Author: Jason Curtis

The safety and efficacy of laparoscopic ventral mesh rectopexy - Can excellent outcomes be achieved in a district general (2018)

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Type of publication:
Conference abstract

Author(s):
*Yassin N.A.; *Orfanos G.; *Farquharson A.L.; *Lacy-Colson J.C.H.

Citation:
Surgical Endoscopy; Dec 2018; vol. 32; Supplement 2, p. S553

Abstract:
Introduction: Laparoscopic ventral mesh rectopexy (VMR) is a popular treatment for symptoms of obstructive defecation in patients suffering with rectal prolapse and rectorectal intussusception. The procedure is technically challenging and may result in serious complications, such as mesh erosions. This study examines the clinical and functional outcomes of patients undergoing VMR in a district general hospital.
Method(s): A retrospective analysis was made of a prospectively maintained database of all laparoscopic VMR procedures. All cases performed by 2 surgeons between February 2012 and June 2016 were included. Length of stay, post-operative complications and functional outcomes were assessed.
Result(s): One hundred patients underwent a laparoscopic VMR procedure during the study period. The mean age was 59.7 years. Nineteen of the patients had external prolapse and 81 had functional bowel symptoms with internal prolapse (rectocele and/or intussusception) as demonstrated on proctography. Pre-operative investigations and pelvic floor multi-disciplinary team (MDT) discussions were performed in all cases. Forty percent of patients had previous pelvic surgery. In the external prolapse group there were 2/19 recurrences (10%). Functional improvement was reported in 96% of the patients. There was only 1 mesh complication (1%).
Conclusion(s): Laparoscopic VMR is an effective and safe procedure for the treatment of symptoms of obstructive defecation. This procedure can be safely performed in the district general hospital setting with excellent clinical and functional outcomes. Thorough preoperative investigations, MDT discussions and standardisation of the surgical technique lead to excellent outcomes.

A 5-year follow-up of vulval swelling due to extraskeletal myxoid chondrosarcoma: A rare case report (2019)

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Type of publication:
Journal article

Author(s):
O'Neill D.; El-Ghobashy A.; Elghobashy M.; Abdelsalam H.; *Metelko M.

Citation:
Molecular and Clinical Oncology; May 2019; vol. 10 (no. 5); p. 483-486

Abstract:
Vulval extraskeletal myxoid chondrosarcoma (EMC) is a rare cause of vulval swelling, reported <10 times in the literature to date. EMC in this location is frequently misdiagnosed due to its rarity, and patients may incur delays in diagnosis and treatment. We herein present the diagnosis and management of the case of vulval EMC in a 42-year-old Caucasian female patient who presented in 2011 with a swelling on the right labium majus. The tumour was initially misdiagnosed as a Bartholin's cyst and managed conservatively. The tumour was ultimately diagnosed as EMC and treated by radical surgical excision and adjuvant radiotherapy. The aim of the present study was to report the results after a long-terms follow-up period and review the available relevant literature.

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A Randomized Trial of Progesterone in Women with Bleeding in Early Pregnancy (2019)

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Type of publication:
Randomised controlled trial

Author(s):
A. Coomarasamy, A.J. Devall, V. Cheed, H. Harb, L.J. Middleton, I.D. Gallos, H. Williams, A.K. Eapen, T. Roberts, C.C. Ogwulu, I. Goranitis, J.P. Daniels, A. Ahmed, R. Bender‑Atik, K. Bhatia, C. Bottomley, J. Brewin, M. Choudhary, F. Crosfill, S. Deb, W.C. Duncan, A. Ewer, K. Hinshaw, T. Holland, F. Izzat, J. Johns, K. Kriedt, M.-A. Lumsden, P. Manda, J.E. Norman, N. Nunes, C.E. Overton, S. Quenby, S. Rao, J. Ross, A. Shahid, *M. Underwood , N. Vaithilingam, L. Watkins, C. Wykes, A. Horne, and D. Jurkovic

Citation:
New England Journal of Medicine 2019;380:p.1815-24.

Abstract:
BACKGROUND
Bleeding in early pregnancy is strongly associated with pregnancy loss. Progesterone is essential for the maintenance of pregnancy. Several small trials have suggested that progesterone therapy may improve pregnancy outcomes in women who have bleeding in early pregnancy.
METHODS
We conducted a multicenter, randomized, double-blind, placebo-controlled trial to evaluate progesterone, as compared with placebo, in women with vaginal bleeding in early pregnancy. Women were randomly assigned to receive vaginal suppositories containing either 400 mg of progesterone or matching placebo twice daily, from the time at which they presented with bleeding through 16 weeks of gestation. The primary outcome was the birth of a live-born baby after at least 34 weeks of gestation. The primary analysis was performed in all participants for whom data on the primary outcome were available. A sensitivity analysis of the primary outcome that included all the participants was performed with the use of multiple imputation to account for missing data.
RESULTS
A total of 4153 women, recruited at 48 hospitals in the United Kingdom, were randomly assigned to receive progesterone (2079 women) or placebo (2074 women). The percentage of women with available data for the primary outcome was 97% (4038 of 4153 women). The incidence of live births after at least 34 weeks of gestation was 75% (1513 of 2025 women) in the progesterone group and 72% (1459 of 2013 women) in the placebo group (relative rate, 1.03; 95% confidence interval [CI], 1.00 to 1.07; P=0.08). The sensitivity analysis, in which missing primary outcome data were imputed, resulted in a similar finding (relative rate, 1.03; 95% CI, 1.00 to 1.07; P=0.08). The incidence of adverse events did not differ significantly between the groups.
CONCLUSIONS
Among women with bleeding in early pregnancy, progesterone therapy administered during the first trimester did not result in a significantly higher incidence of live births than placebo. (Funded by the United Kingdom National Institute for Health Research Health Technology Assessment program; PRISM Current Controlled Trials number, ISRCTN14163439.)

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Pre-transplant Nurse Led Education Clinic (2019)

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Type of publication:
Poster presentation

Author(s):
*Dean S, *Rogers C, *Chand S

Citation:
Joint British Transplant Society and NHS Blood and Transplant Annual Congress 6th – 8th March 2019, Harrogate Convention Centre

Abstract:
Introduction: Locally, there is a 40% pre-emptive renal transplant listing rate, between 2013-2016; and 22% for living donor pre-emptive 2014-2017. Thus we needed to revise our processes. After returning from the tertiary transplant centre, patient feedback including their shock of what was required and their follow-up arrangements, and they felt under-prepared from their local education.
Methods: By creating a separate renal pre-transplant education clinic, we aim to improve the education and experience of potential recipients and donors in order to improve or transplantation rates. This clinic was started in August 2016. It was also important to rationalise the time of the single transplant nurse more effectively.
Results: The nurse was able to stop time wasted travelling between individual consultant clinics, catching patients in an adhoc manner, and time wasted travelling between hospital sites. There was an increase of 20% over a 18 months period of patients transplant listed. Patients feedback has been qualitatively positive after their tertiary centre assessments, with noone reporting feeling under-prepared or shocked from the information and requirements if transplanted. Discussion: The nurse led clinic has been successful and we would like to share this model with other units. Other surprising benefits have included patients being better prepared for their transplantation clinic assessment at the tertiary assessment. Potential living donor assessments and any initial investigations have been identified and performed in a more timely manner. The clinic has also allowed to unmask and address unmet psychological and social needs prior to being assessed for transplantation and thus reducing the psychological burden post-transplantation.