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Shaker H, Leena N, Mayers V, Koussa F, Deshpande A. Day-case approach to immediate breast reconstruction: pushing the boundaries of ambulatory breast surgery in the post-COVID-19 era. Ann R Coll Surg Engl 2021; 103:426-431. [PMID: 34058121 DOI: 10.1308/rcsann.2020.7152] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
INTRODUCTION Day-case surgery is safe and efficacious for most breast surgical procedures. Limited data exist on its use in immediate breast reconstruction. We present our experience of day-case management of mastectomy with immediate pre-pectoral implant-based reconstruction (IBR). METHODS Data were collected on 47 patients who underwent day-case skin-sparing (SSM) or nipple-sparing (NSM) mastectomy with pre-pectoral IBR between October 2017 and September 2019. Clinicopathological data were collected, including postoperative complications, re-admission and re-operation. The data were compared to published national standards. RESULTS Median age was 52 years (range 37-74). Thirty-two patients (68%) had an SSM and 15 (32%) had an NSM. Two patients (4%) had risk-reducing mastectomies and 45 had treatment for invasive cancer or ductal carcinoma in situ (DCIS). Mean tumour size was 33.3mm (range 7-85mm). Forty-two (89%) patients went home on the day of surgery. No patients required re-operation in the first 48 hours. The median postoperative follow-up time was 11.4 months (range 1.8-22.7 months). During the first 90-day postoperative period, eight patients (17%) developed superficial skin necrosis, five patients (10.6%) developed postoperative infections and five patients (10.6%) suffered an implant loss. Eight patients (17%) were readmitted for re-operation. Compared to UK national standards set in the iBRA study, our cohort has demonstrated comparable postoperative infection, implant loss and re-operation and re-admission rates. CONCLUSION We have demonstrated close to 90% day-case success rate for mastectomy with IBR. These early data suggest that immediate IBR can be carried out in a manner that is cost-efficient without impacting surgical outcomes.
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Affiliation(s)
- H Shaker
- Wrightington, Wigan and Leigh NHS Foundation Trust, UK
| | - Nar Leena
- Wrightington, Wigan and Leigh NHS Foundation Trust, UK
| | - V Mayers
- Wrightington, Wigan and Leigh NHS Foundation Trust, UK
| | - F Koussa
- Wrightington, Wigan and Leigh NHS Foundation Trust, UK
| | - A Deshpande
- Wrightington, Wigan and Leigh NHS Foundation Trust, UK
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Singh U, Castle J, Shaker H, Greenhalgh S, Hussain U, Descamps T, Nash S, Wilson M, Hunt R, Kirwan C. PO-75 The relationship between the coagulation and inflammatory phases of wound healing in early breast cancer. Thromb Res 2021. [DOI: 10.1016/s0049-3848(21)00248-6] [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: 10/21/2022]
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Coffey E, Shaker H, Absar M, Nasir N. Management of early breast cancer in women over 90: A 10 year experience. Ann Oncol 2019. [DOI: 10.1093/annonc/mdz240.028] [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: 11/12/2022] Open
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Aldaqadossi HA, Shaker H, Youssof H, Kotb Y, Eladawy M. Outcomes of staged lingual mucosal graft urethroplasty for redo hypospadias repair. J Pediatr Urol 2019; 15:519.e1-519.e7. [PMID: 31303449 DOI: 10.1016/j.jpurol.2019.06.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2018] [Accepted: 06/11/2019] [Indexed: 01/01/2023]
Abstract
BACKGROUND The objective of this study was to present the outcomes for redo hypospadias repair using lingual mucosal graft (LMG). PATIENTS AND METHODS Between June 2012 and February 2017, 47 patients underwent staged LMG urethroplasty for redo hypospadias repair. The inclusion criteria were previous failed hypospadias repair with a paucity of local skin that interferes with correction using skin flaps and demands graft urethroplasty. During the first stage, a well-vascularized bed on the tunica albuginea was created. Then, the harvested LMG was secured to the prepared bed. The second-stage urethroplasty was carried out after six months. In this stage, tubularization of the previously implanted LMG was performed. In four cases, tubularization was difficult owing to graft contracture. This difficulty was managed by using the dorsally degloved penile skin as the onlay island flap in three cases and the buccal mucosa onlay graft in the fourth case. In all cases, a second protective layer from the dartos or tunica vaginalis was developed to cover the neourethra. RESULTS The median (interquartile range [IQR]) age of patients at the first stage was 5 (4-6) years, and the median (IQR) duration between both stages was 7 (6-8) months. The median (IQR) follow-up after the second stage was 15 (13-16) months. The median (IQR) number of previous operations was 2 (2-3). The median (IQR) length of the LMG was 3 (2.5-4) cm, and the median (IQR) width was 1 (1-2) cm. No donor-site major complications, but mild oral discomfort in the first week after graft harvesting, were reported in 39 (83%) patients. After the second stage, complications were reported in nine (19.2%) patients, meatal stenosis in five and fistula in four. The reported success rate was 80.9%. DISCUSSION Reconstruction of previously failed hypospadias is a challenge owing to local tissue scarring and a paucity of adjacent healthy tissue. In this study, the LMG was used in two-stage redo hypospadias repair after previous repair failure. In the present study, a success rate of 80.9% was reported after the second stage. According to this study and the published series, harvesting the LMG is associated with minimal immediate donor-site complications and no long-term morbidity. Another advantage of the LMG is easy harvesting with effortlessly reachable tongue in comparison with the buccal mucosa that is deep and requires application of a mouth retractor. CONCLUSIONS Two-stage LMG urethroplasty is a reliable procedure for salvage urethroplasty. Lingual mucosal graft harvesting is easy, with minor oral complications.
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Affiliation(s)
| | - H Shaker
- Fayoum University, Fayoum, Egypt
| | | | - Y Kotb
- Ain Shams University, Ain Shams, Egypt
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Aldaqadossi HA, Shaker H, Kotb Y, Youssof H, Elgamal S. Penile fasciocutaneous flap urethroplasty for the reconstruction of pediatric long anterior urethral stricture. J Pediatr Urol 2018; 14:555.e1-555.e6. [PMID: 30131215 DOI: 10.1016/j.jpurol.2018.07.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2017] [Accepted: 07/16/2018] [Indexed: 11/29/2022]
Abstract
BACKGROUND Though pediatric urethral stricture is an uncommon urological problem, it is a challenging urological one. The causative factors are iatrogenic, traumatic, and inflammatory. In the current study, the authors report their experience of the treatment of pediatric long anterior urethral stricture using penile circular fasciocutaneous flap. PATIENTS AND METHODS The study included 23 pediatric patients who had long anterior urethral strictures, which were repaired using circular penile fasciocutaneous flap. The flap was elevated through a subcoronal circumferential incision and then it was split ventrally. The strictured portion of the urethra was sharply incised ventrally, extending to 1 cm into normal urethra. The flap was sutured to the urethral plate over silicone catheter of suitable size, which was removed after 3 weeks. The follow-up was scheduled every 3 months for the first year and then yearly thereafter. RESULTS The urethroplasty was successful in 20 cases (86.96%). There were two cases complicated by stricture recurrence, which was managed by visual internal urethrotomy. Fistula formation was reported in one case and was repaired by simple excision and closure. Penile skin necrosis was reported in only one patient and was managed by frequent dressing. DISCUSSION During the last five decades, there was a substantial advancement in the reconstruction of long or complex anterior strictures due to the use of grafts and flaps. During pediatric urethral stricture repair, particular attention must be paid to the differences between adults and children anatomy, e.g. the small urethral lumen and tissue delicateness. McAninch introduced the reconstruction of complex anterior urethral strictures utilizing circular penile fasciocutaneous flap. The technique of penile fasciocutaneous flap urethroplasty takes long time and requires meticulous dissection. Therefore, it should be restricted for long or complex anterior urethra strictures. Success rate in this study was 86.96%, which is in the same league as that reported in literature as regard adults penile fasciocutaneous flap urethroplasty. Whitson et al. reported success rates of 84% and 79% in the 5th and 10th years, respectively. In another study, Kim et al. revealed a success rate of 68.9%. In this study, complications incidence was 21.6%, which is consistent with reported incidence of complications of adults penile fasciocutaneous flap urethroplasty (8%-20%). CONCLUSION According to the outcomes of this study, penile fasciocutaneous flap urethroplasty is a reasonable modality for the reconstruction of long anterior urethral stricture in pediatric patients especially after circumcision.
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Affiliation(s)
| | - H Shaker
- Fayoum Faculty of Medicine, Egypt.
| | - Y Kotb
- Ain Shams Faculty of Medicine, Egypt.
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Abdelaziz A, Shaker H, Aly H, Aldaqados H, Hussein E. Early outcome of pediatric pyeloplasty in kidneys with split renal function less than 10%: A prospective study of 25 cases. African Journal of Urology 2018. [DOI: 10.1016/j.afju.2018.08.003] [Citation(s) in RCA: 1] [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: 10/27/2022] Open
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Shaker H, Saleh A, Ali AH, Abd Elaziz M. Self-Calibrating Enabled Low Cost, Two Channel Type K Thermocouple Interface for Microcontrollers. Arab Journal of Nuclear Sciences and Applications 2018. [DOI: 10.21608/ajnsa.2018.12391] [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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Mahate Z, Shaker H, Absar M, Dabritz G. Axillary clearance following positive sentinel lymph node biopsy in symptomatic breast cancers: Time for a more selective approach? Int J Surg 2018. [DOI: 10.1016/j.ijsu.2018.05.042] [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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Shaker H, Heah J, Castle J, Pritchard S, Albadry H, Nicholson S, Lumsden L, Kirwan C. Extrinsic pathway markers predict survival in Early Breast Cancer. Thromb Res 2018. [DOI: 10.1016/j.thromres.2018.02.103] [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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Rees P, Clouston H, Shaker H, Castle J, Duff S, Kirwan C. Pre-operative systemic coagulation factors as biomarkers in colorectal cancer. Thromb Res 2018. [DOI: 10.1016/j.thromres.2018.02.127] [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: 11/17/2022]
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Farnie G, Shaker H, Castle J, Kirwan C. Evidence for the role of procoagulant stromal fibroblasts in the progression of Ductal Carcinoma in Situ. Thromb Res 2018. [DOI: 10.1016/j.thromres.2018.02.043] [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: 10/17/2022]
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Rees P, Clouston H, Shaker H, Castle J, Duff S, Kirwan C. Patient, tumour and operative factors influencing perioperative hypercoagulability in colorectal cancer. Thromb Res 2018. [DOI: 10.1016/j.thromres.2018.02.072] [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: 10/17/2022]
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Shaker H, Bundred NJ, Albadry H, Nicholson S, Castle J, Lumsden LJ, Pritchard S, Landberg G, Kirwan CC. PO-21 - Stromal fibroblasts in preinvasive breast cancer (ductal carcinoma in situ, DCIS) demonstrate a cancer-like procoagulant phenotypic switch that may facilitate invasion. Thromb Res 2016; 140 Suppl 1:S184. [PMID: 27161710 DOI: 10.1016/s0049-3848(16)30154-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Ductal carcinoma in-situ (DCIS) is a preinvasive breast cancer where cancer cells remain confined within the ductal basement membrane. However, genotypic changes have been identified in stroma surrounding DCIS, outside the basement membrane. Stromal fibroblasts undergo phenotypic change in cancer to promote tumour angiogenesis, proliferation, immunosuppression and metastasis and in vivo can induce invasion of DCIS. Phenotypic changes in DCIS stromal fibroblasts may potentially act as a precursor for invasion. AIM To determine if stromal fibroblasts in DCIS have procoagulant changes similar to those seen in cancer-associated fibroblasts in invasive breast cancer. MATERIALS AND METHODS As part of the prospective cohort study CHAMPion (Cancer induced Hypercoagulabulity as a Marker of Prognosis), patients with DCIS (n=72) and invasive breast cancer (n=292) were recruited. Stromal fibroblasts in tumour and corresponding normal breast tissue (distant from the cancer) were quantified (percentage IHC stained) for tissue factor (TF), thrombin, PAR1 and PAR2. Fibroblasts were identified morphologically, at a minimum distance of 0.2mm from ductal tissue, to avoid myoepithelial scoring. Scoring was performed in duplicate by two independent pathologists. RESULTS Fibroblast TF expression was present in normal breast tissue (mean 43% ([SD 27%]) but markedly increased in DCIS (mean 62% [SD 27%], p=0.002). Fibroblast TF expression was further increased in invasive breast cancer (mean 74% [SD 23%], normal vs invasion, p<0.001; DCIS vs invasion, p=0.03). Fibroblast thrombin and PAR2, but not PAR1, expression was increased in DCIS compared to normal (thrombin: 60% vs 42%, p<0.001; PAR2: 58% vs 41%, p=0.002), however no further significant increase was seen in invasive cancer (thrombin 63%, PAR2 61%). Fibroblast tissue factor correlated with fibroblast thrombin expression (p<0.001, r=0.4) and fibroblast PAR2 expression (p<0.001, r=0.5), with thrombin and PAR2 expression also correlating (p<0.001, r=0.4). CONCLUSIONS Procoagulant phenotypic changes, in terms of increased TF, thrombin and PAR2 expression, occur in stromal fibroblasts at the preinvasive stage. It needs to be determined if this change is functional and therefore a potential therapeutic target for preventing transition to invasion.
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Affiliation(s)
- H Shaker
- Institute of Cancer Sciences, University of Manchester
| | - N J Bundred
- Institute of Cancer Sciences, University of Manchester; Department of Academic Surgery, University Hospital of South Manchester
| | - H Albadry
- Department of Histoathology, University Hospital of South Manchester; Manchester, United Kingdom
| | - S Nicholson
- Department of Histoathology, University Hospital of South Manchester; Manchester, United Kingdom
| | - J Castle
- Institute of Cancer Sciences, University of Manchester
| | - L J Lumsden
- Department of Histoathology, University Hospital of South Manchester; Manchester, United Kingdom
| | - S Pritchard
- Department of Histoathology, University Hospital of South Manchester; Manchester, United Kingdom
| | - G Landberg
- Institute of Cancer Sciences, University of Manchester; Sahlgrenska Cancer Center, University of Gothenburg, Sweden
| | - C C Kirwan
- Institute of Cancer Sciences, University of Manchester; Department of Academic Surgery, University Hospital of South Manchester
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Clouston HW, Davenport A, Gregson H, Shaker H, Duff S, Kirwan CC. PO-51 - Expression of proteins of the tissue factor thrombin pathway is upregulated in the stroma and epithelium of colorectal cancer. Thromb Res 2016; 140 Suppl 1:S195. [PMID: 27161738 DOI: 10.1016/s0049-3848(16)30184-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
INTRODUCTION Colorectal cancer expression of Tissue Factor (TF), PAR1 and PAR2 is associated with a poor prognosis. Their stromal, rather than epithelial, expression has prognostic significance in other cancers, this has not been explored in colorectal cancer. AIM We aimed to determine the expression patterns of Tissue Factor (TF), PAR1 and PAR2 and thrombin in colorectal cancer and normal tissue. MATERIALS AND METHODS Cancer and distant normal tissue were sampled from 37 patients. Expression of TF, Thrombin, PAR1 and PAR2 were determined by immunohistochemistry. Two observers scored expression level (0-3) in individual cells. Percentage of cells having each level of expression was determined and an H-score calculated which are given with 95% CI. RESULTS Normal epithelium did not express TF, but it was expressed by cancer epithelium (36.5 (95% CI 17.6 - 55.4) p<0.001). Thrombin expression was increased in cancer vs normal epithelium (126.2 (95% CI 110.6 - 141.7) vs 101.6 (95% CI 92.5-110.8) p=0.01) as was PAR2 (172.4 (95% CI 152.9-191.8) vs 123.4 (95% CI 107.8-139.0) p<0.001). The increase in cancer epithelium PAR1 expression compared to normal (105.4 (95%CI 84.3-126.5) vs 89.0 (95% CI 80.4-97.6)) was not significant. Normal stroma did not express TF or thrombin however both were expressed by cancer stroma (TF 46.3 (95% CI 24.6-68.0) p<0.001, thrombin 11.4 (95% CI 6.2-16.7) p<0.001). PAR1 and PAR2 were both expressed in normal stroma but demonstrated increased expression in cancer stroma (cancer vs normal; PAR 1: 130.7 (95% CI 112.2-149.2) vs 19.5 (95% CI 11.24-27.7) p<0.001; PAR2: 21.5 (95% CI 12.9-30.1) vs 2.21 (95% CI 0.49-3.92) p<0.001). CONCLUSIONS Upregulated expression of tissue thrombin pathway proteins is seen in colorectal cancer in both epithelial and stromal cells. Procoagulant tumour cells and tumour microenvironment may provide a novel therapeutic target for treatment in colorecal cancer.
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Affiliation(s)
- H W Clouston
- Institute of Cancer Sciences, University of Manchester; Department of Academic Surgery, University Hospital of South Manchester; Manchester, United Kingdom
| | - A Davenport
- Department of Academic Surgery, University Hospital of South Manchester; Manchester, United Kingdom
| | - H Gregson
- Institute of Cancer Sciences, University of Manchester
| | - H Shaker
- Institute of Cancer Sciences, University of Manchester; Department of Academic Surgery, University Hospital of South Manchester; Manchester, United Kingdom
| | - S Duff
- Department of Academic Surgery, University Hospital of South Manchester; Manchester, United Kingdom
| | - C C Kirwan
- Institute of Cancer Sciences, University of Manchester; Department of Academic Surgery, University Hospital of South Manchester; Manchester, United Kingdom
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Sogaolu O, Shaker H, Snape P, O'Reilly D. An increased post-operative inflammatory response is associated with reduced survival following resection of colorectal liver metastases. Int J Surg 2015. [DOI: 10.1016/j.ijsu.2015.07.025] [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: 10/22/2022]
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Abstract
INTRODUCTION Perforated oesophagus is a surgical emergency with significant morbidity and mortality. Systemic fungal infection represents a poor response to the magnitude of the insult, which adds significantly to the risk of morbidity and mortality in these patients. We reviewed our experience with this group of patients over a six-year period in a tertiary referral centre. METHODS A retrospective clinical review was conducted of patients who were admitted following a ruptured oesophagus over a period of six years (January 2002 - January 2008). RESULTS We had 27 admissions (18 men and 9 women) following an isolated perforated oesophagus to our unit. The median patient age was 65 years (range: 22-87 years). The majority (n=24, 89%) presented with spontaneous perforations (Boerhaave's syndrome) and three (11%) were iatrogenic. Fungal organisms, predominantly Candida albicans, were positively cultured in pleural or blood samples in 16 (59%) of the 27 patients. Fourteen patients grew yeasts within the first seven days while two showed a delayed growth after ten days. Overall mortality was 5 out of 27 patients (19%). There was no mortality among the group that did not grow yeasts in their blood/pleural fluid while mortality was 31% (5/16) in the group with systemic fungal infection (p<0.001). A positive fungal culture was also associated with increase ventilation time, intensive care unit stay and inpatient hospital stay but not an increased rate of complications. CONCLUSIONS Systemic fungal infection in patients with a ruptured oesophagus affects a significant proportion of these patients and carries a poor prognosis despite advanced critical care interventions. It may represent a general marker of poor host response to a major insult but can add to mortality and morbidity. It is worth considering adding antifungal therapy empirically at an early stage to antimicrobials in patients with an established diagnosis of a perforated oesophagus.
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Affiliation(s)
- H Elsayed
- Liverpool Heart and Chest Hospital NHS Foundation Trust, UK.
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Abstract
AIM This study was carried out to determine the rate of perioperative blood transfusion and to create an evidence-based approach to requesting blood for elective colorectal surgery. METHOD A comparative cohort study was carried out of 164 patients (107 men, 57 women, median age 68 years) who underwent major colorectal surgery. Details obtained included demographic and operative information, the number of units of blood cross-matched, units used, the reasons for transfusion and patient suitability for electronic issue (EI). The cross-match to transfusion ratio (C:T ratio) was calculated for each procedure and for the whole group of colorectal procedures. RESULTS Some 162 units of blood were cross-matched for 76 (46%) patients, with the remaining 88 (54%) being grouped with serum saved. Twenty-one (13%) were transfused with a total of 48 units of blood. The C:T ratio for all procedures was 3.4/1. The commonest indication for transfusion was anaemia. One patient required an emergency transfusion. The majority (78%) of patients were suitable for EI. There were no significant differences between the transfused and nontransfused groups with regard to age, diagnosis (malignant vs benign) and laparoscopic or open colorectal procedure. CONCLUSION Only a small proportion of patients undergoing elective major colorectal surgery require perioperative blood transfusions, most of which are nonurgent. Blood should not be routinely cross-matched in patients who are suitable for EI.
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Affiliation(s)
- H Shaker
- Department of Surgery, Southport & Ormskirk Hospital, Southport, Merseyside, UK.
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Shaker H, Kirwan C, Landberg G, Bundred NJ. P4-08-04: Preoperative Thrombin Pathway Activation Identifies Node Positive Patients in Early Breast Cancer. Cancer Res 2011. [DOI: 10.1158/0008-5472.sabcs11-p4-08-04] [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: 11/16/2022]
Abstract
Abstract
Activation of the thrombin pathway (TP) is seen in 50% of cancers and plays a significant role in promoting metastasis. Cancer-induced TP activation is exacerbated by surgery, and this activation may be greater in the presence of metastases.
Our aim was to determine if pre-operative plasma d-dimer, a marker of TP activation, correlated with the presence of LN metastases in early breast cancer. We also examined whether surgery-induced TP activation is affected by tumour-associated factors.
Methods
Plasma d-dimer was measured using automated ELISA pre-operatively and at days 1 and 42 following surgery in 103 prospectively recruited patients undergoing surgery for early breast cancer(87 invasive,13 DCIS). D-dimer values were log-transformed and correlated with LN metastases, tumour size and grade and hormone receptor status using parametric statistical tests.
Results
Median age was 68 years (range 46–82). Mean tumour size was 14.6 mm (range 7.5-40). Seventy invasive cancer patients had wide local excision(WLE) and sentinel node biopsy(SNB) and 17 had mastectomy(MX) +/− axillary clearance(ANC).
Twenty-two patients had positive lymph nodes at primary surgery (MX 8,WLE 14). Of these 3(14%) were ER-ve and 19(86%) were ER+ve.
Mean pre-operative d-dimer was higher (p<0.01) in LN positive (704ng/ml, 95% confidence interval, CI, 455–1088) versus LN node negative invasive cancers (443ng/ml, CI 304–627) or DCIS (366ng/ml, CI 284–471). D-dimer was also higher in patients with lymphovascular invasion (612ng/ml, CI 423–886) than in those without (454ng/ml, CI 385–534) and this approached significance (p=0.084).
Post-operative d-dimer was higher (p<0.05) after MX compared to WLE at all timepoints. Following WLE + SNB for invasive cancer, post-operative d-dimer rose and was higher at day 1 and day 42 in LN positive vs LN negative and in ER negative versus ER positive cancers (see table). Repeated measures ANOVA analysis showed that the change in d-dimer over time was significantly different between subjects according to LN status (p=0.037) or ER status (p=0.015). Only one patient in the ER negative group had LN metastases. There was no association between pre or postoperative d-dimer and tumour size, tumour grade or PR status.
Conclusion
Pre-operative TP activation and the thrombotic response to surgery (as measured by d-dimer) is greater in the presence of LN metastases regardless of tumour size.
ER negative cancers (7/8 of which were LN negative) also resulted in a greater d-dimer rise, suggesting a difference in the thrombotic response to surgery between different cancer phenotypes.
Ongoing work will determine if peri-operative TP activation can act as an independent predictor of node status and cancer recurrence.
Citation Information: Cancer Res 2011;71(24 Suppl):Abstract nr P4-08-04.
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Affiliation(s)
- H Shaker
- 1University Hospital of South Manchester, Manchester, United Kingdom; Paterson Institute for Cancer Research, Manchester, United Kingdom
| | - C Kirwan
- 1University Hospital of South Manchester, Manchester, United Kingdom; Paterson Institute for Cancer Research, Manchester, United Kingdom
| | - G Landberg
- 1University Hospital of South Manchester, Manchester, United Kingdom; Paterson Institute for Cancer Research, Manchester, United Kingdom
| | - NJ Bundred
- 1University Hospital of South Manchester, Manchester, United Kingdom; Paterson Institute for Cancer Research, Manchester, United Kingdom
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Shaker H, Khan M, Elsayed H. 101PD ACCURACY OF PRE-OPERATIVE DIAGNOSIS IN THE MANAGEMENT OF BRONCHIOLOALVEOLAR CARCINOMA – ARE SUBLOBAR RESECTIONS FEASIBLE? Lung Cancer 2009. [DOI: 10.1016/s0169-5002(09)70224-7] [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: 12/01/2022]
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Mukhtar S, Shaker H, Basarab A, Byrne JP. Prophylactic antibiotics and Clostridium difficile infection. J Hosp Infect 2006; 64:93-4. [PMID: 16860438 DOI: 10.1016/j.jhin.2006.05.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2006] [Accepted: 05/04/2006] [Indexed: 11/12/2022]
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Shaker H, Wang Y, Loung D, Balbaa L, Fehlings MG, Hassouna MM. Role of C-afferent fibres in the mechanism of action of sacral nerve root neuromodulation in chronic spinal cord injury. BJU Int 2000; 85:905-10. [PMID: 10792175 DOI: 10.1046/j.1464-410x.2000.00559.x] [Citation(s) in RCA: 61] [Impact Index Per Article: 2.5] [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: 11/20/2022]
Abstract
OBJECTIVE To determine whether sacral root neuro-modulation (a promising therapeutic modality in patients with refractory voiding and storage problems) has its effect through the blockade of C-afferent fibres that form the afferent limb of a pathological reflex arc responsible for the dysfunction of bladder storage. MATERIALS AND METHODS The study comprised 39 female Sprague Dawley rats divided into three equal groups: normal controls (group 1); spinally transected at T10 (group 2); spinally transected and electrically stimulated bilaterally at S1 for 6 h daily (group 3). Three weeks after transection the rats were assessed using urodynamics; substance P, neurokinin A and calcitonin gene-related peptide (CGRP) were extracted from the dorsal root ganglia (DRG) of the L5 and L6 roots and quantified by radioimmunoassay. RESULTS Spinally transected rats developed urinary bladder hyper-reflexia after 3 weeks. This was associated with a significant increase in the neuropeptide content of the DRG of L6. Electrostimulation of S1 significantly decreased the neuropeptide content of L6. In contrast, transection and S1 neurostimulation did not affect the neuropeptide content of the L5 DRG, except for CGRP, which increased after spinal transection and decreased with neurostimulation. CONCLUSIONS In spinally transected rats, sacral root neurostimulation abolished bladder hyper-reflexia and attenuated the rise in neuropeptide content of the L6 DRG. These results suggest that the blockade of C-afferent fibre activity is one of the mechanisms of action of sacral root neuromodulation.
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Affiliation(s)
- H Shaker
- Urology Research and Spinal Cord Injury Neurophysiology Laboratories, Divisions of Urology and Neurosurgery, The Toronto Hospital, University of Toronto, Canada
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Abstract
This paper reviews the use of sacral neuromodulation as a treatment modality for patients with bladder dysfunction. The dual functions of the urinary bladder are to act as a reservoir and to evacuate under voluntary control. Bladder dysfunction is a descriptive term describing the loss or the impairment of one or both of these functions. In the first part of the manuscript we describe the different components of sacral neuromodulation: the screening test known as percutaneous nerve evaluation (PNE), which involves screening patients who could potentially benefit from the therapy. Those who show a satisfactory response will have a permanent neuroprosthesis implanted. The technical aspects of both components of neuromodulation are described in detail, as well as the technical difficulties encountered. In the second part we present our long-term results in patients with sacral neuromodulation. Sacral neuromodulation is a safe and efficient therapeutic modality that helps patients with refractory voiding dysfunction restore their bladder function.
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Affiliation(s)
- H Shaker
- The Toronto Hospital, Division of Urology, University of Toronto, Ontario, Canada
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Hamdy N, Bhatia K, Shaker H, Kamel A, Abou-Enein M, Yassin D, el-Sharkawy N, Magrath I. Molecular epidemiology of acute lymphoblastic leukemia in Egypt. Leukemia 1995; 9:194-202. [PMID: 7845017] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
We have characterized immunophenotypically defined acute lymphoblastic leukemia (ALL) in Egypt for rearrangements of the antigen receptor genes, and correlated this with rearrangements of ALL-1 and the presence of p53 mutations. Thirty-nine cases were analyzed for rearrangements of the immunoglobulin (Ig) and T-cell receptor (TCR) genes. All precursor B-cell ALLs (12 cases) contained rearranged Ig heavy-chain (JH) region which was biallelic in 92% of these tumors. In addition to JH rearrangements, TCR delta, beta and gamma rearrangements were observed in 80, 40 and 30% of these cases, respectively. TCR genes were invariably rearranged in T-cell ALLs (11 cases). A small fraction (2/11) of T-cell ALL showed concurrent IgJH rearrangement which was monoallelic. Simultaneous rearrangement of IgJH and TCR genes was also observed in both cases of biphenotypic ALL (coexpressing B and T markers). We observed marked heterogeneity in the pattern of rearrangement of antigen receptor genes in mixed-lineage leukemias (ALL coexpressing myeloid-associated markers), including the retention of germline configuration in two cases. Rearrangements of the ALL-1 gene were confined to the leukemias that demonstrated lineage infidelity. Mutations in p53 were infrequent and were present in only three of 47 ALL cases (6%) analyzed; two of these were mixed-lineage leukemias. These results suggest that mixed-lineage and biphenotypic leukemias accumulate pathogenetic lesions that are distinct from B- and T-cell ALL, and that ALL in developing countries includes molecular entities similar to those in developed countries.
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Affiliation(s)
- N Hamdy
- Pediatric Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD 20892
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Farrag AF, Shaker H, Hamdy NA, Wafaa MA. Clinical characteristics of a population of dyslexic children in Assiut, Egypt. Neuroepidemiology 1995; 14:92-9. [PMID: 7891819 DOI: 10.1159/000109783] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
Two groups of pupils from special tract learning schools were randomly selected for this study. The first group (55 pupils) fulfilled the World Federation of Neurology (WFN) definition of developmental dyslexia (DD). The second group (retarded readers, RR) included 20 pupils with IQs between 80 and 90. A group of normal readers was randomly selected from the 5 school grades as a control group. This study showed that the performance IQ of the DD group was not only higher than the verbal IQ, but the DD group also had superior performance IQ compared to normal readers. In the arithmetic achievement test, both DD and RR groups had nearly similar total scores, which were significantly lower than that of the control group. None of the arithmetic subtests could differentiate between DD and RR groups. In linguistic achievement tests, only spontaneous writing and oral spelling could differentiate subjects with DD from the RR group.
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Affiliation(s)
- A F Farrag
- Department of Neurology, University of Assiut, Egypt
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