The Experts below are selected from a list of 30 Experts worldwide ranked by ideXlab platform
SJ Warren - One of the best experts on this subject based on the ideXlab platform.
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Day case laparoscopic incisional hernia repair is feasible, acceptable, and cost effective
SURG ENDOSC, 2007Co-Authors: SJ WarrenAbstract:Background: Day case surgery is increasingly performed in the United Kingdom. Laparoscopic techniques have increased the number of conditions suitable for a day surgical approach. Findings have shown that laparoscopic incisional hernia repair (LIHR) is superior to conventional open techniques. This study aimed to show that day case LIHR is safe, produces a good clinical outcome, and is cost effective.Methods: Day case laparoscopic repair was performed for 31 consecutive patients (10 men; median age, 67 years; range, 39-80 years). Data were entered prospectively into a database. Patients were discharged within 8 h committed to a 10-day course of oral diclofenac 50 mg three times daily and 2 tablets of Codydramol four times daily. Follow-up evaluation was by telephone consultation. Hospital costs for LIHR and open repair were compared.Results: All procedures were completed laparoscopically on a day case basis. Additional unsuspected defects were found in eight cases (25.8%). The median mesh size was 140 cm(2) (range, 25-375 cm(2)), and the median body mass index (BMI) was 28.7 kg/m(2) (range, 20-37.1 kg/m(2)). Operations were performed or supervised by a single consultant surgeon (S.J.W.). Six postoperative seromas resolved spontaneously. Two port-site infections required oral antibiotics, and one diathermy pad burn healed with simple dressings. The median analgesia requirement was 7 days (range, 0-152 days). There were no recurrences during a median follow-up period of 15 months (range, 3-24 months). There was a saving of E616 per procedure.Conclusions: Day case laparoscopic repair of incisional hernias is feasible and safe and has a good clinical outcome. The hospital costs are less than for open techniques.
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Day case laparoscopic incisional hernia repair is feasible, acceptable, and cost effective
SURG ENDOSC, 2007Co-Authors: SJ WarrenAbstract:Background: Day case surgery is increasingly performed in the United Kingdom. Laparoscopic techniques have increased the number of conditions suitable for a day surgical approach. Findings have shown that laparoscopic incisional hernia repair (LIHR) is superior to conventional open techniques. This study aimed to show that day case LIHR is safe, produces a good clinical outcome, and is cost effective.Methods: Day case laparoscopic repair was performed for 31 consecutive patients (10 men; median age, 67 years; range, 39-80 years). Data were entered prospectively into a database. Patients were discharged within 8 h committed to a 10-day course of oral diclofenac 50 mg three times daily and 2 tablets of Codydramol four times daily. Follow-up evaluation was by telephone consultation. Hospital costs for LIHR and open repair were compared.Results: All procedures were completed laparoscopically on a day case basis. Additional unsuspected defects were found in eight cases (25.8%). The median mesh size was 140 cm(2) (range, 25-375 cm(2)), and the median body mass index (BMI) was 28.7 kg/m(2) (range, 20-37.1 kg/m(2)). Operations were performed or supervised by a single consultant surgeon (S.J.W.). Six postoperative seromas resolved spontaneously. Two port-site infections required oral antibiotics, and one diathermy pad burn healed with simple dressings. The median analgesia requirement was 7 days (range, 0-152 days). There were no recurrences during a median follow-up period of 15 months (range, 3-24 months). There was a saving of E616 per procedure.Conclusions: Day case laparoscopic repair of incisional hernias is feasible and safe and has a good clinical outcome. The hospital costs are less than for open techniques.
John Paul Leach - One of the best experts on this subject based on the ideXlab platform.
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Thinking outside of the box
2016Co-Authors: Pract Neurol, Edward J Newman, Sarah Cooper, Ravi Jampana, John Paul LeachAbstract:A 37-year-old man presented after develop-ing horizontal double vision while driving, 10 days after surgery for metastatic oral cancer. He also reported a dull frontal headache and pulsatile tinnitus while lying flat for several days, preceding the dou-ble vision. The headache was worse in the mornings. He denied any visual blurring or obscurations. The double vision had persisted and was worse when he looked into the distance. Eighteen months previously he had been diagnosed with squamous carcinoma of the tongue and had undergone local surgical excision. Recently, metastatic spread to a left cervical lymph node was confi rmed. CT scanning did not show any local recurrence. Subsequent radical neck dissection did not demonstrate further spread to other lymph nodes. There was no other signifi cant medi-cal history and he was taking Codydramol and diclofenac for the combination of postopera-tive wound discomfort and headache. There had been no other recent drug use. He was a smoker. He originated from Pakistan and had lived in the UK for 13 years with his wife and son, who were well. This patient’s general practitioner referred him urgently to ophthalmology. Examination demonstrated a thin man with normal visual acuity and colour vision (as tested with Ishihara plates). Abduction of the left eye was impaired but other eye movements were full. Ophthalmoscopy revealed moder-ately severe bilateral optic disc swelling with disc haemorrhages and marked peripapillary oedema (fi gure 1). Goldmann visual fi elds dis-played minimal enlargement of blind spots bilaterally
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Thinking Outside of the Box
2015Co-Authors: Edward J Newman, Sarah Cooper, Ravi Jampana, John Paul LeachAbstract:A 37-year-old man presented after developing horizontal double vision while driving, 10 days after surgery for metastatic oral cancer. He also reported a dull frontal headache and pulsatile tinnitus while lying flat for several days, preceding the double vision. The headache was worse in the mornings. He denied any visual blurring or obscurations. The double vision had persisted and was worse when he looked into the distance. Eighteen months previously he had been diagnosed with squamous carcinoma of the tongue and had undergone local surgical excision. Recently, metastatic spread to a left cervical lymph node was confirmed. CT scanning did not show any local recurrence. Subsequent radical neck dissection did not demonstrate further spread to other lymph nodes. There was no other significant medical history and he was taking Codydramol and diclofenac for the combination of postoperative wound discomfort and headache. There had been no other recent drug use. He was a smoker. He originated from Pakistan and had lived in the UK for 13 years with his wife and son, who were well. This patient's general practitioner referred him urgently to ophthalmology. Examination demonstrated a thin man with normal visual acuity and colour vision (as tested with Ishihara plates). Abduction of the left eye was impaired but other eye movements were full. Ophthalmoscopy revealed moderately severe bilateral optic disc swelling with disc haemorrhages and marked peripapillary oedema (figure 1). Goldmann visual fields displayed minimal enlargement of blind spots bilaterally. Figure 1 Funduscopy showing bilateral optic disc swelling with haemorrhages. ### Question 1 Summarise the findings and consider which further investigations you would request The nature of this man's headache suggests raised intracranial pressure. The binocular, horizontal diplopia, worse when viewing …
Michael S Pegg - One of the best experts on this subject based on the ideXlab platform.
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Treating temporarily incompetent patients. No reasonable doubt that patient was incompetent.
BMJ, 1995Co-Authors: Michael S PeggAbstract:EDITOR,--A recent ethical debate centres on two patients who had refused treatment in an accident and emergency department.1 One patient was admitted unconscious after an overdose of Codydramol and was awakened by a dose of naloxone but then refused further treatment. He was, however, treated when the effects of the …
Edward J Newman - One of the best experts on this subject based on the ideXlab platform.
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Thinking outside of the box
2016Co-Authors: Pract Neurol, Edward J Newman, Sarah Cooper, Ravi Jampana, John Paul LeachAbstract:A 37-year-old man presented after develop-ing horizontal double vision while driving, 10 days after surgery for metastatic oral cancer. He also reported a dull frontal headache and pulsatile tinnitus while lying flat for several days, preceding the dou-ble vision. The headache was worse in the mornings. He denied any visual blurring or obscurations. The double vision had persisted and was worse when he looked into the distance. Eighteen months previously he had been diagnosed with squamous carcinoma of the tongue and had undergone local surgical excision. Recently, metastatic spread to a left cervical lymph node was confi rmed. CT scanning did not show any local recurrence. Subsequent radical neck dissection did not demonstrate further spread to other lymph nodes. There was no other signifi cant medi-cal history and he was taking Codydramol and diclofenac for the combination of postopera-tive wound discomfort and headache. There had been no other recent drug use. He was a smoker. He originated from Pakistan and had lived in the UK for 13 years with his wife and son, who were well. This patient’s general practitioner referred him urgently to ophthalmology. Examination demonstrated a thin man with normal visual acuity and colour vision (as tested with Ishihara plates). Abduction of the left eye was impaired but other eye movements were full. Ophthalmoscopy revealed moder-ately severe bilateral optic disc swelling with disc haemorrhages and marked peripapillary oedema (fi gure 1). Goldmann visual fi elds dis-played minimal enlargement of blind spots bilaterally
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Thinking Outside of the Box
2015Co-Authors: Edward J Newman, Sarah Cooper, Ravi Jampana, John Paul LeachAbstract:A 37-year-old man presented after developing horizontal double vision while driving, 10 days after surgery for metastatic oral cancer. He also reported a dull frontal headache and pulsatile tinnitus while lying flat for several days, preceding the double vision. The headache was worse in the mornings. He denied any visual blurring or obscurations. The double vision had persisted and was worse when he looked into the distance. Eighteen months previously he had been diagnosed with squamous carcinoma of the tongue and had undergone local surgical excision. Recently, metastatic spread to a left cervical lymph node was confirmed. CT scanning did not show any local recurrence. Subsequent radical neck dissection did not demonstrate further spread to other lymph nodes. There was no other significant medical history and he was taking Codydramol and diclofenac for the combination of postoperative wound discomfort and headache. There had been no other recent drug use. He was a smoker. He originated from Pakistan and had lived in the UK for 13 years with his wife and son, who were well. This patient's general practitioner referred him urgently to ophthalmology. Examination demonstrated a thin man with normal visual acuity and colour vision (as tested with Ishihara plates). Abduction of the left eye was impaired but other eye movements were full. Ophthalmoscopy revealed moderately severe bilateral optic disc swelling with disc haemorrhages and marked peripapillary oedema (figure 1). Goldmann visual fields displayed minimal enlargement of blind spots bilaterally. Figure 1 Funduscopy showing bilateral optic disc swelling with haemorrhages. ### Question 1 Summarise the findings and consider which further investigations you would request The nature of this man's headache suggests raised intracranial pressure. The binocular, horizontal diplopia, worse when viewing …
Ravi Jampana - One of the best experts on this subject based on the ideXlab platform.
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Thinking outside of the box
2016Co-Authors: Pract Neurol, Edward J Newman, Sarah Cooper, Ravi Jampana, John Paul LeachAbstract:A 37-year-old man presented after develop-ing horizontal double vision while driving, 10 days after surgery for metastatic oral cancer. He also reported a dull frontal headache and pulsatile tinnitus while lying flat for several days, preceding the dou-ble vision. The headache was worse in the mornings. He denied any visual blurring or obscurations. The double vision had persisted and was worse when he looked into the distance. Eighteen months previously he had been diagnosed with squamous carcinoma of the tongue and had undergone local surgical excision. Recently, metastatic spread to a left cervical lymph node was confi rmed. CT scanning did not show any local recurrence. Subsequent radical neck dissection did not demonstrate further spread to other lymph nodes. There was no other signifi cant medi-cal history and he was taking Codydramol and diclofenac for the combination of postopera-tive wound discomfort and headache. There had been no other recent drug use. He was a smoker. He originated from Pakistan and had lived in the UK for 13 years with his wife and son, who were well. This patient’s general practitioner referred him urgently to ophthalmology. Examination demonstrated a thin man with normal visual acuity and colour vision (as tested with Ishihara plates). Abduction of the left eye was impaired but other eye movements were full. Ophthalmoscopy revealed moder-ately severe bilateral optic disc swelling with disc haemorrhages and marked peripapillary oedema (fi gure 1). Goldmann visual fi elds dis-played minimal enlargement of blind spots bilaterally
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Thinking Outside of the Box
2015Co-Authors: Edward J Newman, Sarah Cooper, Ravi Jampana, John Paul LeachAbstract:A 37-year-old man presented after developing horizontal double vision while driving, 10 days after surgery for metastatic oral cancer. He also reported a dull frontal headache and pulsatile tinnitus while lying flat for several days, preceding the double vision. The headache was worse in the mornings. He denied any visual blurring or obscurations. The double vision had persisted and was worse when he looked into the distance. Eighteen months previously he had been diagnosed with squamous carcinoma of the tongue and had undergone local surgical excision. Recently, metastatic spread to a left cervical lymph node was confirmed. CT scanning did not show any local recurrence. Subsequent radical neck dissection did not demonstrate further spread to other lymph nodes. There was no other significant medical history and he was taking Codydramol and diclofenac for the combination of postoperative wound discomfort and headache. There had been no other recent drug use. He was a smoker. He originated from Pakistan and had lived in the UK for 13 years with his wife and son, who were well. This patient's general practitioner referred him urgently to ophthalmology. Examination demonstrated a thin man with normal visual acuity and colour vision (as tested with Ishihara plates). Abduction of the left eye was impaired but other eye movements were full. Ophthalmoscopy revealed moderately severe bilateral optic disc swelling with disc haemorrhages and marked peripapillary oedema (figure 1). Goldmann visual fields displayed minimal enlargement of blind spots bilaterally. Figure 1 Funduscopy showing bilateral optic disc swelling with haemorrhages. ### Question 1 Summarise the findings and consider which further investigations you would request The nature of this man's headache suggests raised intracranial pressure. The binocular, horizontal diplopia, worse when viewing …