London Bridge Hospital

About: London Bridge Hospital is a healthcare organization based out in London, United Kingdom. It is known for research contribution in the topics: Antiphospholipid syndrome & Systemic lupus erythematosus. The organization has 107 authors who have published 122 publications receiving 4523 citations.

Results of resection of medial patellar plica through a supero-lateral portal as a main arthroscopic procedure.

Abstract: PURPOSE OF THE STUDY The aim of this study was to evaluate the results of resection of Medial Patellar Plica of the knee. The criteria for inclusion was that resection of the Medial Patellar Plica was the main arthroscopic intervention performed. MATERIAL From 1st January 2002 to 31st December 2006, 1408 arthroscopies of the knee were carried out at the London Knee Clinic, London Bridge Hospital without the use of a tourniquet. In all cases of Medial Patellar Plica the Plica was observed through a supero-lateral portal as well as the standard portals. 53 knees fulfilled the criteria, of which 35 knees were traced and included in the study with an average follow-up period of 23.7 months. Typically patients were between the ages of 20-30 and engaged in sporting activities. METHODS Age, sex, symptoms (onset and duration), VAS (Visual Analogue pain Scale from 1 to 10) before and after operation, return to sporting activity and patient's subjective evaluation of the result were recorded in 31 patients (35 knees). RESULTS The average period of symptom duration prior to the operation was 18.6 months (minimum 2 months). The mean follow- up period was 23.7 months from operation (8-67 months), average VAS score was 6 points before surgery, and 2 points after surgery (0- no pain, 10 excruciating pain). Mean improvement was 4 points. 34 % of patients were totally pain free after arthroscopic resection (0 point on VAS). 65.8% returned to the same level of sporting activity as occurred before the onset of knee problems. When asked whether they would undergo the same procedure on the other knee 72 % replied positively. DISCUSSION Despite numerous publications about knee Plicae describing their anatomical and patho-physiological characteristics, there are still some arthroscopists who do not believe in their significance as a pathological entity and the diagnosis of Plica Syndrome remains controversial. The success of arthroscopic resection of one or more Plicae in most previous studies is rated on the scale excellent, good, poor, and very poor. The present study focuses on the type of Plica which is most frequently pathological, that is the Medial Patellar Plica and evaluates the outcome of surgery in terms of VAS score, return to sporting activity and the patient's satisfaction with treatment. CONCLUSION Plicae are common anatomical structures, which sometimes become symptomatic. When pathological, they can give rise to quite disabling patello-femoral symptoms as well as participating in the acceleration of arthritic changes. In order to evaluate the Medial Patellar Plica properly including its involvement in patello-femur disorders, it is essential to examine the knee through a supra-patellar portal and to undertake dynamic examination of the knee in various degrees of flexion and extension. Resection of pathological Medial Patellar Plica is a successful procedure giving good results in a majority of patients with return to sporting activities. In some cases however, symptoms persist at a lower intensity even after their resection so that the sporting activity has to be reduced in the long term.

Computerised techniques for detecting gaseous microemboli in blood using pulsed Doppler ultrasound

Abstract: Pulsed Doppler ultrasound and spectral analysis were used to monitor nonpulsatile blood flow generated in a test rig. Two computerised techniques are described for detecting microemboli in blood by analysis of Doppler blood velocity data (sonagram).The two ultrasound microemboli indices identify different features in the ultrasound signals to detect microembolic phenomena. Both indices showed significant increases (p < 0.001) for samples of agitated blood (containing gaseous microemboli) as compared to normal blood injected sequentially into the test rig. The linear relationship demonstrated between data obtained by the two methods (r = 0.91, p < 0.01) indicates that both are providing similar quantitative information regarding the number of microemboli detected.These two computerised techniques may be applied to sonagrams obtained from arterial blood flow and thereby provide information regarding the presence of gaseous microemboli in the circulation during cardiopulmonary bypass surgery.

Key messages for communicating information about BRCA1 and BRCA2 to women with breast or ovarian cancer: Consensus across health professionals and service users.

Abstract: BACKGROUND: Genetic testing of cancer predisposing genes will increasingly be needed in oncology clinics to target cancer treatment. This Delphi study aimed to identify areas of agreement and disagreement between genetics and oncology health professionals and service users about the key messages required by women with breast/ovarian cancer who undergo BRCA1/BRCA2 genetic testing and the optimal timing of communicating key messages. METHODS: Participants were 16 expert health professionals specialising in oncology/genetics and 16 service users with breast/ovarian cancer and a pathogenic BRCA1/BRCA2 variant. Online questionnaires containing 53 inductively developed information messages were circulated to the groups separately. Participants rated each message as key/not key on a Likert scale and suggested additional messages. Questionnaires were modified according to the feedback and up to 3 rounds were circulated. Consensus was reached when there was ≥75% agreement. RESULTS: Thirty key messages were agreed by both groups with 7 of the key messages agreed by ≥95% of participants: dominant inheritance, the availability of predictive testing, the importance of pretest discussion, increased risk of breast and ovarian cancer, and the option of risk-reducing mastectomy and bilateral salpingo-oophorectomy. Both groups agreed that key messages should be communicated before genetic testing and once a pathogenic variant has been identified. CONCLUSIONS: There was a high level of agreement within and between the groups about the information requirements of women with breast/ovarian cancer about BRCA1/BRCA2. These key messages will be helpful in developing new approaches to the delivery of information as genetic testing becomes further integrated into mainstream oncology services.

Cardiopulmonary exercise testing versus spirometry as predictors of cardiopulmonary complications after colorectal surgery

Abstract: To determine the predictive value of spirometry and cardiopulmonary exercise testing (CPET) preoperatively in patients scheduled to undergo elective colorectal surgery. We compared the preoperative results with the incidence of postoperative cardiopulmonary complications. A total of 103 patients were scheduled to undergo preoperative CPET and spirometry; 14 patients did not attend their appointments and another 20 were unable to perform the test. In all, 69 patients (median age 60 years (range 25–85), 35 males) successfully completed cycle ergometry and lung function tests. Forced expiratory volume in 1 s (FEV1), percent forced expiratory volume in 1 s (FEV1/forced vital capacity (FVC)) and anaerobic threshold (AT) were measured. Patients were divided postoperatively according to whether cardiopulmonary complications were absent (group A) or present (group B). Postoperative cardiopulmonary complications developed in 8 of the 69 patients (12 %). Thirty day mortality was 3 %. AT was significantly higher in group A (mean AT = 13.8; SD ± 3.0; range = 8.1–20.8) than in group B (mean = 10.91; SD ± 3.0; Range = 7.9–12), (p = 0.0006). Spirometric pulmonary function tests (FEV1, p = 0.09) and (FEV1/FVC, p = 0.08) showed no intergroup differences. The median hospital length of stay (HLOS) was significantly higher in the group of patients that suffered cardiopulmonary complications (p = 0.0282). CPET allows the prediction of postoperative cardiopulmonary complications which cannot be anticipated by spirometry. Early detection of high risk patients facilitates the planning of patient specific management strategies which are likely to improve outcome through invasive monitoring and optimisation of cardio-respiratory function.

Extensor Pollicis Brevis tendon damage presenting as de Quervain’s disease following kettlebell training

Abstract: Kettlebell exercises are more efficient for an athlete to increase his or her muscle strength. However it carries the risk of injury especially in the beginners. A 39 year old gentleman came to our clinic with radial sided wrist pain following kettlebell exercises. Clinically patient had swelling and tenderness over the tendons in the first dorsal wrist compartment, besides Finklesten test was positive. Patient had a decreased excursion of the thumb when compared to the opposite side. Ultrasound/MRI scan revealed asymmetric thickening of the 1st compartment extensors extending from the base of the thumb to the wrist joint. Besides injury to the Extensor Pollicis Brevis (EPB) tendon by repetitive impact from kettlebell, leading to its split was identified. Detailed history showed that the injury might be due to off-centre handle holding during triceps strengthening exercises. Our report stresses the fact that kettlebell users should be taught about problems of off-center handle holding to avoid wrist injuries. Also, in Kettlebell users with De Quervains disease clinical and radiological evaluation should be done before steroid injection as this might lead to complete tendon rupture.