Leicester Royal Infirmary

About: Leicester Royal Infirmary is a healthcare organization based out in Leicester, United Kingdom. It is known for research contribution in the topics: Population & Carotid endarterectomy. The organization has 5300 authors who have published 6204 publications receiving 208464 citations.

Thymus Transplantation for Complete Digeorge Syndrome: European Experience

Abstract: Background Thymus transplantation is a promising strategy for the treatment of athymic complete DiGeorge syndrome (cDGS). Methods Twelve patients with cDGS underwent transplantation with allogeneic cultured thymus. Objective We sought to confirm and extend the results previously obtained in a single center. Results Two patients died of pre-existing viral infections without having thymopoiesis, and 1 late death occurred from autoimmune thrombocytopenia. One infant had septic shock shortly after transplantation, resulting in graft loss and the need for a second transplant. Evidence of thymopoiesis developed from 5 to 6 months after transplantation in 10 patients. Median circulating naive CD4 counts were 44 × 10 6 /L (range, 11-440 × 10 6 /L) and 200 × 10 6 /L (range, 5-310 × 10 6 /L) at 12 and 24 months after transplantation and T-cell receptor excision circles were 2,238/10 6 T cells (range, 320-8,807/10 6 T cells) and 4,184/10 6 T cells (range, 1,582-24,596/10 6 T cells). Counts did not usually reach normal levels for age, but patients were able to clear pre-existing infections and those acquired later. At a median of 49 months (range, 22-80 months), 8 have ceased prophylactic antimicrobials, and 5 have ceased immunoglobulin replacement. Histologic confirmation of thymopoiesis was seen in 7 of 11 patients undergoing biopsy of transplanted tissue, including 5 showing full maturation through to the terminal stage of Hassall body formation. Autoimmune regulator expression was also demonstrated. Autoimmune complications were seen in 7 of 12 patients. In 2 patients early transient autoimmune hemolysis settled after treatment and did not recur. The other 5 experienced ongoing autoimmune problems, including thyroiditis (3), hemolysis (1), thrombocytopenia (4), and neutropenia (1). Conclusions This study confirms the previous reports that thymus transplantation can reconstitute T cells in patients with cDGS but with frequent autoimmune complications in survivors.

Subintimal and intraluminal recanalisation of occluded crural arteries by percutaneous balloon angioplasty

Abstract: Advances in radiological techniques have allowed successful treatment of arterial stenoses situated in the distal arterial tree. This paper describes the experience at Leicester Royal Infirmary with percutaneous transluminal angioplasty (PTA) for the treatment of occluded crural arteries. Over a 27 month period, 21 patients with 24 ischaemic limbs have undergone PTA for crural artery occlusion. PTA was attempted in a total of 29 occluded crural arteries with a median length of occlusion of 6cm (range 1–30cm). Intraluminal recanalisation was used for short occlusions and the subintimal technique for long occlusions. Technical success with angiographic recanalisation of the artery was achieved in 25 out of 29 crural vessels (86%). Endovascular treatment of crural artery occlusion appears to be a safe and effective treatment which avoids the need for femorodistal surgery in patients with occluded calf vessels.

Patellar tendon or four-strand hamstring? A systematic review of autografts for anterior cruciate ligament reconstruction

Abstract: The choice of graft for anterior cruciate ligament reconstruction remains controversial. A systematic review was performed to compare bone-patella tendon-bone and four-strand hamstring grafts. Medline (1966 onwards), EMBASE (1980 onwards) and the Cochrane database were searched retrieving 6312 possible articles, but only 6 studies fulfilled all the inclusion criteria. To be included, the study had to be prospective, randomised or quasi-randomised, comparing 4SHS and central third BPTB autografts, inserted using an arthroscopically assisted technique and have a minimum 2-year follow-up for all patients. These studies recruited 526 patients, and 475 were followed for at least 2 years with 235 patients receiving a bone-patella tendon-bone graft and 240 receiving a four-strand hamstring graft. Overall, there was a greater chance of extension loss (p=0.007) and a trend towards increased patellofemoral joint pain (p=0.09) with a patella tendon graft. With a four-strand hamstring graft, there is a greater loss of hamstring power (p=0.008) and a trend towards an increased chance of a pivot shift >1 (p=0.12). There was no difference between the two groups in terms of Lachman testing, chance of returning to the same level of sport, clinical knee scores, graft ruptures or other complications.

The reliability of ultrasonographic assessment of neonatal hips

Abstract: Ultrasound scans were made of the hips of 209 neonates born consecutively over a two-week period. Of the 418 scans, 62 images were selected at random and 25 of these were duplicated to give a total of 87 scans. These static images were then presented to five experienced observers who each made nine different assessments and measurements. Interobserver and intraboserver agreement was calculated and expressed as kappa values. Our results showed poor reliability on both counts.