Derriford Hospital

About: Derriford Hospital is a healthcare organization based out in Plymouth, United Kingdom. It is known for research contribution in the topics: Population & Transplantation. The organization has 2892 authors who have published 3137 publications receiving 84438 citations.

The burden of revision sinonasal surgery in the UK—data from the Chronic Rhinosinusitis Epidemiology Study (CRES): a cross-sectional study

Abstract: Objectives The aim of this study was to investigate the surgical revision rate in patients with chronic rhinosinusitis (CRS) in the UK CRS Epidemiology Study (CRES). Previous evidence from National Sinonasal Audit showed that 1459 patients with CRS demonstrated a surgical revision rate 19.1% at 5 years, with highest rates seen in those with polyps (20.6%). Setting Thirty secondary care centres around the UK. Participants A total of 221 controls and 1249 patients with CRS were recruited to the study including those with polyps (CRSwNPs), without polyps (CRSsNPs) and with allergic fungal rhinosinusitis (AFRS). Interventions Self-administered questionnaire. Primary outcome measure The need for previous sinonasal surgery. Results A total of 651 patients with CRSwNPs, 553 with CRSsNPs and 45 with AFRS were included. A total of 396 (57%) patients with CRSwNPs/AFRS reported having undergone previous endoscopic nasal polypectomy (ENP), of which 182 of the 396 (46%) reported having received more than one operation. The mean number of previous surgeries per patient in the revision group was 3.3 (range 2–30) and a mean duration of time of 10 years since the last procedure. The average length of time since their first operation up to inclusion in the study was 15.5 years (range 0–74). Only 27.9% of all patients reporting a prior ENP had received concurrent endoscopic sinus surgery (ESS; n=102). For comparison, surgical rates in patients with CRSsNPs were significantly lower; 13% of cases specifically reported ESS, and of those only 30% reported multiple procedures (χ 2 p Conclusions This study demonstrated that there is a high burden of both primary and revision surgery in patients with CRS, worst in those with AFRS and least in those with CRSsNPs. The burden of revision surgery appears unchanged in the decade since the Sinonasal Audit.

Morphine consumption in patients receiving rectal paracetamol and diclofenac alone and in combination.

Abstract: Paracetamol and diclofenac have different mechanisms of action, and the combination may be more effective than each drug used alone in treating postoperative pain. In a double-blind, controlled design, we studied 60 patients undergoing elective abdominal gynaecological surgery, who received suppositories of paracetamol 1.5 g, diclofenac 100 mg or a combination of the two before the start of surgery. Patients received morphine in the intraoperative period, and cumulative morphine use from a patient-controlled analgesia system was recorded to measure the analgesic effect of the suppositories. Morphine consumption was greatest in the group that received paracetamol alone and lowest in the group given the combination (P

Atypical lymphocyte morphology: an adverse prognostic factor for disease progression in stage A CLL independent of trisomy 12

Abstract: Summary. We studied 270 patients with Binet stage Achronic lymphocytic leukaemia looking for adverse prog-nostic factors. In a multivariate analysis the followingfeatures were found to be risk factors for disease progression:atypical lymphocyte morphology (defined as either >10%prolymphocytes or >15% lymphocytes with cleaved nucleior lymphoplasmacytoid cells); more than two karyotypicabnormalities; lymphocyte count >30 ×10 9 /l; lymphocytedoubling time <1 year; enlargement of one or more lymphnode groups.In a univariate analysis the presence of trisomy 12 alsocorrelated with progressive disease, but this was largely aconsequence of the association between trisomy 12 andatypical lymphocyte morphology. Atypical lymphocytemorphology is an important prognostic factor in stageA CLL, and one which incurs no additional investigationalcost. Keywords: atypical lymphocyte morphology, stage A CLL.The Binet and Rai staging systems separate patients withchronic lymphocytic leukaemia (CLL) into low, intermediateand high risk groups, but cannot predict which low-riskpatients will develop progressive disease (Cheson, 1993;Montserrat & Rozman, 1993). Until recently the predictionof disease progression was of scientific interest but of littlepractical importance since there was no evidence thattreatment of Binet stage A patients with alkylating agentsbefore progression occurred was of any benefit (FrenchCo-operative Group on CLL, 1990). However, there is nowconsiderable interest in the use of new and more intensivetreatments such as nucleoside analogues (Keating