Home About us Contact
|
Home About us Contact | ||
|
|
||
Specialist Centres (specialist + centre)
Selected AbstractsAccelerated rehabilitation of an edentulous patient with an implant retained dental prosthesis: a case reportGERODONTOLOGY, Issue 3 2007Gerald McKenna This case report details the successful rehabilitation of an edentulous patient using a complete upper prosthesis and a lower implant retained overdenture. The provision of care was split between a specialist centre and a primary care setting. This approach reduced inconvenience to the patient. Modern surgical and prosthodontic techniques also reduced the total delivery time. After initial consultation a new set of complete dentures was prescribed with changes in design to the originals. The patient was also planned for placement of two mandibular implants to stabilise and retain the mandibular denture. The first line of treatment involved provision of a new set of dentures constructed by the patient's general dental practitioner. Dental implants were then placed in a specialist centre and the patient returned to the dental practice for attachment of the lower denture to the dental implants. The benefits and success of mandibular implant retained dentures are well documented. With delivery of the overdenture, the patient reported increased satisfaction with his prostheses which allowed him to eat a greater range of foods and enabled him to feel confident when speaking and socialising. [source] Histological grading of invasive breast carcinoma , a simplification of existing methods in a large conservation series with long-term follow-upHISTOPATHOLOGY, Issue 6 2009Jeremy St J Thomas Aims:, To assess the validity of grading in the Edinburgh Breast Conservation Series; a consecutive cohort of 1812 early breast cancer patients treated by breast conservation and radiotherapy between 1981 and 1998 in a single specialist centre with ,9 years' follow-up and full staging data. Methods and results:, A single pathologist (J.St.J.T) graded 1650 cases using the Elston and Ellis method (EE) with particular reference to the component data: acinar differentiation, nuclear pleomorphism and mitotic counts. The original method was then compared with binary scoring of the same components and the relationship to prognosis reassessed. EE grades and individual grade components were prognostic (P < 0.0001) with 10-year cause-specific survival of 95.6%, 86.4% and 74.7% for EE grades 1, 2 and 3, respectively. A binary scoring of grade components produces four groups, splitting EE grade 2 tumours into two groups with different outcomes , 10-year survival rates for the four revised grades were 96.0%, 89.0%, 79.7% and 75.4%, respectively. Conclusions:, Existing grading methodology is fully applicable in the narrower context of a conservation series but can be simplified. Subdivision of EE grade 2 into a true intermediate prognosis group and a second group with a worse prognosis also adds benefit. [source] Risk Factors in Sudden Death in Epilepsy (SUDEP): The Quest for MechanismsEPILEPSIA, Issue 5 2007Lina Nashef Summary:, People with epilepsy may die suddenly and unexpectedly without a structural pathological cause. Most SUDEP cases are likely to be related to seizures. SUDEP incidence varies and is <1:1,000 person-years among prevalent cases in the community and ,1:250 person years in specialist centres. Case,control studies identified certain risk factors, some potentially amenable to manipulation, including uncontrolled convulsive seizures and factors relating to treatment and supervision. Both respiratory and cardiac mechanisms are important. The apparent protective effect of lay supervision supports an important role for respiratory factors, in part amenable to intervention by simple measures. Whereas malignant tachyarrhythmias are rare during seizures, sinus bradycardia/arrest, although infrequent, is well documented. Both types of arrhythmias can have a genetic basis. This article reviews SUDEP and explores the potential of coexisting liability to cardiac arrhythmias as a contributory factor, while acknowledging that at present, bridging evidence between cardiac inherited gene determinants and SUDEP is lacking. [source] The changing face of HIV-associated lymphoma: what can we learn about optimal therapy inl the post highly active antiretroviral therapy era?HEMATOLOGICAL ONCOLOGY, Issue 3 2004Alison Clayton Abstract Epidemiological data indicate that the risk of developing non-Hodgkin lymphoma (NHL) in HIV positive individuals is related to age and CD4 count (i.e. degree of immunosuppression). The prognosis of patients with HIV-NHL has been shown to be linked to several features including age, stage, modified IPI, prior AIDS diagnosis, CD4 count, immunoblastic pathology, LDH, and HAART use. These features are, as would be expected, a mixture of prognostic factors relating to both the HIV, and to the NHL. Population studies indicate that the incidence of associated (HIV-NHL) may be reducing with the advent of HAART, although not all studies concur. However, most population-based studies have not as yet shown a significant improvement in the survival of patients with HIV-NHL with HAART. The optimal chemotherapy for these patients is unknown, although it is generally accepted that CNS prophylaxis is mandatory. There is currently no good evidence of any survival benefit with increased dose intensity from large RCT. However, it must be borne in mind that the large randomised studies comparing differing dose intensities were undertaken before the advent of effective HAART. There is some evidence that there may be a subset of good prognosis patients who may benefit from more intensive therapy.6 Given that the prognosis of patients with HIV can now be considerably improved with HAART, we cannot necessarily assume that the same results would apply with regard to chemotherapy dose intensity. There is some evidence that there is a survival benefit from the addition of HAART to chemotherapy, although this is retrospective. It is likely, however, that the reason for this is that the HAART improves the prognosis of the patients from their HIV, and therefore reduces the number of patients dying from other HIV-related illnesses whilst in remission from their lymphoma, as was seen in large numbers of patients in the earlier chemotherapy trials. It must not be forgotten that the prognosis of the patient's NHL is intimately linked to their prognosis with respect to the HIV. Although the number of patients with HIV-NHL is currently few, there is a need for more trials of chemotherapy, particularly now in the HAART era, when the prognosis from the point of view of the HIV has improved so much. In particular, the issue of dose intensity needs revisiting for patients whose overall prognosis can be improved by commencing HAART. Patients with HIV-NHL should be managed at specialist centres, and where possible should be managed as part of RCT. Copyright © 2005 John Wiley & Sons, Ltd. [source] Ranula: another HIV/AIDS associated oral lesion in Zimbabwe?ORAL DISEASES, Issue 4 2004MM Chidzonga Aim:, To show that sublingual ranula is associated with HIV/AIDS and as such should be considered an HIV/AIDS associated oral lesion in Zimbabwe. Objectives:, To retrospectively study the prevalence, age and gender distribution, the HIV serostatus of ranula patients and the trend in prevalence of ranula and Kaposi's sarcoma (KS) in patients at the two largest referral Oral and Maxillofacial Surgery specialist centres in Harare, Zimbabwe. To use this information to infer an association between ranula and HIV/AIDS in Zimbabwe. Design:, Descriptive study with a retrospective and prospective component. Setting:, Oral and Maxillofacial Surgical clinics at specialist referral hospitals, Harare Central Hospital and Parirenyatwa Government Hospital, Harare, Zimbabwe. Subjects:, Eighty-three cases of ranula were studied: 45 cases retrospectively and 38 consecutively. A total of 231 cases of KS were studied retrospectively. Methods:, Histopathologic records of patients who presented with ranula and KS during the period January 1981 to September 2003 were studied. Gender and age were recorded for each case. Thirty-eight ranula patients studied consecutively during the period June 1999 to September 2003 were consented for HIV testing. Results:, There were 83 cases of ranula; 43.4% male and 56.6% female. There were 231 cases of KS, 61.2% male and 38.8% female. Male to female ratio was 1:1.3 for ranula and for KS was 1:0.6. Ranula was predominant in the 0,10 year age group (73.5%) while KS was most common in the 21,40 year age group (76.4%). Ranula and KS both had a marked rise in prevalence from 1992 to 2003. A total of 88.5% of the ranula cases tested HIV positive with 95% in the 0,10 year age group. Conclusion:, There was a rising prevalence of ranula which mirrors that of KS (an HIV/AIDS associated oral lesion) and that 88.5% of ranula patients were HIV positive with 95% of them in the 0,10 year age group. Sublingual ranula should thus be considered another HIV/AIDS associated lesion in Zimbabwe, especially in children. [source] Clearing the cervical spine in unconscious adult trauma patients: A survey of practice in specialist centres in the UK,ANAESTHESIA, Issue 11 2004P. S. Jones Summary A postal questionnaire survey of neurosurgery and spinal injury departments in the UK was conducted to determine how they assessed the cervical spine in unconscious, adult trauma patients, and at what point immobilisation was discontinued. Of the 32 units contacted, 27 responded (response rate, 84%). Most centres had no protocols to guide initial imaging or when immobilisation devices should be removed. Most responding centres performed fewer than three plain radiographs, and most did not use computerised tomography routinely. Routine use of magnetic resonance imaging or dynamic flexion,extension fluoroscopy was rare, and few units regarded the latter as safe in unconscious patients. There was no consensus on when immobilisation of the cervical spine should be discontinued. Most centres that terminated immobilisation immediately after imaging did so on the basis of plain radiographs alone. Unconscious adult trauma patients remain at risk of inadequate assessment of potential cervical spine injuries. [source] Australian veterinarians who work with horses: views of the futureAUSTRALIAN VETERINARY JOURNAL, Issue 8 2004TJ HEATH Objective To give an account of the views held by Australian veterinarians who work with horses on the future of their professional field. Method Questionnaires were mailed to 866 veterinarians who had been identified as working with horses, and 87% were completed and returned. Data were entered onto an Excel spreadsheet, and analysed using the SAS System for Windows. Results Their future prospects were believed to be very good or excellent by >60% of equine veterinarians but by only 30% of mixed practitioners seeing < 10% horses. The main factors believed likely to affect these prospects were the strength of the equine industries and the economic climate affecting horse owners, followed by the encroachment of cities into areas used for horses, competition from other veterinarians including specialist centres and from non-veterinary operators, and their ability to recruit and retain veterinarians with interest, experience and skill with horses. Urban encroachment, competition and recruitment were especially important for those seeing few horses. Concerns were also expressed about the competence and ethical behaviour of other veterinarians, the physical demands and dangers of horse work, the costs of providing equine veterinary services and of being paid for them, the regulatory restrictions imposed by governments and statutory bodies, the potential effects of litigation, and insurance issues. For many veterinarians in mixed practice these factors have reduced and are likely to reduce further the number of horses seen, to the extent that they have scant optimism about the future of horse work in their practices. Conclusion Economic and local factors will result in an increasing proportion of equine veterinary work being done in specialised equine centres, and the future of horse work in many mixed practices is, at best, precarious. A key factor influencing future prospects will be the availability of competent veterinarians committed to working with horses. [source] Extracorporeal photopheresis: what is it and when should it be used?CLINICAL & EXPERIMENTAL DERMATOLOGY, Issue 7 2009J. Scarisbrick Summary Extracorporeal photopheresis (ECP) is a technique that was developed > 20 years ago to treat erythrodermic cutaneous T-cell lymphoma (CTCL). The technique involves removal of peripheral blood, separation of the buffy coat, and photoactivation with a photosensitizer and ultraviolet A irradiation before re-infusion of cells. More than 1000 patients with CTCL have been treated with ECP, with response rates of 31,100%. ECP has been used in a number of other conditions, most widely in the treatment of chronic graft-versus-host disease (cGvHD) with response rates of 29,100%. ECP has also been used in several other autoimmune diseases including acute GVHD, solid organ transplant rejection and Crohn's disease, with some success. ECP is a relatively safe procedure, and side-effects are typically mild and transient. Severe reactions including vasovagal syncope or infections are uncommon. This is very valuable in conditions for which alternative treatments are highly toxic. The mechanism of action of ECP remains elusive. ECP produces a number of immunological changes and in some patients produces immune homeostasis with resultant clinical improvement. ECP is available in seven centres in the UK. Experts from all these centres formed an Expert Photopheresis Group and published the UK consensus statement for ECP in 2008. All centres consider patients with erythrodermic CTCL and steroid-refractory cGvHD for treatment. The National Institute for Health and Clinical Excellence endorsed the use of ECP for CTCL and suggested a need for expansion while recommending its use in specialist centres. ECP is safe, effective, and improves quality of life in erythrodermic CTCL and cGvHD, and should be more widely available for these patients. [source] Surgical strategies for faecal incontinence , a decision analysis between dynamic graciloplasty, artificial bowel sphincter and end stomaCOLORECTAL DISEASE, Issue 6 2008E. K. Tan Abstract Background Artificial bowel sphincter (ABS) and dynamic graciloplasty (DG) are surgical treatments for faecal incontinence (FI). FI may affect quality of life (QOL) so severely that patients are often willing to consider a permanent end stoma (ES). It is unclear which is the more cost-effective strategy. Method Probability estimates for patients with FI were obtained from published data (ABS, n = 319; DG, n = 301), supplemented by expert opinion. The primary outcome was quality-adjusted life years (QALYs) gained from each strategy. Factors considered were the risk of failure of the primary and redo operation and the consequent risk of permanent stoma. Results were assessed as incremental cost-effectiveness ratio (ICER). Results Over the 5-year time horizon, ES gave a QALY gain of 3.45 for £16 280, giving an ICER of £4719/QALY. ABS produced a gain of 4.38 QALYs for £23 569, giving an ICER of £5387/QALY. DG produced a gain of 4.00 QALYs for £25 035, giving an ICER of £6257/QALY. With the willingness-to-pay threshold set at £30 000/QALY, ES was the most cost-effective intervention. The ABS was most cost-effective after 10 years. Conclusion All three procedures were found to be cost-effective. The ES was most cost-effective over 5 years, while the ABS was most cost-effective in excess of 10. DG maybe considered as an alternative in specialist centres. [source] Surgery for carcinoid tumours of the lower gastrointestinal tractCOLORECTAL DISEASE, Issue 2 2003A. C. Goede Abstract Introduction, Carcinoid tumours are rare neoplasms that originate from neuroendocrine cells of the primitive gastrointestinal tract. Mid- and hind-gut tumours comprise the majority of these rare tumours. With many recent advances in medical treatment the role and importance of surgery and the surgeon needs to be assessed. Method, A Medline, Pubmed and Embase databases search was undertaken. All relevant articles were cross-referenced. Results and conclusions, Incidental findings of carcinoid tumours should be treated at initial surgery whilst elective surgery and further management should be undertaken in specialist centres by a multidisciplinary team. Asymptomatic patients have a better prognosis than those with symptoms. In advanced cases surgery combined with chemotherapy and liver resection is appropriate. The outlook for the majority of cases is good. [source] | ||||||||||