouring the use of antihistaminergic agents for burns pruritus management with a low uptake of agents acting on the central nervous system as well as non-pharmacological adjuncts. The cumulative responses from the cohort of respondents are presented and issues pertinent to further research and clinical management are discussed. © 2009 Elsevier Ltd and ISBI.
Benjamin L.,Stoke Mandeville Hospital
Eye (London, England) | Year: 2014
Surgical training in ophthalmology has altered significantly over the last 25 years as a result of changes in technology, teaching methodology, and the recognition of the need for better structure and supervision. Along with this have evolved changes in curriculae and also in service delivery of our rapidly advancing specialty. Initial abandonment of time-based training has now reached the point of a slightly uneasy combination of a time- and competency-based structure, which will find firmer foundations in the near future. Simulation training and recognition of time spent in practising surgical skills will be important issues for future training programmes.
Sellers W.F.S.,Stoke Mandeville Hospital
British Journal of Anaesthesia | Year: 2013
SummaryManagement of life-threatening acute severe asthma in children and adults may require anaesthetic and intensive care. The inhaled route for drug delivery is not appropriate when only small respiratory gas volumes are shifted; the i.v. route may be associated with greater side-effects. Magnesium sulphate i.v. has a place in acute asthma management because it is a mild bronchodilator, and has a stabilizing effect on the atria which may attenuate tachycardia occurring after inhaled and i.v. salbutamol. If intubation and ventilation are required, a reduction in bronchoconstriction by any means before and during these procedures should reduce morbidity. This narrative review aims to show strengths and weakness of the evidence, present controversies, and forward opinions of the author. The review contains a practical guide to the setting up, use and efficiency of nebulizers, metered dose inhalers, and spacers (chambers). It also presents a commonsense approach to the management of severe asthmatics in whom delay in bronchodilatation would cause clinical deterioration. When self-inhaled agents have had no effect, i.v. drugs may help avoid intubation and ventilation. The review includes suggestions for the use of inhaled anaesthetics, anaesthetic induction, and brief notes on subsequent ventilation of the lungs. © 2012 © The Author . Published by Oxford University Press on behalf of the British Journal of Anaesthesia. All rights reserved.