Staff Publication

Risk factors for treatment failure following cold coagulation cervical treatment for CIN pathology: a cohort-based study (2015)

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Type of publication:
Journal article

Author(s):
*Papoutsis D., *Underwood M ., *Parry-Smith W., *Panikkar J.

Citation:
Archives of Gynecology and Obstetrics, May 2015, vol./is. 292/6(1329-1337)

Abstract:
Purpose: To determine any risk factors for cytology recurrence in women after cold coagulation ablative treatment for cervical intraepithelial neoplasia (CIN). Methods: This was a retrospective observational study of a cohort of women having had cold coagulation between 2001 and 2011 in the colposcopy unit of an NHS hospital. We retrospectively collected data from our colposcopy unit database. Women with previous cervical treatment were excluded. Results: 559 eligible women we re identified with a mean age of 28.7 +/- 6.2 years. Nulliparous women were 66.3 % with smokers involving 35.3 %. Referral cytology, pretreatment cervical punch biopsies and colposcopy were high grade in 51.9, 71.9 and 45.8 % of women. Endocervical crypt involvement (ECI) on pretreatment cervical punch biopsy involved 9.7 % of women. Mean follow-up was 3.1 +/- 2.4 years. Overall cytology recurrence (mild/moderate/severe dyskaryosis) at 6 and 12 months follow-up was 7.4 and 5 %. High-grade cytology recurrence (moderate/severe dyskaryosis) involved 2.7 % of women over the entire follow-up period . Multiple regression analysis showed that ECI on pretreatment cervical pun ch biopsy was a risk factor for high-grade cytology recurrence (HR 3.72; 95 %CI 1.18-11.71; p = 0.024). There were no risk factors identified for overall cytology recurrence. However, when cytology tests with borderline nuclear changes at follow-up were pooled with mild/moderate/severe dyskaryosis cytology tests, then parity >2 was a risk factor for abnormal cytology (HR 1.71; 95 %CI 1.08-2.69; p = 0.022). Conclusions: Endocervical crypt involvement on pretreatment cervical punch biopsy and multiparity >2 are risk factors that increase the likelihood of abnormal cytology following cold coagulation. These two risk factors should be taken in consideration when performing cold coagulation cervical treatment for CIN pathology.

Practical Otolaryngology for Junior Doctors (2015)

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Type of publication:
Book

Author(s):
Thomas Frederick Charles Saunders, Editors: Alistair Mitchell-Innes and *Duncan Bowyer

Citation:
Doctors Academy Publications; 1st edition
ISBN-13: 978-9380573076

Abstract:

This book is designed to guide the junior doctor through an Otolaryngology (ENT) rotation from the first referrals to the practical procedures carried out on a daily basis. ENT departments throughout the world will have different ways of managing particular conditions; however, this book will give the user a framework to deliver good quality clinical care and develop skills with confidence wherever one is working. All information is presented in an easy to digest format to give a handy reference guide on how to manage the hugely varied conditions that are dealt with by Otolaryngology. This makes the book an ideal companion to keep in an on-call bag or clinic room. The advice provided in this book is practical and very clear, with good explanations about simple procedures for settling difficult situations. Information is also provided about looking after patients on the ward following common ENT/Head and Neck operations. An ENT junior doctor should feel more confident quickly after checking through this book for advice, as well as knowing when to escalate a problem to a more knowledgeable senior doctor, if the patient is not improving.

Plasma rich in growth factors (PRGF) as a treatment for high ankle sprain in elite athletes: a randomized control trial (2015)

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Type of publication:
Randomised controlled trial

Author(s):
Laver L, *Carmont MR, McConkey MO, Palmanovich E, Yaacobi E, Mann G, Nyska M, Kots E, Mei-Dan O.

Citation:
Knee Surgery, Sports Traumatology, Arthroscopy. 2015 Nov;23(11):3383-92

Abstract:
PURPOSE:
Syndesmotic sprains are uncommon injuries that require prolonged recovery. The influence of ultrasound-guided injections of platelet-rich plasma (PRP) into the injured antero-inferior tibio-fibular ligaments (AITFL) in athletes on return to play (RTP) and dynamic stability was studied.
METHODS:
Sixteen elite athletes with AITFL tears were randomized to a treatment group receiving injections of PRP or to a control group. All patients followed an identical rehabilitation protocol and RTP criteria. Patients were prospectively evaluated for clinical ability to return to full activity and residual pain. Dynamic ultrasound examinations were performed at initial examination and at 6 weeks post-injury to demonstrate re-stabilization of the syndesmosis joint and correlation with subjective outcome.
RESULTS:
All patients presented with a tear to the AITFL with dynamic syndesmosis instability in dorsiflexion-external rotation, and larger neutral tibia-fibula distance on ultrasound. Early diagnosis and treatment lead to shorter RTP, with 40.8 (+/-8.9) and 59.6 (+/-12.0) days for the PRP and control groups, respectively (p = 0.006). Significantly less residual pain upon return to activity was found in the PRP group; five patients (62.5 %) in the control group returned to play with minor discomfort versus one patient in the treatment group (12.5 %). One patient in the control group had continuous pain and disability and subsequently underwent syndesmosis reconstruction.
CONCLUSIONS:
Athletes suffering from high ankle sprains benefit from ultrasound-guided PRP injections with a shorter RTP, re-stabilization of the syndesmosis joint and less long-term residual pain.
LEVEL OF EVIDENCE: II.

Development of an accelerated functional rehabilitation protocol following minimal invasive Achilles tendon repair. (2018)

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Type of publication:
Journal article

Author(s):
Braunstein M, Baumbach SF, Boecker W, *Carmont MR, Polzer H.

Citation:
Knee Surgery, Sports Traumatology, Arthroscopy. 2018 Mar;26(3):846-853

Abstract:
Surgical repair after acute Achilles tendon rupture leads to lower re-rupture rates than non-surgical treatment. After open repair, early functional rehabilitation improves outcome, but there are risks of infection and poor wound healing. Minimal invasive surgery reduces these risks; however, there are concerns about its stability. Consequently, physicians may have reservations about adopting functional rehabilitation. There is still no consensus about the post-operative treatment after minimal invasive repair. The aim of this study was to define the most effective and safe post-operative rehabilitation protocol following minimal invasive repair.
METHODS: A systematic literature search in Embase, MEDLINE and Cochrane Library for prospective trials reporting on early functional rehabilitation after minimal invasive repair was performed. Seven studies were included.
RESULTS: One randomized controlled trail, one prospective comparative and five prospective non-comparative studies were identified. Four studies performed full weight bearing, all demonstrating good functional results, an early return to work/sports and high satisfaction. One study allowed early mobilization leading to excellent subjective and objective results. The only randomized controlled trial performed the most accelerated protocol demonstrating a superior functional outcome and fewer complications after immediate full weight bearing combined with free ankle mobilization. The non-comparative study reported high satisfaction, good functional results and an early return to work/sports following combined treatment.
CONCLUSION: Immediate weight bearing in a functional brace, together with early mobilization, is safe and has superior outcome following minimally invasive repair of Achilles tendon rupture. Our recommended treatment protocol provides quality assurance for the patient and reliability for the attending physician.
LEVEL OF EVIDENCE: II.

External beam radiotherapy in differentiated thyroid carcinoma: A systematic review. (2016)

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Type of publication:
Systematic Review

Author(s):
*Fussey JM, Crunkhorn R, Tedla M, Weickert MO, Mehanna H.

Citation:
Head Neck. Volume38, IssueS1, April 2016, Pages E2297-E2305

Abstract:
External beam radiotherapy (EBRT) is not a first line treatment in differentiated thyroid carcinoma (DTC), but is recommended as an adjuvant treatment in certain cases. The evidence for EBRT in DTC is limited. A comprehensive literature search was performed. Data on patient demographics, disease stage, treatment characteristics, and outcomes were collected from included articles after quality appraisal. Sixteen articles met the inclusion criteria, with a pooled population of 5114. Only 1 study was prospective and there were no randomized controlled trials. Most of the evidence suggests that EBRT improves locoregional control in patients at high risk of locoregional recurrence. This was corroborated by analysis of pooled patient data. Available evidence suggests an improvement in locoregional control when EBRT is used in patients over the age of 45 at high risk for locoregional recurrence. However, there is a need for long-term prospective multicenter research on the subject.

Investigation of the Role of Semen in Embryo Implantation: a pilot study (2016)

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Type of publication:
Poster presentation

Author(s):
*Cloete H., *Binnersley S., *Henderson A., *Mitchell A., *Kasraie J.

Citation:
Poster presentation at the ACE Annual Conference, 5-6 January 2016.

Abstract:
Aim: To investigate the effect of unprotected intercourse on embryo implantation in patients undergoing fertility treatment. Evidence suggests that seminal plasma elicits an endometrial immune response that promotes tolerance towards an invading conceptus. However, in assisted reproductive techniques (ART), seminal plasma is usually excluded and does not come into contact with the female reproductive tract. In humans, investigators have shown that intra-vaginal and/or intra-cervical application of seminal plasma at the time of fertility treatment may improve pregnancy outcomes.
Method: Women were asked to share information about timing and frequency of intercourse in the week of, and 2 weeks prior to, fresh and frozen embryo transfer (FET). Women who had unprotected intercourse in the 5 days prior to ovulation and up to the day of embryo transfer were assigned to the study group (n = 40). Women who abstained in this period were assigned to the control group (n = 66).
Main study outcomes: Biochemical pregnancy rate, clinical pregnancy rate and implantation rate. Statistical analysis showed no significant difference in main outcomes between groups when results were pooled for all treatment types (in vitro fertilisation (IVF)/intra-cytoplasmic sperm injection (ICSI) and FET cycles). However, a significantly reduced implantation rate was observed in the study group when considering the IVF/ICSI stratum alone (24% versus 44%, p = 0.03).
Conclusion: This pilot study supports intercourse abstinence during fertility treatment, however study limitations such as small sample size and patient recall means further investigation is recommended.

Retrospective study evaluating the Ankyloglossia release procedure within SATH (2015)

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Type of publication:
Journal article

Author(s):
*G. Mihalache, *S. Bhatia, *M. El Muiz, *N. Meixner

Citation:
British Journal of Oral and Maxillofacial Surgery, December 2015 Volume 53, Issue 10, Pages e42–e43

Abstract:
Ankyloglossia also more commonly known as tongue tie is a congenital abnormality, which results in a shorter thick lingual fraenulum which in turn restricts the movement of the tongue. The condition can interfere with breast feeding early on and speech or social functions when older. Ankyloglossia affects approximately 5% of the population. The benefits of breast feeding are well known and health care professionals are becoming more aware of tongue tie as a treatable cause of breast feeding difficulty.