2014

The diagnosis of malignancy following a venous thromboembolic event-how high is the risk? (2014)

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Type of publication:
Conference abstract

Author(s):
*Crawford E., *Moudgil H., *Naicker T., *Ahmad N., *Srinivasan K.

Citation:
European Respiratory Journal, September 2014, vol./is. 44 Supp 58

Abstract:
UK guidance on the treatment of venous thromboembolism (VTE) recommends that patients with a first, unprovoked VTE should be screened for malignancy. This is based on two historical population-based studies which suggest that between 7.5 and 11% of patients diagnosed with an unprovoked VTE will develop cancer in the following two years. (Murchison, J. T. et al. Br J Cancer 2004;91(1):92-95. Baron, J.A. et al. Lancet 1998; 351(9109):1077-1080.) We wanted to compare local figures with this historical data in order to aid local guideline development. A retrospective case note review identified 417 patients within our institution diagnosed with VTE between January 2010 and January 2011. Ten of these patients (2%) developed cancer in the two years following diagnosis. Results In 2 out of 10 of these patients, tests performed as part of the routine work-up for VTE identified abnormalities that ultimately led to a diagnosis of cancer. None of the patients had extensive malignancy screening as advocated by current UK guidance. Within our local population, the risk of developing cancer in the two years following an unprovoked VTE appears to be significantly less than figures quoted in the literature. UK guidelines may not reflect current medical practice, which could be identifying cancer earlier, nor does it take into account the possibility of regional and national variations of disease. A cautious approach should be taken when counselling patients regarding future cancer risk and when considering further investigations for malignancy.

Link to more details or full-text: http://erj.ersjournals.com/content/44/Suppl_58/P4115

 

UK consensus position on the management of homozygous familial hypercholesterolaemia and the introduction of new agents (2014)

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Type of publication:
Conference abstract

Author(s):
R. Cramb, H. Soran, *N. Capps, A. Rees, K. Ray, W. Madira, J. Deanfield, G. Thompson

Citation:
Atherosclerosis, August 2014, vol./is. 235/2(e252-e253), 0021-9150 (August 2014)

Abstract:
Objectives: To provide a consensus position on the potential use of new therapies in the management of homozygous familial hypercholesterolaemia (HoFH) based on a review of the current standards of care, unmet medical need and new clinical evidence. The term HoFH is used to include compound heterozygous familial hypercholesterolamia as defined in the National Institute for Clincal Excellence guidelines. Methods: Participants in this discussion included clinicians managing HoFH in specialist centres, clinicians from lipid clinics and cardiologists with an interest in lipid disorders. Results: HoFH is a rare inherited disorders of cholesterol metabolism with a historical reported prevalence of 1/1,000,000. A survey in the United Kingdom (UK) identified 43 patients with a diagnosis of HoFH who receive care in one of 8 UK specialist centres. Conventional lipid lowering agents have a limited variable effect on low density lipoprotein cholesterol (LDLC) levels in HoFH. The current standard of care is by the use of lipoprotein apheresis that provides a temporary reduction in LDL-C with repeat apheresis at weekly or fortnightly intervals. Some of these patients are unable to tolerate regular apheresis, a high proportion may not achieve the European Athereosclerosis Society LDL-C targets for apheresis and there is uncertainty whether regular apheresis will prevent progression of disease. With the advent of new therapeutic approaches, the first of these being a microsomal transfer protein (MTP) inhibitor, UK clinicians have considered adopting a potentital management pathway to enhance care of patients with HoFH. Conclusion: HoFH are rare but life-threatening conditions, that require specialist therapeutic options. We describe a management pathway for patients with HoFH that considers current therapeutic options and directs the indications for new treatments to ensure maximum clinical benefit.

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Calcaneus osteotomy (2014)

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Type of publication:
Journal article

Author(s):
Tennant J.N., *Carmont M., Phisitkul P.

Citation:
Current Reviews in Musculoskeletal Medicine, 2014, vol./is. 7/4(271-276), 1935-973X;1935-9748 (2014)

Abstract:
Calcaneal osteotomy is an extra-articular, joint-sparing procedure that is used in the correction of cavovarus and planovalgus foot deformity. Careful indications and contraindications for the procedure, with meticulous surgical technique, should be followed to avoid complications and to achieve optimal outcomes. Multiple options of osteotomies exist, including translational (medializing and lateralizing calcaneal osteotomy, with ability to slide proximally or distally, closing wedge (Dwyer), and rotational type osteotomies (Evans, Z-osteotomy). Future directions for innovation include developments of both implants and surgical techniques.

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The Telford tonsillectomy tie trainer: an AirSim model modification (2014)

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Type of publication:
Journal article

Author(s):
*Douglas, JA; *Senior, AJ; *Scott, A

Citation:
Annals of The Royal College of Surgeons of England, Volume 96, Number 8, November 2014, pp. 634-634(1)

Abstract:

Link to more details or full-text: http://www.ingentaconnect.com/content/rcse/arcs/2014/00000096/00000008/art00042

Abdominal cocoon (2014)

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Type of publication:
Journal article

Author(s):
*Christian B S Katz, *Robert T Diggory, Abdus Samee

Citation:
BMJ Case Reports 2014; doi:10.1136/bcr-2013-203102

Abstract:
Intestinal obstruction secondary to cocoon formation is not common. We report a case of a patient who had presented with abdominal pain and distension accompanied by vomiting. Investigations, laparotomy and histology together revealed primary peritoneal carcinoma as the cause of the patient’s symptoms.

Link to more details or full-text: http://casereports.bmj.com/content/2014/bcr-2013-203102.full.pdf+html

The stages of extrication: A prospective study (2014)

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Type of publication:
Journal article

Author(s):
Nutbeam T., *Fenwick R. , Hobson C., Holland V., Palmer M.

Citation:
Emergency Medicine Journal, December 2014, vol./is. 31/12(1006-1008), 1472-0205;1472-0213 (01 Dec 2014)

Abstract:
Background: Many patients will require extrication following a motor vehicle collision (MVC). Little information exists on the time taken for the various stages of extrication. Objective: To report the time taken for the various stages of extrication. Methods: A prospective, observational study carried out in the West Midland Fire Service’s metropolitan area. Time points related to extrication were collected ’live’ by two-way radio broadcast. Any missing data were actively gathered by fire control within 1 h of completion of extrication. This paper reports an interim analysis conducted after 1 year of data collection following a 3-month run-in and training period: data were analysed from 1 January 2011 to 31 December 2011 inclusive. Results: During the study period 228 incidents were identified. Seventy-nine were excluded as they met the predetermined exclusion criteria or had incomplete data collection. This left 158 extrications that were suitable for analysis. The median time for extrication was 30 min, IQR 24-38 min. Conclusions: In patients requiring extrication following an MVC a median time of 8 min is typically required before initial limited patient assessment and intervention. A further 22 min is typically required before full extrication. Prehospital personnel should be aware of these times when planning their approach to a trapped patient.

Link to more details or full-text: http://emj.bmj.com/content/31/12/1006.abstract

 

Anesthetic agents in patients with very long-chain acyl-coenzyme A dehydrogenase deficiency: a literature review (2014)

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Type of publication:
Journal article

Author(s):
*Redshaw C, *Stewart C

Citation:
Pediatric Anesthesia, 11 2014, vol./is. 24/11(1115-9), 1155-5645;1460-9592 (2014 Nov)

Abstract:
Very long-chain acyl-coenzyme A dehydrongenase deficiency (VLCADD) is a rare disorder of fatty acid metabolism that renders sufferers susceptible to hypoglycemia, liver failure, cardiomyopathy, and rhabdomyolysis. The literature about the management of these patients is hugely conflicting, suggesting that both propofol and volatile anesthesia should be avoided. We have reviewed the literature and have concluded that the source papers do not support the statements that volatile anesthetic agents are unsafe. The reports on rhabdomyolysis secondary to anesthesia appear to be due to inadequate supply of carbohydrate not volatile agents. Catabolism must be avoided with minimal fasting, glucose infusions based on age and weight, and attenuation of emotional and physical stress. General anesthesia appears to be protective of stress-induced catabolism and may offer benefits in children and anxious patients over regional anesthesia. Propofol has not been demonstrated to be harmful in VLCADD but is presented in an emulsion containing very long-chain fatty acids which can cause organ lipidosis and itself can inhibit mitochondrial fatty acid metabolism. It is therefore not recommended. Suxamethonium-induced myalgia may mimic symptoms of rhabdomyolysis and cause raised CK therefore should be avoided. Opioids, NSAIDS, regional anesthesia, and local anesthetic techniques have all been used without complication.

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Minimising negative ankle and foot X-rays in the Emergency Department-Are the Ottawa ankle rules good enough? (2014)

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Type of publication:
Journal article

Author(s):
*Crosswell S, *Leaman A, *Phung W

Citation:
Injury, 12 2014, vol./is. 45/12(2002-4), 0020-1383;1879-0267 (2014 Dec)

Abstract:
OBJECTIVES: To review fracture rates in patients who had X-rays of either the ankle or foot or both in the Emergency Department of a district hospital.METHOD: A retrospective review of 2589 Emergency Department patients who had X-rays of the ankle or foot or both over a 12-month period.RESULTS: There were 1199 ankle X-rays taken of which 193 (16%) showed a significant fracture. There were 1081 patients who had a foot X-rayed of which 165 (15%) showed a significant fracture. Younger patients had more X-rays but older patients were more likely to have a fracture. There were 309 patients who had an ipsilateral ankle and foot X-rayed at the same time, and of these 42 (14%) showed one fracture and just two (0.6%) showed a significant fracture of both ankle and foot.CONCLUSIONS: The approach to X-raying ankle and feet in this study is probably widespread, and Ottawa Ankle Rules still seem to be of limited use in diagnosing fractures. This low yield of positive X-ray could be accepted or a more sophisticated ankle rule introduced. Copyright 2014 Elsevier Ltd. All rights reserved.

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BMC medicine editorial board members on open access publishing (2014)

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Type of publication:
Journal article

Author(s):
*Carmont M.R., Lawn S.D., Stray-Pedersen B., Shoenfeld Y., Meier P.

Citation:
BMC Medicine, January 2014, vol./is. 12/1, 1741-7015 (21 Jan 2014)

Abstract:
In recognition of Open Access week (21st-27th October 2013), we asked some BMC Medicine Editorial Board Members to share their views and experiences on open access publishing. In this short video, they highlight the benefits of visibility and dissemination of their research, and discuss the future directions for this model of publishing.

Link to more details or full-text: http://www.biomedcentral.com/1741-7015/12/10