Showing papers by "Wishaw General Hospital published in 2007"
TL;DR: In intake of cooked meat has a significant effect on serum creatinine concentration and eGFR, and Clinicians should ensure that CKD classification is based on samples taken in the appropriate conditions: either fasting or after avoidance ofcooked meat on the day of sampling.
Abstract: BackgroundIngestion of cooked meat increases circulating blood creatinine concentration due to conversion of creatine during cooking. This may cause falsely low estimated glomerular filtration rate...
106 citations
TL;DR: It is suggested that lower preoperative albumin concentrations, but not elevated C-reactive protein concentrations, predict relapse-free, cancer-specific and overall survival, independent of clinico-pathologic status and treatment in patients undergoing potentially curative surgery for primary operable breast cancer.
Abstract: The relationship between the systemic inflammatory response (as evidenced by elevated C-reactive protein and lowered albumin concentrations), clinico-pathologic status and relapse-free, cancer-specific and overall survival was examined in patients with invasive primary operable breast cancer (n=300). The median follow-up of the survivors was 46 months. During this period, 37 patients relapsed and 25 died of their cancer. On multivariate analysis, only tumour size (P<0.05), albumin (P<0.01) and systemic treatment (P<0.0001) were significant independent predictors of relapse-free, cancer-specific and overall survival. Lower serum albumin concentrations (⩽43 g l−1) were associated with deprivation (P<0.05), hormonal receptor negative tumours (P<0.01) and significantly poorer 3-year relapse-free (85 vs 93%, P=0.001) cancer-specific (87 vs 97%, P<0.0001) and overall survival (84 vs 94%, P=0.001) rates. The results of the present study suggest that lower preoperative albumin concentrations, but not elevated C-reactive protein concentrations, predict relapse-free, cancer-specific and overall survival, independent of clinico-pathologic status and treatment in patients undergoing potentially curative surgery for primary operable breast cancer.
72 citations
TL;DR: Intramedullary nailing appears safe and effective for treatment of metastatic bone disease, and confers good functional results, pain relief, and mobility.
Abstract: Purpose. To evaluate whether the operating time correlates with the survival and outcome in patients who underwent intramedullary nailing for metastatic femoral fractures. Methods. Records of 10 men and 11 women aged 43 to 86 (mean, 66) years who underwent intramedullary nailing (4 bilaterally) for metastatic femoral fractures between 1999 and 2003 were reviewed. The patients were followed up for at least 2 years or until their death. The main outcome measure was the correlation between operating time and survival. Operating time was categorised into 5 groups from 60 to 210 minutes, with 30-minute increments. Results. Operating time does not correlate with survival and outcome. The mean survival period was 9.4 months. Pain relief was achieved in 90% of the patients. There was no implant failure, but one loss of reduction. Conclusion. Intramedullary nailing appears safe and effective for treatment of metastatic bone disease, and confers good functional results, pain relief, and mobility.
25 citations
TL;DR: Aim: To document previously unreported acute effects of adrenal insufficiency in mice.
Abstract: AIM:
To document previously unreported acute effects of adrenal insufficiency.
METHODS:
We describe two siblings who presented acutely with hyponatraemia and cerebral oedema following prolonged treatment with high dose inhaled fluticasone.
RESULTS:
A girl aged 5.5 years presented with vomiting, headache, visual impairment and seizures. She was hyponatraemic but not hypoglycaemic. Her conscious level continued to deteriorate and she died, post mortem examination showing small adrenal glands and cerebral oedema. Four weeks later her 7-year-old brother presented with similar symptoms. Assessment showed hyponatraemia with cerebral oedema. His illness responded to intensive care. A diagnosis of adrenal insufficiency was made retrospectively in both cases. The siblings had been receiving Fluticasone propionate (FP) in doses of up to 2000 microg/day for several years.
CONCLUSION:
We believe that the hyponatraemia and cerebral oedema was related to cortisol deficiency, leading to impaired excretion of water. We emphasize the need for careful cerebral monitoring in acute adrenal insufficiency presenting with impaired consciousness.
24 citations
Journal Article•
TL;DR: The technique described has much promise in the management of selected displaced intra-articular fractures of the calcaneus (true tongue shaped / Sanders II), and may also have a limited role in other fracture types in patients with significant co-morbidities, soft tissue compromise and poor healing potential.
Abstract: We describe a modification of the classical Essex-Lopresti manoeuvre for the indirect reduction and stabilisation of displaced intra-articular fractures of the calcaneus. The radiological and functional results achieved using this technique in 15 patients is presented. Ten tongue-shaped and 8 joint depression type fractures were treated by the new method, incorporating the use of an additional traction pin. The pre and postoperative Bohler angles as well as the correction achieved were documented. Functional assessment was carried out using the Maryland Foot Score. The mean pre-operative Bohler angle in the joint depression group was 5.5 degrees, and in the tongue shaped fracture group 5 degrees. The mean postoperative Bohler angle in the joint depression group was 15.8 degrees, and in the tongue shape group was 23.25 degrees. At a mean follow-up of 28 months the joint depression group scored 51/100 on the foot score, and the tongue shaped fracture group 77/100. The mean correction achieved as well as the mean overall functional scores were significantly better in the tongue shaped group. The technique described has much promise in the management of selected displaced intra-articular fractures of the calcaneus (true tongue shaped / Sanders II), and may also have a limited role in other fracture types in patients with significant co-morbidities, soft tissue compromise and poor healing potential.
15 citations
TL;DR: Despite advances in diagnosis, treatment and prevention, tuberculosis (TB) remains a major cause of mortality and morbidity worldwide and many of the commercially available preparations are unsuitable for children.
Abstract: Key points Tuberculosis (TB) is a major cause of morbidity and mortality worldwide. Children with TB are markers of recent disease transmission, usually from infectious adults. The 1 million cases of TB in children registered each year is likely to be a gross underestimate. The diagnosis is challenging and often presumed rather than confirmed. Symptoms, if present, are nonspecific. TB infection occurs when a previously uninfected child inhales an infected aerosol droplet. At this stage, the child usually shows no symptoms, the infection passes undetected and the primary focus heals. In most cases the infection is controlled by the body9s immune system and the organisms remain dormant. This is called latent TB. TB disease can develop either then or at a later stage when the organism multiplies, overpowering the host defences. At this stage, symptoms develop and there may be radiological or microbiological evidence of disease. "More bugs require more drugs". In TB infection, the organism load is small and therefore drug-resistant mutations are rare: hence simpler drug regimes are effective. In TB disease, the number of organisms is greater, so a combination of ≥3 drugs is required. Increasing resistance worldwide has led to four drugs being recommended as standard in many areas. Poor adherence to drug therapy is the main barrier to cure. Although directly observed therapy (DOTS) and intermittent therapy may improve the outcome, neither is a panacea. Co-operation and other strategies are required. Bacille Calmette-Guerin (BCG) vaccination remains the most widely used preventative strategy. Its efficacy is uncertain and its use needs to be targeted to neonates in high-risk areas who are most likely to benefit. The development of new vaccines against pulmonary TB is an important global challenge. Educational aims To describe the epidemiology and natural history of TB in children, focusing on pulmonary TB. To explore the challenges of diagnosis and provide an up-to-date overview of the methods available. To outline the management and prevention of pulmonary TB in children. Summary Despite advances in diagnosis, treatment and prevention, tuberculosis (TB) remains a major cause of mortality and morbidity worldwide. Diagnosis and treatment in children present a challenge, particularly in the face of growing drug resistance and coexistent disease such as HIV. New diagnostic methods have not yet been fully validated for use in children. No new drugs have become available in the past 30 years and many of the commercially available preparations are unsuitable for children. In 2006, a number of major documents and strategies were launched aimed at improving the care of children with TB, a previously neglected area.
14 citations
TL;DR: This account of John Charnley's work is a testimony to the lifetime achievements of one man, whose hard work and dedication have brought enormous benefit to generations of patients the world over.
Abstract: For young doctors embarking on a career in medicine, the decision on which path to take is often influenced by their experiences as an undergraduate student and, in particular, by those doctors and teachers who have stimulated and encouraged them. Likewise, inspiration can be derived from studying the life and work of eminent practitioners of the past. A final year elective module provided me with the opportunity to undertake a detailed critique of an aspect of the history of medicine of my choosing, which enabled me to investigate the history of hip replacement. This opened my eyes to the prodigious contribution of Sir John Charnley in the field of orthopaedics. His commitment to the practice and advancement of medical science is indeed an inspiration. This account of John Charnley's work is a testimony to the lifetime achievements of one man, whose hard work and dedication have brought enormous benefit to generations of patients the world over.
10 citations
TL;DR: In this article, the authors report on a study based around a commercial facilities management service provider's creation of an internal benchmark of how services for an acute hospital perform in terms of service quality.
Abstract: Purpose – The purpose of this paper is to report on a study based around a commercial facilities management (FM) service provider's creation of an internal benchmark of how services for an acute hospital perform in terms of service quality.Design/methodology/approach – The paper presents findings of a hard and soft FM application of the widely‐recognised SERVQUAL performance assessment tool; including its use and usefulness in a healthcare FM context. The paper proceeds to a conceptual discussion on emergent issues. It offers a questioning framework which the authors identify requires further study and debate but raises potentially profound issues for FM. Further replication‐related and conceptual development research is underway.Findings – Principally, the paper discusses the emergence and significance of the psychological phenomenon of cognitive dissonance within the datasets for the private finance initiative hospital case study. The paper also briefly discusses the scope for using the service consumer...
9 citations
TL;DR: The focus of this article is the nature of the collaboration between the partners from the initial ideas to the initiation, validation and ongoing delivery of the programme.
9 citations
TL;DR: Both teenage girls presenting following significant paracetamol overdoses presented within 4 h of the overdose and both were treated with N-acetylcysteine, in accordance with the National Poisons Information Service protocol, and developed significant hypokalaemia within 8 h of presentation.
Abstract: We report on two teenage girls presenting following significant paracetamol overdoses (>28 g paracetamol). Both presented within 4 h of the overdose and both were treated with N-acetylcysteine, in accordance with the National Poisons Information Service protocol. Within 8 h of presentation both had developed significant hypokalaemia with serum potassium concentrations 3.5 mmol/L) after commencing potassium chloride supplementation. An audit of potassium concentrations in 254 patients presenting with significant paracetamol overdose (paracetamol >0.5 mmol/L) admitted through four A&E departments in the West of Scotland showed a significant decline in mean serum potassium from 3.9 mmol/L on admission to 3.6 mmol/L (P = <0.001) over the next 36 h. The mechanism for this hypokalaemia in these two individuals is unclear, however regular monitoring of potassium is advocated in such patients during their initial treatment.
6 citations
TL;DR: An early magnetic resonance image (MRI) scan, initiation of appropriate management, repeat MRI scans and regular follow-up prevented further morbidity.
TL;DR: There is good evidence that timely restoration of coronary blood flow in obstructed infarct related arteries is a significant determinant of both short and long term mortality and morbidity and thrombolysis that remains the main reperfusion strategy in the UK.
Abstract: There is good evidence that timely restoration of coronary blood flow in obstructed infarct related arteries is a significant determinant of both short and long term mortality and morbidity. This is irrespective of whether it is achieved using fibrinolytic therapy or percutaneous coronary intervention (PCI). Despite the clear advantages of primary PCI, it is thrombolysis that remains the main reperfusion strategy in the UK. Recent data have highlighted mortality benefits when antiplatelet treatment and anticoagulation are used as adjuncts to thrombolysis. Moreover, of those who receive thrombolysis, 60% proceed to coronary arteriography within 6 months of their index event. Recent studies have been published clarifying the timing of coronary arteriography in patients who receive thrombolysis as reperfusion therapy.
TL;DR: Skin biopsy from the area demonstrated fibrin thrombi within small venous channels in both the dermis and subcutis, resulting in epidermal necrosis and blistering with no evidence of a primary vasculitis or perivascular inflammatory infiltrate.
Abstract: A 59-year-old man was admitted with a 1-week history of painful red swollen legs and haemorrhagic blisters. He was otherwise well, except for a past medical history of pulmonary fibrosis. He was a reformed smoker of 20 cigarettes daily for 40 years, having stopped in early 2005. General examination was unremarkable except for finger clubbing; there was a family history of idiopathic finger clubbing. Cutaneous examination revealed necrotic ulcers covered by black eschar with pink to purple irregular edges (Fig. 1). His feet were warm with palpable peripheral pulses. Routine laboratory investigations were normal except for mild neutrophilia and raised inflammatory markers. Coagulation screen demonstrated a prothrombin time of 16.7 s [normal range (NR) 11.5–14], partial thromboplastin time 29.4 s (NR 25.5–38.5) and fibrinogen 6.3 g ⁄ L (NR 1.5–4.5). Protein electrophoresis was consistent with an acute-phase reaction. Urinary protein level was normal, and Bence–Jones protein was not present. Hepatitis B surface antigen, hepatitis C antibodies, rheumatoid factor, antinuclear antibody, antineutrophil cytoplasmic antibodies, cold agglutinins and cryoglobulins were not detected. Anticardiolipin IgG and IgM antibodies were normal. Appearance of cryofibrinogen in the plasma was noted within 24 h with approximately 1016 mg ⁄ L of precipitate. Skin biopsy from the area demonstrated fibrin thrombi within small venous channels in both the dermis and subcutis, resulting in epidermal necrosis and blistering with no evidence of a primary vasculitis or perivascular inflammatory infiltrate (Fig. 2). Direct immunofluorescence staining for IgG, IgA and IgM was negative with faint positivity for C3 in some vessels. Chest X-ray confirmed the appearance of pulmonary fibrosis with possible underlying lymph-node enlargement. Computed tomography scan of the chest showed a solid PD
01 Jan 2007
TL;DR: The routine clinical assessment of bone mineral density (BMD) is best undertaken by the use of dual-energy X-ray absorptiometry (DXA) and ultrasound scans, and in the case of DXA exposure to ionizing radiation, has fueled the search for useful and reliable markers of bone turnover.
Abstract: The routine clinical assessment of bone mineral density (BMD) is best undertaken by the use of dual-energy X-ray absorptiometry (DXA) and ultrasound scans These techniques will establish BMD at a particular time Using serial DXA measurements it is possible to measure a change in BMD over a set period of time It is presumed that these measured changes in BMD are caused by alterations in bone turnover, but they are not direct measurements of bone turnover Furthermore, DXA scans and ultrasound can only indicate that loss of BMD has occurred, a single measurement cannot indicate that bone loss is occurring, and might lead to a lowered BMD in the future These radiological and ultrasound techniques have other limitations, not least inherent imprecision of the methods, which means that there have to be considerable changes in bone turnover before changes in BMD can be noticed For example, the 1–2% imprecision of DXA measurement limits scanning to 6-monthly intervals, so that observed changes are certain to be owing to bone loss and not imprecision The skilled nature of these techniques combined with the need for special equipment, and in the case of DXA exposure to ionizing radiation, has fueled the search for useful and reliable markers of bone turnover
TL;DR: The burden travelers returning from abroad place on the department and the nature of the pathology with which they attend was examined in Wishaw General, a Scottish district general hospital with 66,000 new patient ED attendances per year.
Abstract: International tourist arrivals reached an all time high of 763 million worldwide in 2004.1 British nationals made 60 million trips abroad2 of which 90% were to Europe, 5% to the United States, and 5% to the rest of the world. The most popular destinations were Spain and the Canary Islands.3
An average of 1,861 UK citizens die abroad each year and far more suffer illness or injury.4 While data on mortality and on morbidity from infectious diseases are recorded, there are fewer sources of data giving information on morbidity associated with noninfectious hazards experienced by UK citizens traveling abroad.
Over 2 million UK travelers consult their general practitioner annually at a cost of £11 million.5 However, the burden on emergency department (ED) services is not known, nor is the proportion of morbidity that may be preventable.
Wishaw General is a Scottish district general hospital with 66,000 new patient ED attendances per annum. We sought to examine the burden travelers returning from abroad place on the department and the nature of the pathology with which they attend.
The audit was carried out prospectively over 6 months from February 1 to August 1, 2005, a period corresponding to one rotation of …