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Bowman CR, Kearns M, Egan RJ, Lewis WG. Love all, trust a few, do wrong to none. Postgrad Med J 2024; 100:207-208. [PMID: 38142285 DOI: 10.1093/postmj/qgad122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Revised: 11/16/2023] [Accepted: 11/17/2023] [Indexed: 12/25/2023]
Affiliation(s)
| | - Mollie Kearns
- Department of Surgery, Morriston Hospital, Swansea SA6 6NL, United Kingdom
| | - Richard J Egan
- Department of Surgery, Morriston Hospital, Swansea SA6 6NL, United Kingdom
- Department of Medicine, Health and Life Sciences, Swansea University, Swansea SA2 8PP, United Kingdom
| | - Wyn G Lewis
- Department of Surgery, University Hospital of Wales, Cardiff CF14 4XW, United Kingdom
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Kontoghiorghes CP, Bowman CR. Bone Marrow Sarcoidosis: Hiding Within an Evaluation of Hypercalcemia. J Community Hosp Intern Med Perspect 2023; 13:47-49. [PMID: 38596540 PMCID: PMC11000846 DOI: 10.55729/2000-9666.1257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Revised: 08/05/2023] [Accepted: 08/10/2023] [Indexed: 04/11/2024] Open
Abstract
Patients with granulomatous disease often have widespread pulmonary and extrapulmonary disease. In the absence of this, a search of the pulmonary, renal, hepatic, ocular, and bone marrow is warranted in the setting of hypercalcemia with unexplained elevated 1,25-dihydroxyvitamin D, erythrocyte sedimentation rate (ESR), and C-reactive protein (CRP). We present a case of hypercalcemia and a decline in renal function in a patient with bone marrow sarcoidosis. A 45-year-old woman was admitted to the hospital after hypercalcemia, acute kidney injury, and pancytopenia were found on a routine outpatient lab. She was discharged after improvement with IV fluids. She had interval worsening of hypercalcemia and was readmitted within a week for pamidronate treatment. Imaging and labs were concerning for sarcoidosis, but bronchoscopy with biopsy was nondiagnostic. Eventual bone marrow biopsy confirmed evidence of granulomas. Her condition improved with prednisone over 3 months and ultimately, azathioprine. Non-parathyroid hormone-mediated hypercalcemia should be thoroughly worked up for a source to rule out malignancy and to diagnose treatable causes such as sarcoidosis. Sarcoidosis may not present in its traditional pulmonary pattern, necessitating further diagnostic measures such as a bone marrow biopsy.
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Saunders JH, Yanni F, Dorrington MS, Bowman CR, Vohra RS, Parsons SL. Impact of postoperative complications on disease recurrence and long-term survival following oesophagogastric cancer resection. Br J Surg 2019; 107:103-112. [DOI: 10.1002/bjs.11318] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2019] [Revised: 05/02/2019] [Accepted: 07/01/2019] [Indexed: 12/24/2022]
Abstract
Abstract
Background
Postoperative complications after resection of oesophagogastric carcinoma can result in considerable early morbidity and mortality. However, the long-term effects on survival are less clear.
Methods
All patients undergoing intentionally curative resection for oesophageal or gastric cancer between 2006 and 2016 were selected from an institutional database. Patients were categorized by complication severity according to the Clavien–Dindo classification (grades 0–V). Complications were defined according to an international consensus statement. The effect of leak and severe non-leak-related complications on overall survival, recurrence and disease-free survival was assessed using Kaplan–Meier analyses to evaluate differences between groups. All factors significantly associated with survival in univariable analysis were entered into a Cox multivariable regression model with stepwise elimination.
Results
Some 1100 patients were included, with a median age of 69 (range 28–92) years; 48·1 per cent had stage III disease and cancer recurred in 428 patients (38·9 per cent). Complications of grade III or higher occurred in 244 patients (22·2 per cent). The most common complications were pulmonary (29·9 per cent), with a 13·0 per cent incidence of pneumonia. Rates of atrial dysrhythmia and anastomotic leak were 10·0 and 9·6 per cent respectively. Patients with a grade III–IV leak did not have significantly reduced overall survival compared with those who had grade 0–I complications. However, patients with grade III–IV non-leak-related complications had reduced median overall survival (19·7 versus 42·7 months; P < 0·001) and disease-free survival (18·4 versus 36·4 months; P < 0·001). Cox regression analysis identified age, tumour stage, resection margin and grade III–IV non-leak-related complications as independent predictors of poor overall and disease-free survival.
Conclusion
Beyond the acute postoperative period, anastomotic leak does not adversely affect survival, however, other severe postoperative complications do reduce long-term overall and disease-free survival.
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Affiliation(s)
- J H Saunders
- Department of Surgery, Nottingham University Hospitals NHS Trust, Nottingham, NG7 2UH, UK
| | - F Yanni
- Department of Surgery, Nottingham University Hospitals NHS Trust, Nottingham, NG7 2UH, UK
| | - M S Dorrington
- Department of Surgery, Nottingham University Hospitals NHS Trust, Nottingham, NG7 2UH, UK
| | - C R Bowman
- Department of Surgery, Nottingham University Hospitals NHS Trust, Nottingham, NG7 2UH, UK
| | - R S Vohra
- Department of Surgery, Nottingham University Hospitals NHS Trust, Nottingham, NG7 2UH, UK
| | - S L Parsons
- Department of Surgery, Nottingham University Hospitals NHS Trust, Nottingham, NG7 2UH, UK
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Reece-Smith AM, Saunders JH, Soomro IN, Bowman CR, Duffy JP, Kaye PV, Welch NT, Madhusudan S, Parsons SL. Postoperative survival following perioperative MAGIC versus neoadjuvant OE02-type chemotherapy in oesophageal adenocarcinoma. Ann R Coll Surg Engl 2017; 99:378-384. [PMID: 28462649 PMCID: PMC5449699 DOI: 10.1308/rcsann.2017.0024] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/24/2016] [Indexed: 01/02/2023] Open
Abstract
The optimal management of resectable oesophageal adenocarcinoma is controversial, with many centres using neoadjuvant chemotherapy following the Medical Research Council (MRC) oesophageal working group (OE02) trial and the MRC Adjuvant Gastric Infusional Chemotherapy (MAGIC) trial. The more intensive MAGIC regimen is used primarily in gastric cancer but some also use it for oesophageal cancer. A database of cancer resections (2001-2013) provided information on survival of patients following either OE02 or MAGIC-type treatment. The data were compared using Kaplan-Meier analysis. Straight-to-surgery patients were also reviewed and divided into an 'early' cohort (2001-2006, OE02 era) and a 'late' cohort (2006-2013, MAGIC era) to estimate changes in survival over time. Subgroup analysis was performed for responders (tumour regression grade [TRG] 1-3) versus non-responders (TRG 4 and 5) and for anatomical site (gastro-oesophageal junction [GOJ] vs oesophagus). An OE02 regimen was used for 97 patients and 275 received a MAGIC regimen. Those in the MAGIC group were of a similar age to those undergoing OE02 chemotherapy but the proportion of oesophageal cancers was higher among MAGIC patients than among those receiving OE02 treatment. MAGIC patients had a significantly lower stage following chemotherapy than OE02 patients and a higher median overall survival although TRG was similar. On subgroup analysis, this survival benefit was maintained for GOJ and oesophageal cancer patients as well as non-responders. Analysis of responders showed no difference between regimens. 'Late' group straight-to-surgery patients were significantly older than those in the 'early' group. Survival, however, was not significantly different for these two cohorts. Although the original MAGIC trial comprised few oesophageal cancer cases, our patients had better survival with MAGIC than with OE02 chemotherapy in all anatomical subgroups, even though there was no significant change in operative survival over the time period in which these patients were treated. The use of the MAGIC regimen should therefore be encouraged in cases of operable oesophagogastric adenocarcinoma.
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Affiliation(s)
| | | | - I N Soomro
- Nottingham University Hospitals NHS Trust, UK
| | - C R Bowman
- Nottingham University Hospitals NHS Trust, UK
| | - J P Duffy
- Nottingham University Hospitals NHS Trust, UK
| | - P V Kaye
- Nottingham University Hospitals NHS Trust, UK
| | - N T Welch
- Nottingham University Hospitals NHS Trust, UK
| | | | - S L Parsons
- Nottingham University Hospitals NHS Trust, UK
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Saunders JH, Bowman CR, Reece-Smith AM, Pang V, Dorrington MS, Mumtaz E, Soomro I, Kaye P, Madhusudan S, Parsons SL. The role of adjuvant platinum-based chemotherapy in esophagogastric cancer patients who received neoadjuvant chemotherapy prior to definitive surgery. J Surg Oncol 2017; 115:821-829. [PMID: 28257148 DOI: 10.1002/jso.24601] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2016] [Revised: 02/13/2017] [Accepted: 02/13/2017] [Indexed: 11/06/2022]
Abstract
BACKGROUND AND OBJECTIVES For patients with operable esophagogastric cancer, peri-operative chemotherapy confers a significant overall survival benefit compared to surgery alone, however only 30-40% of patients demonstrate histopathological response. It is unclear whether those with no neoadjuvant chemotherapy response should go onto receive adjuvant chemotherapy, as no further benefit may be conferred. METHODS Esophagogastric cancers were prospectively captured with associated histopathological tumor regression grades following neoadjuvant chemotherapy. This cohort was then interrogated for clinico-pathological and survival outcomes. RESULTS Following neoadjuvant chemotherapy and surgery, patients with chemotherapy responsive cancers, who were administered adjuvant chemotherapy gained a significant overall survival benefit. Multivariate Cox analysis, demonstrated a final adjusted hazard ratio for adjuvant therapy of 0.509; (95%CI 0.28-0.93); P = 0.028. In contrast, patients with non-responsive tumors, who underwent adjuvant chemotherapy, did not show any survival benefit. Chemotherapy toxicity was prevalent and contributed to only half of patients receiving adjuvant chemotherapy. CONCLUSIONS These results suggest the benefit of the adjuvant portion of chemotherapy is limited to those who demonstrate a histopathological response to neoadjuvant chemotherapy. The administration of the adjuvant portion of chemotherapy to patients without a response to neoadjuvant chemotherapy may not provide any survival benefit, while potentially causing increased morbidity.
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Affiliation(s)
- John H Saunders
- Department of Upper GI Surgery, Nottingham University Hospitals NHS Trust, Nottingham, United Kingdom.,Cancer Biology Unit, Division of Cancer and Stem Cells, School of Medicine, University of Nottingham, Nottingham, United Kingdom
| | - Christopher R Bowman
- Department of Upper GI Surgery, Nottingham University Hospitals NHS Trust, Nottingham, United Kingdom
| | - Alex M Reece-Smith
- Department of Upper GI Surgery, Nottingham University Hospitals NHS Trust, Nottingham, United Kingdom
| | - Vincent Pang
- Cancer Biology Unit, Division of Cancer and Stem Cells, School of Medicine, University of Nottingham, Nottingham, United Kingdom
| | - Matthew S Dorrington
- Cancer Biology Unit, Division of Cancer and Stem Cells, School of Medicine, University of Nottingham, Nottingham, United Kingdom
| | - Errum Mumtaz
- Department of Upper GI Surgery, Nottingham University Hospitals NHS Trust, Nottingham, United Kingdom
| | - Irshad Soomro
- Department of Histopathology, Nottingham University Hospitals NHS Trust, Nottingham, United Kingdom
| | - Philip Kaye
- Department of Histopathology, Nottingham University Hospitals NHS Trust, Nottingham, United Kingdom
| | - Srinivasan Madhusudan
- Academic Unit of Oncology, Division of Cancer and Stem Cells, School of Medicine, University of Nottingham, Nottingham, United Kingdom
| | - Simon L Parsons
- Department of Upper GI Surgery, Nottingham University Hospitals NHS Trust, Nottingham, United Kingdom.,Cancer Biology Unit, Division of Cancer and Stem Cells, School of Medicine, University of Nottingham, Nottingham, United Kingdom
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Bowman CR, Bailey FC, Elrod-Erickson M, Neigh AM, Otter RR. Effects of silver nanoparticles on zebrafish (Danio rerio) and Escherichia coli (ATCC 25922): a comparison of toxicity based on total surface area versus mass concentration of particles in a model eukaryotic and prokaryotic system. Environ Toxicol Chem 2012; 31:1793-1800. [PMID: 22573570 DOI: 10.1002/etc.1881] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/03/2012] [Revised: 03/07/2012] [Accepted: 03/30/2012] [Indexed: 05/31/2023]
Abstract
Silver nanoparticles (Ag NPs) have been classified as the most abundant NP found in commercial products. In the present study, zebrafish (Danio rerio) and bacteria (Escherichia coli; ATCC 25922) were used to test the size-dependent toxicological effects of Ag NPs, the effects of ionic silver versus Ag NPs, and Ag NP effects on mortality using mass concentration (mg/L) compared with total surface area (nm(2) /L). Several diameters of Ag NPs (20, 50, 110 nm) as well as AgNO(3) were chosen as experimental treatments. Treated zebrafish embryos exhibited anomalies of the heart, namely, slower heart rates and pericardial edema. A size-dependent response was not observed in zebrafish when viewing mortality across all Ag NP treatments, although 20 nm elicited the highest incidence of abnormal motility and induced slower development. An Ag NP dose- and size-dependent response was observed in treated bacteria using mass concentration, with 20-nm Ag NP producing the highest mortality rate. In both zebrafish and bacteria, AgNO(3) was shown to be more toxic than Ag NPs at equivalent concentrations. When total surface area of Ag NPs was used to gauge bacterial mortality, a total surface area-dependent, but not size-dependent, response was observed for all three Ag NPs used in the present study, with nearly 100% mortality observed once a total surface area of approximately 1E + 18 nm(2) /L was reached. This trend was not apparent, however, when measuring total surface area for zebrafish mortality.
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Affiliation(s)
- Christopher R Bowman
- Department of Biology, Middle Tennessee State University, Murfreesboro, Tennessee, USA
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Abstract
Endocarditis caused by Candida albicans was induced in rabbits after insertion of a catheter across the aortic valve. The mean survival time of 34 rabbits was 26 days. Only 7% of temperature recordings taken were elevated. Candida was recovered from only 9% of blood cultures taken. Precipitating and agglutinating serum antibody was detected after 12 days of infection. Antibody titers rose progressively until death in rabbits with endocarditis, whereas titers peaked early and subsequently decreased in animals that received an intravenous injection of C. albicans without precatheterization. Three groups of rabbits were treated for 6 days with amphotericin B, 5-fluorocytosine, or the two durgs in combination. Amphotericin B alone reduced the mean titer of organisms from log10 8.79 +/- 1.46 to log 10 3.1 +/- 1.9 colony-forming units/g. 5-Fluorocytosine was less effective (mean titer after 6 days of therapy was log10 7.4 +/- 0.33 colony-forming units/g). The addition of 5-fluorocytosine to amphotericin B did not increase the rate at which Candida cells were eradicated from the vegetations. These in vivo results corrleated with the failure to demonstrate an increased rate of fungicidal activity in vitro with the two drugs.
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Bowman CR. The Environmental Health Program of the Alaska Area Native Health Service. Alaska Med 1969; 11:128-9. [PMID: 5369103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
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