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.

Using Continuous Glucose Monitoring to Measure the Frequency of Low Glucose Values When Using Biphasic Insulin Aspart 30 Compared With Biphasic Human Insulin 30: A double-blind crossover study in individuals with type 2 diabetes

Abstract: Objective: Rapid-acting insulin analogs in basal-bolus regimens can reduce nocturnal hypoglycemia, so it is conceivable that twice-daily biphasic insulin analogs might reduce hypoglycemia in patients with insulin-treated type 2 diabetes. We used continuous glucose monitoring (CGMS) and self-reported episodes to investigate differences in the frequency of low glucose values in patients with type 2 diabetes, using either biphasic insulin aspart (BIAsp 30) or biphasic human insulin (BHI 30). Research Design and Methods: A double-blind, two-period, cross-over trial involving 160 subjects. After 8-weeks' run-in, subjects were randomized to the first of two 16-week treatment periods. Results: No differences in overall incidence of low interstitial glucose (LIG) were found. 24-h plots of CGMS showed LIG was more frequent at night as during the day, and unrecognized by patients. At night, subjects spent significantly less time (% of total CGMS recorded) with IG <3.5 and <2.5 mmol/l during BIAsp 30 than during BHI 30 treatment (<3.5 mmol/l: 6.36 vs. 7.93% [mean], 0.67 vs. 2.43% [median], respectively, P = 0.018; <2.5 mmol/l: 2.35 vs. 2.86% [mean], 0 vs. 0% [median], P = 0.0467). No treatment difference in HbA1c was observed. Conclusions: Overall rates of low glucose over 24 h were not different, but were twice as frequent at night as during the day in individuals with type 2 diabetes. Compared with BHI 30, BIAsp 30 was associated with similar low IG readings over 24 h, but fewer nocturnal episodes and less self-reported nocturnal hypoglycemia. Conclusions: Trial registration details- This trial was registered at ISRCTN, registration number: ISRCTN34091554 and at ClinicalStudyResults.org, Unique ID: BIASP-1466.

Percutaneous transluminal angioplasty for lower-limb critical ischaemia.

Abstract: Percutaneous transluminal angioplasty (PTA) alone was used to treat 54 (23 per cent) of 232 lower limbs with critical ischaemia. Technical success was achieved in 49 cases (91 per cent) with an immediate symptomatic improvement in 47 (87 per cent). There was no death or limb loss attributable to PTA and three embolic complications were successfully treated by percutaneous aspiration. Symptomatic improvement and haemodynamic patency rates at 24 months were 77 and 78 per cent respectively ; 27 of 34 limbs with ulceration or gangrene had healed with minor surgery by a median of 7.5 (range 3.0-18.0) months. Patient survival and limb salvage rates at the same time interval were 76 and 89 per cent respectively. These results demonstrate that, for a selected group of patients with lower-limb critical ischaemia, PTA can be a highly successful therapeutic option with a low associated morbidity.

Complications after volar locking plate fixation of distal radius fractures

Abstract: Volar locking plates are an increasingly popular treatment for distal radius fractures. We reviewed complications observed after volar locking plate fixation in a busy teaching hospital. The purpose of the study was to assess whether complication rates after volar locking plate use in general, routine trauma practice were higher than published literature from expert users. A retrospective review was carried out of patients treated with a volar locking plate between January 2009 and December 2010. The series included 206 procedures in 204 patients (77 males and 127 females) with mean age of 55 years (range 16-94). Surgery was performed by 18 different consultant surgeons and 11 registrars. A total of 22 complications were observed in 20 patients with an overall complication rate of 9.7%. Seven (3.4%) patients developed tendon problems including four (1.9%) tendon ruptures. Four (1.9%) patients required re-operation for metalwork problems; four patients developed complex regional pain syndrome (CRPS). Three fracture reduction problems were noted. A total of 16 further operations were carried out for complications. The overall complication rate was low even when surgery was done by many surgeons, suggesting that this is a safe and reproducible technique. This study provides information which can be used to counsel patients about risks, including those of tendon and metalwork problems. This allows patients to make an informed decision. Surgeons must have specific strategies to avoid these complications and remain vigilant so that these can be identified and managed early.

Immunohistochemical analysis of HLA antigens and mononuclear infiltrates of benign and malignant breast

Abstract: Using immunohistochemistry, the epithelial expression of HLA Class I and II antigens (and beta 2 microglobulin) was compared in benign and malignant breast, and the stromal lympho-histiocytic infiltrate of these tissues quantified. The findings were compared with certain characteristics of the carcinomas. In contrast to other studies, malignancy was found to be associated with a far greater infiltrate of both lymphocytes and macrophages. In carcinomas, lymphocyte but not macrophage numbers showed a positive correlation with epithelial HLA ABC and HLA DR expression. This was particularly striking for T lymphocytes, and especially for the T4 subset. The histological grade of carcinoma is closely related to the degree of HLA ABC and beta 2 microglobulin expression, but no such relationship was found for HLA DR. There were greater numbers of mononuclear cells in the poorer differentiated tumours compared with other grades. Those carcinomas with evidence of lymph node metastasis contained greater numbers of macrophages identified by the antibody Y1/82A, but none of the other parameters studied was found to be associated with local lymph node status. The use of a large panel of monoclonal antibodies against various cellular subtypes has allowed a more detailed analysis of the interaction between breast epithelium and the host response.