Royal Devon and Exeter Hospital

About: Royal Devon and Exeter Hospital is a healthcare organization based out in Exeter, United Kingdom. It is known for research contribution in the topics: Population & Randomized controlled trial. The organization has 2282 authors who have published 2526 publications receiving 78866 citations. The organization is also known as: RD&E.

Cost‐effectiveness of ultrasound‐guided foam sclerotherapy, endovenous laser ablation or surgery as treatment for primary varicose veins from the randomized CLASS trial

Abstract: This work was carried out as part of a project funded by the National Institute for Health Research (NIHR) Health Technology Assessment (HTA) Programme (project number 06/45/02).

Parastomal hernia following cystectomy and ileal conduit urinary diversion: a systematic review.

Abstract: The natural history of development of Parastomal hernia (PH) following cystectomy and ileal conduit diversion is poorly understood. The aim of this study was to systematically review the frequency and risk factors of PH following ileal conduit diversion. A systematic review of literature was performed and the Cochrane, EMBASE and PubMed databases were searched from 1st January 1985 to 30th April 2016. All articles reporting occurrence of PH following cystectomy and ileal conduit diversion were analysed. The primary outcome measure was the frequency of development of PH. Secondary outcome measures were risk factors for PH development, complications of PH, frequency of PH repair and recurrence of PH. Twelve articles of the 63 originally identified were analysed. Sample sizes ranged from 36 to 1057 patients with a pooled total of 3170 undergoing ileal conduit surgery. Age at the time of surgery ranged from 31 to 92 years. Of the 3170 patients who underwent ileal conduit surgery, 529 patients (17.1%) developed a PH based on either clinical examination or cross sectional imaging. Female gender, high BMI, low preoperative albumin and previous laparotomy were significantly associated with the development of PH in two studies. Repair of PH was offered to 8–75% of patients. The rate of recurrence following repair of PH was reported to range from 27 to 50%. A PH is frequent following cystectomy and ileal conduit urinary diversion. The diagnosis of a PH depends upon duration of clinical follow-up and the use of cross-sectional imaging. The recurrence rates following the repair of a PH remain substantial.

Femoroacetabular impingement syndrome: Nonarthritic hip pain in young adults

Abstract: OBJECTIVE To provide family physicians with an approach to the diagnosis and management of nonarthritic hip pain in young adults, which might occur as a result of femoroacetabular impingement syndrome. SOURCES OF INFORMATION A MEDLINE search from 1950 to April 2007 was carried out using the MeSH terms femoroacetabular, impingement, hip, and syndrome. The existing literature consists of level II studies. To date, randomized controlled trials have not been carried out. MAIN MESSAGE Nonarthritic hip pain in the active adult population has long been a difficult clinical problem to manage. Arthroplasty is rarely an appropriate option and the usual conservative therapies for musculoskeletal problems are frequently ineffective. Recently, abnormal impingement between the acetabulum and femoral head-neck junction, or femoroacetabular impingement syndrome, has been recognized as a relatively common and possibly prearthritic cause of these symptoms. Family physicians can identify these patients by recognizing the clinical history and through specific examination findings. Emerging evidence suggests that early surgical intervention improves function and perhaps prevents or delays the onset of degenerative changes in the hip joint. CONCLUSION Family physicians can identify patients with possible femoroacetabular impingement syndrome and play an important role in the appropriate management of these cases.

Analysis of gross deletions in the MEN1 gene in patients with multiple endocrine neoplasia type 1.

Abstract: Summary Background Mutation analysis with direct DNA sequencing is commonly used for the molecular diagnosis of multiple endocrine neoplasia type 1 (MEN1). However, a significant number of patients, despite clinical features of MEN1, do not show MEN1 mutations on direct DNA sequencing. Some of these patients may have gross gene deletions not detected by direct DNA sequencing or mutations in the noncoding regions of the gene not examined routinely. Objective To determine the prevalence of gross deletions in MEN1 in a large cohort of MEN1 patients. Patients and methods During 1997–2006, we screened MEN1 mutations by direct DNA sequencing in 368 probands referred to our diagnostic molecular genetic laboratory. Of these, 101 probands (23 familial, 78 sporadic) fulfilled the clinical criteria for MEN1 (presence of at least two of the parathyroid, pancreatic or pituitary tumours) but were negative for mutations on DNA sequencing. Their DNA samples were examined for gross deletions of one or more exons of MEN1 by using multiple ligation-dependent probe amplification (MLPA) and long-range polymerase chain reaction (PCR) amplification. We also sequenced the minimal promoter region of MEN1 for mutations in the familial cases. Results We identified a gross deletion involving exons 5 and 6 of MEN1 in one proband (prevalence rate 1%). The sequencing of the minimal promoter region in the familial cases revealed no mutations. Conclusion Gross deletion in the MEN1 gene is an uncommon cause of MEN1 and should be tested for in patients with a high clinical suspicion but without mutations on direct DNA sequencing.