Simon Ogston

University of Dundee, Dundee, Scotland, United Kingdom

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Publications (79)427.79 Total impact

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    ABSTRACT: sec> Introduction Amiodarone is associated with significant adverse drug reactions (ADRs) and guidelines recommend continued monitoring for ADRs during long-term use. However data of compliance with monitoring guidelines is lacking. The aim of this study was to assess the monitoring of liver and thyroid function on long-term amiodarone over 22-years in Tayside and secondly, to determine the incidence of abnormal biochemical results in relation to total exposure of amiodarone. Methods Uutilizing the well-established record linkage database and the prescription-record linkage database available in Tayside, all patients who were prescribed amiodarone over the 22 years were identified. Long-term prescribing of amiodarone was defined as exposure greater than 6 months, baseline testing was defined as blood tests 6 months before or one month after commencing amiodarone and frequency of testing was performed looking at the mean number of days between testing. The test with closest temporal proximity to the commencement of amiodarone was used to identify patients with abnormal liver or/and thyroid function. Patients with baseline biochemical liver and thyroid abnormalities were excluded from the analysis. Results A total of 1413 patients (mean age 71 ± 11, 57% male) on regularly prescribed amiodarone for more than 6 months were included for final analysis. Only 46%, 27% and 21% of patients had liver, thyroid, and combined testing respectively in accordance with national guidance, though monitoring had significantly improved over the last 22 years (p < 0.0005). Importantly our data also shows that, despite monitoring guidance, patients on long-term amiodarone are at risk of hepatic and thyroid toxicity (9.5% and 16% of patients respectively) and are more likely to develop thyroid disease compared to the general population. There was a positive correlation between duration of amiodarone exposure and percentage of patients with an abnormal result (2.46 and 2.5 fold increase over 4 years for liver and thyroid dysfunction respectively .0005). Discussion Risks of developing ADR on amiodarone increase with continued exposure. Our study highlights the need for awareness and continued surveillance. </sec
    Heart (British Cardiac Society) 06/2015; 101(Suppl 4). DOI:10.1136/heartjnl-2015-308066.65 · 6.02 Impact Factor
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    ABSTRACT: Objective To evaluate national trends of trabeculectomy, aqueous shunts and cycloablation performed in Scotland, England and Wales from 1993 to 2012. Methods The annual numbers of trabeculectomies and aqueous shunts carried out between 1993 and 2012 were obtained from national Scottish, English and Welsh National Health Service databases. The annual rates of trabeculectomy, aqueous shunts and cycloablation were calculated per 100 000 of the population and analysed in the following age groups: 0-14 years, 15-59 years, over 60 years. Results The highest annual rate of trabecuelctomy was in 1995, this was followed by a sharp decline and subsequent stable rates since 2000. The total annual rates of aqueous shunts have increased more than sixfold from 2003 to 2012. In the 0-14 years age group from 2003 to 2012 the ratio of trabeculectomy to aqueous shunts has reversed; trabeculectomy rates have decreased while rates of aqueous shunts have increased. From 2003 to 2012, rates of cyclocryotherapy have reduced while rates of photocoagulation to the ciliary body have doubled. Conclusions Trabeculectomy is the most commonly performed glaucoma operation. Aqueous shunts are rapidly increasing in the surgical management of glaucoma. During the study period, the ratio of trabeculectomy to aqueous shunts has reversed in the younger age group (0-14 years). Rates of cyclocyrotherapy to the ciliary body have dramatically declined while laser photocoagulation to the ciliary body is gaining wider acceptability.
    British Journal of Ophthalmology 09/2014; 99(3). DOI:10.1136/bjophthalmol-2013-304465 · 2.81 Impact Factor
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    ABSTRACT: To assess factors contributing to cord venous glucose homeostasis in term infants delivered by elective cesarean section. Observational study of women-infant pairs at delivery. Biochemical and clinical data were collected about factors which might affect the levels of glucose, lactate, norepinephrine, epinephrine, cortisol, human growth hormone, glucagon, and insulin. In the context of this data-set, three models explained a substantial amount regarding the variation: 79% of the variation in cord glucose levels is explained by levels of maternal glucose, cord venous pH, and cord lactate; 77% of the variation of cord lactate is explained by levels of cord venous pH, valine, maternal lactate and glucose, and cord norepinephrine; and 71% of the variation in cord norepinephrine is explained by levels of cord venous pO : Term infants delivered by cesarean section are relatively hyperinsulinemic (insulin:glucose ratio of 2.4) and glucose levels are strongly associated with maternal glucose levels, cord pO
    Journal of Perinatal Medicine 06/2014; 43(3). DOI:10.1515/jpm-2014-0067 · 1.43 Impact Factor
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    ABSTRACT: This paper summarises the study protocol for the randomised controlled trial of iodine supplementation in preterm infants. Iodine is essential for the synthesis of thyroxine, and thyroxine is essential for normal brain development in utero and for the first 2-3 years of life. The recommended iodine intake in parenteral nutrition regimens is 1 μg/kg/day and commercially available parenteral solutions for infants reflect these recommendations. In the absence of other iodine sources, infants are vulnerable to negative iodine balance and insufficiency. As many preterm infants are fed parenterally for prolonged periods with solutions which have been shown to be iodine-deficient, the I2S2 Trial was designed to establish whether iodine supplementation of preterm infants benefits neurodevelopment. © 2014 S. Karger AG, Basel.
    Neonatology 02/2014; 105(4):282-289. DOI:10.1159/000358247 · 2.37 Impact Factor
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    ABSTRACT: To determine all-cause mortality in patients with a first myocardial infarct who were treated with simvastatin compared with high-potency statin and simvastatin/ezetimibe combination. Despite statin use, residual cardiovascular risk remains. Therapeutic options include more potent statins or addition of ezetimibe. There is no clinical outcome data on the use of ezetimibe in such patients. Retrospective longitudinal study using the United Kingdom General Practice Research Database. Patients who had survived 30 days after their first acute myocardial infarct (AMI), had not received prior statin or ezetimibe therapy and were started on a statin within 30 days of AMI were included. Three groups were identified according to their follow-up: (i) simvastatin monotherapy; (ii) high-potency statin group (patients who started on simvastatin and switched to atorvastatin or rosuvastatin); and (iii) ezetimibe/statin combination group (patients who received ezetimibe in addition to statin). 9597 patients (57% male, mean age of 65±13 years) matched study criteria: simvastatin (n=6990 (72.8%)); high-potency statin (n=1883, (19.6%)); and ezetimibe/statin combination (n=724 (7.5%)). During a mean follow-up of 3.2 years, there were 1134 (12%) deaths. In the multivariate proportional hazards model, the adjusted HR for high-potency statin and ezetimibe group were 0.72 (95% CI 0.59 to 0.88, p<0.001) and 0.96 (95% CI 0.64 to 1.43, p=0.85), respectively. A similar result was also obtained in the propensity score analysis that took into account covariates that predicted drug treatment groups. Patients switched to a high-potency statin had a significantly reduced mortality compared with simvastatin monotherapy. There was no observed mortality benefit in the ezetimibe group.
    Heart (British Cardiac Society) 02/2014; 100(11). DOI:10.1136/heartjnl-2013-304678 · 6.02 Impact Factor
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    ABSTRACT: Background:Progesterone receptor (PR) expression assessment in early invasive breast cancer remains controversial. This study sought to re-evaluate PR expression as a potential therapeutic guide in early breast cancer; particularly in oestrogen receptor (ER)-positive, lymph node (LN)-negative disease.Methods:A population cohort of 1074 patients presenting to a single Cancer Centre over 4 years (2000-2004) underwent surgery for primary invasive breast cancer with curative intent. Prospective data collection included patient demographics, pathology, ER and PR expression, HER2 status, adjuvant chemotherapy and endocrine therapy. Progesterone receptor expression was compared with (all causes) overall survival (OS), breast cancer-specific survival (BCSS) and disease-free survival (DFS).Results:Overall survival was 71.0% and BCSS was 83.0% at median follow-up of 8.34 years. Absent PR expression was significantly associated with poorer prognosis for OS, BCSS and DFS (P<0.0001, log-rank), even within the ER-positive, LN-negative group (hazard ratio for BCSS 3.17, 95% CI 1.43-7.01) and was not influenced by endocrine therapy. Cox's regression analysis demonstrated that PR expression was an independent prognostic variable.Conclusion:Absence of PR expression is a powerful, independent prognostic variable in operable, primary breast cancer even in ER-positive, LN-negative patients receiving endocrine therapy. Absence of PR expression should be re-evaluated as a biomarker for poor prognosis in ER-positive breast cancer and such patients considered for additional systemic therapy.British Journal of Cancer advance online publication, 3 December 2013; doi:10.1038/bjc.2013.756
    British Journal of Cancer 12/2013; 110(3). DOI:10.1038/bjc.2013.756 · 4.82 Impact Factor
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    ABSTRACT: Myocardial fibrosis is dysrhythmogenic and may contribute to the high incidence of cardiac death in stroke survivors, especially if they have long QTc. We tested the hypothesis that procollagen-1-carboxy terminal peptide (P1CP), a biomarker of myocardial fibrosis, might be improved following treatment with spironolactone or amiloride in stroke survivors. We also tested the hypothesis that both drugs would shorten QTc. Study design: randomised, double-blinded, placebo-controlled, cross-over trial (spironolactone vs. amiloride vs. placebo). Duration of Study: 3months (1month per drug). Primary endpoints: P1CP, QTc RESULTS: 11 stroke survivors (5 female), aged 71+4, BP 139/81mmHg+20/11mmHg, completed the study. Both spironolactone and amiloride significantly reduced P1CP [Spironolactone-Placebo=-24 ug/L, 95% CI=-40 to -6.9; Amiloride-Placebo=-28 ug/L, 95% CI=-44 to -11]. Spironolactone and amiloride both shortened QTc [Spironolactone vs. Placebo=-18ms(1/2), 95% CI=-36 to -0.55; Amiloride vs Placebo=-25ms(1/2), 95% CI=-42 to -7.5]. Procollagen-1-carboxy terminal peptide was reduced following treatment with spironolactone within a month. Further, this is the first study demonstrating amiloride could also improve myocardial fibrosis. The beneficial effects of both drugs on myocardial fibrosis, coupled with their effects on raising potassium translated to a shortening of QTc. Future studies should test the hypothesis that these drugs might reduce the risk of sudden cardiac death in stroke survivors.
    International journal of cardiology 08/2013; 168(6). DOI:10.1016/j.ijcard.2013.08.027 · 6.18 Impact Factor
  • The British journal of ophthalmology 06/2013; 97(9). DOI:10.1136/bjophthalmol-2013-303471 · 2.81 Impact Factor
  • Heart (British Cardiac Society) 05/2013; 99(Suppl 2):A12-A12. DOI:10.1136/heartjnl-2013-304019.9 · 6.02 Impact Factor
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    ABSTRACT: Chronic heart failure (CHF) is an insulin-resistant state. The degree of insulin resistance (IR) correlates with disease severity and is associated with reduced exercise capacity. In this proof of concept study, we have examined the effect of metformin on IR and exercise capacity in non-diabetic CHF patients identified to have IR. In a double-blind, placebo-controlled study, 62 non-diabetic IR CHF patients (mean age, 65.2 ± 8.0 years; male, 90%; left ventricular ejection fraction, 32.6 ± 8.3%; New York Heart Association class I/II/III/IV, 11/45/6/0) were randomized to receive either 4 months of metformin (n = 39, 2 g/day) or matching placebo (n = 23). IR was defined by a fasting insulin resistance index (FIRI) ≥2.7. Cardiopulmonary exercise testing and FIRI were assessed at baseline and after 4 months of intervention. Compared with placebo, metformin decreased FIRI (from 5.8 ± 3.8 to 4.0 ± 2.5, P < 0.001) and resulted in a weight loss of 1.9 kg (P < 0.001). The primary endpoint of the study, peak oxygen uptake (VO(2)), did not differ between treatment groups. However, metformin improved the secondary endpoint of the slope of the ratio of minute ventilation to carbon dioxide production (VE/VCO(2) slope), from 32.9 ± 15.9 to 28.1 ± 8.8 (P = 0.034). In the metformin-treated group, FIRI was significantly related to the reduction of the VE/VCO(2) slope (R = 0.41, P = 0.036). Metformin treatment significantly improved IR but had no effect on peak VO(2), the primary endpoint of our study. However, metformin treatment did result in a significant improvement in VE/VCO(2) slope. Trial registration: NCT00473876.
    European Journal of Heart Failure 06/2012; 14(11):1303-10. DOI:10.1093/eurjhf/hfs106 · 6.58 Impact Factor
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    ABSTRACT: Mild maternal thyroid dysfunction during early pregnancy is associated with poor neurodevelopment in affected offspring. Most studies are population based or are smaller populations of term/late preterm infants. No studies were found that focused on more preterm infants. Our objective was to describe the relationship between mild maternal thyroid dysfunction at delivery of infants born ≤34 wk and neurodevelopment at 5.5 yr. The study design was follow-up of women and children recruited in Scotland between 1998 and 2001. We evaluated delivery levels of maternal TSH, free T(4) (FT(4)), and T(4) and the association with McCarthy Scale scores adjusted for 26 confounders of neurodevelopment. Maternal serum levels and McCarthy scores were available for 143 women and 166 children. After adjustment for confounders, there were significant 3.2, 2.1, and 1.8 point decrements, respectively, in general cognitive index, verbal subscale, and the perceptual performance subscale for each milliunit per liter increment in maternal TSH. Maternal FT(4) levels were variably associated with neurodevelopment. After adjustment, significant associations were found for the general cognitive index, motor scale, and quantitative subscale; each picomole per liter decrease in FT(4) was associated with an increase of 1.5, 1.7, and 0.9 points, respectively. Maternal T(4) levels showed little relationship with neurodevelopment. None of the women in this analysis had overt hypothyroidism, but mild hypothyroidism was evident in 27%; thyroglobulin antibody (TgAb) was ≥ 40 U/ml in 28% of the women. Higher maternal levels of TSH at delivery of infants born preterm were associated with significantly lower scores on the general cognitive index at 5.5 yr.
    The Journal of Clinical Endocrinology and Metabolism 04/2012; 97(6):1977-85. DOI:10.1210/jc.2011-2451 · 6.31 Impact Factor
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    ABSTRACT: To assess the diagnostic performance of transrectal elastosonography (TRES) for the detection of prostate cancer. Two reviewers independently extracted the data from each study. Quality was assessed with a validated quality assessment tool for diagnostic accuracy studies. Diagnostic accuracy of TRES in relation to current standard references (transrectal ultrasonography [TRUS] biopsies and histopathology of radical prostatectomy [RP] specimens) was estimated. A bivariate random effects model was used to obtain sensitivity and specificity values. Hierarchical summary receiver operating characteristic (HSROC) were calculated. In all, 16 studies (2278 patients) were included in the review. Using histopathology of the RP specimen as reference standard, the pooled data of four studies showed that the sensitivity of TRES ranged between 0.71 to 0.82 and the specificity ranged between 0.60 to 0.95 (pooled diagnostic odds ratio [DOR] 19.6; 95% confidence interval [CI] 7.7-50.03). The sensitivity varied from 0.26 to 0.87 and specificity varied from 0.17 to 0.76 (pooled DOR 2.141; 95% CI 0.525 to -8.737) using TRUS biopsies (minimum of 10) as a reference standard. The quality of most studies was modest. SROC estimated 0.8653 area under the curve predicting high chances of detecting prostate cancer. There were no health economics or health-related quality of life of the participants reported in the studies and all the studies used compressional technique with no reported standardisation. The TRES technique appears to improve the detection of prostate cancer compared with systematic biopsy and shows a good accuracy in comparison with histopathology of the RP specimen. However, studies lacked standardisation of the technique, had poor quality of reporting and a large variation in the outcomes based on the reference standards and techniques used.
    BJU International 03/2012; 110(10). DOI:10.1111/j.1464-410X.2012.11106.x · 3.13 Impact Factor
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    ABSTRACT: There is paucity of data on the prognostic value of pre-operative inflammatory response and post-operative lymph node ratio on patient survival after pancreatic-head resection for pancreatic ductal adenocarcinoma. To evaluate the role of the preoperative inflammatory response and postoperative pathology criteria to identify predictive and/or prognostic variables for pancreatic ductal adenocarcinoma. All patients who underwent pancreaticoduodenectomy for pancreatic ductal adenocarcinoma between 2002 and 2008 were reviewed retrospectively. The following impacts on patient survival were assessed: i) preoperative serum CRP levels, white cell count, neutrophil count, neutrophil/lymphocyte ratio, lymphocyte count, platelet/lymphocyte ratio; and ii) post-operative pathology criteria including lymph node status and lymph node ratio. Fifty-one patients underwent potentially curative resection for pancreatic ductal adenocarcinoma during the study period. An elevated preoperative CRP level (greater than 3 mg/L) was found to be a significant adverse prognostic factor (P=0.015) predicting a poor survival, whereas white cell count (P=0.278), neutrophil count (P=0.850), neutrophil/lymphocyte ratio (P=0.272), platelet/lymphocyte ratio (P=0.532) and lymphocyte count (P=0.721) were not significant prognosticators at univariate analysis. Presence of metastatic lymph nodes did not adversely affect survival (P=0.050), however a raised lymph node ratio predicted poor survival at univariate analysis (P<0.001). The preoperative serum CRP level retained significance at multivariate analysis (P=0.011), together with lymph node ratio (P<0.001) and tumour size (greater than 2 cm; P=0.008). A pre-operative elevated serum CRP level and raised post-operative lymph node ratio represent significant independent prognostic factors that predict poor prognosis in patients undergoing curative resection for pancreatic ductal adenocarcinoma. There is potential for future neo-adjuvant and adjuvant treatment strategies in pancreatic cancer to be tailored based on preoperative and postoperative factors that predict a poor survival.
    JOP: Journal of the pancreas 01/2012; 13(2):199-204.
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    ABSTRACT: Transient hypothyroxinemia is the commonest thyroid dysfunction of premature infants, and recent studies have found adverse associations with neurodevelopment. The validity of these associations is unclear because the studies adjusted for a differing range of factors likely to influence neurodevelopment. The aim was to describe the association of transient hypothyroxinemia with neurodevelopment at 5.5 yr corrected age. We conducted a follow-up study of a cohort of infants born in Scotland from 1999 to 2001 ≤34 wk gestation. We measured scores on the McCarthy scale adjusted for 26 influences of neurodevelopment including parental intellect, home environment, breast or formula fed, growth retardation, and use of postnatal drugs. A total of 442 infants ≤34 wk gestation who had serum T(4) measurements on postnatal d 7, 14, or 28 and 100 term infants who had serum T(4) measured in cord blood were followed up at 5.5 yr. Infants with hypothyroxinemia (T(4) level ≤ 10th percentile on d 7, 14, or 28 corrected for gestational age) scored significantly lower than euthyroid infants (T(4) level greater than the 10th percentile and less than the 90th percentile on all days) on all McCarthy scales, except the quantitative. After adjustment for confounders of neurodevelopment, hypothyroxinemic infants scored significantly lower than euthyroid infants on the general cognitive and verbal scales. Our findings do not support the view that the hypothyroxinemic state, in the context of this analysis, is harmless in preterm infants. Many factors contribute both to the etiology of hypothyroxinemia and neurodevelopment; strategies for correction of hypothyroxinemia should acknowledge its complex etiology and not rely solely on one approach.
    The Journal of Clinical Endocrinology and Metabolism 11/2010; 95(11):4898-908. DOI:10.1210/jc.2010-0743 · 6.31 Impact Factor
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    ABSTRACT: To determine absolute and relative risks of all-cause and cardiovascular mortality among patients newly diagnosed with Type 2 diabetes. In an observational cohort study using record-linkage databases, based in Tayside, Scotland, UK, we identified newly diagnosed patients with Type 2 diabetes in 1993-2004. We also identified a set of non-diabetic comparators from lists of patients registered with a general practice, individually matched to the diabetic patients by sex, age and deprivation. We followed up patients for mortality and cardiovascular mortality over a 12-year period and calculated hazard ratios using Cox regression. There were 10,532 patients with Type 2 diabetes and 21,056 non-diabetic comparators. Diabetic patients in every age/sex group had higher absolute mortality rates. Even taking deprivation into account, the hazard ratio for mortality was 1.32 (95% CI 1.25-1.40), decreasing to 1.15 (1.09-1.22) after adjusting for pre-existing cardiovascular disease. The hazard ratios for cardiovascular mortality were higher, decreasing from 1.51 (1.37-1.67) to 1.23 (1.11-1.36) after adjusting for pre-existing cardiovascular disease. The hazard ratios decreased with increasing age at diagnosis, although the difference in absolute rate of mortality increased slightly with age. Increased mortality risks were only evident 2 years after diagnosis and increased thereafter. Patients with Type 2 diabetes have an increased risk of all-cause and cardiovascular mortality compared with non-diabetic comparators, although this is not observable immediately after diagnosis. Age at diagnosis and duration of the disease independently affect absolute and relative mortality risk.
    Diabetic Medicine 10/2010; 27(10):1124-9. DOI:10.1111/j.1464-5491.2010.03075.x · 3.06 Impact Factor
  • The Lancet 10/2010; 376(9749):1299-1300. DOI:10.1016/S0140-6736(10)61913-7 · 45.22 Impact Factor
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    ABSTRACT: Experimental evidence suggests that xanthine oxidase inhibitors can reduce myocardial oxygen consumption for a particular stroke volume. If such an effect also occurs in man, this class of inhibitors could become a new treatment for ischaemia in patients with angina pectoris. We ascertained whether high-dose allopurinol prolongs exercise capability in patients with chronic stable angina. 65 patients (aged 18-85 years) with angiographically documented coronary artery disease, a positive exercise tolerance test, and stable chronic angina pectoris (for at least 2 months) were recruited into a double-blind, randomised, placebo-controlled, crossover study in a hospital and two infirmaries in the UK. We used computer-generated randomisation to assign patients to allopurinol (600 mg per day) or placebo for 6 weeks before crossover. Our primary endpoint was the time to ST depression, and the secondary endpoints were total exercise time and time to chest pain. We did a completed case analysis. This study is registered as an International Standard Randomised Controlled Trial, number ISRCTN 82040078. In the first treatment period, 31 patients were allocated to allopurinol and 28 were analysed, and 34 were allocated to placebo and 32 were analysed. In the second period, all 60 patients were analysed. Allopurinol increased the median time to ST depression to 298 s (IQR 211-408) from a baseline of 232 s (182-380), and placebo increased it to 249 s (200-375; p=0.0002). The point estimate (absolute difference between allopurinol and placebo) was 43 s (95% CI 31-58). Allopurinol increased median total exercise time to 393 s (IQR 280-519) from a baseline of 301 s (251-447), and placebo increased it to 307 s (232-430; p=0.0003); the point estimate was 58 s (95% CI 45-77). Allopurinol increased the time to chest pain from a baseline of 234 s (IQR 189-382) to 304 s (222-421), and placebo increased it to 272 s (200-380; p=0.001); the point estimate was 38 s (95% CI 17-55). No adverse effects of treatment were reported. Allopurinol seems to be a useful, inexpensive, well tolerated, and safe anti-ischaemic drug for patients with angina. British Heart Foundation.
    The Lancet 06/2010; 375(9732):2161-7. DOI:10.1016/S0140-6736(10)60391-1 · 45.22 Impact Factor
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    ABSTRACT: There is minimal data on the outcome of early laparoscopic cholecystectomy (LC) for acute gallbladder disease when performed by trainees. This study assesses the outcomes of a policy of same admission LC incorporated into a surgical training programme in a major teaching hospital. 447 index LCs performed over a 3-year period were reviewed retrospectively. The indications, operating surgeon, operating time, use of IOC, conversion rates, reasons for conversion and post-operative stay were analysed. Multivariate analysis of reasons for conversion was performed. 150 LCs were performed by consultants and 297 by registrars; 67 were performed by year 1-3 specialist registrars (SpR) and 230 by year 4-6 SpRs. The indications were biliary colic (n=7), acute cholecystitis (n=180), chronic cholecystitis (n=260), carcinoma (n=1). No difference was found in demographics, operating time (105 min Vs 115 min), use of IOC (34% Vs 29%; P=0.2) and post-operative stay (2 days Vs 1 day) between consultants and registrars. The conversion rates were higher for consultants compared to registrars (29 (19%) Vs 28 (9%), P=0.004). The overall conversion rate was 11%. There were no bile duct injuries. Predictors for conversion were CRP>50 at admission and acute cholecystitis. In a teaching hospital setting most acute admission LCs (66%) were performed by trainees. A step wise training programme with active consultant supervision of all index LCs results in low morbidity, low conversion rates, and a short post-operative stay for acute gallbladder disease. This model of same admission cholecystectomy provides a good training opportunity in emergency general surgery.
    The surgeon: journal of the Royal Colleges of Surgeons of Edinburgh and Ireland 06/2010; 8(3):127-31. DOI:10.1016/j.surge.2009.10.021 · 2.21 Impact Factor
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    ABSTRACT: Rheumatoid arthritis (RA) is associated with increased cardiovascular (CV) mortality. Microvascular endothelial dysfunction occurs early in the development of CV disease and is worsened by inflammation. The effect of drug treatment for RA on microvascular function has been poorly studied. We assessed the effect of antirheumatic treatment on microvascular endothelial function in patients with RA, particularly to examine responders versus nonresponders to therapy. Fifty-one patients with active RA and no previous history of CV disease were assessed at baseline and after 2 and 4 months' therapy with either anti-tumor necrosis factor-alpha drugs (etanercept, n = 27, adalimumab, n = 3) or methotrexate, n = 21. RA disease activity, inflammatory measures, and skin microvascular responses, measured using laser Doppler imaging after iontophoretic delivery of acetylcholine (ACh) and sodium nitroprusside (SNP), were assessed at each study visit. Disease Activity Score (DAS28) decreased significantly from baseline to visit 2 and 3 (6.04 +/- 1.2, 4.34 +/- 1.3, 4 +/- 1.3, respectively; p < 0.0001). Endothelium-dependent (ACh) and independent (SNP) responses for the whole cohort did not improve significantly after drug treatment (p = 0.250, p = 0.062, respectively). When patients who responded to antirheumatic therapy (n = 31) were analyzed, there were significant improvements in both ACh (p = 0.028) and SNP responses (p = 0.019). Microvascular endothelial function improves in patients who respond to antirheumatic therapy. These results support the importance of effective therapy for RA patients in terms of CV effects, which might extrapolate to reduced CV events in the future. Clinical trial registration no. ISRCTN57761809.
    The Journal of Rheumatology 03/2010; 37(3):521-8. DOI:10.3899/jrheum.090417 · 3.17 Impact Factor
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    ABSTRACT: The appropriateness of extraction of asymptomatic impacted third molars has been much debated and as a result the number of extractions has fallen in the UK in the past few years. As a direct consequence of this decrease more impacted third molars are left in situ and yet, little is known about the natural history of these teeth. The aim of this study was to create an actuarial life-table and related survival analysis that would shed light on the natural history of an impacted lower third molar. Panoramic radiographs taken in 14 different general dental practices in Scotland were analysed and matched with their respective case notes in order to generate a sample of patients with asymptomatic impacted lower third molars. Subjects were assessed to confirm the presence of impaction and absence of symptoms and then re-assessed 1 year later for the development of symptoms during the study period to relate the incidence of symptoms within 1 year in the sample studied to age. Logistic regression was used to construct a life table based on the survival of symptom-free teeth (independently of extraction) during the study period. The number of patients included in the study was 583 and 421 for the baseline and follow-up assessments respectively. The total number of teeth analysed in both appointments was 676; from those 37 (5.47%) were extracted during the study period. About 562 teeth (83.13%) survived the study period symptom-free. There was a statistically significant inverse association between the development of symptoms studied and age. There was no statistically significant association between extraction and age. The study indicates that older patients are less likely to develop the symptoms studied. In addition the authors believe that there is evidence to suggest that general dental practitioners might not be following current guidelines when deciding whether or not to extract an impacted lower third molar in the centres studied.
    Community Dentistry And Oral Epidemiology 11/2009; 38(1):58-67. DOI:10.1111/j.1600-0528.2009.00501.x · 1.94 Impact Factor

Publication Stats

3k Citations
427.79 Total Impact Points


  • 1998–2014
    • University of Dundee
      • • School of Medicine
      • • School of Nursing and Midwifery
      Dundee, Scotland, United Kingdom
  • 1987–2008
    • Ninewells Hospital
      • Department of Surgery
      Dundee, Scotland, United Kingdom
  • 2003
    • The University of Edinburgh
      • Division of Pathology
      Edinburgh, Scotland, United Kingdom
  • 1996
    • University of Glasgow
      Glasgow, Scotland, United Kingdom