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Haslam P, McCafferty I, Lakshminarayan R, Kasthuri R, Johnston M, Hamady M. Physician associates in interventional radiology: a worrying paradigm. Clin Radiol 2024; 79:161-162. [PMID: 38142139 DOI: 10.1016/j.crad.2023.11.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Accepted: 11/20/2023] [Indexed: 12/25/2023]
Affiliation(s)
- P Haslam
- Interventional Radiology, Newcastle Upon Tyne Hospitals NHS Trust, Newcastle Upon Tyne, UK.
| | - I McCafferty
- Interventional Radiology, Birmingham Women's and Children's Hospital, Birmingham, UK
| | - R Lakshminarayan
- Interventional Radiology, Hull University Teaching Hospitals NHS Trust, Hull, UK
| | - R Kasthuri
- Interventional Radiology, Queen Elizabeth University Hospital, Glasgow, UK
| | - M Johnston
- Brighton and Sussex Medical School and University Hospitals, Sussex, UK
| | - M Hamady
- Department of Surgery and Cancer, Imperial College, London, UK
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Morgan R, Haslam P, McCafferty I, Bryant T, Clarke C, McPherson S, Wells D, Gupta Y, See TC, Lakshminarayan R, Miller F, Scott P, Almazedi B, Bardgett H, Barnacle A, Shaida N, Manoharan D, Lewis M, Taylor J, Bhat R, Shaygi B, Ratnam L. Provision of Interventional Radiology Services 2023. Cardiovasc Intervent Radiol 2024; 47:3-25. [PMID: 37978066 PMCID: PMC10770229 DOI: 10.1007/s00270-023-03600-0] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/17/2023] [Indexed: 11/19/2023]
Affiliation(s)
| | | | | | - Timothy Bryant
- University Hospitals Southampton NHS Foundation Trust, Southampton, UK
| | | | | | - David Wells
- University Hospitals of the North Midlands NHS Trust, Stoke-On-Trent, UK
| | - Yuri Gupta
- University Hospitals Sussex NHS Foundation Trust, Brighton, UK
| | - Teik Choon See
- Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | | | | | - Paul Scott
- Hull University Teaching Hospitals, Hull, UK
| | | | | | - Alex Barnacle
- Great Ormond Street Hospital for Children, London, UK
| | - Nadeem Shaida
- Cambridge University NHS Foundation Trust, Cambridge, UK
| | - Dinesh Manoharan
- Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Mark Lewis
- Norfolk and Norwich University Hospitals NHS Trust, Norwich, UK
| | - Jeremy Taylor
- Frimley Health Foundation Trust, Surrey, Frimley, UK
| | - Rajesh Bhat
- Ninewells Hospital and Medical School, Dundee, UK
| | - Behnam Shaygi
- London North West University Healthcare NHS Trust, London, UK
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Al Rekabi A, Chen M, Patel N, Morgan R, McCafferty I, Haslam P, Hamady M. Well-being and Burnout Amongst Interventional Radiologists in the United Kingdom. Cardiovasc Intervent Radiol 2023; 46:1053-1063. [PMID: 37380792 PMCID: PMC10382397 DOI: 10.1007/s00270-023-03455-5] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Accepted: 04/24/2023] [Indexed: 06/30/2023]
Abstract
PURPOSE To assess the prevalence of burnout amongst Interventional Radiologists (IRs) in the United Kingdom and identify demographic and practice-related stressors that may adversely affect well-being. MATERIALS AND METHODS A survey of 36 questions was divided into two sections. Section A consisted of 14 questions that assessed demographics and work characteristics; Section B assessed burnout, utilizing the 22-item Maslach burnout inventory. Four additional open-ended questions were included to allow participants to voice opinions on the biggest contributors to workplace burnout and plans that could be implemented to alleviate this. The questionnaire was distributed to the British Society of interventional (BSIR) members. The study was conducted between August and September 2022. RESULTS Moderate to severe scores in emotional exhaustion (EE) were recorded in 65% of participants (moderate 26%; severe 39%) of participants r. Moderate to severe depersonalization (DP) scores were recorded in 46% of participants (moderate 23%; severe 23%). Low-moderate levels of personal accomplishment (PA) scores were recorded in 77% of respondents (low 50%; moderate 27%). Weekly hours and out-of-hour IR cover were statistically significant in predicting emotional exhaustion. Age, sex (male), time available for teaching, and weekly hours were statistically significant in predicting the depersonalisation score. Age was a predictive factor for personal accomplishment. The most recurring themes in open response to major contributors of burnout were shortage of IR clinicians and supporting staff as well as the increasing IR workload. CONCLUSIONS This survey has demonstrated high prevalence of burnout amongst Interventional Radiologists in UK. Urgent measures are required to tackle the workforce shortage, recognition of IR workload and control IR resources.
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Affiliation(s)
- Ahmad Al Rekabi
- Division of Interventional Radiology, Imperial Academic and Healthcare NHS Trust, 53 humes avenue, London, W72LJ UK
| | - Mitch Chen
- Division of Interventional Radiology, Imperial Academic and Healthcare NHS Trust, 53 humes avenue, London, W72LJ UK
| | - Neeral Patel
- Division of Interventional Radiology, Imperial Academic and Healthcare NHS Trust, 53 humes avenue, London, W72LJ UK
| | - Robert Morgan
- Department of Radiology, St George’s NHS Trust, London, UK
| | | | - Philip Haslam
- Department of Interventional Radiology, Newcastle Upon Town NHS Trust, Newcastle Upon Tyne, UK
| | - Mohamad Hamady
- Department of Surgery and Cancer, Imperial College London, London, UK
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Muir T, Bertino G, Groselj A, Ratnam L, Kis E, Odili J, McCafferty I, Wohlgemuth WA, Cemazar M, Krt A, Bosnjak M, Zanasi A, Battista M, de Terlizzi F, Campana LG, Sersa G. Bleomycin electrosclerotherapy (BEST) for the treatment of vascular malformations. An International Network for Sharing Practices on Electrochemotherapy (InspECT) study group report. Radiol Oncol 2023; 57:141-149. [PMID: 37341196 DOI: 10.2478/raon-2023-0029] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Accepted: 06/03/2023] [Indexed: 06/22/2023] Open
Abstract
BACKGROUND Biomedical applications of electroporation are expanding out of the field of oncology into vaccination, treatment of arrhythmias and now in the treatment of vascular malformations. Bleomycin is a widely used sclerosing agent in the treatment of various vascular malformations. The application of electric pulses in addition to bleomycin enhances the effectiveness of the drug, as demonstrated by electrochemotherapy, which utilizes bleomycin in the treatment of tumors. The same principle is used in bleomycin electrosclerotherapy (BEST). The approach seems to be effective in the treatment of low-flow (venous and lymphatic) and, potentially, even high-flow (arteriovenous) malformations. Although there are only a few published reports to date, the surgical community is interested, and an increasing number of centers are applying BEST in the treatment of vascular malformations. Within the International Network for Sharing Practices on Electrochemotherapy (InspECT) consortium, a dedicated working group has been constituted to develop standard operating procedures for BEST and foster clinical trials. CONCLUSIONS By treatment standardization and successful completion of clinical trials demonstrating the effectiveness and safety of the approach, higher quality data and better clinical outcomes may be achieved.
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Affiliation(s)
- Tobian Muir
- Department of Reconstructive Plastic Surgery, James Cook University Hospital, Middlesbrough, United Kingdom
| | - Giulia Bertino
- Department of Otolaryngology Head Neck Surgery, University of Pavia, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Policlinico San Matteo Foundation, Pavia, Italy
| | - Ales Groselj
- Department of Otorhinolaryngology and Cervicofacial Surgery, University Medical Centre Ljubljana, Ljubljana, Slovenia
- Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Lakshmi Ratnam
- Department of Interventional Radiology, St George's University Hospitals NHS Foundation Trust, London, United Kingdom
| | - Erika Kis
- Department of Dermatology and Allergology, University of Szeged, Szeged, Hungary
| | - Joy Odili
- Department of Plastic Surgery, St. Georges University Hospitals NHS Trust, London, United Kingdom
| | - Ian McCafferty
- Birmingham Women's and Children's Hospital NHS Foundation Trust, Birmingham, United Kingdom
| | - Walter A Wohlgemuth
- Universitätsklinik und Poliklinik für Radiologie, Universitätsmedizin Halle, Halle, Germany
| | - Maja Cemazar
- Department of Experimental Oncology, Institute of Oncology Ljubljana, Ljubljana, Slovenia
- Faculty of Health Sciences, University of Primorska, Slovenia
| | - Aljosa Krt
- Department of Otorhinolaryngology, Izola General Hospital, Izola, Slovenia
| | - Masa Bosnjak
- Department of Experimental Oncology, Institute of Oncology Ljubljana, Ljubljana, Slovenia
| | | | | | | | - Luca G Campana
- Department of Surgery, Manchester University NHS Foundation Trust, Manchester, United Kingdom
| | - Gregor Sersa
- Department of Experimental Oncology, Institute of Oncology Ljubljana, Ljubljana, Slovenia
- Faculty of Health Sciences, University of Ljubljana, Ljubljana, Slovenia
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Morgan R, Cleveland T, Hamady M, Oberoi R, Haslam P, Kasthuri R, Johnston M, McCafferty I. Interventional radiology in the 21st century: planning for the future. Clin Radiol 2021; 76:865-869. [PMID: 34776043 DOI: 10.1016/j.crad.2021.10.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Accepted: 10/07/2021] [Indexed: 11/29/2022]
Affiliation(s)
- R Morgan
- Department of Radiology, St George's University of London and St George's University Hospitals NHS Foundation Trust, London, UK.
| | - T Cleveland
- Department of Interventional Radiology, Sheffield Vascular Institute, Sheffield Teaching Hospitals, Sheffield, UK
| | - M Hamady
- Department of Interventional Radiology, Imperial College Healthcare NHS Trust, London, UK
| | - R Oberoi
- Department of Interventional Radiology, Oxford University Hospitals, Oxford, UK
| | - P Haslam
- Department of Interventional Radiology, Freeman Hospital, Newcastle, UK
| | - R Kasthuri
- Department of Interventional Radiology, Greater Glasgow & Clyde NHS, Queen Elizabeth University Hospital, Glasgow, UK
| | - M Johnston
- Department of Interventional Radiology, University Hospitals Sussex and Brighton and Sussex Medical School, Brighton, UK
| | - I McCafferty
- Department of Interventional Radiology, University Hospital Birmingham, Birmingham and Women's NHS Trust, Birmingham, UK
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Oliver CL, Brown J, Watkins M, McCafferty I, Oliver RJ. The Addition of Lipid-Based Contrast Medium does not Inactivate the Detergent Sclerosant Sodium Tetradecyl Sulfate in-vitro. Cardiovasc Intervent Radiol 2021; 44:1103-1108. [PMID: 33709269 DOI: 10.1007/s00270-021-02797-2] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Accepted: 02/03/2021] [Indexed: 12/28/2022]
Abstract
PURPOSE To investigate if the detergent sclerosant sodium tetradecyl sulfate (STS) is deactivated by the lipid-based contrast agent ethiodised oil. METHOD 3% STS was mixed with ethiodised oil and room air in a 2:1:4 ratio in two luer lock syringes and a three way connector and agitated to make foam (the Tessari technique) to replicate the clinical use of the products. The assay of STS in the mixture was assessed using the British Pharmacopoeia method. Briefly this is a manual titration method where the solution of STS is mixed with an indicator solution and titrated with hyamine solution of known concentration; the concentration of the STS can then be calculated with the titration results. To further mimic the clinical environment with the presence of blood, the effect of adding increasing amounts of albumin to the STS-ethiodised oil mixture was assessed. RESULTS The assay of STS in the solution after mixing with ethiodised oil was 3% indicating that the ethiodised oil did not deactivate the STS. The addition of albumin to the STS-contrast mixture resulted in near linear neutralisation of the STS with increasing concentrations in the same quantities as with STS alone. CONCLUSIONS The mixture of the lipid-based contrast agent ethiodised oil with the detergent sclerosant STS did not affect the availability of the sclerosant. The continued use of STS-ethiodised oil in the management of vascular malformations can be supported.
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Affiliation(s)
- Charlotte L Oliver
- Limbco Ltd, Plough Lane, Hereford, HR4 0EL, UK
- University of Oxford, Oxford, UK
| | - Judy Brown
- Limbco Ltd, Plough Lane, Hereford, HR4 0EL, UK
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Lenthall R, White P, Cleveland T, McCafferty I, McConachie N. Training additional doctors to perform mechanical thrombectomy for acute ischaemic stroke: why has progress been slow? Clin Radiol 2021; 76:395-398. [PMID: 33658139 DOI: 10.1016/j.crad.2021.01.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Accepted: 01/18/2021] [Indexed: 10/22/2022]
Affiliation(s)
- R Lenthall
- Diagnostic Imaging, Nottingham University Hospitals NHS Trust, QMC Campus, Nottingham, UK.
| | - P White
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University and Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - T Cleveland
- Sheffield Vascular Institute, Sheffield Teaching Hospitals, Sheffield, UK
| | - I McCafferty
- Department of Interventional Radiology, University Hospital Birmingham, NHS Foundation Trust, Birmingham, UK
| | - N McConachie
- Diagnostic Imaging, Nottingham University Hospitals NHS Trust, QMC Campus, Nottingham, UK
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Affiliation(s)
- Mohamad Hamady
- Department of Interventional Radiology, Imperial College-London, Praed Street, London, W2 1NY, UK.
| | - Ian McCafferty
- Consultant Interventional Radiologist, Queen Elizabeth Hospital, Birmingham, UK
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Pathanki A, Sharif K, McCafferty I, Hartley J, McGuirk S. Congenital intrahepatic aorto-portal fistula presenting with cardiac failure. BJR Case Rep 2020; 6:20200006. [PMID: 33299580 PMCID: PMC7709065 DOI: 10.1259/bjrcr.20200006] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2020] [Revised: 06/21/2020] [Accepted: 06/29/2020] [Indexed: 11/05/2022] Open
Abstract
Congenital intrahepatic arterio-portal fistulae (cIAPF) are rare, high-flow vascular malformations that usually present with portal hypertension. They almost never cause heart failure, unless there is associated congenital heart disease or the ductus venosus in patent. We present an unusual case of IAPF in an 11-day-old boy, who presented with features of cardiac failure associated with increased N-terminal pro-brain natriuretic peptide (NT pro-BNP). The IAPF arose directly from the aorta, separated from the hepatic artery and divided to separately supply both left and right portal veins. The ductus venosus was occluded. The IAPF was treated with embolization of the aorto-portal fistula, accessed through a direct percutaneous puncture of the fistula. Embolization was associated with an immediate clinical improvement and a rapid and sustained normalization of the NT pro-BNP level. A similar re-presentation was noted and treated with repeat embolization. The child is well on follow-up. To our knowledge, this is the first case of cIAPF, which was presented with cardiac failure when the ductus venosus has closed and has been treated successfully with direct, percutaneous transhepatic embolization of the fistula, twice. Serial clinical follow-up and ultrasonographical examinations have proven to be an effective strategy to detect recurrent fistulae.
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Affiliation(s)
- Adithya Pathanki
- The liver unit, including small bowel transplantation, Birmingham Children’s Hospital, Steelhouse lane, Birmingham, United Kingdom
| | - Khalid Sharif
- The liver unit, including small bowel transplantation, Birmingham Children’s Hospital, Steelhouse lane, Birmingham, United Kingdom
| | - Ian McCafferty
- Department of Interventional Radiology, Queen Elizabeth Hospital Birmingham, Mindelsohn way, Birmingham, United Kingdom
| | - Jane Hartley
- The liver unit, including small bowel transplantation, Birmingham Children’s Hospital, Steelhouse lane, Birmingham, United Kingdom
| | - Simon McGuirk
- Department of Interventional Radiology, Birmingham Children’s Hospital, Steelhouse lane, Birmingham, United Kingdom
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Lenthall R, White P, McConachie N, McCafferty I, Cleveland T. Re: Mechanical thrombectomy for stroke: are interventional radiologists interested? A survey. Clin Radiol 2020; 75:874-875. [PMID: 32778328 DOI: 10.1016/j.crad.2020.07.007] [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: 07/10/2020] [Accepted: 07/15/2020] [Indexed: 11/27/2022]
Affiliation(s)
- R Lenthall
- Nottingham University Hospitals NHS Trust, Nottingham, UK.
| | - P White
- Translational and Clinical Research Institute, Newcastle University and Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle, UK
| | - N McConachie
- Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - I McCafferty
- University Hospital Birmingham, NHS Foundation Trust, Birmingham, UK
| | - T Cleveland
- Sheffield Vascular Institute, Sheffield Teaching Hospitals, Sheffield, UK
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Rostampour S, Cleveland T, White H, Haslam P, McCafferty I, Hamady M. Response of UK interventional radiologists to the COVID-19 pandemic - survey findings. CVIR Endovasc 2020; 3:41. [PMID: 32592080 PMCID: PMC7317887 DOI: 10.1186/s42155-020-00133-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Accepted: 06/18/2020] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND The COVID-19 pandemic has had an unprecedented effect upon the National Health Service (NHS). Like other specialties, Interventional Radiology (IR) rapidly adapted to the evolving situation. Members of BSIR were surveyed to obtain a snapshot of the experiences of UK IRs in response to COVID-19. An electronic survey was compiled using Google Forms, approved by the BSIR Council Officers and distributed to BSIR members by email on 18 th April 2020. A total of 228 responses were received. The survey was open for a 14-day period and the data analysed in Microsoft Excel 365. The response rate was 29% (228/800). RESULTS Two thirds of respondents work in a Tertiary unit and 33% deliver IR in a District Hospital. 84% have a day-case facility. After the COVID-19 crisis, 81% of respondents were able to maintain 24-7 On-call service. 59% of respondents had been required change their day to day practice to allow the on-call service to continue. 55% of respondents were involved in providing a central line service. Of those questioned, 91% continued to offer endovascular services, 98% genitourinary and 92% hepatobiliary services, although a degree of service reduction was described. 38% have provided IR trainees with additional training material during this pandemic. CONCLUSIONS This survey has confirmed that the responses of UK IR departments to the COVID-19 crisis have ensured vital on-call and urgent services have continued, including ongoing availability of most IR sub-specialties. Availability of a day case facility has possibly influenced the positive response.
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Affiliation(s)
| | - Trevor Cleveland
- Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | | | - Philip Haslam
- Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Ian McCafferty
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Mo Hamady
- Imperial College Healthcare NHS Trust, London, UK
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McWilliams JP, Bilhim TA, Carnevale FC, Bhatia S, Isaacson AJ, Bagla S, Sapoval MR, Golzarian J, Salem R, McClure TD, Kava BR, Spies JB, Sabharwal T, McCafferty I, Tam AL. Society of Interventional Radiology Multisociety Consensus Position Statement on Prostatic Artery Embolization for Treatment of Lower Urinary Tract Symptoms Attributed to Benign Prostatic Hyperplasia: From the Society of Interventional Radiology, the Cardiovascular and Interventional Radiological Society of Europe, Société Française de Radiologie, and the British Society of Interventional Radiology: Endorsed by the Asia Pacific Society of Cardiovascular and Interventional Radiology, Canadian Association for Interventional Radiology, Chinese College of Interventionalists, Interventional Radiology Society of Australasia, Japanese Society of Interventional Radiology, and Korean Society of Interventional Radiology. J Vasc Interv Radiol 2019; 30:627-637.e1. [PMID: 30926185 DOI: 10.1016/j.jvir.2019.02.013] [Citation(s) in RCA: 66] [Impact Index Per Article: 13.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2019] [Accepted: 02/13/2019] [Indexed: 12/14/2022] Open
Affiliation(s)
- Justin P McWilliams
- Department of Radiology, Division of Interventional Radiology, David Geffen School of Medicine at UCLA, Los Angeles, California.
| | - Tiago A Bilhim
- Interventional Radiology Department, St. Louis Hospital, Lisbon, Portugal
| | - Francisco C Carnevale
- Department of Interventional Radiology, University of Sao Paulo Medical School, Sao Paulo, Brazil
| | - Shivank Bhatia
- Department of Radiology and Division of Vascular Interventional Radiology, University of Miami Miller School of Medicine, Miami, Florida
| | - Ari J Isaacson
- Department of Radiology, University of North Carolina, Chapel Hill, North Carolina
| | - Sandeep Bagla
- Vascular Institute of Virginia, Woodbridge, Virginia
| | - Marc R Sapoval
- Department of Vascular and Oncologic Interventional Radiology, Hôpital Européen Georges Pompidou, Paris, France
| | - Jafar Golzarian
- Department of Radiology, Division of Interventional Radiology and Vascular Imaging, University of Minnesota, Minneapolis, Minnesota
| | - Riad Salem
- Department of Radiology, Northwestern University, Chicago, Illinois
| | - Timothy D McClure
- Department of Urology, Weill Cornell Medicine, Lefrak Center for Robotic Surgery, New York, New York
| | - Bruce R Kava
- Department of Urology, University of Miami Miller School of Medicine, Miami, Florida
| | - James B Spies
- Department of Radiology, Georgetown University Medical Center, Washington, DC
| | - Tarun Sabharwal
- Department of Radiology, Guys and St Thomas' Hospital, London, United Kingdom
| | - Ian McCafferty
- Department of Clinical Radiology, Queen Elizabeth Hospital Birmingham, Birmingham, United Kingdom
| | - Alda L Tam
- Department of Interventional Radiology, MD Anderson Cancer Center, Houston, Texas
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Bee J, Bhatt R, McCafferty I, Johnson SR. A 4-year prospective evaluation of protocols to improve clinical outcomes for patients with lymphangioleiomyomatosis in a national clinical centre. Thorax 2015; 70:1202-4. [DOI: 10.1136/thoraxjnl-2015-207171] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2015] [Accepted: 06/11/2015] [Indexed: 11/04/2022]
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Iafrancesco M, Ranasinghe AM, Dronavalli V, Adam DJ, Claridge MW, Riley P, McCafferty I, Mascaro JG. Open aortic arch replacement in high-risk patients: the gold standard. Eur J Cardiothorac Surg 2015; 49:646-51; discussion 651. [DOI: 10.1093/ejcts/ezv149] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2014] [Accepted: 02/19/2015] [Indexed: 11/12/2022] Open
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15
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Yeoh ZW, Navaratnam V, Bhatt R, McCafferty I, Hubbard RB, Johnson SR. Natural history of angiomyolipoma in lymphangioleiomyomatosis: implications for screening and surveillance. Orphanet J Rare Dis 2014; 9:151. [PMID: 25277108 PMCID: PMC4203902 DOI: 10.1186/s13023-014-0151-3] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2014] [Accepted: 09/17/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND LAM is a rare disease of women categorised by lung cysts and lymphatic abnormalities. The disease occurs sporadically or associated with Tuberous Sclerosis Complex (TSC-LAM). Angiomyolipoma, a benign tumour, prone to haemorrhage, occurs mostly in the kidneys in many of these patients. Treatment guidelines exist for angiomyolipoma in patients with TSC but the natural history of angiomyolipoma in sporadic LAM has not been studied. AIMS To document the natural history of angiomyolipoma in a national cohort of patients with sporadic LAM to inform tumour screening and surveillance protocols. METHODS Demographic data, clinical features, lung function and tumour size were obtained from clinical records of patients attending the National Centre for LAM in Nottingham, UK. RESULTS 122 patients with definite or probable LAM by European Respiratory Society criteria were identified. One hundred and seven had sporadic LAM, of which 53 (50%) had at least one angiomyolipoma. In patients with sporadic LAM presentation of angiomyolipoma preceded or followed onset of lung symptoms by up to 11 and 38 years respectively. Mean tumour size was 28 mm (range 5-140 mm) at presentation and growth was 1.8 mm/yr (95% C.I. 0.42-3.82) thereafter. Eleven patients with sporadic LAM had had a nephrectomy due to angiomyolipoma bleeding. The need for intervention did not differ between those with TSC-LAM and sporadic LAM. CONCLUSIONS Patients with LAM have a high prevalence of symptomatic angiomyolipoma which can present at any time. Angiomyolipoma in sporadic-LAM have a similar risk of bleeding to those with TSC. All patients should be screened for angiomyolipoma at diagnosis of lung disease by MRI scanning and the tumours require continuous monitoring.
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Affiliation(s)
| | | | | | | | | | - Simon R Johnson
- Divisions of Respiratory Medicine and Respiratory Research Unit, School of Medicine, University of Nottingham, D Floor, South Block, Queens Medical Centre, Nottingham NG7 2UH, UK.
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Iafrancesco M, Ranasinghe A, Dronavalli V, Adam D, Claridge M, Riley P, McCafferty I, Mascaro J. 044 * OPEN AORTIC ARCH REPLACEMENT IN HIGH RISK PATIENTS: THE GOLD STANDARD. Interact Cardiovasc Thorac Surg 2014. [DOI: 10.1093/icvts/ivu276.44] [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: 11/14/2022] Open
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Balasundaram I, Al-Hadad I, Rehman K, McCafferty I, Monaghan A. The use of foam sclerotherapy to treat low-flow vascular malformations of the head and neck. J Surg Case Rep 2014; 2014:rju095. [PMID: 25252734 PMCID: PMC4172995 DOI: 10.1093/jscr/rju095] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Abstract
Liquid sclerotherapy, laser and surgery have been used in the treatment of head and neck vascular anomalies with variable success for many years. A multidisciplinary team consisting of plastic surgery, maxillofacial surgery and interventional radiology currently treats such lesions by converting liquid sclerosant into foam. Foam sclerotherapy is currently used successfully to treat varicosities of the lower limbs and in this study, we present four cases in which 3% sodium tetradecyl sulfate has been used to treat low-flow vascular malformations in the head and neck.
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Affiliation(s)
- I Balasundaram
- Department of Oral and Maxillofacial Surgery, University Hospital Birmingham Foundation NHS Trust, Birmingham, UK
| | - I Al-Hadad
- Department of Oral and Maxillofacial Surgery, University Hospital Birmingham Foundation NHS Trust, Birmingham, UK
| | - K Rehman
- Department of Oral and Maxillofacial Surgery, University Hospital Birmingham Foundation NHS Trust, Birmingham, UK
| | - I McCafferty
- Department of Radiology, University Hospital Birmingham Foundation NHS Trust, Birmingham, UK
| | - A Monaghan
- Department of Oral and Maxillofacial Surgery, University Hospital Birmingham Foundation NHS Trust, Birmingham, UK
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18
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Srinivasan KG, Vidyadharan R, Patel N, Khan A, McCafferty I, Monaghan A, Lamin S, Nishikawa H. Embolisation of high flow extracranial/peripheral arteriovenous malformations (AVMs) with ethylene vinyl alcohol copolymer (ONYX®) in children—Birmingham Children’s Hospital experience. Eur J Plast Surg 2014. [DOI: 10.1007/s00238-013-0900-x] [Citation(s) in RCA: 1] [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: 11/28/2022]
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19
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Massey J, Barnett V, Riley P, McCafferty I, Ranasinghe A, Mascaro J. Endovascular stent-grafting for thoracic aortic aneurysm: Experiences of one centre with regards to outcomes and consenting. Int J Surg 2013. [DOI: 10.1016/j.ijsu.2013.06.132] [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: 10/26/2022]
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20
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Aga H, Burke G, Sandhu A, McCafferty I, Monaghan A. An audit of incidence of haemoglobinuria in sclerotherapy patients following the institution of a hydration protocol. Br J Oral Maxillofac Surg 2013. [DOI: 10.1016/j.bjoms.2013.05.087] [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: 10/26/2022]
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21
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Kirkham APS, Haslam P, Keanie JY, McCafferty I, Padhani AR, Punwani S, Richenberg J, Rottenberg G, Sohaib A, Thompson P, Turnbull LW, Kurban L, Sahdev A, Clements R, Carey BM, Allen C. Prostate MRI: who, when, and how? Report from a UK consensus meeting. Clin Radiol 2013; 68:1016-23. [PMID: 23827086 DOI: 10.1016/j.crad.2013.03.030] [Citation(s) in RCA: 68] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2013] [Revised: 03/16/2013] [Accepted: 03/20/2013] [Indexed: 10/26/2022]
Abstract
The current pathway for men suspected of having prostate cancer [transrectal biopsy, followed in some cases by magnetic resonance imaging (MRI) for staging] results in over-diagnosis of insignificant tumours, and systematically misses disease in the anterior prostate. Multiparametric MRI has the potential to change this pathway, and if performed before biopsy, might enable the exclusion of significant disease in some men without biopsy, targeted biopsy in others, and improvements in the performance of active surveillance. For the potential benefits to be realized, the setting of standards is vital. This article summarizes the outcome of a meeting of UK radiologists, at which a consensus was achieved on (1) the indications for MRI, (2) the conduct of the scan, (3) a method and template for reporting, and (4) minimum standards for radiologists.
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Affiliation(s)
- A P S Kirkham
- Department of Imaging, University College Hospital, London, UK.
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22
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Kok K, McCafferty I, Monaghan A, Nishikawa H. Percutaneous sclerotherapy of vascular malformations in children using sodium tetradecyl sulphate: the Birmingham experience. J Plast Reconstr Aesthet Surg 2012; 65:1451-60. [PMID: 22717975 DOI: 10.1016/j.bjps.2012.05.005] [Citation(s) in RCA: 17] [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] [Received: 09/21/2011] [Revised: 05/03/2012] [Accepted: 05/06/2012] [Indexed: 10/28/2022]
Abstract
INTRODUCTION AND AIMS Sclerotherapy has become first line treatment for most venous malformations and some lymphatic malformations. We aimed to measure our sclerotherapy treatment success using 3% sodium tetradecyl sulphate (STD) and describe our experience. MATERIALS AND METHODS Retrospective five year review (Jan 04-09) of children with vascular malformations treated at our centre with 3% STD. Patients were classified using the Birmingham classification and treatment success was measured through case note review and pre- and post-treatment photographs. FINDINGS AND RESULTS: Forty-three (84.3%) of the 51 patients with vascular malformations (VM) who underwent sclerotherapy derived a benefit. Twelve patients (23.5%) had an excellent result, 31 (60.8%) were improved whilst eight (15.7%) were unchanged. Using Fisher's exact test, there was a statistically significant difference in achieving complete resolution of superficial VMs compared to lesions involving the deeper layers of the head and neck. 17.6% of patients developed a complication with an overall complication rate of 12.2% per injection. There was one major complication with the remainder consisting of superficial skin necrosis that resolved conservatively. CONCLUSIONS Treatment with 3% STD sclerotherapy is effective in venous and some lymphatic vascular malformations. It should be considered an important treatment modality within a multi-disciplinary setting in these difficult problems.
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Affiliation(s)
- Kenneth Kok
- Department of Plastic and Reconstructive Surgery, Birmingham Children's Hospital, Steelhouse Lane, Birmingham B4 6NH, West Midlands, United Kingdom.
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23
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Burke E, Aga H, McCafferty I, Nishikawa H, Monaghan A, Lamin S. Successes and pitfalls: a 5-year experience of Onyx® in the management of high-flow vascular malformations. Br J Oral Maxillofac Surg 2012. [DOI: 10.1016/j.bjoms.2012.04.169] [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: 11/26/2022]
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24
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Rehman KU, Sittampalam G, McCafferty I, Monaghan A. The use of foam sclerotherapy for the treatment of head and neck vascular malformations. Br J Oral Maxillofac Surg 2009; 47:631-2. [DOI: 10.1016/j.bjoms.2009.03.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/07/2009] [Indexed: 11/26/2022]
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25
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Ansari J, Doherty A, McCafferty I, Wallace M, Deshmukh N, Porfiri E. Neoadjuvant Sunitinib Facilitates Nephron-Sparing Surgery and Avoids Long-Term Dialysis in a Patient With Metachronous Contralateral Renal Cell Carcinoma. Clin Genitourin Cancer 2009; 7:E39-41. [DOI: 10.3816/cgc.2009.n.021] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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26
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Mendonca DA, McCafferty I, Nishikawa H, Lester R. Venous malformations of the limbs: the Birmingham experience, comparisons and classification in children. J Plast Reconstr Aesthet Surg 2008; 63:383-9. [PMID: 19114320 DOI: 10.1016/j.bjps.2008.11.055] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2008] [Revised: 10/27/2008] [Accepted: 11/08/2008] [Indexed: 10/21/2022]
Abstract
The management of vascular anomalies in upper and lower limbs is complex. The current practice at Birmingham Children's Hospital is based on a multidisciplinary approach, involving plastic surgeons, interventional radiologists, vascular surgeons, dermatologists and laser specialists. This study reviews the management strategies for peripheral venous malformations (VMs) and proposes a simple classification system to aid treatment. A retrospective review was undertaken involving all paediatric patients presenting with (VMs) of the upper and lower limbs, managed by the same multidisciplinary team over a period of 3 years. A total of 33 patients were identified, of whom 19 had lesions located in the upper limb. Treatment modalities included surgery, sclerotherapy, a combination of the two and conservative management. The indications for treatment included: (1) worsening pain, (2) increased swelling, (3) reduced function, (4) bleeding or ulceration and finally, (5) cosmetic deformity. Following treatment, outcome measures with regards to the symptoms were graded into (1) improved, (2) worsened and (3) unchanged. Based on magnetic resonance imaging, we were able to apply our classification to separate the lesions into Type 1a (superficial localised): nine, Type 1b (superficial diffused): five, Type 2 (Fascia/muscle infiltration): nine, Type 3 (Bone/joint infiltration): seven and Type 4 (Extensive whole-limb infiltration): three. In patients with upper limb VMs (n=19), eight lesions (42%) were superficial and localised (Type 1a) while the rest were diffused lesions. In contrast, in the lower limb (n=14), only one lesion (7%) was superficial while the rest were diffused lesions. Lower success rate for treatment was noted in lower limb malformations (p<0.05). In eight patients with recurrence of symptoms, six had Type 3 (intra-articular) lesions. There was one major and three minor complications following treatment. An outline of the management strategies for VMs in peripheral limbs is discussed in this article. An anatomical classification is described which aids in management and communication.
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Affiliation(s)
- Derick A Mendonca
- Department of Plastic and Reconstructive Surgery, Birmingham Children's Hospital, SteelHouse Lane, Birmingham B4 6NH West Midlands, United Kingdom.
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27
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Balasundaram I, Al-Hadad I, Williams R, McCafferty I, Nishikawa H, Monaghan A. A novel multidisciplinary approach to treating vascular malformations of thehead and neck - a patient's perspective. Br J Oral Maxillofac Surg 2008. [DOI: 10.1016/j.bjoms.2008.07.147] [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: 11/26/2022]
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28
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Cooper SC, Olliff SP, McCafferty I, Wigmore SJ, Mirza DF. Polyarteritis nodosa, presenting as life-threatening gastrointestinal hemorrhage in a liver transplant recipient. Liver Transpl 2008; 14:151-4. [PMID: 18236387 DOI: 10.1002/lt.21283] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [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] [Indexed: 12/31/2022]
Abstract
This unique case reports the first recorded episode in the medical literature of vasculitis post-liver transplantation, presenting as life-threatening gastrointestinal hemorrhage. A 52-year-old Caucasian woman underwent orthotopic liver transplantation (OLT) for autoimmune cirrhosis complicated by hepatoma and portal vein thrombosis. Late hepatic artery thrombosis led to a second liver graft. Following recovery from an episode of acute rejection, the patient presented with large volume hematemesis, melena, and hemochezia (passage of fresh blood from the rectum). Following upper and lower gastrointestinal endoscopy and surgery, angiography illustrated the presence of polyarteritis nodosa (PAN), which was successfully treated with high-dose steroid therapy. Gastrointestinal hemorrhage is an unusual presentation of vasculitis, especially PAN. The occurrence of this phenomenon post-OLT, in the presence of immunosuppression is previously unreported.
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Affiliation(s)
- Sheldon C Cooper
- Liver Unit, Queen Elizabeth Hospital, University Hospital Birmingham, National Health Service Foundation Trust, Birmingham, United Kingdom
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29
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Santo KC, Guest P, McCafferty I, Bonser RS. Aortoesophageal fistula secondary to stent-graft repair of the thoracic aorta after previous surgical coarctation repair. J Thorac Cardiovasc Surg 2007; 134:1585-6. [DOI: 10.1016/j.jtcvs.2007.08.027] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2007] [Accepted: 08/07/2007] [Indexed: 10/22/2022]
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30
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Santo K, McCafferty I, Guest P, Bonser R. A Fatal Complication Following Hybrid Total Arch Replacement with Supra-aortic Artery Translocation and Endovascular Stenting. Eur J Vasc Endovasc Surg 2007; 34:534-6. [PMID: 17582793 DOI: 10.1016/j.ejvs.2007.04.016] [Citation(s) in RCA: 2] [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: 01/16/2007] [Accepted: 04/22/2007] [Indexed: 11/25/2022]
Abstract
This case highlights the successful management of acute Type B dissection complicated by visceral malperfusion. Even though the procedure of hybrid supra-aortic translocation and endovascular stenting corrected the malperfusion, it is important for vigilant CT scan surveillance for the post operative complications which can occur with this procedure.
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Affiliation(s)
- K Santo
- Department of Cardiac Surgery, University Hospital Birmingham NHS Trust, UK
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31
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Sachithanandan A, McCafferty I, Riley P, Bonser RS, Rooney SJ. Emergency Endovascular Stent Graft Repair of Aorto-Bronchial Fistulas Postcoarctation Repair. J Card Surg 2007; 22:524-6. [DOI: 10.1111/j.1540-8191.2007.00456.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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32
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Burke G, Walker R, Monaghan A, McCafferty I, Nishikawa H. Establishing a facial vascular anomoly service. Br J Oral Maxillofac Surg 2007. [DOI: 10.1016/j.bjoms.2007.07.151] [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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33
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Dhillon MS, McCafferty I, Davies AM, Tillman RM. Intra-osseous pseudoaneurysm following curettage of an aneurysmal bone cyst. Skeletal Radiol 2007; 36 Suppl 1:S46-9. [PMID: 16710722 DOI: 10.1007/s00256-006-0126-0] [Citation(s) in RCA: 2] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2005] [Revised: 02/09/2006] [Accepted: 02/13/2006] [Indexed: 02/02/2023]
Abstract
BACKGROUND Pseudoaneurysms secondary to bone tumours are rare and most of the reported cases are related to osteochondromas, either due to direct pressure or following surgery. Aneurysmal bone cysts are relatively common bony lesions usually treated by curettage. DISCUSSION We describe an unusual case of pseudoaneurysm of the anterior tibial artery complicating curettage of an aneurysmal bone cyst which presented as a rapidly enlarging mass clinically thought to be rapid recurrence of the tumour. This was successfully treated by embolisation.
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Affiliation(s)
- M S Dhillon
- Department of Clinical Radiology, University Hospitals Coventry and Warwickshire (Walsgrave Hospital), Clifford Bridge Road, Coventry, UK.
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34
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Burling D, Halligan S, Atchley J, Dhingsar R, Guest P, Hayward S, Higginson A, Jobling C, Kay C, Lilford R, Maskell G, McCafferty I, McGregor J, Morton D, Kumar Neelala M, Noakes M, Philips A, Riley P, Taylor A, Bassett P, Wardle J, Atkin W, Taylor SA. CT colonography: interpretative performance in a non-academic environment. Clin Radiol 2007; 62:424-9; discussion 430-1. [PMID: 17398266 DOI: 10.1016/j.crad.2006.11.004] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.6] [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: 05/22/2006] [Revised: 09/15/2006] [Accepted: 11/08/2006] [Indexed: 11/16/2022]
Abstract
AIM To investigate interpretative accuracy and reporting time for radiologists performing computed tomography (CT) colonography in day-to-day non-academic clinical practice. MATERIALS AND METHODS Thirteen radiologists from seven centres, who were reporting CT colonography in non-academic daily clinical practice, interpreted a dataset of 15 colonoscopically validated cases in a controlled environment. Ten cases had either a cancer or polyp >10mm; one case had a medium polyp and four were normal. Correct case categorization and interpretation times were compared using analysis of variance to aggregated results obtained from both experienced observers and observers recently trained using 50 cases, working in an academic environment. The effect of experience was determined using Spearman's rank correlation. RESULTS Individual accuracy was highly variable, range 53% (95% CI 27-79%) to 93% (95% CI 68-100%). Mean accuracy overall was significantly inferior to experienced radiologists (mean 75 versus 88%, p=0.04) but not significantly different from recently trained radiologists (p=0.48). Interpretation time was not significantly different to experienced readers (mean 12.4 min versus 11.7, p=0.74), but shorter than recently trained radiologists (p=0.05). There was a significant, positive, linear correlation between prior experience and accuracy (p<0.001) with no plateau. CONCLUSION Accuracy for sub-specialist radiologists working in a non-academic environment is, on average, equivalent to radiologists trained using 50 cases. However, there is wide variability in individual performance, which generally falls short of the average performance suggested by meta-analysis of published data. Experience improves accuracy, but alone is insufficient to determine competence.
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Affiliation(s)
- D Burling
- University College Hospital, London, UK
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35
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Khan KY, Xiong T, McCafferty I, Riley P, Ismail T, Lilford RJ, Morton DG. Frequency and impact of extracolonic findings detected at computed tomographic colonography in a symptomatic population. Br J Surg 2007; 94:355-61. [PMID: 17262750 DOI: 10.1002/bjs.5498] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.4] [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: 11/08/2022]
Abstract
Abstract
Background
Extracolonic findings are frequently recognized alongside colonic pathology at computed tomographic colonography (CTC). This study assessed the clinical impact of extracolonic findings in a symptomatic population at high risk of colorectal cancer.
Methods
CTC was performed in a consecutive cohort of patients assessed in a fast-track colorectal cancer clinic as being at high risk of colorectal cancer. A review of CTC findings and case notes was undertaken. Patients with extracolonic findings were followed up for at least 12 months.
Results
Thirty-one (13·8 per cent) of 225 patients investigated by CTC had colorectal cancer. Extracolonic findings were identified in 81 (53·3 per cent) of 152 patients with normal or non-neoplastic bowel findings, compared with 27 (37 per cent) of 73 patients with colorectal neoplasia (P = 0·025). Twenty-four patients (10·7 per cent) with extracolonic findings underwent further investigation or treatment. The median duration of investigation was 19·5 weeks. Seventy-five clinical events were recorded, including 14 surgical procedures.
Conclusion
A prospective cost–benefit analysis of diagnostic CTC should be performed before it is established as a first-line investigation for colonic symptoms.
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Affiliation(s)
- K Y Khan
- Department of Surgery, Queen Elizabeth Hospital, University of Birmingham, Birmingham, UK
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36
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Gibbins J, Pankhurst T, Murray J, McCafferty I, Baiden-Amissahk K, Shafeek S, Lipkin GW. Extramedullary haematopoiesis in the kidney: a case report and review of literature. ACTA ACUST UNITED AC 2006; 27:391-4. [PMID: 16307541 DOI: 10.1111/j.1365-2257.2005.00724.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.0] [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: 11/27/2022]
Abstract
We report a 47-year-old man with myelofibrosis who presented with bilateral nephromegaly secondary to extramedullary haematopoiesis. We discuss diagnosis and treatment of this rare case and review the literature.
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Affiliation(s)
- J Gibbins
- Department of Nephrology, University Hospital Birmingham, Birmingham, UK
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Abstract
We report a case of venous obstruction secondary to Hodgkin's lymphoma. Multiple Wallstents were inserted into the superior vena cava to relieve obstructive symptoms secondary to tumor. This procedure was complicated by stent migration into the right ventricle and a presumed stent infection. We describe the percutaneous management of these complications and discuss the issues surrounding the use of stents in this setting. We conclude that these complications can be managed percutaneously. However, the technical details of stent placement are essential in minimizing complications of this type.
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Okorie M, Hussain S, Riley P, McCafferty I. The use of self-expandable metal stents in the palliation of malignant bowel obstruction. Oncol Rep 2004. [DOI: 10.3892/or.12.1.67] [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: 11/06/2022] Open
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39
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Fisher NC, McCafferty I, Dolapci M, Wali M, Buckels JA, Olliff SP, Elias E. Managing Budd-Chiari syndrome: a retrospective review of percutaneous hepatic vein angioplasty and surgical shunting. Gut 1999; 44:568-74. [PMID: 10075967 PMCID: PMC1727471 DOI: 10.1136/gut.44.4.568] [Citation(s) in RCA: 125] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND The role of percutaneous hepatic vein angioplasty in the management of Budd-Chiari syndrome has not been well defined. Over a 10 year period at our unit, we have often used this technique in cases of short length hepatic vein stenosis or occlusion, reserving surgical mesocaval shunting for cases of diffuse hepatic vein occlusion or failed angioplasty. AIMS To review the outcome of angioplasty and surgical shunting to define their respective roles. PATIENTS All patients treated by angioplasty or surgical shunting for non-malignant hepatic vein obstruction over a ten year period from 1987 to 1996. METHODS A case note review of pretreatment features and clinical outcome. RESULTS Angioplasty was attempted in 21 patients with patent hepatic vein branches and was successful in 18; in three patients treatment was unsuccessful and these patients had surgical shunts. Fifteen patients were treated by surgical shunting only. Mortality according to definitive treatment was 3/18 following angioplasty and 8/18 following surgery; in most cases this reflected high risk status prior to treatment. Venous or shunt reocclusion rates were similar for both groups and were associated with subtherapeutic warfarin in half of these cases. Most surviving patients in both groups are asymptomatic although one surgical patient has chronic hepatic encephalopathy. CONCLUSION With appropriate case selection, many patients with Budd-Chiari syndrome caused by short length hepatic vein stenosis or occlusion may be managed successfully by angioplasty alone. Medium term outcome is good following this procedure provided that anticoagulation is maintained. Further follow up is required to assess for definitive benefits but we suggest that this should be included as a valid initial approach in the algorithm for management of Budd-Chiari syndrome.
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Affiliation(s)
- N C Fisher
- Liver Unit, Queen Elizabeth Hospital, Birmingham, UK
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40
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Bradshaw KA, Pagano D, Bonser RS, McCafferty I, Guest PJ. Multiplanar reformatting and three-dimensional reconstruction: for pre-operative assessment of the thoracic aorta by computed tomography. Clin Radiol 1998; 53:198-202. [PMID: 9528870 DOI: 10.1016/s0009-9260(98)80100-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [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: 02/07/2023]
Abstract
INTRODUCTION Conventional CT demonstrates pathology of the thoracic aorta. This study aimed to evaluate the additional contributions to surgical planning of multiplanar reformatting, maximum intensity projections and three-dimensional (3-D) reconstruction. DESIGN Retrospective. SUBJECT AND METHODOLOGY: Fifty-three patients with newly diagnosed pathology of the thoracic aorta were scanned over a 15-month period; 25 scans were spiral acquisitions. Scans were acquired during and following rapid injection of 100 ml of intravenous iopromide. The reconstructed data was displayed as axial images, oblique or other multiplanar reformats and shaded surface display 3-D reconstructions. Two radiologists and two surgeons reviewed the images. The axial images were assessed initially, subsequently the reformats and 3-D reconstructed views were examined looking particularly for additional information that might add to the surgical management. RESULTS Pathologies encountered were aortic dissection (21 patients, including two with Marfan's syndrome), saccular aneurysms (eight), fusiform aneurysms (16), aortic root and ascending aortic dilatation (seven) and coarctation (one). The relationship of aneurysms and dissections to major vessels are better shown with 3-D reconstruction or oblique reformats. Morphology of saccular aneurysms, particularly the neck, is well shown with 3-D reconstruction. Coarctation was best demonstrated by oblique reformats. There was little additional information from 3-D reconstruction or reformats in assessment of type A dissection. Improved spatial orientation by visualization in varying projections was helpful for surgical planning in certain cases of type B dissection, fusiform aneurysms and aortic root and ascending aortic root dilatation. Spiral acquisitions have the advantage of speed and hence a greater anatomical coverage for a single breath-hold. CONCLUSION Oblique reformats and 3-D reconstruction, although using identical data as the axial images, in specific cases were felt to aid surgical assessment of aneurysms and dissections, thus assisting pre-operative planning.
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Affiliation(s)
- K A Bradshaw
- Department of Radiology, Queen Elizabeth Hospital, Birmingham, UK
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41
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Abstract
Reports on a trip to St Petersburg and Russian attitudes to health
education as well as some of the health problems in Russia. Outlines
educational practices in Russia – looks at lack of support with
regard to the development of health education policies and the growing
desire to press for change. Concludes that, in addition to environmental
and economic difficulties, there is a substantial threat from the
Western problems of alcohol, illegal drugs and HIV; some of the more
pressing concerns related to disease prevention and nutritional health
have delayed the resources allocated to health education in the
curriculum.
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Wallace GR, Briffa J, McCafferty I, Askenase PW, Chain BM. The T-cell response to haptenated insulins. I. The proliferative response. Immunology 1989; 66:39-44. [PMID: 15493260 PMCID: PMC1385117] [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] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/01/2023] Open
Abstract
Mice were primed with TNP-derivatized insulin, or TNP-Mycobacteria, and lymph node cells were challenged in vitro with haptenated and unhaptenated antigens. Using either priming antigen, T-cell proliferative responses could be obtained to TNP-insulin. In B10 (H-2b), mice, which are responders to beef insulin (BI), but not to pork insulin (PI), TNP-BI or TNP-PI primed a response to TNP beef and TNP pork insulins, and to beef but not pork insulin, suggesting that a proportion of the response was directed to the modified portion of the molecule. However, priming with BI resulted in responsiveness to TNP-PI, but not to PI. Also, TNP-BI stimulated an augmented proliferative response in BI-primed mice. These results suggest that TNP modification can alter the antigenicity of the carrier molecule, perhaps by enhancing weak interactions with MHC molecules on presenting cells. Finally, there was no evidence that the TNP-dependent response to TNP-pork insulin was down-regulated by suppressor cells directed at the carrier molecule.
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Affiliation(s)
- G R Wallace
- Immunology Unit, Department of Biology (Medawar Building), University College London, London UK
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Chain B, McCafferty I, Wallace G, Askenase PW. Improvement of the in vitro T cell proliferation assay by a modified method that separates the antigen recognition and IL-2-dependent steps. J Immunol Methods 1987; 99:221-8. [PMID: 3108408 DOI: 10.1016/0022-1759(87)90131-1] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
T cell activation is commonly assayed in vitro by measuring the proliferative response of primed cells to an antigenic stimulus. We have modified the conventional form of this assay by dividing up the response into two stages. During the first stage, antigen drives the specific expression of IL-2 receptor expression. This phase is carried out in the presence of homologous mouse serum, in order to reduce non-specific responses to a minimum. During the second phase, proliferation of these activated T cells is driven by the addition of excess exogenous IL-2. This modified form of proliferation assay significantly increased the signal to noise ratio which can be attained, and is of particular value when looking at the T cell response to weak (e.g., cross-reactive) antigens, or low concentrations of antigen.
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Abstract
Any manager or entrepreneur who aims to survive for a considerable period needs information not only on what is going on now, and what happened several months ago, but also what is likely to happen in the future. As none of us has perfect vision in this area, we are going to rely on a certain amount of intuition — playing hunches — and on the information that can be gained from forecasting.
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Gorham S, McCafferty I, Baraza R, Scott R. Preliminary development of a collagen membrane for use in urological surgery. Urol Res 1984; 12:295-9. [PMID: 6523651 DOI: 10.1007/bf00258039] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
A series of experiments have been carried out in-vitro in order to assess the possibility of using a collagen membrane in the repair of various sections of the urinary tract following operative surgery such as the removal of a stone from the ureter. The collagen film has been tested for its compatability with urine, its ability to prevent leakage of fluid in a simulated wound in-vitro and for its ability to withstand any degradative effect of liver and kidney homogenates. The material was not significantly degraded by either urine or by tissue homogenates and was able to prevent leakage of fluid under the experimental conditions employed. Although some slight build-up of calcium and some trace elements took place after incubation in urine over a six-day period this was not significant. On the basis of the results obtained it has been decided to proceed to in-vivo trials on rabbits using the collagen membrane. The possibility of using such a material in partial nephrectomy operations is discussed.
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McCafferty I. Health education. Oiling the publicity machine. Health Soc Serv J 1984; 94:50. [PMID: 10265137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
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McCafferty I, Perkins ER. Research in health education units--warts and all. Health Educ J 1984; 43:19-22. [PMID: 10267892 DOI: 10.1177/001789698404300106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
While there is general agreement that research in health education is valuable, there is considerable disagreement on the form it should take, and how it should be organised. After a review of the problems and opportunities from two perspectives, a number of points are suggested which should be taken into account by anyone considering basing research posts in service units.
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