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.

Cardiovascular and plasma catecholamine responses at tracheal extubation

Abstract: The haemodynamic responses to tracheal extub-ation at the end of surgery were compared with those occurring at tracheal intubation in 12 patients undergoing major elective surgery. Arterial can-nulation was performed and heart rate (HR), systolic arterial pressure (SAP) and diastolic arterial pressure (DAP) were measured before induction of anaesthesia, before tracheal intubation, at the end of surgery and 1. 3 and 5 min after tracheal extubation. Laryngoscopy was avoided at the end of surgery. At all but the first of these stages, venous blood was obtained for measurement of plasma concentrations of adrenaline and noradrenaline. Rate-pressure product (RPP) was derived from SAP x HR. After tracheal intubation there were significant (P

BSACI guideline for the diagnosis and management of peanut and tree nut allergy

Abstract: Summary Peanut nut and tree nut allergy are characterised by IgE mediated reactions to nut proteins Nut allergy is a global disease Limited epidemiological data suggest varying prevalence in different geographical areas Primary nut allergy affects over 2% of children and 05% of adults in the UK Infants with severe eczema and/or egg allergy have a higher risk of peanut allergy Primary nut allergy presents most commonly in the first five years of life, often after the first known ingestion with typical rapid onset IgE-mediated symptoms The clinical diagnosis of primary nut allergy can be made by the combination of a typical clinical presentation and evidence of nut specifc IgE shown by a positive skin prick test (SPT) or specific IgE (sIgE) test Pollen food syndrome is a distinct disorder, usually mild, with oral/pharyngeal symptoms, in the context of hay fever or pollen sensitisation, which can be triggered by nuts It can usually be distinguish clinically from primary nut allergy The magnitude of a SPT or sIgE relates to the probability of clinical allergy, but does not relate to clinical severity SPT of ≥ 8 mm or sIgE ≥ 15 KU/L to peanut is highly predictive of clinical allergy Cut off values are not available for tree nuts Test results must be interpreted in the context of the clinical history Diagnostic food challenges are usually not necessary but may be used to confirm or refute a conflicting history and test result As nut allergy is likely to be a long-lived disease, nut avoidance advice is the cornerstone of management Patients should be provided with a comprehensive management plan including avoidance advice, patient specific emergency medication and an emergency treatment plan and training in administration of emergency medication Regular re-training is required

The Association between Visual Impairment and Mortality in Elderly People

Abstract: By linking together the results from two surveys of elderly people in an English community it has been possible to consider visual impairment as a possible risk factor for mortality in people aged 75 years and over. Although minor degrees of visual impairment are associated with an increased mortality rate, blind people survive better than those with less serious visual impairments. Associations are considered between visual impairment and other known risk factors for mortality in the elderly. Visual impairment is shown to be associated with degree of social contact, whether a person lives alone, dementia score, physical activity score and number of unmet needs.

Sphincter of oddi dysfunction: Results of treatment by endoscopic sphincterotomy

Abstract: From a consecutive series of 451 patients with post-cholecystectomy symptoms referred for endoscopic retrograde cholangiopancreatography (ERCP), 40 (9 per cent) were diagnosed as having sphincter of Oddi dysfunction. Eight patients were excluded from the study because of incomplete data (n = 6) or additional diagnoses (n = 2). Thirty of the patients had successful ERCP and endoscopic sphincterotomy (ES); this failed in the remaining two because of severe papillary stenosis (6.3 per cent). Endoscopic biliary manometry was performed in 23 patients (77 per cent). Immediate post-ES complications occurred in eight patients (25 per cent). At a median follow-up of 46 months (range 10-88 months) 19 patients had a good outcome (63.3 per cent) and 11 patients had a poor outcome (36.7 per cent). Patients with a good outcome tended to have a delay of months or years following cholecystectomy before the development of symptoms (median 6 years versus 0 years, P = 0.0003). At ERCP, patients with a good outcome had greater common bile duct diameters (mean +/- s.d. mm, 12.6 +/- 3.6 versus 8.8 +/- 1.8, P = 0.0003) and delayed drainage from the biliary tree of injected contrast (13 versus 2 patients, P = 0.02). Endoscopic biliary manometry was abnormal in all 15 patients with a good outcome in whom it was performed but in only 3 out of 8 patients with a poor outcome (P = 0.003). Sphincter of Oddi dysfunction is an important, albeit uncommon, cause of post-cholecystectomy symptoms. ES provides symptomatic relief in the majority of patients but improved criteria for predicting outcome are required.