1
|
Narroway H, Bourke B, Tchen A. O062 Acquired carotid-jugular fistulas following carotid endarterectomy: a narrative review. Br J Surg 2022. [DOI: 10.1093/bjs/znac242.062] [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: 11/05/2022]
Abstract
Abstract
Introduction
Acquired arterio-venous fistulas (AVF) involving the carotid artery are most commonly the result of trauma and catheterisation of the neck vessels. Left untreated, carotid-jugular fistulas (CJF) may precipitate ischaemic neurological symptoms due to thromboembolism or shunting of blood through the AVF.
Methods
A literature review was performed to determine the incidence and outcomes of acquired carotid-jugular AVFs following carotid endarterectomy (CEA). Electronic searches were performed using three databases, PubMed, EMBASE, and Google Scholar.
Results
Three case studies met inclusion criteria for analysis. The first case occurred 4-months following a left CEA. CT-angiography and duplex ultrasound identified a pseudoaneurysm arising from the proximal internal carotid artery. A CJF was identified on re-intervention and carotid ligation was performed following unsuccessful attempts to repair the defect. The patient has ongoing mild dysphonia with no other complications at 18 months follow-up. The second case occurred 6 years following right CEA. Catheter angiography revealed an AVF between the right external carotid artery (ECA) and internal jugular vein, treated with coil embolization. The patient made complete neurological recovery and had no further complications at 2 years follow-up. The third case occurred 4 years following right CEA. Catheter angiography identified fistulisation between the lingual branch of the right ECA and right retromandibular vein, treated with transarterial particle embolization. The patient made a complete neurological recovery.
Conclusion
Carotid-jugular AVFs are rare following CEA. This review proposes that carotid-jugular AVFs may be amenable to both open and endovascular intervention with durable outcomes. Proceduralists should be cognisant of this complication.
Take-home message
Carotid-jugular arteriovenous fistulas are rare following carotid endarterectomy and may be amenable to both open and endovascular intervention with durable outcomes.
Collapse
Affiliation(s)
- H Narroway
- Gosford Hospital , Gosford, New South Wales , Australia
| | - B Bourke
- Gosford Hospital , Gosford, New South Wales , Australia
| | - A Tchen
- Gosford Hospital , Gosford, New South Wales , Australia
| |
Collapse
|
2
|
Narroway H, Kovacic J. O036 Does Cxbladder accurately exclude bladder urothelial cell malignancy on diagnostic and surveillance cystoscopy? a prospective multi-centre study. Br J Surg 2022. [DOI: 10.1093/bjs/znac242.036] [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: 11/06/2022]
Abstract
Abstract
Introduction and Objectives
Health systems incur significant costs from bladder cancer. Diagnostic and surveillance protocols are intensive. Urine cytology and Computed tomography (CT) have low sensitivity as screening and surveillance tools. Cxbladder is a non-invasive urinary biomarker approved for use in Australia, with high reported sensitivity in bladder cancer detection. The purpose of this study was to determine the accuracy of Cxbladder as a screening and surveillance tool in patients with suspected and established bladder cancer, respectively.
Methods
A prospective trial (88 participants) was performed at Gosford and North Gosford Hospitals (New South Wales, Australia). Inclusion criteria were: patients undergoing investigation for macroscopic haematuria or bladder cancer surveillance. Patients were asked to perform a Cxbladder test prior to either flexible or rigid cystoscopy. Exclusion criteria were: patients aged < 18 years, or patients that had undergone transurethral resection of the bladder within five months. Testing kits were supplied at no cost by Pacific Edge Ltd. Cxbladder results were then compared with cystoscopic findings, the prevailing gold-standard for bladder cancer diagnosis.
Results
Sensitivity and specificity of Cxbladder for detection of bladder cancer were 76.5% and 45.1% respectively. Positive and negative predictive values (PPV/NPV) were 31.7% and 85% respectively. False negative cases comprised low-grade papillary tumours only. Cxbladder had 100% NPV in detection of high-risk bladder cancer.
Conclusion
There is evidence to support Cxbladder as a screening tool in the detection of high-risk bladder cancer. Further studies involving larger populations are required to validate its accuracy.
Take-home message
The purpose of this study was to determine the accuracy of Cxbladder as a screening and surveillance tool in patients with suspected and established bladder cancer, respectively. Sensitivity and specificity of Cxbladder for detection of bladder cancer were 76.5% and 45.1% respectively, whilst a 100% negative predictive value was obtained in detection of high-risk bladder cancer.
Collapse
Affiliation(s)
- H Narroway
- Gosford Hospital , Gosford, New South Wales , Australia
| | - J Kovacic
- Gosford Hospital , Gosford, New South Wales , Australia
| |
Collapse
|
3
|
Narroway H, Parkin C, Latif E. P16 Endoloop ligatures in the retrieval of urethral foreign bodies: a narrative review. Br J Surg 2022. [DOI: 10.1093/bjs/znac231.016] [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: 11/06/2022]
Abstract
Abstract
Introduction
Self-insertion of foreign bodies into the urethra has been described previously in patients presenting to hospital emergency services. Treatment typically involves procedural retrieval under local anaesthesia using basket or forceps, cystoscopy, or open surgery. An Endoloop is a device designed to snare colonic polyps during endoscopy with nylon loops. It is not traditionally used for retrieval of urethral foreign bodies. Our objective was to determine the incidence, safety and efficacy of this approach.
Methods
A narrative review was performed. Primary outcomes were technical success, defined as uncomplicated retrieval of foreign body, and adverse events related to pain, bleeding, infection, and damage to structures. Electronic searches were performed using PubMed, Embase and Google Scholar. Reference lists of selected studies were searched manually.
Results
2 case studies met inclusion criteria for analysis, both describing self-insertion of urethral foreign bodies for purposes of sexual arousal. These comprised a 30-year-old male (magnets) and a 29- year-old female (metal urethral sound). Both patients underwent successful retrieval of foreign body using an Endoloop ligature. There were no symptoms post-operatively and no procedural complications were reported.
Conclusion
An Endoloop ligature should be considered in conjunction with endoscopy when difficulties are experienced or anticipated with basket or forceps retrieval. Follow-up is mandatory to monitor for complications due to foreign body insertion such as urethritis, incontinence, fistula and diverticulum formation. Referral to psychological services is encouraged to reduce the risk of recurrence. Further studies are required to validate the efficacy and safety of this technique.
Take-home message
An Endoloop ligature should be considered in conjunction with endoscopy when difficulties are experienced or anticipated with basket or forceps retrieval of urethral foreign bodies.
Collapse
Affiliation(s)
- H Narroway
- Gosford Hospital , Gosford, New South Wales , Australia
| | - C Parkin
- Gosford Hospital , Gosford, New South Wales , Australia
| | - E Latif
- Gosford Hospital , Gosford, New South Wales , Australia
| |
Collapse
|
4
|
Kovacic J, Narroway H, Bourke B, Bourke V, Louie-Johnsun M, Latif E. Management of urological iatrogenic renal artery pseudoaneurysm with selective angioembolisation: A single centre analysis. EUR UROL SUPPL 2022. [DOI: 10.1016/s2666-1683(22)00182-3] [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: 10/18/2022] Open
|
5
|
Jackson S, Hanna B, Narroway H, Chung A. Electrical neuromodulation in bladder dysfunction: Mapping the state-of-the-art with bibliometric analysis of field and top 100 cited articles. Neurourol Urodyn 2021; 40:1414-1423. [PMID: 34058034 DOI: 10.1002/nau.24710] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Revised: 04/09/2021] [Accepted: 05/08/2021] [Indexed: 11/11/2022]
Abstract
AIMS Electrical neuromodulation of bladder function has been extensively investigated in the literature. To date, there has been no characterization of the field, and there is a lack of bibliometric literature to guide future studies. We directed this scientometric analysis to characterize the distribution, characteristics and relationships of the field, with subanalysis of top 100 articles. METHODS The Web of Science Core Collection of the Thompson Reuters Web of Science was searched and analyzed to determine distributions and characteristics of clinical research investigating electrical neuromodulation in bladder dysfunction. Field citation and coauthorship networks were mapped, and recent citation bursts of the past decade are described. The top 100 cited articles were categorized, with level of evidence rating system applied. RESULTS A total of 872 articles published from 1949 until October 2020 were included in field analysis. Europe demonstrated the highest continental productivity within field (n = 539, 61.81%), and the United States the top nation (35.55% of field, 39.24% of top 100 articles). The Journal of Urology has historically published the most articles in the field (n = 150, 17.20%), and top 100 articles (n = 41, 40.20%). Top 100 articles reported studies of neuromodulation effects via sacral neuromodulation (n = 59); of non-neurological bladder dysfunction (n = 72); urinary incontinence (n = 92), frequency (n = 73) and urgency (n = 68) symptomology. CONCLUSIONS Analysis of electrical neuromodulation of bladder dysfunction literature reveals historical development, core research clusters and relationships, and an increase in publication activity over past decades.
Collapse
Affiliation(s)
- Stuart Jackson
- Nepean Urology Research Group, Nepean Hospital, Kingswood, New South Wales, Australia.,Department of Surgery, University of Sydney, Camperdown, New South Wales, Australia
| | - Bishoy Hanna
- Nepean Urology Research Group, Nepean Hospital, Kingswood, New South Wales, Australia
| | - Harry Narroway
- Department of Vascular Surgery, Gosford Hospital, Gosford, New South Wales, Australia
| | - Amanda Chung
- Concord Repatriation General Hospital, Department of Surgery, Sydney University, Sydney, New South Wales, Australia.,Department of Urology, Royal North Shore Hospital, St Leonards, New South Wales, Australia.,Department of Urology, Northern Beaches Hospital, Frenches Forest, New South Wales, Australia.,Department of Urology, Sydney Adventist Hospital, Wahroonga, New South Wales, Australia
| |
Collapse
|
6
|
McNamara N, Narroway H, Williams M, Brookes J, Farag J, Cistulli D, Bannon P, Marasco S, Potapov E, Loforte A. Contemporary outcomes of continuous-flow left ventricular assist devices-a systematic review. Ann Cardiothorac Surg 2021; 10:186-208. [PMID: 33842214 DOI: 10.21037/acs-2021-cfmcs-35] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [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: 12/28/2022]
Abstract
Background End stage heart failure is a major cause of morbidity and mortality, and its prevalence is expected to rise with the ageing population. For suitable patients, orthotopic heart transplantation remains the gold standard therapy, however, a paucity of donor organs has led to the development of left ventricular assist devices (LVAD). These devices can be utilized as either a bridge-to-transplant (BTT) or as an alternative to heart transplantation. While these devices can prolong life and improve quality of life, they are associated with a significant number of adverse events. We aim to systematically review the literature to quantify survival and the incidence of adverse events following implantation of continuous-flow LVADs (cf-LVAD). Methods A systematic review was performed to determine outcomes following implantation of a cf-LVAD. Primary outcomes were survival and frequency of adverse events (such as bleeding, infection, thrombosis, stroke and right ventricular failure). Secondary outcomes included quality of life and assessment of functional status. Results Sixty-three studies reported clinical outcomes of 9,280 patients. Survival after cf-LVAD varied between studies. Industry-funded trials generally reported better overall survival than the single- and multi-center case series, which showed significant variation. The largest registry report documented twelve, twenty-four and forty-eight-month survival rates of 82%, 72% and 57% respectively. The most commonly reported adverse events were gastrointestinal bleeding (GIB), device-related infection, neurological events and right heart failure (RHF). Bleeding, RHF and infection were the most frequent complications experienced by those supported with cf-LVAD, occurring in up to 35%, 40% and 55% of patients, respectively. Quality of life as measured using the Kansas City Cardiomyopathy Questionnaire (KCCQ) and functional status as measured with the 6-minute walk test (6MWT) improved after cf-LVAD implantation with no decline evident two years after implantation. Conclusions The paucity of donor hearts has led to the development of left-ventricular assist devices as a BTT or as a destination therapy (DT). Outcomes after cf-LVAD implantation are excellent, with short-term survival comparable to heart transplantation, but long-term survival remains limited due to the incidence of post-implantation adverse events. Despite these complications, quality of life and functional status improve significantly post-implantation and remain improved over the long-term. This study demonstrates the potential benefits of cf-LVAD therapy whilst also identifying adverse events as an area of increased morbidity and mortality.
Collapse
Affiliation(s)
- Nicholas McNamara
- Cardiothoracic Surgical Department, Royal Prince Alfred Hospital, Sydney, Australia.,Faculty of Health and Medicine, University of Sydney, Sydney, Australia.,Baird Institute of Applied Heart and Lung Research, Sydney, Australia
| | - Harry Narroway
- Department of Vascular Surgery, Gosford Hospital, Gosford, Australia
| | - Michael Williams
- Cardiothoracic Surgical Department, Royal Prince Alfred Hospital, Sydney, Australia.,Faculty of Health and Medicine, University of Sydney, Sydney, Australia
| | - John Brookes
- Cardiothoracic Surgical Department, Royal Prince Alfred Hospital, Sydney, Australia
| | - James Farag
- Cardiothoracic Surgical Department, Royal Prince Alfred Hospital, Sydney, Australia.,Baird Institute of Applied Heart and Lung Research, Sydney, Australia
| | - David Cistulli
- Cardiothoracic Surgical Department, Royal Prince Alfred Hospital, Sydney, Australia
| | - Paul Bannon
- Cardiothoracic Surgical Department, Royal Prince Alfred Hospital, Sydney, Australia.,Baird Institute of Applied Heart and Lung Research, Sydney, Australia
| | - Silvana Marasco
- Cardiothoracic Surgical Department, The Alfred, Melbourne, Australia.,Department of Medicine and Surgery, Monash University, Melbourne, Australia
| | - Evgenij Potapov
- Deutsches Zentrum für Herz Kreislauf Forschung (DZHK) - Standort Berlin/Charité, Berlin, Germany.,Department of Cardiothoracic and Vascular Surgery, Deutsches Herzzentrum Berlin (DHZB), Berlin, Germany
| | - Antonio Loforte
- Division of Cardiac Surgery, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| |
Collapse
|
7
|
Parkin CJ, Narroway H, Ryan J, Latif E. Thinking outside the loop: use of an endoloop in retrieving a urethral foreign body. ANZ J Surg 2021; 91:E634-E636. [PMID: 33580611 DOI: 10.1111/ans.16634] [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] [Received: 11/17/2020] [Revised: 01/05/2021] [Accepted: 01/19/2021] [Indexed: 11/24/2022]
Affiliation(s)
- Cameron J Parkin
- Department of Urology, Gosford Hospital, Central Coast Local Health District, Central Coast Council, New South Wales, Australia
| | - Harry Narroway
- Department of Urology, Gosford Hospital, Central Coast Local Health District, Central Coast Council, New South Wales, Australia
| | - James Ryan
- Department of Urology, Gosford Hospital, Central Coast Local Health District, Central Coast Council, New South Wales, Australia
| | - Edward Latif
- Department of Urology, Gosford Hospital, Central Coast Local Health District, Central Coast Council, New South Wales, Australia
| |
Collapse
|