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Biomedical subjects

A Leslie

Publications and source records attributed to A Leslie.

At least 19 recordsLinked to original sources
PubMed2006

Thyroid isthmusectomy: a critical appraisal.

Thyroid lobectomy with isthmusectomy is the standard surgical technique for removal of unilateral thyroid nodules, and it involves the exposure of the tracheoesophageal grooves. Thyroid isthmusectomy is a surgical procedure that excises only the thyroid isthmus. It allows excision of a lesion without the exposure of the tracheoesophageal grooves. We aimed to demonstrate that isthmusectomy could be a safe alternative to thyroid lobectomy with isthmusectomy in patients with nodules confined to the isthmus or the pyramidal lobe. This was a prospective study performed over a five year period from 1999 to 2004. Inclusion criteria for thyroid isthmusectomy were: patients with a single lesion located in the region of the thyroid isthmus or the pyramidal lobe; maximum lesion diameter of 30 mm; and cytological reports of non-diagnostic appearance, follicular cells or suspicion of malignancy. Nine patients were identified with these criteria. Histology included two colloid nodules, three benign follicular adenomas, two Hurthle cell adenomas and two papillary thyroid carcinomas. There were no recorded complications. Thyroid isthmusectomy is a safe alternative to thyroid lobectomy with isthmusectomy in patients who have nodules confined to the isthmus and pyramidal lobe. Leaving a cuff of normal thyroid tissue has the advantage of not exposing the tracheoesophageal grooves, thus minimising potential damage to the recurrent laryngeal nerves and parathyroids. Surgeons performing isthmusectomies should be experienced in more complex thyroid surgical procedures.

Adult↗
PubMed2006

Relationship between point gene mutation, chromosomal abnormality, and tumour suppressor gene methylation status in colorectal adenomas.

Epigenetic mechanisms in carcinogenesis may have a significant role in the development of colorectal cancer. To investigate this phenomenon in early-stage disease, promoter methylation status in the tumour suppressor genes APC, MGMT, hMLH1, P14/P14ARF, and CDKN2A/P16 was investigated in 78 colorectal adenomas. These had previously been characterized for mutations of APC, KRAS, and TP53 genes and for chromosomal abnormality by comparative genomic hybridization (CGH). APC hypermethylation was seen in 52 tumours (66.7%). APC showed either methylation or mutation in 66 lesions (84.6%), but these events were not statistically associated. MGMT methylation was detected in 39 cases (50%). Adenomas with this abnormality showed a significantly lower number of chromosomal changes by CGH (p < 0.02), confirming that DNA repair defect of this type is associated with a lower level of chromosomal instability. An hMLH1 methylation defect was seen in only one adenoma (1.3%), from a patient who had a synchronous cancer showing the same defect. Methylation of P14 (P14ARF) was seen in 31 adenomas (39.7%) and CDKN2A (P16) abnormality in 25 (32.1%). DNA methylation at two or more loci was seen in 46 tumours (59%), while 11 lesions (14.1%) showed no evidence of hypermethylation at any of the loci studied. Methylation at any or all of MGMT, P14 or P16 was significantly associated with APC methylation (p = 0.01). Those neoplasms with more than two methylated genes showed significantly fewer chromosomal abnormalities than adenomas with one or no methylated loci (p < 0.001). There was no association between specific individual chromosomal abnormalities, APC, KRAS or TP53 mutations and any pattern of methylation abnormality. We conclude that methylation abnormality is very common in pre-invasive colorectal neoplasia, and that high level methylation is associated with low level chromosomal instability.

Adaptor Proteins, Signal Transducing↗
PubMed2005

Lower gastrointestinal symptoms are not predictive of colorectal neoplasia in a faecal occult blood screen-positive population.

BACKGROUND: The aim of this study was to evaluate the incidence of lower gastrointestinal symptoms in faecal occult blood (FOB) test-positive participants in a colorectal screening programme, and to compare the colonoscopic findings in symptomatic and asymptomatic individuals. METHODS: Five hundred and sixty-three consecutive individuals with a positive FOB test in the Scottish arm of the national colorectal cancer screening pilot were studied. All were aged between 50 and 69 years and underwent colonoscopy. Before the procedure the participants were given a standard questionnaire to elicit gastrointestinal symptoms; these were correlated with the colonoscopic findings. RESULTS: Of the 563 participants, 439 (78.0 per cent) had one or more lower gastrointestinal symptoms and 124 (22.0 per cent) were symptom free. Taking adenoma and carcinoma together, 322 (57.2 per cent) of the subjects were found to have colorectal neoplasia, and 128 (22.7 per cent) had a completely normal colon. Rectal bleeding was the most common symptom, followed by change in bowel habit, abdominal pain, tenesmus, unexplained weight loss, rectal pain and unexplained anaemia. No significant associations were found between any of these symptoms and the findings at colonoscopy. CONCLUSION: In a FOB test-positive screened population, lower gastrointestinal symptoms are common, but are not predictive of colorectal neoplasia.

Abdominal Pain↗
PubMed2004

Impact of a critical care outreach team on critical care readmissions and mortality.

AIMS: The aim of a critical care outreach team is to facilitate discharges from critical care beds, educate ward staff in the management of deteriorating patients, facilitate transfer to critical care and reduce readmission rates to critical care. Although intuitively a good idea, there are few data to support outreach in terms of reducing the readmission rate to critical care and subsequent patient mortality. This retrospective observational study attempted to determine the change in the critical care readmission rate, an indicator of the quality of critical care, critical care mortality and in-hospital mortality following the introduction of a critical care outreach team in a major teaching hospital. METHODS: A retrospective review of 1380 discharges from critical care was undertaken and the readmissions identified (n = 176). Readmission rate, mortality and other demographic data were compared between the pre and post-outreach periods. RESULTS: Critical care mortality, in-hospital mortality and 30-day mortality were all reduced in the post-outreach period amongst readmissions to critical care. There was also a decease in the overall mortality of all patients admitted to critical care. There were no apparent causative factors for this reduction in mortality before and following outreach. CONCLUSIONS: There are many confounding factors in assessing the impact of outreach teams in hospitals. This study tentatively concludes that outreach teams may have a favourable impact on mortality rate amongst readmissions to critical care, but more data is needed from multicentre trials.

APACHE↗
PubMed2004

Optimising neonatal transfer.

Services for neonatal intensive care in the United Kingdom have evolved in a largely unplanned fashion. Units of different sizes provide various amounts of intensive care, and, with a few exceptions, there is little or no formal regional or subregional organisation. Chronic underresourcing and the salvaging of ever more complex infants have resulted in tertiary neonatal intensive care units operating at full capacity most of the time, a situation compounded by a chronic national shortage of nursing staff. These factors have in turn resulted in an increase in requirements for emergency perinatal transfers.

Hospital Bed Capacity↗
PubMed2004

Benign complications of expandable metal stents used in the palliation of oesophageal carcinoma: two case reports.

We describe two patients who were treated with self-expanding metal stent (SEMS) insertion as palliation of malignant oesophageal strictures. Both patients re-presented with dysphagia several months after SEMS insertion due to benign strictures. Initial treatment with balloon dilation and medical management had limited success so both patients had further SEMS inserted across the secondary benign strictures. This provided very good symptomatic relief. Chemotherapy and chemo-radiation in patients with inoperable oesophageal carcinoma are prolonging patient survival. As patients survival lengthens benign complications of SEMS may become an increasing clinical problem.

Adenocarcinoma↗
PubMed2003

The interrupted serosubmucosal anastomosis - still the gold standard.

BACKGROUND: The single-layer appositional serosubmucosal anastomosis is a well established technique and appears to have a favourable record. Over a 15-year period the senior author of this paper has performed or directly supervised 553 anastomoses using this technique. This report describes the results of these operations, the results of stapled anastomoses carried out during the same period and discusses the utility of the handsewn technique. METHODS: From August 1986 to July 2001, 553 intestinal anastomoses in 550 patients were fashioned using single-layer, interrupted serosubmucosal 3/0 braided polyamide and 131 anastomoses in 131 patients were performed using a circular anastomosing stapler. RESULTS: One anastomotic leakage occurred in the group of patients whose anastomosis was handsewn (0.2%) and 11 leaks occurred in those who had a stapled anastomoses (8.4%). The mortality rate in each group was similar (2% and 2.3%, respectively). There were no deaths attributable to anastomotic dehiscence in either group. CONCLUSION: In this prospectively audited series of 553 handsewn anastomoses the leakage rate was 0.2%. These results compare favourably with other published series and continue to support a single layer of interrupted serosubmucosal sutures as the gold standard for anastomoses involving the large or small bowel.

Anastomosis, Surgical↗
PubMed2003

Neonatal transfers by advanced neonatal nurse practitioners and paediatric registrars.

OBJECTIVE: To evaluate the safety and practicality of using advanced neonatal nurse practitioners (ANNPs) to lead acute neonatal transfers. DESIGN: Comparison of transport times, transport interventions, and physiological variables, covering the first four complete years of operating a transport service that uses ANNPs and specialist paediatric registrars (SpRs) interchangeably. SETTING: Tertiary neonatal transport service. PATIENTS: The first 51 transfers of sick infants under 28 days of age by an ANNP led transport team into Nottingham compared with the next consecutive SpR led transfer after each ANNP led one. MAIN OUTCOME MEASURES: Transport times; interventions and support given during stabilisation for transfer and during transfer; condition on completion of transfer, assessed from blood glucose, systolic blood pressure, pH, oxygenation, and temperature. RESULTS: The ANNP led team responded more rapidly to requests for transfer and took longer to stabilise babies. The groups undertook similar numbers of procedures during stabilisation, and there were no differences in the ventilatory and other support that infants needed in transit. The infants transferred by the doctor led group had worse values for pH (doctor led, 7.31 (6.50-7.46); ANNP led, 7.35 (7.04-7.50), p = 0.02) and PaO(2) (doctor led, 6.7 (2.4-13.1); ANNP led, 8.7 (3.5-17.0); p = 0.008) before transfer (all values median (range)). Comparisons of the infant's condition before and after transfer showed a significant improvement in temperature for the infants transferred by ANNP led teams (36.8 degrees C (34.0-37.8) v 37.0 degrees C (34.6-38.0), p = 0.001) and in oxygen saturation (96% (88-100) v 98% (92-100), p = 0.01). There were no differences between the ANNP and doctor led groups in the values obtained for any variable after transfer. CONCLUSIONS: Clinical condition on completion of transport is similar for babies transferred by ANNP and doctor led teams. ANNP led transport appears to be practical and safe.

England↗
PubMed2002

The colorectal adenoma-carcinoma sequence.

BACKGROUND: It is widely accepted that the adenoma-carcinoma sequence represents the process by which most, if not all, colorectal cancers arise. The evidence supporting this hypothesis has increased rapidly in recent years and the purpose of this article is to review this evidence critically and highlight its clinical significance. METHODS: Medline searches were used to identify recent key articles relating to the adenoma-carcinoma sequence. Further pertinent articles were obtained by manual scanning of the reference lists of identified papers. RESULTS: The evidence supporting the adenoma-carcinoma sequence can be classified as epidemiological, clinicopathological and genetic. The most recent and largest body of data relates to molecular genetic events and their cellular effects; however, many other approaches, such as cytogenetics, molecular cytogenetics and cytometry, have also yielded valuable information. CONCLUSION: Recent work continues to support the adenoma-carcinoma sequence, but there is a paucity of data on the interrelationship between different genetic mutations and on the relationship between molecular and other types of genetic abnormalities. The clinical utility of the observations described has yet to be fully realized and global genetic analysis of colorectal tumours may prove to be central in rational adenoma management.

Adenoma↗
PubMed2002

Detection of colorectal carcinoma on double contrast barium enema when double reporting is routinely performed: an audit of current practice.

PURPOSE: To determine the sensitivity of double contrast barium enema (DCBE) in the detection of colorectal carcinoma (CRC) when double reporting is routinely performed. METHOD AND MATERIALS: Over a 1-year period all patients with a diagnosis of CRC within a large teaching hospital were identified. Using computer records, any patient with CRC who had had a DCBE within 5 years of diagnosis was identified. During this time period all DCBE were double reported by the radiographer or radiology trainee who performed the enema and by a consultant radiologist specializing in gastrointestinal radiology. RESULTS: Over the 1-year period 169 patients were identified with a diagnosis of CRC. Seventy patients had had a DCBE within the preceding 5 years. Sixty-four patients had had CRC diagnosed on the DCBE. One patient had a sessile polyp diagnosed, which was removed at colonoscopy and found to be an invasive adenocarcinoma. In five cases (7%) the CRC was not diagnosed on DCBE. In three cases the lesions could be seen retrospectively, in one case the lesion could not be seen and in one case the examination had been incomplete. CONCLUSION: In our series the miss-rate for CRC was 7%. Previous studies have shown miss-rates of 15-24%. These studies have not routinely employed double reporting. Our results suggest that double reporting of DCBE significantly reduces the miss-rate and that this reduction is due to fewer perceptive errors.

Adult↗
PubMed2002

Management of colorectal cancer.

Colorectal cancer is the second most common cause of cancer death in the UK. Prompt investigation of suspicious symptoms is important, but there is increasing evidence that screening for the disease can produce significant reductions in mortality. High quality surgery is of paramount importance in achieving good outcomes, particularly in rectal cancer, but adjuvant radiotherapy and chemotherapy have important parts to play. The treatment of advanced disease is still essentially palliative, although surgery for limited hepatic metastases may be curative in a small proportion of patients.

Chemotherapy, Adjuvant↗
PubMed2002

Colonoscopy.

Colonoscopy is now the gold standard method for investigating most colonic symptoms. However, it is a demanding procedure that can be associated with low completion rates and significant complications, and it requires considerable skill to perform colonoscopy consistently well and safely. In this article, the key steps in performing colonoscopy are described with a view to providing the trainee with a logical sequence of manoeuvres on which to base a sound technique.

Colonoscopes↗
PubMed2001

Opportunity for audit: establishing and monitoring the use of protocols for nurse-led treatments of minor injuries.

During the last three years an integrated initiative has evolved in the casualty units of nine community hospitals in the Grampian region of Scotland. This has involved the development of nurse-led treatments for minor injuries based on a large number of assessment/treatment protocols. This paper describes how this change was used as an opportunity to initiate audit within clinical practice. Methods of auditing the use of the new protocols are detailed and baseline results are reported and discussed. In this way it is hoped that nurses involved in similar developments can learn from the strengths and weaknesses of this initiative.

Clinical Protocols↗
PubMed2001

Error in radiology.

The level of error in radiology has been tabulated from articles on error and on "double reporting" or "double reading". The level of error varies depending on the radiological investigation, but the range is 2-20% for clinically significant or major error. The greatest reduction in error rates will come from changes in systems.

Magnetic Resonance Imaging↗
PubMed2000

Who should be performing routine abdominal ultrasound? A prospective double-blind study comparing the accuracy of radiologist and radiographer.

AIM: To compare the accuracy of radiographers and radiologists in routine abdominal ultrasound. MATERIALS AND METHODS: One hundred consecutive patients attending for routine abdominal ultrasound were included. Each patient was examined by both a radiographer and radiologist. Both operators noted their findings and wrote a concluding report without conferring. Reports were compared. Where there was disagreement the patient was either re-examined by another radiologist or had further investigation. RESULTS: Of 100 patients, 52 were men and 48 were women. The age range was 19-88 years (median 52 years). Thirty-seven patients had renal tract ultrasound, one had an aortic ultrasound and 62 had general upper abdominal ultrasound. In 44 cases both operators reported the examination as normal. In 49 cases both operators reported the examinations as abnormal and there was complete agreement between the operators. In seven cases there was not complete agreement between operators. Three of these disagreements were considered minor and four major. In three of the seven cases the radiographer was correct, and in four the radiologist was correct. CONCLUSION: Experienced radiographers and radiologists are highly accurate in performing and interpreting routine abdominal sonography. Both operators missed a small minority of abnormalities. There was no statistically significant difference in the accuracy of radiographers and radiologist.

Abdomen↗
PubMed2000

The influence of clinical information on the reporting of CT by radiologists.

The aim of the study was to determine whether clinical information alters the CT report. This prospective blinded study consisted of 50 consecutive patients who attended a Department of Radiology for CT. Each study was interpreted by two of three consultant radiologists, before and after knowledge of the clinical information. 19 reports were changed after clinical information was known. Clinical follow-up was available in 15 cases. In ten cases the reports were more accurate after clinical information and in five cases the reports were less accurate. In three of the five cases where accuracy was reduced, the clinical information was incorrect. It was concluded that clinical information affects the CT report. If the information is accurate it has a beneficial effect; if it is inaccurate it has a detrimental effect. The more complex the investigation, the more important the clinical information. There was a correlation between readers regarding the influence of clinical information. Correct clinical information therefore improves the radiology report. It is the responsibility of the clinician to provide this information in an accurate and legible form.

Adolescent↗
PubMed1999

Plexiform neurofibroma of the small bowel infiltrated with metastatic adenocarcinoma.

Neurofibromatosis Type 1 (NF1) is not classically associated with gastrointestinal manifestations although these patients are at increased risk of several GI complications. We describe the ultrasound, CT and barium findings in a patient with NF1 who had a huge benign plexiform neurofibroma of the ileum that was infiltrated with metastatic adenocarcinoma.

Adenocarcinoma↗