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Ahmed O, Bolger JC, O'Neill B, Robb WB. Use of esophageal stents to relieve dysphagia during neoadjuvant therapy prior to esophageal resection: a systematic review. Dis Esophagus 2020; 33:5673617. [PMID: 31828290 DOI: 10.1093/dote/doz090] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Esophageal cancer stenting offers symptomatic relief for patients suffering from dysphagia. There are limited data to support their use to relieve dysphagia and improve nutrition during neoadjuvant therapy with some concern that they may negatively impact oncological outcomes. The aim of this systematic review was to quantify the impact of esophageal stents on outcomes prior to resection with curative intent. A literature search was performed using Embase, Medline, PubMed, PubMed Central, the Cochrane library for articles pertaining to esophageal stent use prior to or during neoadjuvant chemotherapy or chemoradiotherapy in patients planned for curative esophagectomy. Data extracted included basic demographics, clinical, nutritional and oncologic outcomes. A total of 9 studies involving 465 patients were included. Esophageal stent use resulted in a significant improvement in mean dysphagia scores in the immediate post stent period but failed to demonstrate any positive changes in weight, body mass index (BMI) or albumin. Only 33% of stented patients ultimately progressed to potential curative surgical resection and stents were associated with reduced R0 resection rates and lower overall survival. This systematic review shows that, although esophageal stenting is associated with improvements in dysphagia during neoadjuvant therapy, their effect on improving patient nutritional status is less clear and they may be associated with poorer long-term oncological outcomes. Stents should be used with caution in patients who are being considered for potentially curative resection of esophageal malignancies and other strategies of nutritional supplementation should be considered.
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Karim N, Marinelli A, Cantor E, Boyalla V, Malaczynska-Rajpold K, Ahmed O, Khan H, Haldar S, Jones D, Hussein W, Markides V, Wong T, Jarman J. P2831Safety of atrial fibrillation catheter ablation in the elderly. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz748.1141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Catheter ablation for drug refractory, symptomatic atrial fibrillation (AF), is becoming increasingly common and can be beneficial in alleviating symptoms. However, in the elderly, there are concerns about the risks an invasive procedure poses, with limited published data available in those aged over 80 years.
Purpose
To determine the complication risk of AF catheter ablation in the elderly
Methods
Complications were identified from patient records in 3156 consecutive patients who underwent radiofrequency catheter ablation for AF, at a tertiary cardiology centre between 2013–2017. All cases were performed under general anesthesia.
Results
In this cohort of 3156 patients (mean age= 62.9±11.0 years, female = 29.9%), 90 (2.85%) (mean age= 66±10.0 years, female = 49.5%) complications were identified. In patients aged ≥80 years, complications occurred in 5 out of 99 patients (5.05%) (mean age= 82.6±1.2, female=100%), compared to 85 out of 3057 patients (2.78%) in those aged <80 years (mean age= 65±10.3, female = 49.4%). The difference was not significant p=0.18. Complications in the elderly all occurred acutely, and included groin haematoma (2.02%), pneumonia (2.02%) and pericardial effusion (1.01%).
Conclusion
Catheter ablation for AF in patients ≥80 years of age, is not associated with a significant increase in complication risk, compared to those who are younger.
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Ahmed S, Chalchal H, Dwernychuk L, Iqbal N, Salim M, Gowan-Moody D, Asif T, Khan M, Lim J, Bulych D, Ahmed O, Sami A, Kontulainen S, Leis A. Role of individualized intervention(s) on quality of life (QoL) and adherence to adjuvant endocrine therapy in premenopausal women with early-stage breast cancer (bc): MyChoice study. Ann Oncol 2019. [DOI: 10.1093/annonc/mdz240.113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Ahmed O, Pramfalk C, Pedrelli M, Olin M, Steffensen KR, Eriksson M, Parini P. Genetic depletion of Soat2 diminishes hepatic steatosis via genes regulating de novo lipogenesis and by GLUT2 protein in female mice. Dig Liver Dis 2019; 51:1016-1022. [PMID: 30630736 DOI: 10.1016/j.dld.2018.12.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2018] [Revised: 11/23/2018] [Accepted: 12/10/2018] [Indexed: 12/11/2022]
Abstract
Depletion of the cholesterol esterifying enzyme acyl-Coenzyme A: cholesterol acyltransferase 2 (ACAT2, encoded by Soat2) protects mice from atherosclerosis, diet-induced hypercholesterolemia, and hepatic steatosis when fed high-cholesterol diet. The glucose transporter 2 (GLUT2) represents the main gate of glucose uptake by the liver. Lipid synthesis from glucose (de novo lipogenesis; DNL) plays a pivotal role in the development of hepatic steatosis. Inhibition of DNL is a successful approach to reverse hepatic steatosis, as shown by different studies in mice and humans. Here we aimed to investigate whether depletion of Soat2 per se can reduce hepatic steatosis, also in the presence of very low levels of cholesterol in the diet, and the underlying mechanisms. Female Soat2-/- and wild type mice were either fed high-fat or high-carbohydrate diet and both contained <0.05% (w/w) cholesterol. Analysis in serum, liver, muscles and adipose tissues were performed. We found Soat2-/- mice fed high-fat, low-cholesterol diet to have less hepatic steatosis, decreased expression of genes involved in DNL and lower hepatic GLUT2. Similar findings were found in Soat2-/- mice fed high-carbohydrate, low-cholesterol diet. CONCLUSION: Depletion of Soat2 reduces hepatic steatosis independently of the presence of high levels of cholesterol in the diet. Our study provides a link between hepatic cholesterol esterification, DNL, and GLUT2.
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Hills G, Kennedy M, Ahmed O, Tang JW. Managing seasonal influenza in hospitalized patients - without an influenza point-of-care test. J Hosp Infect 2019; 102:471-473. [PMID: 31125582 DOI: 10.1016/j.jhin.2019.05.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2019] [Accepted: 05/16/2019] [Indexed: 10/26/2022]
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O’Connell L, O’Connell RM, Ahmed O, Mealy K. Audit of PPI Prescribing Practices: A Risk to Patient Safety? IRISH MEDICAL JOURNAL 2019; 112:911. [PMID: 31241278] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Aim Proton pump inhibitors (PPIs) are frequently prescribed to surgical patients (50-60%) to prevent gastrointestinal bleeding. However, most surgical patients are at low risk of significant bleeds. The aim of this audit was to identify inappropriate PPI prescribing, if any, in a cohort of surgical inpatients. Methods This was a prospective analysis completed over a 4 month period. Data was collected via review of clinical notes and drug charts. The audit standard was the consensus guideline on indications for PPI use issued by Scarpignato et al (2016). Results In total 89 patients were included (n = 89). 73% were on PPI therapy. 30% had a documented indication for therapy which was concordant with recommendations. However, the majority of PPI prescriptions (70%) were inappropriate. Conclusion PPIs are frequently prescribed to surgical patients without an appropriate indication. Indiscriminate use of these drugs has implications in the form of costs and potential complications.
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Hasan Z, Irfan M, Masood Q, Ahmed O, Moosajee US, Rao S, Salahuddin N. Raised levels of IFN-gamma and IL-13 are associated with pre-diabetes amongst newly diagnosed patients with Tuberculosis. J PAK MED ASSOC 2019; 69:468-473. [PMID: 31000846] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
OBJECTIVE To investigate pre-diabetes and diabetes in newly-diagnosed tuberculosis patients and to assess the association of serum cytokine levels with diabetes status. METHODS The cross-sectional study was conducted at Indus Hospital and The Aga Khan University Hospital, Karachi from May to November 2015, and included patients of either gender aged 18 years or more with a confirmed diagnosis of tuberculosis who were either newly diagnosed or had received up to 1 month of anti-tuberculosis therapy were included. Patients were enrolled from among those presenting to the clinics at Indus Hospital, Karachi, and the Department of Medicine, Aga Khan University Hospital (AKUH), Karachi. The patients were tested for glycosylated haemoglobin and random blood glucose. Diabetes was defined as HbA1c >6.5%; pre-diabetes as HbA1c=5.7-6.4%; and normoglycaemic as HbA1c <5.7%. Serum cytokines were investigated using the Bio-plex 27, Bio-Rad assay. SPSS version 19.0 was used for data analysis.. RESULTS Of the 211 subjects, 110(52%) were females and 101(48%) were males. The overall median age of the sample was 26 years, and 100(47.3%) subjects were underweight. Of the total, 24(11.4%) had diabetes and 45(21.3%) had pre-diabetes. Of the diabetics, only 7(29%) knew their status prior to screening. Interferon-gamma and interleukin-13 were significantly different among tuberculosis patients with diabetes, pre-diabetes and normoglycaemia (p<0.05). Glycosylated haemoglobin levels showed a significant correlation with interferon-gamma levels. CONCLUSIONS Raised interleukin-13 and interferon-gamma levels in newly-diagnosed tuberculosis patients with pre-diabetes.
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Tasse J, Chauhan N, Ahmed O, Madassery S, Tabriz D, Arslan B. 04:12 PM Abstract No. 439 Safety of Yttrium-90 radioembolization for the treatment of hepatocellular carcinoma in patients with hyperbilirubinemia. J Vasc Interv Radiol 2019. [DOI: 10.1016/j.jvir.2018.12.519] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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Rabei R, Patel K, Ginsburg M, Arslan B, Turba U, Ahmed O. 04:12 PM Abstract No. 207 Trends in vertebral augmentation for vertebral compression fractures in the US elderly Medicare population. J Vasc Interv Radiol 2019. [DOI: 10.1016/j.jvir.2018.12.263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
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Ahmed O, Jaber B, Ozen M, Arslan B, Tasse J, Madassery S, Turba U. 03:00 PM Abstract No. 63 Below-the-elbow revascularization for the treatment of upper extremity critical limb ischemia. J Vasc Interv Radiol 2019. [DOI: 10.1016/j.jvir.2018.12.105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
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Ahmed O, Patel K, Clayton B, Patel M, Ginsburg M. 04:12 PM Abstract No. 266 Provider specific utilization of chest port placements in the Medicare population: a decade-long analysis. J Vasc Interv Radiol 2019. [DOI: 10.1016/j.jvir.2018.12.328] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
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Ahmed O, Cherkadu V, Kalavagunta PK, Shang J. Solvent-dependent regio- and stereo-selective reactions of 3-formylchromones with 2-aminobenzothiazoles and transacetalization efficiency of the product 3-((benzo[d]thiazol-2-ylimino)butyl)-4H-chromen-4-one. RSC Adv 2019; 9:20573-20581. [PMID: 35515575 PMCID: PMC9065747 DOI: 10.1039/c9ra02763g] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2019] [Accepted: 05/16/2019] [Indexed: 11/21/2022] Open
Abstract
Using 2-propanol as the solvent, 3-formylchromones and 2-aminobenzothiaoles formed corresponding imines, while 1° and 2°-alcohols formed the corresponding 2-alkoxy-3-enamines with selectivity for the Z-isomer. Changing the substrates with similar molecules such as 3-formylchromone with quinoline-, quinolone- and indole-3-carbaldehydes sometimes resulted in the formation of the corresponding imines, whereas replacing 2-aminobenzothiazole with amides resulted in the formation of acetals. Considering the effect of the solvent, replacing alcohols with the aprotic solvents THF and CH2Cl2 resulted in the formation of imines and enamines, which are the characteristic reactions of 2-propanol and other 1° and 2°-alcohols, respectively. 2-Alkoxy-3-enamines were found to undergo transacetalization with both short and long chain alcohols. The novelty of these reactions is that they did not require an external catalyst, all the reactions were performed at the same temperature, and purification was achieved by filtration. The transacetalization we performed herein is a new concept, which has not been reported to date. In contrast, other similar reactions, such as transalkoxylation, transalkylation, and transetherification, are performed on a commercial scale using expensive catalysts such as Otera's catalyst. The highly sensitive nature of 3-formylchromones towards variations in the substrates and solvents to form different products and the reason behind the selective formation of the Z-isomer of 2-alkoxy-3-enamines and its transacetalization efficiency need further studies to understand the reaction mechanism and possibly other factors such as solvent effects. 2-Propanol forms lmine (4), other alcohols forms enamine (3) which can undergo transacetalization and replacing 2 with amides forms acetals (5).![]()
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Littmann K, Ahmed O, Gustafsson U, Pramfalk C, Öörni K, Larsson L, Sahlin S, Camejo G, Parini P, Eriksson M. Simvastatin and ezetimibe reduce plasma lipoprotein binding to human arterial proteoglycans in gallstone diseased patients. Atherosclerosis 2018. [DOI: 10.1016/j.atherosclerosis.2018.06.739] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Ahmed O, Rabei R, Patel K, Patel M, Ginsburg M, Clayton B, Arslan B. Abstract No. 454 Percutaneous interventions for hemodialysis access: national trends in. . . the Medicare population. J Vasc Interv Radiol 2018. [DOI: 10.1016/j.jvir.2018.01.499] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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Arslan B, Ozen M, Tasse J, Madassery S, Ahmed O, Turba U. 4:03 PM Abstract No. 158 Midterm outcomes after below-the-ankle interventions for Rutherford 5-6 critical limb ischemia patients. J Vasc Interv Radiol 2018. [DOI: 10.1016/j.jvir.2018.01.178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022] Open
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Kotarska M, Riaz R, Arslan B, Turba U, Tasse J, Madassery S, Ahmed O. 4:00 PM Abstract No. 380 Vacuum-assisted suction thrombectomy (VAST) for the treatment of acute peripheral arterial thromboembolism. J Vasc Interv Radiol 2018. [DOI: 10.1016/j.jvir.2018.01.429] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022] Open
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Ahmed O, Brahmania M, Kelley M, Kowgier M, Khalili K, Beecroft R, Renner E, Wong D, Shah H, Feld J, Janssen HL, Sherman M. A77 TRACKING WAIT TIMES AND OUTCOMES OF RADIOFREQUENCY ABLATION IN PATIENTS WITH HEPATOCELLULAR CARCINOMA: A QUALITY IMPROVEMENT INITIATIVE. J Can Assoc Gastroenterol 2018. [DOI: 10.1093/jcag/gwy008.078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Ahmed O, Teshima CW, Akram H, Mosko J. A331 QUALITY GAPS IN THE MANAGEMENT OF PATIENTS WITH ACUTE PANCREATITIS. J Can Assoc Gastroenterol 2018. [DOI: 10.1093/jcag/gwy009.331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Ahmed O, Rodrigues DM, Brahmania M, Patel K. A188 LOW INCIDENCE OF SPONTANEOUS BACTERIAL PERITONITIS IN ASYMPTOMATIC OUTPATIENTS WITH CIRRHOSIS UNDERGOING PARACENTESIS: A SYSTEMATIC REVIEW AND META-ANALYSIS. J Can Assoc Gastroenterol 2018. [DOI: 10.1093/jcag/gwy009.188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Negm OH, Ahmed O, Figueredo GP, Hamed MR, Pollard L, Garibaldi J, Sewell H, Robertson JF. Abstract P2-02-08: Validation of an autoantibody blood test for the detection of early breast cancer (BC), particularly hormone receptor positive BC. Cancer Res 2018. [DOI: 10.1158/1538-7445.sabcs17-p2-02-08] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: Breast cancer (BC) remains the most common type of cancer in women, with an incidence of 1.6 million cases per year worldwide. Early detection through mammographic screening reduces BC mortality by ˜20%, which while highly significant still leaves 80% of BC deaths unchanged. Furthermore, mammographic screening is only applicable to women between 50-70 years, in which only about one third of BCs occurs. There is an urgent need to identify a test, preferably a blood test showing high sensitivity and specificity for early BC across all ages of patients and all tumour types. Advances in understanding of the human autoantibody (AAB) response to early cancers has allowed us to harness this biological phenomenon for early cancer detection. .
Aim: To identify a panel of tumor associated antigens (TAAs) which would detect AABs in the blood with high sensitivity and specificity for early BC: enabling cancer/normal discrimination.
Methods: Serum samples from 120 BC patients and matched controls were tested against a panel of 60 multiple TAAs using an optimised new multiplex microarray platform. A sub-group of 60 samples were also tested for AABs to estrogen receptor (ER). The selected TAAs were spotted onto a glass slide surface in an automated, highly reproducible system platform. If serum autoantibodies are present they bind to one or more of the TAA spots. Bound antibodies are detected with a fluorescent reporter and signal intensity measured using GenePix pro-6.
Data analysis: A Monte Carlo Simulation method was employed to define the best panel of the antigens with optimised cutoff points in each assay that would yield the highest sensitivity and specificity to discriminate BC patients from controls.
AAB positivity in the BC group was analysed by tumor size (≤20mm versus >20mm), histological grade, lymph node status (positive or negative) and ER status (positive or negative)
Results: Using a panel of 12 TAAs, AABs were detected in pre-op blood of 34/60 (57%) primary BC patients compared to 9/59 controls (15%) (p=0.000003); one control sample data was unavailable. This gave a sensitivity of 57% and specificity of 85%. Median age of BC patients was 59yrs (20-81) versus 59yrs (28-81) in controls. There was no significant difference for AAB detection when compared to tumour size, grade, lymph node status or ER status. In the sub-group of 60 patients where ER antigen was measured using a panel of 8 TAAs AABs were detected in 20/29 BC patients compared to 2/30 controls (p=3.5e-7). This represents a sensitivity of 69% with a specificity of 93%.
Conclusions: These results confirmed our hypothesis that AABs can be detected in women of all ages with early BC. AABs were not related to tumour size, grade, lymph node status or ER status. If a panel of AAB assays can be validated it opens the possibility of a blood test for detection of early BC. Future direction of this research will be i) validation studies of a panel of AABs for detection of early BC, ii) detection of AABs at the earliest stages of carcinogenesis and iii) a panel of AABs which detect ER positive BC thereby enabling stratified chemoprevention in a high risk group combined with mammographic screening.
Citation Format: Negm OH, Ahmed O, Figueredo GP, Hamed MR, Pollard L, Garibaldi J, Sewell H, Robertson JF. Validation of an autoantibody blood test for the detection of early breast cancer (BC), particularly hormone receptor positive BC [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr P2-02-08.
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Rabei R, Mathevosian S, Tasse J, Madassery S, Arslan B, Turba U, Ahmed O. Primary constrained TIPS for treating refractory ascites or variceal bleeding secondary to hepatic cirrhosis. Br J Radiol 2018; 91:20170409. [PMID: 29166137 DOI: 10.1259/bjr.20170409.pmid29166137;pmcid:pmc5965479] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/21/2023] Open
Abstract
OBJECTIVE To report an initial experience using a primary constrained transjugular intrahepatic portosystemic shunt (TIPS) technique for treating cirrhotic patients with refractory ascites or variceal bleeding. METHODS All patients undergoing primary constrained (n = 9) and conventional (n = 18) TIPS between July 2014 and June 2016 were retrospectively reviewed. Preprocedure demographics, Child-Pugh, model for end-stage liver disease and technical variables were recorded. Outcomes measured included technical and clinical success, complications, 30-day mortality, as well as necessity for TIPS revision. Average (SD) and median follow-up was 237 (190) and 226 days. RESULTS All constrained and conventional TIPS were technically successful (100%). Clinical success as defined as a reduction or improvement in presenting symptoms was 88.9% (8/9) and 100% (18/18) in the constrained and conventional groups, respectively (p = 1). The average reduction in portosystemic gradient was lower in the constrained group, 6.1 mmHg compared with 10.6 mmHg in the conventional group (p = 0.73). The rate of hepatic encephalopathy following TIPS placement was higher in the conventional group [16.7% (3/18)] compared with 0% in the constrained group (p = 0.52). The percentage of patients requiring TIPS revision was lower in the constrained group, although the results were not significant (11.1 vs 22.2%, p = 0.63). CONCLUSION Primary constrained TIPS is a feasible modification to conventional TIPS with similar technical and clinical success rates. A trend towards a smaller reduction in the portosystemic gradient and need for revision was observed in the constrained group. Advances in knowledge: Primary constrained TIPS allows for greater stepwise control over shunt diameter and may represent an improved technique for patients at risk for hepatic encephalopathy.
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Ahmed O, Pommier R, Cros J, Sauvanet A. A false postoperative recurrence of intraductal and papillary mucinous neoplasm of the pancreas. J Visc Surg 2018; 155:165-166. [PMID: 29291923 DOI: 10.1016/j.jviscsurg.2017.12.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Stenosis of pancreatico-digestive anastomoses following pancreaticoduodenectomy is frequently observed. In a patient operated on for intraductal papillary and mucinous neoplasm, it can induce a massive dilatation of the main pancreatic duct leading to the misdiagnosis of tumor recurrence with main duct involvement.
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Rabei R, Mathevosian S, Tasse J, Madassery S, Arslan B, Turba U, Ahmed O. Primary constrained TIPS for treating refractory ascites or variceal bleeding secondary to hepatic cirrhosis. Br J Radiol 2017; 91:20170409. [PMID: 29166137 DOI: 10.1259/bjr.20170409] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVE To report an initial experience using a primary constrained transjugular intrahepatic portosystemic shunt (TIPS) technique for treating cirrhotic patients with refractory ascites or variceal bleeding. METHODS All patients undergoing primary constrained (n = 9) and conventional (n = 18) TIPS between July 2014 and June 2016 were retrospectively reviewed. Preprocedure demographics, Child-Pugh, model for end-stage liver disease and technical variables were recorded. Outcomes measured included technical and clinical success, complications, 30-day mortality, as well as necessity for TIPS revision. Average (SD) and median follow-up was 237 (190) and 226 days. RESULTS All constrained and conventional TIPS were technically successful (100%). Clinical success as defined as a reduction or improvement in presenting symptoms was 88.9% (8/9) and 100% (18/18) in the constrained and conventional groups, respectively (p = 1). The average reduction in portosystemic gradient was lower in the constrained group, 6.1 mmHg compared with 10.6 mmHg in the conventional group (p = 0.73). The rate of hepatic encephalopathy following TIPS placement was higher in the conventional group [16.7% (3/18)] compared with 0% in the constrained group (p = 0.52). The percentage of patients requiring TIPS revision was lower in the constrained group, although the results were not significant (11.1 vs 22.2%, p = 0.63). CONCLUSION Primary constrained TIPS is a feasible modification to conventional TIPS with similar technical and clinical success rates. A trend towards a smaller reduction in the portosystemic gradient and need for revision was observed in the constrained group. Advances in knowledge: Primary constrained TIPS allows for greater stepwise control over shunt diameter and may represent an improved technique for patients at risk for hepatic encephalopathy.
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Ahmed O, Nugent M, Cahill R, Mulsow J. Attitudes to trainee-led surgical mentoring. Ir J Med Sci 2017; 187:821-826. [DOI: 10.1007/s11845-017-1703-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2017] [Accepted: 10/20/2017] [Indexed: 11/29/2022]
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West L, Girffin S, Weiler R, Win K, Ahmed O. Under utilisation of concussion assessment tools by sports clinicians working in cerebral palsy football. J Sci Med Sport 2017. [DOI: 10.1016/j.jsams.2017.09.255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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