The Royal Free Hospital

London, United Kingdom

The Royal Free Hospital

London, United Kingdom
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Davies J.,The Royal Free Hospital | Kadir R.A.,The Royal Free Hospital
Thrombosis Research | Year: 2017

Heavy menstrual bleeding (HMB) is defined as excessive menstrual blood loss (MBL) > 80 mL per cycle, that interferes with a woman's physical, emotional, social wellbeing and quality of life. Aetiology is due to underlying uterine pathologies, coagulopathy, ovulation dysfunction, or iatrogenic. Up to 20% of women with HMB will have an underlying inherited bleeding disorder (IBD). Assessment of HMB should entail a menstrual and gynaecological history and a bleeding score to distinguish those women who require additional haematological investigations. A pelvic examination and ultrasound scan help to rule out presence of any underlying pathology. Management depends on the underlying cause and the woman's preference and her fertility wishes. Medical therapies include hormonal treatments; levonorgestrel-releasing intrauterine system (LNG-IUS) and combined hormonal contraceptives are most commonly used. Ulipristal acetate is an approved preoperative treatment for uterine fibroids, and has demonstrated efficacy in reducing MBL. Haemostatic therapies include tranexamic acid and DDAVP (1-deamino-8-D-arginine). DDAVP is used for HMB associated with certain IBDs. These therapies can be used in isolation or in combination with hormonal treatments. HMB associated with certain severe IBDs may require factor concentrate administration during menses to alleviate symptoms. Endometrial ablation is a minor surgical procedure that is associated with low operative morbidity and can be performed as an outpatient. Hysterectomy remains the definitive treatment of choice when medical therapies have failed and endometrial ablation is not suitable. © 2017

News Article | March 2, 2017

- Cydar announces the appointment of Lord Davies of Abersoch as Chairman, Dr Franz B. Humer and James Downing as Non-Executive Directors - Professor John E. Deanfield to head a new Scientific and Technology Advisory Board - First US installation at Major U.S. Academic Medical Center Cydar Limited ("the Company"), a world leading cloud based surgical guidance software company, announces the appointment of a new Non-Executive Chairman and new Non-Executive Directors. Lord Davies of Abersoch has been appointed Non-Executive Chairman. Dr Franz B. Humer and James B. Downing join the Board as Non-Executive Directors. Professor John Deanfield, will head a new Scientific and Technology Advisory Board. Cydar is the first company in the world using high performance cloud computing to provide surgical guidance in the operating room. At its core, fully-automatic computer vision tracks patients during X-ray guided surgery; enabling it to combine diagnostic scans, planning information and real-time imaging with millimetre precision. "I am delighted to join Cydar as Non-Executive Chairman. The UK is a recognised leader in knowledge based industries, and commercialising British Science is a key driver for long term economic growth. Cydar represents an opportunity for the digital revolution in medicine to help break through the intelligence barrier and generate evidence based improvements for better healthcare outcomes. I look forward to working with the Board and Executives to ensure Cydar has the right strategy and human capital, to help build an innovative, global company to achieve its great potential." "Our successful transition from early-stage to growth company is testament to the efforts of our original Board and outgoing Non-Executive Chairman Mark Evans, who remains as a Non-Executive Director. We believe the skills and experience that Lord Davies, Dr Franz Humer, Jim Downing and Prof John Deanfield now bring will prove invaluable as we pursue our commercial and technology aspirations to be a world leader in cloud based surgical guidance software." First US Luminary Site at Duke University Hospital The Company also announces that it has signed its first US contract with the prestigious Duke University Hospital. This marks the Company's strategic decision to open a US gateway for its first FDA-cleared product, Cydar EV, and to pre-launch its US commercialisation strategy whilst it continues to develop its next clinical indications. Cynthia K. Shortell, M.D. Professor and Chief, Division of Vascular Surgery. Acting Chief, Division of Trauma and Critical Care Surgery. Chief of Staff, Department of Surgery, Duke University Medical Center, commented: "Data from the clinical trials that supported the product's approval suggest it has the potential to be a significant advance in image-guided surgery. We look forward to the opportunity to gain experience with this exciting new technology." "We are delighted to be working with Duke and Professor Cynthia Shortell. Duke is a key luminary site for us and this is an invaluable gate-opening and validation of our Software as a Service offering". "The contract with Duke is the culmination of our efforts to establish a US presence. Installation and onboarding there represents the completion of a comprehensive evaluation process, which included IT, information security, operating room, data sharing and business approvals. We now have significant interest in our product from US physicians and hospitals alike and I expect Duke to act as springboard for our US launch in March." Lord Mervyn Davies brings commercial and international experience to the Board as both a former CEO and Chairman of Standard Chartered Bank, former Minister for Trade, Investment, Small Business and Infrastructure and as current Chairman of Corsair Capital and a Director across a diverse range of companies. Dr Franz B. Humer brings a wealth of healthcare and commercialisation experience as well as deep insights into clinical applications and health data. He is former CEO and Chairman of Roche Plc, having previously been at Glaxo and Schering Plough. James Downing brings extensive deal structuring and negotiating skills as a corporate finance specialist, and former Deputy Head of European Investment Banking at JP Morgan Chase & Co and currently as Non-Executive Director on a number of companies. Professor Deanfield brings expertise in cardiovascular imaging, large-scale clinical trials and outcomes research, both nationally and internationally. He is Professor of Cardiology at University College London and Director of the National Institute for Cardiovascular Outcomes Research (NICOR). Cydar Ltd is a private UK company established in 2012, originally a spin out from Kings College London and Guys & St Thomas' NHS trust. It has successfully completed clinical trials to gain CE Mark and FDA Clearance for its first product - Cydar EV - in 2016 and is currently being used in several UK hospitals, including The Royal Free Hospital and at Guys & St Thomas's Hospital, in London. Cydar Inc (US) is a wholly-owned subsidiary of Cydar Ltd.

Tolan D.J.M.,Leeds Teaching Hospitals NHS Trust | Greenhalgh R.,The Royal Free Hospital | Zealley I.A.,Ninewells Hospital | Halligan S.,University College London | Taylor S.A.,University College London
Radiographics | Year: 2010

Magnetic resonance (MR) enterography is a clinically useful technique for the evaluation of both intraluminal and extraluminal small bowel disease, particularly in younger patients with Crohn disease. MR enterography offers the advantages of multiplanar capability and lack of ionizing radiation. It allows evaluation of bowel wall contrast enhancement, wall thickening, and edema, findings useful for the assessment of Crohn disease activity. MR enterography can also depict other pathologic findings such as lymphadenopathy, fistula and sinus formation, abscesses, and abnormal fold patterns. Even subtle disease manifestations may be detected when adequate distention of the small bowel is achieved, although endoscopic and double-contrast barium small bowel techniques remain superior in the depiction of changes in early Crohn disease (eg, aphthoid ulceration). Further research will be needed to determine whether MR imaging enhancement patterns may reliably help discriminate between active and inactive disease. © RSNA, 2010.

Agarwal B.,The Royal Free Hospital | Davenport A.,University College London
World Journal of Hepatology | Year: 2014

Renal function in patients with advanced cirrhosis is an important prognostic factor for survival both prior to and following liver transplantation. The importance of renal function is reflected by the introduction of the model for end stage liver disease (MELD) score, which includes serum creatinine. The MELD score has been shown to predict the short term risk of death for transplant wait listed patients and is currently used by many countries to allocate liver transplants on the basis of severity of underlying illness. Changes in serum creatinine are also used to stage acute kidney injury. However prior to liver transplantation the serum creatinine typically over estimates underlying renal function, particularly when a colorimetric Jaffe based assay is used, and paradoxically then under estimates renal function post liver transplantation, particularly when immunophyllins are started early as part of transplant immunosuppression. As acute kidney injury is defined by changes in serum creatinine, this potentially leads to over estimation of the incidence and severity of acute kidney injury in the immediate post-operative period. © 2014 Baishideng Publishing Group Inc.

Saksena J.,The Whittington Hospital | Platts A.D.,The Royal Free Hospital | Dowd G.S.E.,The Royal Free Hospital
Knee | Year: 2010

Total knee replacement is a well-established treatment for osteoarthritis with increasing numbers performed each year. Recurrent haemarthrosis is a relatively rare complication following TKR being reported in up to 1.6% of patients. While some causes are related to direct trauma to blood vessels, others are more obscure and may be difficult to diagnose. The purpose of this review is to give an overview of this unusual complication and summarise the current methods of management. © 2009 Elsevier B.V. All rights reserved.

Kadir R.A.,The Royal Free Hospital | Davies J.,The Royal Free Hospital
Journal of Thrombosis and Haemostasis | Year: 2013

The past few decades have seen major advances in multidisciplinary obstetric care and management of gynecological conditions in women with bleeding disorders. Awareness of the impact of bleeding disorders has improved among the obstetric and gynecological community. Undiagnosed bleeding disorders can be the underlying cause for a significant proportion of women with heavy menstrual bleeding. They may also be the cause or a contributory factor for other gynecological problems, such as dysmenorrhea, intermenstrual bleeding, and endometriosis. Hemostatic assessment should be considered in women referred for menstrual abnormalities if they have a positive bleeding history as quantified by bleeding assessment tools. The reproductive choices and options for prenatal diagnosis are also expanding for families with hemophilia with a drive toward achieving a non-invasive approach. Current non-invasive prenatal diagnostic techniques are limited to identification of fetal gender. Research is ongoing to overcome the specific diagnostic challenges of identifying hemophilia mutations, utilizing free fetal DNA circulating in maternal plasma. The management of obstetric hemorrhage has recently evolved to include a greater focus on the identification of and early treatment for coagulation disorders. Deficiencies in certain hemostatic variables are associated with progression to more severe bleeding; therefore, specific interventions have been proposed to target this. Evidence is still lacking to support such strategy, and future research is required to assess the efficacy and the safety of these hemostatic interventions in women with persistent PPH. © 2013 International Society on Thrombosis and Haemostasis.

Berwin J.T.,The Royal Free Hospital
BMJ case reports | Year: 2012

An 84-year-old lady with a history of chronic recurrent rectal prolapse, presented to accident and emergency with a significant portion of small bowel and mesentery protruding out of her anus. The small bowel was not contained within peritoneum, nor was this a pararectal herniation. On examination of the rectum, a longitudinal tear was found in the anterior rectal wall, through which the small bowel had prolapsed. Hours after reducing the small bowel back into the anus, it prolapsed a second time. Due to multiple co-morbidities, this patient was not fit for surgery. The defect was temporarily repaired on the ward and the patient treated with aggressive antibiotic therapy. The patient continued to deteriorate, became septic, acidotic, hypotensive and died a day later.

Trigg D.E.,The Royal Free Hospital | Stergiotou I.,The Royal Free Hospital | Peitsidis P.,The Royal Free Hospital | Kadir R.A.,The Royal Free Hospital
Haemophilia | Year: 2012

Desmopressin (DDAVP) is commonly used for treatment and prevention of bleeding complications in patients with bleeding disorders including haemophilia A, von Willebrand's disease (VWD) and other less common disorders. This article reviews the current evidence for the use of DDAVP in pregnancy to clarify its efficacy and safety with regard to maternal and foetal outcome. A search of the literature found 30 studies that reported DDAVP use in pregnancy for prophylaxis or treatment of bleeding complications with 216 pregnancies reported in total. The most common indication was prophylaxis for prevention of bleeding during pregnancy and postpartum haemorrhage. DDAVP was used successfully in the first and early second trimester for bleeding prophylaxis in 50 pregnancies. No postpartum bleeding complications were reported in 167 out of 172 pregnancies when DDAVP was used for peripartum haemostatic cover. Twenty-nine studies reported no significant adverse events as a result of treatment with DDAVP. One case of water intoxication seizure and one case of premature labour following the use of DDAVP was reported in a single study. Other maternal side effects included facial flushing and headache and were reported by one study. These side effects were generally well tolerated by patients. There were no other significant adverse events reported in any of the studies as a result of DDAVP use. Foetal outcome was recorded in ten studies with no adverse foetal outcomes. In conclusion, this review shows that DDAVP in selected cases is effective in reducing bleeding complications associated with pregnancy and childbirth with a good safety record. Further research is needed to confirm these findings as they are based on the currently available evidence from small studies and case series only. © 2011 Blackwell Publishing Ltd.

Huq F.Y.,The Royal Free Hospital | Kadir R.A.,The Royal Free Hospital
Haemophilia | Year: 2011

Pregnancy, labour and delivery present intrinsic haemostatic challenges to women with and carriers of bleeding disorders and their offspring. Deficiency of fibrinogen and factor XIII are associated with miscarriage, placental abruption and foetal loss. The risk of antenatal complications including antepartum haemorrhage is unknown in women with other bleeding disorders. There is a significant risk of postpartum haemorrhage (primary and secondary) in women with all types of bleeding disorders. This can be serious and life threatening in those with severe defects such as Bernard Soulier syndrome and Glanzmann's thrombasthenia. Three to four percent of infants with haemophilia experience cranial bleeding that occurs during labour and delivery. The safest method of delivery for affected babies remains controversial. However, the rate of planned Caesarean section is increasing among known carriers of haemophilia. If vaginal delivery is planned, prolonged labour and difficult delivery especially vacuum extraction are associated with the highest risk of cranial bleeding and should be avoided. The optimal management of pregnancy in women with inherited bleeding disorders requires a multidisciplinary approach and advanced individualized management plan taking into consideration obstetric and bleeding risk factors. Women with mild or moderate bleeding disorders can be managed at their local maternity unit in close collaboration with a tertiary centre. However, those with severe or rare disorders or carrying an affected infant should be managed in a tertiary centre with an onsite Haemophilia centre. © 2011 Blackwell Publishing Ltd.

Wong J.M.-L.,The Royal Free Hospital | Mann H.A.,The Royal Free Hospital | Goddard N.J.,The Royal Free Hospital
Haemophilia | Year: 2012

Total knee arthroplasty, or replacement (TKR), is now the most commonly performed surgical procedure performed in adults with haemophilia. It is indicated when end-stage haemophilic arthropathy results in intractable pain and reduced function. In patients with haemophilia, however, there has always been a concern about the high risk of infection, which carries with it potentially catastrophic consequences. The aims of this study were to review the case series of TKR for haemophilic arthropathy published in the medical literature, comparing the published infection rates and the differing clotting factor replacement regimes employed. Nineteen retrospective case series were identified; representing 556 TKR's in 455 patients with an overall infection rate of 7.9%. Case series which maintained a high level of clotting factor replacement throughout the first two postoperative weeks, however, had an infection rate of 2.15%, significantly lower than that of case series using the clotting factor replacement regime currently recommended in the World Federation of Hemophilia guidelines (9.22%P=0.00545). We believe this study supports the use of a high level clotting factor replacement regime, replacing clotting factors to maintain them at a higher level for a longer period of time than currently recommended in international guidelines. © 2011 Blackwell Publishing Ltd.

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