The North Staffordshire Royal Infirmary was a hospital at Hartshill in the English county of Staffordshire. It was located half a mile east of the site of the Royal Stoke University Hospital. It was run by the University Hospitals of North Midlands NHS Trust.
Introduction . This paper compares different approaches to recanalization in a model of the middle cerebral artery (MCA). Methods . An occlusive thrombus (lamb's blood) was introduced into the MCA of a model of the cerebral circulation perfused with Hartmann's solution (80 pulsations/min, mean pressure 90 mm Hg). Three methods of clot retrieval were tested: thrombus aspiration via a 4F catheter (n=26), thrombus aspiration via the GP thrombus aspiration device (GPTAD) (n=30), and mechanical thrombectomy via the Solitaire Device (n=30). Results . Recanalization rate was similar for all 3 approaches (62%, 77%, and 85%). Time to recanalization was faster with aspiration devices (41 SD 42 s for 4F and 61 SD 21 s for GPTAD) than with the Solitaire (197 SD 64 sP<.05Kruksal-Wallis). Clot fragmentation was the same in the Solitaire (23%) and the GPTAD (23%), but higher with the 4F (53%,P<.05). Conclusion . In this model, thrombus aspiration was faster than mechanical thrombectomy, and similarly effective at recanalization. These results should be confirmed in vivo .
Objective: To report a rare case of fatal early acute thrombosis of mechanical mitral prosthesis. Methods: A 62-year-old lady, who underwent closed mitral valvotomy for rheumatic heart disease 19 years ago, presented with Canadian Cardiovascular Society Class II angina and New York Heart Association Class III dyspnoea. Investigations including echocardiogram and cardiac catheterisation revealed mixed mitral valve disease. She had severe pulmonary artery hypertension with pulmonary artery wedge pressure of 35 mm of mercury. Significant stenosis in the midportion of dominant right coronary artery was also demonstrated. She underwent mitral valve replacement using mechanical tilting disc prosthesis, DeVega tricuspid annuloplasty and saphenous vein bypass graft to the distal right coronary artery. After having made satisfactory early postoperative progress, she suffered an asystolic cardiac arrest about 26 h postoperatively. Results: The patient succumbed despite all resuscitative measures. Autopsy revealed an adherent thrombus occluding the atrial surface of the minor orifice of mechanical prosthesis, which prevented the valve from functioning. Conclusion: To the best of our knowledge, this is the first case of prosthetic valve thrombosis (PVT) occurring on the first postoperative day in a patient with a mechanical valve prosthesis, without any circulatory assist device. 2006 Published by European Association for Cardio-Thoracic Surgery. All rights reserved.
Objective: To highlight an uncommon problem of heparin induced thrombocytopenia after coronary artery bypass operation. Methods: We report the case of a 59-year-old man who suffered severe type II heparin induced thrombocytopenia (HIT) after coronary artery bypass operation. He experienced extensive skin necrosis at sites of saphenous vein harvesting, which progressed to cause soft tissue necrosis of both feet. He also exhibited secondary clinical features arising from pulmonary, hepatic and renal dysfunction suggestive of extensive venous thrombosis. Primary treatment of the haematological disorder was achieved by discontinuation of all forms of heparin and the administration of a heparinoid intravenously. Secondary treatment included forefoot amputations and skin grafting. Results: Though the patient suffered a protracted period of recovery he was discharged home well. Conclusion: We have reported this complex case in order to familiarise cardiothoracic surgeons with the extreme characteristics of type II HIT and to emphasise that early diagnosis and treatment will facilitate a successful outcome. q 2003 Elsevier B.V. All rights reserved.
One of the most rewarding tasks a nurse can ever perform is to support someone at the end of their life, and appropriate care and support at this time should be available to all who need this regardless of personal circumstances. However, it is becoming increasingly evident that personal factors (i.e. where you live, poverty, social class, gender, sexuality, age, ethnicity, religion and disability) can all affect the nature and quality of the palliative care received, and certain marginalized populations are likely to be perceived as 'disadvantaged dying'. People with intellectual disabilities are often regarded as a marginalized group, and never more so as when they are diagnosed with a life-limiting condition and as the end of life draws imminently closer. This article introduces the challenges faced by nurses caring for people with intellectual disabilities diagnosed with a life-limiting condition. The overall aim is to identify the inherent challenges involved so that they can be addressed from a practical perspective.
Aim The aim of this study was to evaluate pelvic tilt on commonly performed measurements on radiography in primary protrusio acetabuli and developmental dysplasia of the hip. Materials and methods A dry assembled pelvis and spine skeleton was positioned in an isocentric skull unit and films exposed with increasing degrees of angulation of pelvic tilt. The films were then read by two independent readers for seven different measurements used to evaluate the hips and acetabular: acetabular line to ilioischial line, teardrop appearance, intercristal/intertuberous ratio, co-ordinates of femoral head, centre edge angle, acetabular depth/width ratio and acetabular angle. Results There was so much variation in the protrusio results that no formal recommendation of any standard radiographic test can be given. Only the inter tuberous distance is not effected by pelvic tilt. The acetabular angles for developmental dysplasia of the hip showed the most potential with pelvic tilt below 15°. Conclusion As pelvic tilt increases, measurements used in protusio become unreliable, and computed tomography/magnetic resonance imaging are probably going to be more accurate as one can directly visualise pelvic intrusion. We recommend a lateral view to assess the degree of pelvic tilt in patients with protrusion to ensure these measurements are valid.
