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.

Comparison of computed tomography and duplex imaging in assessing aortic morphology following endovascular aneurysm repair

Abstract: Background Computed tomography (CT) has been used to assess patients following endovascular aneurysm repair to determine the need for secondary endoluminal or operative procedures. This prospective study compared CT and duplex imaging to evaluate aneurysm morphology following endoluminal aortic grafting. Methods Twenty patients were evaluated at regular intervals following successful endoluminal aneurysm repair. CT and duplex scanning were compared in their ability to determine aneurysm and aortic diameter, the presence of perigraft extravasation (endoleaks) and technical defects in the endograft. Results In 2() patients who were assessed 6 months after operation, duplex imaging identified four endoleaks (two early, two late; one proximal, three distal). In three cases, the aneurysm diameter progressively increased after operation. In patients with a thrombosed aneurysm sac, the aneurysm regressed at a median of 0.40 (range 0.13-0.8) cm per year. The CT findings were similar (median regression 0.43 (range 0-1.0) cm per year), although CT was unable to predict the site of the leak as accurately as duplex imaging. CT demonstrated that the diameter of the juxtarenal aorta increased following endografting. Conclusion Duplex imaging is a less invasive, less costly alternative to CT in the follow-up of patients after endoluminal aortic surgery. increase in size of the aneurysm sac following cndovascular aneurysm repair strongly suggests the presence of an endoleak.

The significance of cagA and vacA subtypes of Helicobacter pylori in the pathogenesis of inflammation and peptic ulceration.

Abstract: AIMS: To assess the significance of cagA and vacA subtypes of Helicobacter pylori in relation to inflammation and density of bacterial colonisation in vivo within a dyspeptic UK population. METHODS: Dyspeptic patients who were Helicobacter pylori positive had antral samples taken for histology and culture. Gastroduodenal pathology was noted. The grade of bacterial density and inflammation was assessed using the Sydney system. Bacterial DNA was extracted and the vacA alleles and the cagA/gene typed using PCR. RESULTS: 120 patients were studied. There was high rate of cagA positive strains in this population. Bacterial density did not correlate with the presence of peptic ulceration. There was a significant association between cagA positive strains and increased inflammation and bacterial density. The vacA s1 type independently correlated with extensive chronic inflammation but there was no association with bacterial density. The vacA m type did not correlate with extent of inflammation or bacterial density. CONCLUSIONS: The results suggest that cagA is important in the pathogenesis of inflammation and peptic ulceration. These findings are in keeping with the hypothesis that cagA acts as a marker for a cag pathogenicity island which encodes several genes involved in inflammation. The vacA s1 allele correlates with inflammation independently of cagA, possibly through its enhanced ability to produce the vacuolating cytotoxin.

Myeloperoxidase aids prognostication together with N-terminal pro-B-type natriuretic peptide in high-risk patients with acute ST elevation myocardial infarction

Abstract: Background: Inflammation plays a critical role in acute myocardial infarction (MI). One such inflammatory marker is myeloperoxidase (MPO). Its role as a predictor of death or MI in patients with ST segment elevation myocardial infarction (STEMI) is unclear. Aim: To investigate the role of MPO as a predictor of death or MI in patients with STEMI and to compare it with N-terminal pro-B-type natriuretic peptide (NT-BNP). Method: 384 post STEMI patients were studied. Patients were followed up for the combined end point of death or readmission with non-fatal MI. Results: There were 40 deaths and 37 readmissions with MI. Median MPO was raised in patients experiencing death or MI than in survivors (median (range), 50.6 (15.3–124.1) ng/ml vs 33.5 (6.6–400.2) ng/ml, p = 0.001). Using a Cox proportional hazards model, log median MPO (HR 6.91, 95% CI 1.79 to 26.73, p = 0.005) and log median NT-BNP (HR 4.21, 95% CI 1.53 to 11.58, p = 0.005) independently predicted death or non-fatal MI. MPO had predictive power in both below and above median NT-BNP levels (log rank 5.60, p = 0.020 and log rank 5.12, p = 0.024, respectively). The receiver-operating curve for median NT-BNP yielded an area under the curve (AUC) of 0.72 (95% CI 0.65 to 0.79, p Conclusion: MPO and NT-BNP may be useful tools for risk stratification of all acute coronary syndromes, including patients with STEMI at higher risk.