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One Grade (one + grade)
Selected AbstractsO-11 Proposal for extending the role Of ABMSPS in reporting cervical loopsCYTOPATHOLOGY, Issue 2007K. Ellis Introduction:, The advanced biomedical scientist practitioner (ABMSP) in Cervical Cytology was established in the NHS cervical screening programme (NHSCCSP) in 2001 and there are approximately 60 ABMSPs in post. The aim of this study was to explore the potential for further expansion of their role in the NHSCSP by reporting the histology of loop excision biopsies of the cervical transformation zone (LLETZ). Methods:, The initial study included LLETZ specimens from 55 sequential patients, which, according to standard local practice had the diagnosis of CIN confirmed by cervical punch biopsy prior to the procedure. All the cases were independently examined by an ABMSP and a consultant histopathologist and reports complying with the Royal College of pathologists (RCPath) minimum data sets were assembled. The cases were reviewed at the discussion microscope and ABMSP reports were compared to the final reports issued by the histopathologist. Results:, In the preliminary findings, total agreement between ABMSP and consultant histopathologist was reached on just under 90% of cases. Of those cases that did not reach total agreement, none varied by more than one grade. There was agreement on other parameters from the RCPath minimum data sets. Discussion:, Based on our preliminary findings, it appears there may be scope for extending the role of ABMSPs to report LLETZ samples under the supervision of a histopathologist. We plan to increase the number of cases both in our department and through collaboration with other UK centres and to present evidence to the RCPath, with a view to adoption of this role by ABMSPs and development of an appropriate training scheme. [source] Chemoradiation therapy is effective for the palliative treatment of malignant dysphagiaDISEASES OF THE ESOPHAGUS, Issue 3 2004J. A. Harvey SUMMARY., Between 1993 and 2001, 106 patients with esophageal cancer were reviewed at a multidisciplinary clinic and treated with palliative intent by chemoradiation therapy. This study assesses the palliative benefit on dysphagia and documents the toxicity of this treatment. The study population comprised 72 men and 34 women with a median age of 69 years. Patients were treated with a median radiation dose of 35 Gy in 15 fractions with a concurrent single course of 5 FU-based chemotherapy. Dysphagia was measured at the beginning and completion of treatment and at monthly intervals until death, using a modified DeMeester (4-point) score. Treatment was well tolerated, with only 5% of patients failing to complete therapy. The treatment-related mortality was 6%. The median survival for the study population was 7 months. The median baseline score at presentation was 2 (difficulty with soft food). Following treatment, 49% of patients were assessed as having a dysphagia score of 0 (no dysphagia). Seventy-eight per cent had an improvement of at least one grade in their dysphagia score after treatment. Only 14% of patients showed no improvement with treatment. Fifty-one per cent maintained improved swallowing until the time of last follow-up or death. This single-institution study shows that chemoradiation therapy administered for the palliation of malignant dysphagia is well tolerated and produces a sustainable normalization in swallowing for almost half of all patients. [source] ORIGINAL INVESTIGATIONS: Tissue Harmonic Imaging in Echocardiography: Better Valve Imaging, But at What Cost?ECHOCARDIOGRAPHY, Issue 2 2008Karin Hawkins M.D. Background: Tissue harmonic imaging (THI) improves echocardiographic image quality and is widely utilized. Unfortunately it also makes structures appear artificially thickened. We sought to examine its impact on the imaging of left-sided heart valves. Methods: A large echocardiographic database was searched for full, standard transthoracic echocardiographic exams performed 12-month periods before (n = 3,786) and after (n = 3,914) transition to THI at a single institution. Patients with prosthetic valves were excluded. Results: The mean age of patients was 63 ± 17 years and 65% were men. No appreciable difference in demographics was observed between time periods. While inadequate visualization of the mitral valve was reduced by 30% using THI (P = 0.014), reports of leaflet thickening increased by 28% (P = 0.005). Similarly, inadequate aortic valve visualization was reduced by 53% with THI (P < 0.001), at the expense of more aortic sclerosis (+6%, P = 0.034). Among the 480 patients with echocardiograms using each modality (time interval between studies: 370 ± 143 days), THI did not appreciably improve visualization of the either valve. Although no significant increase in mitral thickness was seen with THI, aortic sclerosis was increased by at least one grade in 24.5% (P < 0.006). Conclusion: This study suggests that while THI enhances imaging of difficult to visualize valves, it may overestimate mitral and aortic valve thickness. This could lead to overdiagnosis and unnecessary follow-up studies. Cardiologists interpreting THI echocardiograms should become familiar with the modality's shortcomings. [source] Evaluation of the McGrath® Series 5 videolaryngoscope after failed direct laryngoscopy,ANAESTHESIA, Issue 7 2010R. R. Noppens Summary Unanticipated difficulties during tracheal intubation and failure to intubate are among the leading causes of anaesthesia-related morbidity and mortality. Using the technique of video laryngoscopy, the alignment of the oral and pharyngeal axes to facilitate tracheal intubation is unnecessary. In this study we evaluated the McGrath® Series 5 videolaryngoscope for tracheal intubation in 61 patients who exhibited Cormack and Lehane grade 3 or 4 laryngoscopies with a Macintosh laryngoscope. Using the McGrath resulted in an improved glottic view, compared to Macintosh laryngoscope. Laryngoscopy was improved by one grade in 10%, by two grades in 80% and by three grades in 10% of cases (p < 0.0001). The success rate for intubation was 95% with the McGrath. These results suggest that the McGrath videolaryngoscope can be used with a high success rate to facilitate tracheal intubation in difficult intubation situations. [source] Prospective audit of major amputations for peripheral vascular diseaseBRITISH JOURNAL OF SURGERY (NOW INCLUDES EUROPEAN JOURNAL OF SURGERY), Issue 4 2001S. R. Vallabhaneni Background: Primary amputation followed by prosthetic fitting has been proposed as an alternative worth considering if lower limb bypass has poor prospects of patency. This is an outcome audit of major amputations at a single centre where amputations were performed only if limb salvage was not possible. Methods: Consecutive major amputations (n = 162) for peripheral vascular disease from January 1996 to December 1998 were studied prospectively. Duration of hospital stay, causes of morbidity and mortality, and reasons for being unsuitable for prosthesis were recorded. Mobility at admission and after rehabilitation was documented using a standard grading system (grades 1,6). Results: There were 114 above-knee, 45 below-knee and three through-knee amputations. The 30-day mortality rate was 14 per cent (22 patients), increasing to 29 per cent (47) at 9 months. Some 57 patients (35 per cent) were rehabilitated with a prosthetic limb (30 above knee, 27 below knee). Mobility with prosthesis was better or maintained in 24 patients, worse by one grade in 17, and by two or more grades in the remaining 16. Fifty-eight patients (36 per cent) were unsuitable for an artificial limb; in four this was because of stump-related problems, and the rest because of co-morbidity. Cardiorespiratory events were the most frequent cause of morbidity and mortality. The mean hospital stay after amputation was 37 days in survivors. Conclusion: Perioperative and late mortality rates following amputation are high. A large proportion of amputees were not suitable for prosthesis, mainly because of co-morbidity. Of the patients receiving a prosthesis, only 42 per cent (15 per cent of the total) maintained or improved their mobility. The results are unlikely to be different if a policy of selective primary amputation were to be adopted. The outcome of amputation is worse than widely perceived despite the improvements in prostheses and a well executed rehabilitation process. © 2001 British Journal of Surgery Society Ltd [source] | ||||||||||