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Tuesday 18 February 2014

WUTH publication: Ethnic differences in lower limb revascularisation and amputation rates. Implications for the aetiopathology of atherosclerosis?

Citataion: Atherosclerosis. 2014, 233(2), 503-507.
Author: Ahmad N, Thomas GN, Chan C, Gill P
Abstract: OBJECTIVE: Peripheral arterial disease, as a result of atherosclerosis, is the commonest reason for lower limb revascularisation and amputation in England. We describe the prevalence rate of these procedures among the White, South Asian and Black populations living in England and describe the association of ethnicity to amputation, both with and without, revascularisation.
METHOD: We extracted data from 90 million English hospital admissions between 2003 and 2009 and calculated prevalence rates among 50-84 year olds using census data. Logistic regression demonstrated whether ethnicity was related to amputation, both with and without revascularisation, independent of demographic (age, sex, social class) and disease risk factors (diabetes, hypertension, hypercholesterolaemia, coronary and cerebral vascular disease, smoking).
RESULTS: There were 25 308 amputations and 136 215 revascularisations. The age adjusted prevalence rate for amputation was 26/100 000 and revascularisation 142/100 000. The prevalence ratio (95% confidence intervals) (White British = 100) of amputation in the Asian and Black populations was; 60 (54-66) and 169 (155-183) respectively with revascularisation ratios; 89 (86-92) and 94 (89-98) respectively. South Asians had approximately half the risk of amputation both with and without a revascularisation than Whites despite much higher rates of known atherosclerotic risk factors. The odds of having an amputation without any revascularisation was 63% higher in Blacks but fully attenuated by demographic and disease risk factors.
CONCLUSION: South Asians experience the lowest rate of both major lower limb amputation and revascularisation in England. The association cannot be explained by demographic or cardiovascular risk factors. This may have implications in the aetiopathology of atherosclerosis.


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Friday 14 February 2014

WUTH publication: Traumatic disorders of forearm rotation: anatomy, biomechanics and treatment

Citation: British Journal of Hospital Medicine. 2014, 75(2), 72-7
Author: Mehta N, J Macfarlane R, Brown D
Abstract: The forearm is a complex structure which produces a wide range of movement. Forearm injuries are very common, but many injuries are missed or poorly treated. This article examines the anatomy and biomechanics of the forearm, and describes the important injuries to be recognized.


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WUTH publication: Prosthetic iris devices

Citation: Canadian Journal of Ophthalmology. 2014, 49(1), 6-17
Author: Srinivasan S, Ting DS, Snyder ME, Prasad S, Koch HR
Abstract: Congenital iris defects may usually present either as subtotal aniridia or colobomatous iris defects. Acquired iris defects are secondary to penetrating iris injury, iatrogenic after surgical excision of iris tumours, collateral trauma after anterior segment surgery, or can be postinflammatory in nature. These iris defects can cause severe visual disability in the form of glare, loss of contrast sensitivity, and loss of best corrected visual acuity. The structural loss of iris can be reconstructed with iris suturing, use of prosthetic iris implants, or by a combination of these, depending on the relative amount of residual iris stromal tissue and health of the underlying pigment epithelium. Since the first implant of a black iris diaphragm posterior chamber intraocular lens in 1994, advances in material and design technology over the last decade have led to advances in the prosthetic material, surgical technique, and instrumentation in the field of prosthetic iris implants. In this article, we review the classification of iris defects, types of iris prosthetic devices, implantation techniques, and complications.


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Monday 10 February 2014

WUTH publication: Closure of minor tracheoesophageal fistulae with calcium hydroxlapatite

Citation: Auris, Nasus, Larynx. 2013, 40(5), 491-2
Author: Kasbekar AV, Sherman IW
Abstract: OBJECTIVE: To demonstrate a novel technique for the closure of a pinhole tracheoesophageal fistula using Radiesse (calcium hydroxylapatite).
METHODS: Two patients underwent closure of a persistent tracheoesophageal fistula with four quadrant injections of Radiesse around the fistulous tract.
RESULTS: Both patients had their fistulas successful closed. The first patient died after 3 months due to lung metastasis. The second patient required a further attempt at closure with Radiesse injection and has been without a leak for 18 months at his last follow up appointment.
CONCLUSION: We feel this is an acceptable minimally invasive method to close a persistent pinhole tracheoesophageal fistula after failed management with chemical cautery.


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WUTH publication: The use of hip radiographs in primary care: the inter-observer agreement of reporting native hip pathology

Citation: Hip International, 2014, 24(3), 290-4
Author: Kenyon PJ, Perry D, Barrett M, Carroll FA, Thomas G
Abstract: Plain radiographs are often the first line investigation in identifying the cause of hip pain, though they do not differentiate all morphologically normal and abnormal hips. Interpretation of radiographs is subjective, depending on the patient history and physical signs. A radiological report can be misleading and may lead to, unnecessary radiation exposure, a delay in referral and a delay to definitive treatment. This study was to investigate the inter-observer reliability in the reporting of plain radiographs. <bold>Methods:</bold> Sixty-one consecutive antero-posterior (AP) radiographs of native hips were identified that had been referred to one of the senior authors from the community with "hip pain". Images were anonymised within PACS (picture archiving and communication system) and reviewed by a consultant orthopaedic surgeon, two consultant musculoskeletal radiologists, one senior orthopaedic registrar and one senior radiology registrar. Each reviewer was given a pre-constructed proforma, and asked to report the radiographs. <bold>Results:</bold> There is a varying degree of 'agreement' for many of the commonly used terms on a hip radiograph. Agreement between all observers varied, by description, between 23.3% (CAM Lesion) to 93.3% (AVN). Multi-rater agreement showed Kappa values ranging from 0.12 (poor) to 0.6 (moderate). Overall there were widespread inconsistencies, even amongst the most widely used terms. <bold>Conclusion:</bold> There is variable agreement amongst musculoskeletal radiology and orthopaedic experts when analysing plain radiographs of the native hip. This has implications for utility of reporting and therefore treatment in the community setting.


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