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Terms modified by Single Centre Selected AbstractsRandomised controlled trial comparing the efficacy of same-day administration of mifepristone and misoprostol for termination of pregnancy with the standard 36 to 48 hour protocolBJOG : AN INTERNATIONAL JOURNAL OF OBSTETRICS & GYNAECOLOGY, Issue 2 2007J Guest Objective, To determine the efficacy of oral mifepristone followed by vaginal misoprostol 6 hours later compared with the standard 36- to 48-hour regimen for medical termination of pregnancy. Design, Single centre, two arm, parallel, open randomised controlled trial. Setting, Medical termination service at a teaching hospital. Sample, Four hundred and fifty women undergoing medical termination of pregnancy at up to 63 days of gestation. Methods, Eligible women were randomised to receive mifepristone 200 mg orally followed by vaginal misoprostol 800 micrograms either 6 hours (n= 225) or 36,48 hours (n= 225) later. All participants were invited to attend for a follow-up pelvic ultrasound scan within 7 days following the misoprostol administration. For those women in whom products of conception remained at the follow-up ultrasound scan, expectant management ensued with weekly follow-up ultrasound scans until the termination was complete. They could elect to undergo an evacuation of uterus at any stage following the scan. Those women with a nonviable gestation sac at the follow-up scan were offered a further dose of vaginal misoprostol 800 micrograms or suction termination of pregnancy. Women with a continuing pregnancy were managed with surgical termination. Main outcome measure, Successful medical abortion defined as no requirement for medical or surgical intervention beyond the initial dose of misoprostol. Results, One hundred and sixty-five women (79%) in the 6-hour group and 197 women (92%) in the 36- to 48-hour group had a successful termination at first follow-up ultrasound or presumed on the basis of other considerations (those not seen for ultrasound but deemed successful by negative pregnancy test, products passed on ward or long-term assessment of notes). Twenty-two women (10%) in the 6-hour regimen required up to three further ultrasound scans after 7 days following the mifepristone administration in order to ensure that the termination process was complete. None of these women required a suction evacuation of uterus. In the 36- to 48-hour regimen, ten (5%) women had up to two further ultrasound scans to confirm a complete termination without the need for a surgical evacuation of uterus. Therefore, the overall successful termination rate in the 6-hour regimen was 89% (187/210) compared with 96% (207/215) in the 36- to 48-hour regimen (relative risk = 0.92, 95% CI 0.84,0.98). Repeat administration of misoprostol or surgical treatment was required in 23 women (11%) in the 6-hour group and 8 women (4%) in the 36- to 48-hour group. A viable pregnancy was found in five women (2%) in the 6-hour group and in three women (1%) in the 36- to 48-hour group. Conclusions, Oral mifepristone 200 mg followed by vaginal misoprostol 800 micrograms after 6 hours is not as effective at achieving a complete abortion compared with the 36- to 48-hour protocol. [source] A cognitive and affective pattern in posterior fossa strokes in children: a case seriesDEVELOPMENTAL MEDICINE & CHILD NEUROLOGY, Issue 7 2010MANOELLE KOSSOROTOFF Aim, Posterior fossa strokes account for about 10% of ischaemic strokes in children. Although motor and dysautonomic symptoms are common, to our knowledge cognitive and affective deficits have not been described in the paediatric literature. Our aim, therefore, was to describe these symptoms and deficits. Method, In a retrospective study, we included all cases of posterior fossa strokes in children occurring at a single centre between 2005 and 2007, and investigated cognitive and affective deficits. Results, Five males aged 3 to 14 years met the inclusion criteria. They all presented very early with mood disturbances: outbursts of laughter and/or crying and alternating agitation or prostration that disappeared spontaneously within a few days. Persistent cognitive deficits were also diagnosed in all five: initial mutism, then anomia, followed by comprehension deficiency and deficiencies of planning ability, visual,spatial organization, and attention. Despite early and intensive rehabilitation, recovery from these cognitive deficits was slow and sometimes incomplete, and on follow-up they proved to be more disabling than the motor symptoms. Interpretation, These findings are similar to the cerebellar cognitive affective syndrome described in adults, and quite similar to the language and affective deficits observed in children after surgery for posterior fossa tumour. This is consistent with the role of the cerebellum and brainstem in affective and cognitive processes from early development. [source] Topiramate in Patients with Learning Disability and Refractory EpilepsyEPILEPSIA, Issue 4 2002Kevin Kelly Summary: ,Purpose: Management of seizures in learning disabled people is challenging. This prospective study explored the efficacy and tolerability of adjunctive topiramate (TPM) in patients with learning disability and refractory epilepsy attending a single centre. Methods: Sixty-four patients (36 men, 28 women, aged 16,65 years) were begun on adjunctive TPM after a 3-month prospective baseline on unchanged medication. Efficacy end points were reached when a consistent response was achieved over a 6-month period at optimal TPM dosing. These were seizure freedom or ,50% seizure reduction (responder). Appetite, behaviour, alertness, and sleep were assessed by caregivers throughout the study. Results: Sixteen (25%) patients became seizure free with adjunctive TPM. There were 29 (45%) responders. A further 10 (16%) patients experiencing a more modest improvement in seizure control continued on treatment at the behest of their family and/or caregivers. TPM was discontinued in the remaining nine (14%) patients, mainly because of side effects. Final TPM doses and plasma concentrations varied widely among the efficacy outcome groups. Many patients responding well to adjunctive TPM did so on ,200 mg daily. Mean carer scores did not worsen with TPM therapy. Conclusions: TPM was effective as add-on therapy in learning-disabled people with difficult-to-control epilepsy. Seizure freedom is a realistic goal in this population. [source] Surgical portosystemic shunts and the Rex bypass in children: a single-centre experienceHPB, Issue 3 2009Sukru Emre Abstract Objectives:, This study aimed to illustrate the indications for, and types and outcomes of surgical portosystemic shunt (PSS) and/or Rex bypass in a single centre. Methods:, Data were collected from children with a PSS and/or Rex bypass between 1992 and 2006 at Mount Sinai Medical Center, New York. Results:, Median age at surgery was 10.7 years (range 0.3,22.0 years). Indications included: (i) refractory gastrointestinal bleeding in portal hypertension associated with (a) compensated cirrhosis (n= 12), (b) portal vein thrombosis (n= 10), (c) hepatoportal sclerosis (n= 3); (ii) refractory ascites secondary to Budd,Chiari syndrome (n= 3), and (iii) familial hypercholesterolaemia (n= 4). There were 20 distal splenorenal, four portacaval, three Rex bypass, two mesocaval, two mesoatrial and one proximal splenorenal shunts. At the last follow-up (median 2.9 years, range 0.1,14.1 years), one shunt (Rex bypass) was thrombosed. Two patients had died and two had required a liver transplant. These had a patent shunt at last imaging prior to death or transplant. Conclusions:, Portosystemic shunts and Rex bypass have been used to manage portal hypertension with excellent outcomes. In selected children with compensated liver disease, PSS may act as a bridge to liver transplantation or represent an attractive alternative. [source] Outcome of surgical treatment for recurrent pyogenic cholangitis: a single-centre studyHPB, Issue 1 2009Kit-fai Lee Abstract Background:, Recurrent pyogenic cholangitis (RPC) is still a common disease in East Asia. The present study reviews the operative results for this disease in a single centre. Methods:, The records of 85 patients who underwent surgical treatment for RPC from August 1995 to March 2008 were retrospectively reviewed. Results:, Patients included 35 men and 50 women with a median age of 61 years. Types of surgery included: hepatectomy (65.9%); hepatectomy plus drainage (9.4%); drainage alone (14.1%), and percutaneous choledochoscopy (10.6%). There was no operative mortality. Complications occurred in 40% of patients and half the complications involved wound infections. The overall incidences of residual stone, stone recurrence and biliary sepsis recurrence were 21.2%, 16.5% and 21.2%, respectively, over a median follow-up of 45.4 months. The drainage-alone group and percutaneous choledochoscopy group had higher incidences of residual stone, stone recurrence and biliary sepsis recurrence. In hepatectomy patients, regardless of whether or not a drainage procedure had been performed, rates of residual stone, stone recurrence and biliary sepsis recurrence were 15.6%, 7.8% and 9.4%, respectively, over a median follow-up of 42.7 months. Conclusions:, Hepatectomy is safe and yields the best treatment outcome for RPC. It should be considered as the treatment of choice for suitable patients with RPC. [source] Gastrointestinal stromal tumours: A clinico-radiologic review from a single centre in South IndiaJOURNAL OF MEDICAL IMAGING AND RADIATION ONCOLOGY, Issue 6 2009A Singh Summary Gastrointestinal stromal tumours (GISTs) are rare tumours but are the commonest mesenchymal neoplasms in the gastrointestinal tract. To our knowledge, there is no large case series in Asian countries in which a clinico-radiological descriptive analysis of these tumours has been carried out. In this retrospective study, we analysed our experience of 70 patients with histopathologically proven GISTs, who were presurgically investigated by using CT, and describe the demography, anatomical distribution, imaging features and clinical course of the GIST. We found an unusually large predominance of males in our study, stomach and small bowel appeared to have been involved similarly and small bowel tumours had a higher rate of metastases. We also highlight some unusual CT features of these tumours that we encountered during the study, such as the presence of metastatic lymphadenopathy and satellite nodules, relapse in appendices epiploicae of the bowel, metachronous liposarcoma, adrenal and lung metastases, multiplicity of lesions and aneurysmal dilatation of the bowel. Two of our patients also had multiple neurofibromas, whose association with GIST has been seen in earlier reports. To the best of our knowledge, this article presents one of the largest series of articles on GISTs, to date, in Asian countries. We conclude with a differential diagnosis of GIST, with salient features distinguishing each entity. [source] Radical radiotherapy with high-dose-rate brachytherapy for uterine cervix cancer long-term results,JOURNAL OF MEDICAL IMAGING AND RADIATION ONCOLOGY, Issue 6 2007TH Khor Summary The aim of this is to report the results of radical radiotherapy in carcinoma of the cervix treated by high-dose rate (HDR) intracavitary brachytherapy and external beam radiotherapy (XRT) at a single centre in Singapore. This is a retrospective analysis of 106 consecutive cases with histologically proven cervical cancer, treated by HDR brachytherapy and XRT at the Mount Elizabeth Hospital from 1990 to 1993. External beam radiotherapy to the pelvis was delivered with 6 MV photons, to 45,50.4 Gy in 1.8 Gy fractions. High-dose-rate brachytherapy comprised two to three applications of an intrauterine tandem with paired ovoids, to a median dose of 18 Gy to point ,A', carried out during XRT. All 106 patients completed treatment. Their ages ranged from 32 to 80 years (median 57 years). Most patients presented with stage II or III disease (44 and 37%, respectively) and with squamous cell carcinoma (91%). Median follow-up time was 59 months (range 2,169 months). The 5-year relapse-free survival rate across all stages was 71%. The corresponding overall survival rate was 69%. Local control was achieved in 86 patients (81%); six patients had residual disease (6%), and 14 patients had local recurrence (13%). Fourteen patients developed metastatic disease (13%). On univariate analysis, tumour stage, haemoglobin level, number of brachytherapy treatments and overall treatment time were found to be prognostic factors for overall survival. Late complications were mild (Radiation Therapy Oncology Group score 1,2), except for one patient with grade 4 rectal toxicity. The complication rates were 8, 14 and 45%, respectively, for the rectum, bladder and vagina (stenosis). The use of two to three fractions of HDR intracavitary brachytherapy in addition to pelvic XRT achieves good outcomes. [source] The effect of candidate familiarity on examiner OSCE scoresMEDICAL EDUCATION, Issue 9 2007Ann Jefferies Context, Although examiners are a large source of variability in the objective structured clinical examination (OSCE), the exact causes of examiner variance remain understudied. Objective, This study aimed to determine whether examiner familiarity with candidates influences candidate scores. Methods, A total of 24 candidates from 4 neonatal-perinatal training programmes participated in a 10-station OSCE. Sixteen trainees and 7 examiners came from a single centre (site A) and 8 candidates and 5 examiners came from the other 3 centres. Examiners completed station-specific binary checklists and an overall global rating; standardised patients (SPs) and standardised health professionals (SHPs) completed 4 process ratings and the overall rating. A fixed-effect, 2-way analysis of variance was performed to ascertain whether there was interaction between examiner site and candidate site. Results, Interstation Cronbach's , was 0.80 for the examiner checklist, 0.88 for the examiner global rating and 0.88 for the SP or SHP global rating. Although the checklist scores awarded by site A examiners were significantly higher than those awarded by non-site A examiners, there was no significant interaction between examiner and candidate site (P = 0.124). Similarly, the interaction between examiner and candidate site for the global rating was not significant (P = 0.207). Global ratings awarded by SPs and SHPs were also higher in stations where site A faculty examined site A candidates, suggesting the observed differences may have been related to performance. Conclusions, Results from this small dataset suggest that examiner familiarity with candidates does not influence how examiners score candidates, confirming the objective nature of the OSCE. Confirmation with a larger study is required. [source] Common variable immunodeficiency: 20-yr experience at a single centrePEDIATRIC ALLERGY AND IMMUNOLOGY, Issue 2 2009Ma Pilar Llobet Common variable immunodeficiency (CVID) is the most common symptomatic primary immunodeficiency. It can present at any age in patients with a history of recurrent bacterial infections, with or without a family history of other primary immunodeficiencies (PID), and shows a wide range of clinical manifestations and immunological data. Diagnosis is based on low IgG, IgM and/or IgA levels. Delayed diagnosis and therapy can lead to bronchiectasis and malabsorption. The aim of this study was to describe a paediatric population diagnosed of CVID and its evolution in the population. Memory B-cell (MB) classification carried out in these patients was correlated with clinical manifestations and outcome. Clinical and immunological data of 22 CVID children under 18 yr treated at our centre between 1985 and 2005 are presented. Immunological studies included those for diagnosis and MB quantification. Differences in form of presentation, familial incidence and MB classification were reviewed. A statistical descriptive analysis was made. Infections were the commonest manifestation, affecting mainly respiratory (19/22) and gastrointestinal (10/22) tracts. Bronchiectasis was present in seven cases, and detected prior to CVID diagnosis in five. Replacement therapy led to a significant reduction in the number of infections. Severe complications appeared mostly in patients without MB. Patients of the same family share the same MB group. Family members had also been diagnosed of CVID in seven cases. Early diagnosis and therapy are essential to improve outcome in these patients. MB studies are useful in children to orient prognosis and further genetic studies. [source] First-trimester combined screening for Down syndrome: prediction of low birth weight, small for gestational age and pre-term delivery in a cohort of non-selected womenPRENATAL DIAGNOSIS, Issue 3 2008Kasper Pihl Abstract Objective To establish the relationship between the first-trimester screening markers [pregnancy-associated plasma protein A (PAPP-A), free human chorionic gonadotrophin-, (,-hCG), nuchal translucency (NT)], the Down syndrome (DS) risk estimate, and the adverse outcomes such as low birth weight, small for gestational age (SGA) and pre-term delivery. Methods A retrospective cohort study including 1734 non-selected singleton pregnancies consecutively enrolled into the programme of first-trimester combined screening for DS in a 12-month period at a single centre. Data from the Prenatal Patient Registry in ASTRAIA were combined with the Danish National Newborn Screening Registry and Danish Birth Registry. Results There was a significant relation between low PAPP-A MoM, low ,-hCG MoM, increased risk estimate for DS and low birth weight and SGA. Low PAPP-A MoM and increased NT showed a significant relation to pre-term and spontaneous pre-term delivery. Low PAPP-A MoM showed a significant relation to early pre-term delivery. Conclusion First-trimester screening markers exhibited a significant relation to low birth weight, SGA and to some extent, to pre-term and early pre-term delivery. The screening performance of individual markers was poor. Copyright © 2008 John Wiley & Sons, Ltd. [source] Long-term effect of bronchial artery embolization in Korean patients with haemoptysisRESPIROLOGY, Issue 6 2006Yong Gil KIM Objective and background: Bronchial artery embolization (BAE) has been regarded as a bridging therapy in the management of massive haemoptysis until a more definite therapy can be pursued. The long-term effectiveness of BAE and the factors associated with failure to control bleeding in an Asian setting of tuberculosis are unknown and were investigated. Methods: Over approximately 4 years, 139 patients received BAE to treat haemoptysis at a single centre, of these, 118 had been followed up for more than 1 year (median 23 months) and were retrospectively recruited into the study. Patients were divided into those who required readmission for treatment of recurrent haemoptysis after BAE (re-bleeding group), and those who did not (non-rebleeding group). Results: Of the 118 patients, 112 (95.8%) had haemoptysis of greater than 100 mL per day. The most common underlying cause of haemoptysis was pulmonary tuberculosis. Eight patients, four of whom had advanced lung cancer, died after BAE. There were 32 patients (27.1%) in the re-bleeding group. Aspergillosis was significantly associated with re-bleeding after BAE (P < 0.05). There were no differences in gender, age, degree of haemoptysis, or APACHE II scores between the re-bleeding and non-rebleeding groups. Twelve patients in the re-bleeding group had a repeat BAE only, whereas seven underwent surgery after repeat BAE. Of the 118 patients who underwent initial BAE, one showed a transient spinal ischaemia. Conclusions: BAE with appropriate medical treatment should be sufficient for most patients with massive haemoptysis. In patients with massive haemoptysis due to aspergilloma, however, elective surgery should be considered if bleeding is not controlled by repeated BAE. [source] The Influence of Socioeconomic Deprivation on Outcomes Following Renal Transplantation in the United KingdomAMERICAN JOURNAL OF TRANSPLANTATION, Issue 7 2010M. R. Stephens Socio-economic deprivation is an important determinant of poor health and is associated with a higher incidence of end-stage renal disease, higher mortality for dialysis patients and lower chance of being listed for transplantation. The influence of deprivation on outcomes following renal transplantation has not previously been reported in the United Kingdom. The Welsh Index of Multiple Deprivation was used to assess the influence of socio-economic deprivation on outcomes for 621 consecutive renal transplant recipients from a single centre in the United Kingdom transplanted between 1997 and 2005. Outcomes measured were rate of acute rejection and graft survival. Patients from the most deprived areas were significantly more likely to experience an episode of acute rejection requiring treatment (36% vs. 27%, p=0.01) and increasing overall deprivation correlated with increasing rates of rejection (p=0.03). Income deprivation was significantly and independently associated with graft survival (HR 1.484, p=0.046). Among patients who experienced acute rejection 5-year graft survival was 79% for those from the most deprived areas compared with 90% for patients from the least deprived areas (p = 0.018). Overall socio-economic deprivation is associated with higher rate of acute rejection following renal transplantation and income deprivation is a significant and independent predictor of graft survival. [source] Transjugular intrahepatic portosystemic shunt: an analysis of outcomesANZ JOURNAL OF SURGERY, Issue 10 2009Timothy P. Kurmis Abstract Background:, Transjugular intrahepatic portosystemic shunts (TIPS) are utilized for the management of complications of portal hypertension, particularly diuretic-resistant ascites and recurrent variceal bleeding. It has also been applied in Budd,Chiari syndrome and hepatorenal syndrome. We report the results in a small series, over 9 years, from a single centre, and compare these to those published in the literature. Methods:, A retrospective case note review of 20 consecutive TIPS procedures performed at Flinders Medical Centre from January 1997 to December 2005 was completed. All indications were included in the analysis. Underlying liver disease, peri-procedure complications, relief of symptoms and patient survival were recorded. Data on type of TIPS, shunt patency and method of follow-up were recorded. Results:, Thirty-six TIPS were performed in 20 subjects. All initial TIPS attempts were successful. Indications were: refractory ascites (18), acute variceal bleeding (12) and hepatorenal syndrome (2). There were no peri-procedure deaths, however. Ninety-day mortality was 20%. Outcomes in model of end-stage liver disease score and biochemical characteristics post-TIPS were comparable to those reported. Overall, TIPS dysfunction rate was 35% at 1 year. TIPS follow-up and patency surveillance was an ad hoc combination of Doppler ultrasound and venography. Conclusion:, TIPS procedure outcomes in our centre are similar to those reported in the literature from large centres. TIPS patency rates may be improved with regular monitoring and early intervention when stenosis occurs. [source] Choosing medical or surgical terminations of pregnancy in the first trimester: What is the difference?AUSTRALIAN AND NEW ZEALAND JOURNAL OF OBSTETRICS AND GYNAECOLOGY, Issue 2 2009Felicity GOODYEAR-SMITH Background: Women seeking termination of pregnancy in Auckland, New Zealand can chose between medical and surgical options up to eight weeks gestation. Aims: To assess demographic differences or changes over time between proportions of women choosing medical or surgical abortions at a single centre and determine whether changing the mifepristone,misoprostol interval from two to one day impacted on outcomes. Methods: Retrospective audit of two consecutive years (December 2005,November 2006 and December 2006,November 2007) of first-trimester surgical and medical terminations where the mifepristone-misoprostol interval was reduced from two to one day between years. Analysis using descriptive statistics and assessment of probability of observed differences between groups. Results: A total of 1495 terminations were performed in 2005,2006 and 1588 in 2006,2007. No significant difference (P = 0.4) of eligible women choosing medical (21% and 23%) or surgical abortion between years. Ethnicity, age and residency status did not influence choice. Medical termination of pregnancy was more likely in women who were without previous children (P = 0.009), pregnancies (P = 0.02) or terminations (P = 0.04). Medical termination was similarly effective within six hours with either two- or one-day intervals. Conclusions: Both medical and surgical first-trimester abortions are safe and effective. It is optimal to be able to offer women choice. Reducing the medical interval to one day does not increase adverse outcomes. [source] Office ultrasound should be the first-line investigation for confirmation of correct ESSURE placementAUSTRALIAN AND NEW ZEALAND JOURNAL OF OBSTETRICS AND GYNAECOLOGY, Issue 4 2005Gareth WESTON Abstract Background:, Hysteroscopic options for permanent birth control (PBC), such as the ESSURE device, are becoming increasingly popular as an alternative to laparoscopic tubal ligation. The success of the technique hinges upon correct device placement within the intramural portion of the fallopian tube. Objective:, To determine the utility of office ultrasound for confirming correct ESSURE PBC device placement at the 3-month check in a general gynaecology practice. Study population:, The first 99 patients in a single centre following ESSURE PBC device placement. Type of study:, Prospective cohort study. Methods:, Clinical data was reviewed from patient records, both from the time of the initial procedure and from the follow-up at 3 months. All women underwent an ultrasound at the 3-month check. Results:, The ESSURE PBC devices were placed successfully in 84.8% of cases. Of those cases with apparently successful placement, office ultrasound alone confirmed correct device placement at the 3-month check in 94% of cases. Further imaging was needed in only 6% of cases. Discussion:, Office ultrasound performed by the general gynaecologist at the 3-month check is more convenient for the patient, and is sufficient to confirm ESSURE PBC device placement in the vast majority of cases. We propose that the protocol for ESSURE PBC device follow-up should be altered to replace X-ray with ultrasound as the first-line investigation. [source] Improvement in quality of life after botulinum toxin-A injections for idiopathic detrusor overactivity: results from a randomized double-blind placebo-controlled trialBJU INTERNATIONAL, Issue 11 2009Arun Sahai OBJECTIVE To determine whether botulinum toxin-A (BTX-A) treatment has an effect on the quality of life (QoL) of patients with overactive bladder (OAB) refractory to anticholinergics. PATIENTS AND METHODS This was a single centre, randomized, double-blind, placebo-controlled trial. Participants were men and women with idiopathic detrusor overactivity (IDO). Participants were randomised to receive either 200 U of BTX-A (Botox®, Allergan Inc., Irvine, CA, USA; n = 16) or placebo (n = 18) via a trigone-sparing flexible cystoscopic technique. QoL was assessed using the King's Health Questionnaire (KHQ) at baseline and at 4 and 12 weeks, after injection. At 12 weeks patients were ,unblinded' and a further open-label follow-up in the BTX-A group occurred at 24 weeks. The changes in the subdomains of the KHQ were assessed over the study period. RESULTS Overall QoL was significantly improved in the BTX-A treated patients compared with placebo in the blinded part of the study. When analysing the KHQ subdomains, ,Incontinence Impact', ,Emotions', ,Physical Limitations', ,Social Limitations' and ,Severity Measures' were significantly improved in those that received BTX-A compared with placebo. The ,Symptom Severity' domain was also significantly improved at 4 weeks but not at 12 weeks. At 12 weeks ,Role Limitations' also became statistically significant in favour of BTX-A. The open-label extension study suggested these benefits last for at least 24 weeks. CONCLUSIONS BTX-A bladder injections at 200 U appear to improve QoL in patients with OAB symptoms and IDO refractory to anticholinergics for at least 24 weeks. As well as the improvement seen in clinical parameters with this form of therapy, perhaps of more importance to the patient, is the improvement in QoL. [source] 46 Laparoscopic versus open living donor nephrectomy: a contemporary series from a single centreBJU INTERNATIONAL, Issue 2006R.E. POWER Introduction:, Laparoscopic living donor nephrectomy offers potential advantages to the donor and has become a routine procedure for live kidney procurement worldwide. Since 2000 our live donor patients have been offered a laparoscopic nephrectomy. Patients and Methods:, Between February 2000 and August 2005 we performed 183 donor-recipient operations at our institution (ODN = 83 and LND = 100). We prospectively collected information on all donors and recipients for the same period to audit our experience with the first 100 LDN,s. Patients made their operative choice following discussions regarding the unit experience and literature information. We present our findings with specific emphasis on donor operative details and early recipient graft outcome. Results:, Donor and recipient age, gender, body mass index, HLA mismatches, warm ischaemia and vascular anastomotic times did not significantly differ between the two groups. There were two conversions to an open operation in the LND group and neither impacted upon recipient graft outcome. The mean operative duration was 178 ± 38 for the LDN and 159 ± 34 min for the ODN (P < 0.05). The mean length of hospital stay was 4.7 ± 1.2 days in the LND group versus 6.8 ± 1.5 days in the ODN group (P < 0.05). There was one case of delayed graft function in both groups. Serum creatinine at 1, 6 and 12 months did not differ significantly between either groups. Vascular and ureteric complications and lymphocoele rates were similar in both groups. Conclusions:, Our contemporaneous series demonstrates the safe introduction of a laparoscopic living donor programme without compromise towards donor patient safety or allograft outcome. [source] Sequential cohort study of Dacron® patch closure following carotid endarterectomyBRITISH JOURNAL OF SURGERY (NOW INCLUDES EUROPEAN JOURNAL OF SURGERY), Issue 3 2005T. Ali Background: Carotid endarterectomy reduces the risk of stroke and death in patients with severe carotid artery stenosis. This study examined whether the technique used to close the arteriotomy influenced the rate of perioperative transient ischaemic attack (TIA), stroke or death. Methods: A cohort of 236 patients undergoing carotid endarterectomy at a single centre was studied; 117 patients had primary closure of the arteriotomy and 119 patients in a sequential series had closure with a Dacron® patch. A standard endarterectomy with completion intraoperative duplex imaging and digital subtraction angiography was used throughout. Results: Patch closure was associated with a significant reduction in the 30-day combined death, stroke and TIA rate: 10·3 per cent for primary closure versus 2·5 per cent for patch closure (P = 0·017). The risk of any cerebral event (stroke or TIA) was also significantly reduced (7·7 versus 1·7 per cent; P = 0·033). Residual stenosis on completion angiography was more common after primary closure (24·6 versus 7·4 per cent; P = 0·003). Conclusion: Dacron® patch closure had a higher technical success rate on completion imaging and was associated with a significant reduction in the risk of perioperative stroke, TIA and death. Copyright © 2005 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd. [source] Comparison of extra-anatomic bypass grafting with angioplasty for atherosclerotic disease of the supra-aortic trunksBRITISH JOURNAL OF SURGERY (NOW INCLUDES EUROPEAN JOURNAL OF SURGERY), Issue 11 2004B. Modarai Background: Symptomatic stenosis of the supra-aortic trunks (subclavian, innominate and common carotid arteries) can be treated by angioplasty/stenting or surgical bypass. The aim of this study was to compare the initial success and outcome of these two types of treatment. Methods: A prospective database was used to collect information on the presentation, initial success, complications and outcome in 76 patients treated in a single centre between 1983 and 2003. Results: Thirty-five surgical extra-anatomic bypasses were performed, 13 carotid to carotid, 14 carotid to subclavian, two carotid to axillary, three axillary to axillary, one subclavian to axillary and two subclavian to subclavian. One graft occluded after 19 years. No limbs were amputated and no patient had a stroke. The secondary patency rate was 97 per cent at a mean follow-up of 5 years. Forty-one angioplasties were attempted, 34 of the left subclavian, six of the right subclavian and one of the innominate artery. Angioplasty for six subclavian occlusions was unsuccessful. Twenty-seven of 33 arteries remained patent at a mean follow-up of 4 years after a successful endovascular procedure. Conclusion: Extra-anatomic bypass for supra-aortic trunk disease has a better patency than angioplasty, with a comparable complication rate. Copyright © 2004 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd. [source] Management of aortic aneurysm infected with SalmonellaBRITISH JOURNAL OF SURGERY (NOW INCLUDES EUROPEAN JOURNAL OF SURGERY), Issue 9 2003R. B. Hsu Background: This study reviewed the clinical outcomes of patients with an aortic aneurysm infected with Salmonella treated by a single centre over 6 years. Methods: Data were collected by a retrospective case-note review. Results: Between September 1995 and December 2001, 121 patients with non-typhoid Salmonella bacteraemia were treated, of whom 24 patients had an aortic aneurysm infected with Salmonella. Ten had a suprarenal and 14 an infrarenal aortic infection. The most common responsible pathogen was group C Salmonella (12 patients). All of the 20 patients who had combined medical and surgical therapy survived, whereas two of four who had medical therapy alone died. There were two late deaths during a mean follow-up of 23 (range 3,63) months. Conclusion: The incidence of aortic infection in patients with non-typhoid Salmonella bacteraemia was high in Taiwan. Timely surgical intervention and prolonged intravenous antibiotic therapy resulted in excellent outcomes. Copyright © 2003 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd. [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] Efficacy of systemic ganciclovir as a therapeutic strategy for cytomegalovirus-associated anterior uveitis in immunocompetent patientsACTA OPHTHALMOLOGICA, Issue 2009M ANGI Purpose Cytomegalovirus (CMV)-associated anterior uveitis is a newly recognized entity that accounts for half of patients with Posner-Schlossman syndrome. To date, the therapeutic management of these patients remains controversial. The aim of this study was to assess the efficacy of systemic Ganciclovir as a treatment for PCR-proven CMV-associated hypertensive anterior uveitis. Methods Retrospective interventional study of 27 consecutive patients treated in a single centre between 2002 and 2008. Main outcome measures included intraocular pressure (IOP) and anterior chamber inflammation. Results All patients responded to systemic Ganciclovir, with mean IOP dropping from 32 to 14 mmHg (p<0,05). Relapses occurred in 50% of cases within one year from the first antiviral course. Repeated treatment allowed control of the disease in 75% of cases (follow-up range: 12-78 months). Conclusion Ganciclovir is effective but remains a suspensive therapeutic strategy. [source] Use of A-type CpG oligodeoxynucleotides as an adjuvant in allergen-specific immunotherapy in humans: a phase I/IIa clinical trialCLINICAL & EXPERIMENTAL ALLERGY, Issue 4 2009G. Senti Summary Background B-type CpG oligodeoxynucleotides (ODN) is currently used in clinical trials because of its prolonged half,life, which is due to its phosphorothioate backbone. A-type CpG ODN is a stronger inducer of IFN but has an unstable phosphodiester backbone that has so far prohibited its clinical use. However, upon association with virus-like particles (VLP) consisting of the bacteriophage Q, coat protein, A-type CpG ODN can be stabilized and can become an efficient adjuvant in mice. Therefore, the phase I/IIa study presented represents the first test of A-type CpGs in humans. Objective To test the safety, tolerability and clinical efficacy of QbG10 as an adjuvant for subcutaneous immunotherapy with a house dust mite (HDM) allergen extract in allergic patients. Methods A single centre, open-label phase I/IIa study evaluated the safety, tolerability and clinical efficacy of QbG10 as an adjuvant to immunotherapy with a subcutaneous HMD allergen extract in 20 patients suffering from HDM allergy. Twenty-one patients were enrolled between March and July 2005. Individual immunotherapy lasted 10 weeks. Clinical end-points included questionnaires, conjunctival provocation, skin prick tests and the measurement of allergen-specific IgG and IgE. Results QbG10 was well tolerated. Almost complete tolerance to the allergen was observed in conjunctival provocation testing after treatment with QbG10, and symptoms of rhinitis and allergic asthma were significantly reduced. Within 10 weeks of therapy, patients were nearly symptom-free and this amelioration lasted for at least 38 weeks post-treatment. Following injections of QbG10 and HDM allergen extract, allergen-specific IgG increased, while there was a transient increase in allergen-specific IgE titres. Skin reactivity to HDM was reduced. Conclusion The subcutaneous application of HDM allergen, together with A-type CpG ODN packaged into VLP, was safe. All patients achieved practically complete alleviation of allergy symptoms after 10 weeks of immunotherapy. This promising clinical outcome calls for larger placebo-controlled phase II studies. [source] Histopathological features of Proteus syndromeCLINICAL & EXPERIMENTAL DERMATOLOGY, Issue 3 2008S. E. H. Hoey Summary Background., Proteus syndrome is a rare, sporadic overgrowth disorder for which the underlying genetic defect remains unknown. Although the clinical course is well-described there is no systematic histopathological description of the lesional pathology. Objective., To describe the histopathological features encountered in a series of patients with Proteus syndrome from a single centre. Methods., Patients with Proteus syndrome who had undergone therapeutic surgical resection or biopsy were identified from a database and the histopathological findings were reviewed, with particular regard to descriptive features of the underlying tissue abnormality. Results., There were 18 surgical specimens from nine patients, median age 4 years (range 1,9), classified into four main categories: soft-tissue swellings (lipomatous lesions), vascular anomalies (vascular malformation and haemangioma), macrodactyly (hamartomatous overgrowth) and others (sebaceous naevus and nonspecific features). In all cases, the clinical features of overgrowth were due to increased amounts of disorganized tissue, indicating a hamartomatous-type defect in which normal tissue constituents were present, but with an abnormal distribution and architecture. Vascular malformations represented a prominent category of lesions, accounting for 50% of the specimens, predominantly comprising lymphatic and lymphovascular malformations. No malignancy or cytological atypia was identified in any case. Conclusions., The histopathological features of lesions resected from children with Proteus syndrome predominantly include hamartomatous mixed connective tissue lesions, benign neoplasms such as lipomata, and lymphatic-rich vascular malformations. [source] Early surfactant in spontaneously breathing with nCPAP in ELBW infants , a single centre four year experienceACTA PAEDIATRICA, Issue 3 2008Angela Kribs Abstract Objective: To evaluate whether the experience with a method to administer surfactant during spontaneous breathing with nasal continuous positive airway pressure (nCPAP) as primary respiratory support in infants with respiratory distress syndrome (RDS) influences the frequency of its use and affects the outcome of patients. Methods: All inborn extremely low birthweight (ELBW) infants treated after introduction of the method were retrospectively studied (n = 196). The entire observational period was divided into four periods (periods 1,4) and compared with a control period (period 0) (n = 51). Primary respiratory support, demographics, prenatal risks and outcomes were compared. Results: There were no changes in demographics or prenatal risks over time. The choice of nCPAP as initial airway management significantly increased from 69% to 91% and for nCPAP with surfactant from 75% to 86%. The rate of nCPAP failure decreased from 46% to 25%. Survival increased significantly between periods 0 and 1 from 76% to 90% and survival without bronchopulmonary dysplasia (BPD) rose from 65% to 80%. No changes in nonpulmonary outcomes were observed. Conclusion: The success of nCPAP increased with increasing use of nCPAP with surfactant. Simultaneously, mortality decreased without deterioration of other outcomes indicating that the use of surfactant in spontaneous breathing with nCPAP could be beneficial. [source] Adrenal function and mortality in children and adolescents with Prader,Willi syndrome attending a single centre from 1991,2009CLINICAL ENDOCRINOLOGY, Issue 5 2010Natalie A. Connell No abstract is available for this article. [source] Congenital hypopituitarism: clinical, molecular and neuroradiological correlatesCLINICAL ENDOCRINOLOGY, Issue 3 2009Ameeta Mehta Summary Objective, Recent studies have suggested that mutations in genes encoding several hypothalamo,pituitary (H,P) transcription factors result in hypopituitarism [isolated GH deficiency (IGHD) and combined pituitary hormone deficiency (CPHD)], which may in turn be related to the neuroanatomy revealed by magnetic resonance (MR) imaging. Although studies have focused on patients with either optic nerve hypoplasia (ONH) or isolated hypopituitarism with normal optic nerves, few studies have compared the two groups. We aimed to relate the clinical phenotype of a large cohort (n = 170) of children with congenital hypopituitarism including septo-optic dysplasia (SOD) attending a single centre to the neuroradiological and genetic findings. Design, Clinical, biochemical, MR imaging and molecular data were analysed retrospectively in 170 patients with or ,at-risk' (with ONH) of hypopituitarism to determine predictors of hypopituitarism. Results, The presence of ONH was significantly associated with an absent septum pellucidum [odds ratio (OR) 31·5, 95% confidence intervals (CI) 7·3,136·6, P < 0·001], an abnormal corpus callosum (OR 10·5, 95% CI 3·8,28·6, P < 0·001) and stalk abnormalities (OR 2·3, 95% CI 1·2,4·2, P = 0·009). The risk of hypopituitarism was 27·2 times greater in patients with an undescended posterior pituitary (95% CI 3·6,205·1, P < 0·001). Anterior pituitary hypoplasia (OR 3·1, 95% CI 1·3,7·0, P = 0·006) and an absent pituitary stalk (P < 0·001) were also significantly associated with hypopituitarism. With respect to the type or severity of hypopituitarism, CPHD was more often associated with an abnormal corpus callosum (OR 6·1, 95% CI 1·4,27·4, P = 0·008) and stalk abnormalities (OR 2·8, 95% CI 1·3,6·1, P = 0·006). Male to female ratio was significantly greater in patients with normal optic nerves (3·3:1) as compared with those with ONH (1·2:1). The prevalence of diabetes insipidus, thyrotrophin and ACTH deficiencies was significantly greater in patients with ONH as compared with ,idiopathic' hypopituitarism. Mutations in pituitary transcription factors and genes regulating GH secretion were rare (5/170) in this cohort of patients with sporadic hypopituitarism. Conclusion, Our data suggest that individuals presenting with ONH are at high risk for neuroradiologic and endocrine abnormalities. The neuroradiologic features are predictive not only of the presence, but also of the type, of hypopituitarism. The association of midline abnormalities with hypopituitarism in this cohort suggests a common developmental origin for these features, the aetiology of which remains unidentified in the majority of cases. [source] Long-term (up to 18 years) effects on GH/IGF-1 hypersecretion and tumour size of primary somatostatin analogue (SSTa) therapy in patients with GH-secreting pituitary adenoma responsive to SSTaCLINICAL ENDOCRINOLOGY, Issue 2 2007Jean Christophe Maiza Summary Context The role of somatostatin analogues (SSTa) in the treatment of acromegaly. Objective To evaluate the antihormonal and antitumour efficacy of long-term (up to 18 years) primary treatment with SSTa in patients with GH-secreting pituitary adenoma responsive to SSTa. Design An open, prospective, single-centre, clinical study. Patients Thirty-six acromegalic patients, aged 17,75 years (postoral glucose tolerance test GH > 1 µg/l, increased IGF-1 for age and sex), were monitored in a single centre and treated with SSTa as first-line therapy. The mean pretreatment GH level was 13·5 ± 3·1 µg/l, and IGF-1 (as a percentage of the value over the normal range) was 302 ± 26%. The patients had macroadenoma (n = 25), microadenoma (n = 8) or empty sella turcica (n = 3). The mean duration of treatment was 8 years (range 3,18 years). Hormonal and morphological monitoring was undertaken after 6 months, and then the patients were followed annually. Results After 1 year, the mean GH and IGF-1 levels had reduced considerably (GH: 2·4 ± 0·3 µg/l; IGF-1; 174 ± 14%, P < 0·01), and they continued to decrease over 10 years, with a mean GH level of 1·6 ± 0·1 µg/l and IGF-1 of 123 ± 18% (P = 0·02). GH < 2 µg/l, normal IGF-1, or both were observed in 25 (70%), 24 (67%) and 21 (58%) patients, respectively. The mean reduction in tumour volume was 43% (range 13,97%) and shrinkage > 20% was obtained in 21 patients (72%). SSTa treatment was well tolerated with few digestive or metabolic side-effects. Conclusion Long-term (up to 18 years) treatment with SSTa used as first-line therapy is effective from both an antihormonal and antitumour perspective, and is well tolerated in acromegalic patients. [source] Quality of life assessment after non-laser endonasal dacryocystorhinostomyCLINICAL OTOLARYNGOLOGY, Issue 5 2006A. Ho Objective:, There has been a lack of patient-centred evidence in the Otolaryngology literature, that non-laser endonasal dacryocystorhinostomy improves the quality of life of patients. Many studies demonstrate successful outcomes based on non-validated subjective patient reporting. The aim of this survey was to evaluate the impact of non-laser endonasal dacryocystorhinostomy on the quality of life of patients using a validated questionnaire, the Glasgow Benefit Inventory (GBI). Design:, Prospective non-randomised case series. Setting:, Secondary otorhinolaryngology,ophthalmology centre, single centre. Participants:, Sixty-five consecutive patients undergoing non-laser endonasal dacryocystorhinostomy were asked to complete a questionnaire at their follow-up clinic appointment. All patients had a minimum of 9 months follow-up. Main outcome measures:, A consultant ophthalmologist reviewed each patient six months after surgery and recorded the outcomes as ,cure', ,better', ,no change' or ,worse'. We defined ,success' as cured or better. ,Failure' suggests no improvement or worsening epiphora. The validated 18-item GBI was used. Results:, Fully completed questionnaires were received from 55 patients. Mean total GBI scores were +34 for successful non-laser endonasal dacryocystorhinostomy and ,19 for failed non-laser endonasal dacryocystorhinostomy (Mann,Whitney z = 3.8, P < 0.001). Conclusion:, Successful non-laser endonasal dacryocystorhinostomy does confer significant quality of life improvement. [source] Improved final height in Turner's syndrome following growth-promoting treatment at a single centreACTA PAEDIATRICA, Issue 9 2003EJ Gault Aims: To examine the final height (FH) outcome of girls with Turner's syndrome (TS) treated at a single Scottish centre (Glasgow group), to compare it with an earlier national analysis (Scottish group) and to suggest reasons for any change. Methods: Retrospective growth and treatment data for 29 Glasgow patients were compared with those of 26 Scottish patients. Results: Age at GH start (mean ± SD) was 10.1 ± 2.6 vs 12.1 ± 1.7 y (p < 0.01) in the Glasgow versus Scottish groups, with overall duration of treatment 6.2 ± 2.4 vs 3.7 ± 1.1 y (p < 0.001) and years of GH treatment before pubertal induction 2.7 ± 2.8 vs 0.3 ± 0.8 y (p < 0.001), respectively. Pubertal induction was at a similar age: 12.7 ± 1.8 vs 12.8 ± 1.8 y (ns). FH was 151.1 ± 4.6 cm in the Glasgow group compared with 142.6 ± 5.6 cm in the Scottish group (p < 0.001), with FH -projected adult height (PAH) 5.7 ± 4.6 cm vs 0.6 ± 3.6 cm (p < 0.001), respectively. Univariate analysis of the Glasgow group's FH , PAH with a number of growth and treatment variables identified no statistically significant relationships. Conclusion: This group's improved FH and FH , PAH, relative to an earlier sample, are attributed to the introduction of GH treatment from a younger age and for longer, overall and before pubertal induction. In addition, the authors believe that compliance with treatment has been enhanced by this single centre's dedicated Turner clinic and the efforts of its established "growth team". These data demonstrate that a favourable FH can be achieved using a safe and financially viable dose of GH, while inducing puberty at a "normal" age. [source] | |||||||||||||||||||||||||||||||