Bradford Royal Infirmary

About: Bradford Royal Infirmary is a healthcare organization based out in Bradford, United Kingdom. It is known for research contribution in the topics: Population & Pregnancy. The organization has 1630 authors who have published 1663 publications receiving 43774 citations.

Familial thrombophilia and retinal vein occlusion

Abstract: Purpose To perform a pilot study on the prevalence of familial thrombophilia in all cases of retinal vein occlusion with no known risk factors. Methods Over the 1 year study period 71 patients presented with a new diagnosis of retinal vein occlusion (age 28-90 years). Fifty-five (77%) were excluded because of local predisposing factors. The remaining 16 (23%) had a full risk factor history taken and blood investigations of rheological factors and thrombophilia including tests for the factor V Leiden mutation, prothrombin G20210A allele and hyperhomocysteinaemia. Results Of those with no local predisposing factors, 3 patients had antiphospholipid antibodies, 3 had raised fibrinogen levels, 4 had hyperhomocysteinaemia and 1 was heterozygous for the Leiden mutation. Other lifestyle risk factors such as obesity, smoking and a positive family history of venous thrombosis were not uncommon. No patient had the prothrombin G20210A variant. Conclusions It seems likely that several risk factors, both genetic and acquired, need to be present for thrombosis to occur. In investigating a new patient with a retinal vein occlusion one should test for hypertension, glaucoma and diabetes mellitus. Estimation of plasma viscosity and a full blood count are cheap investigations which may reveal neoplasia or vasculitis, and lipid levels should be estimated. In a young patient or one with an unexpected vein occlusion and a personal or family history of thrombosis, a hypercoagulable state may rarely be identified. This additional testing should include testing for antiphospholipid antibodies and a full thrombophilia screen including the factor V Leiden mutation, homocysteine and the prothrombin variant as part of a clinical trial. Until the role of these markers in thrombosis is better defined in relation to causation of retinal vein occlusion and treatment has been shown to improve outcome, we can not recommend them for routine testing. If a hereditary defect is found, referral should be made to a haematologist and consideration given to anticoagulation and screening of family members to prevent further thrombotic episodes. Retinal vein occlusions are multifactorial in origin except in rare cases.

Consanguinity and Prevalence Patterns of Inherited Disease in the UK Pakistani Community

Abstract: Objectives: The aim of this paper is to describe the current knowledge about inherited diseases in UK children of Pakistani origin, who now number over 300,000, a

Self-expanding tracheobronchial stents in the management of major airway problems.

Abstract: The management of patients with critical major airways obstruction has been made possible by the recent introduction of expandable metal stents as the sole treatment or as an adjunct to other treatment modalities, to alleviate the distressing symptoms from tracheobronchial obstructions Gianturco self-expanding stents were used successfully in the management of 27 patients. The indications were: stenosis from postoperative strictures and recurrent tumours (n = 6), extrinsic compression from metastatic disease (n = 9), inoperable primary tumours of central airways (n = 9), airway collapse from relapsing polychondritis (n = 1), excessive mediastinal shift following right pneumonectomy (n = 1) and endobronchial non-Hodgkin's lymphoma (n = 1). Twenty three patients had immediate relief of stridor and the remaining two patients were successfully weaned from ventilatory support. There were two postoperative deaths. The stents were inserted under general anaesthesia through a rigid bronchoscope under direct vision. The ease of insertion under radiological control, self-expanding nature of the stents and the lack of major complications on follow-up of up to 47 months are particular advantages. The self-expanding tracheobronchial stents are a useful addition to our armamentarium in maintenance of the airways in patients with major airway stenosis and collapse.

Efficacy of Continuous Extrapleural Intercostal Nerve Block on Post-Thoracotomy pain and Pulmonary Mechanics

Abstract: To assess the efficacy of continuous extrapleural intercostal nerve block on postoperative pain and pulmonary function, a prospective, randomized, double-blind, placebo-controlled trial was conducted on 56 patients undergoing elective thoracotomy. Infusion was started before closing the chest and was continued for 5 days. Subjective pain relief was assessed on a linear visual analogue scale. Pulmonary function was measured on the day before operation and daily for 5 days. There were 29 patients in a group which received bupivacaine and 27 in a control group which received saline. The bupivacaine group had lower pain scores (P less than 0.01) and required less papaveretum (P less than 0.01) than the control group. Forced vital capacity, forced expiratory volume in 1 s and peak expiratory flow rate were maximally reduced at 24 h to median values of 56, 60 and 57 per cent, respectively, of preoperative control values in the bupivacaine group, and to 25, 30 and 32 per cent in the control group. These differences are highly significant (P less than 0.01). Restoration of pulmonary function was superior in the bupivacaine group (P less than 0.01). There were no infusion-related complications. After thoracotomy, continuous intercostal blockade with bupivacaine is a safe and effective method of pain relief which reduces the early loss of postoperative pulmonary function significantly and more rapidly restores respiratory mechanics.