Staff Publication

BerEP4 and CD34 immunostaining distinguishes basaloid tricholemmoma from basal cell carcinoma (2014)

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Type of publication:
Conference abstract

Author(s):
Turnbull N., Ghumra W., *Mudaliar V., Vella J., Sanders S., Taibjee S., Carr R.

Citation:
American Journal of Dermatopathology, February 2014, vol./is. 36/2(e54-e55), 0193-1091 (February 2014)

Abstract:
Aim: To study of the utility of an immunopanel comprising BerEP4, EMA and CD34 in the differential diagnosis of basaloid tricholemmoma and basal cell carcinoma. Method: An immunopanel comprising BerEP4, EMA and CD34 was applied to 48 tricholemmomas (TL) diagnosed and collected over a 12 year period including 10 tumours with a prominent basaloid component (BTL). Patterns of immunostaining were compared with BCC from our extensive database. Positive immunostaining was defined as moderate to strong intensity in a minimum of 10% of the tumour area. Results: Positivity for BerEP4, EMA and CD34 respectively was as follows: TL – 1/24 (4.1%), 4/21 (19%), 34/34 (100%), BTL- 2/9 (22%), 1/7 (14%), 10/10 (100%) and BCC – 218/219 (99.5%), 10/199 (5%), 0/14 (0%). CD34 in TL was often only focally positive (10% in 5/ 10 cases of BTL). BerEP4 was expressed in at most 20% of the tumour area in basaloid tricholemmomas, but in at least 40% of the tumour area in 95.4% of BCC. Conclusion: Immunostaining for CD34 in combination with BerEP4 helps distinguish BTL from BCC.

Link to more details or full-text: http://gsia.tums.ac.ir/images/UserFiles/12030/Forms/306/XXXIV_Symposium_of_the_International_Society_of_25.pdf

Anatomy of the sural nerve and its relation to the achilles tendon by ultrasound examination (2014)

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Type of publication:
Journal article

Author(s):
Kammar H., *Carmont M.R., Kots E., Laver L., Mann G., Nyska M., Mei-Dan O.

Citation:
Orthopedics, March 2014, vol./is. 37/3(e298-e301), 0147-7447 (March 2014)

Abstract:
Sural nerve injury is a relatively common complication after surgery on the Achilles tendon. Studies to determine the course of the sural nerve have been performed on cadaveric specimens. The purpose of this cross-sectional study was to use ultrasound to determine the relations of the sural nerve in a healthy population. The authors performed ultrasound examination of the posterior triangle of the ankle and Achilles tendon to determine the course of the sural nerve relative to the Achilles tendon in healthy participants. The mean distance between the nerve and the tendon was 21.48, 11.47, 5.8, and 0.81 mm lateral to the Achilles tendon as measured at the insertion and 4, 8, and 11 cm proximally, respectively. Male participants tended to have a nerve that was initially more lateral to the Achilles insertion compared with women. The distance between the sural nerve and the Achilles tendon was found to be lower in older participants, with the nerve passing significantly closer to the tendon at all levels (P

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Nephrotic-range proteinuria on interferon-beta treatment: Immune-induced glomerulonephritis or other pathway? (2014)

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Type of publication:
Journal article

Author(s):
*Yuste C., *Rapalai M., *Pritchard B.A., *Jones T.J., Tucker B., *Ramakrishna S.B.

Citation:
Clinical Kidney Journal, April 2014, vol./is. 7/2(190-193), 2048-8505;2048-8513 (April 2014)

Abstract:
We present a case report of a 37-year-old woman with multiple sclerosis (MS) who developed nephrotic-range proteinuria secondary to membrano proliferative glomerulonephritis (MPGN)-like disease with mesangial C3 deposition without evidence of immune-complex deposition in the context of long-term interferon-beta (IFN-beta) therapy. The complete remission of proteinuria following cessation of IFN-beta, strongly suggests causality. To our knowledge, this is the second case report of MPGN associated with IFN-beta use. This being the case, the negative immune screen, normal inflammatory markers and the absence of immune complex deposits would imply a different pathway to that previously suggested.

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Obesity delays 62 day treatment pathway for breast cancer (2014)

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Type of publication:
Conference abstract

Author(s):
*Lake B., *Pearson L., *Wilkins H., *Rastall S.

Citation:
European Journal of Surgical Oncology, May 2014, vol./is. 40/5(624), 0748-7983 (May 2014)

Abstract:
Introduction: There is increasing obesity in the UK, affecting 26% of women. The highest rate is in the West Midlands. (HSCIC 2013) This growing obese population will significantly impact health care. Breast cancer diagnosis and treatment have a 62 day cancer target. (CRS 2007) Accepted practice is triple assessment which is affected by elevated BMI; more difficult examination, repeated biopsy, technically difficult and time consuming imaging. This can delay diagnosis and treatment of breast cancer. Method: Somerset Cancer Database was used to identify all patients diagnosed with non-invasive or invasive Breast Cancer from 1st April 2012 – 31st March 2013 at Shrewsbury & Telford NHS Trust. Patients having hormone treatment or radiotherapy alone were excluded. Patient demographics were obtained from Pre-operative Anaesthetic Database. Biopsy rate was obtained from review. Imaging was reviewed by Breast Radiographer. SPSS was used to calculate independent T-test for statistical analysis. Results: 505 patients were diagnosed, of these 352 had surgery. Mean age 60 (30-87), mean BMI 28.6(16.5-55), with 35% of patients classified as obese. Number of days to treatment of BMI 35, 36 to 42 days was statistically significant P>0.0438 (T=2.0348, SE 2.949). Time taken for mammogram for super-obese patient BMI compared to normal BMI was significantly longer 7.5 minutes to 3.4 minutes P>0.0001 (T=11.6028, SE 0.353). Conclusion: Obesity significantly delays treatment pathway in Breast Cancer patients, and increases mammographic imaging time. These are important considerations with an increasingly obese population for health care provision planning of such patients.

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Retinopathy of prematurity in English neonatal units: A national population-based analysis using NHS operational data (2014)

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Type of publication:
Journal article

Author(s):
Wong H.S., Santhakumaran S., Statnikov Y., Gray D., Watkinson M., Modi N., Kadalraja R., Kefas J., Srinnel S., Ramesh C., Rackham O., Brearey S., Thirumurugan A., Losa I., McBride T., Amegavie L., Zipitis C., Yadan M., Maddock N., Moise J., Edi-Osagie N., Heal C., Birch J., Al-Zidgali F., Hasib A., Kisat H., Soe A., Long D., Fedee J., Lama M., Gupta R., Rawlingson, De Boer R.C., Rao P., Blake K., Bhaduri A.K., Halahakoon C., *Deshpande, Mohite A., Tewary K.K., Palmer K., Gallagher A., Nycyk J., Simmons P., Morgen I., Underhill H.C., Mahesh Babu R.N., Dalton S., Dixon H., James M., Jayalal V., Dyke M., Babiker S., Soe T., Rubin S., Ogilvy-Stuart A., Evans I., Wickham T., Van Someren V., Watkin S., Blumberg R., Sharief N., Aladangady N., Sullivan C., Alsford L., Sharma B., Khan A., Hamdan S., Ahmed J.S., Foo A., Talekar R., Adiotomre P., Gibson A., Thomas M., Mathur R., Cruwys M., Mannix P., Ariff H., Garbasa M., Lal M., Bosman D., Fenton A., Bolton A.R., Abu-Harb M., Verber I., Olivier J., Larson J., Cherinet Y., Munyard P., Osbourne N., Raman M., Watts T., Hannam S., Walter S., Kuna J., Chang Y.L., Shephard R., Lindo D., Calvert S., Wigfield R., Wylie P.., Misra I., Shettihalli N., Khashu M., Hall M., Groves C., De Halpert P., Schapira D., Kinsey S., Butterworth S., Garg A., Whitehead G., Sanghavi R., Whincup G., Khader K., Mallik A., Amess P., Godden C., Reynolds P., Brannan N., Noble V., Rao A.S., Wardle S., Ratnayaka M., Holman J., Zengeya S., Jones S., Wach R., Tooley J., Mann R.J., Eaton M., Babirecki M., Seal S., Schwartz K., Gibson D., Jampala C., Pairaudeau P., Miall L., Shyamannr K., Qunib M.

Citation:
Archives of Disease in Childhood: Fetal and Neonatal Edition, May 2014, vol./is. 99/3(F196-F202), 1359-2998;1468-2052 (May 2014)

Abstract:
Objectives: To report on retinopathy of prematurity (ROP) screening compliance against a national guideline, factors associated with non-compliance and effect on ROP treatment. Design: National cohort study using operational NHS data from the National Neonatal Research Database (NNRD) for the period 2009-2011. Setting: 161 (94%) neonatal units in England. Population: Infants born below 32 weeks’ gestation and/or with a birth weight below 1501 g. Main outcome measures: ROP screening status (’on-time’, ’early’, ’late’, ’unknown’) and associated infant and neonatal unit characteristics, ROP treatment. Results: The proportion of infants screened on-time increased over the study period (p

Link to more details or full-text: http://fn.bmj.com/cgi/pmidlookup?view=long&pmid=24361602

Diagnostic accuracy of point-of-care tests for detecting albuminuria: A systematic review and meta-analysis (2014)

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Type of publication:
Journal article

Author(s):
*McTaggart M.P., Newall R.G., Hirst J.A., Bankhead C.R., Lamb E.J., Roberts N.W., Price C.P.

Citation:
Annals of Internal Medicine, April 2014, vol./is. 160/8(550-557), 0003-4819;1539-3704 (15 Apr 2014)

Abstract:
Experts recommend screening for albuminuria in patients at risk for kidney disease. Purpose: To systematically review evidence about the diagnostic accuracy of point-of-care (POC) tests for detecting albuminuria in individuals for whom guidelines recommend such detection. Data Sources: Cochrane Library, EMBASE, Medion database, MEDLINE, and Science Citation Index from 1963 through 5 December 2013; hand searches of other relevant journals; and reference lists. Study Selection: Cross-sectional studies, published in any language, that compared the accuracy of machine-read POC tests of urinary albumin-creatinine ratio with that of laboratory measurement. Data Extraction: Two independent reviewers extracted study data and assessed study quality using the QUADAS-2 (Quality Assessment of Diagnostic Accuracy Studies 2) tool. Data Synthesis: Sixteen studies (n = 3356 patients) that evaluated semiquantitative or quantitative POC tests and used random urine samples collected in primary or secondary ambulatory care settings met inclusion criteria. Pooling results from a bivariate randomeffects model gave sensitivity and specificity estimates of 76% (95% CI, 63% to 86%) and 93% (CI, 84% to 97%), respectively, for the semiquantitative test. Sensitivity and specificity estimates for the quantitative test were 96% (CI, 78% to 99%) and 98% (CI, 93% to 99%), respectively. The negative likelihood ratios for the semiquantitative and quantitative tests were 0.26 (CI, 0.16 to 0.40) and 0.04 (CI, 0.01 to 0.25), respectively. Limitation: Accuracy estimates were based on data from singlesample urine measurement, but guidelines require that diagnosis of albuminuria be based on at least 2 of 3 samples collected in a 6-month period. Conclusion: A negative semiquantitative POC test result does not rule out albuminuria, whereas quantitative POC testing meets required performance standards and can be used to rule out albuminuria.

Link to more details or full-text: Hepatology

The use of a remifentanil infusion and elective tracheostomy to avoid ventilation in a patient with tetanus (2014)

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Type of publication:
Journal article

Author(s):
*Redshaw C., *Slater R.

Citation:
Journal of the Intensive Care Society, April 2014, vol./is. 15/2(161-163), 1751-1437

Abstract:
Tetanus is very rare in developed countries but the mortality is still high in the elderly population despite access to intensive care medicine. Death can frequently occur from secondary complications due to the need to sedate, paralyse and ventilate patients in an effort to control spasms. We describe the case of a 77-year-old man with tetanus in whom we successfully controlled tetanic spasms with a remifentanil infusion where conventional treatment failed, thus preventing the need for mechanical ventilation. We also describe the use of an elective percutaneous tracheostomy which was performed for airway protection. This prevented him from developing pneumonia from aspirating the excess secretions caused by the autonomic features of tetanus.

 

Safety of short, in-hospital delays before surgery for acute appendicitis: Multicentre cohort study, systematic review, and meta-analysis (2014)

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Type of publication:
Journal article

Author(s):
Bhangu A., Panagiotopoulou I.G., Chatzizacharias N., Rana M., Rollins K., Ejtehadi F., Jha B., Tan Y.W., Fanous N., Markides G., Tan A., Marshal C., Akhtar S., Mullassery D., Ismail A., Hitchins C., Sharif S., Osborne L., Sengupta N., Challand C., Pournaras D., Bevan K., King J., Massey J., Sandhu I., Wells J.M., Teichmann D.A., Peckham-Cooper A., Sellers M., Folaranmi S.E., Davies B., Potter S., Egbeare D., Kallaway C., Parsons S., Upchurch E., Lazaridis A., Cocker D., King D., Behar N., Loukogeorgakis S.P., Kalaiselvan R., Marzouk S., H. Turner E.J., Kaptanis S., Kaur V., Shingler G., Bennett A., Shaikh S., Aly M., Coad J., Khong T., Nouman Z., Crawford J., Szatmary P., West H., MacDonald A., Lambert J., Gash K., Hanks K.A., Griggs E., Humphreys L., Torrance A., Hardman J., Taylor L., Rex D., Bennett J., Crowther N., McAree B., Flexer S., Mistry P., Jain P., Hwang M., Richardson J., Oswald N., Wells A., Newsome H., Martinez P., B. Alvarez C.A., Leon J., Carradice D., Gohil R., Mount M., Campbell A., Iype S., Dyson E., Groot-Wassink T., Ross A.R., Charlesworth P., Baylem N., Voll J., Sian T., Creedon L., Hicks G., Goring J., Ng V., Tiboni S., Palser T., Rees B., Ravindra P., Neophytou C., Dent H., Lo T., Broom L., O’Connell M., Foulkes R., Griffith D., Butcher K., McLaren O., Tai A., Yano H., T. Torrance H.D., Moussa O., Mittapalli D., Watt D., Basson S., Gilliland J., Wilkins A., Yee J., Cain H., Wilson M., Pearson J., Turnbull E., Brigic A., Yassin N.A., Clarke J., Mallappa S., Jackson P., Jones C., Lakshminarayanan B., Sharma A., Fareed K., Yip G., Brown A., Patel N., Ghisel M., Tanner N., Jones H., Witherspoon J., Phillips M., Ho M.F., Ng S., Mak T., Campain N., Mukhey D., Mitchell W.K., Amawi F., Dickson E., Aggarwal S., Satherley L.K., Asprou F., Keys C., Steven M., Muhlschlegel J., Hamilton E., Yin J., Dilworth M., Wright A., Spreadborough P., Singh M., Mockford K., Morgan J., *Ball W., *Royle J., *Lacy-Colson J., Lai W., Griffiths S., Mitchell S., Parsons C., Joel A.S., Mason P.F., Harrison G.J., Steinke J., Rafique H., Battersby C., Hawkins W., Gurram D., Hateley C.A., Penkethman A., Lambden C., Conway A., Dent P., Yacob D., Oshin O.A., Hargreaves A., Gossedge G., Long J., Walls M., Futaba K., Pinkney T., Puig S., Nepogodiev D., Marriott P., Boddy A., Jones A., Tennuci C., Battersby N., Wilkin R., Lloyd C., Sein E., McEvoy K., Whisker L., Austin S., Colori A., Sinclair P., Loughran M., Lawrence A., Horsnell J., Bagenal J., Pisesky A., Mastoridis S., Solanki K., Siddiq I., Merker L., Sarmah P., Richardson C., Hanratty D., Evans L., Mortimer M., Bhalla A., Bartlett D., Beral D., Blencowe N.S., Cornish J., Haddow J.B., Hall N.J., Johnstone M., Pilgrim S., Trong S., Velineni R.

Citation:
Annals of Surgery, May 2014, vol./is. 259/5(894-903), 0003-4932;1528-1140 (May 2014)

Abstract:
OBJECTIVE: To determine safety of short in-hospital delays before appendicectomy. BACKGROUND: Short organizational delays before appendicectomy may safely improve provision of acute surgical services. METHODS: The primary endpoint was the rate of complex appendicitis (perforation, gangrene, and/or abscess). The main explanatory variable was timing of surgery, using less than 12 hours from admission as the reference. The first part of this study analyzed primary data from a multicentre study on appendicectomy from 95 centers. The second part combined this data with a systematic review and meta-analysis of published data. RESULTS: The cohort study included 2510 patients with acute appendicitis, of whom 812 (32.4%) had complex findings. Adjusted multivariable binary regression modelling showed that timing of operation was not related to risk of complex appendicitis [12-24 hours odds ratio (OR) 0.98 (P = 0.869); 24-48 hours OR 0.88 (P = 0.329); 48+ hours OR 0.82 (P = 0.317)]. However, after 48 hours, the risk of surgical site infection and 30-day adverse events both increased [adjusted ORs 2.24 (P = 0.039) and 1.71 (P = 0.024), respectively]. Meta-analysis of 11 nonrandomized studies (8858 patients) revealed that delay of 12 to 24 hours after admission did not increase the risk of complex appendicitis (OR 0.97, P = 0.750). CONCLUSIONS: Short delays of less than 24 hours before appendicectomy were not associated with increased rates of complex pathology in selected patients. These organizational delays may aid service provision, but planned delay beyond this should be avoided. However, where optimal surgical systems allow for expeditious surgery, prompt appendicectomy will still aid fastest resolution of pain for the individual patient.

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Postpartum posterior reversible encephalopathy syndrome (PRES) in a twin pregnancy complicated by preeclampsia-eclampsia: Case report (2014)

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Type of publication:
Journal article

Author(s):
*Papoutsis D., *El-Attabi N., *Sizer A.

Citation:
Clinical and Experimental Obstetrics and Gynecology, 2014, vol./is. 41/3(351-353), 0390-6663 (2014)

Abstract:
This is the second case in literature of posterior reversible encephalopathy syndrome (PRES) in a twin pregnancy complicated by preeclampsia-eclampsia. A 27-year-old primigravida with dichorionic diamniotic twin pregnancy was admitted at 36 weeks of gestation for induction of labour due to preeclampsia. On the second day postpartum, the patient developed severe hypertension, visual symptoms, confusion, headache, and eclamptic fits. Head computed tomography (CT) showed hypodense basal ganglia lesions. The patient was treated in the intensive treatment unit with hydralazine and labetalol infusions and anticonvulsants. Five days later, there was complete clinical improvement and follow-up magnetic resonance imaging (MRI) was normal. The patient was discharged 11 days post-delivery. Diagnosis of PRES is based on the presence of clinical features of acute neurologic compromise, abnormal neuroimaging findings, and complete reversibility of findings after prompt treatment. Early recognition and proper treatment result in complete reversibility of this condition.