2017

Effectiveness of intragastric balloon as a bridge to definitive bariatric surgery in the super-obese endoscopic and percutaneous interventional procedures (2017)

Posted on by

Type of publication:
Conference abstract

Author(s):
*Ball W.; *Raza S.S.; *Loy J.; *Riera M.; *Pattar J.; *Adjepong S.; *Rink J.; *Lyons H.; *Price B.

Citation:
Obesity Surgery; Jul 2017; vol. 27 (Supplement 1); p. 335

Abstract:
Introduction: Super Obese patients with body mass index (BMI) > 60KG/M2 pose particular difficulties for primary laparoscopic bariatric surgery. Laparoscopic port access, stapling and suturing become increasingly difficult with higher BMI. Our unit's practice of placing an intragastric balloon for 6 months prior to definitive surgery in patients with BMI > 60KG/M2 aims to make definitive surgery less difficult by reducing weight. Objectives: To quantify weight loss after balloon placement and determine if these patients subsequently underwent definitive bariatric surgery. Methods: Retrospective review of 46 consecutive patients with intragastric balloon placement using SPSS statistical analysis on the results. Results: Median weight loss 14kg (0-42) P<0.0001, median % excess weight loss (%EWL) 15% (-3.3-64.66) P<0.001 and median BMI reduction 5KG/M2 (-1.3-13.9) P<0.001. 29/46 (63%) patients underwent definitive bariatric surgery. 10/46 (22%) patients had minor complications (nausea, vomiting and pain) requiring re-admission, of these 7/10 (70%) had early balloon removal and 6/10 (60%) did not have definitive bariatric surgery. 6/46 patients had second balloon placement median weight loss-6kg (-22-33), median %EWL-4.85% (-21.6-34.96), median BMI reduction-1.3KG/M2 (-8.5-2.5). Conclusion: Results from intragastric balloon placement are encouraging and comparable with a recent metaanalysis. Re-admissions and low %EWL with the first balloon are predictors for early balloon removal and failure to proceed to definitive surgery. Intragastric balloons as a bridge to definitive bariatric surgery are effective and safe. Sequential intragastric balloons are not recommended.

Breast reconstruction affects coping mechanisms in breast cancer survivors (2017)

Posted on by

Type of publication:
Journal article

Author(s):
*Lake, B., Fuller, H.R., *Rastall, S, *Usman, T

Citation:
Indian Journal of Surgery, December 2017

Abstract:
Coping strategies used by women with breast cancer are vital for adjustment to their disease. Whilst it is clear that factors such as age at diagnosis, social support and ethnicity can influence coping mechanisms, there is currently no information about whether breast reconstruction changes mechanisms of coping for such patients. The aims of this study, therefore, were to determine how women who have had immediate breast reconstruction and mastectomy cope, compared to those who have mastectomy alone, and whether there are differences in coping mechanisms due to breast reconstruction surgery. This was a retrospective cohort study, using a standardised questionnaire called the Brief Cope Scale. Inclusion criteria was the following: all women who had immediate breast reconstruction and mastectomy in Shropshire from 2003 to 2014 for ductal carcinoma in situ or node-negative invasive breast cancer. Each patient was matched for year of diagnosis, adjuvant therapy and age to one woman who had mastectomy alone. Two hundred thirty-four questionnaires were sent with a 58% response rate. Significantly more patients from the reconstruction cohort coped by active coping (T value 1.66, P value 0.04) compared to those in the mastectomy alone cohort. In contrast, significantly more patients in the mastectomy alone cohort coped by active venting compared to the reconstruction cohort (T value 1.71, P value 0.04). This study indicates for the first time that breast reconstruction may alter coping mechanisms in breast cancer survivors. Awareness of these coping mechanisms will enable clinicians to provide appropriate, individualised support.

Cardiac safety profile for random complex waveforms (2017)

Posted on by

Type of publication:
Journal article

Author(s):
Pratt H, Andrews C, Panescu D, *Lake B.

Citation:
39th Annual International Conference of the IEEE Engineering in Medicine and Biology Society (EMBC), Seogwipo, 2017, pp. 3712-3718.

Abstract:
INTRODUCTION:
A rigorous method for assessing the Ventricular Fibrillation (VF) risk of a Random Complex Waveform (RCW) has not been previously available. Real-life hazardous events motivated us to develop such method. An RCW is observable and recordable. It consists of multiple different components randomly added one to the other. Assessment for VF risk exists for non-random waveforms, particularly VF thresholds for 50/60 Hz alternating currents, but not for RCWs.
METHODS:
We developed a method which considers exposure to a segment of an RCW. It transforms complex segment exposure to values which can be compared with AC root-mean-square (rms) magnitude/duration curves, for determination of VF risk. Human contact could occur for any given time duration within the segment. The current of most risk is the greatest found for all possible instances of that duration. This is termed the "Probable Current" (PC) for that duration. All possible exposure durations in the waveform segment are considered, giving a set of PCs, thus allowing the plotting of a PC curve. The PC set is compared with a criterion for VF risk, termed the Justified Current (JC) curve.
RESULTS:
The theory is presented. Demonstrations and examples are given. Code is shown for generating the PC curve.
CONCLUSION:
VF risk can be found for an RCW using the rigorous algorithm presented.
SIGNIFICANCE:
The VF for RCWs has not been considered previously. A rigorous statement of a method for VF risk assessment allows extension from regular waveforms to RCWs.

Evaluation of patient and clinician reported outcomes in the routine clinical setting (2017)

Posted on by

Type of publication:
Poster presentation

Author(s):
*Zuydam AC, Rogers SN, Grayson, *McLaughlin K, *Probert, Voyce C

Citation:
British Association of Health and Neck Oncologists, BAHNO Annual Scientific Meeting, Royal College of Physicians, London, Friday 12th May 2017

Abstract:
Treatment for head and neck cancer can have an impact on both swallowing function ,and quality of life. It is important that any measures used have sufficient sensitivity to highlight issues .The aims of this study were to assess the relationship between swallowing assessments and to evaluate whether clinical swallowing measures can predict swallowing outcomes.

Methods
This was a prospective cohort study. Subjects had Primary Squamous cell cancer of the oropharynx, nasopharynx or hypopharynx Stage T1‐4, N0‐ 2b, M0 disease. Treatment was with Chemo‐radiotherapy/ radiotherapy ,including induction.The measures used were University of Washington Quality of Life Questionnaire , Performance Status Scale Head and Neck Cancer ( PSSHN) Functional Oral Intake Scale( FOIS ) and the Water Swallow Test ( WST).

Results

Data were collected on 38 patients. The 3m PSSHN was significantly correlated with both the 12m PSSHN (r = .761) and the 12m FOIS (r = .657 ).The 3m FOIS was correlated with the 3m PSSHN (r = .662 ).The 12m PSSHN was significantly correlated with the 12m FOIS (r = .823). The WST was also found to potentially have some predictive power.

Conclusions
A number of measures were found to have clinical significance, and could be valuable to collect in a clinic setting.. Identification of relevant issues early on can enable clinicians to provide patients with information about what they can expect ,and ensure intervention is timely.

Link to poster [no password required]

 

Evaluation of nutritional status and PEG dependence during chemoradiotherapy (2017)

Posted on by

Type of publication:
Conference abstract

Author(s):
*McLaughlin K , *Zuydam A, *Probert C ,Voyce C ,Grayson K

Citation:
British Association of Health and Neck Oncologists, BAHNO Annual Scientific Meeting, Royal College of Physicians, London, Friday 12th May 2017

Abstract:
Background: Chemoradiotherapy treatment for head and neck cancer can cause significant adverse side-effects that have the potential to impair nutritional status, physical functioning and quality of life. The aims of the study were to measure nutritional status and use of enteral tube feeding at the end of treatment and 3 months post-treatment and to assess the relationship between these factors and patient reported outcomes.

Methods: Subjects treated with chemotherapy and/or radiotherapy with curative intent were recruited prospectively over 18 months. Data were collected on 33 subjects with a diagnosis of primary squamous cell carcinoma of the oropharynx, nasopharynx or hypopharynx stage T1-4, N0-2b, M0 disease at baseline, at end of treatment and 3 months post-treatment. Nutrition outcomes were weight, percentage weight change, gastrostomy dependence (days of PEG use) and percentage of nutritional requirements met orally and via PEG.

Results:
As expected baseline BMI was significantly lower at end of treatment and 3 months post-treatment compared to baseline. The mean percentage weight loss of 5.6% during treatment is comparable to other studies. Mean nutrition via PEG was 85.0% and 35.6% of requirements at end of treatment and 3 months post-treatment respectively. Mean PEG dependence at 3 months was 85 days. There was a trend towards significance for increased weight loss and days of PEG use at 3 months (r=0.406).

Conclusions:
The data show some interesting trends, however the small sample size limited statistical analysis. Further research with a larger cohort is required to explore the findings further.

Clinical risk factors predicting genital fungal infections with sodium-glucose cotransporter 2 inhibitor treatment: The ABCD nationwide dapagliflozin audit (2018)

Posted on by

Type of publication:
Journal article

Author(s):
Thong KY, Yadagiri M, Barnes DJ, *Morris DS, Chowdhury TA, Chuah LL, Robinson AM, Bain SC, Adamson KA, Ryder REJ; ABCD Nationwide Dapagliflozin Audit contributors.

Citation:
Primary Care Diabetes. 2018 Feb;12(1):45-50

Abstract:
INTRODUCTION: Treatment of type 2 diabetes with sodium-glucose cotransporter 2 (SGLT2) inhibitors may result in genital fungal infections. We investigated possible risk factors for developing such infections among patients treated with the SGLT2 inhibitor dapagliflozin. METHODS: The Association of British Clinical Diabetologists (ABCD) collected data on patients treated with dapagliflozin in routine clinical practice from 59 diabetes centres. We assessed possible associations of patient's age, diabetes duration, body mass index, glycated haemoglobin, renal function, patient sex, ethnicity and prior genital fungal infection, urinary tract infection, urinary incontinence or nocturia, with the occurrence of ≥1 genital fungal infection within 26 weeks of treatment. RESULTS:  1049 out of 1116 patients (476 women, 573 men) were analysed. Baseline characteristics were, mean±SD, age 56.7±10.2years, BMI 35.5±6.9kg/m2 and HbA1c 9.4±1.5%. Only patient sex (13.2% women vs 3.3% men) and prior history of genital fungal infection (21.6% vs 7.3%) were found to be associated with occurrence of genital fungal infections after dapagliflozin treatment, adjusted OR 4.22 [95%CI 2.48,7.19], P<0.001 and adjusted OR 2.41 [95% CI 1.04,5.57], P=0.039, respectively. CONCLUSION:  Women and patients with previous genital fungal infections had higher risks of developing genital fungal infections with dapagliflozin treatment.

The impact of age on the art of mammography and how to adapt accordingly (2017)

Posted on by

Type of publication:
Journal article

Author(s):
*Lake, B.; *Cielecki, L. ; *Williams, S.; *Worrall, C.; *Metelko, M.

Citation:
Radiography; Nov 2017; vol. 23 (no. 4) e120–e121

Abstract:
Introduction Breast cancer is increasingly a disease of the elderly, and combined with the NHS Breast Screening Extension means that more elderly patients are having mammography. Increasing age can make mammography more technically difficult. This is a technical note detailing the results of a local audit which may be of interest due to potential service implications. Method A retrospective audit of the first year of screening extension of The Shropshire Breast Screening Programme. Aims to collect data on patient demographics and describe the technical adaptations developed in Shropshire. Results Breast screening extension has increased by 2.5 times the number of women aged 70–74 screened, and doubled the overall numbers of women over 70 screened. Significantly more older patients are being screened to present technical challenges to a screening programme. Data was obtained from a month of screening showed that 29% of patients over 70 needed extra time for positioning. Reasons included 22% difficulty in obtaining adequate positioning and 15% needed a relative to aid with consent. Discussion In the Shropshire screening programme different technical adaptations have been developed and are key to ensuring adequate images. These include double appointments, two radiographers, thorough assessment, steeper angles, seated examinations, from-below imaging and pre-planning for subsequent screen. Conclusion Significantly more older women are having breast screening due to the increasing incidence of breast cancer and the Breast Screening Programme extension. Increasing age can significantly increase time taken for adequate imaging and present technical challenges. Development of technical adaptations to art of mammography is key to achieve adequate images.

Link to full-text

Thyroid-stimulating hormone suppression therapy for differentiated thyroid cancer: The role for a combined T3/T4 approach (2017)

Posted on by

Type of publication:
Journal article

Author(s):
*Fussey, Jonathan Mark; Khan, Habib; *Ahsan, Farhan; *Prashant, Ravi; Pettit, *Laura

Citation:
Head & neck; Dec 2017; vol. 39 (no. 12); p. 2567-2572

Abstract:
BACKGROUND In the management of differentiated thyroid carcinoma, surgery with or without postoperative radioiodine, and thyroid-stimulating hormone (TSH) suppression is the standard of care in most patients. Levothyroxine is recommended for long-term TSH suppression. For some patients, this may be difficult to tolerate due to adverse effects, such as impaired cognitive function.METHODS This article reviews the evidence for the role of combination treatment with triiodothyronine (T3) and levothyroxine (T4) in these patients.RESULTS The evidence for combination T3 and T4 treatment comes mainly from studies on hypothyroidism, and research into its use for TSH suppression is limited.CONCLUSION Although the evidence  base is not strong, there is a small group of patients who may benefit from combination T3 and T4 treatment due to difficulty tolerating thyroxine. Until further evidence is available, a case-by-case approach is recommended.

Link to full-text [Available to eligible users with an NHS OpenAthens account]

Altmetrics

Tendon end separation with loading in an Achilles tendon repair model: comparison of non-absorbable vs. absorbable sutures (2017)

Posted on by

Type of publication:
Journal article

Author(s):
*Carmont, Michael R; Kuiper, Jan Herman; Grävare Silbernagel, Karin; Karlsson, Jón; Nilsson-Helander, Katarina

Citation:
of experimental orthopaedics; Dec 2017; vol. 4 (no. 1); p. 26

Abstract:
BACKGROUND Rupture of the Achilles tendon often leads to long-term morbidity, particularly calf weakness associated with tendon elongation. Operative repair of Achilles tendon ruptures leads to reduced tendon elongation. Tendon lengthening is a key problem in the restoration of function following Achilles tendon rupture. A study was performed to determine differences in initial separation, strength and failure characteristics of differing sutures and numbers of core strands in a percutaneous Achilles tendon repair model in response to initial loading.METHODSNineteen bovine Achilles tendons were repaired using a percutaneous/ minimally invasive technique with a combination of a modified Bunnell suture proximally and a Kessler suture distally, using non-absorbable 4-strand 6-strand repairs and absorbable 8-strand sutures. Specimens were then cyclically loaded using phases of 10 cycles of 100 N, 100 cycles of 100 N, 100 cycles of 190 N consistent with  early range of motion training and weight-bearing, before being loaded to failure.RESULTS Pre-conditioning of 10 cycles of 100 N resulted in separations of 4 mm for 6-strand, 5.9 mm for 4-strand, but 11.5 mm in 8-strand repairs, this comprised 48.5, 68.6 and 72.7% of the separation that occurred after 100 cycles of 100 N. The tendon separation after the third phase of 100 cycles of 190 N was 17.4 mm for 4-strand repairs, 16.6 mm for 6-strand repairs and 26.6 mm for 8-strand repairs. There were significant differences between the groups (p < 0.0001). Four and six strand non-absorbable repairs had significantly less separation than 8-strand absorbable repairs (p = 0.017 and p = 0.04 respectively). The mean (SEM) ultimate tensile strengths were 4-strand 464.8 N (27.4), 6-strand 543.5 N (49.6) and 8-strand 422.1 N (80.5). Regression analysis reveals no significant difference between the overall strength of the 3 repair models (p = 0.32) (4 vs. 6: p = 0.30, 4 vs. 8: p = 0.87; 6 vs. 8: p = 0.39). The most common mode of failure was pull out of the Kessler suture from the distal stump in 41.7% of specimens. CONCLUSION The use of a non-absorbable suture resulted in less end-to-end separation when compared to absorbable sutures when an Achilles tendon repair model was subject to cyclical loading. Ultimate failure occurred more commonly at the distal Kessler suture end although this occurred with separations in excess of clinical failure. The effect of early movement and loading on the Achilles tendon is not fully understood and requires more research.

Link to full-text [no password required]

Emerging concepts and spectrum of renal injury following Intravesical BCG for non-muscle invasive bladder cancer. (2017)

Posted on by

Type of publication:
Journal article

Author(s):
*Mohammed, Azharuddin; *Arastu, Zubair

Citation:
BMC urology; Dec 2017; vol. 17 (no. 1); p. 114

Abstract:
BACKGROUNDIntravesical Bacilli Calmette-Guerin (IVBCG) therapy for non-muscle invasive bladder cancer (NMIBC) has long been in use successfully. Albeit rarely, we still face with its safety concerns more than 25 years on since its approval by US Food and Drug Agency in 1990. Local and systemic infection following intravesical BCG is widely reported as compared to immune mediated local or systemic hypersensitivity reactions involving kidneys; acute kidney injury (AKI) and other renal manifestations are well reported but not of chronic kidney disease (CKD).CASEAn interesting case of a female was referred to nephrologists in advanced stages of CKD at an eGFR of 10 ml/min/1.732 following IVBCG for NMIBC. Our patient's renal function plateaued when IVBCG was held; and worsened again when reinstilled. It introduces the concept of 'repetitive' immune mediated renal injury presenting as progressive CKD rather than AKI, as is generally reported. Although response was poor, corticosteroids stopped CKD progression to end stage renal disease.CONCLUSIONSWe highlight the need for increased awareness and early recognition of IVBCG renal complications by both urologists and nephrologists in order to prevent progressive and irreversible renal damage. Low incidence of IVBCG renal complications may also be due to under recognition in the era prior to CKD Staging and AKI Network (and AKI e-alerts) that defined AKI as a rise in serum creatinine of ≥26umol/L; hence an unmet need for urgent prospective studies. Major literature review focuses on emerging spectrum of histopathological IVBCG related renal complications and their outcomes.

Link to full-text [no password required]