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Martin-Hirsch P, Wood N, Whitham NL, Macdonald R, Kirwan J, Anagnostopoulos A, Hutson R, Theophilou G, Otify M, Smith M, Myriokefalitaki E, Quinland W, Mahon-Daly F, Clayton RD, Nagar H, Harley I, Dobbs S, Ratnavelu N, Kucukmetin A, Fisher AD, Tailor A, Butler-Manuel S, Madhuri K, Edmondson RJ. Survival of women with early-stage cervical cancer in the UK treated with minimal access and open surgery. BJOG 2019; 126:956-959. [PMID: 30658010 DOI: 10.1111/1471-0528.15617] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/21/2018] [Indexed: 01/10/2023]
Affiliation(s)
- P Martin-Hirsch
- Sharoe Green Unit, Royal Preston Hospital, Lancashire Teaching Hospitals NHS Trust, Preston, UK
| | - N Wood
- Sharoe Green Unit, Royal Preston Hospital, Lancashire Teaching Hospitals NHS Trust, Preston, UK
| | - N L Whitham
- Sharoe Green Unit, Royal Preston Hospital, Lancashire Teaching Hospitals NHS Trust, Preston, UK
| | | | - J Kirwan
- Liverpool Women's Hospital, Liverpool, UK
| | | | - R Hutson
- Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | | | - M Otify
- Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - M Smith
- Christie NHS Foundation Trust, Manchester, UK
| | | | - W Quinland
- Christie NHS Foundation Trust, Manchester, UK
| | - F Mahon-Daly
- Division of Cancer Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - R D Clayton
- St Mary's Hospital, Manchester University Foundation NHS Trust, Manchester, UK
| | - H Nagar
- Belfast City Hospital, Belfast, UK
| | - I Harley
- Belfast City Hospital, Belfast, UK
| | - S Dobbs
- Belfast City Hospital, Belfast, UK
| | - N Ratnavelu
- Northern Gynaecological Oncology Centre, Queen Elizabeth Hospital, Sheriff Hill, Gateshead, UK
| | - A Kucukmetin
- Northern Gynaecological Oncology Centre, Queen Elizabeth Hospital, Sheriff Hill, Gateshead, UK
| | - A D Fisher
- Northern Gynaecological Oncology Centre, Queen Elizabeth Hospital, Sheriff Hill, Gateshead, UK
| | - A Tailor
- Royal Surrey County Hospital NHS Trust, Guildford, UK
| | | | - K Madhuri
- Royal Surrey County Hospital NHS Trust, Guildford, UK
| | - R J Edmondson
- Division of Cancer Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK.,St Mary's Hospital, Manchester University Foundation NHS Trust, Manchester, UK
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Tan CO, Hu RTC, Harley I, Weinberg L. Novel Transoesophageal Echocardiographic Views Attain Superior Incident Angles for Tricuspid, but not Pulmonary, Valvular Doppler Interrogation. Anaesth Intensive Care 2016; 44:628-35. [DOI: 10.1177/0310057x1604400504] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
For accurate spectral Doppler valvular evaluation, intraoperative sonographers must use transoesophageal echocardiographic (TOE) views that offer optimal incident angles. We hypothesised that views added to the 2013 American Society of Echocardiography/Society of Cardiovascular Anesthesiologists (ASE/SCA) standard views and other novel views we have described of the tricuspid (TV) and pulmonary valves (PV) offered superior incident angles to those included in the origina 1999 ASE/SCA recommendations for comprehensive intraoperative TOE examination. We compared the acquisition feasibility and incident angles obtained by these views in 62 patients undergoing elective cardiac surgery, who received TOE monitoring as standard care. Overall, the 2013 ASE/SCA standard and novel views provided superior incident angles for the TV (28% and 66% of patients) whereas the 1999 ASE/SCA standard views provided superior incident angles for the PV (79% of patients, P <0.0001). The novel 90° mid-oesophageal modified bicaval view (90°MEMBC) and the 1999 ASE/SCA standard aortic arch short-axis view (AoArSAX) obtained best incident angles for the TV (mean [95% confidence interval] 13° [10°-16°]) and PV (5° [3°-7°]) respectively. PV view acquisition feasibility between the 1999 ASE/SCA standard, 2013 ASE/SCA standard and novel views was not significantly different (acquisition rate difference 11%, P >0.11). We conclude that the 2013 ASE/SCA TV standard and novel views obtained superior incident angles for the tricuspid, but not pulmonary valves. We recommend that ntraoperative sonographers consider the use of these views, particularly when incident angles obtained with standard views are suboptimal.
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Affiliation(s)
- C. O. Tan
- Department of Anaesthesia, Austin Hospital, Melbourne, Victoria
| | - R. T. C. Hu
- Department of Anaesthesia, Austin Hospital, Melbourne, Victoria
| | - I. Harley
- Department of Anaesthesia, Austin Hospital, Melbourne, Victoria
| | - L. Weinberg
- Department of Anaesthesia, Austin Hospital, Melbourne, Victoria
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Craig E, McAvoy A, Nagar H, Harley I, Dobbs S. 21. Total laparoscopic radical trachelectomy as a fertility sparing technique in early cervical cancer in a ‘Buddy’ operating institute: Demonstration of technique and review of outcomes. Eur J Surg Oncol 2016. [DOI: 10.1016/j.ejso.2016.06.027] [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] Open
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Cronin C, Hewitt M, Harley I, O’Donoghue K, O’Reilly BA. Robot-assisted laparoscopic cervical cerclage as an interval procedure. ACTA ACUST UNITED AC 2012. [DOI: 10.1007/s10397-012-0725-9] [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: 10/14/2022]
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O'Kane C, Chinnadurai A, Johnston K, Harley I, McCracken G. A Multicentre Review of Operative Gynaecological Laparoscopy and Associated Complications in Northern Ireland; 347 Cases. J Minim Invasive Gynecol 2010. [DOI: 10.1016/j.jmig.2010.08.389] [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: 10/19/2022]
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McCluggage WG, Harley I, Houghton JP, Geyer FC, MacKay A, Reis-Filho JS. Composite cervical adenocarcinoma composed of adenoma malignum and gastric type adenocarcinoma (dedifferentiated adenoma malignum) in a patient with Peutz Jeghers syndrome. J Clin Pathol 2010; 63:935-41. [DOI: 10.1136/jcp.2010.080150] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [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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Weinberg L, Spanger MC, Harley I, Story DA, Hall A. Multislice Computed Tomography Coronary Angiography: Risk Stratification of Patients in the Perioperative Period. Anaesth Intensive Care 2008; 36:308-23. [DOI: 10.1177/0310057x0803600303] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [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
Multislice computed tomography coronary angiography is emerging as a reliable noninvasive method for the assessmentofcoronaryarterydisease, coronaryanatomyand cardiac function. Improvements in computed tomography technology hold the promise of replacing the standard invasive procedure of conventional coronary angiography in selected patient groups. The ability of a six-second scan to identify flow-limiting coronary artery stenoses as well as characterising coronary atheromatous plaque components provides valuable information that can assist in refining perioperative cardiovascular risk. Multislice computed tomography's high negative predictive value and high specificity for stenoses allows it to effectively rule out coronary artery disease in patients with cardiac risk factors who have non-diagnostic or equivocal noninvasive cardiac stress tests. Other uses include evaluating patients who are symptomatic following percutaneous coronary intervention, evaluating coronary artery bypass grafts and coronary stent patency, detecting coronary stenosis prior to valve surgery and assessing coronary anatomy in patients with technically difficult arterial access. Avoiding the small but definite risks of conventional coronary angiography makes cardiac computed tomography an appealing alternative. An overview of multislice computed tomography is presented with particular attention placed on its role in the risk stratification of selected patients in the perioperative period. A risk stratification algorithm is suggested.
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Affiliation(s)
- L. Weinberg
- Department of Anaesthesia, Austin Health, Heidelberg and Department of Surgery, University of Melbourne, Austin Health, Victoria; Knox Private Hospital, Wantirna, Victoria; Department of Anaesthesia and Intensive Care, Peter MacCallum Cancer Institute, East Melbourne, Victoria, Australia
- Department of Anaesthesia, Austin Health
| | - M. C. Spanger
- Department of Anaesthesia, Austin Health, Heidelberg and Department of Surgery, University of Melbourne, Austin Health, Victoria; Knox Private Hospital, Wantirna, Victoria; Department of Anaesthesia and Intensive Care, Peter MacCallum Cancer Institute, East Melbourne, Victoria, Australia
- Knox Private Hospital
| | - I. Harley
- Department of Anaesthesia, Austin Health, Heidelberg and Department of Surgery, University of Melbourne, Austin Health, Victoria; Knox Private Hospital, Wantirna, Victoria; Department of Anaesthesia and Intensive Care, Peter MacCallum Cancer Institute, East Melbourne, Victoria, Australia
- Department of Anaesthesia, Austin Health
| | - D. A. Story
- Department of Anaesthesia, Austin Health, Heidelberg and Department of Surgery, University of Melbourne, Austin Health, Victoria; Knox Private Hospital, Wantirna, Victoria; Department of Anaesthesia and Intensive Care, Peter MacCallum Cancer Institute, East Melbourne, Victoria, Australia
- Head of Research, Department of Anaesthesia, and Associate Professor, University of Melbourne, Department of Surgery, Austin Health
| | - A. Hall
- Department of Anaesthesia, Austin Health, Heidelberg and Department of Surgery, University of Melbourne, Austin Health, Victoria; Knox Private Hospital, Wantirna, Victoria; Department of Anaesthesia and Intensive Care, Peter MacCallum Cancer Institute, East Melbourne, Victoria, Australia
- Department of Anaesthesia and Intensive Care, Peter MacCallum Cancer Institute
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Hauspy J, Beiner M, Harley I, Ehrlich L, Rasty G, Covens A. Sentinel lymph nodes in early stage cervical cancer. Gynecol Oncol 2007; 105:285-90. [PMID: 17368525 DOI: 10.1016/j.ygyno.2007.02.008] [Citation(s) in RCA: 84] [Impact Index Per Article: 4.9] [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: 11/01/2006] [Revised: 02/02/2007] [Accepted: 02/07/2007] [Indexed: 11/29/2022]
Abstract
OBJECTIVES Lymph node status is the most important prognostic factor in cervical cancer. Sentinel lymph node (SLN) procedures have been purported to reduce peri- and postoperative morbidity and operative time. METHODS All patients with surgically managed clinical FIGO stage IA/B1 cervical cancer underwent SLN followed by pelvic lymphadenectomy with technetium+/-lymphazurin from April 2004 to April 2006. 0.1-0.2 mci of filtered sulfur colloid technetium was injected submucosally into 4 quadrants of the exocervix. Lymphazurin (4cc) was only used if technetium was unsuccessful in identifying bilateral sentinel lymph nodes. Serial microsections at 5 microm intervals were performed and stained intraoperatively. Complete pelvic node dissections were performed in all patients. RESULTS Forty-two patients underwent SLN, prior to full pelvic lymphadenectomy. Thirty-nine patients were included for the purposes of this study. The incidence in detecting at least one sentinel node was 98% per patient, and 85% per side. Identification of bilateral sentinel lymph nodes was successful in 28 cases (72%). The median number of SLN/side was 2. Three patients were found to have metastatic tumor to lymph nodes. No false negatives were identified. No adverse effects were noted. CONCLUSIONS SLN biopsy in cervical cancer is feasible to do, with a low false negative rate. We believe SLN should be evaluated per side and not per patient, that a pelvic lymphadenectomy is otherwise required. By following this protocol, the false negative rate can be minimized. The combined reported FN rate in the literature is 1.8%. If our definition is applied, the majority of reported false negative SLN is not actual false negatives.
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Affiliation(s)
- J Hauspy
- Division of Gynecologic Oncology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Canada
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Hauspy J, Nevin A, Harley I, Mason W, Quirt I, Ghazarian D, Laframboise S. Paraneoplastic syndrome in vaginal melanoma: a case report and review of the literature. Int J Gynecol Cancer 2007; 17:1159-63. [PMID: 17309666 DOI: 10.1111/j.1525-1438.2006.00857.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [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: 11/30/2022] Open
Abstract
The authors of this article present a case of a woman diagnosed with a vaginal melanoma who developed paraneoplastic syndrome (PNS) soon after diagnosis. A review of the literature regarding PNSs in gynecological malignancies is also described in this article. To our knowledge, this is the first reported case of paraneoplastic cerebellar degeneration with opsoclonus myoclonus secondary to a vaginal melanoma. In addition, our patient had an unusually acute progression to pancerebellar symptoms over the course of 3 weeks. Her paraneoplastic symptoms improved significantly after partial resection of the melanoma.
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Affiliation(s)
- J Hauspy
- Department of Gynecologic Oncology, Princess Margaret Hospital, University Health Network, University of Toronto, Toronto, Ontario, Canada
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Abstract
AIMS Traditionally, advanced stage ovarian carcinoma is treated by debulking surgery followed by chemotherapy. However, in some circumstances preoperative chemotherapy may be given before optimal surgical debulking. This study aims to describe the morphological features found in ovarian carcinoma after chemotherapy because these have not been detailed previously. METHODS Histological sections were examined from 18 cases of ovarian carcinoma that had been treated by preoperative chemotherapy. The morphology was compared with any pre-chemotherapy biopsies that had been performed. Tumours were classified as showing morphological features suggesting a good response to chemotherapy (n = 14) or as showing little or no response (n = 4). Serum CA125 values before and after chemotherapy were compared. In all cases, the mitotic activity index (MAI), volume percentage of epithelium (VPE), and mean nuclear area (MNA) of tumour cells were calculated. RESULTS The preoperative biopsies were all typical ovarian serous or endometrioid adenocarcinomas. Morphological features present in the group responding to chemotherapy included the presence of small groups or single tumour cells in a densely fibrotic stroma. Tumour cells were characterised by both nuclear and cytoplasmic alteration, making accurate tumour typing and grading impossible. Nuclear features included the presence of bizarre enlargement with hyperchromatism, irregularity of outline, and chromatin clumping or smudging. Cytoplasmic alterations included intense eosinophilia, vacuolation, or foam cell change. There were pronounced stromal changes of fibrosis, inflammation, collections of foamy histiocytes, cholesterol cleft formation, haemosiderin deposition, fat necrosis, and dystrophic calcification, including the presence of many free psammoma bodies. There was no correlation between morphological response and biochemical response, as determined by serum CA125 values. In all nine cases in which pre-chemotherapy and post-chemotherapy biopsies were available, the MNA increased post-chemotherapy (p = 0.007, paired Wilcoxon test) and in six of nine cases the MAI decreased (p = 0.093). CONCLUSIONS Because preoperative chemotherapy is being used increasingly in the management of ovarian cancer, pathologists should be aware of the resultant morphological effects. Accurate tumour typing and grading is impossible. In some cases, it may be difficult to confirm the presence of residual tumour, making it imperative that pre-chemotherapy tissue biopsies are obtained. Definite confirmation of residual tumour may require the examination of multiple histological sections from areas showing pronounced stromal changes, sometimes with multiple levels and immunohistochemistry. In the absence of definite residual tumour, the report should state that the features are consistent with the prior presence of tumour.
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Affiliation(s)
- W G McCluggage
- Department of Pathology, Royal Group of Hospitals Trust, Grosvenor Road, Belfast BT12 6BL, Northern Ireland.
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Abstract
This paper examines the lifetime prevalence and correlates of major depressive disorder in a cohort of former school-age mothers and compares the prevalence and correlates to those found in women of the same age, ethnicity, and geographical location as the school-age mothers. The sociodemographic characteristics show some striking differences. The former young mothers were less likely to be on public assistance (19% vs 42%), but were more likely to be working (78% vs. 55%), to have completed high school or college and to meet the DSM-III criteria for depression (10.7% vs. 4.9%) than the sample of community women. The only factor related to depression in the former school-age mothers was a diagnosis of drug/alcohol abuse or dependence.
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Affiliation(s)
- S M Horwitz
- Department of Epidemiology and Public Health, Yale University School of Medicine, New Haven, CT 06520-8034, USA
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