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.

A retrospective audit of the combined pituitary function test, using the insulin stress test, TRH and GnRH in a district laboratory.

Abstract: SUMMARY objective To assess the value of the combined insulin stress test (IST), thyrotrophin-releaslng hormone (TRH) and gonadotrophin hormone-releasing hormone (GnRH) tests design A retrospective audit of 232 such tests performed between 1980 and 1989 inclusive patients One hundred and ninety-seven patients with known or suspected pituitary disease measurements IST, TRH and GnRH responses were retrieved from laboratory records. Case notes were surveyed for clinical data and additional results results A basal serum cortisol level of > 100 nmol/l (or > 200 nmol/l in patients who had recently received glucocorticoid replacement therapy) accurately predicted a subnormal response to hypoglycaemla. All patients with a basal cortisol level of >400 nmol/l, except those who had recently received steroids, showed a normal cortisol response. In retrospect, by consideration of such basal values, 55% of ISTs could have been avoided if the only aim was to assess cortisol reserve. A deficient growth hormone (GH) response to hypoglycaemia was, however, common In patients with a normal cortisol response. Two-thirds of patients with GH deficiency would have been missed If an IST had been avoided on the basis either of basal cortisol levels alone, or of cortisol responses to an alternative test which did not test GH reserve. There was poor agreement between the pituitary response to TRH and GnRH and basal levels of thyroxlne and gonadotrophins respectively, suggesting that these releasing hormone tests are misleading. conclusions The IST provides information regarding pituitary function not provided by other tests of the hypothalamlc-pltuitary-adrenal axis, so that the choice between the IST and alternative tests must depend on a critical assessment of what Information is required. Routine TRH and GnRH testing appears to yield little Information of practical clinical value

The Abductor Digiti Minimi Muscle Flap

Abstract: The problems of extensive scarring involving the median and ulnar nerves at the wrist are discussed. Possible methods of separating the dermal cicatrix from the nerves are skin flaps or muscle flaps. A case is presented in which an abductor digiti minimi muscle flap was used. The reasons for this choice are discussed and the technique described.

Antidepressants may not assist recovery in practice: a naturalistic prospective survey

Abstract: A total of 130 people attending psychiatric hospitals within 6 months of onset or relapse of an episode of depressive disorder were interviewed about their symptoms and treatment at the time of their initial contact. After a mean 4-month interval, 119 were reassessed to test the hypothesis that patients treated with antidepressants would be significantly more likely to be clinically improved compared with those untreated. Severity and duration of the episode emerged as the only significant clinical predictors of clinical improvement. Patients on treatment with antidepressants at the start of the study showed a nonsignificant trend for a lesser degree of clinical improvement, even when clinical severity and compliance were taken into account. Those who were not commenced on treatment until later in the study also fared no better than those who were never prescribed antidepressants. The effect of low doses of antidepressants (almost always a tricyclic) appeared to be less beneficial than either higher doses or clinical management without antidepressant drugs. The need for further experimental and naturalistic studies conducted over various periods of time and the implications for clinical practice, medical audit and the appropriate use of health outcome indicators are discussed.

Cluster analysis of diffusion tensor magnetic resonance images in human head injury

Abstract: OBJECTIVE: Issues surrounding the nature of the edema associated with traumatic brain injury in humans, and its evolution in the acute phase, remain unresolved. This study aimed to characterize the topographical nature of the pathophysiological changes in human traumatic brain injury with diffusion tensor magnetic resonance imaging. METHODS: Multislice diffusion-weighted magnetic resonance imaging data were acquired from five patients undergoing elective ventilation for management of traumatic focal contusion or hematomas. The diffusion tensor and the T2-weighted intensity were then computed for every voxel in the image data set for each patient. The topographical distribution of abnormalities in the trace of the diffusion tensor and T2-weighted images were characterized by cluster analysis. RESULTS: In four patients with technically satisfactory data, a narrow band of tissue was observed in the periphery of focal lesions, which was characterized by selective reduction in the trace of the diffusion tensor, without any associated increase in the T2-weighted signal intensity. CONCLUSION: This change is interpreted as indicating either a partial redistribution of water from the extra- to intracellular compartment, or a reduction in the diffusivity of water in the intracellular or cytosolic environment. These diffusion and T2-weighted characteristics are also found in early ischemic change, hence, such regions may represent potentially salvageable tissue at risk of permanent damage. The study illustrates the advantage of using information contained within the diffusion tensor in addition to more conventional imaging sequences.

Meniscal Extrusion in Young Athletes: Associated Knee Joint Abnormalities

Abstract: OBJECTIVE. The objective of our study was to assess the rate of meniscal extrusion and its connection with common meniscal and joint abnormalities.MATERIALS AND METHODS. MR signs of meniscal extrusion were evaluated retrospectively in 24 rugby and soccer players (40 knees) who are currently free of pain in the knee, impaired mobility, and joint swelling. The control group consisted of 23 consecutive active individuals (36 knees) with no history of knee problems. The criterion for extrusion of the meniscus was defined as a distance of 3 mm or more between the peripheral border of the meniscus and the edge of the tibial plateau measured on coronal images.RESULTS. Forty-eight percent of the athletes' knees and 30% of the control subjects' knees showed evidence of meniscal extrusion. Among the athletes, a significant association between meniscal extrusion and joint effusion (11 cases), meniscal tears (seven cases), and anterior cruciate ligament (ACL) tear (four cases) was found (p ≤ 0.004). In the control gr...