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Author(s): Lambert, J., Al Majid, S., Salaman, R., Gavan, D., Sheikh, A. & Gill, M.
Source: The International Journal of Medical Robotics and Computer Assisted Surgery, 2022 Apr 20, pp. e2407. Abstract: We describe the technical operative details of the robotic repair of a type II endoleak (T2E) following endovascular abdominal aortic aneurysm repair (EVAR). We demonstrate that indocyanine green (ICG) can be used intra-operatively to demonstrate perfusion of the colon following ligation of the inferior mesenteric artery (IMA) vessel feeding the aneurysm sac. Conclusion: A total robotic approach can be performed safely with intra-operative ICG used to demonstrate colonic perfusion as an added safety measure.
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Author(s): Garg, S. et al.
Source: Cardiovascular Revascularization Medicine : including molecular interventions 2022 May; Vol. 38, pp. 124-126. Abstract: Medical and/or economic reasons sometimes necessitate the staging of percutaneous coronary intervention (SPCI) procedures in patients with complex coronary artery disease; however, the impact of this on very long-term outcomes is unknown. The aim of the present study is to assess 10-year all-cause mortality in patients with the three-vessel disease (3VD) and/or left main disease (LM) undergoing SPCI. Author(s): Garg, S. et al.
Source: Catheterization and Cardiovascular Interventions : Official Journal of the Society for Cardiac Angiography & Interventions 2022 May 02. Abstract: Several studies have suggested that proton pump inhibitors (PPIs) may reduce the antiplatelet effects of clopidogrel and/or aspirin, possibly leading to cardiovascular events. We aimed to investigate the association between PPI and clinical outcomes in patients treated with ticagrelor monotherapy or conventional antiplatelet therapy after percutaneous coronary intervention (PCI). In contrast to conventional antiplatelet strategy, there were no evidence suggesting the interaction between ticagrelor monotherapy and PPIs on increased cardiovascular events, which should be confirmed in further studies. Author(s): Azam, A et al.
Source: The European Respiratory Journal, 2022 May 12. Abstract: There is an emerging understanding that coronavirus disease 2019 (COVID-19) is associated with increased incidence of pneumomediastinum. We aimed to determine its incidence among patients hospitalised with COVID-19 in the United Kingdom and describe factors associated with outcome. Author(s): Anton Krige, Sarah G. Brearley, Céu Mateus, Gordon L. Carlson, Steven Lane
Source: BJS Open, Volume 6, Issue 3, June 2022, zrac055, Abstract: Rectus sheath catheter analgesia (RSCA) and thoracic epidural analgesia (TEA) are both used for analgesia following laparotomy. The aim was to compare the analgesic effectiveness of RSCA with TEA after laparotomy for elective colorectal and urological surgery. METHOD: Patients undergoing elective midline laparotomy were randomized in a non-blinded fashion to receive RSCA or TEA for postoperative analgesia at a single UK teaching hospital. The primary quantitative outcome measure was dynamic pain score at 24 h after surgery. A nested qualitative study (reported elsewhere) explored the dual primary outcome of patient experience and acceptability. Secondary outcome measures included rest and movement pain scores over 72 h, functional analgesia, analgesia satisfaction, opiate consumption, functional recovery, morbidity, safety, and cost-effectiveness. RESULTS: A total of 131 patients were randomized: 66 in the RSCA group and 65 in the TEA group. The median (interquartile range; i.q.r.) dynamic pain score at 24 h was significantly lower after TEA than RSCA (33 (11–60) versus 50.5 (24.50–77.25); P = 0.018). Resting pain score at 72 h was significantly lower after RSCA (4.5 (0.25–13.75) versus 12.5 (2–13); P = 0.019). Opiate consumption on postoperative day 3 (median (i.q.r.) morphine equivalent 17 (10–30) mg versus 40 (13.25–88.50) mg; P = 0.038), hypotension, or vasopressor dependency (29.7 versus 49.2 per cent; P = 0.023) and weight gain to day 3 (median (i.q.r.) 0 (−1–2) kg versus 1 (0–3) kg; P = 0.046) were all significantly greater after TEA, compared with RSCA. There were no significant differences between groups in other secondary outcomes, although more participants experienced serious adverse events after TEA compared with RSCA, which was also the more cost-effective. CONCLUSIONS: TEA provided superior initial postoperative analgesia but only for the first 24 h. By 72 hours RSCA provides superior analgesia, is associated with a lower incidence of unwanted effects, and may be more cost-effective. Author(s): Papamichail M; Department of Hepato-Pancreato-Biliary Surgery, Royal Blackburn Hospital; Pizanias M; Department of General Surgery, Whittington Hospital, London; Heaton ND; Department of Liver Transplant and Hepato-Pancreato-Biliary Surgery, Institute of Liver Studies, Kings Health Partners at King's College Hospital NHS Trust, London.
Source: Hepatobiliary & pancreatic diseases international : HBPD INT, 2022 Apr; Vol. 21 (2). Abstract: Primary and secondary liver tumors are not always amenable to resection due to location and size. Inadequate future liver remnant (FLR) may prevent patients from having a curative resection or may result in increased postoperative morbidity and mortality from complications related to small-for-size syndrome (SFSS). Author(s): Haque, Adam; Al-Khaffaf, Haytham; Cumbria and Lancashire Vascular and Endovascular Centre, East Lancashire Hospitals NHS Trust, Blackburn.Source: Annals of vascular surgery 2022 Apr; Vol. 81, pp. 267-272. Abstract: High output cardiac failure is a serious complication of arteriovenous fistulae•Re-do surgery aims to reduce flow rate through the AVF whilst maintaining access•The Secondary Extension Technique (SET) is an effective surgical technique•Evaluating the success of re-do surgery is thus far limited to clinical observation•Reductions in Pro-BNP correlate with flow rate and resolution of symptoms post SET.
Author(s): Ali M; School of Medicine, The University of Manchester: Shiwani HA; Burnley General Hospital.
Source: The Egyptian heart journal : (EHJ) : official bulletin of the Egyptian Society of Cardiology, 2022 Apr 05; Vol. 74 (1), pp. 23. Abstract: Myocarditis has been discovered to be a significant complication of coronavirus disease 2019 (COVID-19), a condition caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) virus. COVID-19 myocarditis seems to have distinct inflammatory characteristics, which make it unique to other viral etiologies. The incidence of COVID-19 myocarditis is still not clear as a wide range of figures have been quoted in the literature; however, it seems that the risk of developing myocarditis increases with more severe infection. Furthermore, the administration of the mRNA COVID-19 vaccine has been associated with the development of myocarditis, particularly after the second dose. COVID-19 myocarditis has a wide variety of presentations, ranging from dyspnea and chest pain to acute heart failure and possibly death. Author(s): Taylor AK; School of Medicine, Leeds Institute of Health Sciences, Faculty of Medicine and Health, University of Leeds; Kausar A & Chang D; Department of General Surgery, Royal Blackburn Hospital et al.
Source: BJGP open, 2022 Apr 06. Abstract: Ten per cent of patients diagnosed with pancreatic cancer undergo pancreaticoduodenectomy. It is known that these patients have unmet psychological support needs, and GPs are key in enabling effective coordination of care for people living with life-shortening conditions. Author(s): Serruys, P.; Gao, C.; Garg, S et al.
Source: Journal of the American College of Cardiology, 2022 Supplement; 79(15) Abstract: To compare the observed and individual predicted mortalities according to the SYNTAX score II 2020 (SSII-2020) in the all-comers SYNTAX population, and retrospectively assess the appropriateness of revascularization with percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG) in patients with three vessel disease (3VD) and/or left main disease (LMCAD). Author(s): Lead Nurse Endoscopist, Burnley General Hospital.
Source: Nursing Standard; 37(4) Abstract: Colonoscopy is an invasive, endoscopic procedure undertaken to visualise the inner lumen of the colon and is used for a variety of diagnostic purposes. The procedure is increasingly performed by nurse endoscopists. This article provides an overview of the indications and contraindications for colonoscopy and describes various elements of the procedure, including consent, sedation and bowel preparation within the context of the evidence base. The article also discusses patient care before, during and after the procedure. Author(s): Newton, Laura: Department of Rheumatology, Burnley General Teaching Hospital et al.
Source: Rheumatology, Volume 61, Issue 4, April 2022, Pages 1645–1650. Abstract: Diagnosing the idiopathic inflammatory myopathies (IIMs) can be challenging as several conditions, including genetic myopathies such as limb girdle muscular dystrophy type R12 (LGMD 2 l, anoctaminopathy) mimic the presentation. Here we describe learning points identified from review of four patients with LGMD 2 l who were initially incorrectly diagnosed with IIM. Our aim is to provide clinicians working in adult rheumatology services with a toolkit to help identify non-inflammatory presentations of myopathy. Author(s): Sgourakis G; Departament of General Surgery, Royal Blackburn Hospital et al.
Source: Journal of hepato-biliary-pancreatic sciences, 2022 Feb 05. Abstract: Recently there has been a growing interest in the laparoscopic management of common bile duct stones with gallbladder in situ (LBDE), which is favoring the expansion of this technique. Our study identified the standardization factors of LBDE and its implementation in the single-stage management of choledocholithiasis. Based on this multicenter survey, LBDE is a safe and effective approach when performed by experienced teams. The generalization of LBDE will be based on developing training programs. Author(s): May, P., Yeowell, G., Connell, L. and Littlewood, C.
Affiliation: East Lancashire Hospitals NHS Trust. Faculty of Health, Psychology and Social Care, Manchester Metropolitan University. Allied Health Research Unit, University of Central Lancashire/Rakehead Rehabilitation Centre, East Lancashire Hospitals NHS Trust. Source: Musculoskeletal Science and Practice, June 2022 59 Abstract: Recovery following an upper arm break can be prolonged and cause loss of independence. Appropriate information provision to empower and enable active participation in rehabilitation is vital to achieve the best clinical outcomes. Current information leaflets made available for patients following upper arm breaks are not fit for purpose and are written in a way that the general population would not readily understand. There is an urgent need to understand the information needs of patients and present such information in an accessible way to optimise clinical outcomes following upper arm breaks. Author(s): Taylor AK. School of Medicine, Leeds Institute of Health Sciences.
Kausar A; Department of General Surgery, Royal Blackburn Hospital. Chang D; Department of General Surgery, Royal Blackburn Hospital. Phelan A; School of Medicine, Keele University. Chew-Graham CA; Academic Clinical Fellow in Psychiatry, School of Medicine, Leeds Institute of Health Sciences. Source: BJGP open, 2022 Jan 19. Abstract: Ten percent of patients diagnosed with pancreatic cancer undergo pancreaticoduodenectomy. It is known that these patients have unmet psychological support needs, and GPs are key in enabling effective coordination of care for people living with life-shortening conditions. Aim: To explore patients' perspectives on the role of primary care in their management, and their sources of support. Conclusion: Patients may feel a 'burden' to both healthcare professionals and their own support networks following pancreaticoduodenectomy. Primary care is in a key position to proactively offer psychological support. Author(s): Seethamraju RR; From the NICU, Lancashire Women and Newborn Center (R.R.S.), Burnley General Hospital, East Lancashire et al.
Source: Simulation in healthcare : journal of the Society for Simulation in Healthcare, 2022 Feb 01; Vol. 17 (1), pp. e122-e127. Abstract: The PediSTARS Faculty Development Program is a novel approach for simulation faculty training with an aim to increase the pool of trained simulation faculty in India and neighboring countries that could then facilitate simulation-based training, both at their own workplaces and in the PediSTARS simulation-based workshops that provide training in pediatric and neonatal emergencies. This commentary describes the evolution of the faculty development program, the initial process, the feedback obtained, the changes undertaken, the progress made to date, and the challenges ahead. There is also an emphasis on the key generalizable principles that can be applicable to other low-resource settings. Author(s): Rattanasirivilai P; Department of Ophthalmology, East Lancashire Hospitals NHS Trust.
Ali ZC; Manchester Royal Eye Hospital, University of Manchester. Khoo DI; Department of Ophthalmology, East Lancashire Hospitals NHS Trust. Shankar V; Department of Ophthalmology, East Lancashire Hospitals NHS Trust. Source: European journal of ophthalmology, 2022 Jan; Vol. 32 (1), pp. 300-308. Abstract: We aim to compare the outcomes of trabeculectomy with mitomycin-C by a fellowship-trained glaucoma surgeon in the first hundred compared to second hundred surgeries. We found no statistical difference between the first hundred and second hundred patient's postoperative IOP at week 4 ( p = 0.17), 3 months ( p = 0.74), 6 months ( p = 0.46), 12 months ( p = 0.47), 18 months ( p = 0.13) or at final follow up ( p = 0.53). The mean final follow up period was 3.6 ± 0.7 years. Mean IOP reduction in Group 1 was from 27.1 ± 10.8 to 12.6 ± 7.1 ( p < 0.0001) and Group 2 from 22.8 ± 8.4 to 11.3 ± 4.2 ( p < 0.0001). Kaplan-Meier graphs showed no significant difference in complete success ( p = 0.0693) or qualified success ( p = 0.0866) between Group 1 and Group 2. Bleb interventions were not statistically significant between two groups. There was a significantly higher rate of complications with the first hundred patients ( p < 0.0001).; Conclusion: Both first hundred and second hundred patient groups achieved statistically similar outcomes in long term IOP control. Significant reduction of complications was achieved in the second group of patients. Author(s): Mudiganty, S., Hughes, L., Choudry, Q. and Bokhari, A. s, Barts Health NHS Trust and East Lancashire Hospitals NHS Trust.
Source: SICOT-J, Vol 8, p 2 (2022) Abstract: Periprosthetic fractures are associated with significant morbidity and mortality. The “hub and spoke model” consists of a central organisation (the hub) and a series of secondary units (the spokes). This study reviews the presentation, management, and outcomes of periprosthetic fractures at a large general district hospital, the Royal Blackburn Hospital. Author(s): McEvoy, M. Department of Anesthesiology, Vanderbilt University School of Medicine.
Raymond, Britany L. Hi-RiSE Perioperative Optimization Clinic, Vanderbilt University Medical Center. Krige, A. Department of Anaesthesia and Critical Care, Royal Blackburn Teaching Hospital. Source: Anesthesiology Clinics March 2022 40(1):35-58 Abstract: Opioid-based analgesia in the perioperative period can provide excellent pain control, but this approach exposes the patient to avoidable side effects and possible harm. Optimal analgesia, an approach that targets the fastest functional recovery with adequate pain control while minimizing side effects, can be achieved with opioid minimization. Many different options for nonopioid multimodal analgesia exist and have been shown to be efficacious, with certain modalities being more beneficial for specific surgeries. This review will present the evidence and practical tips for these management strategies. Comorbid mental health issues in patients with pemphigus vulgaris and pemphigus foliaceus.17/3/2022 Author(s): Matthews R; Department of Post-Graduate Medical Education, Royal Blackburn Teaching Hospital.
Ali Z; Department of Post-Graduate Medical Education, Salford Royal Foundation Trust. Source: Clinical and experimental dermatology,2022 Jan; Vol. 47 (1), pp. 24-29. Abstract: The term 'pemphigus' refers to chronic autoimmune skin disorders that cause blistering erosions on the skin and oral mucosa. The two major clinical forms are pemphigus vulgaris and pemphigus foliaceus. Although rare, they confer a stark symptomatic burden upon patients that significantly impacts daily life. Comorbid mental health issues are not routinely screened for in patients with pemphigus, and current UK guidance provides no formal provision for the identification and treatment of psychological issues. This review is the first of its kind, to our knowledge, to systematically examine the available evidence on mental health issues in pemphigus. Author(s): Lamb R; Department of Clinical Radiology, East Lancashire Hospitals Trust
Kahlon A; Department of Clinical Radiology, East Lancashire Hospitals Trust Sukumar S; Department of Clinical Radiology, University Hospital of South Manchester Layton B; Department of Clinical Radiology, East Lancashire Hospitals Trust Source: Clinical radiology, 2022 Jan 07 Abstract: Diverticula of the small bowel can be categorised as true, with Meckel's being the only example, or false. False small bowel diverticula (SBD) are acquired through herniation of the internal layers of the bowel wall through the muscularis propria. Peri-ampullary duodenal diverticula are a well-recognised example; however, the importance of more distal SBD in the jejunum and ileum is underappreciated, and they are under-reported on cross-sectional imaging. SBD are a known cause of anaemia, malabsorption, and diarrhoea, and there are myriad complications of SBD and Meckel's diverticula, which range in severity from inflammation and perforation to haemorrhage, tumour formation, and obstruction. Before the advent of computed tomography (CT), SBD were readily diagnosed on fluoroscopic oral contrast studies; however, radiologists are less comfortable with their cross-sectional imaging appearances. This imaging review combines our experience of multiple proven cases, with illustrative diagrams and radiological images of SBD to provide distinct imaging characteristics, allowing for confident diagnosis of SBD and their numerous complications. We discuss the importance of SBD as a cause of benign, non-surgical pneumoperitoneum. We additionally provide important pitfalls to be aware of such as SBD masquerading as other abnormalities. Author(s): Kyzas, P. Department of Oral and Maxillofacial Surgery, Royal Blackburn Teaching Hospital
Source: Plastic and Reconstructive Surgery. Feb 01, 2022 149(2):359e-361e Abstract: Patient-specific planning and three-dimensional printing have revolutionized head and neck reconstruction. Tumor resection/flap harvesting are guided by laboratory-made guides using the patient’s scan data. This leads to the downfall of many surgical myths, five of which are debunked in this article. Author(s): Krige A; Department of Anaesthesia and Critical Care, Royal Blackburn Teaching Hospital
Kelliher LJS; Department of Anaesthetics, Royal Surrey County Hospital NHS Foundation Trust Source: Anesthesiology clinics, 2022 Mar; Vol. 40 (1), pp. 91-105 Abstract: This article will focus on the perioperative management of hepatic resection for colorectal cancer (CRC) liver metastases (CLRMs) (the liver is the dominant metastatic site for CRC) within the context of the Enhanced Recovery After Surgery (ERAS) paradigm. It discusses the epidemiology and outcomes along with the history of hepatic resection surgery and pertinent anatomy. Author(s): Kolářová, Barbora; Richards, Jim; Haltmar, Hana; Lippertová, Klára; Connell, Louise; Chohan, Ambreen
Affiliation: Faculty of Health Sciences, Palacký University Olomouc, Czech Republic Kinesiology Laboratory, Rehabilitation Department, University Hospital, Olomouc, Czech Republic Allied Health Research Unit, University of Central Lancashire, Preston, United Kingdom Faculty of Physical Culture, Palacký University Olomouc, Czech Republic East Lancashire Hospitals NHS Trust, Burnley, United Kingdom Source: Journal of Bodywork & Movement Therapies, Jan2022; 29: 161-166. Abstract: The use of motor imagery (MI) has been shown to offer significant improvements in movement performance in sports, and is now receiving a lot of attention as a relatively new therapeutic approach which can be applied in rehabilitation. However, the effects of MI on the quality of movement is still unclear. This study explored the immediate effect of MI on reaching tasks in healthy subjects. The results indicate that the use of MI just after physical practice appears to have an immediate effect on the muscle activity and kinematics during a reaching task, which may suggest an improved quality of movement. This proof of concept study shows the potential for MI to improve the quality of performing reaching task and offers a possible therapeutic option for Stroke survivors and other neuromuscular disorders. Author(s): Khudr, J; Hughes, L; Younis, F.
Affiliation: Department of Vascular Surgery, Royal Liverpool & Broadgreen Hospitals NHS Trust. Department of Trauma and Orthopaedics, East Lancashire Hospitals NHS Trust. Source: British Journal of Hospital Medicine (17508460) 83(1), pp. 1-10 Abstract: Wide awake local anaesthesia no tourniquet, also known as WALANT, is the practice of performing surgery under local anaesthetic in the absence of a tourniquet. This technique uses the vasoconstrictive effects of adrenaline and the local anaesthetic effects of lignocaine to establish a Bier block with haemostatic control. Permitting active patient participation intraoperatively, wide awake local anaesthesia no tourniquet surgery improves patient compliance with rehabilitation and yields higher patient satisfaction. With reduced cost and equipment requirements, this method improves accessibility for patients and productivity for healthcare institutions. This is of particular benefit within the current COVID-19 climate, as wide awake local anaesthesia no tourniquet technique provides a means of overcoming restrictions to theatre access and anaesthetic support. This review delves into the current uses of wide awake local anaesthesia no tourniquet surgery, outlining the initial conception of the practice by Canadian surgeons. The advantages and disadvantages are considered, and potential future applications of this technique are discussed. |
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