C.J. Pattenden
Leicester General Hospital
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Featured researches published by C.J. Pattenden.
Colorectal Disease | 2006
G. Garcea; I. Majid; C. D. Sutton; C.J. Pattenden; W. M. Thomas
Introduction Colovesical fistulae are well‐recognized but relatively uncommon presentation to colorectal surgery. As a result, few centres have sufficient experience in the investigation and surgical treatment of colovesical fistulae to develop clear protocols in its management.
Digestive Diseases and Sciences | 2007
G. Garcea; C.J. Pattenden; J. Stephenson; A. Dennison; David P. Berry
This study presents the experience with laparoscopic deroofing of nonparasitic liver cysts at a single center over a 9-year period. A total of 25 patients, undergoing 32 operations, were identified. Median cyst diameter was 10 cm for de novo cysts and 9.5 cm for recurrent cysts. Six patients had multiple cysts consistent with polycystic liver disease. In total, there were 26 laparoscopic procedures and 2 open conversions. Four procedures were commenced as open, three of which were for recurrent cysts. Minor complications were bleeding from a port site (n=1), pneumothorax (n=2), and intra-abdominal collection (n=1). One major complication of bile leak and relaparotomy occurred following an open deroofing. No major complications were recorded for laparoscopic procedures. Symptomatic recurrence of cysts occurred in four patients with simple cysts (5%) and one patient with polycystic liver disease. We conclude that laparoscopic liver cyst deroofing is an effective method of dealing with symptomatic nonparasitic liver cysts.
British Journal of Surgery | 2007
Christopher D. Mann; C.P. Neal; Matthew S. Metcalfe; C.J. Pattenden; A. Dennison; David P. Berry
Resection offers the only realistic chance of cure for hepatic colorectal metastases. The aim of this study was to examine the potential of laparoscopy and laparoscopic intraoperative ultrasonography (IOUS) for detecting incurable disease, and to determine whether the Clinical Risk Score (CRS) is useful in selecting patients for laparoscopy before hepatic resection.
Journal of Gastrointestinal Surgery | 2006
Giuseppe Garcea; Benjamin Jackson; C.J. Pattenden; C. D. Sutton; C.P. Neal; Ashley R. Dennison; David P. Berry
The Early Warning Score (EWS) is a widely used general scoring system to monitor patient progress with a varying score of 0-20 in critically unwell patients. This study evaluated the EWS system compared with other established scoring systems in patients with acute pancreatitis. EWS scores were compared with APACHE scores, Imrie scores, computed tomography grading scores, and Ranson criteria for 110 admissions with acute pancreatitis. A favorable outcome was considered to be survival without intensive therapy unit admission or surgery. Nonsurvivors, necrosectomy, and critical care admission were considered adverse outcomes. EWS was the best predictor of adverse outcome in the first 24 hours of admission (receiver operating curve, 0.768). The most accurate predictor of mortality overall was EWS on day 3 of admission (receiver operating curve, 0.920). EWS correlated with duration of intensive therapy unit stay and number of ventilated days (P<0.05) and selected those who went on to develop pancreas-specific complications such as pseudocyst or ascites. EWS of 3 or above is an indicator of adverse outcome in patients with acute pancreatitis. EWS can accurately and reliably select both patients with severe acute pancreatitis and those at risk of local complications.
Ejso | 2009
A.D. Barlow; Apostolos Nakas; C.J. Pattenden; A.E. Martin-Ucar; A. Dennison; David P. Berry; David M. Lloyd; G.S. Robertson; David A. Waller
AIMS Surgical resection of combined hepatic and pulmonary metastases remains controversial in light of limited supportive evidence. This study aimed to audit our initial experience with this aggressive surgical strategy. METHODS Between 1997 and 2006 we assessed 19 patients with colorectal cancer metastases for combined liver and lung metastasectomy, of whom 16 patients underwent surgery. We retrospectively reviewed perioperative and survival data. RESULTS Synchronous liver metastases were present in three out of 16 patients at time of diagnosis of the primary tumour, and one out of 16 patients had synchronous lung and liver metastases with the primary tumour. Of those 12 patients who developed metachronous metastases five patients developed liver metastases first, one patient developed pulmonary metastases first, and six patients developed synchronous liver and lung metastases. Thirty nine operations were performed on 16 patients. The median hospital stay was 5.5 (2-10) days for the pulmonary and 7 (1-23) days for the hepatic resections. There were no in-hospital deaths. Chemotherapy was given to five patients prior to metastasectomy and nine received adjuvant chemotherapy following metastasectomy. Median survival from diagnosis of metastatic disease was 44 months (8-87 months). Estimated 1-year survival from diagnosis of metastatic disease was 94%, estimated 5-year survival was 20%. CONCLUSION We believe an aggressive but selective surgical approach to combined hepatic and pulmonary colorectal metastases is justified by limited resource requirements and encouraging survival.
Transfusion Medicine and Hemotherapy | 2013
Thomas C. Hall; C.J. Pattenden; Chloe Hollobone; Cristina Pollard; Ashley R. Dennison
Objective: Preoperative over-ordering of blood is common and leads to the wastage of blood bank resources. The preoperative blood ordering and transfusion practices for common elective general surgical procedures were evaluated in our university hospital to formulate a maximum surgical blood order schedule (MSBOS) for those procedures where a cross-match appears necessary. Methods: We evaluated blood ordering practices retrospectively in all elective general surgical procedures in our institution over a 6-month period. Cross-match-to-transfusion ratios (C:T) were calculated and compared to current trust and the British Society of Haematology (BSH) guidelines. The adjusted C:T ratio was also calculated and was defined as the C:T ratio when only cross-matched blood used intraoperatively was included in the calculation. Results: 541 patients were identified during the 6-month period. There were 314 minor and 227 major surgeries carried out. 99.6% (n = 226) of the patients who underwent major surgery and 95.5% (n = 300) of the patients having minor surgery had at least a group and save (G and S) test preoperatively. A total of 507 units of blood were cross-matched and 238 units were used. The overall C:T ratio was therefore 2.1:1, which corresponds to a 46.9% red cell usage. There was considerable variation in the C:T ratio, depending on the type of surgery performed. The adjusted C:T ratio varied between 3.75 and 37. Conclusions: Compliance with transfusion policies is poor and over-ordering of blood products commonplace. Implementation of the updated recommended MSBOS and introduction of G and S for eligible surgical procedures is a safe, effective and cost-effective method to prevent preoperative over-ordering of blood in elective general surgery. Savings of GBP 8,596.00 per annum are achievable with the incorporation of updated evidence-based guidelines in our university hospital.
European Journal of Cancer Care | 2010
Cristina Pollard; G. Garcea; C.J. Pattenden; R. Curran; C.P. Neal; David P. Berry; A. Dennison
In order to maximise patient care, assessment of the adequacy of the service provision by the Clinical Nurse Specialist (CNS) must be regularly undertaken. This study attempted to determine whether CNSs were providing an adequate service via retrospective and prospective audit. The results of a comprehensive audit of the work of the CNS within a tertiary referral Hepatobiliary Unit are presented. The audit involved postal and telephone questionnaires as well as prospective collection of data. The majority of responses from patients were positive, with many finding the CNS a useful and well-utilised contact. Overall, the CNSs performed well in each of their designated tasks; however, areas were still identified which could be further improved. Audit is essential in providing feedback to the CNS and to identify areas which require improvement. The CNS has evolved to meet a clinical gap in patient care, and as a result, the role of a CNS is frequently nebulous or poorly defined. This renders evaluation of the CNS problematic and fraught with difficulties. However, a thorough assessment can still be made using carefully constructed audit looking at each task of the CNS.
Phytotherapy Research | 2008
Severine Illouz; Eliane Alexandre; C.J. Pattenden; Louise Mark; Philippe Bachellier; M'Balu Webb; David P. Berry; Ashley R. Dennison; Lysiane Richert
Curcumin (CUR) is a major component of a dietary spice derived from the roots of Curcuma longa. It has strong antioxidant activities and hepatoprotective properties. Primary human hepatocytes are clinically used in transplantation or in bioartificial liver devices for the treatment of patients with liver failure. Fresh and cryopreserved hepatocytes are also used in vitro for the study of drugs in pharmacotoxicology. We aimed to assess whether CUR could improve human liver cell viability and prevent oxidative damage responsible for large cell loss during cell preparation. Our study showed beneficial effects of CUR (25 µM) on freshly isolated human hepatocytes, increasing significantly metabolic activity of viable attached cells when seeded with CUR for 24 h. However CUR added during the cell isolation process did not have any significant impact on cell isolation outcomes or on cryopreservation outcomes. Conversely, CUR added during the thawing of frozen cells had a negative effect on the cell attachment capacity of hepatocytes that were cryopreserved in the presence or absence of CUR. In conclusion, although having positive effects on viability and challenge of oxidative stress on cultured human hepatocytes, CUR had no beneficial effect on cell isolation or cryopreservation outcomes. Copyright
Journal of Evaluation in Clinical Practice | 2008
Giuseppe Garcea; Ibrar Majid; C.J. Pattenden; Christopher D. Sutton; Christopher P. Neal; David P. Berry
In general, a surgical day case is a patient admitted for investigation or operation on a planned non-resident basis who requires facilities for recovery [1]. For these patients the proposed limit of their hospital stay is 23 hours or less [1,2]. In reality, many day surgery units (DSUs) do not operate over a 23-hour period, hence, patients requiring a hospital stay longer than planned will need transfer to a main surgical ward. The Department of Health in the UK has set a target of 75% of elective surgery to be performed as day cases, and it has been recommended that the unplanned admission rate should be less than 3% for these cases [1]. Identifying the predisposing factors contributing to unplanned admissions is vital in order to reduce costs and pressure on acute hospital beds.
Anz Journal of Surgery | 2007
G. Garcea; C. D. Sutton; C.J. Pattenden; C.P. Neal; David P. Berry; A. Dennison
The incidence of burst abdomens is reported to be 3% with a mortality of 25%.1 Burst abdomens are managed by the control of wound infection and primary closure. Deep tension sutures are frequently used to give further support to the abdominal wall. We describe a variation on deep retention sutures, which gives adequate support to the abdominal wall with no risk of ‘cutting out’. Following debridement of the abdominal wall, three to four suction drain tubes are disconnected from their collecting flasks. The tubing should be a gauge small enough to allow it to be knotted easily. The suction drain tubes are then placed ‘through and through’ the abdominal wall. The abdominal wall is closed using a continuous suture; as the surgeon progresses down the laparotomy wound, the suction drain tubing is knotted over the abdominal wound for further support (Fig. 1). In cases of gross contamination, mass closure can be omitted to give a controlled laparostoma. The drains are left in situ for 4weeks before removal. Many methods for closure of the burst abdominal wound have been described, including silver wire retention sutures,2 adjustable nylon ties,3 parallel retention sutures,4 mesh repair1 and secondary intention healing. If the abdominal wall can be approximated without tension, primary closure without mesh is the preferred option.1 Suction drain tubing offers good support to the abdominal wall with no danger of the sutures ‘cutting out’.