Author: Jason Curtis

Benign testicular tumour in non-palpable scrotal lesions in patients with abnormal testicular ultrasound (2018)

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Type of publication:
Conference abstract

Author(s):
*Phan Y.; *Loh A.; *Rosli M.; *Anankumar A.; *Lynn N.

Citation:
Journal of Clinical Urology; Jun 2018; vol. 11 ; Supp 1; p. 74

Abstract:
Introduction: Radical orchidectomy may represent a life changing experience for patients. Clinicians strive to accurately diagnose testicular malignancy through careful scrotal examination and testicular ultrasound prior to surgery. Nevertheless, no investigation is 100% accurate. We aim to find out the occurrence of benign testicular tumour in men without palpable scrotal lesions but with abnormal testicular ultrasound. Methodology: All pathological outcomes of orchidectomies from Jan 2011 to Dec 2016 were retrospectively analysed. Results: 220 orchidectomies were performed during this period. 146 patients with a mean age of 44 years old underwent radical inguinal orchidectomies for possible malignancies due to abnormal testicular ultrasound findings with or without palpable lesions. 115 of these patients had palpable scrotal lesions. 101(88%) of these men had malignant tumours on histopathology. 31 patients had no palpable scrotal lesion but had abnormal testicular ultrasound findings that are suspicious of a testicular tumour. Of these patients, 15 (48%) had malignant tumours while 16 patients (52%) had benign testicular tumours. Conclusions: 88% patients with clinically palpable scrotal tumour and ultrasound abnormality were found to have malignant tumour. In contrast, only 52% patients were found to have malignant tumours with ultrasound abnormality without a palpable lesion. Whilst this may not change the need for surgical excision, it is an important consideration in the pre-operative counseling of these men and offer ultrasound surveillance in these men.

A patient centred, self-management app providing digital support and follow up care for citizens with prostate cancer (2018)

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Type of publication:
Conference abstract

Author(s):
*Elves A.; *Dunk S.; *Perry S.; *Srihari N.; Khanduri S.; Redgrave R.; Pope R.

Citation:
Journal of Clinical Urology; Jun 2018; vol. 11 ; p. 26

Abstract:
Introduction: The challenges of increasing cancer survivors, National Survivorship Programme/Recovery package and drive to stratified care combined with funding and workforce constraints require novel approaches to follow-up care. We describe a web-based App facilitating stratified care through remote patient self management for patients undergoing follow-up for prostate cancer. Method: Patients with stable prostate cancer were eligible for recruitment. The App was offered as a replacement to face to face follow-up or for communication and support. App functionalities include remote follow-up, self-reporting of disease/treatment effects, multimedia information/sign posting and secure messaging to a clinical nurse specialist. Outcomes included up-take, use of App functionalities, number of follow-ups delivered, escalations in care and user satisfaction. Results: One hundred and twenty patients identified were eligible for the App. Sixty five patients recruited gen-erated 342 messages and 627 patient self-reported disease/treatment effect entry sessions providing 3036 readings. Sexual health and hormone side effects were most common reported issues.Sixty-six per cent of users were over 69 years. Forty four patients received digital follow-up over the 10 month period. Clinician concerns about disease progression or user lack of internet access or device were the principle obstacle to recruitment. Conclusion: The App was safe and allowed patients to provide feedback upon symptoms, wellbeing and interact proactively with their healthcare team on an ad hoc basis as well as regular follow-up. This fundamental change in approach to delivery of clinical care has wider application to a range of urological conditions.

Sparing the superficial lobe of the parotid during radical radiotherapy for oropharyngeal carcinoma (2018)

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Type of publication:
Conference abstract

Author(s):
*Pettit L.; *Welsh A.G.; *Williams M.T.; *Puzey C.H.

Citation:
Radiotherapy and Oncology; Apr 2018; vol. 127

Abstract:
Purpose or Objective: Parotid sparing IMRT has been shown to reduce incidence of xerostomia, leading to
recovery of salivary function and subsequently improve quality of life. It is usual to contour the whole parotid gland (WPG) which is considered a parallel organ. It can be challenging to meet dose constraints of the WPG even with VMAT. The general consensus in the U.K. has been to use a simple planning constraint of mean < 24 Gy to the WPG. However, this is not always achievable, especially with large tumours. Previous work suggests if only part of the parotid was spared this may be enough for preservation of saliva function. Material and Methods A retrospective dosimetric analysis of ten previous unselected patients who had received bilateral radical radiotherapy 65 Gy in 30 fractions for squamous cell carcinoma of the oropharynx that were identified from ARIA. Demographics were recorded on an excel spreadsheet. The deep lobe (DL) and superficial lobe (SL) of the ipsilateral (IL) and contralateral (CL) parotid gland were contoured on each CT planning slice. Mean dose to the deep lobe (DL) and superficial lobe (SL) was calculated from the original plan with the volume of the WPG. V40 and D50 were recorded. All treatment was replanned using a SL tolerance of V40 < 33% and D50 < 50% without compromise to the PTV's or change to other OAR. The DL of the parotid was not considered an organ at risk (OAR) for the re-plan. Results 10 patients were identified. 8 male, 2 female. All had squamous cell carcinoma of the oropharynx, 7 had tonsilar primaries, 2 base of tongue and 1 posterior pharyngeal wall. 7 were positive for p16. 9 also received concurrent platinum based chemotherapy. As expected the mean volume of the IL and CL parotid were similar (32.8 cc IL (7.8 cc DL, 24.7 cc SL, 31.9 cc CL (7.6 cc DL, 23.7 cc SL). On average, the DL accounted for 24.8% of the IL parotid and 25.1% of the CL parotid. Average IL SL mean dose was significantly reduced from 36.1 Gy to 33.9 Gy, average CL SL mean dose reduced from 28.3 Gy to 25.5 Gy (p = 0.02 t-test). Conclusion Our retrospective study confirmed that tolerances to the superficial lobe only are relatively easy and practical to meet. Previous work suggests that D50 may be a more reliable predictor of recovery of parotid function than mean dose to whole gland. Following this retrospective study our department will change dose constraints to superficial lobe V40 < 33% and D50 < 50% and no longer consider the deep lobe an OAR. Prospective data will investigate preservation of salivary function using D50/V40. (Figure Presented).

Three-layered technique to repair an oroantral fistula using a posterior-pedicled inferior turbinate, buccal fat pad, and buccal mucosal advancement flap (2018)

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Type of publication:
Journal article

Author(s):
*Darr, A; *Jolly, K; Martin, T; Monaghan, A; Grime, P; Isles, M; Beech, T; Ahmed, S

Citation:
British Journal of Oral and Maxillofacial Surgery; Volume 56, Issue 7, September 2018, Pages 638-639

Biomarkers and Pharmacogenomics in Kidney Transplantation (2018)

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Type of publication:
Journal article

Author(s):
Crowley, L E; *Mekki, M; *Chand, S

Citation:
Molecular Diagnosis and Therapy; Oct 2018; vol. 22 (no. 5); p. 537-550

Abstract:
This review is focused on present and future biomarkers, along with pharmacogenomics used in clinical practice for kidney transplantation. It aims to highlight biomarkers that could potentially be used to improve kidney transplant early and long-term graft survival, but also potentially patient co-morbidity. Future directions for improving outcomes are discussed, which include immune tolerance and personalising immunosuppression regimens.

Over 70s breast cancer management: A single institute experience (2018)

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Type of publication:
Conference abstract

Author(s):
Dube M.; Talaat A.; *Rastall S.; *Przyczyna A.; *Usman T.

Citation:
European Journal of Surgical Oncology; Jun 2018; vol. 44 (no. 6); p. 898

Abstract:
Introduction: With increasing life expectancy, awareness and improved referral system more women over the age of 70 (70+) are diagnosed with breast cancer. NICE guidelines recommended standard treatment of breast cancer irrespective of age and decision rather based on co-morbidities and frailty. To review our compliance with NICE guidelines we audited management of breast cancer of 70+ women over a period of five years. Methods: Retrospective case note analysis of 833 70+ women with breast cancer diagnosed from April 2010 to March 2015. Breast MDT recommendations, reason for choice of treatment, co-morbidities and performance status recorded. Results: Out of 2729 breast cancer diagnosis 30% (833) were 70+. The median age was 78. Surgery was the treatment of choice in all five years and is represented by 60% in year one, four and five; 55% in year two; 45% in year three. Primary endocrine treatment was the next treatment of choice among 28% in year one, 23% in year two, 30% in year three, 20% in year four, and 25% in year five. Offer and acceptance adjuvant treatments have increased in year wise analysis. Conclusions: We have noticed a shift towards surgery from primary endocrine therapy in year wise analysis. There has been an increase of number of 70+ patients diagnosed with breast cancer. Inclusion of performance status had improved offer of adjuvant treatment in the last year of the study. More individualised and evidence based management recommended to offer appropriate treatment in this age group.

Revision surgery following extended latissimus dorsi flap and implant based breast reconstruction: a district general hospital experience (2018)

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Type of publication:
Conference abstract

Author(s):
Dube M.; *Sheikh H.; *Rastall S.

Citation:
European Journal of Surgical Oncology; Jun 2018; vol. 44 (no. 6); p. 902-903

Abstract:
Introduction: Extended latissimus dorsi (ELD) flap breast reconstruction has been a very well-established reconstruction modality after mastec-tomy. Although recently number of ELD flap operation has decreased due to popularity of implant based reconstruction we found rate of revisional surgery were less with ELD reconstruction. Rates of revisional surgery have been quoted between 30%-75% in the literature. After 5 years we evaluate our rates of revision surgery. Methods: Analysis of a prospectively maintained breast reconstruction database. Types of initial surgery, complications and rate of revision sur-gery after radiotherapy specifically noted. Results: Total Reconstructions: 127 Immediate Reconstructions: 90 (78 ELD flap, 12 Implant only with acellular dermal matrix (ADM) Total patients who had further surgery 5 Fat grafting after ELD Flap 3 Fat grafting after implant only 1 Changeofimplant 1 *Patients with ELD reconstruction also had post-operative radiotherapy and 1 had small skin breakdown of the breast after primary surgery. Delayed Reconstructions: 37 Fat grafting after ELDflap Reconstruction 1 Symmetrisation surgery: 9 Total Patients requiring contralateral symmetry surgery 9 Augmentation mastopexy after immediate ELD 2 Mastopexy after delayed ELD 1 Reduction mastopexy after immediate ELD 4 Reduction mastopexy after delayed ELD 2 Time from primary surgery to symmetrisation or corrective surgery was between 8 months to 3 years. Conclusions: About 1.5% of patients required corrective surgery to the reconstructed or contralateral breast. High level of patient satisfaction found with ELD flap breast reconstruction than implant as only small number of patient required corrective surgery even after postoperative radiotherapy.

A phase 2b, randomized, double-blind, placebo-controlled trial of presatovir (GS-5806), a novel oral rsv fusion inhibitor, for the treatment of respiratory syncytial virus (RSV) in hospitalized adults (2018)

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Type of publication:
Conference abstract

Author(s):
Hanfelt-Goade D.; Maimon N.; Nimer A.; Riviere F.; Catherinot E.; Ison M.; Jeong S.; Walsh E.; Falsey A.R.; Gafter-Gvili A.; Nama S.; Napora P.; Chowers M.; Bergeron A.; Zeltser D.; *Moudgil H.; Limaye A.P.; Couturaud F.; Nseir W.; McKevitt M.; Porter D.; Jordan R.; Guo Y.; German P.; Watkins T.R.; Gossage D.L.; Chien J.W.

Citation:
American Journal of Respiratory and Critical Care Medicine; May 2018; vol. 197

Abstract:
RATIONALE: Presatovir has been shown to significantly reduce nasal viral load and signs and symptoms of RSV infection in a healthy human challenge study. We evaluated the safety and efficacy of presatovir in hospitalized adults infected with RSV. METHODS: RSV infected subjects with <= 5 days of symptoms were randomized (1:1) to oral presatovir 200 mg or placebo once on Day 1, in addition to standard of care. Subjects were stratified by 4 categories: no chronic airways or lung disease, chronic obstructive pulmonary disease (COPD), asthma or other chronic airways or lung disease. The primary endpoint was the time weighted average change (TWAC) in nasal RSV viral load from baseline through Day 5. Secondary endpoints included mean TWAC in patient reported outcomes (Flu-PROTM), duration of hospital stay following study drug administration and rate of unplanned medical encounters related to a respiratory illness after initial hospital discharge through Day 28. RESULTS: From May 2014 to May 2017, 189 subjects from 78 centers were enrolled. Mean (SD) duration of symptoms prior to first dose of study drug was 3 (1.2) and 3 (1.1) days for the presatovir and placebo groups respectively. Despite maintaining mean plasma levels above 4-fold paEC95 for 5 days, presatovir treatment did not reduce the TWAC in viral load or the mean number of hospitalization free days (Table). The placebo group had a greater TWAC in Flu-PROTM score and a lower rate of unplanned medical encounters after initial hospital discharge than the presatovir group. The percentage of subjects with Treatment- Emergent Adverse Events (TEAE) and >= Grade 3 TEAEs (presatovir vs. placebo) were similar in both groups [65.2% vs. 67.0%] and [6.5% vs. 8.5%] respectively. The percentage of subjects with serious adverse events was also similar [8.7% vs 13.8%]. Two COPD subjects in the presatovir group died due to worsening COPD, one on day 5 during the study period and the other on day 36 after the study period. CONCLUSIONS: Presatovir did not significantly reduce viral load or improve clinical outcomes in hospitalized adults with RSV. (Table Presented) .