Staff Publication

Anesthetic agents in patients with very long-chain acyl-coenzyme A dehydrogenase deficiency: a literature review (2014)

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Type of publication:
Journal article

Author(s):
*Redshaw C, *Stewart C

Citation:
Pediatric Anesthesia, 11 2014, vol./is. 24/11(1115-9), 1155-5645;1460-9592 (2014 Nov)

Abstract:
Very long-chain acyl-coenzyme A dehydrongenase deficiency (VLCADD) is a rare disorder of fatty acid metabolism that renders sufferers susceptible to hypoglycemia, liver failure, cardiomyopathy, and rhabdomyolysis. The literature about the management of these patients is hugely conflicting, suggesting that both propofol and volatile anesthesia should be avoided. We have reviewed the literature and have concluded that the source papers do not support the statements that volatile anesthetic agents are unsafe. The reports on rhabdomyolysis secondary to anesthesia appear to be due to inadequate supply of carbohydrate not volatile agents. Catabolism must be avoided with minimal fasting, glucose infusions based on age and weight, and attenuation of emotional and physical stress. General anesthesia appears to be protective of stress-induced catabolism and may offer benefits in children and anxious patients over regional anesthesia. Propofol has not been demonstrated to be harmful in VLCADD but is presented in an emulsion containing very long-chain fatty acids which can cause organ lipidosis and itself can inhibit mitochondrial fatty acid metabolism. It is therefore not recommended. Suxamethonium-induced myalgia may mimic symptoms of rhabdomyolysis and cause raised CK therefore should be avoided. Opioids, NSAIDS, regional anesthesia, and local anesthetic techniques have all been used without complication.

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Minimising negative ankle and foot X-rays in the Emergency Department-Are the Ottawa ankle rules good enough? (2014)

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Type of publication:
Journal article

Author(s):
*Crosswell S, *Leaman A, *Phung W

Citation:
Injury, 12 2014, vol./is. 45/12(2002-4), 0020-1383;1879-0267 (2014 Dec)

Abstract:
OBJECTIVES: To review fracture rates in patients who had X-rays of either the ankle or foot or both in the Emergency Department of a district hospital.METHOD: A retrospective review of 2589 Emergency Department patients who had X-rays of the ankle or foot or both over a 12-month period.RESULTS: There were 1199 ankle X-rays taken of which 193 (16%) showed a significant fracture. There were 1081 patients who had a foot X-rayed of which 165 (15%) showed a significant fracture. Younger patients had more X-rays but older patients were more likely to have a fracture. There were 309 patients who had an ipsilateral ankle and foot X-rayed at the same time, and of these 42 (14%) showed one fracture and just two (0.6%) showed a significant fracture of both ankle and foot.CONCLUSIONS: The approach to X-raying ankle and feet in this study is probably widespread, and Ottawa Ankle Rules still seem to be of limited use in diagnosing fractures. This low yield of positive X-ray could be accepted or a more sophisticated ankle rule introduced. Copyright 2014 Elsevier Ltd. All rights reserved.

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BMC medicine editorial board members on open access publishing (2014)

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Type of publication:
Journal article

Author(s):
*Carmont M.R., Lawn S.D., Stray-Pedersen B., Shoenfeld Y., Meier P.

Citation:
BMC Medicine, January 2014, vol./is. 12/1, 1741-7015 (21 Jan 2014)

Abstract:
In recognition of Open Access week (21st-27th October 2013), we asked some BMC Medicine Editorial Board Members to share their views and experiences on open access publishing. In this short video, they highlight the benefits of visibility and dissemination of their research, and discuss the future directions for this model of publishing.

Link to more details or full-text: http://www.biomedcentral.com/1741-7015/12/10

Overlap between dermatomyositis and ANCA vasculitides (2014)

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Type of publication:
Journal article

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

Citation:
Clinical Kidney Journal, February 2014, vol./is. 7/1(59-61), 2048-8505;2048-8513 (February 2014)

Abstract:
We present the second report of the association between antineutrophil cytoplasm antibodies (ANCA)-associated vasculitis with dermatomyositis (DM). A 47-year-old woman suddenly developed rapidly progressive renal failure in the context of (DM). The kidney biopsy showed focal and segmental necrotizing glomerulonephritis with crescent formation. Cyclophosphamide treatment was commenced resulting in a significant recovery of kidney function and maintenance of recovery at 6 months. Although the pathophysiology is unknown, we hypothesize that CD8-T-deficient cells and MPO+ neutrophils in the DM lesions play an important role in the disease process.

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UK temporomandibular joint replacement database: Report on baseline data (2014)

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Type of publication:
Journal article

Author(s):
*Idle M.R., Lowe D., Rogers S.N., Sidebottom A.J., Speculand B., Worrall S.F.

Citation:
British Journal of Oral and Maxillofacial Surgery, March 2014, vol./is. 52/3(203-207), 0266-4356;1532-1940 (March 2014)

Abstract:
Our goal is to establish the long-term collection of data on temporomandibular joint replacement from all centres in the UK where this is done. Currently, 16 surgeons have been identified, and 13 of them had entered data when this paper was being prepared. Data are entered online through the Snap Survey and then analysed annually. We report on 402 patients (332 (83%) female and 70 (17%) male) who had 577 joints inserted between 1994 and 2012. The main diagnoses that resulted in total joint replacement were osteoarthritis, failed operation, ankylosis, and seronegative arthritis. Preoperatively, the median (IQR) maximal incisal opening was 20 (15-26) mm (mean 20) and the median pain scores on the visual analogue scale (VAS 0-10) were 8 for both joints. The median (IQR) baseline dietary score (liquid 0 – solid 10) was 4 (3-6). A total of 173 (43%) patients had had one or more open procedure(s) before total replacement, 177 (44%) had not had open operation, and 52 (13%) had no data entered. The 3 primary systems used were the TMJ Concepts System (Ventura, USA), the Biomet System (Biomet/Lorenz Microfixation, Jacksonville, USA), and the Christensen System (TMJ Implants, Golden, USA). The median (IQR) duration of inpatient stay was 3 (2-4) days (mean 3). Follow-up data will be collected to assess patient recorded outcome measures (PROM) and objective measurements of total joint replacements in the UK from 1994 onwards. 2013 The British Association of Oral and Maxillofacial Surgeons.

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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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