Leicester General Hospital

About: Leicester General Hospital is a healthcare organization based out in Leicester, United Kingdom. It is known for research contribution in the topics: Population & Transplantation. The organization has 2481 authors who have published 3034 publications receiving 107437 citations.

A prospective study of the predictive power of spiral computed tomographic angiography for defining renal vascular anatomy before live-donor nephrectomy.

Abstract: The advent of laparoscopic donor nephrectomy for renal transplantation has focused minds to an even greater degree on the vascular anatomy of the donor kidney. The authors from Leicester determined the accuracy of spiral CT imaging for donor venous anatomy and comparing it to the operative findings, either at open or laparoscopic donor nephrectomy. They found the technique to be an excellent way of assessing potential renal donors in terms of the gonadal and adrenal veins, but less so for predicting lumbar veins. OBJECTIVE To determine the accuracy of spiral computed tomography (CT) imaging of donor venous anatomy by comparing CT angiography (CTA) and operative findings, for both laparoscopic (LDN) and open donor nephrectomy. PATIENTS AND METHODS LDN presents unique surgical challenges, particularly with complex venous or arterial anatomy. The limitations of surgical access, poor visibility of the superior and posterior borders of the renal vein during LDN, and the variability of venous anatomy in this region, contribute to the difficulty of LDN, underlining the importance of imaging beforehand. Forty live donors (mean age 46 years, sd 11; 65% female) were assessed by CTA before donation. Scans were reported by the same radiologist. The number and diameter of ‘predicted’ renal arteries, veins and renal vein tributaries were documented. The donor kidney was removed by two consultant surgeons, and after back-table perfusion the same details were recorded and taken as the ‘reference’ findings. Tributaries of <1 mm diameter were not recorded. The right kidney was retrieved in seven patients; 25 of the 40 kidneys were retrieved by LDN and the other 15 by open surgery. RESULTS In all, 48 actual renal arteries were identified at nephrectomy; of these, 47 were predicted by CTA. Likewise, 41 actual renal veins were found at nephrectomy, 40 of which were predicted. The overall accuracy of spiral CTA in predicting the presence or absence of renal vein tributaries was 83% for gonadal and adrenal veins, and 75% for lumbar veins. There were seven false-negative lumbar veins found at nephrectomy; in these cases the CTA films were retrospectively examined, and five of these seven veins were identified. The predicted renal vein tributary diameter correlated poorly with the measured diameter at nephrectomy. CONCLUSIONS Assessing potential renal donors before surgery with spiral CTA provides an accurate prediction of the presence or absence of the gonadal and adrenal vein, but is less accurate for predicting lumbar veins. This is especially pertinent as the posterior lumbar tributaries have the most intra-individual variation, and are the most difficult to display and control at LDN. This highlights the need for meticulous dissection of the renal vein, particularly along its posterior wall.

Statins and secondary prevention of venous thromboembolism: pooled analysis of published observational cohort studies

Abstract: Aims There have been suggestions that statins may have a potential role in secondary prevention of venous thromboembolism (VTE) [which includes deep vein thrombosis (DVT) and pulmonary embolism (PE)], but the evidence is inconsistent. We aimed to evaluate the association between statin use and risk of recurrent VTE. Methods and results We conducted a systematic review and meta-analysis of observational cohort studies. All relevant studies which reported associations between statin use and recurrent VTE outcomes were identified from MEDLINE, EMBASE, Web of Science, and manual search of bibliographies from inception to January 2017. Study specific relative risks (RRs) with 95% confidence intervals were aggregated using random effects models. Eight eligible studies comprising of 103 576 participants and 13 168 recurrent VTE outcomes were included in the pooled analysis. In pooled analysis of 7 studies, the RR for recurrent VTE was 0.73 (0.68-0.79) when comparing statin use with no use. There was no evidence of heterogeneity between contributing studies (I2=0%, 0-71%; P = 0.93). The RRs for recurrent PE (three studies) and DVT (two studies) comparing statin use with no statin use were 0.75 (95% CI: 0.58-0.96) and 0.66 (95% CI: 0.60-0.71) respectively. Conclusion Available evidence from observational cohort studies suggests a beneficial effect of statin use on VTE recurrence. Well-designed intervention studies are needed to corroborate these findings.

Results following conservative lateral sphincteromy for the treatment of chronic anal fissures.

Abstract: Introduction Lateral sphincterotomy is now the standard surgical treatment for fissure-in-ano. Healing is achieved in 90% of cases, however, sphincterotomy also carries a significant risk of incontinence. Traditional sphincterotomy comprises of division of the internal sphincter up to the level of the dentate line, a more conservative division could lead to a lower incontinence rate, with an equivalent healing rate. Materials and methods A total of 65 patients undergoing conservative lateral sphincterotomy under a single operator between January 1996 and January 2002 were reviewed. Specific questions were asked regarding overall success of the operation, leakage of fluid, faeces or flatus and recurrence of fissure symptoms. Supplemental data was obtained from a retrospective analysis of the patients' case notes to ascertain demographics, length of hospital stay and complication rate. Results Sixty of 65 patients responded to our postal questionnaire. The male to female ratio was 1 : 1 and the mean age 40.3 years of age. No complications were recorded and 97% of patients had achieved fissure healing by the time of their out-patient follow-up (mean 6.9 weeks). Two patients reported new incontinence following their procedure; one patient experienced incontinence of fluid and flatus (1.7%) and the remaining patient complained of incontinence to flatus only. No patients experienced incontinence of faeces. Eleven patients experienced persistent symptoms of pain and bleeding but only 6 of these patients required treatment from their general practitioner which consisted of stool softeners and topical analgesia. No patients required re-operation. Conclusion A conservative division of the internal anal sphincter results in adequate fissure healing and a much lower incontinence rate than that previously recorded in the literature for more traditional divisions of the internal anal sphincter.

Pre-Incision Infiltration of Local Anesthetic Reduces Postoperative Pain with No Effects on Bruising and Wound Cosmesis After Thyroid Surgery

Abstract: Optimizing postoperative pain control is an important aspect in perioperative patient care. The aim of this study was to investigate the efficacy of preincision local anesthetic infiltration in postoperative pain management for thyroid surgery and its relationship to bruising and wound cosmesis. In a randomized single-blinded study, 39 consecutive patients listed for thyroid surgery were assigned into two groups. Group I (n = 19) received subcuticular preincision infiltration with 10 ml of bupivacaine (0.5%) and Group II (n = 20) received no infiltration. Postoperatively, the pain experienced was evaluated by two methods: verbal response scores and linear analogue scores (0-100 mm) at different time intervals following surgery. Bruising and cosmetic effects resulting from surgery were assessed using a linear analogue score at discharge. The two groups were well matched for confounding variables. Pain scores were significantly different at 6 hours post operatively (p = 0.0341) with mean scores Group I = 33 and Group II = 50, but this difference disappeared at 24 hours. No patients (0%) received IV morphine in Group I compared to 5 patients (25%) in Group II. There was no significant difference in the mean bruising scores (p = 0.8864) and mean cosmetic scores (p = 0.3339) at discharge. Preincision infiltration with bupivacaine provides easy and better analgesic control postoperatively in patients following thyroid surgery with no effects on bruising or wound cosmesis.

Uses and Limitations of the Restricted Mean Survival Time: Illustrative Examples From Cardiovascular Outcomes and Mortality Trials in Type 2 Diabetes.

Abstract: This article describes an alternative to the hazard ratio for reporting effects of interventions in trials: the restricted mean survival time. By presenting examples from trials with cardiovascular...