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O'Donovan P, McAleese T, Harty J. Does lucency equate to revision? A five-year retrospective review of Attune and Triathlon total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 2023; 31:4773-4781. [PMID: 37516985 PMCID: PMC10598109 DOI: 10.1007/s00167-023-07509-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Accepted: 07/06/2023] [Indexed: 08/01/2023]
Abstract
PURPOSE The Attune® total knee arthroplasty system was introduced in 2013 to address lingering issues of patient dissatisfaction. However, recent literature reports concerns of early tibial tray debonding. The aim of this study was to compare the incidence of radiolucent lines, survivorship and patient reported outcome-measures between the Attune® system and the well-established Triathlon® system. METHODS This retrospective database review was conducted at a single institution in Cork, Ireland. All primary Attune® (N = 445) and Triathlon® (N = 285) systems implanted between 2015 and 2016 were reviewed. Radiolucent lines were assessed for those with a minimum two-year radiological follow-up (Attune® = 338; Triathlon® = 231). X-rays were taken post op, at 6 months, 2 years and 5 years. Radiolucent lines were documented using the Modern Knee Society Radiographic System. Five-year survival was assessed using Kaplan-Meier analysis with the Log Rank method to determine statistical significance. The Oxford Knee Score and EQ-5D-5L, were collected pre-op, at 6 months, 2 years and 5 years post-operatively and compared using the Kruskal-Wallis Test. RESULTS The Attune® had a higher proportion of radiolucent lines at the tibial tray [87.1% (54/62) vs 61.4% (27/44); p = 0.001] and at the implant-cement interface [62.9% (39/62) vs 43.2% (19/44); p = 0.02]. Conversely, the Triathlon® had a higher proportion AT the femur [38.6% (17/44) vs 12.9% (8/62); p = 0.001] and at the cement-bone interface [56.8% (25/44) vs 37.1% (23/62); p = 0.02]. The overall frequency of radiolucent lines was similar in both the Attune® and Triathlon® groups [17.8%, (60/338) vs 17.7%, (41/231); p = 0.49]. There was no difference in revision-free survival analysis at 5 years (Attune® 97.8% vs Triathlon® 95.8%; p = 0.129). The Attune® performed better at 5 years in the Oxford Knee Score [Attune® = 42.6 (SD 5.2) vs Triathlon® = 41 (SD 6.4); p = 0.001] and in the EQ-5D [Attune® = 0.773 (SD 0.187) vs Triathlon® = 0.729 (SD 0.218); p = 0.013]. There was no difference at 5 years in the EQ-VAS [Attune® = 80.4 (SD 13.7) vs Triathlon® = 78.5 (SD 15.3); p = 0.25]. CONCLUSION The Attune® system exhibited a higher incidence of radiolucent lines at the tibial tray. However, this did not lead to decreased survivorship at medium term follow-up compared to the Triathlon®. Furthermore, improvements in patient reported outcomes modestly favoured the Attune® system. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Paul O'Donovan
- School of Medicine, University College Cork, Brookfield Health Sciences Complex, College Road, Cork, Ireland.
- Department of Trauma and Orthopaedics, South Infirmary Victoria University Hospital, Cork, Ireland.
| | - Timothy McAleese
- Department of Trauma and Orthopaedics, South Infirmary Victoria University Hospital, Cork, Ireland
| | - James Harty
- Department of Trauma and Orthopaedics, South Infirmary Victoria University Hospital, Cork, Ireland
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Shoemark A, Griffin H, Wheway G, Hogg C, Lucas JS, Camps C, Taylor J, Carroll M, Loebinger MR, Chalmers JD, Morris-Rosendahl D, Mitchison HM, De Soyza A, Brown D, Ambrose JC, Arumugam P, Bevers R, Bleda M, Boardman-Pretty F, Boustred CR, Brittain H, Caulfield MJ, Chan GC, Fowler T, Giess A, Hamblin A, Henderson S, Hubbard TJP, Jackson R, Jones LJ, Kasperaviciute D, Kayikci M, Kousathanas A, Lahnstein L, Leigh SEA, Leong IUS, Lopez FJ, Maleady-Crowe F, McEntagart M, Minneci F, Moutsianas L, Mueller M, Murugaesu N, Need AC, O'Donovan P, Odhams CA, Patch C, Perez-Gil D, Pereira MB, Pullinger J, Rahim T, Rendon A, Rogers T, Savage K, Sawant K, Scott RH, Siddiq A, Sieghart A, Smith SC, Sosinsky A, Stuckey A, Tanguy M, Taylor Tavares AL, Thomas ERA, Thompson SR, Tucci A, Welland MJ, Williams E, Witkowska K, Wood SM. Genome sequencing reveals underdiagnosis of primary ciliary dyskinesia in bronchiectasis. Eur Respir J 2022; 60:13993003.00176-2022. [PMID: 35728977 DOI: 10.1183/13993003.00176-2022] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Accepted: 05/12/2022] [Indexed: 01/11/2023]
Abstract
BACKGROUND Bronchiectasis can result from infectious, genetic, immunological and allergic causes. 60-80% of cases are idiopathic, but a well-recognised genetic cause is the motile ciliopathy, primary ciliary dyskinesia (PCD). Diagnosis of PCD has management implications including addressing comorbidities, implementing genetic and fertility counselling and future access to PCD-specific treatments. Diagnostic testing can be complex; however, PCD genetic testing is moving rapidly from research into clinical diagnostics and would confirm the cause of bronchiectasis. METHODS This observational study used genetic data from severe bronchiectasis patients recruited to the UK 100,000 Genomes Project and patients referred for gene panel testing within a tertiary respiratory hospital. Patients referred for genetic testing due to clinical suspicion of PCD were excluded from both analyses. Data were accessed from the British Thoracic Society audit, to investigate whether motile ciliopathies are underdiagnosed in people with bronchiectasis in the UK. RESULTS Pathogenic or likely pathogenic variants were identified in motile ciliopathy genes in 17 (12%) out of 142 individuals by whole-genome sequencing. Similarly, in a single centre with access to pathological diagnostic facilities, 5-10% of patients received a PCD diagnosis by gene panel, often linked to normal/inconclusive nasal nitric oxide and cilia functional test results. In 4898 audited patients with bronchiectasis, <2% were tested for PCD and <1% received genetic testing. CONCLUSIONS PCD is underdiagnosed as a cause of bronchiectasis. Increased uptake of genetic testing may help to identify bronchiectasis due to motile ciliopathies and ensure appropriate management.
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Affiliation(s)
- Amelia Shoemark
- Respiratory Research Group, Molecular and Cellular Medicine, University of Dundee, Dundee, UK
- Royal Brompton Hospital and NHLI, Imperial College London, London, UK
- Newcastle University and NIHR Biomedical Research Centre for Ageing, Freeman Hospital, Newcastle upon Tyne, UK
| | - Helen Griffin
- Primary Immunodeficiency Group, Newcastle University Translational and Clinical Research Institute, Newcastle upon Tyne, UK
- Newcastle University and NIHR Biomedical Research Centre for Ageing, Freeman Hospital, Newcastle upon Tyne, UK
| | - Gabrielle Wheway
- Human Development and Health, Faculty of Medicine, University of Southampton, Southampton, UK
| | - Claire Hogg
- Royal Brompton Hospital and NHLI, Imperial College London, London, UK
| | - Jane S Lucas
- Primary Ciliary Dyskinesia Centre, University Hospital Southampton NHS Foundation Trust, Southampton, UK
- Clinical and Experimental Sciences Academic Unit, University of Southampton Faculty of Medicine, Southampton, UK
| | | | - Carme Camps
- Wellcome Centre for Human Genetics, University of Oxford, Oxford, UK
- NIHR Oxford Biomedical Research Centre, Clinical Informatics Research Office, John Radcliffe Hospital, Oxford, UK
| | - Jenny Taylor
- Wellcome Centre for Human Genetics, University of Oxford, Oxford, UK
- NIHR Oxford Biomedical Research Centre, Clinical Informatics Research Office, John Radcliffe Hospital, Oxford, UK
| | - Mary Carroll
- Primary Ciliary Dyskinesia Centre, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | | | - James D Chalmers
- Respiratory Research Group, Molecular and Cellular Medicine, University of Dundee, Dundee, UK
| | - Deborah Morris-Rosendahl
- Clinical Genetics and Genomics, Royal Brompton Hospital, Guy's and St Thomas' NHS Foundation Trust and NHLI, Imperial College London, London, UK
| | - Hannah M Mitchison
- Genetics and Genomic Medicine Department, University College London, UCL Great Ormond Street Institute of Child Health, London, UK
- These authors contributed equally to this manuscript
| | - Anthony De Soyza
- Newcastle University and NIHR Biomedical Research Centre for Ageing, Freeman Hospital, Newcastle upon Tyne, UK
- These authors contributed equally to this manuscript
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Keegan NM, Furney S, Walshe J, Gullo G, Kennedy J, Bulger K, McCaffrey J, Kelly CM, Egan K, O'Donovan P, Hernando A, Teiserskiene A, Parker I, Farrelly AM, Carr A, Calzaferri G, McDermott R, Keane MM, Grogan L, Breathnach OS, Morris PG, Toomey S, Hennessy BT. Abstract P1-19-24: A phase Ib trial of copanlisib in combination with trastuzumab in pretreated recurrent or metastatic HER2-positive breast cancer “PantHER”. Cancer Res 2020. [DOI: 10.1158/1538-7445.sabcs19-p1-19-24] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background Activation of the phosphoinositide -3 kinase (PI3K) pathway is a resistance mechanism to anti-HER2 targeted therapy. This trial was conducted to determine the maximum tolerated dose (MTD) of copanlisib, an oral pan-class I PI3K inhibitor, combined with trastuzumab for patients with advanced HER2 positive breast cancer resistant to anti-HER2 therapy. Patients and Methods In this phase Ib open label dose escalation study, using a 6 + 6 design, patients with advanced HER2-positive breast cancer who had disease progression following at least one prior line of HER2 therapy in the metastatic setting were treated with a dose escalation schedule of copanlisib (dose level 1 =45mg or dose level 2 = 60mg) IV on days 1, 8 and 15 of a 28 day cycle along with a fixed dose of trastuzumab 2mg/kg weekly after a loading dose of 4mg/kg in cycle 1. Archival tumour tissue, voluntary serial tumour biopsies and serial plasma samples were collected for genomic sequencing. Results Twelve patients were enrolled. MTD was determined as copanlisib 60mg plus trastuzumab 2mg/kg weekly. There was no dose limiting toxicity. The most common treatment-related adverse events (AE) of any grade experienced in more than 2 patients were hyperglycemia (58%), fatigue (58%), nausea (58%) and hypertension (50%). Confirmed stable disease at 16 weeks was observed in 6 (50%) participants. PIK3CA mutations were detected in archival tumour tissue of 6 (50%) patients and did not appear to influence likelihood of clinical benefit. PIK3CA mutations were detected in serial plasma ctDNA of all 12 patients and fluctuated over the course of treatment. Next-Generation Sequencing (NGS) analysis identified novel somatic mutations in the TTRAP gene, which encodes a PI3K-like protein kinase, detected only in tumour samples obtained at metastatic time points. Additionally, NGS analysis demonstrated clear temporal genomic heterogeneity with decreasing PIK3CA mutation variant allele frequency (VAF) post therapy Conclusions The combination of copanlisib and trastuzumab was safely administered with good overall tolerability in this trial. Preliminary anti-tumour stability was observed in patients with heavily pre-treated metastatic HER2 positive breast cancer. Translational studies identified a number of potential biomarkers for further study in the now initiated phase 2 clinical trial.
Citation Format: Niamh M Keegan, Simon Furney, Janice Walshe, Giuseppe Gullo, John Kennedy, Kyran Bulger, John McCaffrey, Catherine M Kelly, Keith Egan, P O'Donovan, Andres Hernando, Ausra Teiserskiene, Imelda Parker, Angela M Farrelly, Aoife Carr, Giulio Calzaferri, Ray McDermott, Maccon M Keane, Liam Grogan, Oscar S Breathnach, Patrick G Morris, Sinead Toomey, Bryan T Hennessy. A phase Ib trial of copanlisib in combination with trastuzumab in pretreated recurrent or metastatic HER2-positive breast cancer “PantHER” [abstract]. In: Proceedings of the 2019 San Antonio Breast Cancer Symposium; 2019 Dec 10-14; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2020;80(4 Suppl):Abstract nr P1-19-24.
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Affiliation(s)
| | - Simon Furney
- 2Genomic Oncology Research Group, Department of Physiology & Medical Physics, Center for Systems Medicine, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Janice Walshe
- 3Department of Medical Oncology, St Vincent's University Hospital, Dublin 4, Ireland
| | - Giuseppe Gullo
- 3Department of Medical Oncology, St Vincent's University Hospital, Dublin 4, Ireland
| | - John Kennedy
- 4Department of Medical Oncology, St James's Hospital, Dublin 8, Ireland
| | - Kyran Bulger
- 5Department of Medical Oncology, Midland Regional Hospital, Tullamore, Ireland
| | - John McCaffrey
- 6Department of Medical Oncology, Mater Misericordia University Hospital, Dublin 7, Ireland
| | - Catherine M Kelly
- 6Department of Medical Oncology, Mater Misericordia University Hospital, Dublin 7, Ireland
| | - Keith Egan
- 7Cancer Clinical Trials & Research Unit, Beaumont Hospital, Dublin 9, Ireland
| | - P O'Donovan
- 8Genomic Oncology Research Group, Department of Physiology & Medical Physics, Centre for Systems Medicine, Royal College of Surgeons in Ireland, Dublin 2, Ireland
| | - Andres Hernando
- 9Cancer Trials Ireland, Innovation House, Glasnevin, Dublin 11, Ireland
| | | | - Imelda Parker
- 9Cancer Trials Ireland, Innovation House, Glasnevin, Dublin 11, Ireland
| | - Angela M Farrelly
- 10Department of Molecular Medicine, Royal College of Surgeons in Ireland, Dublin 9, Ireland
| | - Aoife Carr
- 10Department of Molecular Medicine, Royal College of Surgeons in Ireland, Dublin 9, Ireland
| | - Giulio Calzaferri
- 11Department of Medical Oncology, St Vincent's University Hospital, Dublin 4, Ireland, Dublin 4, Ireland
| | - Ray McDermott
- 9Cancer Trials Ireland, Innovation House, Glasnevin, Dublin 11, Ireland
| | - Maccon M Keane
- 12Department of Medical Oncology, Galway University Hospital, Galway, Ireland
| | | | | | | | - Sinead Toomey
- 10Department of Molecular Medicine, Royal College of Surgeons in Ireland, Dublin 9, Ireland
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McElvaney OJ, Huizing M, Gahl WA, O'Donovan P, Horan D, Logan PM, Reeves EP, McElvaney NG. Hermansky-Pudlak syndrome with a novel genetic variant in HPS1 and subsequent accelerated pulmonary fibrosis: significance for phenocopy diseases. Thorax 2018; 73:1085-1088. [PMID: 29941477 DOI: 10.1136/thoraxjnl-2018-211920] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2018] [Revised: 05/17/2018] [Accepted: 05/21/2018] [Indexed: 11/03/2022]
Abstract
The Hermansky-Pudlak syndrome (HPS) is a collection of autosomal-recessive disorders characterised by tyrosinase-positive oculocutaneous albinism (OCA), bleeding diatheses and, in selected individuals, early-onset accelerated pulmonary fibrosis, neutropaenia and granulomatous colitis. We describe a young man who presented following a self-directed literature review prompted by severe bleeding complications following minor surgical and dental procedures in the context of OCA. HPS was clinically suspected, with subsequent genetic testing confirming biallelic mutations in the HPS1 gene. Of interest, this is the only described HPS type 1 patient with two different (compound heterozygote) splice site variants in HPS1 In addition to detailing a novel genetic result and outlining the progressive clinical course of disease in this case, we discuss the management of HPS, the prognostic value of subtype analysis and the technical difficulties relating to transplantation in the case of HPS-associated advanced pulmonary fibrosis. This case also illustrates the concept of lung phenocopy relationships and the potential for elucidating the pathogenesis of more common pulmonary disorders by studying genetic diseases that result in similar phenotypes. Furthermore, it re-emphasises the importance of the patient voice, particularly with regard to complex diagnoses and rare diseases.
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Affiliation(s)
- Oliver J McElvaney
- Irish Centre for Genetic Lung Disease, Royal College of Surgeons in Ireland, Beaumont Hospital, Dublin, Ireland
| | - Marjan Huizing
- Medical Genetics Branch, National Human Genome Research Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - William A Gahl
- Medical Genetics Branch, National Human Genome Research Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Paul O'Donovan
- Hermansky-Pudlak Syndrome Network, Oyster Bay, New York, USA
| | - Deirdre Horan
- Irish Centre for Genetic Lung Disease, Royal College of Surgeons in Ireland, Beaumont Hospital, Dublin, Ireland
| | - P Mark Logan
- Department of Radiology, Beaumont Hospital, Dublin, Ireland
| | - Emer P Reeves
- Irish Centre for Genetic Lung Disease, Royal College of Surgeons in Ireland, Beaumont Hospital, Dublin, Ireland
| | - Noel G McElvaney
- Irish Centre for Genetic Lung Disease, Royal College of Surgeons in Ireland, Beaumont Hospital, Dublin, Ireland
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Bhattacharya S, Middleton LJ, Tsourapas A, Lee AJ, Champaneria R, Daniels JP, Roberts T, Hilken NH, Barton P, Gray R, Khan KS, Chien P, O'Donovan P, Cooper KG, Abbott J, Barrington J, Bhattacharya S, Bongers MY, Brun JL, Busfield R, Clark TJ, Cooper J, Cooper KG, Corson SL, Dickersin K, Dwyer N, Gannon M, Hawe J, Hurskainen R, Meyer WR, O'Connor H, Pinion S, Sambrook AM, Tam WH, van Zon-Rabelink IAA, Zupi E. Hysterectomy, endometrial ablation and Mirena® for heavy menstrual bleeding: a systematic review of clinical effectiveness and cost-effectiveness analysis. Health Technol Assess 2011; 15:iii-xvi, 1-252. [PMID: 21535970 DOI: 10.3310/hta15190] [Citation(s) in RCA: 69] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE The aim of this project was to determine the clinical effectiveness and cost-effectiveness of hysterectomy, first- and second-generation endometrial ablation (EA), and Mirena® (Bayer Healthcare Pharmaceuticals, Pittsburgh, PA, USA) for the treatment of heavy menstrual bleeding. DESIGN Individual patient data (IPD) meta-analysis of existing randomised controlled trials to determine the short- to medium-term effects of hysterectomy, EA and Mirena. A population-based retrospective cohort study based on record linkage to investigate the long-term effects of ablative techniques and hysterectomy in terms of failure rates and complications. Cost-effectiveness analysis of hysterectomy versus first- and second-generation ablative techniques and Mirena. SETTING Data from women treated for heavy menstrual bleeding were obtained from national and international trials. Scottish national data were obtained from the Scottish Information Services Division. PARTICIPANTS Women who were undergoing treatment for heavy menstrual bleeding were included. INTERVENTIONS Hysterectomy, first- and second-generation EA, and Mirena. MAIN OUTCOME MEASURES Satisfaction, recurrence of symptoms, further surgery and costs. RESULTS Data from randomised trials indicated that at 12 months more women were dissatisfied with first-generation EA than hysterectomy [odds ratio (OR): 2.46, 95% confidence interval (CI) 1.54 to 3.93; p = 0.0002), but hospital stay [WMD (weighted mean difference) 3.0 days, 95% CI 2.9 to 3.1 days; p < 0.00001] and time to resumption of normal activities (WMD 5.2 days, 95% CI 4.7 to 5.7 days; p < 0.00001) were longer for hysterectomy. Unsatisfactory outcomes associated with first- and second-generation techniques were comparable [12.2% (123/1006) vs 10.6% (110/1034); OR 1.20, 95% CI 0.88 to 1.62; p = 0.2). Rates of dissatisfaction with Mirena and second-generation EA were similar [18.1% (17/94) vs 22.5% (23/102); OR 0.76, 95% CI 0.38 to 1.53; p = 0.4]. Indirect estimates suggested that hysterectomy was also preferable to second-generation EA (OR 2.32, 95% CI 1.27 to 4.24; p = 0.006) in terms of patient dissatisfaction. The evidence to suggest that hysterectomy is preferable to Mirena was weaker (OR 2.22, 95% CI 0.94 to 5.29; p = 0.07). In women treated by EA or hysterectomy and followed up for a median [interquartile range (IQR)] duration of 6.2 (2.7-10.8) and 11.6 (7.9-14.8) years, respectively, 962/11,299 (8.5%) women originally treated by EA underwent further gynaecological surgery. While the risk of adnexal surgery was similar in both groups [adjusted hazards ratio 0.80 (95% CI 0.56 to 1.15)], women who had undergone ablation were less likely to need pelvic floor repair [adjusted hazards ratio 0.62 (95% CI 0.50 to 0.77)] and tension-free vaginal tape surgery for stress urinary incontinence [adjusted hazards ratio 0.55 (95% CI 0.41 to 0.74)]. Abdominal hysterectomy led to a lower chance of pelvic floor repair surgery [hazards ratio 0.54 (95% CI 0.45 to 0.64)] than vaginal hysterectomy. The incidence of endometrial cancer following EA was 0.02%. Hysterectomy was the most cost-effective treatment. It dominated first-generation EA and, although more expensive, produced more quality-adjusted life-years (QALYs) than second-generation EA and Mirena. The incremental cost-effectiveness ratios for hysterectomy compared with Mirena and hysterectomy compared with second-generation ablation were £1440 per additional QALY and £970 per additional QALY, respectively. CONCLUSIONS Despite longer hospital stay and time to resumption of normal activities, more women were satisfied after hysterectomy than after EA. The few data available suggest that Mirena is potentially cheaper and more effective than first-generation ablation techniques, with rates of satisfaction that are similar to second-generation techniques. Owing to a paucity of trials, there is limited evidence to suggest that hysterectomy is preferable to Mirena. The risk of pelvic floor surgery is higher in women treated by hysterectomy than by ablation. Although the most cost-effective strategy, hysterectomy may not be considered an initial option owing to its invasive nature and higher risk of complications. Future research should focus on evaluation of the clinical effectivesness and cost-effectiveness of the best second-generation EA technique under local anaesthetic versus Mirena and types of hysterectomy such as laparoscopic supracervical hysterectomy versus conventional hysterectomy and second-generation EA. FUNDING The National Institute for Health Research Health Technology Assessment programme.
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Middleton LJ, Champaneria R, Daniels JP, Bhattacharya S, Cooper KG, Hilken NH, O'Donovan P, Gannon M, Gray R, Khan KS, Abbott J, Barrington J, Bhattacharya S, Bongers MY, Brun JL, Busfield R, Sowter M, Clark TJ, Cooper J, Cooper KG, Corson SL, Dickersin K, Dwyer N, Gannon M, Hawe J, Hurskainen R, Meyer WR, O'Connor H, Pinion S, Sambrook AM, Tam WH, van Zon-Rabelink IAA, Zupi E. Hysterectomy, endometrial destruction, and levonorgestrel releasing intrauterine system (Mirena) for heavy menstrual bleeding: systematic review and meta-analysis of data from individual patients. BMJ 2010; 341:c3929. [PMID: 20713583 PMCID: PMC2922496 DOI: 10.1136/bmj.c3929] [Citation(s) in RCA: 89] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/06/2010] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To evaluate the relative effectiveness of hysterectomy, endometrial destruction (both "first generation" hysteroscopic and "second generation" non-hysteroscopic techniques), and the levonorgestrel releasing intrauterine system (Mirena) in the treatment of heavy menstrual bleeding. DESIGN Meta-analysis of data from individual patients, with direct and indirect comparisons made on the primary outcome measure of patients' dissatisfaction. DATA SOURCES Data were sought from the 30 randomised controlled trials identified after a comprehensive search of the Cochrane Library, Medline, Embase, and CINAHL databases, reference lists, and contact with experts. Raw data were available from 2814 women randomised into 17 trials (seven trials including 1359 women for first v second generation endometrial destruction; six trials including 1042 women for hysterectomy v first generation endometrial destruction; one trial including 236 women for hysterectomy v Mirena; three trials including 177 women for second generation endometrial destruction v Mirena). Eligibility criteria for selecting studies Randomised controlled trials comparing hysterectomy, first and second generation endometrial destruction, and Mirena for women with heavy menstrual bleeding unresponsive to other medical treatment. RESULTS At around 12 months, more women were dissatisfied with outcome with first generation hysteroscopic techniques than with hysterectomy (13% v 5%; odds ratio 2.46, 95% confidence interval 1.54 to 3.9, P<0.001), but hospital stay (weighted mean difference 3.0 days, 2.9 to 3.1 days, P<0.001) and time to resumption of normal activities (5.2 days, 4.7 to 5.7 days, P<0.001) were longer for hysterectomy. Unsatisfactory outcomes were comparable with first and second generation techniques (odds ratio 1.2, 0.9 to 1.6, P=0.2), although second generation techniques were quicker (weighted mean difference 14.5 minutes, 13.7 to 15.3 minutes, P<0.001) and women recovered sooner (0.48 days, 0.20 to 0.75 days, P<0.001), with fewer procedural complications. Indirect comparison suggested more unsatisfactory outcomes with second generation techniques than with hysterectomy (11% v 5%; odds ratio 2.3, 1.3 to 4.2, P=0.006). Similar estimates were seen when Mirena was indirectly compared with hysterectomy (17% v 5%; odds ratio 2.2, 0.9 to 5.3, P=0.07), although this comparison lacked power because of the limited amount of data available for analysis. CONCLUSIONS More women are dissatisfied after endometrial destruction than after hysterectomy. Dissatisfaction rates are low after all treatments, and hysterectomy is associated with increased length of stay in hospital and a longer recovery period. Definitive evidence on effectiveness of Mirena compared with more invasive procedures is lacking.
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Affiliation(s)
- L J Middleton
- Birmingham Clinical Trials Unit, University of Birmingham, Birmingham B15 2TT.
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Durn JH, Marshall KM, Farrar D, O'Donovan P, Scally AJ, Woodward DF, Nicolaou A. Lipidomic analysis reveals prostanoid profiles in human term pregnant myometrium. Prostaglandins Leukot Essent Fatty Acids 2010; 82:21-6. [PMID: 19954938 DOI: 10.1016/j.plefa.2009.11.002] [Citation(s) in RCA: 25] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2009] [Revised: 06/26/2009] [Accepted: 11/05/2009] [Indexed: 11/22/2022]
Abstract
Prostanoids modulate the activity of human pregnant myometrium and their functional role can be appreciated through characterisation of prostanoid receptors and tissue concentration of prostanoids. We have applied a lipidomic approach to elucidate the profile of prostanoids in human non-labouring and labouring myometrium. We have identified a total of nineteen prostanoids including prostacyclin, thromboxanes, prostaglandins and dihydro-prostaglandins. Prostacyclin was the predominant prostanoid in both non-labouring and labouring myometria, with PGD(2) and PGF(2alpha) being the second most abundant. Although the total amount of prostanoids was increased in the labouring tissue, PGE(2) and 13,14-dihydro-15-keto-PGE(2) were the only prostanoids to increase significantly at early and late labour (p< or =0.001). Our data suggest that PGF(2alpha) plays an important role in parturition, whilst the increase in PGE(2) could occur to facilitate cervical dilation and relaxation of the lower myometrium during labour. Although the elevation in TXA(2) was less marked than expected, in terms of translation to function even a relatively small increase in the level of this potent spasmogen may have significant effects.
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Affiliation(s)
- J H Durn
- School of Pharmacy, University of Bradford, Bradford BD7 1DP, UK
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Williams T, Richardson S, O'Donovan P, Ardagh M. The forensic nurse practitioner role (emergency nursing)--potential response to changing health needs in New Zealand. Med Law 2005; 24:111-23. [PMID: 15887617] [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: 05/02/2023]
Abstract
There is little existing policy related to Forensic Evidence collection in the Emergency Department environment within New Zealand (NZ). A case study based on the Christchurch Hospital Emergency Department (ChCh ED) environment is presented, which outlines the need to develop a specialised nursing role, that of Forensic Nurse Practitioner (emergency care). The role of nursing input in the field of Forensic Medicine in NZ is essentially limited to the psychiatric focus. While roles such as those of the Forensic Psychiatric Nurse are relatively well established, there is an apparent absence of other 'forensic' functions, in particular those related to victims or perpetrators of crime. It is an accepted feature of emergency care that serious injuries and deaths do occur despite intervention. In addition, there are significant numbers of patients who present as a result of assault or in suspicious circumstances. Awareness of the importance of forensic evidence collection, appropriate storage and disposal of material is growing. Legal implications have significance for nurses, in particular with the movement towards Advanced Nursing Practice with its focus on increasing autonomy, accountability and independent practice. In order to achieve holistic healthcare and to provide appropriate and effective interventions, forensic emergency nursing skills need to be developed.
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Affiliation(s)
- Tracey Williams
- Emergency Department, Christchurch Hospital, Christchurch, New Zealand
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Paschopoulos M, Kaponis A, Makrydimas G, Zikopoulos K, Alamanos Y, O'Donovan P, Paraskevaidis E. Selecting distending medium for out-patient hysteroscopy. Does it really matter? Hum Reprod 2004; 19:2619-25. [PMID: 15459167 DOI: 10.1093/humrep/deh464] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.2] [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: 11/14/2022] Open
Abstract
BACKGROUND The aim of this prospective randomized study was to evaluate the role of carbon dioxide (CO2) and normal saline for diagnostic accuracy in out-patient hysteroscopy. METHODS Women admitted to our Department in order to undergo total abdominal hysterectomy also underwent diagnostic hysteroscopy, 12-24 h prior to surgery. The selection of distending medium was made after randomization. Two groups of patients were formed, group A (CO2; n=39) and group B (normal saline; n=35). More than half of the women in the study population were post-menopausal. Post-hysteroscopy, all women were asked to rank any symptom that they felt during the procedure on a 4-point scale (0=none; 1=mild; 2=severe; 3=inability to perform hysteroscopy). The hysteroscopic diagnosis was compared with the macroscopic findings and the histological examination of the surgical specimen after hysterectomy. RESULTS The percentage who completed hysteroscopy was 89.74% within group A and 97.14% within group B. Most patients of both groups felt some pain of mild intensity. The diagnostic accuracy of hysteroscopy was similar for both media when major pathology [large polyps (group A 91.7%; group B 92.7%), myomas (group A 81.25%; group B 92.7%) and/or hyperplasia (group A 87.5%; group B 90.2%)] of the endometrial cavity was detected. In contrast, in cases of minor pathology (small polyps, mucosal elevations, crypts, hypervascularization), hysteroscopy with saline presented with significantly higher diagnostic accuracy (85.4%) compared with hysteroscopy with CO2 (64.6%). CONCLUSIONS In out-patient hysteroscopy, CO2 and normal saline were comparable with regard to patient discomfort and for the detection of major pathology of the endometrial cavity. Normal saline seems to be the most appropriate medium for the detection of minor pathology of the endometrial cavity.
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Affiliation(s)
- M Paschopoulos
- Department of Obstetrics and Gynecology, Ioannina University School of Medicine, 45500 Ioannina, Greece
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Graber DJ, Ardagh MW, O'Donovan P, St George I. A telephone advice line does not decrease the number of presentations to Christchurch Emergency Department, but does decrease the number of phone callers seeking advice. N Z Med J 2003; 116:U495. [PMID: 12861309] [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: 03/03/2023]
Abstract
AIM To describe the effect of a pilot national telephone advice service (Healthline) on a public hospital emergency department. METHODS We prospectively gathered information from the Christchurch Hospital Emergency Department (ED) computer- and non-computer-based information systems, for a six-month period during the operation of Healthline. We compared the data with five earlier periods when Healthline was not running. In addition, Healthline collected and analysed data from call log information. RESULTS There was a small increase (1.1%) in ED attendance during the study period. Patients referred by Healthline had a similar triage distribution to the general ED population, but a lower admission rate (29% vs 47%). Telephone calls to the ED dropped dramatically during the study period. CONCLUSIONS Healthline had little effect on overall ED census and appeared to refer patients with similar acuity to the general ED census. It decreased the workload for ED nursing staff charged with answering advice calls.
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Affiliation(s)
- David J Graber
- Emergency Department, Christchurch Hospital, Christchurch, New Zealand.
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Ardagh MW, Wells JE, Cooper K, Lyons R, Patterson R, O'Donovan P. Effect of a rapid assessment clinic on the waiting time to be seen by a doctor and the time spent in the department, for patients presenting to an urban emergency department: a controlled prospective trial. N Z Med J 2002; 115:U28. [PMID: 12362191] [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: 02/26/2023]
Abstract
AIMS To test the hypothesis that triaging certain emergency department (ED) patients through a rapid assessment clinic (RAC) improves the waiting times, and times in the department, for all patients presenting to the emergency department. METHODS For ten weeks an additional nurse and doctor were rostered. On the odd weeks, these two staff ran a RAC and on even weeks, they did not, but simply joined the other medical and nursing staff, managing patients in the traditional way. Patients suitable for triage to the RAC were those for whom disposal was readily apparent, interventions required were quickly undertaken, and lengthy investigations or assessment were not required. After the ten-week period data from the five weeks of the RAC and the five weeks with no RAC, but the same staffing level, were analysed and compared. RESULTS During the five weeks of the RAC clinic a total of 2263 patients attended the ED, and 361 of these were referred to the RAC clinic. During the five control weeks a total of 2204 patients attended the ED. There was no significant difference in the distribution across triage categories between the RAC and non-RAC periods. The waiting times to be seen by a doctor show no difference at Triage 2 and 3 and a difference of several minutes for Triage 4 and 5 categories. The times patients spent in the ED also show no difference for Triage 2 and 3 and about 20 to 25 minutes advantage for RAC-week patients in Triage categories 4 and 5. CONCLUSIONS The rapid management of patients with problems which do not require prolonged assessment or decision making, is beneficial not only to those patients, but also to other patients sharing the same, limited resources.
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Affiliation(s)
- M W Ardagh
- Christchurch School of Medicine and Health Sciences, Christchurch, New Zealand.
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Mc Gurgan P, O'Donovan P, Jones SE. The effect of operator gender on patient satisfaction: does the ‘Y’ in outpatient hysteroscopy matter? ACTA ACUST UNITED AC 2001. [DOI: 10.1046/j.1365-2508.2001.00388.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: 11/20/2022]
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Abstract
Menorrhagia is a common clinical problem. Recently several different ablative techniques have been described to treat it in the expectation of reducing hysterectomy rates. This paper describes the current status of microwave endometrial ablation, its clinical efficacy, its safety profile and future development.
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Affiliation(s)
- E Downes
- Chase Farm Hospital, The Ridgeway, Enfield, UK.
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O'Donovan P, McGurgan P. Micro-endoscopy in gynaecology. Int J Gynaecol Obstet 2000. [DOI: 10.1016/s0020-7292(00)86166-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Quinn P, Gurgan PM, O'Donovan P. Does the “Y” in out-patient hysteroscopy matter? Int J Gynaecol Obstet 2000. [DOI: 10.1016/s0020-7292(00)80483-x] [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: 11/24/2022]
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McGurgan P, O'Donovan P. Choice of treatment for menorrhagia. Lancet 1999; 354:1032-3. [PMID: 10501391 DOI: 10.1016/s0140-6736(05)76639-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Abstract
A woman with a very poor obstetric history with a cervical pregnancy was managed without hysterectomy. Diagnosis was made by the transvaginal ultrasound. Haemorrhage was controlled by suction evacuation and balloon tamponade. Although cervical perforation occurred, the tamponade was able to control haemorrhage after repair of the perforation.
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Affiliation(s)
- M G Okeahialam
- Department of Obstetrics and Gynaecology, Bradford Royal Infirmary, West Yorkshire, UK
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Abstract
BACKGROUND Malignant pleural effusions are classically exudative, though occasionally they can be transudative. We attempted to determine the prevalence of transudative malignant pleural effusions and to describe their clinical and radiographic characteristics. METHODS We studied the medical records of 215 patients with malignant pleural effusion, which contained complete data on pleural fluid analysis for 171 of them. RESULTS Eight cases of transudative malignant effusion were found. Seven of these eight patients had a concomitant disorder known to cause transudative pleural effusion. One patient had fluid overload due to renal failure, and another had been admitted earlier with congestive heart failure. Two patients had definite evidence of deep venous thrombosis, allowing us to postulate pulmonary embolism as a factor contributing to transudation. Three patients had CT evidence of superior vena cava obstruction. Only one patient had no known associations with causes of transudative effusion. CONCLUSION Malignant pleural effusions were transudative in 5% of our patients. In all except one patient, some evidence suggested the concomitant presence of a transudative state.
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Affiliation(s)
- M Ashchi
- Division of Cardiology, University of Connecticut, Hartford Hospital, USA
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Okeahialam MG, O'Donovan P, Teffnell DJ. Uterine rupture in labour following surgical termination of pregnancy. J OBSTET GYNAECOL 1997; 17:488. [PMID: 15511933 DOI: 10.1080/01443619750112556] [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: 10/27/2022]
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O'Donovan P. Integrated health systems: managing the transition to the new environment. J Cardiovasc Manag 1995; 6:17-20. [PMID: 10153785] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
Affiliation(s)
- P O'Donovan
- William Beaumont Hospital, Royal Oak, MI, USA
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O'Donovan P. Making the transition to a new environment requires forethought and planning. Health Care Strateg Manage 1994; 12:15-7. [PMID: 10136297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
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Kelly AM, Richards D, Kerr L, Grant J, O'Donovan P, Basire K, Graham R. Failed validation of a clinical decision rule for the use of radiography in acute ankle injury. N Z Med J 1994; 107:294-5. [PMID: 8093158] [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: 01/28/2023]
Abstract
AIM To validate the Ottawa clinical decision rule for the use of radiography in acute ankle injuries. METHOD A prospective, multicentre trial of 350 adult patients presenting with acute ankle injuries consisting of correlation of the features of the Ottawa clinical decision rule with the results of x-rays. RESULTS There were 75 fractures in 350 patients, five of which would have been missed by the clinical decision rule. The sensitivity of the rule was 93% with a specificity of 11%. The positive predictive value was 22%, the false negative rate 14%. Fractures that would have been missed by the clinical decision rule included one unstable fracture of the ankle, one fracture of the talus, one calcaneal fracture and one fracture each of the cuboid and navicular. CONCLUSION The Ottawa clinical decision rule for the use of radiography in acute ankle injuries is unacceptable for application in emergency departments in New Zealand due to a high false negative rate.
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Affiliation(s)
- A M Kelly
- Emergency Department Hutt Hospital, Lower Hutt, New Zealand
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Abstract
Esophageal pathology rarely presents as posterior mediastinal abnormalities on chest roentgenograms, with the most common being hiatal hernia. We describe a patient with giant esophageal varices manifesting as a retrocardiac, posterior mediastinal mass.
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Affiliation(s)
- S G Basheda
- Cleveland Clinic, Department of Pulmonary Disease/Critical Care Medicine
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Thornton JG, Ali S, O'Donovan P, Griffin N, Wells M, MacDonald RR. Flow cytometric studies of ploidy and proliferative indices in the Yorkshire trial of adjuvant progestogen treatment of endometrial cancer. Br J Obstet Gynaecol 1993; 100:253-61. [PMID: 8476831 DOI: 10.1111/j.1471-0528.1993.tb15239.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
OBJECTIVE To estimate whether flow cytometric indices provide independent measures of prognosis or predict response to prophylactic progestogens in endometrial cancer. DESIGN Endometrial tumour specimens were retrieved and analysed by flow cytometry from 257 women who had been randomly allocated in a previous trial to receive prophylactic progestogen in addition to conventional therapy for endometrial carcinoma. SETTING Fourteen district and two teaching hospitals in West Yorkshire. SUBJECTS Women developing primary endometrial cancer between 1975 and 1983. MAIN OUTCOME MEASURES Tumour ploidy status and proliferative indices and the relation of these to tumour stage and grade, to prognosis and to response to progestogens. RESULTS Ploidy status and proliferative indices were related to tumour stage, grade and patient survival but were not independent predictors of survival. They did not predict patients who would respond to progestogens although there was a nonsignificant trend towards patients with diploid tumours surviving longer after progestogen treatment. CONCLUSIONS Flow cytometry adds little to established prognostic indicators for endometrial cancer.
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Affiliation(s)
- J G Thornton
- Institute of Epidemiology and Health Services Research, University of Leeds, UK
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Watson AJ, Gupta JK, O'Donovan P, Dalton ME, Lilford RJ. The results of tubal surgery in the treatment of infertility in two non-specialist hospitals. Br J Obstet Gynaecol 1990; 97:561-8. [PMID: 2202431 DOI: 10.1111/j.1471-0528.1990.tb02541.x] [Citation(s) in RCA: 40] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
The results of surgery for tubal damage, other than reversal of sterilization, were studied in two large hospitals. This is the first recent study from centres claiming no special expertise in this surgery. An unusually high follow-up rate was obtained. The term pregnancy rate for patients operated on for bilateral distal tubal occlusion was 4%. The success rate is lower than the lowest reported, overall success rates for each cycle of in vitro fertilization (IVF) and very much lower than cumulative term pregnancy rates for tubal surgery reported by most other authors. Patients with distal tubal occlusion but minimal adhesions had the best prognosis. Our results suggest that, provided in vitro fertilization is available, only those patients with good prognostic factors should undergo tubal surgery. These represent the minority of all patients with non-iatrogenic tubal blockage.
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Affiliation(s)
- A J Watson
- Department of Obstetrics and Gynaecology, St. James's Hospital, Leeds
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Affiliation(s)
- S M Krawtz
- Department of Pulmonary Medicine, Cleveland Clinic Foundation
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O'Donovan P, Gupta JK, Savage J, Thornton JG, Lilford RJ. Is routine antenatal booking vaginal examination necessary for reasons other than cervical cytology if ultrasound examination is planned? Br J Obstet Gynaecol 1988; 95:556-9. [PMID: 3291933 DOI: 10.1111/j.1471-0528.1988.tb09482.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Sixteen ovarian cysts, including one borderline ovarian malignancy, and ten trichomonal vaginal discharges but no cases of cervical incompetence or ectopic pregnancy had been detected at booking vaginal examination in 11,622 consecutive antenatal case records abstracted retrospectively. In an attitude survey of pregnant women 77% believed that vaginal examination was reassuring, 55% found it unpleasant, and 18% thought it could cause miscarriage. This, and a review of the literature, suggests that routine vaginal examination if ultrasound is planned has few advantages beyond the taking of a cervical smear.
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Affiliation(s)
- P O'Donovan
- Department of Obstetrics and Gynaecology, General Infirmary, Leeds
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O'Donovan P, Abraham M. Somatic tissue-male germ cell barrier in three hermaphrodite invertebrates:Dugesia biblica (Platyhelminthes),Placobdella costata (Annelida), andLevantina hierosolyma (Mollusca). J Morphol 1987; 192:217-227. [DOI: 10.1002/jmor.1051920304] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Boylan P, O'Donovan P, Owens OJ. Fetal breathing movements and the diagnosis of labor: a prospective analysis of 100 cases. Obstet Gynecol 1985; 66:517-20. [PMID: 3900838] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
One hundred patients self-admitted to the hospital with a diagnosis of labor, were observed for up to 45 minutes with real-time ultrasonography to determine if the presence or absence of fetal breathing movements was helpful in separating false labor from true labor. Fetal breathing movements were not detected in 31 patients, and 30 of these delivered spontaneously within 48 hours; fetal breathing movements were present in 69 cases, and pregnancy continued for at least 48 hours in 56; of the remaining 13, labor occurred spontaneously within 48 hours in eight, whereas five had labor induced. Assessment of the cervix by Bishop score after ultrasound further improved diagnostic precision; none of 13 patients with a score greater than 9 exhibited fetal breathing movements, and all delivered within 48 hours. Gestational age did not influence outcome; 25 patients were preterm, and all 22 in whom fetal breathing movements were present continued for more than 48 hours. The results suggest that the absence of fetal breathing movements differentiates true labor from false labor.
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O'Donovan P, O'Brien N. Group B beta haemolytic disease in preterm twins associated with the ingestion of infected breast milk--a case report. Ir J Med Sci 1985; 154:158-9. [PMID: 3891672 DOI: 10.1007/bf02937260] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
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O'Donovan P, O'Herlihy C. Unexpected delivery outside hospital. Ir Med J 1984; 77:283-5. [PMID: 6480329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
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O'Donovan P, Brady MP, O'Donnell J, Kirwan WO. Quality of result in hernia repair--review of 166 consecutive groin hernia operations. Ir Med J 1983; 76:283-284. [PMID: 6874311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
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O'Donovan T, O'Donovan P. Emergicenters: the next wave. Health Serv Manager 1982; 15:1-3. [PMID: 10253773] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
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Kimber WD, Brown M, Deutsch GA, Faricy R, Kenney J, Lester S, Lilja GP, O'Donovan P. Mechanisms of rapid entry into the system. Minn Med 1978; 61:593,595,597,599. [PMID: 713985] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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