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Roberts F, Steinberg S. Paul B. Robertson Memoriam. J Dent Res 2023; 102:1285-1287. [PMID: 37772930 DOI: 10.1177/00220345231195615] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/30/2023] Open
Affiliation(s)
- F Roberts
- University of Washington, Seattle, WA, USA
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Graupe M, Tignor A, Veneziale K, Jensen M, Khadr L, Beckstrom H, Gister M, Hendricks K, NL M, Roberts F, Youngberg S, Schachtner S. Accelerating Improvement: The Pediatric Acute Care Cardiology Collaborative (PAC3) Data Timeliness Project. Int J Qual Health Care 2022; 34:6771334. [DOI: 10.1093/intqhc/mzac086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Revised: 08/11/2022] [Accepted: 10/24/2022] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
The Pediatric Acute Care Cardiology Collaborative (PAC3) is a learning network focused on improving acute care cardiology patient outcomes. Data submission timeliness is a vulnerability for PAC3 and most clinical registries, directly affecting collaborative benchmarking, quality improvement (QI) and research projects.
Methods
PAC3 conducted a collaborative-wide QI project addressing data timeliness and efficiency. Data analysis of submitted cases from September 2019 – February 2020 revealed nine “High Performer” centers who submitted cases within 67 days of hospital dicharge (the limit for timeliness) >90% of the time, and eight “High Potential” sites who submitted timely cases <75% of the time. The SMART aim was to increase case submission timeliness in “High Potential” centers from 41% to 80% by December 2020. A secondary aim was for “High Performer” site timeliness to be maintained. During the intervention phase (March-December 2020), PDSA cycles included webinars, facilitated exploratory conversations, data review, and development of a best practice guide (“Getting Started Toolkit”). Onboarded “New Centers” starting in 2020 were also invited to test intervention effectiveness. Balancing measures included data collector job satisfaction and stress, and resubmission rates.
Results
“High Performer” and “High Potential” centers submitted 11,358 cases from November 2019-December 2020. Timely submission rates for “High Potential” centers improved from 40.6% to 74.6% and were maintained at >90% for “High Performer” centers. “New Centers” averaged 92.6% timely case submissions during their first six months. Data collector job satisfaction and stress were not impacted, and resubmission rates did not increase.
Conclusions
PAC3’s multi-center QI project increased data submission timeliness in a large pediatric subspecialty registry. The lessons learned and the Toolkit developed can be applied in other registries to improve data submission efficiency, with resultant improvement in benchmarking, QI, research, length of stay and outcomes.
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Affiliation(s)
- M Graupe
- Heart Center Administration, Children’s Health , Dallas, Texas, USA
| | - A Tignor
- James M Anderson Center of Excellence, Cincinnati Children’s Hospital , Cincinnati, Ohio, USA
| | - K Veneziale
- Children’s Hospital of Philadelphia and the University of Pennsylvania Perelman School of Medicine , Philadelphia, Pennsylvania, USA
| | - M Jensen
- Children’s Mercy Hospital Department of Pediatric Cardiovascular Surgery , Kansas City, Missouri, USA
| | - L Khadr
- University of Michigan Congenital Heart Center, C.S. Mott Children’s Hospital , Ann Arbor, Michigan, USA
| | - H Beckstrom
- Children’s Heart Center, Ann & Robert H. Lurie Children’s Hospital of Chicago , Chicago, Illinois, USA
| | - M Gister
- Heart Center Administration, Children’s Health , Dallas, Texas, USA
| | - K Hendricks
- Heart Center Administration, Children’s Health , Dallas, Texas, USA
| | - Madsen NL
- Division of Cardiology, Department of Pediatrics, University of Texas Southwestern Medical Center , Dallas, Texas, USA
| | - F Roberts
- Heart Vascular Institute, UPMC Children’s Hospital of Pittsburgh , Pittsburgh, Pennsylvania USA
| | - S Youngberg
- Intermountain Primary Children’s Hospital , Salt Lake City, Utah, USA
| | - S Schachtner
- Children’s Hospital of Philadelphia and the University of Pennsylvania Perelman School of Medicine , Philadelphia, Pennsylvania, USA
- Department of Pediatrics, Division of Pediatric Cardiology, Cincinnati Children’s Hospital , Cincinnati, Ohio, USA
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Bourke R, Perez S, Mogollo AZ, Finucane C, Leenders M, Roberts F, Morren G, Maree A, De Melis M, Kenny RA, Foran T. 302 MONITORING FALLS RISK IN THE COMMUNITY USING AN IMPLANTABLE CARDIAC MONITOR WITH EMBEDDED ACCELEROMETER. Age Ageing 2022. [DOI: 10.1093/ageing/afac218.265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Falls are the most common cause of injury amongst older adults. Falls can lead to hospitalisation, functional decline and are associated with increased morbidity and mortality. The holy grail for clinicians would be to predict increased likelihood of falls occurring and intervene before the event. Understanding underlying dynamic biophysiological changes may therefore inform novel predictor models and falls prevention. This study examines activity and cardiac data acquired from an implanted Medtronic Reveal LINQ™ Insertable Cardiac Monitor (ICM) with an embedded tri-axial accelerometer.
Methods
Thirty participants with at least one unexplained fall in the previous two years were prospectively recruited. All met criteria for ICM insertion following comprehensive assessment. Participants were followed for one year and attended every three-months for cardiac and gait assessment. Information pertaining to activity levels, posture changes and cardiac parameters were collected daily from the device. Summary metrics and trends were collected for inclusion in a continual assessment of falls risk.
Results
Mean age of participants was 68.0 years (±9.3). 19/30 (63.3%) were female. 22/30 (73.3%) had at least one cardiovascular condition documented in their medical history. There was seasonal variation in activity levels. Twelve participants had falls and cardiovascular, gait and activity variables were examined at the time of a fall to determine any trends in biophysiological changes.
Conclusion
Causes of falls are usually multifactorial. A holistic approach is necessary to manage and minimise risk factors. The use of an ICM with an embedded tri-axial accelerometer allows clinicians to formulate an algorithm to determine if a person is at an increased risk of falling based on biophysiological changes. This may create an opportunity for falls to be predicted and prevented.
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Affiliation(s)
- R Bourke
- St. James Hospital Mercer’s Institute for Successful Ageing, , Dublin, Ireland
- Trinity College Dublin School of Medicine, , Dublin, Ireland
| | - S Perez
- St. James Hospital Mercer’s Institute for Successful Ageing, , Dublin, Ireland
- Trinity College Dublin School of Medicine, , Dublin, Ireland
| | - AZ Mogollo
- St. James's Hospital Department of Medical Physics and Bioengineering, , Dublin, Ireland
| | - C Finucane
- St. James's Hospital Department of Medical Physics and Bioengineering, , Dublin, Ireland
- Trinity College Dublin School of Medicine, , Dublin, Ireland
- St. James Hospital Mercer’s Institute for Successful Ageing, , Dublin, Ireland
| | - M Leenders
- Medtronic Bakken Research Center , Maastricht, Netherlands
| | - F Roberts
- Medtronic Bakken Research Center , Maastricht, Netherlands
| | - G Morren
- Medtronic Bakken Research Center , Maastricht, Netherlands
| | - A Maree
- St. James Hospital Department of Cardiology, , Dublin, Ireland
- Trinity College Dublin School of Medicine, , Dublin, Ireland
| | - M De Melis
- Medtronic Bakken Research Center , Maastricht, Netherlands
| | - RA Kenny
- Trinity College Dublin School of Medicine, , Dublin, Ireland
- St. James Hospital Mercer’s Institute for Successful Ageing, , Dublin, Ireland
| | - T Foran
- St. James's Hospital Department of Medical Physics and Bioengineering, , Dublin, Ireland
- St. James Hospital Mercer’s Institute for Successful Ageing, , Dublin, Ireland
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Croughan S, O'Cronin D, O'Brien D, Roberts F, Underwood S, O'Connell J, Jackson A, McCarthy J, Fahey S. Vancomycin-Resistant Enterococci in Patients Attending for Colonoscopy: An Estimate of Community Prevalence. Ir Med J 2022; 115:649. [PMID: 36302298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
Aims Ireland has the highest vancomycin-resistant Enterococcus faecium (VRE) bloodstream infection prevalence in Europe. Two patterns of VRE carriage are recognised. European, with widespread community prevalence and North American, where carriage is predominantly nosocomial. It is unclear which pattern is dominant in Ireland. This uncertainty limits infection control measures. This study sought to explore this issue via a cross sectional point prevalence study. Methods Asymptomatic community volunteers, represented by patients undergoing elective outpatient colonoscopy testing, were opportunistically screened for VRE. Demographic and risk factor data were collected via a patient survey. Rectal swabs were collected before colonoscopy and VRE was identified using the VITEK MS system. Results 102 patients were cultured. A single patient tested positive, representing a prevalence rate of 0.98% (95% CI <0.01-5.8%). This patient demonstrated traditional risk factors, suggesting nosocomial rather than community acquisition. 94% (N=94) of patients had no knowledge of VRE, while 83% (N=83) had low levels of concern regarding hospital acquired infections. Conclusion There is a low incidence of VRE in the Irish community setting, in contrast to other European Countries, suggesting asymptomatic community colonization is not responsible for the high rates of VRE seen in Ireland. Wider screening or atypical infection control measures would not be supported by this data.
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Affiliation(s)
- S Croughan
- Department of Emergency Medicine, St. James Hospital, James Street, D08NHY1, Ireland
| | - D O'Cronin
- Department of Anesthesiology, Mercy University Hospital, Cork, T12WE28, Ireland
| | - D O'Brien
- Department of Microbiology, Mercy University Hospital, Cork, T12WE28, Ireland
| | - F Roberts
- Department of Anesthesiology, Mercy University Hospital, Cork, T12WE28, Ireland
| | - S Underwood
- Department of Anesthesiology, Mercy University Hospital, Cork, T12WE28, Ireland
| | - J O'Connell
- Department of Anesthesiology, Mercy University Hospital, Cork, T12WE28, Ireland
| | - A Jackson
- Department of Medicine, Mercy University Hospital, Cork, T12WE28, Ireland
| | - J McCarthy
- Department of Medicine, Mercy University Hospital, Cork, T12WE28, Ireland
| | - S Fahey
- Department of Microbiology, Mercy University Hospital, Cork, T12WE28, Ireland
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Roberts F, Birmingham K, Darlison L, Hertzberg K, Chapman K, Krampikowski J, Bunden D, King L, Tebbutt E, Potter E. 142 Improving Functional Outcomes During Covid-19 for Both COVID-19 and Non COVID-19 Positive Older Adults Through the Introduction. Age Ageing 2021. [PMCID: PMC7989638 DOI: 10.1093/ageing/afab030.103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Purpose To improve the functional outcomes of older adults presenting to the Health and Ageing wards during the COVID-19 pandemic through a focussed rehabilitation list. The intended benefits to the older adult and service were for: 1. Daily rehabilitation input for older adults. 2. Older adults to spend less time immobile. 3. Ongoing rehabilitation intervention while awaiting medical clearance for discharge. 4. Increased staff satisfaction 5. Better outcomes on discharge. 6. Rehabilitation ethos on the Health and Ageing wards. Methods The quality improvement project was carried out using the Plan, Do, Study, Act (PDSA) cycle. Three iterative PDSA cycles were carried out over the course of the project to deliver proactive interventions as a result of analysis of baseline data and stakeholder involvement. These interventions were aimed at developing communication around the rehabilitation list within the team and sustainability of this list. Results The project resulted in better functional outcomes for older adults and increased staff morale. Between May 2020–June 2020, a total of 56 patients were seen on the rehabilitation list, with 84% of these patients seeing improvements in their Elderly Mobility Scores (EMS). 27% of patients on the rehabilitation list saw a change to their initial discharge plan, either needing reduced packages of care or reduced need for ongoing rehabilitation in an external setting. Conclusions The quality improvement project found that with focussed rehabilitation older adult inpatients with or without COVID-19 can make significant functional gains. These gains have wider effects on their outcomes on discharge and also for the service through increased morale and job satisfaction. Due to demand and capacity issues in the acute setting, older adults who would often benefit from ongoing input are not always reviewed regularly. This project demonstrates that with focussed rehabilitation older adults can improve and achieve better functional outcomes.
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Biefer HRC, Isker J, Nian Y, El Fatimy R, Camacho V, Emmert MY, Fish S, Loscalzo AJ, Roberts F, Battinelli E, Loscalzo J, Vasudevan A, Abdallah E. Serotonin-Induced Vasoconstriction Mediated by NAD+ as a Therapy for Bleeding Disorders. Thorac Cardiovasc Surg 2021. [DOI: 10.1055/s-0041-1725839] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Roberts F. 23 Earlier Therapy Intervention in the Emergency Department to Improve Clinical Outcomes for Fallers Aged 65 and Over. Age Ageing 2020. [DOI: 10.1093/ageing/afz183.23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Purpose
To improve clinical outcomes for fallers aged 65 and over presenting to the emergency department through earlier therapy intervention and multidisciplinary focussed assessments.
The intended benefits to the older person and service were for:Older adult fallers to be referred more quickly for a therapy assessment.Older adults to spend less time immobile on an emergency department trolley.Timely multidisciplinary discharge plans being formulated in line with national guidelines.Increased numbers of older adults receiving holistic comprehensive geriatric assessments.
Methods
The quality improvement project was carried out using the Plan, Do, Study, Act (PDSA) cycle. Three iterative PDSA cycles were carried out over the course of the project to deliver simple, proactive interventions developed as a result of local baseline data analysis as well as stakeholder and root cause analysis. These interventions were all aimed at increasing the visual presence of the therapy team within the emergency department.
Results
The project resulted in an increased referral speed of fallers aged 65 and over for assessment, which led to increased numbers of older adult fallers receiving holistic, multidisciplinary assessments. 120% more adult fallers were seen in January 2019 compared to the previous year, and 58% more fallers were seen in February 2019 compared to 2018.
The earlier intervention by the therapy team also led to more older adults up and moving sooner, which had positive effects in terms of maintaining their dignity.
Conclusions
The quality improvement project found that more older adults aged 65 and over admitted to the emergency department with a fall can receive holistic, multidisciplinary assessments through the introduction of small, simple interventions aimed at increasing the proactivity and overall visual presence of the physiotherapy team.
The team are providing care to a larger number of older adults, improving their functional independence, dignity and quality of life and giving them an overall more positive experience.
The ED model of care is traditionally nursing and medical led but what this improvement project shows it that it is essentially the collaborative nature of the multidisciplinary team that can lead to better clinical outcomes for older adults attending the emergency department.
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Jooste R, Roberts F, O'Sullivan EP, Whitaker DK. Global capnography and airway teaching. A reply. Anaesthesia 2019; 74:813. [DOI: 10.1111/anae.14688] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Affiliation(s)
- R. Jooste
- Royal Papworth Hospital Cambridge UK
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Velikova G, Williams LJ, Willis S, Dixon JM, Loncaster J, Hatton M, Clarke J, Kunkler IH, Russell NS, Alhasso A, Adamson D, Algurafi H, Allerton R, Anandadas C, Bahl A, Barraclough L, Barrett-Lee P, Barthakur U, Bedi C, Beresford M, Bishop J, Blackman G, Bliss P, Bloomfield D, Blunt M, Branson T, Brazil L, Brunt A, Chakrabarti A, Chittalie A, Churn M, Clarke J, Cleator S, Crellin P, Danwata F, De-Silva-Minor S, Dhadda A, Eicholz A, Fernando I, Forrest J, Fraser J, Geropantas K, Goodman A, Grieve R, Griffin M, Hadaki M, Hall A, Hatton M, Hicks J, Hignett S, Hogg M, Jyothirmayi R, Khan M, Kumar S, Lawton P, Lee D, Lewinski C, Lim C, Locke I, Loncaster J, Lumsden G, Lupton S, Magee B, Marshall J, Masinghe S, McGregor C, McLennan M, Memtsa P, Milanovic D, Misra V, Mithal N, Mukesh MB, Neal A, Needleman S, Persic M, Quigley M, Raj S, Riddle P, Ritchie D, Roberts F, Robson P, Roe H, Rolles M, Shah N, Sharma R, Sherwin E, Simmonds P, Skailles G, Skaria S, Soe W, Sripadam R, Stevens A, Stockdale A, Storey N, Storey N, Syndikus I, Thorp N, Thorp N, Upadhyay S, Varughese M, Walji N, Welch R, Wells T, Wolstenholme V, Wolstenholme V, Woodings P, Yuille F. Quality of life after postmastectomy radiotherapy in patients with intermediate-risk breast cancer (SUPREMO): 2-year follow-up results of a randomised controlled trial. Lancet Oncol 2018; 19:1516-1529. [DOI: 10.1016/s1470-2045(18)30515-1] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2018] [Revised: 06/29/2018] [Accepted: 07/02/2018] [Indexed: 11/12/2022]
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Jooste R, Roberts F, Mndolo S, Mabedi D, Chikumbanje S, Whitaker DK, O'Sullivan EP. Global Capnography Project (GCAP): implementation of capnography in Malawi - an international anaesthesia quality improvement project. Anaesthesia 2018; 74:158-166. [PMID: 30255496 PMCID: PMC6686157 DOI: 10.1111/anae.14426] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/04/2018] [Indexed: 11/27/2022]
Abstract
The Lancet Commission on Global Surgery emphasised the importance of access to safe anaesthesia care. Capnography is an essential monitor for safe anaesthesia, but is rarely available in low‐income countries. The aim of this study was twofold: to measure the prevalence of capnography in the operating theatres and in intensive care units; and to determine whether its introduction was feasible and could improve the early recognition of critical airway incidents in a low‐income country. This is the first project to do this. Forty capnographs were donated to eight hospitals in Malawi. Thirty‐two anaesthesia providers received a 1‐day capnography training course with pre‐ and post‐course knowledge testing. Providers kept logbooks of capnography use and recorded their responses to abnormal readings. On follow‐up at 6 months, providers completed questionnaires on any significant patient safety incidents identified using capnography. In January 2017, at the commencement of the project, only one operating theatre had a capnograph. Overall, 97% and 100% ‘capnography gaps’ were identified in the theatres and intensive care units, respectively. The mean (SD) scores of our capnography multiple choice questionnaires improved after training from 15.00 (3.16) to 18.70 (0.99), p = < 0.001. The capnography equipment was appropriately robust and performed well. Six months following implementation, 24 (77%) anaesthesia providers reported recognising 44 oesophageal intubations and 28 (90%) believed that capnography had saved lives. This study has shown it is feasible to introduce capnography in a low‐income country, resulting in early recognition of critical airway incidents and ultimately helping to save lives. Building on the experience of the first trial of pulse oximetry implementation in low‐income countries in 2007, we believe this is one of the most important projects in anaesthesia safety in the last decade.
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Affiliation(s)
- R Jooste
- Department of Anaesthesia, St. James Hospital, Dublin, Ireland
| | - F Roberts
- Department of Anaesthesia, St. James Hospital, Dublin, Ireland
| | - S Mndolo
- Department of Anaesthesia, Queen Elizabeth Central Hospital, Blantyre, Malawi
| | - D Mabedi
- Department of Anaesthesia, Zomba District Hospital, Zomba, Malawi
| | - S Chikumbanje
- Department of Anaesthesia, Queen Elizabeth Central Hospital, Blantyre, Malawi
| | | | - E P O'Sullivan
- Department of Anaesthesia, St. James Hospital, Dublin, Ireland
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Roberts F, MacDuff E. An update on mesenchymal tumours of the orbit with an emphasis on the value of molecular/cytogenetic testing. Saudi J Ophthalmol 2018; 32:3-12. [PMID: 29755264 PMCID: PMC5944000 DOI: 10.1016/j.sjopt.2018.02.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2017] [Revised: 02/08/2018] [Accepted: 02/11/2018] [Indexed: 02/07/2023] Open
Abstract
Mesenchymal tumours of the orbit are uncommon. Beyond childhood primary sarcomas are extremely rare and the literature is limited to case reports and short case series. However there is a diverse assortment of benign and malignant soft tissue tumours that may involve the orbit. Techniques to identify tumour specific cytogenetic or molecular genetic abnormalities often resulting in over- expressed proteins are becoming an increasingly important ancillary technique for these tumours. This review focuses on 3 specific areas: 1. Orbital mesenchymal tumours where cytogenetics are important to reach the correct diagnosis. The majority of these are chromosomal translocations that often result in a fusion gene and protein product; 2. Orbital mesenchymal tumours where cytogenetics are important to identify patients who will do well versus those with a poorer prognosis. This is turn helps with therapeutic options. In some tumours e.g. synovial sarcoma the chromosomal translocations can occur with 2 different regions resulting in different fusion products that carry a different prognosis. Alternatively whilst the majority of alveolar rhadomyosarcomas are fusion positive a minority are fusion negative with a better prognosis; 3. Orbital mesenchymal tumours where the identification of specific cytogenetic abnormalities has resulted in overexpression of specfic proteins which are diagnostically useful biomarkers for immunohistochemistry.
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Affiliation(s)
- F. Roberts
- Department of Pathology, Queen Elizabeth University Hospital, Govan Road, Glasgow G51 4TF, United Kingdom
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Joseph J, Shekarchi-Shahgharhi E, Sweeting E, Roberts F, Dodwell D, Kumar S. 1921 Locoregional recurrence in younger women with breast cancer following breast conserving surgery and hypofractionated radiotherapy. Eur J Cancer 2015. [DOI: 10.1016/s0959-8049(16)30870-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Rosenfeldt MT, Bell LA, Long JS, O'Prey J, Nixon C, Roberts F, Dufès C, Ryan KM. E2F1 drives chemotherapeutic drug resistance via ABCG2. Oncogene 2014; 33:4164-72. [PMID: 24276245 DOI: 10.1038/onc.2013.470] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2013] [Revised: 09/12/2013] [Accepted: 10/06/2013] [Indexed: 12/18/2022]
Abstract
Multidrug resistance is a major barrier against successful chemotherapy, and this has been shown in vitro to be often caused by ATP-binding cassette (ABC) transporters. These transporters are frequently overexpressed in human cancers and confer an adverse prognosis in many common malignancies. The genetic factors, however, that initiate their expression in cancer are largely unknown. Here we report that the major multidrug transporter ABCG2 (BCRP/MXR) is directly and specifically activated by the transcription factor E2F1--a factor perturbed in the majority of human cancers. E2F1 regulates ABCG2 expression in multiple cell systems, and, importantly, we have identified a significant correlation between elevated E2F1 and ABCG2 expression in human lung cancers. We show that E2F1 causes chemotherapeutic drug efflux both in vitro and in vivo via ABCG2. Furthermore, the E2F1-ABCG2 axis suppresses chemotherapy-induced cell death that can be restored by the inhibition of ABCG2. These findings therefore identify a new axis in multidrug resistance and highlight a radical new function of E2F1 that is relevant to tumor therapy.
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Affiliation(s)
- M T Rosenfeldt
- Tumour Cell Death Laboratory, Cancer Research UK Beatson Institute, Glasgow, UK
| | - L A Bell
- Tumour Cell Death Laboratory, Cancer Research UK Beatson Institute, Glasgow, UK
| | - J S Long
- Tumour Cell Death Laboratory, Cancer Research UK Beatson Institute, Glasgow, UK
| | - J O'Prey
- Tumour Cell Death Laboratory, Cancer Research UK Beatson Institute, Glasgow, UK
| | - C Nixon
- Tumour Cell Death Laboratory, Cancer Research UK Beatson Institute, Glasgow, UK
| | - F Roberts
- Department of Pathology, Western Infirmary, Glasgow, UK
| | - C Dufès
- Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde, Glasgow, UK
| | - K M Ryan
- Tumour Cell Death Laboratory, Cancer Research UK Beatson Institute, Glasgow, UK
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Tsim S, Dick C, Roberts F, Gronski M, Stobo D, Noble C, MacDuff R, O'Rourke N, MacLeod N, Laird B, Kirk A, Blyth K. 76 Early experience of a regional mesothelioma MDT in the West of Scotland. Lung Cancer 2014. [DOI: 10.1016/s0169-5002(14)70076-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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15
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Cooper WA, Roberts F. Pulmonary pathology: new updates. J Clin Pathol 2013; 66:831. [PMID: 24067550 DOI: 10.1136/jclinpath-2013-201898] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Affiliation(s)
- W A Cooper
- Tissue Pathology and Diagnostic Oncology, Royal Prince Alfred Hospital, , Sydney, New South Wales, Australia
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Lin A, Looi J, Looi K, Chow K, Roberts F, White H, Webster M, Ellis C. Primary Percutaneous Coronary Intervention for Patients with St Elevation Myocardial Infarction—Past and Present at Auckland City Hospital. Heart Lung Circ 2012. [DOI: 10.1016/j.hlc.2012.03.055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Roberts F, Lucas A, Johnson S. The use of a single empirical outcome measure to assess welfare in slaughter plants: between- and within-sector comparisons of the supply base for a major retail multiple. Anim Welf 2012. [DOI: 10.7120/096272812x13353700594003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Ritchie D, Gregory M, Betts T, Drummond S, Kincaid W, Roberts F, Kemp E, Cauchi P. PO-0949 AUDIT OF RUTHENIUM-106 BRACHYTHERAPY FOR POSTERIOR UVEAL MELANOMA IN THE SCOTTISH OPHTHALMIC ONCOLOGY SERVICE. Radiother Oncol 2012. [DOI: 10.1016/s0167-8140(12)71282-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Kretschmar S, Yin L, Roberts F, London R, Flemmig TT, Arushanov D, Kaiyala K, Chung WO. Protease inhibitor levels in periodontal health and disease. J Periodontal Res 2011; 47:228-35. [PMID: 22029638 DOI: 10.1111/j.1600-0765.2011.01425.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND AND OBJECTIVE Our previous study showed that protease inhibitors were attenuated by the periodontal pathogen Porphyromonas gingivalis in cultured gingival epithelial cells. We hypothesize that fewer protease inhibitors would be present in more advanced periodontal disease sites, where the level of P. gingivalis may be high. The goal of this study was to investigate the relationship between the protease inhibitor [secretory leukocyte protease inhibitor (SLPI), elastase-specific inhibitor (ELAFIN) and squamous cell carcinoma antigen (SCCA)] levels in gingival crevicular fluid and the number of P. gingivalis micro-organisms in subgingival plaque. MATERIAL AND METHODS Plaque samples from subjects without (n = 18) and with moderate to advanced periodontitis (n = 41) were used to quantify P. gingivalis using real-time PCR. Protease inhibitor levels in the gingival crevicular fluid of all the subjects were determined by ELISA. RESULTS P. gingivalis was detected in 68.3% of patients with periodontitis, while 16.7% of subjects without periodontitis had a detectable level of P. gingivalis. Patients with periodontitis and P. gingivalis in their plaque exhibited lower SLPI and ELAFIN levels (p < 0.001) compared with control subjects without periodontitis. Secretory leukocyte protease inhibitor was also reduced (p < 0.05) in gingival crevicular fluid of periodontitis patients without a detectable level of P. gingivalis. Periodontitis patients with high vs. low levels of P. gingivalis exhibited reciprocal mean levels of SLPI and ELAFIN concentrations. CONCLUSION The reduced concentrations of SLPI and ELAFIN may contribute to the loss of host protective capacity and increase susceptibility to breakdown from chronic infection. The work of this investigation may aid in finding diagnostic and prognostic markers in periodontal health and disease and may also help in finding pharmacological targets directed against periodontal inflammation.
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Affiliation(s)
- S Kretschmar
- Department of Oral Health Sciences, University of Washington, Seattle, WA, USA
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Ting DSJ, Sau CY, Srinivasan S, Ramaesh K, Mantry S, Roberts F. Changing trends in keratoplasty in the West of Scotland: a 10-year review. Br J Ophthalmol 2011; 96:405-8. [DOI: 10.1136/bjophthalmol-2011-300244] [Citation(s) in RCA: 56] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Lin A, Looi K, Looi J, Chow K, Roberts F, White H, Webster M, Ellis C. Primary Percutaneous Coronary Intervention for all Patients with ST Elevation Myocardial Infarction—The Initial Experience at Auckland City Hospital 2006/2007. Heart Lung Circ 2011. [DOI: 10.1016/j.hlc.2011.03.058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Cameron CM, Roberts F, Connell J, Sproule MW. Diffuse idiopathic pulmonary neuroendocrine cell hyperplasia: an unusual cause of cyclical ectopic adrenocorticotrophic syndrome. Br J Radiol 2011; 84:e14-7. [PMID: 21172958 DOI: 10.1259/bjr/91375895] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
We present the case of a 73-year-old woman who presented with clinical features of Cushing's syndrome, confirmed biochemically with elevated levels of cortisol and adrenocorticotrophic hormone (ACTH). Petrosal venous sampling showed no ACTH gradient and MRI of pituitary was normal, suggesting ectopic ACTH production. In the course of further investigations, a thoracic CT was carried out to look for evidence of bronchial neoplasm. Although there was no discrete tumour identified, CT revealed widespread fine nodularity in the right middle and lower lobe. Subsequent trans-bronchial and video-assisted thorascopic biopsy showed pulmonary tumourlets and two typical carcinoid tumours on a background of diffuse idiopathic pulmonary neuroendocrine cell neoplasia (DIPNECH). We describe the clinical, radiological and histological features of this rare condition.
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Affiliation(s)
- C M Cameron
- Department of Radiology, Gartnavel General Hospital, Glasgow, UK.
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Chow K, Looi K, Looi J, Lin A, Roberts F, White H, Ellis C. ST Elevation Myocardial Infarction: Suboptimal Use of Secondary Prevention Medications at Review Five Years Later. Heart Lung Circ 2011. [DOI: 10.1016/j.hlc.2011.05.105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Awan MA, Roberts F, Hegarty B, Ramaesh K. The outcome of deep anterior lamellar keratoplasty in herpes simplex virus-related corneal scarring, complications and graft survival. Br J Ophthalmol 2010; 94:1300-3. [PMID: 20554507 DOI: 10.1136/bjo.2009.169300] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
AIMS To determine the visual outcome, graft survival and complications after deep anterior lamellar keratoplasty (DALK) in patients with herpes simplex virus (HSV)-related corneal scarring. METHODS A retrospective analysis of the patients who had DALK for HSV-related corneal scarring between January 2004 and February 2007 was performed. Mean follow-up was 30 months (range 16-48 months). The statistical significance of host corneal vascularisation was determined using Fisher's exact test. RESULTS There were 18 eyes from 18 patients and the mean age was 57 years. Preoperative visual acuity ranged from hand movements (HM) to 6/12. Fifty per cent of the eyes achieved visual acuity of 6/12 or better postoperatively. Six eyes (33%) had recurrence of HSV-related inflammation, eight eyes (including four eyes with recurrence of HSV-related inflammation) developed graft rejection and four eyes (including two eyes with recurrence of HSV-related inflammation) had bacterial keratitis. The graft survival rate was 83%. Three eyes developed glaucoma and one eye required trabeculectomy. Immunohistochemistry revealed that HSV was focally positive or equivocal in four recipient corneal buttons, and transmission electron microscopy showed intracellular HSV virions in two of them. CONCLUSIONS This is the largest series of DALK for herpetic corneal scarring that shows a comparable visual outcome and better graft survival rate than penetrating keratoplasty. There is significant risk of recurrence of HSV-related inflammation and graft rejection that requires timely recognition and adequate management.
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Affiliation(s)
- M A Awan
- Tennent Institute of Ophthalmology, Gartnavel General Hospital, 1053 Great Western Road, Glasgow, UK.
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Gerrard GE, O'Toole L, Roberts F. Should we routinely offer a second admission for radioiodine to patients with high-risk differentiated thyroid cancer? Clin Oncol (R Coll Radiol) 2010; 22:136-9. [PMID: 20152708 DOI: 10.1016/j.clon.2010.01.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2009] [Revised: 12/14/2009] [Accepted: 12/21/2009] [Indexed: 11/19/2022]
Abstract
AIMS To assess whether an elective second admission for radioiodine is useful for patients with high-risk differentiated thyroid cancer (DTC). MATERIALS AND METHODS A retrospective analysis was carried out on 47 high-risk DTC patients treated with a second admission for radioiodine at our centre during the 2007-2008 period. RESULTS In 21 patients (45%), the surgeon described an incomplete resection. Twenty-six (55%) had surgical macroscopic complete resection, but cancer cells at the margin of excision histologically. Overall, at the second admission for radioiodine, 27 patients (57%) had a normal post-treatment scan and undetectable thyroid-stimulating hormone (TSH) stimulated thyroglobulin. Twenty patients (43%) had raised stimulated thyroglobulin at second admission for radioiodine, of whom only six (13%) had abnormal uptake (>0.1%) on the post-treatment scan. CONCLUSIONS A second admission for radioiodine could have been avoided in most patients. Instead, information from stimulated thyroglobulin and a diagnostic radioiodine scan would have been sufficient to guide further management. This study also provides interesting outcome data on incompletely resected DTC.
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Affiliation(s)
- G E Gerrard
- St James Institute of Oncology, St James's Hospital, Leeds, UK.
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Puddy E, Edwards B, Wrench I, Roberts F. Does the transversus abdominis plane (TAP) block improve analgesia following subarachnoid anaesthesia with intrathecal diamorphine? A randomised double blinded control trial. Anaesthesia 2010. [DOI: 10.1111/j.1365-2044.2009.06184_2.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Macdonald ECA, Gregory ME, Lockington D, Kennedy A, Roberts F, Ramaesh K. Observation of the in vivo movement of host keratocytes into donor tissue following corneal graft; a novel technique. Br J Ophthalmol 2009; 94:790-4. [DOI: 10.1136/bjo.2009.168377] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Subedi N, Roberts F. Radiotherapy treatment of keloid scars and other benign conditions: is there a need for a database of patients treated? Br J Dermatol 2009; 161:194-5. [PMID: 19438467 DOI: 10.1111/j.1365-2133.2009.09169.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Abela JE, Wright DM, Hennessy A, Roberts F, Anderson JR. Chemotherapy induced carcinoma-adenoma regression in the caecum. J Clin Pathol 2009; 62:282-3. [PMID: 19251957 DOI: 10.1136/jcp.2008.060996] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
The case of a male patient with synchronous oesophago-gastric junction (OGJ) and caecal adenocarcinomas is reported. His management is described, particularly the administration of neoadjuvant chemotherapy targeting his upper gastrointestinal cancer. Synchronous gastrectomy and hemicolectomy were performed. Histopathological examination of the surgical specimen confirmed the OGJ cancer but only identified a caecal adenoma. This is believed to be the first description of chemotherapy induced reversal of the adenoma-carcinoma sequence.
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Affiliation(s)
- J E Abela
- Department of Surgery, Southern General Hospital, Glasgow, UK.
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Ross JJ, Dean SJ, Koppel DA, Roberts F, Kemp EG. Massive orbital recurrence of uveal melanoma without metastases after 28 years. Br J Ophthalmol 2008; 94:632. [DOI: 10.1136/bjo.2008.146340] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Pitchamuthu H, Gonzalez P, Kyle P, Roberts F. Fat-forming variant of solitary fibrous tumour of the orbit: the entity previously known as lipomatous haemangiopericytoma. Eye (Lond) 2008; 23:1479-81. [PMID: 18617906 DOI: 10.1038/eye.2008.215] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
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Penman D, Downie I, Roberts F. Positive immunostaining for thyroid transcription factor-1 in primary and metastatic colonic adenocarcinoma: a note of caution. J Clin Pathol 2006; 59:663-4. [PMID: 16731609 PMCID: PMC1860399 DOI: 10.1136/jcp.2005.030064] [Citation(s) in RCA: 56] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Immunohistochemistry for thyroid transcription factor-1 (TTF-1) is considered an important ancillary technique for distinguishing primary pulmonary adenocarcinomas from metastases. A case of metastatic colonic adenocarcinoma in a bronchial biopsy specimen that showed focal positive nuclear staining for TTF-1 is reported here. The primary colonic adenocarcinoma was retrieved from the file and immunostaining also showed focal nuclear positivity for TTF-1. This confirmed the morphological and clinical impression of colonic metastases in the bronchial biopsy specimen. To investigate this apparent aberrant TTF-1 expression, further sections from primary colonic adenocarcinoma were immunostained for TTF-1 using the SPT24 antibody clone. Three of the six cases studied showed focal nuclear positivity with the SPT24 clone. All six cases were subsequently shown to be negative with the 8G7G1 clone. It is concluded that the SPT24 antibody to TTF-1 may show focal nuclear positivity in adenocarcinomas of colorectal origin such that focal staining in small biopsy specimens should be interpreted with caution.
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Affiliation(s)
- D Penman
- Department of Pathology, University of Glasgow, Western Infirmary, Glasgow, UK
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Abstract
PURPOSE A retrospective analysis of all cases of orbital exenteration performed at the National Scottish Ocular Oncology Center over an 11 year period. METHODS We sought all exenteration cases (1993-2003) from ocular oncology and oculoplastic databases. Fifteen exenterations were performed. One case record was irretrievable. Clinicopathological features and outcome of 14 patients were analyzed. All operations were performed by the same consultant. RESULTS The male to female ratio was 1:1 and the average age at surgery was 66 years. There was a left sided predominance of pathology demonstrated (right to left orbit ratio was 1:1.3. The average follow up period postsurgery was 35 months. The most common underlying diagnosis was malignant melanoma (9/14). Ocular/orbital discomfort was the most frequent presenting symptom (7/14); a mass lesion (10/14) was the most common presenting sign. The average duration of symptoms/signs prior to tertiary institution referral was 10.9 months (range: 0.5-60 months). Exenteration was performed on average 39.7 months (range: 0.13-204) after initial tertiary center presentation. This included patients managed from the outset who failed treatment(s) and then required exenteration. The eyelids were sacrificed in ten cases (10/14). Sockets were lined with eyelid skin (4/10), split skin (thigh) (3/10) or healed secondarily (7/10). Thirteen cases (13/14) had clear histological margins. The average post operative stay was 8.3 days. The most common complication was socket fistula formation (7/14). Ethmoid sinuses were always involved. The average time to fistula development was 4.9 months (sockets lined by skin = 2.2 months compared with sockets left to heal secondarily = 6.9 months). The majority of patients wore occlusive shields long term. CONCLUSION The most common pathology necessitating exenteration was malignant melanoma. Most patients presented with a mass lesion. Histological tumor free margins were obtained in thirteen of fourteen cases. The most common complication was socket fistula formation.
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Affiliation(s)
- A Taylor
- Oculoplastic and Ocular Oncology Fellow-Tennent Institute of Ophthalmology, Gartnavel General Hospital, 1053 Great Western Road, Glasgow, G12 OYN, Scotland, UK.
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Muqit MMK, Roberts F. In regards to Conill et al.: Brachytherapy with 192Ir as treatment of carcinoma of the tarsal structure of the eyelid (Int J Radiat Oncol Bio Phys 2004;59:1326-1329). Int J Radiat Oncol Biol Phys 2006; 65:959. [PMID: 16751086 DOI: 10.1016/j.ijrobp.2006.02.058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2006] [Accepted: 02/23/2006] [Indexed: 11/20/2022]
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Abstract
BACKGROUND The presence of lipid in the cell cytoplasm is useful for supporting the diagnosis of sebaceous gland carcinoma (SGC). Currently this requires histochemical stains that are carried out on frozen sections of unprocessed tissue. Recently, several anti-adipocytic antibodies that recognise proteins associated with lipid vesicles have been described. These antibodies can be applied to paraffin-wax sections. AIM To assess the ability of anti-adipocytic antibodies to identify intracytoplasmic lipid in SGC. METHODS Immunohistochemistry with a monoclonal antibody to adipophilin and polyclonal antibodies to perilipin and TIP47/PP17 was carried out on archival, formalin-fixed, paraffin-wax-embedded sections of 26 samples of SGC. The immunostaining was compared with 22 other eyelid tumours (11 basal cell carcinomas (BCC), 10 squamous cell carcinomas (SCC) and 1 Merkel cell tumour). RESULTS Immunohistochemical staining was positive in 23, 10 and 2 cases of 26 SGC with adipophilin, perilipin and TIP47, respectively. The positive staining identified cytoplasmic lipid vesicles. Anti-adipophilin was positive in five other eyelid tumours (4 BCC and 1 SCC) staining small cytoplasmic granules that can be easily distinguished from the staining in SGC. CONCLUSIONS Immunohistochemical staining for adipophilin and perilipin is a useful ancillary technique for the demonstration of lipid in SGC that may be applied to paraffin-wax sections.
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Affiliation(s)
- K Muthusamy
- Department of Pathology, University of Glasgow, Western Infirmary, Glasgow, UK
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Roscoe D, Bryce E, Roberts F, Patrick D, Naus M, Henry B, Cronk D, McManus K. P7.05 Teaching Infection Control: Get Caught in our Web. J Hosp Infect 2006. [DOI: 10.1016/s0195-6701(06)60134-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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