1
|
El-Dhuwaib Y, Selvasekar C, Corless DJ, Deakin M, Slavin JP. Venous thromboembolism following colorectal resection. Colorectal Dis 2017; 19:385-394. [PMID: 27654996 DOI: 10.1111/codi.13529] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2015] [Accepted: 06/23/2016] [Indexed: 02/08/2023]
Abstract
AIM The study investigated the rate of significant venous thromboembolism (VTE) following colorectal resection during the index admission and over 1 year following discharge. It identifies risk factors associated with VTE and considers the length of VTE prophylaxis required. METHOD All adult patients who underwent colorectal resections in England between April 2007 and March 2008 were identified using Hospital Episode Statistics data. They were studied during the index admission and followed for a year to identify any patients who were readmitted as an emergency with a diagnosis of deep venous thrombosis or pulmonary embolism. RESULTS In all, 35 997 patients underwent colorectal resection during the period of study. The VTE rate was 2.3%. Two hundred and one (0.56%) patients developed VTE during the index admission and 571 (1.72%) were readmitted with VTE. Following discharge from the index admission, the risk of VTE in patients with cancer remained elevated for 6 months compared with 2 months in patients with benign disease. Age, postoperative stay, cancer, emergency admission and emergency surgery for patients with inflammatory bowel disease (IBD) were all independent risk factors associated with an increased risk of VTE. Patients with ischaemic heart disease and those having elective minimal access surgery appear to have lower levels of VTE. CONCLUSION This study adds to the benefits of minimal access surgery and demonstrates an additional risk to patients undergoing emergency surgery for IBD. The majority of VTE cases occur following discharge from the index admission. Therefore, surgery for cancer, emergency surgery for IBD and those with an extended hospital stay may benefit from extended VTE prophylaxis. This study demonstrates that a stratified approach may be required to reduce the incidence of VTE.
Collapse
Affiliation(s)
- Y El-Dhuwaib
- Institute for Science and Technology in Medicine, Keele University, Stoke on Trent, UK
| | - C Selvasekar
- Department of Surgery, Christie NHS Foundation Trust, Manchester, UK
| | - D J Corless
- Department of Surgery, Mid Cheshire Hospitals NHS Foundation Trust, Crewe, UK
| | - M Deakin
- Institute for Science and Technology in Medicine, Keele University, Stoke on Trent, UK.,Department of Surgery, Royal Stoke University Hospital, Stoke on Trent, UK
| | - J P Slavin
- Institute for Science and Technology in Medicine, Keele University, Stoke on Trent, UK.,Department of Surgery, Mid Cheshire Hospitals NHS Foundation Trust, Crewe, UK
| |
Collapse
|
2
|
Vohra RS, Pasquali S, Kirkham AJ, Marriott P, Johnstone M, Spreadborough P, Alderson D, Griffiths EA, Fenwick S, Elmasry M, Nunes Q, Kennedy D, Basit Khan R, Khan MAS, Magee CJ, Jones SM, Mason D, Parappally CP, Mathur P, Saunders M, Jamel S, Ul Haque S, Zafar S, Shiwani MH, Samuel N, Dar F, Jackson A, Lovett B, Dindyal S, Winter H, Fletcher T, Rahman S, Wheatley K, Nieto T, Ayaani S, Youssef H, Nijjar RS, Watkin H, Naumann D, Emeshi S, Sarmah PB, Lee K, Joji N, Heath J, Teasdale RL, Weerasinghe C, Needham PJ, Welbourn H, Forster L, Finch D, Blazeby JM, Robb W, McNair AGK, Hrycaiczuk A, Charalabopoulos A, Kadirkamanathan S, Tang CB, Jayanthi NVG, Noor N, Dobbins B, Cockbain AJ, Nilsen-Nunn A, Siqueira J, Pellen M, Cowley JB, Ho WM, Miu V, White TJ, Hodgkins KA, Kinghorn A, Tutton MG, Al-Abed YA, Menzies D, Ahmad A, Reed J, Khan S, Monk D, Vitone LJ, Murtaza G, Joel A, Brennan S, Shier D, Zhang C, Yoganathan T, Robinson SJ, McCallum IJD, Jones MJ, Elsayed M, Tuck L, Wayman J, Carney K, Aroori S, Hosie KB, Kimble A, Bunting DM, Fawole AS, Basheer M, Dave RV, Sarveswaran J, Jones E, Kendal C, Tilston MP, Gough M, Wallace T, Singh S, Downing J, Mockford KA, Issa E, Shah N, Chauhan N, Wilson TR, Forouzanfar A, Wild JRL, Nofal E, Bunnell C, Madbak K, Rao STV, Devoto L, Siddiqi N, Khawaja Z, Hewes JC, Gould L, Chambers A, Urriza Rodriguez D, Sen G, Robinson S, Carney K, Bartlett F, Rae DM, Stevenson TEJ, Sarvananthan K, Dwerryhouse SJ, Higgs SM, Old OJ, Hardy TJ, Shah R, Hornby ST, Keogh K, Frank L, Al-Akash M, Upchurch EA, Frame RJ, Hughes M, Jelley C, Weaver S, Roy S, Sillo TO, Galanopoulos G, Cuming T, Cunha P, Tayeh S, Kaptanis S, Heshaishi M, Eisawi A, Abayomi M, Ngu WS, Fleming K, Singh Bajwa D, Chitre V, Aryal K, Ferris P, Silva M, Lammy S, Mohamed S, Khawaja A, Hussain A, Ghazanfar MA, Bellini MI, Ebdewi H, Elshaer M, Gravante G, Drake B, Ogedegbe A, Mukherjee D, Arhi C, Giwa Nusrat Iqbal L, Watson NF, Kumar Aggarwal S, Orchard P, Villatoro E, Willson PD, Wa K, Mok J, Woodman T, Deguara J, Garcea G, Babu BI, Dennison AR, Malde D, Lloyd D, Satheesan S, Al-Taan O, Boddy A, Slavin JP, Jones RP, Ballance L, Gerakopoulos S, Jambulingam P, Mansour S, Sakai N, Acharya V, Sadat MM, Karim L, Larkin D, Amin K, Khan A, Law J, Jamdar S, Smith SR, Sampat K, M O'shea K, Manu M, Asprou FM, Malik NS, Chang J, Johnstone M, Lewis M, Roberts GP, Karavadra B, Photi E, Hewes J, Gould L, Chambers A, Rodriguez D, O'Reilly DA, Rate AJ, Sekhar H, Henderson LT, Starmer BZ, Coe PO, Tolofari S, Barrie J, Bashir G, Sloane J, Madanipour S, Halkias C, Trevatt AEJ, Borowski DW, Hornsby J, Courtney MJ, Virupaksha S, Seymour K, Robinson S, Hawkins H, Bawa S, Gallagher PV, Reid A, Wood P, Finch JG, Parmar J, Stirland E, Gardner-Thorpe J, Al-Muhktar A, Peterson M, Majeed A, Bajwa FM, Martin J, Choy A, Tsang A, Pore N, Andrew DR, Al-Khyatt W, Taylor C, Bhandari S, Chambers A, Subramanium D, Toh SKC, Carter NC, Mercer SJ, Knight B, Tate S, Pearce B, Wainwright D, Vijay V, Alagaratnam S, Sinha S, Khan S, El-Hasani SS, Hussain AA, Bhattacharya V, Kansal N, Fasih T, Jackson C, Siddiqui MN, Chishti IA, Fordham IJ, Siddiqui Z, Bausbacher H, Geogloma I, Gurung K, Tsavellas G, Basynat P, Kiran Shrestha A, Basu S, Chhabra Mohan Harilingam A, Rabie M, Akhtar M, Kumar P, Jafferbhoy SF, Hussain N, Raza S, Haque M, Alam I, Aseem R, Patel S, Asad M, Booth MI, Ball WR, Wood CPJ, Pinho-Gomes AC, Kausar A, Rami Obeidallah M, Varghase J, Lodhia J, Bradley D, Rengifo C, Lindsay D, Gopalswamy S, Finlay I, Wardle S, Bullen N, Iftikhar SY, Awan A, Ahmed J, Leeder P, Fusai G, Bond-Smith G, Psica A, Puri Y, Hou D, Noble F, Szentpali K, Broadhurst J, Date R, Hossack MR, Li Goh Y, Turner P, Shetty V, Riera M, Macano CAW, Sukha A, Preston SR, Hoban JR, Puntis DJ, Williams SV, Krysztopik R, Kynaston J, Batt J, Doe M, Goscimski A, Jones GH, Smith SR, Hall C, Carty N, Ahmed J, Panteleimonitis S, Gunasekera RT, Sheel ARG, Lennon H, Hindley C, Reddy M, Kenny R, Elkheir N, McGlone ER, Rajaganeshan R, Hancorn K, Hargreaves A, Prasad R, Longbotham DA, Vijayanand D, Wijetunga I, Ziprin P, Nicolay CR, Yeldham G, Read E, Gossage JA, Rolph RC, Ebied H, Phull M, Khan MA, Popplewell M, Kyriakidis D, Hussain A, Henley N, Packer JR, Derbyshire L, Porter J, Appleton S, Farouk M, Basra M, Jennings NA, Ali S, Kanakala V, Ali H, Lane R, Dickson-Lowe R, Zarsadias P, Mirza D, Puig S, Al Amari K, Vijayan D, Sutcliffe R, Marudanayagam R, Hamady Z, Prasad AR, Patel A, Durkin D, Kaur P, Bowen L, Byrne JP, Pearson KL, Delisle TG, Davies J, Tomlinson MA, Johnpulle MA, Slawinski C, Macdonald A, Nicholson J, Newton K, Mbuvi J, Farooq A, Sidhartha Mothe B, Zafrani Z, Brett D, Francombe J, Spreadborough P, Barnes J, Cheung M, Al-Bahrani AZ, Preziosi G, Urbonas T, Alberts J, Mallik M, Patel K, Segaran A, Doulias T, Sufi PA, Yao C, Pollock S, Manzelli A, Wajed S, Kourkulos M, Pezzuto R, Wadley M, Hamilton E, Jaunoo S, Padwick R, Sayegh M, Newton RC, Hebbar M, Farag SF, Spearman J, Hamdan MF, D'Costa C, Blane C, Giles M, Peter MB, Hirst NA, Hossain T, Pannu A, El-Dhuwaib Y, Morrison TEM, Taylor GW, Thompson RLE, McCune K, Loughlin P, Lawther R, Byrnes CK, Simpson DJ, Mawhinney A, Warren C, McKay D, McIlmunn C, Martin S, MacArtney M, Diamond T, Davey P, Jones C, Clements JM, Digney R, Chan WM, McCain S, Gull S, Janeczko A, Dorrian E, Harris A, Dawson S, Johnston D, McAree B, Ghareeb E, Thomas G, Connelly M, McKenzie S, Cieplucha K, Spence G, Campbell W, Hooks G, Bradley N, Hill ADK, Cassidy JT, Boland M, Burke P, Nally DM, Hill ADK, Khogali E, Shabo W, Iskandar E, McEntee GP, O'Neill MA, Peirce C, Lyons EM, O'Sullivan AW, Thakkar R, Carroll P, Ivanovski I, Balfe P, Lee M, Winter DC, Kelly ME, Hoti E, Maguire D, Karunakaran P, Geoghegan JG, Martin ST, McDermott F, Cross KS, Cooke F, Zeeshan S, Murphy JO, Mealy K, Mohan HM, Nedujchelyn Y, Fahad Ullah M, Ahmed I, Giovinazzo F, Milburn J, Prince S, Brooke E, Buchan J, Khalil AM, Vaughan EM, Ramage MI, Aldridge RC, Gibson S, Nicholson GA, Vass DG, Grant AJ, Holroyd DJ, Jones MA, Sutton CMLR, O'Dwyer P, Nilsson F, Weber B, Williamson TK, Lalla K, Bryant A, Carter CR, Forrest CR, Hunter DI, Nassar AH, Orizu MN, Knight K, Qandeel H, Suttie S, Belding R, McClarey A, Boyd AT, Guthrie GJK, Lim PJ, Luhmann A, Watson AJM, Richards CH, Nicol L, Madurska M, Harrison E, Boyce KM, Roebuck A, Ferguson G, Pati P, Wilson MSJ, Dalgaty F, Fothergill L, Driscoll PJ, Mozolowski KL, Banwell V, Bennett SP, Rogers PN, Skelly BL, Rutherford CL, Mirza AK, Lazim T, Lim HCC, Duke D, Ahmed T, Beasley WD, Wilkinson MD, Maharaj G, Malcolm C, Brown TH, Shingler GM, Mowbray N, Radwan R, Morcous P, Wood S, Kadhim A, Stewart DJ, Baker AL, Tanner N, Shenoy H, Hafiz S, Marchi JA, Singh-Ranger D, Hisham E, Ainley P, O'Neill S, Terrace J, Napetti S, Hopwood B, Rhys T, Downing J, Kanavati O, Coats M, Aleksandrov D, Kallaway C, Yahya S, Weber B, Templeton A, Trotter M, Lo C, Dhillon A, Heywood N, Aawsaj Y, Hamdan A, Reece-Bolton O, McGuigan A, Shahin Y, Ali A, Luther A, Nicholson JA, Rajendran I, Boal M, Ritchie J. Population-based cohort study of variation in the use of emergency cholecystectomy for benign gallbladder diseases. Br J Surg 2016; 103:1716-1726. [PMID: 27748962 DOI: 10.1002/bjs.10288] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2016] [Revised: 06/21/2016] [Accepted: 07/06/2016] [Indexed: 01/05/2023]
Abstract
Abstract
Background
The aims of this prospective population-based cohort study were to identify the patient and hospital characteristics associated with emergency cholecystectomy, and the influences of these in determining variations between hospitals.
Methods
Data were collected for consecutive patients undergoing cholecystectomy in acute UK and Irish hospitals between 1 March and 1 May 2014. Potential explanatory variables influencing the performance of emergency cholecystectomy were analysed by means of multilevel, multivariable logistic regression modelling using a two-level hierarchical structure with patients (level 1) nested within hospitals (level 2).
Results
Data were collected on 4744 cholecystectomies from 165 hospitals. Increasing age, lower ASA fitness grade, biliary colic, the need for further imaging (magnetic retrograde cholangiopancreatography), endoscopic interventions (endoscopic retrograde cholangiopancreatography) and admission to a non-biliary centre significantly reduced the likelihood of an emergency cholecystectomy being performed. The multilevel model was used to calculate the probability of receiving an emergency cholecystectomy for a woman aged 40 years or over with an ASA grade of I or II and a BMI of at least 25·0 kg/m2, who presented with acute cholecystitis with an ultrasound scan showing a thick-walled gallbladder and a normal common bile duct. The mean predicted probability of receiving an emergency cholecystectomy was 0·52 (95 per cent c.i. 0·45 to 0·57). The predicted probabilities ranged from 0·02 to 0·95 across the 165 hospitals, demonstrating significant variation between hospitals.
Conclusion
Patients with similar characteristics presenting to different hospitals with acute gallbladder pathology do not receive comparable care.
Collapse
Affiliation(s)
| | - R S Vohra
- Trent Oesophago-Gastric Unit, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - S Pasquali
- Surgical Oncology Unit, Veneto Institute of Oncology IOV-IRCCS, Padova, Italy
| | - A J Kirkham
- Cancer Research UK Clinical Trials Unit, University of Birmingham, Birmingham, UK
| | - P Marriott
- West Midlands Research Collaborative, Academic Department of Surgery, University of Birmingham, Birmingham, UK
| | - M Johnstone
- West Midlands Research Collaborative, Academic Department of Surgery, University of Birmingham, Birmingham, UK
| | - P Spreadborough
- West Midlands Research Collaborative, Academic Department of Surgery, University of Birmingham, Birmingham, UK
| | - D Alderson
- Academic Department of Surgery, University of Birmingham, Birmingham, UK
| | - E A Griffiths
- Department of Upper Gastrointestinal Surgery, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - S Fenwick
- Aintree University Hospital NHS Foundation Trust
| | - M Elmasry
- Aintree University Hospital NHS Foundation Trust
| | - Q Nunes
- Aintree University Hospital NHS Foundation Trust
| | - D Kennedy
- Aintree University Hospital NHS Foundation Trust
| | | | | | | | | | - D Mason
- Wirral University Teaching Hospital
| | | | | | | | - S Jamel
- Barnet and Chase Farm Hospital
| | | | - S Zafar
- Barnet and Chase Farm Hospital
| | | | - N Samuel
- Barnsley District General Hospital
| | - F Dar
- Barnsley District General Hospital
| | | | | | | | | | | | | | - K Wheatley
- Sandwell and West Birmingham Hospitals NHS Trust
| | - T Nieto
- Sandwell and West Birmingham Hospitals NHS Trust
| | - S Ayaani
- Sandwell and West Birmingham Hospitals NHS Trust
| | - H Youssef
- Heart of England Foundation NHS Trust
| | | | - H Watkin
- Heart of England Foundation NHS Trust
| | - D Naumann
- Heart of England Foundation NHS Trust
| | - S Emeshi
- Heart of England Foundation NHS Trust
| | | | - K Lee
- Heart of England Foundation NHS Trust
| | - N Joji
- Heart of England Foundation NHS Trust
| | - J Heath
- Blackpool Teaching Hospitals NHS Foundation Trust
| | - R L Teasdale
- Blackpool Teaching Hospitals NHS Foundation Trust
| | | | - P J Needham
- Bradford Teaching Hospitals NHS Foundation Trust
| | - H Welbourn
- Bradford Teaching Hospitals NHS Foundation Trust
| | - L Forster
- Bradford Teaching Hospitals NHS Foundation Trust
| | - D Finch
- Bradford Teaching Hospitals NHS Foundation Trust
| | | | - W Robb
- University Hospitals Bristol NHS Trust
| | | | | | | | | | | | | | | | - B Dobbins
- Calderdale and Huddersfield NHS Trust
| | | | | | | | - M Pellen
- Hull and East Yorkshire NHS Trust
| | | | - W-M Ho
- Hull and East Yorkshire NHS Trust
| | - V Miu
- Hull and East Yorkshire NHS Trust
| | - T J White
- Chesterfield Royal Hospital NHS Foundation Trust
| | - K A Hodgkins
- Chesterfield Royal Hospital NHS Foundation Trust
| | - A Kinghorn
- Chesterfield Royal Hospital NHS Foundation Trust
| | - M G Tutton
- Colchester Hospital University NHS Foundation Trust
| | - Y A Al-Abed
- Colchester Hospital University NHS Foundation Trust
| | - D Menzies
- Colchester Hospital University NHS Foundation Trust
| | - A Ahmad
- Colchester Hospital University NHS Foundation Trust
| | - J Reed
- Colchester Hospital University NHS Foundation Trust
| | - S Khan
- Colchester Hospital University NHS Foundation Trust
| | - D Monk
- Countess of Chester NHS Foundation Trust
| | - L J Vitone
- Countess of Chester NHS Foundation Trust
| | - G Murtaza
- Countess of Chester NHS Foundation Trust
| | - A Joel
- Countess of Chester NHS Foundation Trust
| | | | - D Shier
- Croydon Health Services NHS Trust
| | - C Zhang
- Croydon Health Services NHS Trust
| | | | | | | | - M J Jones
- North Cumbria University Hospitals Trust
| | - M Elsayed
- North Cumbria University Hospitals Trust
| | - L Tuck
- North Cumbria University Hospitals Trust
| | - J Wayman
- North Cumbria University Hospitals Trust
| | - K Carney
- North Cumbria University Hospitals Trust
| | | | | | | | | | | | | | | | | | | | | | - M P Tilston
- Northern Lincolnshire and Goole NHS Foundation Trust
| | - M Gough
- Northern Lincolnshire and Goole NHS Foundation Trust
| | - T Wallace
- Northern Lincolnshire and Goole NHS Foundation Trust
| | - S Singh
- Northern Lincolnshire and Goole NHS Foundation Trust
| | - J Downing
- Northern Lincolnshire and Goole NHS Foundation Trust
| | - K A Mockford
- Northern Lincolnshire and Goole NHS Foundation Trust
| | - E Issa
- Northern Lincolnshire and Goole NHS Foundation Trust
| | - N Shah
- Northern Lincolnshire and Goole NHS Foundation Trust
| | - N Chauhan
- Northern Lincolnshire and Goole NHS Foundation Trust
| | - T R Wilson
- Doncaster and Bassetlaw Hospitals NHS Foundation Trust
| | - A Forouzanfar
- Doncaster and Bassetlaw Hospitals NHS Foundation Trust
| | - J R L Wild
- Doncaster and Bassetlaw Hospitals NHS Foundation Trust
| | - E Nofal
- Doncaster and Bassetlaw Hospitals NHS Foundation Trust
| | - C Bunnell
- Doncaster and Bassetlaw Hospitals NHS Foundation Trust
| | - K Madbak
- Doncaster and Bassetlaw Hospitals NHS Foundation Trust
| | - S T V Rao
- Dorset County Hospital NHS Foundation Trust
| | - L Devoto
- Dorset County Hospital NHS Foundation Trust
| | - N Siddiqi
- Dorset County Hospital NHS Foundation Trust
| | - Z Khawaja
- Dorset County Hospital NHS Foundation Trust
| | | | | | | | | | | | | | | | | | - D M Rae
- Frimley Park Hospital NHS Trust
| | | | | | | | | | - O J Old
- Gloucestershire Hospitals NHS Trust
| | | | - R Shah
- Gloucestershire Hospitals NHS Trust
| | | | - K Keogh
- Gloucestershire Hospitals NHS Trust
| | - L Frank
- Gloucestershire Hospitals NHS Trust
| | - M Al-Akash
- Great Western Hospitals NHS Foundation Trust
| | | | - R J Frame
- Harrogate and District NHS Foundation Trust
| | - M Hughes
- Harrogate and District NHS Foundation Trust
| | - C Jelley
- Harrogate and District NHS Foundation Trust
| | | | | | | | | | - T Cuming
- Homerton University Hospital NHS Trust
| | - P Cunha
- Homerton University Hospital NHS Trust
| | - S Tayeh
- Homerton University Hospital NHS Trust
| | | | | | - A Eisawi
- Tees Hospitals NHS Foundation Trust
| | | | - W S Ngu
- Tees Hospitals NHS Foundation Trust
| | | | | | - V Chitre
- Paget University Hospitals NHS Foundation Trust
| | - K Aryal
- Paget University Hospitals NHS Foundation Trust
| | - P Ferris
- Paget University Hospitals NHS Foundation Trust
| | | | | | | | | | | | | | | | - H Ebdewi
- Kettering General Hospital NHS Foundation Trust
| | - M Elshaer
- Kettering General Hospital NHS Foundation Trust
| | - G Gravante
- Kettering General Hospital NHS Foundation Trust
| | - B Drake
- Kettering General Hospital NHS Foundation Trust
| | - A Ogedegbe
- Barking, Havering and Redbridge University Hospitals NHS Trust
| | - D Mukherjee
- Barking, Havering and Redbridge University Hospitals NHS Trust
| | - C Arhi
- Barking, Havering and Redbridge University Hospitals NHS Trust
| | | | | | | | | | | | | | - K Wa
- Kingston Hospital NHS Foundation Trust
| | - J Mok
- Kingston Hospital NHS Foundation Trust
| | - T Woodman
- Kingston Hospital NHS Foundation Trust
| | - J Deguara
- Kingston Hospital NHS Foundation Trust
| | - G Garcea
- University Hospitals of Leicester NHS Trust
| | - B I Babu
- University Hospitals of Leicester NHS Trust
| | | | - D Malde
- University Hospitals of Leicester NHS Trust
| | - D Lloyd
- University Hospitals of Leicester NHS Trust
| | | | - O Al-Taan
- University Hospitals of Leicester NHS Trust
| | - A Boddy
- University Hospitals of Leicester NHS Trust
| | - J P Slavin
- Leighton Hospital, Mid Cheshire Hospitals NHS Foundation Trust
| | - R P Jones
- Leighton Hospital, Mid Cheshire Hospitals NHS Foundation Trust
| | - L Ballance
- Leighton Hospital, Mid Cheshire Hospitals NHS Foundation Trust
| | - S Gerakopoulos
- Leighton Hospital, Mid Cheshire Hospitals NHS Foundation Trust
| | - P Jambulingam
- Luton and Dunstable University Hospital NHS Foundation Trust
| | - S Mansour
- Luton and Dunstable University Hospital NHS Foundation Trust
| | - N Sakai
- Luton and Dunstable University Hospital NHS Foundation Trust
| | - V Acharya
- Luton and Dunstable University Hospital NHS Foundation Trust
| | - M M Sadat
- Macclesfield District General Hospital
| | - L Karim
- Macclesfield District General Hospital
| | - D Larkin
- Macclesfield District General Hospital
| | - K Amin
- Macclesfield District General Hospital
| | - A Khan
- Central Manchester NHS Foundation Trust
| | - J Law
- Central Manchester NHS Foundation Trust
| | - S Jamdar
- Central Manchester NHS Foundation Trust
| | - S R Smith
- Central Manchester NHS Foundation Trust
| | - K Sampat
- Central Manchester NHS Foundation Trust
| | | | - M Manu
- Royal Wolverhampton Hospitals NHS Trust
| | | | - N S Malik
- Royal Wolverhampton Hospitals NHS Trust
| | - J Chang
- Royal Wolverhampton Hospitals NHS Trust
| | | | - M Lewis
- Norfolk and Norwich University Hospitals NHS Foundation Trust
| | - G P Roberts
- Norfolk and Norwich University Hospitals NHS Foundation Trust
| | - B Karavadra
- Norfolk and Norwich University Hospitals NHS Foundation Trust
| | - E Photi
- Norfolk and Norwich University Hospitals NHS Foundation Trust
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - J Hornsby
- North Tees and Hartlepool NHS Foundation Trust
| | | | | | - K Seymour
- Northumbria Healthcare NHS Foundation Trust
| | - S Robinson
- Northumbria Healthcare NHS Foundation Trust
| | - H Hawkins
- Northumbria Healthcare NHS Foundation Trust
| | - S Bawa
- Northumbria Healthcare NHS Foundation Trust
| | | | - A Reid
- Northumbria Healthcare NHS Foundation Trust
| | - P Wood
- Northumbria Healthcare NHS Foundation Trust
| | - J G Finch
- Northampton General Hospital NHS Trust
| | - J Parmar
- Northampton General Hospital NHS Trust
| | | | | | - A Al-Muhktar
- Sheffield Teaching Hospitals NHS Foundation Trust
| | - M Peterson
- Sheffield Teaching Hospitals NHS Foundation Trust
| | - A Majeed
- Sheffield Teaching Hospitals NHS Foundation Trust
| | | | | | - A Choy
- Peterborough City Hospital
| | | | - N Pore
- United Lincolnshire Hospitals NHS Trust
| | | | | | - C Taylor
- United Lincolnshire Hospitals NHS Trust
| | | | | | | | | | | | | | | | - S Tate
- Portsmouth Hospitals NHS Trust
| | | | | | - V Vijay
- The Princess Alexandra Hospital NHS Trust
| | | | - S Sinha
- The Princess Alexandra Hospital NHS Trust
| | - S Khan
- The Princess Alexandra Hospital NHS Trust
| | | | - A A Hussain
- King's College Hospital NHS Foundation Trust
| | | | - N Kansal
- Gateshead Health NHS Foundation Trust
| | - T Fasih
- Gateshead Health NHS Foundation Trust
| | - C Jackson
- Gateshead Health NHS Foundation Trust
| | | | | | | | | | | | | | - K Gurung
- Queen Elizabeth Hospital NHS Trust
| | - G Tsavellas
- East Kent Hospitals University NHS Foundation Trust
| | - P Basynat
- East Kent Hospitals University NHS Foundation Trust
| | | | - S Basu
- East Kent Hospitals University NHS Foundation Trust
| | | | - M Rabie
- East Kent Hospitals University NHS Foundation Trust
| | - M Akhtar
- East Kent Hospitals University NHS Foundation Trust
| | - P Kumar
- Burton Hospitals NHS Foundation Trust
| | | | - N Hussain
- Burton Hospitals NHS Foundation Trust
| | - S Raza
- Burton Hospitals NHS Foundation Trust
| | - M Haque
- Royal Albert Edward Infirmary, Wigan Wrightington and Leigh NHS Trust
| | - I Alam
- Royal Albert Edward Infirmary, Wigan Wrightington and Leigh NHS Trust
| | - R Aseem
- Royal Albert Edward Infirmary, Wigan Wrightington and Leigh NHS Trust
| | - S Patel
- Royal Albert Edward Infirmary, Wigan Wrightington and Leigh NHS Trust
| | - M Asad
- Royal Albert Edward Infirmary, Wigan Wrightington and Leigh NHS Trust
| | - M I Booth
- Royal Berkshire NHS Foundation Trust
| | - W R Ball
- Royal Berkshire NHS Foundation Trust
| | | | | | | | | | - J Varghase
- Royal Bolton Hospital NHS Foundation Trust
| | - J Lodhia
- Royal Bolton Hospital NHS Foundation Trust
| | - D Bradley
- Royal Bolton Hospital NHS Foundation Trust
| | - C Rengifo
- Royal Bolton Hospital NHS Foundation Trust
| | - D Lindsay
- Royal Bolton Hospital NHS Foundation Trust
| | | | | | | | | | | | - A Awan
- Royal Derby NHS Foundation Trust
| | - J Ahmed
- Royal Derby NHS Foundation Trust
| | - P Leeder
- Royal Derby NHS Foundation Trust
| | | | | | | | | | - D Hou
- Hampshire Hospital NHS Foundation Trust
| | - F Noble
- Hampshire Hospital NHS Foundation Trust
| | | | | | - R Date
- Lancashire Teaching Hospitals NHS Foundation Trust
| | - M R Hossack
- Lancashire Teaching Hospitals NHS Foundation Trust
| | - Y Li Goh
- Lancashire Teaching Hospitals NHS Foundation Trust
| | - P Turner
- Lancashire Teaching Hospitals NHS Foundation Trust
| | - V Shetty
- Lancashire Teaching Hospitals NHS Foundation Trust
| | | | | | | | - S R Preston
- Royal Surrey County Hospital NHS Foundation Trust
| | - J R Hoban
- Royal Surrey County Hospital NHS Foundation Trust
| | - D J Puntis
- Royal Surrey County Hospital NHS Foundation Trust
| | - S V Williams
- Royal Surrey County Hospital NHS Foundation Trust
| | | | | | - J Batt
- Royal United Hospital Bath NHS Trust
| | - M Doe
- Royal United Hospital Bath NHS Trust
| | | | | | | | - C Hall
- Salford Royal NHS Foundation Trust
| | - N Carty
- Salisbury Hospital Foundation Trust
| | - J Ahmed
- Salisbury Hospital Foundation Trust
| | | | | | | | - H Lennon
- Southport and Ormskirk Hospital NHS Trust
| | - C Hindley
- Southport and Ormskirk Hospital NHS Trust
| | - M Reddy
- St George's Healthcare NHS Trust
| | - R Kenny
- St George's Healthcare NHS Trust
| | | | | | | | - K Hancorn
- St Helens and Knowsley Teaching Hospitals NHS Trust
| | - A Hargreaves
- St Helens and Knowsley Teaching Hospitals NHS Trust
| | | | | | | | | | - P Ziprin
- Imperial College Healthcare NHS Trust
| | | | - G Yeldham
- Imperial College Healthcare NHS Trust
| | - E Read
- Imperial College Healthcare NHS Trust
| | | | | | | | | | - M A Khan
- Mid Staffordshire NHS Foundation Trust
| | | | | | - A Hussain
- Mid Staffordshire NHS Foundation Trust
| | | | | | | | | | | | | | | | | | - S Ali
- City Hospitals Sunderland NHS Foundation Trust
| | - V Kanakala
- City Hospitals Sunderland NHS Foundation Trust
| | - H Ali
- Tunbridge Wells and Maidstone NHS Trust
| | - R Lane
- Tunbridge Wells and Maidstone NHS Trust
| | | | | | - D Mirza
- University Hospital Birmingham NHS Foundation Trust
| | - S Puig
- University Hospital Birmingham NHS Foundation Trust
| | - K Al Amari
- University Hospital Birmingham NHS Foundation Trust
| | - D Vijayan
- University Hospital Birmingham NHS Foundation Trust
| | - R Sutcliffe
- University Hospital Birmingham NHS Foundation Trust
| | | | - Z Hamady
- University Hospital Coventry and Warwickshire NHS Trust
| | - A R Prasad
- University Hospital Coventry and Warwickshire NHS Trust
| | - A Patel
- University Hospital Coventry and Warwickshire NHS Trust
| | - D Durkin
- University Hospital of North Staffordshire NHS Trust
| | - P Kaur
- University Hospital of North Staffordshire NHS Trust
| | - L Bowen
- University Hospital of North Staffordshire NHS Trust
| | - J P Byrne
- University Hospital Southampton NHS Foundation Trust
| | - K L Pearson
- University Hospital Southampton NHS Foundation Trust
| | - T G Delisle
- University Hospital Southampton NHS Foundation Trust
| | - J Davies
- University Hospital Southampton NHS Foundation Trust
| | | | | | | | - A Macdonald
- University Hospital South Manchester NHS Foundation Trust
| | - J Nicholson
- University Hospital South Manchester NHS Foundation Trust
| | - K Newton
- University Hospital South Manchester NHS Foundation Trust
| | - J Mbuvi
- University Hospital South Manchester NHS Foundation Trust
| | - A Farooq
- Warrington and Halton Hospitals NHS Trust
| | | | - Z Zafrani
- Warrington and Halton Hospitals NHS Trust
| | - D Brett
- Warrington and Halton Hospitals NHS Trust
| | | | | | - J Barnes
- South Warwickshire NHS Foundation Trust
| | - M Cheung
- South Warwickshire NHS Foundation Trust
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - M Wadley
- Worcestershire Acute Hospitals NHS Trust
| | - E Hamilton
- Worcestershire Acute Hospitals NHS Trust
| | - S Jaunoo
- Worcestershire Acute Hospitals NHS Trust
| | - R Padwick
- Worcestershire Acute Hospitals NHS Trust
| | - M Sayegh
- Western Sussex Hospitals NHS Foundation Trust
| | - R C Newton
- Western Sussex Hospitals NHS Foundation Trust
| | - M Hebbar
- Western Sussex Hospitals NHS Foundation Trust
| | - S F Farag
- Western Sussex Hospitals NHS Foundation Trust
| | | | | | | | - C Blane
- Yeovil District Hospital NHS Trust
| | - M Giles
- York Teaching Hospital NHS Foundation Trust
| | - M B Peter
- York Teaching Hospital NHS Foundation Trust
| | - N A Hirst
- York Teaching Hospital NHS Foundation Trust
| | - T Hossain
- York Teaching Hospital NHS Foundation Trust
| | - A Pannu
- York Teaching Hospital NHS Foundation Trust
| | | | | | - G W Taylor
- York Teaching Hospital NHS Foundation Trust
| | | | | | | | | | | | | | | | | | | | | | | | | | - T Diamond
- Belfast City Hospital, Mater Infirmorum Hospital Belfast and Royal Victoria Hospital
| | - P Davey
- Belfast City Hospital, Mater Infirmorum Hospital Belfast and Royal Victoria Hospital
| | - C Jones
- Belfast City Hospital, Mater Infirmorum Hospital Belfast and Royal Victoria Hospital
| | - J M Clements
- Belfast City Hospital, Mater Infirmorum Hospital Belfast and Royal Victoria Hospital
| | - R Digney
- Belfast City Hospital, Mater Infirmorum Hospital Belfast and Royal Victoria Hospital
| | - W M Chan
- Belfast City Hospital, Mater Infirmorum Hospital Belfast and Royal Victoria Hospital
| | - S McCain
- Belfast City Hospital, Mater Infirmorum Hospital Belfast and Royal Victoria Hospital
| | - S Gull
- Belfast City Hospital, Mater Infirmorum Hospital Belfast and Royal Victoria Hospital
| | - A Janeczko
- Belfast City Hospital, Mater Infirmorum Hospital Belfast and Royal Victoria Hospital
| | - E Dorrian
- Belfast City Hospital, Mater Infirmorum Hospital Belfast and Royal Victoria Hospital
| | - A Harris
- Belfast City Hospital, Mater Infirmorum Hospital Belfast and Royal Victoria Hospital
| | - S Dawson
- Belfast City Hospital, Mater Infirmorum Hospital Belfast and Royal Victoria Hospital
| | - D Johnston
- Belfast City Hospital, Mater Infirmorum Hospital Belfast and Royal Victoria Hospital
| | - B McAree
- Belfast City Hospital, Mater Infirmorum Hospital Belfast and Royal Victoria Hospital
| | | | | | | | | | | | | | | | | | | | | | | | | | - P Burke
- University Hospital Limerick
| | | | - A D K Hill
- Louth County Hospital and Our Lady of Lourdes Hospital
| | - E Khogali
- Louth County Hospital and Our Lady of Lourdes Hospital
| | - W Shabo
- Louth County Hospital and Our Lady of Lourdes Hospital
| | - E Iskandar
- Louth County Hospital and Our Lady of Lourdes Hospital
| | | | | | | | | | | | | | | | | | - P Balfe
- St Luke's General Hospital Kilkenny
| | - M Lee
- St Luke's General Hospital Kilkenny
| | - D C Winter
- St Vincent's University and Private Hospitals, Dublin
| | - M E Kelly
- St Vincent's University and Private Hospitals, Dublin
| | - E Hoti
- St Vincent's University and Private Hospitals, Dublin
| | - D Maguire
- St Vincent's University and Private Hospitals, Dublin
| | - P Karunakaran
- St Vincent's University and Private Hospitals, Dublin
| | - J G Geoghegan
- St Vincent's University and Private Hospitals, Dublin
| | - S T Martin
- St Vincent's University and Private Hospitals, Dublin
| | - F McDermott
- St Vincent's University and Private Hospitals, Dublin
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - S Gibson
- Crosshouse Hospital, Ayrshire and Arran
| | | | - D G Vass
- Crosshouse Hospital, Ayrshire and Arran
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - H C C Lim
- Glangwili General and Prince Philip Hospital
| | - D Duke
- Glangwili General and Prince Philip Hospital
| | - T Ahmed
- Glangwili General and Prince Philip Hospital
| | - W D Beasley
- Glangwili General and Prince Philip Hospital
| | | | - G Maharaj
- Glangwili General and Prince Philip Hospital
| | - C Malcolm
- Glangwili General and Prince Philip Hospital
| | | | | | | | - R Radwan
- Morriston and Singleton Hospitals
| | | | - S Wood
- Princess of Wales Hospital
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
3
|
Carlson J, Slavin J. Health benefits of fibre, prebiotics and probiotics: a review of intestinal health and related health claims. Quality Assurance and Safety of Crops & Foods 2016. [DOI: 10.3920/qas2015.0791] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Affiliation(s)
- J. Carlson
- Department of Food Science and Nutrition, University of Minnesota, Twin Cities 1334 Eckles Avenue, St. Paul, MN 55108, USA
| | - J. Slavin
- Department of Food Science and Nutrition, University of Minnesota, Twin Cities 1334 Eckles Avenue, St. Paul, MN 55108, USA
| |
Collapse
|
4
|
Erickson J, Sadeghirad B, Lytvyn L, Adams-Webber T, Johnston B, Slavin J. Dietary Sugar Intake: Systematic Review of Public Health Guidelines and their Recommendations. J Acad Nutr Diet 2016. [DOI: 10.1016/j.jand.2016.06.040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
|
5
|
Erickson J, Wang Q, Slavin J. Effect of White Grape Juice Compared to Apple Juice on Gastrointestinal Tolerance and Breath Hydrogen Response in Healthy Human Subjects. J Acad Nutr Diet 2016. [DOI: 10.1016/j.jand.2016.06.162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
|
6
|
Ngan S, Charoenlap C, Imanishi J, Slavin J, Ngan C, Chu J, Chander S, Choong P. Factors influencing unplanned excision in soft tissue sarcoma. Eur J Cancer 2016. [DOI: 10.1016/j.ejca.2016.03.027] [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: 10/21/2022]
|
7
|
El-Dhuwaib Y, Slavin J, Corless DJ, Begaj I, Durkin D, Deakin M. Bile duct reconstruction following laparoscopic cholecystectomy in England. Surg Endosc 2016; 30:3516-25. [PMID: 26830413 PMCID: PMC4956705 DOI: 10.1007/s00464-015-4641-8] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2015] [Accepted: 10/22/2015] [Indexed: 12/16/2022]
Abstract
Objectives To determine the incidence of bile duct reconstruction (BDR) following laparoscopic cholecystectomy (LC) and to identify associated risk factors. Background Major bile duct injury (BDI) requiring reconstruction is a serious complication of cholecystectomy. Methods All LC and attempted LC operations in England between April 2001 and March 2013 were identified. Patients with malignancy, a stone in bile duct or those who underwent bile duct exploration were excluded. This cohort of patients was followed for 1 year to identify those who underwent BDR as a surrogate marker for major BDI. Logistic regression was used to identify factors associated with the need for reconstruction. Results In total, 572,223 LC and attempted LC were performed in England between April 2001 and March 2013. Five hundred (0.09 %) of these patients underwent BDR. The risk of BDR is lower in patient that do not have acute cholecystitis [odds ratio (OR) 0.48 (95 % CI 0.30–0.76)]. The regular use of on-table cholangiography (OTC) [OR 0.69 (0.54–0.88)] and high consultant caseload >80 LC/year [OR 0.56 (0.39–0.54)] reduced the risk of BDR. Patients who underwent BDR were 10 times more likely to die within a year than those who did not require further surgery (6 vs. 0.6 %). Conclusions The rate of BDR following laparoscopic cholecystectomy in England is low (0.09 %). The study suggests that OTC should be used more widely and provides further evidence in support of the provision of LC services by specialised teams with an adequate caseload (>80).
Collapse
Affiliation(s)
- Y El-Dhuwaib
- The Institute for Science and Technology in Medicine, Keele University, Stoke-on-Trent, UK
| | - J Slavin
- The Institute for Science and Technology in Medicine, Keele University, Stoke-on-Trent, UK.,Department of Surgery, Mid Cheshire Hospitals NHS Foundation Trust, Crewe, UK
| | - D J Corless
- Department of Surgery, Mid Cheshire Hospitals NHS Foundation Trust, Crewe, UK
| | - I Begaj
- Health Informatics Department, University Hospitals Birmingham, Birmingham, UK
| | - D Durkin
- Department of Surgery, Royal Stoke University Hospital, Stoke-on-Trent, ST4 6RG, UK
| | - M Deakin
- The Institute for Science and Technology in Medicine, Keele University, Stoke-on-Trent, UK. .,Department of Surgery, Royal Stoke University Hospital, Stoke-on-Trent, ST4 6RG, UK.
| |
Collapse
|
8
|
Ali A, Bell S, Bilsland A, Slavin J, Lynch V, Elgoweini M, Derakhshan M, Oien K, Duthie F. 47P Investigating various thresholds as immunohistochemistry cut-offs for observer agreement. Ann Oncol 2015. [DOI: 10.1093/annonc/mdv518.22] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
|
9
|
Knipp DJ, Kilcommons LM, Gjerloev J, Redmon RJ, Slavin J, Le G. A large-scale view of Space Technology 5 magnetometer response to solar wind drivers. Earth Space Sci 2015; 2:115-124. [PMID: 27981071 PMCID: PMC5125408 DOI: 10.1002/2014ea000057] [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] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/24/2014] [Revised: 02/26/2015] [Accepted: 03/17/2015] [Indexed: 06/01/2023]
Abstract
In this data report we discuss reprocessing of the Space Technology 5 (ST5) magnetometer database for inclusion in NASA's Coordinated Data Analysis Web (CDAWeb) virtual observatory. The mission consisted of three spacecraft flying in elliptical orbits, from 27 March to 27 June 2006. Reprocessing includes (1) transforming the data into the Modified Apex Coordinate System for projection to a common reference altitude of 110 km, (2) correcting gain jumps, and (3) validating the results. We display the averaged magnetic perturbations as a keogram, which allows direct comparison of the full-mission data with the solar wind values and geomagnetic indices. With the data referenced to a common altitude, we find the following: (1) Magnetic perturbations that track the passage of corotating interaction regions and high-speed solar wind; (2) unexpectedly strong dayside perturbations during a solstice magnetospheric sawtooth oscillation interval characterized by a radial interplanetary magnetic field (IMF) component that may have enhanced the accompanying modest southward IMF; and (3) intervals of reduced magnetic perturbations or "calms," associated with periods of slow solar wind, interspersed among variable-length episodic enhancements. These calms are most evident when the IMF is northward or projects with a northward component onto the geomagnetic dipole. The reprocessed ST5 data are in very good agreement with magnetic perturbations from the Defense Meteorological Satellite Program (DMSP) spacecraft, which we also map to 110 km. We briefly discuss the methods used to remap the ST5 data and the means of validating the results against DMSP. Our methods form the basis for future intermission comparisons of space-based magnetometer data.
Collapse
Affiliation(s)
- D. J. Knipp
- Aerospace Engineering SciencesUniversity of Colorado BoulderBoulderColoradoUSA
- High Altitude Observatory, NCARBoulderColoradoUSA
| | - L. M. Kilcommons
- Aerospace Engineering SciencesUniversity of Colorado BoulderBoulderColoradoUSA
| | - J. Gjerloev
- Applied Physics LaboratoryJohns Hopkins UniversityLaurelMarylandUSA
- Birkeland Centre of ExcellenceUniversity of BergenBergenNorway
| | - R. J. Redmon
- National Geophysical Data Center, NOAABoulderColoradoUSA
| | - J. Slavin
- Atmospheric, Oceanic and Space SciencesUniversity of MichiganAnn ArborMichiganUSA
| | - G. Le
- NASA Goddard Space Flight CenterGreenbeltMarylandUSA
| |
Collapse
|
10
|
Learmont JP, Powell G, Slavin J, Facey M, Pianta M. A case of benign periosteal chondroma seeding into humeral medullary bone via percutaneous needle biopsy tract. BJR Case Rep 2015; 1:20150104. [PMID: 30363208 PMCID: PMC6159157 DOI: 10.1259/bjrcr.20150104] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2015] [Accepted: 04/09/2015] [Indexed: 11/05/2022] Open
Abstract
We report an occurrence of periosteal chondroma seeding into the medulla of humerus via percutaneous needle biopsy tract. To our knowledge, this is the first described case of benign cartilage tumour biopsy tract seeding in the literature. We discuss the clinical, radiological and histological features of periosteal chondroma, as well as the diagnostic challenges associated with distinguishing this entity from periosteal chondrosarcoma. Finally, we briefly discuss the safety of imaging-guided percutaneous needle biopsy and methods to minimize the risk of iatrogenic tumour seeding.
Collapse
|
11
|
Lewin J, Khamly KK, Young RJ, Mitchell C, Hicks RJ, Toner GC, Ngan SYK, Chander S, Powell GJ, Herschtal A, Te Marvelde L, Desai J, Choong PFM, Stacker SA, Achen MG, Ferris N, Fox S, Slavin J, Thomas DM. A phase Ib/II translational study of sunitinib with neoadjuvant radiotherapy in soft-tissue sarcoma. Br J Cancer 2014; 111:2254-61. [PMID: 25321190 PMCID: PMC4264446 DOI: 10.1038/bjc.2014.537] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [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: 07/20/2014] [Revised: 08/29/2014] [Accepted: 09/17/2014] [Indexed: 12/16/2022] Open
Abstract
Background: Preoperative radiotherapy (RT) is commonly used to treat localised soft-tissue sarcomas (STS). Hypoxia is an important determinant of radioresistance. Whether antiangiogenic therapy can ‘normalise' tumour vasculature, thereby improving oxygenation, remains unknown. Methods: Two cohorts were prospectively enrolled. Cohort A evaluated the implications of hypoxia in STS, using the hypoxic tracer 18F-azomycin arabinoside (FAZA-PET). In cohort B, sunitinib was added to preoperative RT in a dose-finding phase 1b/2 design. Results: In cohort A, 13 out of 23 tumours were hypoxic (FAZA-PET), correlating with metabolic activity (r2=0.85; P<0.001). Two-year progression-free (PFS) and overall (OS) survival were 61% (95% CI: 0.44–0.84) and 87% (95% CI: 0.74–1.00), respectively. Hypoxia was associated with radioresistance (P=0.012), higher local recurrence (Hazard ratio (HR): 10.2; P=0.02), PFS (HR: 8.4; P=0.02), and OS (HR: 41.4; P<0.04). In Cohort B, seven patients received sunitinib at dose level (DL): 0 (50 mg per day for 2 weeks before RT; 25 mg per day during RT) and two patients received DL: −1 (37.5 mg per day for entire period). Dose-limiting toxicities were observed in 4 out of 7 patients at DL 0 and 2 out of 2 patients at DL −1, resulting in premature study closure. Although there was no difference in PFS or OS, patients receiving sunitinib had higher local failure (HR: 8.1; P=0.004). Conclusion: In STS, hypoxia is associated with adverse outcomes. The combination of sunitinib with preoperative RT resulted in unacceptable toxicities, and higher local relapse rates.
Collapse
Affiliation(s)
- J Lewin
- Peter MacCallum Cancer Centre, East Melbourne, Victoria, Australia
| | - K K Khamly
- Peter MacCallum Cancer Centre, East Melbourne, Victoria, Australia
| | - R J Young
- Peter MacCallum Cancer Centre, East Melbourne, Victoria, Australia
| | - C Mitchell
- Peter MacCallum Cancer Centre, East Melbourne, Victoria, Australia
| | - R J Hicks
- 1] Peter MacCallum Cancer Centre, East Melbourne, Victoria, Australia [2] The University of Melbourne, St Vincent's Hospital Campus, Fitzroy, Victoria, Australia
| | - G C Toner
- 1] Peter MacCallum Cancer Centre, East Melbourne, Victoria, Australia [2] The University of Melbourne, St Vincent's Hospital Campus, Fitzroy, Victoria, Australia
| | - S Y K Ngan
- Peter MacCallum Cancer Centre, East Melbourne, Victoria, Australia
| | - S Chander
- Peter MacCallum Cancer Centre, East Melbourne, Victoria, Australia
| | - G J Powell
- 1] Peter MacCallum Cancer Centre, East Melbourne, Victoria, Australia [2] Department of Orthopaedics, St. Vincent's Hospital, Fitzroy, Victoria, Australia [3] Department of Surgery, The University of Melbourne, St. Vincent's Hospital, Fitzroy, Victoria, Australia
| | - A Herschtal
- Peter MacCallum Cancer Centre, East Melbourne, Victoria, Australia
| | - L Te Marvelde
- Peter MacCallum Cancer Centre, East Melbourne, Victoria, Australia
| | - J Desai
- Peter MacCallum Cancer Centre, East Melbourne, Victoria, Australia
| | - P F M Choong
- 1] Peter MacCallum Cancer Centre, East Melbourne, Victoria, Australia [2] Department of Orthopaedics, St. Vincent's Hospital, Fitzroy, Victoria, Australia [3] Department of Surgery, The University of Melbourne, St. Vincent's Hospital, Fitzroy, Victoria, Australia
| | - S A Stacker
- 1] Peter MacCallum Cancer Centre, East Melbourne, Victoria, Australia [2] Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Victoria, Australia
| | - M G Achen
- 1] Peter MacCallum Cancer Centre, East Melbourne, Victoria, Australia [2] Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Victoria, Australia
| | - N Ferris
- Peter MacCallum Cancer Centre, East Melbourne, Victoria, Australia
| | - S Fox
- Peter MacCallum Cancer Centre, East Melbourne, Victoria, Australia
| | - J Slavin
- The University of Melbourne, St Vincent's Hospital Campus, Fitzroy, Victoria, Australia
| | - D M Thomas
- 1] Peter MacCallum Cancer Centre, East Melbourne, Victoria, Australia [2] The University of Melbourne, St Vincent's Hospital Campus, Fitzroy, Victoria, Australia [3] The Kinghorn Cancer Centre, Garvan Institute of Medical Research, 370 Victoria Street, Darlinghurst, New South Wales 2010, Australia
| |
Collapse
|
12
|
Steyn N, Heggie A, MacGregor D, Aldred MJ, Talacko AA, Coleman H, Bonar F, Slavin J, Wall M, Firth N. Clinical pathologic conference case 4: a 15-year-old boy with radiographic changes in the left mandible. Oral Surg Oral Med Oral Pathol Oral Radiol 2013; 116:e71-5. [PMID: 23926615 DOI: 10.1016/j.oooo.2013.01.053] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
MESH Headings
- 12E7 Antigen
- Adolescent
- Antigens, CD/analysis
- Antigens, CD/genetics
- Cell Adhesion Molecules/analysis
- Cell Adhesion Molecules/genetics
- Diagnosis, Differential
- Humans
- In Situ Hybridization, Fluorescence
- Jaw Neoplasms/drug therapy
- Jaw Neoplasms/genetics
- Jaw Neoplasms/pathology
- Male
- Mandible/pathology
- Proto-Oncogene Protein c-fli-1/analysis
- Proto-Oncogene Protein c-fli-1/genetics
- Radiography, Panoramic
- Sarcoma, Ewing/drug therapy
- Sarcoma, Ewing/genetics
- Sarcoma, Ewing/pathology
- Sarcoma, Small Cell/pathology
- Translocation, Genetic
Collapse
Affiliation(s)
- N Steyn
- Dorevitch Pathology, Royal Children's Hospital
| | | | | | | | | | | | | | | | | | | |
Collapse
|
13
|
Affiliation(s)
- J P Slavin
- Department of Surgery, Leighton Hospital, Middlewich Road, Crewe, Cheshire CW1 4QJ, UK.
| | | | | |
Collapse
|
14
|
Affiliation(s)
- J. Slavin
- Department of Food Science and Nutrition; University of Minnesota; USA
| |
Collapse
|
15
|
O'Neill M, Wang S, Thomas W, Slavin J. Both White and Brown Rice More Satiating than Glucose Drink. J Acad Nutr Diet 2012. [DOI: 10.1016/j.jand.2012.06.048] [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: 11/29/2022]
|
16
|
Abstract
INTRODUCTION The aim of this study was to investigate whether definitive treatment of gallstone pancreatitis (GSP) by either cholecystectomy or endoscopic sphincterotomy in England conforms with British Society of Gastroenterology (BSG) guidelines and to validate these guidelines. METHODS Hospital Episode Statistics data were used to identify patients admitted for the first time with GSP between April 2007 and April 2008. These patients were followed until April 2009 to identify any who underwent definitive treatment or were readmitted with a further bout of GSP as an emergency. RESULTS A total of 5,454 patients were admitted with GSP between April 2007 and April 2008, of whom 1,866 (34.2%) underwent definitive treatment according to BSG guidelines, 1,471 on the index admission. Patients who underwent a cholecystectomy during the index admission were less likely to be readmitted with a further bout of GSP (1.7%) than those who underwent endoscopic sphincterotomy alone (5.3%) or those who did not undergo any form of definitive treatment (13.2%). Of those patients who did not undergo definitive treatment before discharge, 2,239 received definitive treatment following discharge but only 395 (17.6%) of these had this within 2 weeks. Of the 505 patients who did not undergo definitive treatment on the index admission and who were readmitted as an emergency with GSP, 154 (30.5%) were admitted during the 2 weeks immediately following discharge. CONCLUSIONS Following an attack of mild GSP, cholecystectomy should be offered to all patients prior to discharge. If patients are not fit for surgery, an endoscopic sphincterotomy should be performed as definitive treatment.
Collapse
Affiliation(s)
| | - M Deakin
- University Hospital of North Staffordshire NHS Trust,UK
| | - GG David
- Mid Cheshire Hospitals NHS Foundation Trust,UK
| | - D Durkin
- University Hospital of North Staffordshire NHS Trust,UK
| | - DJ Corless
- Mid Cheshire Hospitals NHS Foundation Trust,UK
| | - JP Slavin
- Mid Cheshire Hospitals NHS Foundation Trust,UK
| |
Collapse
|
17
|
Jones JM, Klurfeld DM, Slavin J, Waybright S. Preparing for the 2015 Dietary Guidelines: Attributes of Refined Grains, Added Fibers, and Bran. CEREAL FOOD WORLD 2012. [DOI: 10.1094/cfw-57-2-0086] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Affiliation(s)
- J. M. Jones
- St. Catherine University, Arden Hills, MN, U.S.A
| | - D. M. Klurfeld
- USDA Agricultural Research Service, Beltsville, MD, U.S.A
| | - J. Slavin
- University of Minnesota, St. Paul, MN, U.S.A
| | | |
Collapse
|
18
|
Dimitroulis G, Slavin J, Morrison W. Histological fate of abdominal dermis–fat grafts implanted in the temporomandibular joint of the rabbit following condylectomy. Int J Oral Maxillofac Surg 2011; 40:177-83. [DOI: 10.1016/j.ijom.2010.09.022] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2010] [Revised: 04/10/2010] [Accepted: 09/24/2010] [Indexed: 11/30/2022]
|
19
|
Abstract
INTRODUCTION A temporary loop ileostomy is often created to minimize the impact of peritoneal sepsis if anastomotic dehiscence occurs following low colorectal anastomosis. Although it has been suggested that a loop ileostomy should be reversed within 12 weeks of formation, this is often not the case. We set out to analyse the use of loop ileostomy following elective anterior resection in England and to identify factors associated with non and delayed reversal. METHOD Hospital episode statistics for the years 2001-2006 were obtained from the Department of Health. Patients undergoing elective anterior resection with a loop ileostomy for a primary diagnosis of rectal or recto-sigmoid cancer between April 2001 and March 2003 were identified as the study cohort. This cohort was followed until March 2006 to identify patients undergoing reversal of an ileostomy in an English NHS Hospital. RESULTS A total of 6582 patients had an elective anterior resection between April 2001 and March 2003, of which 964 (14.6%) also had an ileostomy. Seven hundred and two (75.1%) patients were reversed before March 2006. Advancing age and comorbidity were statistically related to nonreversal. Median time to reversal was 207 days (Interquartile range 119-321.5 days). Postoperative chemotherapy and comorbidity significantly delayed reversal. CONCLUSIONS One in four loop ileostomies performed to defunction an elective anterior resection is not reversed, and in the presence of significant comorbidity one in three is not reversed. Only 12% is reversed within 12 weeks.
Collapse
Affiliation(s)
- G G David
- Leighton Research Unit, Department of General Surgery, Mid Cheshire Hospitals NHS Foundation Trust, Crewe, UK
| | | | | | | | | | | |
Collapse
|
20
|
Abstract
INTRODUCTION Hartmann's procedure is widely used in the management of complicated diverticular disease and for colorectal cancer. Very little national data are available about the reasons for performing this procedure and the reversal rate. METHOD Hospital episode statistics data were obtained from The Department of Health and exported to an Access database for analysis. A cohort of patients who underwent a Hartmann's procedure between April 2001 and March 2002 were identified and followed until April 2006 to identify patients undergoing reversal of Hartmann's. RESULTS Approximately 3950 Hartmann's procedures were performed between April 2001 and March 2002, 2853 as an emergency and 1097 as an elective procedure. Most emergency Hartmann's were performed for benign disease (2067, 72.5%) whereas a majority of the elective Hartmann's were performed for cancer (756, 68.9%). Seven hundred and thirty six (23.3%) of these patients underwent reversal during the study period. The median time interval between a Hartmann's procedure and reversal was 284.5 days (interquartile range 181-468.25). CONCLUSION This study represents the single largest cohort in whom outcome after Hartmann's procedure has been studied. A majority of Hartmann's are performed as an emergency for benign diseases and most of them are not reversed.
Collapse
Affiliation(s)
- G G David
- Leighton Research Unit, Department of General Surgery, Mid Cheshire Hospitals NHS Trust, Leighton Hospital, Crewe, UK
| | | | | | | | | | | |
Collapse
|
21
|
Selvasekar CR, David G, Corless DJ, Khan AU, Slavin JP. Rectal cancer surgery: is restoration of intestinal continuity the primary aim? Gut 2009; 58:311; author reply 311-2. [PMID: 19136525] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/08/2022]
|
22
|
David GG, Al-Sarira AA, Willmott S, Deakin M, Corless DJ, Slavin JP. Authors' reply: Management of acute gallbladder disease in England ( Br J Surg 2008; 95: 472–476). Br J Surg 2008. [DOI: 10.1002/bjs.6339] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- G G David
- Leighton Research Unit, Department of General Surgery, University Hospital of North Staffordshire, Stoke-on-Trent, UK
| | - A A Al-Sarira
- Leighton Research Unit, Department of General Surgery, University Hospital of North Staffordshire, Stoke-on-Trent, UK
| | - S Willmott
- Research and Development Office, Mid Cheshire Hospitals NHS Trust, Crewe, UK
| | - M Deakin
- Department of General Surgery, University Hospital of North Staffordshire, Stoke-on-Trent, UK
| | - D J Corless
- Leighton Research Unit, Department of General Surgery, University Hospital of North Staffordshire, Stoke-on-Trent, UK
| | - J P Slavin
- Leighton Research Unit, Department of General Surgery, University Hospital of North Staffordshire, Stoke-on-Trent, UK
| |
Collapse
|
23
|
David GG, Al-Sarira AA, Willmott S, Deakin M, Corless DJ, Slavin JP. Authors' reply 2: Management of acute gallbladder disease in England ( Br J Surg 2008; 95: 472–476). Br J Surg 2008. [DOI: 10.1002/bjs.6341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- G G David
- Leighton Research Unit, Department of General Surgery, Crewe, UK
| | - A A Al-Sarira
- Leighton Research Unit, Department of General Surgery, Crewe, UK
| | - S Willmott
- Research and Development Office, Mid Cheshire Hospitals NHS Trust, Crewe, UK
| | - M Deakin
- Department of General Surgery, University Hospital of North Staffordshire, Stoke-on-Trent, UK
| | - D J Corless
- Leighton Research Unit, Department of General Surgery, Crewe, UK
| | - J P Slavin
- Leighton Research Unit, Department of General Surgery, Crewe, UK
| |
Collapse
|
24
|
Abstract
BACKGROUND Recent literature suggests that early laparoscopic cholecystectomy for acute gallbladder disease is safe and efficacious, but few data are available on the management of acute gallbladder disease in England. METHODS Hospital Episode Statistics data for the years 2003-2005 were obtained from the Department of Health. All patients admitted as an emergency with acute gallbladder disease during the period from April 2003 to March 2004 were included as a cohort. Repeat emergency admissions for acute gallbladder disease, and cholecystectomies performed during the first admission, an emergency readmission or an elective admission were followed up until March 2005. RESULTS Some 25,743 patients were admitted as an emergency with acute gallbladder disease, of whom 3791 had an emergency cholecystectomy during the first admission (open cholecystectomy (OC) 29.8 per cent, laparoscopic conversion rate (LCR) 10.7 per cent) and 9806 patients had an elective cholecystectomy (OC 11.3 per cent, LCR 8.3 per cent) during the study period. CONCLUSION Early cholecystectomy for acute gallbladder disease is not widely practised by surgeons in England. Open cholecystectomy is more commonly used in the emergency than in the elective setting. Early laparoscopic cholecystectomy following an emergency admission carries a higher conversion rate than elective cholecystectomy.
Collapse
Affiliation(s)
- G G David
- Leighton Research Unit, Department of General Surgery, Crewe, UK
| | | | | | | | | | | |
Collapse
|
25
|
|
26
|
Abstract
Abstract
Background
The 2001 UK National Health Service guidance on improving outcomes recommended centralization of oesophageal resection. The aim of this study was to analyse national trends in oesophageal resection in England to determine whether centralization has occurred and its impact on outcomes.
Methods
The study used data from Hospital Episode Statistics for 1997–1998 to 2003–2004 and included patients who had resection for oesophageal cancer. The annual hospital volume was grouped into five categories based on the recommendation for annual volume for a designated centre.
Results
A total of 11 838 oesophageal resections were performed. The total number of hospitals performing resections decreased, mainly owing to a fall in the number of very low-volume hospitals (117 in 1997 to 45 in 2003). The proportion of resections performed in very high-volume hospitals increased from 17·8 per cent during 1997–1999 to 21·9 per cent during 2002–2003 (P < 0·001). The overall in-hospital mortality rate was 10·1 per cent, with a significant reduction over time (from 11·7 to 7·6 per cent; P < 0·001). The decline in mortality rate may be due to increased numbers of patients undergoing surgery in higher-volume hospitals. There was an increase in the annual number of new patients from 5672 to 6230 during the study, although a fall in the proportion of resections from 31·5 to 26·0 per cent (P < 0·001).
Conclusion
Centralization and multidisciplinary team expertise partly explain the improvement in mortality rate, but changes in preoperative selection also play a part.
Collapse
Affiliation(s)
- A A Al-Sarira
- Leighton Research Unit, Department of Surgery, Leighton Hospital, Mid Cheshire NHS Trust, Crewe, UK
| | | | | | | | | | | |
Collapse
|
27
|
|
28
|
Abstract
BACKGROUND Early endoscopic retrograde cholangio-pancreatography with or without endoscopic sphincterotomy (ERCP+/-ES) has been advocated to reduce complications in patients presenting with a severe attack of gallstone-associated acute pancreatitis (GAP). However, a recent trial has reported contradictory results. Importantly, patients with acute cholangitis were excluded suggesting it may be a major confounding factor affecting previous studies. OBJECTIVES To assess the effectiveness of early ERCP+/-ES compared to conservative management stratified according to severity of disease, concealment of randomisation, acute cholangitis and bilirubin level in the reduction of mortality, morbidity, length of hospitalisation and cost in adults suspected of having GAP. SEARCH STRATEGY We searched - Cochrane Library (Issue 4 2003), Medline (1966-2004), EMBASE (1980-2004) and LILACS. 'Grey literature' was sought by looking at cited references and hand searched to identify further relevant trials. Conference proceedings of United European Gastroenterology Week (published in Gut) and Digestive Disease Week (published in Gastroenterology) were also hand searched. SELECTION CRITERIA Randomized controlled trials (RCT) of adult patients, from 15 years old or greater, presenting with gallstone-associated acute pancreatitis (GAP) comparing ERCP +/- ES versus Conservative management within 72 hours of admission. DATA COLLECTION AND ANALYSIS Data were assessed for quality independently by two reviewers. Wherever appropriate, results were pooled together and sub-grouped by predicted severity of disease. Fixed and random effects models were applied. Sensitivity analysis was performed to test the fragility of results. MAIN RESULTS Three trials, involving 511 patients, met inclusion criteria. The test for heterogeneity yielded statistically non-significant results (p-value 0.1 to 0.63) suggesting all comparisons were above the established threshold for combinability (p<0.1). Fixed effect and random effect meta-analyses gave identical results. Early ERCP +/- ES was associated with non-significant effect on reduction of mortality in predicted mild (OR = 0.62, 95% CI = 0.27 to 1.41) and severe GAP (OR = 0.62, 95% CI = 0.27 to 1.41). Reduction in complications was non-significant in predicted mild (OR = 0.89, 95% CI = 0.53 to 1.49), but significant in severe GAP (OR = 0.27, 95% CI = 0.14 to 0.53). There was insufficient evidence to draw any conclusions about hospital stay and cost. REVIEWERS' CONCLUSIONS Odds of having complications are reduced in predicted severe disease by early ERCP +/- ES. This effect was however, non-significant in predicted mild disease and for reduction of mortality in either predicted mild or severe disease. These results are controlled for confounding due to associated acute cholangitis and are robust for clinical and statistical heterogeneity.
Collapse
Affiliation(s)
- K Ayub
- University Department of Surgery, University of Wales College of Medicine, Heath Park, Cardiff, UK, CF14 4XN
| | | | | |
Collapse
|
29
|
Choong PFM, Nizam I, Ngan SYK, Schlict S, Powell G, Slavin J, Smith P, Toner G, Hicks R. Thallium-201 scintigraphy–a predictor of tumour necrosis in soft tissue sarcoma following preoperative radiotherapy? Eur J Surg Oncol 2003; 29:908-15. [PMID: 14624787 DOI: 10.1016/j.ejso.2003.09.003] [Citation(s) in RCA: 16] [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: 11/28/2022] Open
Abstract
AIM Thallium-201 (Tl-201) scintigraphy in patients with malignant soft tissue tumours was evaluated to determine whether the images correlated with histological response to preoperative radiotherapy. METHODS We studied 54 patients, median age 32 (range 17-84) years, with non-metastatic, malignant soft tissue tumours diagnosed between 1996 and 2001. Thirty-eight patients had unoperated tumours and 16 patients had previous incomplete excisions. All patients received preoperative radiotherapy followed by surgery. No patient received chemotherapy as part of their initial management. Qualitative analyses of early phase (30 min) and late phase (4 h) Tl-201 scintigraphic images before and after preoperative radiotherapy were compared with the degree of tumour necrosis determined histologically. RESULTS In the previously unoperated group, all 38 patients had increased TL-201 uptake in the late phase of scanning prior to radiotherapy suggesting metabolically active tissue. In the previously excised group 11 patients had increased Tl-201 uptake in the late phase of scanning prior to radiotherapy. Following radiotherapy, patients with Tl-201 retention on late phase scans had a lower rate of necrosis than patients with minimal retention, p<0.0001. Following radiotherapy, 28 of 29 patients with minimal uptake on the late phase had 80% or more necrosis, while 24 of 25 patients with increased uptake on the late phase had less than 80% necrosis (p<0.0001). Patients with previously excised tumours who had thallium retention following radiotherapy demonstrated evidence of residual disease at surgery. All patients with incompletely excised tumours who had no thallium retention on late phase scanning after radiotherapy demonstrated no evidence of residual disease at surgery. CONCLUSION Thallium scintigraphy is a readily available investigative tool, which when used in conjunction with other imaging modalities in the assessment of primary and incompletely excised malignant soft tissue tumours, may predict histological tumour response to preoperative radiotherapy.
Collapse
Affiliation(s)
- P F M Choong
- Department of Orthopaedics, St Vincent's Hospital, Melbourne, Vic., Australia.
| | | | | | | | | | | | | | | | | |
Collapse
|
30
|
Bhatia M, Proudfoot AEI, Wells TNC, Christmas S, Neoptolemos JP, Slavin J. Treatment with Met-RANTES reduces lung injury in caerulein-induced pancreatitis. Br J Surg 2003; 90:698-704. [PMID: 12808617 DOI: 10.1002/bjs.4102] [Citation(s) in RCA: 38] [Impact Index Per Article: 1.8] [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: 12/16/2022]
Abstract
BACKGROUND Severe acute pancreatitis leads to a systemic inflammatory response characterized by widespread leucocyte activation and, as a consequence, distant lung injury. In CC chemokines the first two cysteine residues are adjacent to each other. The aim of this study was to evaluate the effect of Met-RANTES, a CC chemokine receptor antagonist, on pancreatic inflammation and lung injury in caerulein-induced acute pancreatitis in mice. METHODS Acute pancreatitis was induced in mice by hourly intraperitoneal injection of caerulein. Met-RANTES was administered either 30 min before or 1 h after starting caerulein injections, and pancreatic inflammation and lung injury were assessed. There were five groups of eight mice each including controls. RESULTS Treatment with Met-RANTES had little effect on caerulein-induced pancreatic damage. Met-RANTES, however, reduced lung injury when given either before administration of caerulein (mean(s.e.m.) lung myeloperoxidase (MPO) 1.47(0.19) versus 3.70(0.86)-fold increase over control, P = 0.024; mean(s.e.m.) microvascular permeability 1.15(0.05) versus 3.57(0.63) lavage to plasma fluorescein isothiocyanate-labelled albumin fluorescence ratio (L/P) per cent, P = 0.002) or after caerulein administration (lung MPO 1.96(0.27) versus 3.65(0.63)-fold increase over control, P = 0.029; microvascular permeability 0.94(0.04) versus 2.85(0.34) L/P per cent, P < 0.001). CONCLUSION Treatment with Met-RANTES reduces lung damage associated with caerulein-induced pancreatitis in mice. Chemokine receptor antagonists may be of use for the treatment of the systemic complications of acute pancreatitis.
Collapse
Affiliation(s)
- M Bhatia
- Department of Pharmacology, National University of Singapore, Singapore.
| | | | | | | | | | | |
Collapse
|
31
|
Finch MD, Formela L, Jones L, Sutton R, Hartley MN, Slavin J, Neoptolemos JP. Laparoscopic ultrasonography is accurate for staging large pancreatic tumours. Br J Surg 2003. [DOI: 10.1046/j.1365-2168.1999.1062i.x] [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: 11/20/2022]
Abstract
Abstract
Background
The accuracy of laparoscopic ultrasonography in staging pancreatic and periampullary tumours in a referral unit was determined and its use for the subgroup of tumours of stage T3 or greater was assessed.
Methods
From a larger series of staging laparoscopies 22 patients with pancreatic lesions and five with periampullary tumours who were being considered for resection were staged with laparoscopy and laparoscopic ultrasonography. Only patients with computed tomography (CT) or magnetic resonance imaging (MRI) scans indicating potentially or equivocally resectable disease were included. The laparoscopist was blinded to the results of CT and MRI. Laparoscopy and laparoscopic ultrasonography were undertaken according to a standard protocol using a B & K Medical Diagnostic Ultrasound System 3535 with a colour flow Doppler module. Ascitic fluid was sent for cytology and metastatic disease was biopsied. Results were recorded on a pro forma which included an assessment of resectability. In the case of large tumours this included an assessment of the potential for a positive resection margin or the need for portal vein resection to obtain tumour clearance. The decision to pursue resection was made by the consultant surgeon, based on all the information available including that from laparoscopic ultrasonography. No patient was denied a surgical exploration on the basis of local irresectability determined only by laparoscopic ultrasonography. The predictions regarding resectability were compared with findings at open surgery and with histology.
Results
Assessment of irresectability by laparoscopic ultrasonography resulted in nine true positives, 16 true negatives, no false positives and one false negative. For pancreatic adenocarcinoma there were eight true positives, 13 true negatives and one false negative. Among the pancreatic group ten of 13 tumours correctly predicted as resectable were stage T3 or greater (Union Internacional Contra la Cancrum, 1997). Of those predicted to be irresectable, all eight were T3 or greater. Among this latter group three were predicted to be irresectable on the basis of local factors alone, two on the basis of metastatic disease alone and three on the basis of both local factors and metastases. Overall, for detection of irresectable disease laparoscopic ultrasonography had a positive predictive value of 100 per cent, a negative predictive value of 94 per cent and an accuracy of 96 per cent. Accuracy was 95 per cent for both the pancreatic tumour subgroup and the T3 pancreatic subgroup.
Conclusion
Laparoscopic ultrasonography was accurate for predicting irresectability in this group of referred patients. The technique was also accurate for the subgroup with T3 or greater pancreatic tumours.
Collapse
Affiliation(s)
- M D Finch
- Department of Surgery, University of Liverpool, Liverpool, UK
| | - L Formela
- Department of Surgery, University of Liverpool, Liverpool, UK
| | - L Jones
- Department of Surgery, University of Liverpool, Liverpool, UK
| | - R Sutton
- Department of Surgery, University of Liverpool, Liverpool, UK
| | - M N Hartley
- Department of Surgery, University of Liverpool, Liverpool, UK
| | - J Slavin
- Department of Surgery, University of Liverpool, Liverpool, UK
| | - J P Neoptolemos
- Department of Surgery, University of Liverpool, Liverpool, UK
| |
Collapse
|
32
|
Slavin J, Ghaneh P, Sutton R, Hartley MR, Hughes M, Garvey C, Rowlands P, Neoptolemos JP. Initial results with a minimally invasive technique of pancreatic necrosectomy. Br J Surg 2002. [DOI: 10.1046/j.1365-2168.2001.01730-4.x] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Abstract
Background
The aim of the study was to evaluate the initial results with a new technique of minimally invasive pancreatic necrosectomy (MIPN).
Methods
A retrospective audit was carried out of pancreatic necrosectomies performed on one unit from October 1996. Patients were divided into two groups: those admitted before November 1998 who underwent a conventional open necrosectomy and those admitted after this date who were considered for treatment with MIPN.
Results
Thirty-one patients underwent pancreatic necrosectomy, of which 20 cases were tertiary referrals. Thirteen patients (median age 51 (range 33–77) years; ten men, three women) admitted before November 1998 underwent a conventional open technique; seven of these patients died. Since then, 18 patients (median age 59 (range 33–74) years; ten women, eight men) have undergone necrosectomy, 12 by MIPN (median of 3 (range 1–6) procedures) and six by an open technique. Reasons for using an open technique included a left renal adenocarcinoma (one patient), poor access route (three patients) and failure to insert a guidewire under computed tomographic control (two patients). There were two deaths during this later period (P < 0·05, Fisher's exact test in comparison with the earlier time period). In patients who were discharged there was no difference in length of stay in the intensive treatment unit (median 5 (range 0–24) versus 5 (range 0–84) days) or in-hospital stay (median 66 (range 29–159) versus 75 (range 31–202) days) between the two time periods.
Conclusion
A minimally invasive approach provides a promising alternative to open pancreatic necrosectomy.
Collapse
Affiliation(s)
- J Slavin
- Royal Liverpool University Hospital, Liverpool, UK
| | - P Ghaneh
- Royal Liverpool University Hospital, Liverpool, UK
| | - R Sutton
- Royal Liverpool University Hospital, Liverpool, UK
| | - M R Hartley
- Royal Liverpool University Hospital, Liverpool, UK
| | - M Hughes
- Royal Liverpool University Hospital, Liverpool, UK
| | - C Garvey
- Royal Liverpool University Hospital, Liverpool, UK
| | - P Rowlands
- Royal Liverpool University Hospital, Liverpool, UK
| | | |
Collapse
|
33
|
Shokuhi S, Bhatia M, Christmas S, Sutton R, Neoptolemos JP, Slavin J. Levels of the chemokines growth-related oncogene alpha and epithelial neutrophil-activating protein 78 are raised in patients with severe acute pancreatitis. Br J Surg 2002; 89:566-72. [PMID: 11972545 DOI: 10.1046/j.1365-2168.2002.02060.x] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND Multiple organ dysfunction syndrome secondary to systemic leucocyte activation is the major cause of death following an attack of acute pancreatitis. Although plasma levels of interleukin (IL) 8 are known to be raised in acute pancreatitis, levels of other CXC chemokines such as growth-related oncogene (GRO) alpha and epithelial neutrophil-activating protein (ENA) 78, which are also potent neutrophil chemoattractants and activators, have not been measured. METHODS Timed plasma samples were obtained from 51 patients with acute pancreatitis, 27 with a severe attack and 24 with mild disease according to the Atlanta classification. Samples were analysed to determine levels of C-reactive protein (CRP), IL-8, GRO-alpha and ENA-78. RESULTS Plasma levels of IL-8, GRO-alpha and ENA-78 were increased in patients with severe as opposed to mild acute pancreatitis as early as 24 h following disease onset. Using cut-off levels of 7 pg/ml for IL-8, 70 pg/ml for GRO-alpha and 930 pg/ml for ENA-78, peak levels within the first 24 h of admission had an accuracy of 81, 71 and 87 per cent respectively in predicting the severity of an attack of acute pancreatitis. CONCLUSION In patients with severe acute pancreatitis plasma levels of GRO-alpha and ENA-78 were raised in addition to those of IL-8, suggesting that all three chemokines are involved in the inflammatory response in this condition.
Collapse
Affiliation(s)
- S Shokuhi
- Departments of Surgery and Immunology, University of Liverpool, 5th floor University Clinical Departments Building, Daulby Street, Liverpool L69 3GA, UK
| | | | | | | | | | | |
Collapse
|
34
|
Mayer JM, Raraty M, Slavin J, Kemppainen E, Fitzpatrick J, Hietaranta A, Puolakkainen P, Beger HG, Neoptolemos JP. Serum amyloid A is a better early predictor of severity than C-reactive protein in acute pancreatitis. Br J Surg 2002. [PMID: 11856128 DOI: 10.1046/j.1365-2168.2002.01972.x] [Citation(s) in RCA: 45] [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] [Indexed: 12/28/2022]
Abstract
BACKGROUND Serum amyloid A (SAA) is an early and sensitive marker of the extent of tissue trauma and inflammation. The aim of this study was to compare the early prognostic accuracy of SAA with that of serum C-reactive protein (CRP) in acute pancreatitis. METHODS In a prospective multicentre trial, plasma SAA and CRP levels were measured in patients with severe and mild acute pancreatitis, and in a control group with acute abdominal pain. Plasma samples were collected on admission and at 6-h intervals for 48 h, every 12 h between 48 and 72 h, then daily for 5 days. Plasma SAA was measured by a new enzyme-linked immunosorbent assay and CRP was measured by immunoturbidometry. RESULTS There were 137 patients with mild and 35 with severe acute pancreatitis, and 74 control patients. SAA levels were significantly higher in patients with severe acute pancreatitis than in those with mild acute pancreatitis, on admission, at 24 h or less after symptom onset, and subsequently. Whereas plasma CRP concentration was also significantly higher in patients with severe acute pancreatitis on admission, it failed to distinguish mild from severe acute pancreatitis until 30-36 h after symptom onset. SAA levels predicted severity (sensitivity 67 per cent, specificity 70 per cent, negative predictive value 89 per cent, mean(s.d.) area under curve 0.7(0.05)) significantly better than CRP (57 per cent, 60 per cent, 84 per cent, 0.59(0.06) respectively) on admission (P = 0.02) and at 24 h following symptom onset (area under curve 0.65(0.09) versus 0.58(0.09) respectively; P < or = 0.02). CONCLUSION Plasma SAA concentration is an early marker of severity in acute pancreatitis and is superior to CRP estimation on hospital admission and at 24 h or less after symptom onset. This study suggests that plasma SAA concentration is clinically useful, with the potential to replace CRP in the management of acute pancreatitis.
Collapse
Affiliation(s)
- J M Mayer
- Department of General Surgery, University Hospital of Ulm, Ulm, Germany
| | | | | | | | | | | | | | | | | |
Collapse
|
35
|
Mayer JM, Raraty M, Slavin J, Kemppainen E, Fitzpatrick J, Hietaranta A, Puolakkainen P, Beger HG, Neoptolemos JP. Serum amyloid A is a better early predictor of severity than C-reactive protein in acute pancreatitis. Br J Surg 2002; 89:163-71. [PMID: 11856128 DOI: 10.1046/j.0007-1323.2001.01972.x] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Serum amyloid A (SAA) is an early and sensitive marker of the extent of tissue trauma and inflammation. The aim of this study was to compare the early prognostic accuracy of SAA with that of serum C-reactive protein (CRP) in acute pancreatitis. METHODS In a prospective multicentre trial, plasma SAA and CRP levels were measured in patients with severe and mild acute pancreatitis, and in a control group with acute abdominal pain. Plasma samples were collected on admission and at 6-h intervals for 48 h, every 12 h between 48 and 72 h, then daily for 5 days. Plasma SAA was measured by a new enzyme-linked immunosorbent assay and CRP was measured by immunoturbidometry. RESULTS There were 137 patients with mild and 35 with severe acute pancreatitis, and 74 control patients. SAA levels were significantly higher in patients with severe acute pancreatitis than in those with mild acute pancreatitis, on admission, at 24 h or less after symptom onset, and subsequently. Whereas plasma CRP concentration was also significantly higher in patients with severe acute pancreatitis on admission, it failed to distinguish mild from severe acute pancreatitis until 30-36 h after symptom onset. SAA levels predicted severity (sensitivity 67 per cent, specificity 70 per cent, negative predictive value 89 per cent, mean(s.d.) area under curve 0.7(0.05)) significantly better than CRP (57 per cent, 60 per cent, 84 per cent, 0.59(0.06) respectively) on admission (P = 0.02) and at 24 h following symptom onset (area under curve 0.65(0.09) versus 0.58(0.09) respectively; P < or = 0.02). CONCLUSION Plasma SAA concentration is an early marker of severity in acute pancreatitis and is superior to CRP estimation on hospital admission and at 24 h or less after symptom onset. This study suggests that plasma SAA concentration is clinically useful, with the potential to replace CRP in the management of acute pancreatitis.
Collapse
Affiliation(s)
- J M Mayer
- Department of General Surgery, University Hospital of Ulm, Ulm, Germany
| | | | | | | | | | | | | | | | | |
Collapse
|
36
|
Abstract
After acute pancreatitis, sepsis secondary to infected pancreatic necrosis is the main cause of late stage death. Routine prophylactic antibiotic use following a severe attack of pancreatitis has been proposed but remains contentious. Three recent randomised controlled studies compared routine antibiotic prophylaxis to no treatment. All three showed reduced sepsis rates and two showed reduced rates of pancreatic infection, but in none was there any effect on operation rate. Only one study, from Finland, has shown any effect on mortality. A feature of the use of prophylactic antibiotics in acute pancreatitis is the increased frequency of drug-resistant or unusual organisms, including fungi, cultured from pancreatic tissue removed at necrosectomy. Mortality may be increased in this group of patients. The aim of antibiotic prophylaxis is a reduced death or operation rate rather than reduced sepsis rates per se and it is possible that the use of prophylactic antibiotics in acute pancreatitis merely masks the underlying disease process without affecting the natural history. There are, thus, too many uncertainties to enable a clear recommendation on routine antibiotic prophylaxis in severe acute pancreatitis. Further well-designed, adequately powered studies are required to establish the role of antibiotic prophylaxis in severe acute pancreatitis.
Collapse
Affiliation(s)
- J Slavin
- University Department of Surgery, Royal Liverpool University Hospital, 5th Floor UCD Building, Daulby Street, Liverpool, L69 3GA, UK.
| | | |
Collapse
|
37
|
Abstract
Infection complicating pancreatic necrosis leads to persisting sepsis, multiple organ dysfunction syndrome and accounts for about half the deaths that occur following acute pancreatitis. Severe cases due to gallstones require urgent endoscopic sphincterotomy. Patients with pancreatic necrosis should be followed with serial contrast enhanced computed tomography (CE-CT) and if infection is suspected fine needle aspiration of the necrotic area for bacteriology (FNAB) should be undertaken. Treatment of sterile necrosis should initially be non-operative. In the presence of infection necrosectomy is indicated. Although traditionally this has been by open surgery, minimally invasive procedures are a promising new alternative. There are many unresolved issues in the management of pancreatic necrosis. These include, the use of antibiotic prophylaxis, the precise indications for and frequency of repeat CE-CT and FNAB, and the role of enteral feeding.
Collapse
Affiliation(s)
- J Slavin
- Senior Lecturer, Department of Surgery, Royal Liverpool University Hospital 5th floor UCD Building, Daulby Street, Liverpool, L69 3GA, United Kingdom, UK.
| | | | | | | | | | | | | | | |
Collapse
|
38
|
Abstract
The outlook for patients with pancreatic cancer has been grim. There have been major advances in the surgical treatment of pancreatic cancer, leading to a dramatic reduction in post-operative mortality from the development of high volume specialized centres. This stimulated the study of adjuvant and neoadjuvant treatments in pancreatic cancer including chemoradiotherapy and chemotherapy. Initial protocols have been based on the original but rather small GITSG study first reported in 1985. There have been two large European trials totalling over 600 patients (EORTC and ESPAC-1) that do not support the use of chemoradiation as adjuvant therapy. A second major finding from the ESPAC-1 trial (541 patients randomized) was some but not conclusive evidence for a survival benefit associated with chemotherapy. A third major finding from the ESPAC-1 trial was that the quality of life was not affected by the use of adjuvant treatments compared to surgery alone. The ESPAC-3 trial aims to assess the definitive use of adjuvant chemotherapy in a randomized controlled trial of 990 patients.
Collapse
Affiliation(s)
- P Ghaneh
- Department of Surgery, University of Liverpool, 5th Floor UCD Building, Daulby Street, Liverpool, L69 3GA, UK
| | | | | | | | | |
Collapse
|
39
|
Affiliation(s)
- E Kemppainen
- Department of Surgery, Helsinki University Central Hospital, Finland.
| | | | | | | | | | | |
Collapse
|
40
|
McCombe D, Brown T, Slavin J, Morrison WA. The histochemical structure of the deep fascia and its structural response to surgery. J Hand Surg Br 2001; 26:89-97. [PMID: 11281657 DOI: 10.1054/jhsb.2000.0546] [Citation(s) in RCA: 39] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
The histochemical structure of the deep fascia and its interface with the underlying muscle was examined in ten pigs. This structure was also evaluated after it had been raised as a fascial flap and in another site after the underlying muscle surface had been disrupted. The deep fascial is a simple structure of densely-packed collagen bundles and elastin fibres, and has hyaluronic acid concentrated on its inner surface, which is in contact with the underlying muscle. There is no specialised lining of this surface of the fascia to account for its gliding properties. The post-surgical specimens demonstrated preservation of the structure of the interface between fascia and muscle, including the retention of the hyaluronic acid lining, if the epimysium was intact. However, if the epimysium was disrupted, the structure of the interface was obliterated.
Collapse
Affiliation(s)
- D McCombe
- Department of Biochemistry, Bernard O'Brien Institute of Microsurgery, St.Vincent's Hospital, Monash University, Melbourne, Australia
| | | | | | | |
Collapse
|
41
|
Bhatia M, Neoptolemos JP, Slavin J. Inflammatory mediators as therapeutic targets in acute pancreatitis. Curr Opin Investig Drugs 2001; 2:496-501. [PMID: 11566005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/21/2023]
Abstract
Multi-organ dysfunction syndrome (MODS) is the primary cause of morbidity and mortality in acute pancreatitis. Recent studies have established the critical role played by inflammatory mediators such as TNFalpha, IL-1beta, IL-6, IL-8, CINC/GROalpha, PAF, IL-10, C5a, ICAM-1 and substance P in acute pancreatitis and the resultant MODS. Potentially, there is a therapeutic window between symptom onset and the development of distant organ damage, when anti-inflammatory therapy may be of use. Elucidation of the key mediators in acute pancreatitis coupled with the discovery of specific inhibitors may make it possible to develop clinically effective anti-inflammatory therapy.
Collapse
Affiliation(s)
- M Bhatia
- Department of Surgery, University of Liverpool, Royal Liverpool University Hospital, UK.
| | | | | |
Collapse
|
42
|
Abstract
Whole grains are nutrient rich and may protect against chronic disease. To study this, we previously reviewed 14 case-control studies of colorectal, gastric, and endometrial cancers and found consistently lower risk in those with high than in those with low whole-grain intake. Questions remained concerning other cancers, dietary assessment, quantity consumed, confounding, and differential study quality. Here we expand the review to 40 case-control studies of 20 cancers and colon polyps. Odds ratios are < 1 for 46 of 51 mentions of whole-grain intake and for 43 of 45 after exclusion of 6 mentions with design/reporting flaws or low intake. The pooled odds ratio for high vs. low whole-grain intake among the 45 mentions was 0.66 (95% confidence interval = 0.60-0.72); they range from 0.59 to 0.78 across four types of dietary questionnaires. Odds ratios were < 1 in 9 of 10 mentions of studies of colorectal cancers and polyps, 7 of 7 mentions of gastric and 6 of 6 mentions of other digestive tract cancers, 7 of 7 mentions of hormone-related cancers, 4 of 4 mentions of pancreatic cancer, and 10 of 11 mentions of 8 other cancers. Most pooled odds ratios for specific cancers were in the range of 0.5-0.8, notable exceptions being breast (0.86) and prostate (0.90). The pooled odds ratio was similar in studies that adjusted for few and many covariates. Dose-response associations were stronger in studies using food-frequency questionnaires than in more quantitative questionnaires. The case-control evidence is supportive of the hypothesis that whole-grain intake protects against various cancers.
Collapse
Affiliation(s)
- D R Jacobs
- Division of Epidemiology, School of Public Health, University of Minnesota, Minneapolis 55454, USA
| | | | | | | |
Collapse
|
43
|
Ostapowicz G, Dallinger M, Bell SJ, Strasser SI, Watson KJR, Slavin J, Santamaria J, Desmond PV. Changes in hepatitis C-related liver disease in a large clinic population. Intern Med J 2001. [DOI: 10.1111/j.1444-0903.2001.00018.x] [Citation(s) in RCA: 4] [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: 12/01/2022]
|
44
|
Ostapowicz G, Dallinger M, Bell SJ, Strasser SI, Watson KJ, Slavin J, Santamaria J, Desmond PV. Changes in hepatitis C-related liver disease in a large clinic population. Intern Med J 2001; 31:90-6. [PMID: 11480484] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/20/2023]
Abstract
BACKGROUND Hepatitis C virus (HCV) infection is a significant problem in the Australian community. Over the past few years, the number of patients with diagnosed hepatitis C has increased greatly. The aims of the present study were to define the clinical features of a large group of patients with chronic HCV infection and to examine changes occurring in the referral base and epidemiological characteristics of this group since analysis of the first 342 patients in 1994. METHODS The study included 1,546 consecutive anti-HCV-positive patients who had been referred to St Vincent's Hospital from January 1990 to June 1998. Clinical and laboratory data were collected on all patients. RESULTS Referrals from general practitioners increased from 31% to 70% of all patients between 1990-1993 and 1994-1998. A history of injecting drug use (IDU) was present in 64% of the patients. While 89% of the IDU group was Australasian born, 49% of those in the sporadic group were born overseas. Cirrhosis was found in 18% of biopsied patients. Age, infection duration, age at infection, Mediterranean or Asian origin and a history of transfusion or lack of HCV risk factors were associated with cirrhosis on univariate analysis. Patient age was the only independent predictor of cirrhosis. CONCLUSION The majority of patients with HCV are diagnosed in general practice. A risk factor for infection is identified in 82% of patients. While our reported prevalence of cirrhosis may be an overestimate of that in the overall HCV community, the ultimate disease burden is likely to be significant.
Collapse
Affiliation(s)
- G Ostapowicz
- Department of Gastroenterology, St Vincent's Hospital, Melbourne, Victoria, Australia
| | | | | | | | | | | | | | | |
Collapse
|
45
|
Abstract
Pancreatic cancer was once considered to be a disease without hope. Advances in regionalisation of treatment in specialist units have resulted in a great improvement in resection outcome. Studies in advanced pancreatic cancer have indicated an advantage for chemotherapy. For 15 years only the GITSG had tested adjuvant therapy in a randomised controlled trial. This small study of only 43 patients suggested a survival benefit for post-operative chemoradiotherapy combined with follow-on chemotherapy. Recently two large trials of over 800 patients, one from the EORTC and the other from ESPAC, have shown no benefit from chemoradiotherapy alone. Results from a Norwegian and from ESPAC suggest that adjuvant chemotherapy (without chemoradiotherapy) prolongs survival. The major randomisation and recruitment centres for ESPAC include Berne, Switzerland, Verona, Italy and Liverpool, UK. The ESPAC-3 Trial plans to recruit 990 patients to definitively answer the chemotherapy question as adjuvant treatment for pancreatic cancer. The new millennium brings hope at last to the most challenging cancer of all--cancer of the pancreas.
Collapse
Affiliation(s)
- P Ghaneh
- Department of Surgery, University of Liverpool, UK
| | | | | | | |
Collapse
|
46
|
Henderson M, Danks J, Moseley J, Slavin J, Harris T, McKinlay M, Hopper J, Martin T. Parathyroid hormone-related protein production by breast cancers, improved survival, and reduced bone metastases. J Natl Cancer Inst 2001; 93:234-7. [PMID: 11158193 DOI: 10.1093/jnci/93.3.234] [Citation(s) in RCA: 87] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- M Henderson
- University of Melbourne, Department of Surgery, St. Vincent's Hospital, Fitzroy, Australia.
| | | | | | | | | | | | | | | |
Collapse
|
47
|
Bhatia M, Brady M, Zagorski J, Christmas SE, Campbell F, Neoptolemos JP, Slavin J. Treatment with neutralising antibody against cytokine induced neutrophil chemoattractant (CINC) protects rats against acute pancreatitis associated lung injury. Gut 2000; 47:838-44. [PMID: 11076884 PMCID: PMC1728153 DOI: 10.1136/gut.47.6.838] [Citation(s) in RCA: 121] [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: 12/17/2022]
Abstract
BACKGROUND Lung injury manifest clinically as adult respiratory distress syndrome (ARDS) is a common cause of morbidity and mortality following acute pancreatitis (AP). Neutrophils play a critical role in the progression of AP to ARDS. C-x-C chemokines are potent neutrophil chemoattractants and activators and have been implicated in AP. AIMS To evaluate the effect of blocking the C-x-C chemokine, cytokine induced neutrophil chemoattractant (CINC), in AP on pancreatic inflammation and the associated lung injury in rats. METHODS AP was induced by hourly intraperitoneal injections of caerulein. Goat anti-CINC antibody was administered either before or after starting caerulein injections to evaluate the prophylactic and therapeutic effects, respectively. Severity of AP was determined by measuring plasma amylase, pancreatic water content, and pancreatic myeloperoxidase (MPO) activity as a measure of neutrophil sequestration in the pancreas. Lung injury was determined by measurement of pulmonary microvascular permeability and lung MPO activity. RESULTS Treatment with anti-CINC antibody had little effect on caerulein induced pancreatic damage. However, it reduced the caerulein mediated increase in lung MPO activity as well as lung microvascular permeability when administered either prophylactically (lung MPO (fold increase over control): 1.53 (0.21) v. 3.30 (0.46), p<0.05; microvascular permeability (L/P%): 0.42 (0.07) v. 0.77 (0.11), p<0.05) or therapeutically (lung MPO (fold increase over control): 2.13 (0.10) v 4.42 (0.65), p<0.05; microvascular permeability (L/P%): 0.31 (0.05) v 0.79 (0.13), p<0.05). CONCLUSION Treatment with anti-CINC antibody afforded significant protection against pancreatitis associated lung injury. These results suggest that CINC plays an important role in the systemic inflammatory response in AP.
Collapse
Affiliation(s)
- M Bhatia
- Department of Surgery, University of Liverpool, Royal Liverpool University Hospital, Liverpool, UK.
| | | | | | | | | | | | | |
Collapse
|
48
|
Abstract
The capacity of multiple myeloma cells to generate parathyroid hormone-related protein (PTHrP) has been examined by in situ assessment of PTHrP mRNA and PTHrP protein in myeloma cells of patients in whom the disease was associated with the development of hypercalcaemia. The presence of PTHrP mRNA was evaluated by in situ hybridization using an antisense riboprobe, and PTHrP by immunohistochemistry using a monoclonal antibody, in archival bone marrow trephine specimens from 17 patients. PTHrP mRNA was detected in myeloma cells in 16 of the 17 patients, indicating a high frequency of PTHrP gene expression in myeloma cells in these subjects. PTHrP protein was, on the other hand, detected in the myeloma cells of only five of these patients. The impact of the mercury-based fixation and decalcification procedure used for processing the bone marrow trephine specimens was assessed to determine the influence of this process on the outcome of the immunohistochemical assay for PTHrP. It was shown that this preparative procedure resulted in a marked reduction of immunohistochemically detectable PTHrP, which provides a possible explanation for the lower frequency of positivity for PTHrP in myeloma cells in the bone marrow specimens. The present findings are consistent with the view that PTHrP can be generated in myeloma cells in vivo, and could contribute to osteolysis and hypercalcaemia, as in patients with cancer.
Collapse
Affiliation(s)
- H Zeimer
- Department of Medicine, St. Vincent's Hospital, Fitzroy, Victoria 3065, Australia
| | | | | | | | | | | |
Collapse
|
49
|
Abstract
Dietary carbohydrates range in molecular size from simple sugars to complex polymers with a degree of polymerization (DP) of up to 100,000 or more. Oligosaccharides are generally defined as carbohydrates from 2 to 20 monomeric units long. Oligosaccharides have been dietary staples since antiquity but have received much less attention than other carbohydrates such as simple sugars or dietary fiber. Recently, interest in oligosaccharides has increased not only because of properties that include sweetening ability and fat replacement, but also because of resistance to digestion in the upper gastrointestinal tract and fermentation in the large bowel. Thus, some oligosaccharides have functional effects similar to soluble dietary fiber such as enhancement of a healthy gastrointestinal tract, improvement of glucose control, and modulation of the metabolism of triglycerides. These oligosaccharides are the nondigestible oligosaccharides. These compounds are easily incorporated into processed foods and hold much promise as functional ingredients in nutraceutical products.
Collapse
Affiliation(s)
- M Roberfroid
- Université Catholique de Louvain, Department of Pharmaceutical Sciences, Brussels, Belgium
| | | |
Collapse
|
50
|
Gan E, Costello A, Slavin J, Stillwell RG. Pitfalls in the diagnosis of prostate adenocarcinoma from holmium resection of the prostate. Tech Urol 2000; 6:185-8. [PMID: 10963483] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/17/2023]
Abstract
PURPOSE Holmium laser resection of the prostate (HoLRP) provides tissue for histologic analysis that was not possible using previous coagulative laser prostatectomies. It was assumed that these tissue specimens would yield the same histologic information as specimens obtained by transurethal resection of the prostate and would be adequate for diagnosis of cancer. However, tissue subjected to laser treatment may sustain thermal injury, resulting in artifactual change. The aim of this study was to define the histologic characteristics of prostate tissue after holmium laser prostatectomy and the influence of thermal change on diagnosis of malignancy. MATERIALS AND METHODS All prostate tissue was examined after HoLRP. Examination included prostate-specific antigen (PSA) staining and immunostaining for high-molecular-weight cytokeratins. Histologic features are described. RESULTS Thermal injury after HoLRP was more extensive than previously believed. Artifacts observed under low power consisted of glandular distortion and contraction with crowding. Higher magnification revealed clumping of the chromatin of the nucleus, resulting in hyperchromasia and irregularity of the nucleus and loss of polarity. These changes may be mistaken for malignant change. It will be difficult to detect malignancy in areas involved by thermal injury. When prostate cancer exists, grading of cancer will be affected by these artifacts. Uptake of immunohistochemical staining with PSA and high-molecular-weight cytokeratins is nonspecific in areas of injury, reducing their usefulness in these cases. CONCLUSIONS Detection of malignancy may be compromised by thermal injury occurring after HoLRP. Preliminary preoperative transrectal ultrasound-guided biopsies may still be necessary for diagnosis of malignancy.
Collapse
Affiliation(s)
- E Gan
- Department of Urology, St. Vincent Hospital, Melbourne, Australia
| | | | | | | |
Collapse
|