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Borg P, Ng HHL, Mullan D, Aziz O, Laasch HU. Ultrasound-guided day-case wide-bore percutaneous mucin aspiration in advanced pseudomyxoma peritonei. Clin Radiol 2023; 78:e458-e462. [PMID: 36842914 DOI: 10.1016/j.crad.2023.01.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Revised: 01/26/2023] [Accepted: 01/26/2023] [Indexed: 02/18/2023]
Abstract
AIM To evaluate percutaneous ultrasound-guided day-case mucin aspiration in advanced pseudomyxoma peritonei (PMP) using a wide-bore drain with regards to its safety and efficacy. MATERIALS AND METHODS All patients who underwent percutaneous mucin aspiration for PMP between 2019-2021 at a single national peritoneal tumour service were included in this study. Under local anaesthesia, a suction-enabled 28-32 F catheter was used for drainage following wire-guided track dilatation. The volume drained and difference in abdominal girth pre- and post-procedure were measured. Patients graded difficulty in breathing and abdominal discomfort pre- and post-procedure. Histology reports were reviewed. RESULTS Sixteen patients received 56 percutaneous mucin aspirations between 2019-2021. The aetiology was a low-grade appendiceal mucinous neoplasm (LAMN) in 50% of patients. The mean amount of mucin drained was 7,320 ± 3,000ml (range 300-13,500 ml). The mean reduction in abdominal girth post-procedure was 12.2 ± 5 cm (range 0-27 cm). Only grade 1 complications were observed. CONCLUSION Percutaneous ultrasound-guided day-case aspiration of mucin for advanced and recurrent PMP using a wide-bore drain is a safe and effective procedure. It may be used in the palliative setting or as a bridge to surgery in the very symptomatic patient or if there is a reversible contraindication to surgery.
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Affiliation(s)
- P Borg
- Department of Radiology, The Christie NHS Foundation Trust, Manchester, UK.
| | - H H-L Ng
- School of Medicine, Faculty of Medicine and Health, University of Leeds, Leeds, UK
| | - D Mullan
- Department of Radiology, The Christie NHS Foundation Trust, Manchester, UK
| | - O Aziz
- Colorectal and Peritoneal Oncology Centre, The Christie NHS Foundation Trust, Manchester, UK; Faculty, Institute of Cancer Sciences, University of Manchester, Manchester, UK
| | - H-U Laasch
- Department of Radiology, The Christie NHS Foundation Trust, Manchester, UK; Department of Natural Sciences, University of Chester, Chester, UK
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Daga K, Berry T, Mullan D, Laasch HU. Transformation of indwelling peritoneal catheter placement for malignant ascites from an inpatient to a day-case service: analysis of patient risk and financial implication. Clin Radiol 2022; 77:689-693. [DOI: 10.1016/j.crad.2022.05.027] [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] [Received: 10/05/2021] [Revised: 05/06/2022] [Accepted: 05/13/2022] [Indexed: 11/03/2022]
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Hague C, McPartlin A, Lee LW, Hughes C, Mullan D, Beasley W, Green A, Price G, Whitehurst P, Slevin N, van Herk M, West C, Chuter R. An evaluation of MR based deep learning auto-contouring for planning head and neck radiotherapy. Radiother Oncol 2021; 158:112-117. [PMID: 33636229 DOI: 10.1016/j.radonc.2021.02.018] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Revised: 02/02/2021] [Accepted: 02/15/2021] [Indexed: 10/22/2022]
Abstract
INTRODUCTION Auto contouring models help consistently define volumes and reduce clinical workload. This study aimed to evaluate the cross acquisition of a Magnetic Resonance (MR) deep learning auto contouring model for organ at risk (OAR) delineation in head and neck radiotherapy. METHODS Two auto contouring models were evaluated using deep learning contouring expert (DLCExpert) for OAR delineation: a CT model (modelCT) and an MR model (modelMRI). Models were trained to generate auto contours for the bilateral parotid glands and submandibular glands. Auto-contours for modelMRI were trained on diagnostic images and tested on 10 diagnostic, 10 MR radiotherapy planning (RTP), eight MR-Linac (MRL) scans and, by modelCT, on 10 CT planning scans. Goodness of fit scores, dice similarity coefficient (DSC) and distance to agreement (DTA) were calculated for comparison. RESULTS ModelMRI contours improved the mean DSC and DTA compared with manual contours for the bilateral parotid glands and submandibular glands on the diagnostic and RTP MRs compared with the MRL sequence. There were statistically significant differences seen for modelMRI compared to modelCT for the left parotid (mean DTA 2.3 v 2.8 mm), right parotid (mean DTA 1.9 v 2.7 mm), left submandibular gland (mean DTA 2.2 v 2.4 mm) and right submandibular gland (mean DTA 1.6 v 3.2 mm). CONCLUSION A deep learning MR auto-contouring model shows promise for OAR auto-contouring with statistically improved performance vs a CT based model. Performance is affected by the method of MR acquisition and further work is needed to improve its use with MRL images.
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Affiliation(s)
- C Hague
- Department of Head and Neck Clinical Oncology, The Christie NHS Foundation Trust, Manchester, UK.
| | - A McPartlin
- Department of Head and Neck Clinical Oncology, The Christie NHS Foundation Trust, Manchester, UK.
| | - L W Lee
- Department of Head and Neck Clinical Oncology, The Christie NHS Foundation Trust, Manchester, UK.
| | - C Hughes
- Department of Head and Neck Clinical Oncology, The Christie NHS Foundation Trust, Manchester, UK.
| | - D Mullan
- Department of Radiology, The Christie NHS Foundation Trust, Manchester, UK.
| | - W Beasley
- Christie Medical Physics and Engineering, The Christie NHS Foundation Trust, Manchester, UK.
| | - A Green
- Division of Cancer Sciences, Faculty of Biology, Medicine and Heath, University of Manchester, Manchester Academic Health Science Centre, The Christie NHS Foundation Trust, Manchester, UK.
| | - G Price
- Division of Cancer Sciences, Faculty of Biology, Medicine and Heath, University of Manchester, Manchester Academic Health Science Centre, The Christie NHS Foundation Trust, Manchester, UK.
| | - P Whitehurst
- Christie Medical Physics and Engineering, The Christie NHS Foundation Trust, Manchester, UK.
| | - N Slevin
- Department of Head and Neck Clinical Oncology, The Christie NHS Foundation Trust, Manchester, UK
| | - M van Herk
- Christie Medical Physics and Engineering, The Christie NHS Foundation Trust, Manchester, UK; Division of Cancer Sciences, Faculty of Biology, Medicine and Heath, University of Manchester, Manchester Academic Health Science Centre, The Christie NHS Foundation Trust, Manchester, UK.
| | - C West
- Division of Cancer Sciences, Faculty of Biology, Medicine and Heath, University of Manchester, Manchester Academic Health Science Centre, The Christie NHS Foundation Trust, Manchester, UK.
| | - R Chuter
- Christie Medical Physics and Engineering, The Christie NHS Foundation Trust, Manchester, UK; Division of Cancer Sciences, Faculty of Biology, Medicine and Heath, University of Manchester, Manchester Academic Health Science Centre, The Christie NHS Foundation Trust, Manchester, UK.
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4
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Haslett K, Koh P, Hudson A, Ryder W, Falk S, Mullan D, Taylor B, Califano R, Blackhall F, Faivre-Finn C. Phase I trial of the MEK inhibitor selumetinib in combination with thoracic radiotherapy in non-small cell lung cancer. Clin Transl Radiat Oncol 2021; 28:24-31. [PMID: 33748440 PMCID: PMC7970011 DOI: 10.1016/j.ctro.2021.02.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [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: 01/07/2021] [Revised: 02/19/2021] [Accepted: 02/20/2021] [Indexed: 12/25/2022] Open
Abstract
Background The RAS/RAF/MEK/ERK signalling pathway has a pivotal role in cancer proliferation and modulating treatment response. Selumetinib inhibits MEK and enhances effects of radiotherapy in preclinical studies. Patients and methods Single-arm, single-centre, open-label phase I trial. Patients with stage III NSCLC unsuitable for concurrent chemo-radiotherapy, or stage IV with dominant thoracic symptoms, were recruited to a dose-finding stage (Fibonacci 3 + 3 design; maximum number = 18) then an expanded cohort (n = 15). Oral selumetinib was administered twice daily (starting dose 50 mg) commencing 7 days prior to thoracic radiotherapy, then with radiotherapy (6-6.5 weeks; 60-66 Gy/30-33 fractions). The primary objective was to determine the recommended phase II dose (RP2D) of selumetinib in combination with thoracic radiotherapy. Results 21 patients were enrolled (06/2010-02/2015). Median age: 62y (range 50-73). M:F ratio 12(57%):9(43%). ECOG PS 0:1, 7(33%):14(67%). Stage III 16(76%); IV 5(24%). Median GTV 64 cm3 (range 1-224 cm3). 15 patients comprised the expanded cohort at starting dose. All 21 patients completed thoracic radiotherapy as planned and received induction chemotherapy. 13 (62%) patients received the full dose of selumetinib.In the starting cohort no enhanced radiotherapy-related toxicity was seen. Two patients had dose-limiting toxicity (1x grade 3 diarrhoea/fatigue and 1x pulmonary embolism). Commonest grade 3-4 adverse events: lymphopaenia (19/21 patients) and hypertension (7/21 patients). One patient developed grade 3 oesophagitis. No patients developed grade ≥3 radiation pneumonitis. Two patients were alive at the time of analysis (24 and 26 months follow-up, respectively). Main cause of first disease progression: distant metastases ± locoregional progression (12/21 [57.1%] patients). Six patients had confirmed/suspected pneumocystis jiroveci pneumonia. Conclusion We report poor outcome and severe lymphopenia in most patients treated with thoracic radiotherapy and selumetinib at RP2D in combination, contributing to confirmed/clinically suspected pneumocystis jiroveci pneumonia. These results suggest that this combination should not be pursued in a phase II trial.ClinicalTrials.gov reference: NCT01146756.
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Affiliation(s)
- K. Haslett
- The Christie NHS Foundation Trust, United Kingdom
| | - P. Koh
- University of Manchester, United Kingdom
- New Cross Hospital, United Kingdom
| | - A. Hudson
- The Christie NHS Foundation Trust, United Kingdom
| | - W.D. Ryder
- University of Manchester, United Kingdom
| | - S. Falk
- The Christie NHS Foundation Trust, United Kingdom
| | - D. Mullan
- The Christie NHS Foundation Trust, United Kingdom
| | - B. Taylor
- The Christie NHS Foundation Trust, United Kingdom
| | - R. Califano
- The Christie NHS Foundation Trust, United Kingdom
- University of Manchester, United Kingdom
| | - F. Blackhall
- The Christie NHS Foundation Trust, United Kingdom
- University of Manchester, United Kingdom
| | - C. Faivre-Finn
- The Christie NHS Foundation Trust, United Kingdom
- University of Manchester, United Kingdom
- Corresponding author at: The Christie NHS Foundation Trust, United Kingdom.
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Hague C, Beasley W, Green A, Garcez K, Lee L, Maranzano M, McPartlin A, Mullan D, Sykes A, Thomson D, van Herk M, West C, Slevin N. Evaluation of a Novel Atlas to Reduce Variability of Contouring Masticatory Muscles in Head and Neck Cancer Patients. Int J Radiat Oncol Biol Phys 2018. [DOI: 10.1016/j.ijrobp.2018.07.858] [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: 10/28/2022]
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6
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Wilson G, Bentley D, Mullamitha S, Braun M, Nasralla M, Bell J, Mullan D, Hasan J, Saunders M, Marti F, McBain C, Alam N, Laasch H, Najran P, Westwood T, Jeans S, Tipping J, Manoharan P, Lawrance J. Selective internal radiation therapy (SIRT) with yttrium-90 microspheres and peri-procedural FOLFIRI/irinotecan in pre-treated colorectal liver metastases patients: An analysis of outcomes from a UK Cancer Centre between 2009 and 2017. Ann Oncol 2018. [DOI: 10.1093/annonc/mdy151.274] [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: 11/13/2022] Open
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7
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Haslett K, Blackhall F, Koh P, Ashcroft L, Asselin M, Harris C, Jackson A, Manoharan P, Mullan D, Ryder W, Taylor B, Faivre-Finn C. PO-0753: Phase I trial evaluating MEK inhibitor selumetinib with concomitant thoracic radiotherapy in NSCLC. Radiother Oncol 2018. [DOI: 10.1016/s0167-8140(18)31063-6] [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]
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8
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Wilson G, Mullamitha S, Bentley D, Bell J, Mullan D, Carter L, Chittalia A, Howell S, Laasch HU, Westwood T, Jeans S, Tipping J, Ryder D, Farquharson F, Arumugam P, Sheen A, Rajashanker B, Armstrong A, Misra V, Manoharan P, Lawrance J. Abstract P1-14-06: Selective internal radiation therapy (SIRT) with Yttrium-90 resin microspheres and FOLFOX/5FU chemotherapy in pre-treated breast cancer patients with liver metastases: A retrospective analysis of response rates, times to progression and survival of patients treated in Manchester UK between 2010 and 2016. Cancer Res 2018. [DOI: 10.1158/1538-7445.sabcs17-p1-14-06] [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:
SIRT is a globally licensed technique of Radio-Embolization (RE) of hepatic tumors via intra-arterial infusion of β-particle emitting Yttrium-90 (Y-90) radio-labelled microspheres. It increases response rates and hepatic time to progression in metastatic colorectal cancer when used in combination with 5FU/Oxaliplatin (FOLFOX) chemotherapy with acceptable toxicity profile. FOLFOX gives a radio-sensitizing effect and also controls disease outside the liver. Breast cancer liver metastases (BCLM) patients often have extra-hepatic disease and respond to multiple lines of systemic therapy and SIRT is infrequently used.
Methods and patients
Between 2010 and 2016 we treated 25 BCLM patients with Y-90 SIRT.
Receptor status: 20 ER+ve/HER-2 -ve, 3 ER-ve/HER-2 +ve, 2 triple -ve.
Eleven patients had liver only disease with 14 also having known extra-hepatic disease. Average number of previous lines of therapy in metastatic setting: chemotherapy = 2.4; endocrine = 1. Sixty-four % patients had prior Capecitabine (n=16); 12% platinum (n=3, all Carboplatin). Twenty patients received chemotherapy with SIRT: 17 had modified FOLFOX6 (Oxaliplatin/bolus 5FU day1, infusional 5FU day 1-3 (46 hrs); 3 patients had Modified de Gramont style 5FU alone. Five patients had no chemotherapy.
Sir-spheres were inserted on day 2 of FOLFOX with the 5FU infusion pump continuing to day 3. Further 2-weekly FOLFOX chemo cycles were at clinician's discretion: average number delivered 3.8. Four patients had the liver treated in two halves, approximately 6 weeks apart. One patient received SIRT only to half the liver. Patients were imaged with PET-CT/CT before and 2-3 months after SIRT. Retrospective case note review was performed and data correlated to evaluate tumor response (RR); hepatic and extra hepatic progression free survival (HPFS and EHPFS) and overall survival (OS). Accurate toxicity data was not recorded.
Results
Hepatic CT response rates: PR 56% (n=14), SD 28% (n=7) and PD 16% (n=4). Hepatic PET response rates: CR 32% (n=8), PR 40% (n=10), SD 12% (n=3), PD 16%(n=4). (Overall PET liver disease control rate = 84%).
Eight patients (32%) had extra-hepatic PD at first assessment. Of them, 4 had PR, 2 SD and 2 PD in the liver at that assessment. Two HER-2 +ve patients had brain metastases as first sign of PD within 75 days, an area not previously screened. Of 16 pre-treated with Capecitabine, liver CT response rates: 62.5% PR, 18.75% SD (n=10,3). Post SIRT/FOLFOX, average number of therapy lines: 2 for chemo and 0.75 for endocrine, with 8 patients still alive at time of censoring.
Median OS: 766 HPFS: 210 days (CI 140-286). Median EHPFS in patients with extra-hepatic disease: 152 days (CI 96-636).
Conclusions
SIRT with FOLFOX in previously treated BCLM patients produces high response rates, excellent tumor control and time to progression in the liver with good overall survival. It does not seem to decrease the ability to give further lines of chemotherapy and can be considered as an option for breast cancer patients with liver metastases.
Citation Format: Wilson G, Mullamitha S, Bentley D, Bell J, Mullan D, Carter L, Chittalia A, Howell S, Laasch H-U, Westwood T, Jeans S, Tipping J, Ryder D, Farquharson F, Arumugam P, Sheen A, Rajashanker B, Armstrong A, Misra V, Manoharan P, Lawrance J. Selective internal radiation therapy (SIRT) with Yttrium-90 resin microspheres and FOLFOX/5FU chemotherapy in pre-treated breast cancer patients with liver metastases: A retrospective analysis of response rates, times to progression and survival of patients treated in Manchester UK between 2010 and 2016 [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr P1-14-06.
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Affiliation(s)
- G Wilson
- The Christie NHS Foundation Trust, Manchester, Lancashire, United Kingdom; Central Manchester University Hospitals NHS Foundation Trust, Manchester, Lancashire, United Kingdom
| | - S Mullamitha
- The Christie NHS Foundation Trust, Manchester, Lancashire, United Kingdom; Central Manchester University Hospitals NHS Foundation Trust, Manchester, Lancashire, United Kingdom
| | - D Bentley
- The Christie NHS Foundation Trust, Manchester, Lancashire, United Kingdom; Central Manchester University Hospitals NHS Foundation Trust, Manchester, Lancashire, United Kingdom
| | - J Bell
- The Christie NHS Foundation Trust, Manchester, Lancashire, United Kingdom; Central Manchester University Hospitals NHS Foundation Trust, Manchester, Lancashire, United Kingdom
| | - D Mullan
- The Christie NHS Foundation Trust, Manchester, Lancashire, United Kingdom; Central Manchester University Hospitals NHS Foundation Trust, Manchester, Lancashire, United Kingdom
| | - L Carter
- The Christie NHS Foundation Trust, Manchester, Lancashire, United Kingdom; Central Manchester University Hospitals NHS Foundation Trust, Manchester, Lancashire, United Kingdom
| | - A Chittalia
- The Christie NHS Foundation Trust, Manchester, Lancashire, United Kingdom; Central Manchester University Hospitals NHS Foundation Trust, Manchester, Lancashire, United Kingdom
| | - S Howell
- The Christie NHS Foundation Trust, Manchester, Lancashire, United Kingdom; Central Manchester University Hospitals NHS Foundation Trust, Manchester, Lancashire, United Kingdom
| | - H-U Laasch
- The Christie NHS Foundation Trust, Manchester, Lancashire, United Kingdom; Central Manchester University Hospitals NHS Foundation Trust, Manchester, Lancashire, United Kingdom
| | - T Westwood
- The Christie NHS Foundation Trust, Manchester, Lancashire, United Kingdom; Central Manchester University Hospitals NHS Foundation Trust, Manchester, Lancashire, United Kingdom
| | - S Jeans
- The Christie NHS Foundation Trust, Manchester, Lancashire, United Kingdom; Central Manchester University Hospitals NHS Foundation Trust, Manchester, Lancashire, United Kingdom
| | - J Tipping
- The Christie NHS Foundation Trust, Manchester, Lancashire, United Kingdom; Central Manchester University Hospitals NHS Foundation Trust, Manchester, Lancashire, United Kingdom
| | - D Ryder
- The Christie NHS Foundation Trust, Manchester, Lancashire, United Kingdom; Central Manchester University Hospitals NHS Foundation Trust, Manchester, Lancashire, United Kingdom
| | - F Farquharson
- The Christie NHS Foundation Trust, Manchester, Lancashire, United Kingdom; Central Manchester University Hospitals NHS Foundation Trust, Manchester, Lancashire, United Kingdom
| | - P Arumugam
- The Christie NHS Foundation Trust, Manchester, Lancashire, United Kingdom; Central Manchester University Hospitals NHS Foundation Trust, Manchester, Lancashire, United Kingdom
| | - A Sheen
- The Christie NHS Foundation Trust, Manchester, Lancashire, United Kingdom; Central Manchester University Hospitals NHS Foundation Trust, Manchester, Lancashire, United Kingdom
| | - B Rajashanker
- The Christie NHS Foundation Trust, Manchester, Lancashire, United Kingdom; Central Manchester University Hospitals NHS Foundation Trust, Manchester, Lancashire, United Kingdom
| | - A Armstrong
- The Christie NHS Foundation Trust, Manchester, Lancashire, United Kingdom; Central Manchester University Hospitals NHS Foundation Trust, Manchester, Lancashire, United Kingdom
| | - V Misra
- The Christie NHS Foundation Trust, Manchester, Lancashire, United Kingdom; Central Manchester University Hospitals NHS Foundation Trust, Manchester, Lancashire, United Kingdom
| | - P Manoharan
- The Christie NHS Foundation Trust, Manchester, Lancashire, United Kingdom; Central Manchester University Hospitals NHS Foundation Trust, Manchester, Lancashire, United Kingdom
| | - J Lawrance
- The Christie NHS Foundation Trust, Manchester, Lancashire, United Kingdom; Central Manchester University Hospitals NHS Foundation Trust, Manchester, Lancashire, United Kingdom
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Haslett K, Blackhall F, Koh P, Ashcroft L, Asselin M, Harris C, Jackson A, Manoharan P, Mullan D, Ryder D, Taylor M, Faivre-Finn C. MA 17.14 Phase I Trial Evaluating MEK Inhibitor Selumetinib with Concomitant Thoracic Radiotherapy in Non-Small-Cell Lung Cancer. J Thorac Oncol 2017. [DOI: 10.1016/j.jtho.2017.09.620] [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: 11/25/2022]
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Fitzsimons D, Mullan D, Wilson J, Chew E, Conway B, Corcoran B, Gamble J, Hanna L, Mcmullan G, Mcma-Hon M, Mulholland P, Stewart C, Stockdale P. 1375: The palliative care needs of patients with heart failure from the perspective of the patient, carer and clinical team. Eur J Cardiovasc Nurs 2017. [DOI: 10.1177/14745151060050s163] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- D. Fitzsimons
- Belfast City Hospital Trust, Belfast, N Ireland BT9 7AB
- Institute of Nursing Research, University of Ulster
| | - D. Mullan
- Belfast City Hospital Trust, Belfast, N Ireland BT9 7AB
| | - J. Wilson
- Belfast City Hospital Trust, Belfast, N Ireland BT9 7AB
| | - E. Chew
- Belfast City Hospital Trust, Belfast, N Ireland BT9 7AB
| | - B. Conway
- Belfast City Hospital Trust, Belfast, N Ireland BT9 7AB
| | - B. Corcoran
- Belfast City Hospital Trust, Belfast, N Ireland BT9 7AB
| | - J. Gamble
- Belfast City Hospital Trust, Belfast, N Ireland BT9 7AB
| | - L. Hanna
- Belfast City Hospital Trust, Belfast, N Ireland BT9 7AB
| | - G. Mcmullan
- Belfast City Hospital Trust, Belfast, N Ireland BT9 7AB
| | - M. Mcma-Hon
- Belfast City Hospital Trust, Belfast, N Ireland BT9 7AB
| | - P. Mulholland
- Belfast City Hospital Trust, Belfast, N Ireland BT9 7AB
| | - C. Stewart
- Belfast City Hospital Trust, Belfast, N Ireland BT9 7AB
| | - P. Stockdale
- Belfast City Hospital Trust, Belfast, N Ireland BT9 7AB
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Mullan D, Bolton J, Davenport S, Mcgeough M, Mcmonagle J, Neely M, Waring C, Carelton J, Walker E. 1383: Implementation of a nurse led acute chest pain team: Impact on patient care. Eur J Cardiovasc Nurs 2016. [DOI: 10.1016/j.ejcnurse.2007.01.076] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- D. Mullan
- Chest Pain Team, Cardiology Unit, Belfast City Hospital Trust, Lisburn Road, Belfast BT9 TAB, United Kingdom
| | - J. Bolton
- Chest Pain Team, Cardiology Unit, Belfast City Hospital Trust, Lisburn Road, Belfast BT9 TAB, United Kingdom
| | - S. Davenport
- Chest Pain Team, Cardiology Unit, Belfast City Hospital Trust, Lisburn Road, Belfast BT9 TAB, United Kingdom
| | - M. Mcgeough
- Chest Pain Team, Cardiology Unit, Belfast City Hospital Trust, Lisburn Road, Belfast BT9 TAB, United Kingdom
| | - J. Mcmonagle
- Chest Pain Team, Cardiology Unit, Belfast City Hospital Trust, Lisburn Road, Belfast BT9 TAB, United Kingdom
| | - M. Neely
- Chest Pain Team, Cardiology Unit, Belfast City Hospital Trust, Lisburn Road, Belfast BT9 TAB, United Kingdom
| | - C. Waring
- Chest Pain Team, Cardiology Unit, Belfast City Hospital Trust, Lisburn Road, Belfast BT9 TAB, United Kingdom
| | - J. Carelton
- Chest Pain Team, Cardiology Unit, Belfast City Hospital Trust, Lisburn Road, Belfast BT9 TAB, United Kingdom
| | - E. Walker
- Chest Pain Team, Cardiology Unit, Belfast City Hospital Trust, Lisburn Road, Belfast BT9 TAB, United Kingdom
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Foley J, Mullan D, Mohan H, Schmidt K. Abdominal aortitis on PET CT: A case report and review of the literature. Int J Surg Case Rep 2015; 10:104-6. [PMID: 25827296 PMCID: PMC4429952 DOI: 10.1016/j.ijscr.2015.02.029] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2014] [Revised: 02/09/2015] [Accepted: 02/16/2015] [Indexed: 11/03/2022] Open
Abstract
INTRODUCTION Aortitis often occurs in patients with systemic vasculitis. PRESENTATION OF CASE We reported a 73 year old man with giant cell arteritis who was presented with abdominal pain and weight loss. DISCUSSION Aortitis was diagnosed on PET-CT scan performed because initial investigations raised the possibility of pancreatic pathology. CONCLUSION This case highlights the utility of PET-CT in the diagnosis of abdominal aortitis and the need to consider aortitis as a differential in patients with abdominal pain with a history of vasculitis.
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Affiliation(s)
- J Foley
- Department of Surgery, Wexford General Hospital, Wexford, Ireland.
| | - D Mullan
- Department of Surgery, Wexford General Hospital, Wexford, Ireland
| | - H Mohan
- Department of Surgery, Wexford General Hospital, Wexford, Ireland
| | - K Schmidt
- Department of Surgery, Wexford General Hospital, Wexford, Ireland
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Mohan HM, Mullan D, McDermott F, Whelan RJ, O'Donnell C, Winter DC. Saving lives, limbs and livelihoods: considerations in restructuring a national trauma service. Ir J Med Sci 2014; 184:659-66. [PMID: 25481642 DOI: 10.1007/s11845-014-1234-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2014] [Accepted: 11/22/2014] [Indexed: 01/11/2023]
Abstract
STUDY HYPOTHESIS Level 1 trauma centers reduce mortality and improve functional outcomes in major trauma. Despite this, many countries, including Ireland, do not have officially designated major trauma centers (MTC). This study aimed to examine international trauma systems, and determine how to "best fit" trauma care in a small country (Ireland) to international models. METHODS The literature was reviewed to examine international models of trauma systems. An estimate of Irish trauma burden and distribution was made using data from the Road Safety Authority (RSA) on serious or fatal RTAs. Models of a restructured trauma service were constructed and compared with international best practice. RESULTS Internationally, a major trauma center surrounded by a regional trauma network has emerged as the gold standard in trauma care. In Ireland, there are no nationally coordinated trauma networks and care is provided by 26 acute hospitals with a mean distance to hospital from RTAs of 20.6 km ± 15.6. Based on our population, Ireland needs two Level 1 MTCs (in the two areas of major population density in the east and south), with robust surrounding trauma networks including Level 2 or 3 trauma centers. With this model, the estimated mean number of cases per Level 1 MTC per year would be 628, with a mean distance to MTC of 80.5 ± 59.2 km, (maximum distance 263.5 km). CONCLUSION Clearly designated and adequately resourced MTCs with trauma networks are needed to improve trauma outcomes, with concomitant investment in pre-hospital infrastructure.
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Affiliation(s)
- H M Mohan
- Department of Surgery, St Vincent's University Hospital, Elm Park, Dublin, 4, Ireland,
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Suntharanathan J, Edwards DW, Mullan D, Martin DF, Laasch HU. New "knitted" EGIS esophageal stent allows atraumatic inside-out removal by inversion. Endoscopy 2014; 45 Suppl 2 UCTN:E187-8. [PMID: 23832501 DOI: 10.1055/s-0032-1310147] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Affiliation(s)
- J Suntharanathan
- Department of Radiology, The Christie NHS Foundation Trust, Manchester, UK
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Kibriya N, Wilbraham L, Mullan D, Puro P, Vasileuskaya S, Edwards DW, Laasch HU. Disc-retained tubes for radiologically inserted gastrostomy (RIG): not up to the job? Clin Radiol 2013; 68:1128-32. [PMID: 23942264 DOI: 10.1016/j.crad.2013.06.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2013] [Revised: 06/09/2013] [Accepted: 06/14/2013] [Indexed: 10/26/2022]
Abstract
AIM To assess the insertion procedure and performance of disc-retained gastrostomy tubes, recording complications and accidental displacements by prospective audit, and to determine whether primary placement of the tube off-licence was feasible. MATERIALS AND METHODS Disc-retained 12 F single-lumen Monarch gastrostomy tubes (Enteral UK, Selby, UK) were inserted by three gastrointestinal interventional radiologists in a supra-regional cancer centre. The 12 F tubes required a 20 F peel-away sheath with four-point gastropexy fixation and were placed under conscious sedation, using electrocardiogram (EEG) bispectral index monitoring. Follow-up was performed in an in-house gastrostomy drop-in clinic at 1 week and 1 month, supplemented with weekly telephone follow-up. Patients also had open access to the gastrostomy drop-in clinic for immediate advice and complication management. RESULTS Eighteen patients underwent primary insertion of a Monarch gastrostomy tube over 5 months. A total of 6/18 (33%) tubes displaced; 4/18 (22%) completely, 2/18 (11%) occult into the peritoneum. Four of 18 (22%) patients developed infection at the stoma site. Due to the unexpectedly poor performance of the tube, the study was terminated early. CONCLUSION Initial experience with the Monarch disc-retained gastrostomy tube demonstrates it unsuitable for primary placement with current protocols. In view of the potentially serious complications, the Medicines and Healthcare Products Regulatory Agency (MHRA) has been informed. A request has been made to the distributer to reassess the tube design and/or review the procedure promoted for primary placement.
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Affiliation(s)
- N Kibriya
- Department of Radiology, The Christie NHS Foundation Trust, Manchester M20 4BX, UK.
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Mullan D, Jacob A, Laasch H. Malignant ascites: cost savings and complications with ultrasound-guided placement of tunnelled catheters. Cancer Imaging 2010. [DOI: 10.1102/1470-7330.2010.9045] [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] Open
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Mullan D, Wijendra D, Hill S, Laasch H. Recurrent malignant ascites: radiological treatment options and comparison of cost effectiveness. Cancer Imaging 2010. [DOI: 10.1102/1470-7330.2010.9080] [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] Open
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Fitzsimons D, Mullan D, Wilson JS, Conway B, Corcoran B, Dempster M, Gamble J, Stewart C, Rafferty S, McMahon M, MacMahon J, Mulholland P, Stockdale P, Chew E, Hanna L, Brown J, Ferguson G, Fogarty D. The challenge of patients' unmet palliative care needs in the final stages of chronic illness. Palliat Med 2007; 21:313-22. [PMID: 17656408 DOI: 10.1177/0269216307077711] [Citation(s) in RCA: 182] [Impact Index Per Article: 10.7] [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: 11/17/2022]
Abstract
BACKGROUND There is consensus in the literature that the end of life care for patients with chronic illness is suboptimal, but research on the specific needs of this population is limited. AIM This study aimed to use a mixed methodology and case study approach to explore the palliative care needs of patients with a non-cancer diagnosis from the perspectives of the patient, their significant other and the clinical team responsible for their care. Patients (n = 18) had a diagnosis of either end-stage heart failure, renal failure or respiratory disease. METHODS The Short Form 36 and Hospital and Anxiety and Depression Questionnaire were completed by all patients. Unstructured interviews were (n = 35) were conducted separately with each patient and then their significant other. These were followed by a focus group discussion (n = 18) with the multiprofessional clinical team. Quantitative data were analysed using simple descriptive statistics and simple descriptive statistics. All qualitative data were taped, transcribed and analysed using Colaizzi's approach to qualitative analysis. FINDINGS Deteriorating health status was the central theme derived from this analysis. It led to decreased independence, social isolation and family burden. These problems were mitigated by the limited resources at the individual's disposal and the availability of support from hospital and community services. Generally resources and support were perceived as lacking. All participants in this study expressed concerns regarding the patients' future and some patients described feelings of depression or acceptance of the inevitability of imminent death. CONCLUSION Patients dying from chronic illness in this study had many concerns and unmet clinical needs. Care teams were frustrated by the lack of resources available to them and admitted they were ill-equipped to provide for the individual's holistic needs. Some clinicians described difficulty in talking openly with the patient and family regarding the palliative nature of their treatment. An earlier and more effective implementation of the palliative care approach is necessary if the needs of patients in the final stages of chronic illness are to be adequately addressed.
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Affiliation(s)
- D Fitzsimons
- Nursing Research and Development, Belfast City Hospital, Belfast, Northern Ireland.
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Mullan D. Ethics and death. Ir Nurs News 1970:10-1. [PMID: 5199668] [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: 01/14/2023]
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Mullan D. A Catholic priest's approach to the sick. Ir Nurs News 1967:10-5. [PMID: 5181799] [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: 01/14/2023]
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