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.

Measurement of blood flow velocity in the basal cerebral circulation: advantages of transcranial color-coded sonography over conventional transcranial Doppler.

Abstract: Unlike conventional transcranial Doppler (TCD), transcranial color-coded sonography (TCCS) enables imaging of the basal cerebral arteries using color-flow ultrasonography and correction for the angle of insonation when determining blood flow velocities. We present hemodynamic data from 20 normal subjects, each studied with TCD and TCCS. Velocities derived using TCCS with angle correction were significantly greater than those derived using TCD in all vessels (mean velocities [cm/sec; mean with 95% confidence intervals])—anterior cerebral artery: TCD 48 (45–50), TCCS 62 (58–66), p < .0001; middle cerebral artery: TCD 61 (58–64), TCCS 70 (66–74), p < .0001; posterior cerebral artery: TCD 43 (41–46), TCCS 54 (50–57), p < .0001; basilar artery: TCD 40 (34–45), TCCS 45 (38–52), p <.01. Pulsatility index values were significantly greater in all arteries when determined by TCCS, and resistance index values were significantly greater except in the basilar artery. Correcting for the angle of insonation using TCCS may enable estimation of blood flow velocities closer to the “true” values than those derived using conventional TCD. © 1995 John Wiley & Sons, Inc.

Dose requirements, efficacy and side effects of morphine and pethidine delivered by patient-controlled analgesia after gynaecological surgery.

Abstract: We have compared the dose requirements and side effects of morphine with those of pethidine when administered by patient-controlled analgesia in 40 patients (ASA I-II, 20-65 yr) after elective total abdominal hysterectomy. Patients were allocated randomly, in a double-blind manner, to receive either morphine (bolus dose 2 mg, lockout time 10 min) or pethidine (bolus dose 20 mg, lockout time 10 min) for postoperative pain relief. Mean 24-h morphine and pethidine consumption was 70 (SEM 6.2) mg and 660 (67.8) mg, respectively (ratio 1:9.4). There were no significant differences in postoperative sedation, nausea, pain relief and patient satisfaction (VAS 0-100 mm), and requirements for antiemetics. Four patients receiving pethidine were withdrawn because of postoperative confusion and one receiving morphine because of intractable nausea and vomiting. The 95% confidence interval for this difference between the groups for VAS scores of sedation, nausea and pain were approximately 30 mm.

Predicting the short-term outcome of first episodes and recurrences of clinical depression : A prospective study of life events, difficulties, and social support networks

Abstract: Background: The study employed interview-based, investigator-rated measures of symptoms and psychosocial adversity in a panel survey to predict clinical course of depression. Method: 130 men and women attending psychiatric hospitals for episodes of depressive disorders were interviewed with the Present State Examination and Life Events and Difficulties Schedule. After a mean 4-month interval, 119 were successfully reassessed to test the hypothesis that recovery from clinical depression is related to rates of life event stress and difficulties (termed psychosocial adversity) in the 6 to 12 months preceding initial evaluation. Results: The severity (p <.01) and the duration (p <.01) of the episode of depression up until the initial evaluation emerged as the only significant background predictors of episode severity at later follow-up. High levels of adversity were significantly (p <.05) related to a poor clinical course, due to failure to recover from first-onset and from second episodes. Recovery from all but first episodes was predicted by higher levels of social support rated at initial attendance. There was no evidence for the buffering of the harmful effects of adversity by larger, more connected social support networks. Conclusion: Both life event stress and support network characteristics are associated with the short-term outcome of depressive episodes. The findings for social support in particular confirm growing evidence of the importance of distinguishing between early and later relapsing episodes in causal investigations of depression. They reveal a progressive vulnerability to deficits in social circumstances with advancing course of disorder.

Electronic fetal heart rate monitoring: retrospective reflections on a twentieth-century technology.

Abstract: Continuous electronic monitoring of the fetal heart rate (FHR) in labour was introduced into British obstetric practice in the 1960s and 1970s. A report in 1970 showed that 1 in 279 women in labour had electronic fetal heart rate monitoring (EFM), 1 in 333 had fetal blood pH estimation by fetal blood sampling (FBS), and 1 in 1000 had bothl. Seven years later, a survey of 17 hospitals (11 district general hospitals and 6 teaching hospitals)2 indicated that every teaching hospital aimed to monitor all patients and 5 were already doing so, but universal monitoring was not possible within any of the district general hospitals. In 5, only 'high-risk' cases were monitored, whereas in the remainder every available machine was utilized but monitoring was performed according to priority. Only one of the 17 hospitals did not routinely use a scalp electrode when cervical dilatation permitted its application. Despite these figures, the author of the report concluded that 'acceptance of biophysical and biochemical monitoring in Britain was slow.' This paper is neither a further review of the scientific case for EFM as done thoroughly by Goodlin3 and more recently by Steer4, nor is it an evaluation of the monitoring techniques, since this work continues5'6. Rather, the aim has been to examine the introduction of continuous EFM into British obstetric practice-in particular, how it came to be introduced so widely and rapidly.

Current evidence is insufficient to define an optimal threshold for intervention in isolated type II endoleak after endovascular aneurysm repair.

Abstract: PurposeTo report a systematic review and meta-regression of the association between the threshold for intervention in patients with isolated type II endoleak after endovascular aneurysm repair (EVA...