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.

Assessment of baroreceptor-cardiac reflex sensitivity using time domain analysis in patients with IDDM and the relation to left ventricular mass index.

Abstract: Autonomic dysfunction in insulin-dependent diabetic (IDDM) patients has been associated with abnormalities of left ventricular function and an increased risk of sudden death. A group of 30 patients with IDDM and 30 age, sex and blood pressure matched control subjects underwent traditional tests of autonomic function. In addition, baroreceptor-cardiac reflex sensitivity (BRS) was assessed using time domain (sequence) analysis of systolic blood pressure and pulse interval data recorded non-invasively using the Finapres beat-to-beat blood pressure recording system. ’Up BRS' sequences–increases in systolic blood pressure associated with lengthening of R-R interval, and ’down BRS' sequences–decreases in systolic blood pressure associated with shortening of R-R interval were identified and BRS calculated from the regression of systolic blood pressure on R-R interval for all sequences. We also assessed heart rate variability using power spectral analysis and, after expressing components of the spectrum in normalised units, assessed sympathovagal balance from the ratio of low to high frequency powers. IDDM subjects underwent 2-D echocardiography to assess left ventricular mass index. Standard tests of autonomic function revealed no differences between IDDM patients and control subjects, but dramatic reductions in baroreceptor-cardiac reflex sensitivity were detected in IDDM patients. ’Up BRS' when supine was 11.2 ± 1.5 ms/mmHg (mean ± SEM) compared with 20.4 ± 1.95 in control subjects (p < 0.003) and when standing was 4.1 ± 1.9 vs 7.6 ± 2.7 ms/mmHg (p < 0.001). Down BRS when supine was 11.5 ± 1.2 vs 22 ± 2.6 (p < 0.001) and standing was 4.4 ± 1.9 vs 7.3 ± 2.5 ms/mmHg (p < 0.003). There were significant relations between impairment of the baroreflex and duration of diabetes (p < 0.001) and poor glycaemic control (p < 0.001). From a fast Fourier transformation of supine heart rate data and using a band width of 0.05–0.15 Hz as low-frequency and 0.2–0.35 Hz as high frequency total spectral power of R-R interval variability was significantly reduced in the IDDM group for both low-frequency (473 ± 62.8 vs 746.6 ± 77.6 ms2 p = 0.002) and high frequency bands 125.2 ± 12.9 vs 459.3 ± 89.8 ms2 p < 0.0001. When the absolute powers were expressed in normalised units the ratio of low frequency to high frequency power (a measure of sympathovagal balance) was significantly increased in the IDDM group (2.9 ± 0.53 vs 4.6 ± 0.55, p < 0.002 supine: 3.8 ± 0.49 vs 6.6 ± 0.55, p < 0.001 standing). Thus, time domain analysis of baroreceptor-cardiac reflex sensitivity detects autonomic dysfunction more frequently in IDDM patients than conventional tests. Impaired BRS is associated with an increased left ventricular mass index and this abnormality may have a role in the increased incidence of sudden death seen in young IDDM patients. [Diabetologia (1996) 39: 1385–1391]

Effects of antenatal and postnatal corticosteroids on the preterm lung

Abstract: It is nearly 25 years since Liggins and Howie first reported the maturational benefits of antenatal corticosteroids given to mothers of preterm infants.1 They reported reduced incidence of respiratory distress syndrome (RDS) in preterm infants delivered to mothers treated with antenatal steroids. Since then, several other studies have reported similar benefits for antenatal corticosteroids. Indeed, Crowley2 has reported a meta-analysis of 15 randomised trials, conducted between 1972 and 1994, which studied the use of antenatal corticosteroids in preterm labour. Overall, the incidence of RDS was halved in infants delivered to mothers who had received antenatal corticosteroids compared with those born to mothers treated with placebo. Secondary analysis clearly showed that when antenatal corticosteroids are given between 24 hours and 7 days before delivery, the odds ratio is 0.35 (95% CI 0.26–0.46). This is reduced to 0.8 (95% CI 0.56–1.15) if antenatal corticosteroids are given at less than 24 hours before delivery, and to 0.63 (95% CI 0.38–1.07) if given more than seven days before delivery. Clearly, antenatal corticosteroids require at least 24 hours to exert their effects.#### Key messages Ante- and postnatal corticosteroids: Clinical trials of postnatal systemic corticosteroids in established chronic lung disease of prematurity (CLD) have been thoroughly reviewed by Ehrenkranz and Mercurio.3 At least nine randomised controlled trials of parenteral or oral dexamethasone have been reported for infants aged 2–6 weeks of postnatal age.4-12 All except two5 10 were devoted exclusively to intubated babies. The UK collaborative trial, one of the largest with 285 babies, covered a wide clinical spectrum of disease.5 The main outcome measures in most …

Infrapoliteal percutaneous transluminal angioplasty: A safe and successful procedure

Abstract: Aim: To review outcome of 40 consecutive infrapopliteal percutaneous transluminal angioplasty (PTA) procedures performed over a 65 month period Chief outcome measures: The indication for PTA was intermittent claudication in 20 (50%) cases and rest pain, ulceration or gangrene in the remainder Results: There was one technical failure; the remaining 39 limbs were all clinically improved by 24 h and this improvement was maintained at 3 months in 36 (90%) There were no deaths nor limb loss related to PTA and 2 embolic complications were successfully treated percutaneously The primary and secondary symptomatic patencies at 24 months were 59 and 79% respectively The actuarial limb salvage rate at 1 year for the 20 limbs presenting with critical ischaemia was 77%, and 10 of the 14 procedures performed for ulceration or gangrene resulted in healing with only minor surgical intervention Conclusions: With modern endovascular techniques, infrapopliteal PTA is a safe, worthwhile and durable procedure

Inguinal herniotomy in children: a five year survey.

Abstract: This retrospective review covers our experience over 5 years of 436 hernia repairs in 392 children upto the age of 15 years. The number of emergency presentations was 71 (18.1 per cent) and 66.2 per cent of these were under the age of 12 months. Most cases were initially treated conservatively and only 18 children required operation on the day of admission. There were 11 recurrences (7 elective and 4 emergency cases) giving a recurrence rate of 2.5 per cent. In all eleven cases the original operation was performed by a junior surgeon. The complication rate (excluding recurrences) was 2.8 per cent but may be an underestimate because of the limitations of a retrospective study. We suspect our results are typical of those to be found in any large British hospital and that with careful training and supervision of junior staff in the technique of inguinal herniotomy the results could be improved and approach those found in specialist paediatric units in America.