Showing papers by "London Bridge Hospital published in 2018"

Diagnosing Thoracic Outlet Syndrome: Current Approaches and Future Directions

Abstract: The diagnosis of thoracic outlet syndrome (TOS) has long been a controversial and challenging one. Despite common presentations with pain in the neck and upper extremity, there are a host of presenting patterns that can vary within and between the subdivisions of neurogenic, venous, and arterial TOS. Furthermore, there is a plethora of differential diagnoses, from peripheral compressive neuropathies, to intrinsic shoulder pathologies, to pathologies at the cervical spine. Depending on the subdivision of TOS suspected, diagnostic investigations are currently of varying importance, necessitating high dependence on good history taking and clinical examination. Investigations may add weight to a diagnosis suspected on clinical grounds and suggest an optimal management strategy, but in this changing field new developments may alter the role that diagnostic investigations play. In this article, we set out to summarise the diagnostic approach in cases of suspected TOS, including the importance of history taking, clinical examination, and the role of investigations at present, and highlight the developments in this field with respect to all subtypes. In the future, we hope that novel diagnostics may be able to stratify patients according to the exact compressive mechanism and thereby suggest more specific treatments and interventions.

Algorithmic Approach for Optical Coherence Tomography-Guided Stent Implantation During Percutaneous Coronary Intervention.

Abstract: Intravascular imaging plays a key role in optimizing outcomes for percutaneous coronary intervention (PCI). Optical coherence tomography (OCT) utilizes a user-friendly interface and provides high-resolution images. OCT can be used as part of daily practice in all stages of a coronary intervention: baseline lesion assessment, stent selection, and stent optimization. Incorporating a standardized, algorithmic approach when using OCT allows for precision PCI.

Fluoroscopy-free cryoablation of atrial fibrillation guided solely by transoesophageal echocardiography: a case report.

Abstract: Background Atrial fibrillation (AF) ablation has been shown to be possible using minimal or no fluoroscopic imaging for guidance. However, the techniques previously described focus on radiofrequency ablation or rely on the use of resource-heavy technology such as intra-cardiac echocardiography. We describe the first reported case in the literature of successful fluoroscopy-free AF cryoablation guided solely by transoesophageal echocardiography (TOE). Case summary A 65-year-old gentleman underwent cryoablation of paroxysmal AF using TOE guidance only with no use of fluoroscopy. Transoesophageal echocardiography was used in all stages of the procedure including guidance for transseptal puncture, ensuring balloon position in the pulmonary veins, and checking for post-procedure pericardial effusion. After 5 months of follow-up, the patient remains in sinus rhythm and has discontinued all antiarrhythmic and anticoagulant medication. Discussion This case demonstrates for the first time the feasibility of fluoroscopy-free cryoablation using only TOE for guidance.

Hughes syndrome (antiphospholipid syndrome) and the nervous system

Abstract: The original clinical descriptions of the antiphospholipid syndrome/Hughes syndrome: ‘Thrombosis, abortion, cerebral disease and the lupus anticoagulant’, highlighted the importance of neurological features in the clinical presentation of the syndrome. Such has been the frequency of neurological involvement in the clinical experience of Hughes syndrome over the ensuing 35 years, that central and peripheral nerve involvement come a close second to obstetric involvement as the commonest features of the syndrome.

Management of pregnancy in systemic lupus erythematosus: What a GP should know.

Abstract: Autoimmune Connective Tissue Diseases such as systemic lupus erythematosus (SLE) often affect women during their childbearing years. For years, women with potentially serious systemic autoimmune diseases have been advised against getting pregnant. We now know that, with careful medical and obstetric management, most of these women can have successful pregnancies. Successful, however, does not mean uneventful. Doctors and patients must be ready to deal with possible complications for both mother and child. Women should be discouraged from getting pregnant until their disease is under control. Fertility in women with rheumatic disease is generally not affected. In rheumatoid arthritis, the total number of pregnancies is slightly lower than in the general population, this seems to be more closely tied to personal choice than infertility. In SLE, fertility is similar to the general population. However, SLE patients with chronic kidney disease stages 3–5, with estimated glomerular filtration rate (eEGR) of <50ml/min, amenorrhoea due to previous high cumulative doses of cyclophosphamide and/or active disease may have reduced fertility. Even during times of severe SLE activity, women are able to conceive.

Multidisciplinary approach to the management of adult eosinophilic oesophagitis in the United Kingdom.

Abstract: Dietary intervention is effective for the management of eosinophilic oesophagitis (EoE) in both adults and children [1]. The majority of research has been conducted in Spain or the United States [1], with no studies of dietary intervention published in the United Kingdom. Restrictive elimination diets can be challenging and swallowed topical corticosteroids have also been shown to be an effective treatment in adults This article is protected by copyright. All rights reserved.

The Big 3

Abstract: Some years ago, I published a booklet called ‘The Big 3’. This was a clinical summary of three conditions: lupus, Sjögren’s syndrome and Hughes syndrome. In the following 15 years, although little has changed in terms of the clinical descriptions, one thing has changed significantly: clinical recognition of ‘The Big 3’. Whereas, 25 years ago all three conditions were regarded as rare and ‘small print’ affairs, they are now diagnosed and treated in increasing numbers, not only in general practice here in the UK, but in reports from centres around the world. In this Special Issue for the Royal College of General Practitioners, dealing with ‘connective tissue’ diseases, the emphasis will be focussed on diagnosis and management. This introductory chapter takes an anecdotal, mainly clinical look at Lupus, Sjogren’s syndrome and Hughes syndrome, hopefully serving as an introduction to the more detailed chapters that follow in this Special Issue.

The role of dentists in management of snoring with oral appliances

Abstract: This paper aims to highlight the importance of dentists in the management of sleep-related breathing disorders through the provision of mandibular advancement appliances (MAAs). An update on the use of MAA therapy is provided with respect to current clinical practice guidelines, their mode of action, selection and an awareness of their relative advantages and disadvantages, along with follow-up and practical aspects to their provision. CPD/Clinical Relevance: With the increasing recognition of the role of mandibular advancement appliances in the management of sleep-related breathing disorders, the importance of trained dentists in what is recognized as Dental Sleep Medicine is highlighted in this update.