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Mânica S, Merdietio Boedi R, Pandey H, Shields C. Identifying teeth and tooth fragments from digital 3D models. Morphologie 2024; 108:100774. [PMID: 38457861 DOI: 10.1016/j.morpho.2024.100774] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 01/29/2024] [Revised: 02/21/2024] [Accepted: 02/22/2024] [Indexed: 03/10/2024]
Abstract
Dental anatomy is an essential skill for human identification in forensic odontology. With the advent of technology enabling virtual autopsies, there is scope for virtual consultation by forensic odontologists especially when the expertise is unavailable but needed in zones of conflict or disasters. This study aimed to investigate potential benefits and challenges of identifying intact and damaged teeth from 3D scanned digital models. Ten 3D tooth models - nine permanent and deciduous human teeth and one animal tooth were uploaded on a hosting platform. A 3-part survey was circulated among 60 forensic odontologists with questions about demography (P1), tooth identification of the scanned 3D models (P2) and the perceived usefulness of 3D models for tooth identification (P3). This was the first time that a survey required the identification of individual human teeth (intact or not) and animal tooth combined. The response rate for study participation was 58%. Substantial agreement among participants was seen in the determination of tooth classification (i.e., molars, premolars) or non-human and tooth within the same tooth class (i.e., lateral incisors, second molar) (both k=0.61). The least agreement (k=0.21) was seen in identification of tooth according to the FDI notation with a mean accuracy of 0.34. While most responders correctly identified the animal tooth, most incorrect responses were seen in the identification of the intact third molar. While 3D-scanned teeth have the potential to be identified virtually, forensic odontologists should continuously test their skills in tooth morphology and dental anatomy of humans (damaged or not) and animals.
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Affiliation(s)
- S Mânica
- Centre for Forensic and Legal Medicine and Dentistry, School of Dentistry, level 7, University of Dundee, Nethergate, Dundee DD1 4HN, Scotland, United Kingdom.
| | - R Merdietio Boedi
- Centre for Forensic and Legal Medicine and Dentistry, School of Dentistry, level 7, University of Dundee, Nethergate, Dundee DD1 4HN, Scotland, United Kingdom; Department of Dentistry, Universitas Diponegoro, Jl. Prof. Mr. Sunario, Tembalang, Semarang, Central Java 50275, Indonesia
| | - H Pandey
- Centre for Forensic and Legal Medicine and Dentistry, School of Dentistry, level 7, University of Dundee, Nethergate, Dundee DD1 4HN, Scotland, United Kingdom
| | - C Shields
- Dundee Dental School, University of Dundee, Nethergate, School of Dentistry, Dundee DD1 4HN, Scotland, United Kingdom
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2
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Mulligan K, Corry E, Donohoe F, Glennon K, Vermeulen C, Reid-Schachter G, Thompson C, Walsh T, Shields C, McCormack O, Conneely J, Khan MF, Boyd WD, McVey R, O'Brien D, Treacy A, Mulsow J, Brennan DJ. Multidisciplinary Surgical Approach to Increase Survival for Advanced Ovarian Cancer in a Tertiary Gynaecological Oncology Centre. Ann Surg Oncol 2024; 31:460-472. [PMID: 37875740 DOI: 10.1245/s10434-023-14423-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Accepted: 09/26/2023] [Indexed: 10/26/2023]
Abstract
PURPOSE The purpose of this paper is to report on changes in overall survival, progression-free survival, and complete cytoreduction rates in the 5-year period after the implementation of a multidisciplinary surgical team (MDT). METHODS Two cohorts were used. Cohort A was a retrospectively collated cohort from 2006 to 2015. Cohort B was a prospectively collated cohort of patients from January 2017 to September 2021. RESULTS This study included 146 patients in cohort A (2006-2015) and 174 patients in cohort B (2017-2021) with FIGO stage III/IV ovarian cancer. Median follow-up in cohort A was 60 months and 48 months in cohort B. The rate of primary cytoreductive surgery increased from 38% (55/146) in cohort A to 46.5% (81/174) in cohort B. Complete macroscopic resection increased from 58.9% (86/146) in cohort A to 78.7% (137/174) in cohort B (p < 0.001). At 3 years, 75% (109/144) patients had disease progression in cohort A compared with 48.8% (85/174) in cohort B (log-rank, p < 0.001). Also at 3 years, 64.5% (93/144) of patients had died in cohort A compared with 24% (42/174) of cohort B (log-rank, p < 0.001). Cox multivariate analysis demonstrated that MDT input, residual disease, and age were independent predictors of overall (hazard ratio [HR] 0.29, 95% confidence interval [CI] 0.203-0.437, p < 0.001) and progression-free survival (HR 0.31, 95% CI 0.21-0.43, p < 0.001). Major morbidity remained stable throughout both study periods (2006-2021). CONCLUSIONS Our data demonstrate that the implementation of multidisciplinary-team, intraoperative approach allowed for a change in surgical philosophy and has resulted in a significant improvement in overall survival, progression-free survival, and complete resection rates.
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Affiliation(s)
- Karen Mulligan
- UCD Gynaecological Oncology Group, Catherine McAuley Research Centre, University College Dublin School of Medicine, Mater Misericordiae University Hospital, Eccles Street, Dublin 7, Ireland
| | - Edward Corry
- UCD Gynaecological Oncology Group, Catherine McAuley Research Centre, University College Dublin School of Medicine, Mater Misericordiae University Hospital, Eccles Street, Dublin 7, Ireland
| | - Fionán Donohoe
- UCD Gynaecological Oncology Group, Catherine McAuley Research Centre, University College Dublin School of Medicine, Mater Misericordiae University Hospital, Eccles Street, Dublin 7, Ireland
| | - Kate Glennon
- UCD Gynaecological Oncology Group, Catherine McAuley Research Centre, University College Dublin School of Medicine, Mater Misericordiae University Hospital, Eccles Street, Dublin 7, Ireland
| | - Carolien Vermeulen
- UCD Gynaecological Oncology Group, Catherine McAuley Research Centre, University College Dublin School of Medicine, Mater Misericordiae University Hospital, Eccles Street, Dublin 7, Ireland
| | - Gillian Reid-Schachter
- UCD Gynaecological Oncology Group, Catherine McAuley Research Centre, University College Dublin School of Medicine, Mater Misericordiae University Hospital, Eccles Street, Dublin 7, Ireland
| | - Claire Thompson
- UCD Gynaecological Oncology Group, Catherine McAuley Research Centre, University College Dublin School of Medicine, Mater Misericordiae University Hospital, Eccles Street, Dublin 7, Ireland
| | - Tom Walsh
- UCD Gynaecological Oncology Group, Catherine McAuley Research Centre, University College Dublin School of Medicine, Mater Misericordiae University Hospital, Eccles Street, Dublin 7, Ireland
| | - Conor Shields
- Department of Surgery, Mater Misericordiae University Hospital, Dublin 7, Ireland
- National Centre for Peritoneal Malignancy, Mater Misericordiae University Hospital, Dublin 7, Ireland
| | - Orla McCormack
- Department of Surgery, Mater Misericordiae University Hospital, Dublin 7, Ireland
- National Centre for Peritoneal Malignancy, Mater Misericordiae University Hospital, Dublin 7, Ireland
| | - John Conneely
- Department of Surgery, Mater Misericordiae University Hospital, Dublin 7, Ireland
- National Centre for Peritoneal Malignancy, Mater Misericordiae University Hospital, Dublin 7, Ireland
| | - Mohammad Faraz Khan
- Department of Surgery, Mater Misericordiae University Hospital, Dublin 7, Ireland
- National Centre for Peritoneal Malignancy, Mater Misericordiae University Hospital, Dublin 7, Ireland
| | - William D Boyd
- UCD Gynaecological Oncology Group, Catherine McAuley Research Centre, University College Dublin School of Medicine, Mater Misericordiae University Hospital, Eccles Street, Dublin 7, Ireland
| | - Ruaidhrí McVey
- UCD Gynaecological Oncology Group, Catherine McAuley Research Centre, University College Dublin School of Medicine, Mater Misericordiae University Hospital, Eccles Street, Dublin 7, Ireland
- Department of Gynaecology, St Vincent's Hospital, Elm Park, Dublin 4, Ireland
| | - Donal O'Brien
- Department of Gynaecology, St Vincent's Hospital, Elm Park, Dublin 4, Ireland
| | - Ann Treacy
- Department of Pathology, Mater Misericordiae University Hospital, Dublin 7, Ireland
| | - Jurgen Mulsow
- Department of Surgery, Mater Misericordiae University Hospital, Dublin 7, Ireland
- National Centre for Peritoneal Malignancy, Mater Misericordiae University Hospital, Dublin 7, Ireland
| | - Donal J Brennan
- UCD Gynaecological Oncology Group, Catherine McAuley Research Centre, University College Dublin School of Medicine, Mater Misericordiae University Hospital, Eccles Street, Dublin 7, Ireland.
- National Centre for Peritoneal Malignancy, Mater Misericordiae University Hospital, Dublin 7, Ireland.
- Department of Gynaecology, St Vincent's Hospital, Elm Park, Dublin 4, Ireland.
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Martín-Román L, Hannan E, Faraz Khan M, Müller AS, Shields C, Aird J, Moran B, Mulsow J. Correlation between PSOGI pathological classification and survival outcomes of patients with pseudomyxoma peritonei treated using cytoreductive surgery and HIPEC: national referral centre experience and literature review. Pleura Peritoneum 2023; 8:65-74. [PMID: 37304162 PMCID: PMC10249754 DOI: 10.1515/pp-2023-0001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2023] [Accepted: 04/04/2023] [Indexed: 06/13/2023] Open
Abstract
Objectives The Peritoneal Surface Oncology Group International (PSOGI) consensus subdivided pseudomyxoma peritonei (PMP) into four groups according to histopathological features. The aim of this paper is to report survival outcomes after cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) from a national referral centre and to correlate the PSOGI classification with survival. Methods A retrospective study of a prospectively maintained database was performed. Consecutive patients treated with CRS + HIPEC for PMP of appendiceal origin were included (September-2013 to December-2021). Pathological features of the peritoneal disease were used to classify patients into the four groups proposed by PSOGI. Survival analysis was performed to evaluate the correlation of pathology on overall survival (OS) and disease-free survival (DFS). Results Overall, 104 patients were identified; 29.6 % were reclassified as acellular mucin (AM), 43.9 % as low-grade mucinous carcinoma peritonei (LGMCP), 22.4 % as high-grade MCP (HGMCP) and 4.1 % as HGMCP with signet ring cells (HGMCP-SRC). Median PCI and rate of optimal cytoreduction were 19 and 82.7 %, respectively. Median OS and DFS were not reached, 5-year OS and DFS were 88.6(SD 0.04) % and 61.6(SD 0.06) %, respectively. Log-Rank test revealed significant differences in terms of OS and DFS across the different histological subgroups (p<0.001 in both cases). However, histology did not retain its significance in the multivariate analysis for OS or DFS (p=0.932 and p=0.872, respectively). Conclusions Survival outcomes after CRS + HIPEC for PMP are excellent. The PSOGI pathological classification correlates with OS and DFS, but differences were not significant at multivariate analysis when adjusted for other prognostic factors.
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Affiliation(s)
- Lorena Martín-Román
- Department of Surgery, National Centre for Peritoneal Malignancy, Mater Misericordiae University Hospital, Dublin, Ireland
| | - Enda Hannan
- Department of Surgery, National Centre for Peritoneal Malignancy, Mater Misericordiae University Hospital, Dublin, Ireland
| | - Mohammad Faraz Khan
- Department of Surgery, National Centre for Peritoneal Malignancy, Mater Misericordiae University Hospital, Dublin, Ireland
| | - Anna Sophia Müller
- Department of Surgery, National Centre for Peritoneal Malignancy, Mater Misericordiae University Hospital, Dublin, Ireland
| | - Conor Shields
- Department of Surgery, National Centre for Peritoneal Malignancy, Mater Misericordiae University Hospital, Dublin, Ireland
| | - John Aird
- Department of Pathology, Mater Misericordiae University Hospital, Dublin, Ireland
| | - Brendan Moran
- Peritoneal Malignancy Institute, Basingstoke and North Hampshire Hospital, Basingstoke, UK
| | - Jurgen Mulsow
- Department of Surgery, National Centre for Peritoneal Malignancy, Mater Misericordiae University Hospital, Dublin, Ireland
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Hardy NP, MacAonghusa P, Dalli J, Gallagher G, Epperlein JP, Shields C, Mulsow J, Rogers AC, Brannigan AE, Conneely JB, Neary PM, Cahill RA. Clinical application of machine learning and computer vision to indocyanine green quantification for dynamic intraoperative tissue characterisation: how to do it. Surg Endosc 2023:10.1007/s00464-023-09963-2. [PMID: 36894810 PMCID: PMC10338552 DOI: 10.1007/s00464-023-09963-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Accepted: 02/12/2023] [Indexed: 03/11/2023]
Abstract
INTRODUCTION Indocyanine green (ICG) quantification and assessment by machine learning (ML) could discriminate tissue types through perfusion characterisation, including delineation of malignancy. Here, we detail the important challenges overcome before effective clinical validation of such capability in a prospective patient series of quantitative fluorescence angiograms regarding primary and secondary colorectal neoplasia. METHODS ICG perfusion videos from 50 patients (37 with benign (13) and malignant (24) rectal tumours and 13 with colorectal liver metastases) of between 2- and 15-min duration following intravenously administered ICG were formally studied (clinicaltrials.gov: NCT04220242). Video quality with respect to interpretative ML reliability was studied observing practical, technical and technological aspects of fluorescence signal acquisition. Investigated parameters included ICG dosing and administration, distance-intensity fluorescent signal variation, tissue and camera movement (including real-time camera tracking) as well as sampling issues with user-selected digital tissue biopsy. Attenuating strategies for the identified problems were developed, applied and evaluated. ML methods to classify extracted data, including datasets with interrupted time-series lengths with inference simulated data were also evaluated. RESULTS Definable, remediable challenges arose across both rectal and liver cohorts. Varying ICG dose by tissue type was identified as an important feature of real-time fluorescence quantification. Multi-region sampling within a lesion mitigated representation issues whilst distance-intensity relationships, as well as movement-instability issues, were demonstrated and ameliorated with post-processing techniques including normalisation and smoothing of extracted time-fluorescence curves. ML methods (automated feature extraction and classification) enabled ML algorithms glean excellent pathological categorisation results (AUC-ROC > 0.9, 37 rectal lesions) with imputation proving a robust method of compensation for interrupted time-series data with duration discrepancies. CONCLUSION Purposeful clinical and data-processing protocols enable powerful pathological characterisation with existing clinical systems. Video analysis as shown can inform iterative and definitive clinical validation studies on how to close the translation gap between research applications and real-world, real-time clinical utility.
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Affiliation(s)
- Niall P Hardy
- UCD Centre for Precision Surgery, School of Medicine, University College Dublin, Dublin, Ireland
| | | | - Jeffrey Dalli
- UCD Centre for Precision Surgery, School of Medicine, University College Dublin, Dublin, Ireland
| | - Gareth Gallagher
- UCD Centre for Precision Surgery, School of Medicine, University College Dublin, Dublin, Ireland
| | | | - Conor Shields
- Department of General and Colorectal Surgery, Mater Misericordiae University Hospital, Dublin, Ireland
| | - Jurgen Mulsow
- Department of General and Colorectal Surgery, Mater Misericordiae University Hospital, Dublin, Ireland
| | - Ailín C Rogers
- Department of General and Colorectal Surgery, Mater Misericordiae University Hospital, Dublin, Ireland
| | - Ann E Brannigan
- Department of General and Colorectal Surgery, Mater Misericordiae University Hospital, Dublin, Ireland
| | - John B Conneely
- Department of Hepatobiliary, Foregut and Bariatric Surgery, Mater Misericordiae University Hospital, Dublin, Ireland
| | - Peter M Neary
- Department of General and Colorectal Surgery, University Hospital Waterford, University College Cork, Waterford, Ireland
| | - Ronan A Cahill
- UCD Centre for Precision Surgery, School of Medicine, University College Dublin, Dublin, Ireland.
- Department of General and Colorectal Surgery, Mater Misericordiae University Hospital, Dublin, Ireland.
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Sparks R, Power S, Kearns E, Clarke A, Mohan HM, Brannigan A, Mulsow J, Shields C, Cahill RA. Fallibility of tattooing colonic neoplasia ahead of laparoscopic resection: a retrospective cohort study. Ann R Coll Surg Engl 2023; 105:126-131. [PMID: 35175862 PMCID: PMC9889182 DOI: 10.1308/rcsann.2021.0319] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 10/21/2021] [Indexed: 02/03/2023] Open
Abstract
INTRODUCTION Precise geographical localisation of colonic neoplasia is a prerequisite for proper laparoscopic oncological resection. Preoperative endoscopic peri-tumoural tattoo practice is routinely recommended but seldom scrutinised. METHODS A retrospective review of recent consecutive patients with preoperative endoscopic lesional tattoo who underwent laparoscopic colonic resection as identified from our prospectively maintained cancer database with supplementary clinical chart and radiological, histological, endoscopic and theatre database/logbook interrogation. RESULTS Some 210 patients with 'tattooed' colonic neoplasia were identified, of whom 169 underwent laparoscopic surgery (mean age 68 years, median BMI 27.8kg/m2, male-to-female ratio 95:74). The majority of tumours were malignant (149; 88%), symptomatic (133; 79%) and proximal to the splenic flexure (92; 54%). Inaccurate colonoscopist localisation judgement occurred in 12% of cases, 60% of which were corrected by preoperative staging computed tomography scan. A useful lesional tattoo was absent in 11/169 cases (6.5%) being specifically stated as present in 104 operation notes (61%) and absent in 10 (5.9%). Tumours missing overt peritumoral tattoos intraoperatively were more likely to be smaller, earlier stage and injected longer preoperatively (p=0.006), although half had histological ink staining. Eight lesions missing tattoos were radiologically occult. Four (44%) of these patients had on-table colonoscopy, and five (55%) needed laparotomy (conversion rate 55% vs 23% overall, p<0.005) with one needing a second operation to resect the initially missed target lesion. Mean (range) operative duration and postoperative length of stay of those missing tattoos compared with those with tattoos was 200 (78-300) versus 188 (50-597) min and 15.5 (4-22) versus 12(4-70) days (p>0.05). CONCLUSIONS Tattoo in advance of attempting laparoscopic resection is vital for precision cancer surgery especially for radiologically unseen tumours to avoid adverse clinical consequence.
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Affiliation(s)
- R Sparks
- Mater Misericordiae University Hospital, Dublin, Ireland
| | - S Power
- Mater Misericordiae University Hospital, Dublin, Ireland
| | | | - A Clarke
- Mater Misericordiae University Hospital, Dublin, Ireland
| | | | - A Brannigan
- Mater Misericordiae University Hospital, Dublin, Ireland
| | - J Mulsow
- Mater Misericordiae University Hospital, Dublin, Ireland
| | - C Shields
- Mater Misericordiae University Hospital, Dublin, Ireland
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Power JW, Dempsey PJ, Yates A, Fenlon H, Mulsow J, Shields C, Cronin CG. Peritoneal malignancy: anatomy, pathophysiology and an update on modern day imaging. Br J Radiol 2022; 95:20210217. [PMID: 34826229 PMCID: PMC9153709 DOI: 10.1259/bjr.20210217] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
With increasing subspecialised experience in radical cytoreductive surgery and intra-abdominal chemotherapy for peritoneal malignancy, outcomes have improved significantly in selected patients. The surgery and the treatment regimens are radical and therefore correct patient selection is critical. The radiologist plays a central role in this process by estimating, as precisely as possible, the pre-treatment disease burden. Because of the nature of the disease process, accurate staging is not an easy task. Tumour deposits may be very small and in locations where they are very difficult to detect. It must be acknowledged that no form of modern day imaging has the capability of detecting the smallest peritoneal nodules, which may only be visible to direct inspection or histopathological evaluation. Nonetheless, it behoves the radiologist to be as exact and precise as possible in the reporting of this disease process. This is both to select patients who are likely to benefit from radical treatment, and just as importantly, to identify patients who are unlikely to achieve adequate cytoreductive outcomes. In this review, we outline the patterns of spread of disease and the anatomic basis for this, as well as the essential aspects of reporting abdominal studies in this patient group. We provide an evidence-based update on the relative strengths and limitations of our available multimodality imaging techniques namely CT, MRI and positron emission tomography/CT.
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Affiliation(s)
- Jack W Power
- University College Dublin (UCD) School of Medicine, Mater Misericordiae University Hospital, Dublin, Ireland
| | - Philip J Dempsey
- University College Dublin (UCD) School of Medicine, Mater Misericordiae University Hospital, Dublin, Ireland
| | - Andrew Yates
- University College Dublin (UCD) School of Medicine, Mater Misericordiae University Hospital, Dublin, Ireland
| | - Helen Fenlon
- University College Dublin (UCD) School of Medicine, Mater Misericordiae University Hospital, Dublin, Ireland
| | | | - Conor Shields
- University College Dublin (UCD) School of Medicine, Mater Misericordiae University Hospital, Dublin, Ireland
| | - Carmel G Cronin
- University College Dublin (UCD) School of Medicine, Mater Misericordiae University Hospital, Dublin, Ireland
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Shields C, Willis H, Nichani J, Sladen M, Kluk-de Kort K. Listening effort: WHAT is it, HOW is it measured and WHY is it important? Cochlear Implants Int 2021; 23:114-117. [PMID: 34844525 DOI: 10.1080/14670100.2021.1992941] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- C Shields
- Department of Paediatric Otolaryngology, Royal Manchester Children's Hospital, Manchester Foundation Trust, Manchester, UK.,Division of Human Communication, Development & Hearing, University of Manchester, Manchester, UK
| | - H Willis
- Independent Stress Management Consultant and CI User, Reading, UK
| | - J Nichani
- Department of Paediatric Otolaryngology, Royal Manchester Children's Hospital, Manchester Foundation Trust, Manchester, UK
| | - M Sladen
- Department of Paediatric Otolaryngology, Royal Manchester Children's Hospital, Manchester Foundation Trust, Manchester, UK
| | - K Kluk-de Kort
- Division of Human Communication, Development & Hearing, University of Manchester, Manchester, UK
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Higgins MJ, Mulsow J, Staunton O, Aird J, Cronin C, Dunne MT, Burke J, Shields C, Faul E, McCawley N, Toomey D, Conneely J, O'Neill B. Pragmatic use of short-course radiotherapy, chemotherapy and surgery for stage IV rectal cancer with locally advanced or symptomatic primary tumours. J Med Imaging Radiat Oncol 2021; 65:940-950. [PMID: 34464496 DOI: 10.1111/1754-9485.13312] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 02/05/2021] [Accepted: 07/31/2021] [Indexed: 01/04/2023]
Abstract
INTRODUCTION We assessed management of patients with de novo metastatic rectal cancer, referred for radiotherapy to the rectum, who were candidates for short-course radiotherapy (SCRT) and chemotherapy, followed by resection of all disease. We assessed surgical outcomes, overall survival (OS) and progression-free survival (PFS). METHODS Retrospective review of patients meeting criteria: (i) treatment with SCRT to rectum; (ii) locally advanced primary rectal cancer; and (iii) resectable distant metastases at diagnosis. Data were collected from charts, correspondence and electronic patient records. OS and PFS were calculated using the Kaplan-Meier method. RESULTS Between 2016 and 2020, 48 patients with stage IV rectal cancer at diagnosis were treated with SCRT. Only 15 patients (31%) had resectable metastatic disease and were intended for SCRT (25 Gy/5#), then chemotherapy, followed by resection of all sites of disease and are included in our study. 12 of the 15 surgical candidates (80%) had rectal surgery as planned, and 11 of the 15 (73%) had resection of the rectal primary and all metastatic disease. One patient had a pathological complete response (pCR), and 50% of surgical patients had a Mandard TRG of 1 or 2. Median PFS and OS for the 15 surgical candidates were 12.6 and 25.2 months, respectively, with a median FU of 21.2 months. CONCLUSION For this cohort of patients, our treatment paradigm is pragmatic and results in excellent pathological response. However, the effectiveness of this approach should be the subject of future prospective studies.
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Affiliation(s)
- Martin J Higgins
- St Luke's Radiation Oncology Network, Dublin, Ireland.,Beaumont Hospital, Dublin, Ireland
| | - Jurgen Mulsow
- Mater Misericordiae University Hospital, Dublin, Ireland.,Mater Private Hospital, Dublin, Ireland
| | | | - John Aird
- Mater Misericordiae University Hospital, Dublin, Ireland
| | - Carmel Cronin
- Mater Misericordiae University Hospital, Dublin, Ireland
| | - Mary T Dunne
- Clinical Trials Unit, St. Lukes's Hospital, Dublin, Ireland
| | | | - Conor Shields
- Mater Misericordiae University Hospital, Dublin, Ireland
| | - Eleanor Faul
- Mater Misericordiae University Hospital, Dublin, Ireland
| | | | - Des Toomey
- Mater Misericordiae University Hospital, Dublin, Ireland
| | | | - Brian O'Neill
- St Luke's Radiation Oncology Network, Dublin, Ireland.,Beaumont Hospital, Dublin, Ireland
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McInerney N, Khan MF, McLoughlin J, Shields C, Eaton D, Cahill RA. Emergency perioperative near-infrared assessment of small bowel viability in a case of incarcerated diaphragmatic hernia - a video vignette. Colorectal Dis 2021; 23:2204-2205. [PMID: 33974341 DOI: 10.1111/codi.15726] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Revised: 05/03/2021] [Accepted: 05/04/2021] [Indexed: 02/08/2023]
Affiliation(s)
- Niall McInerney
- UCD Centre for Precision Surgery, University College Dublin, Dublin 7, Ireland
| | - Mohammad Faraz Khan
- UCD Centre for Precision Surgery, University College Dublin, Dublin 7, Ireland
| | - Joseph McLoughlin
- Department of Cardiothoracic Surgery, Mater Misericordiae University Hospital, Dublin 7, Ireland
| | - Conor Shields
- UCD Centre for Precision Surgery, University College Dublin, Dublin 7, Ireland.,Department of Surgery, Mater Misericordiae University Hospital, Dublin, Ireland
| | - Donna Eaton
- Department of Cardiothoracic Surgery, Mater Misericordiae University Hospital, Dublin 7, Ireland
| | - Ronan A Cahill
- UCD Centre for Precision Surgery, University College Dublin, Dublin 7, Ireland
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Keyes AM, Kelly ME, McInerney N, Khan MF, Bolger JC, McCormack E, Grundy J, McCormack O, MacHale J, Conneely J, Brennan D, Cahill R, Shields C, Moran B, Mulsow J. Short-term outcomes in older patients with peritoneal malignancy treated with cytoreductive surgery and HIPEC: Experience with 245 patients from a national centre. Eur J Surg Oncol 2021; 47:2358-2362. [PMID: 33895028 DOI: 10.1016/j.ejso.2021.04.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2021] [Revised: 03/18/2021] [Accepted: 04/06/2021] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Cytoreductive Surgery (CRS) combined with hyperthermic intraperitoneal chemotherapy (HIPEC) is increasingly accepted as the optimal management of selected patients with peritoneal malignancy. There is limited published evidence on outcomes in older patients treated by this complex therapeutic strategy. METHODS A retrospective review of a prospective database of all patients who underwent CRS with HIPEC in a single institution over seven years. A comparative analysis of outcomes in patients under 65 undergoing CRS and HIPEC with patients ≥65 years was performed. The key endpoints were morbidity, mortality, reintervention rate and length of stay in the high dependency/intensive care (HDU/ICU) units. RESULTS Overall, 245 patients underwent CRS and HIPEC during the study period, with 76/245 (31%) ≥65 years at the time of intervention. Tumour burden measured by the peritoneal carcinomatosis index (PCI) score was a median of 11 for both groups. Median length of hospital stay in the ≥65-year-old group was 14.5 days versus 13 days in the <65-year-old group (∗p = 0.01). Patients aged ≥65-years spent a median of one more day in the critical care unit ∗(p = 0.001). Significant morbidity (Clavien-Dindo ≥ Grade IIIa) was higher in the ≥65-year than the <65-year group (18.4% versus 11.2%). There were no perioperative deaths in the ≥65-year group. CONCLUSION This study demonstrates higher perioperative major morbidity in ≥65-year group, but with low mortality in patients undergoing CRS/HIPEC for disseminated intraperitoneal malignancy. This increased morbidity does not translate into higher rates of re-interventions and highlights the importance of optimal patient selection.
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Affiliation(s)
- Alan Martin Keyes
- National Centre for Peritoneal Malignancy, Department of Surgery, Mater Misericordiae University Hospital, Eccles Street, Dublin 7, Ireland.
| | - Michael Eamon Kelly
- National Centre for Peritoneal Malignancy, Department of Surgery, Mater Misericordiae University Hospital, Eccles Street, Dublin 7, Ireland
| | - Niall McInerney
- National Centre for Peritoneal Malignancy, Department of Surgery, Mater Misericordiae University Hospital, Eccles Street, Dublin 7, Ireland
| | - Mohammad Faraz Khan
- National Centre for Peritoneal Malignancy, Department of Surgery, Mater Misericordiae University Hospital, Eccles Street, Dublin 7, Ireland
| | - Jarlath Christopher Bolger
- Department of Hepatobiliary Surgery, Mater Misericordiae University Hospital, Eccles Street, Dublin 7, Ireland
| | - Emilie McCormack
- National Centre for Peritoneal Malignancy, Department of Surgery, Mater Misericordiae University Hospital, Eccles Street, Dublin 7, Ireland
| | - Josh Grundy
- National Centre for Peritoneal Malignancy, Department of Surgery, Mater Misericordiae University Hospital, Eccles Street, Dublin 7, Ireland
| | - Orla McCormack
- National Centre for Peritoneal Malignancy, Department of Surgery, Mater Misericordiae University Hospital, Eccles Street, Dublin 7, Ireland
| | - John MacHale
- Department of Anaesthesiology, Mater Misericordiae University Hospital, Eccles Street, Dublin 7, Ireland
| | - John Conneely
- National Centre for Peritoneal Malignancy, Department of Surgery, Mater Misericordiae University Hospital, Eccles Street, Dublin 7, Ireland
| | - Donal Brennan
- National Centre for Peritoneal Malignancy, Department of Surgery, Mater Misericordiae University Hospital, Eccles Street, Dublin 7, Ireland
| | - Ronan Cahill
- National Centre for Peritoneal Malignancy, Department of Surgery, Mater Misericordiae University Hospital, Eccles Street, Dublin 7, Ireland
| | - Conor Shields
- National Centre for Peritoneal Malignancy, Department of Surgery, Mater Misericordiae University Hospital, Eccles Street, Dublin 7, Ireland
| | - Brendan Moran
- Basingstoke and North Hampshire Hospital, Peritoneal Malignancy Institute, Basingstoke, UK
| | - Jürgen Mulsow
- National Centre for Peritoneal Malignancy, Department of Surgery, Mater Misericordiae University Hospital, Eccles Street, Dublin 7, Ireland
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11
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Hermand H, Lefèvre JH, Shields C, Chafai N, Debove C, Beaugerie L, Svrcek M, Parc Y. Postoperative diagnostic revision for Crohn disease after subtotal colectomy for inflammatory bowel disease. Int J Colorectal Dis 2021; 36:709-715. [PMID: 33084950 DOI: 10.1007/s00384-020-03783-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/09/2020] [Indexed: 02/04/2023]
Abstract
PURPOSE Subtotal colectomy (STC) is performed for severe acute and refractory colitis. The diagnosis can be difficult even after the surgery when colectomy specimen has overlapping features of ulcerative colitis (UC) and Crohn's disease (CD). The aim of this study was to evaluate the rate of postoperative diagnostic revision to CD after surgery and determine predictor factors. METHODS Retrospective study of 110 patients who underwent STC (2005-2018). RESULTS Preoperative diagnosis comprised UC = 80 (73%), CD = 11 (10%), and unclassified colitis (IBDU = 19, 17%). Initial diagnosis of IBDU and UC was modified to CD in 6 patients (6%) after STC. The final diagnosis after the follow-up of 10 ± 6 years switched from CD for 8 patients (9%). The multivariate analysis showed that patients with a colitis evolving for less than 10 years and initial diagnosis of IBDU were the two independent factors associated with an increased risk of diagnosis change to CD (p = 0.03; p = 0.016). At the end of the follow-up, 15 patients (14%) had a definitive stoma. CONCLUSIONS In patients with IBD, attention must be paid to determine the right restorative strategy to patients with an evolution of the disease less than 10 years or with IBDU who are more at risk to have a diagnosis change to CD after STC.
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Affiliation(s)
- Hélène Hermand
- Department of Digestive Surgery, AP-HP, Hôpital Saint Antoine, Sorbonne Université, F-75012, Paris, France
| | - Jérémie H Lefèvre
- Department of Digestive Surgery, AP-HP, Hôpital Saint Antoine, Sorbonne Université, F-75012, Paris, France.
| | - Conor Shields
- Department of Digestive Surgery, AP-HP, Hôpital Saint Antoine, Sorbonne Université, F-75012, Paris, France
- Mater Misericordia University Hospital, Dublin, Ireland
| | - Najim Chafai
- Department of Digestive Surgery, AP-HP, Hôpital Saint Antoine, Sorbonne Université, F-75012, Paris, France
| | - Clotilde Debove
- Department of Digestive Surgery, AP-HP, Hôpital Saint Antoine, Sorbonne Université, F-75012, Paris, France
| | - Laurent Beaugerie
- Department of Gastroenterology, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique, AP-HP Hôpital Saint-Antoine, Sorbonne Université, Paris, France
| | - Magali Svrcek
- Department of Pathology, Assistance Publique Hôpitaux de Paris, Hôpital Saint Antoine, Sorbonne Université, Paris, France
| | - Yann Parc
- Department of Digestive Surgery, AP-HP, Hôpital Saint Antoine, Sorbonne Université, F-75012, Paris, France
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12
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Healy P, Bird B, Shields C, Conneely J, McEntee G, Mulsow J, McCormack O. Cytoreductive surgery and heated intraperitoneal chemotherapy (HIPEC) for gastric cancer peritoneal metastases- the early experience of the first Gastric HIPEC centre in the British Isles. Eur J Surg Oncol 2021. [DOI: 10.1016/j.ejso.2020.11.162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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13
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Mulligan KM, Glennon K, Donohoe F, O'Brien Y, Mc Donnell BC, Bartels HC, Vermeulen C, Walsh T, Shields C, McCormack O, Conneely J, Boyd WD, Mc Vey R, Mulsow J, Brennan DJ. Multidisciplinary Surgical Approach to Increase Complete Cytoreduction Rates for Advanced Ovarian Cancer in a Tertiary Gynecologic Oncology Center. Ann Surg Oncol 2021; 28:4553-4560. [PMID: 33423175 DOI: 10.1245/s10434-020-09494-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Accepted: 12/01/2020] [Indexed: 02/06/2023]
Abstract
BACKGROUND Surgical resection remains the cornerstone of ovarian cancer management. In 2017, the authors implemented a multi-disciplinary surgical team comprising gynecologic oncologists as well as colorectal, hepatobiliary, and upper gastrointestinal (GI) surgeons to increase gross macroscopic resection rates. This report aims to describe changes in complete cytoreduction rates and morbidity after the implementation of a multi-disciplinary surgical team comprising gynecologic oncologists as well as colorectal, hepatobiliary, and upper GI surgeons in a tertiary gynecologic oncology unit. METHODS The study used two cohorts. Cohort A was a retrospectively collated cohort from 2006 to 2015. Cohort B was a prospectively collated cohort of patients initiated in 2017. A multidisciplinary approach to preoperative medical optimization, intraoperative management, and postoperative care was implemented in 2017. The patients in cohort B with upper abdominal disease were offered primary cytoreduction with or without hyperthermic intraperitoneal chemotherapy (HIPEC). Before 2017, the patients with upper abdominal disease received neoadjuvant chemotherapy (cohort A). RESULTS This study included 146 patients in cohort A (2006-2015) and 93 patients in cohort B (2017-2019) with stages 3 or 4 ovarian cancer. The overall complete macroscopic resection rate (CC0) increased from 58.9 in cohort A to 67.7% in cohort B. The rate of primary cytoreductive surgery (CRS) increased from 38 (55/146) in cohort A to 42% (39/93) in cohort B. The CC0 rate for the patients who underwent primary CRS increased from 49 in cohort A to 77% in cohort B. Major morbidity remained stable throughout both study periods (2006-2019). CONCLUSIONS The study data demonstrate that implementation of a multidisciplinary team intraoperative approach and a meticulous approach to preoperative optimization resulted in significantly improved complete resection rates, particularly for women offered primary CRS.
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Affiliation(s)
- Karen M Mulligan
- Department of Gynaecological Oncology, Catherine Mc Auley Research Centre, University College Dublin School of Medicine, Mater Misericordiae University Hospital, Dublin 7, Ireland
| | - Kate Glennon
- Department of Gynaecological Oncology, Catherine Mc Auley Research Centre, University College Dublin School of Medicine, Mater Misericordiae University Hospital, Dublin 7, Ireland
| | - Fionán Donohoe
- Department of Gynaecological Oncology, Catherine Mc Auley Research Centre, University College Dublin School of Medicine, Mater Misericordiae University Hospital, Dublin 7, Ireland
| | - Yvonne O'Brien
- Department of Gynaecological Oncology, Catherine Mc Auley Research Centre, University College Dublin School of Medicine, Mater Misericordiae University Hospital, Dublin 7, Ireland
| | - Brian C Mc Donnell
- Department of Gynaecological Oncology, Catherine Mc Auley Research Centre, University College Dublin School of Medicine, Mater Misericordiae University Hospital, Dublin 7, Ireland
| | - Helena C Bartels
- Department of Gynaecological Oncology, Catherine Mc Auley Research Centre, University College Dublin School of Medicine, Mater Misericordiae University Hospital, Dublin 7, Ireland
| | - Carolien Vermeulen
- Department of Gynaecological Oncology, Catherine Mc Auley Research Centre, University College Dublin School of Medicine, Mater Misericordiae University Hospital, Dublin 7, Ireland
| | - Tom Walsh
- Department of Gynaecological Oncology, Catherine Mc Auley Research Centre, University College Dublin School of Medicine, Mater Misericordiae University Hospital, Dublin 7, Ireland
| | - Conor Shields
- Department of Surgery, Mater Misericordiae University Hospital, Dublin 7, Ireland.,National Centre for Peritoneal Malignancy, Mater Misericordiae University Hospital, Dublin 7, Ireland
| | - Orla McCormack
- Department of Surgery, Mater Misericordiae University Hospital, Dublin 7, Ireland.,National Centre for Peritoneal Malignancy, Mater Misericordiae University Hospital, Dublin 7, Ireland
| | - John Conneely
- Department of Surgery, Mater Misericordiae University Hospital, Dublin 7, Ireland.,National Centre for Peritoneal Malignancy, Mater Misericordiae University Hospital, Dublin 7, Ireland
| | - William D Boyd
- Department of Gynaecological Oncology, Catherine Mc Auley Research Centre, University College Dublin School of Medicine, Mater Misericordiae University Hospital, Dublin 7, Ireland
| | - Ruaidhrí Mc Vey
- Department of Gynaecological Oncology, Catherine Mc Auley Research Centre, University College Dublin School of Medicine, Mater Misericordiae University Hospital, Dublin 7, Ireland
| | - Jurgen Mulsow
- Department of Surgery, Mater Misericordiae University Hospital, Dublin 7, Ireland.,National Centre for Peritoneal Malignancy, Mater Misericordiae University Hospital, Dublin 7, Ireland
| | - Donal J Brennan
- Department of Gynaecological Oncology, Catherine Mc Auley Research Centre, University College Dublin School of Medicine, Mater Misericordiae University Hospital, Dublin 7, Ireland. .,National Centre for Peritoneal Malignancy, Mater Misericordiae University Hospital, Dublin 7, Ireland.
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14
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McGrath K, Casserly M, O'mara F, Mulsow J, Shields C, Staunton O, Teeling SP, Ward M. Zap it track it: the application of Lean Six Sigma methods to improve the screening system of low-grade mucinous neoplasms of the appendix in an acute hospital setting. Int J Qual Health Care 2020; 31:35-44. [PMID: 31665301 DOI: 10.1093/intqhc/mzz075] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [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: 03/01/2019] [Revised: 05/20/2019] [Accepted: 07/03/2019] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVE To improve the number of patients receiving annual computed tomography (CT) scan and tumour markers, who are diagnosed with low-grade mucinous neoplasms (LAMN). DESIGN A pre-/post-intervention design was employed using Lean Six Sigma methods to identify gaps in the screening system and to develop and implement solutions for a more robust, auditable screening programme. SETTING The patients diagnosed with LAMN of the appendix referred to the acute hospital and are enrolled in the screening service. PARTICIPANTS Consultant colorectal surgeons, cancer nurse specialist, colorectal medical team and quality improvement staff. INTERVENTIONS Diagnostic tools identified gaps in the current process. A set of improvements were implemented to standardize the pathway for referral and surveillance of patients, provide information on the condition and treatment and standardize and track information received by patients and their referring hospital. MAIN OUTCOME MEASURE(S) Pre and post-intervention outcome measures were taken for the number of patients who receive an annual CT of thoracic, abdomen and peritoneum and tumour markers and number of patients who receive information and contact details. RESULTS At baseline, of the 28 patients that met the inclusion criteria only 61% had a correct follow-up. Following the implementation of improvements, 78% of patients had correct follow-up and 90% had received information. CONCLUSIONS Gaps in the current cancer screening system were identified and improvements implemented a reduced number of patients having an incorrect follow-up. Findings are applicable across all precancerous screening systems irrespective of the type of malignancy. The methods used empowered patients and fostered an interdisciplinary team approach to care.
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Affiliation(s)
- Kathleen McGrath
- Cancer Services, Mater Misericordiae University Hospital, Eccles St, Dublin 7, Republic of Ireland
| | - Mairéad Casserly
- Pharmacy Department, Mater Misericordiae University Hospital, Eccles St, Dublin 7, Republic of Ireland
| | - Freda O'mara
- Group Management, Ireland East Hospital Group, Mater Misericordiae University Hospital, Eccles St, Dublin 7, Republic of Ireland
| | - Jurgen Mulsow
- Peritoneal Malignancy Institute and Colorectal Surgery, Mater Misericordiae University Hospital, Eccles St, Dublin 7, Republic of Ireland
| | - Conor Shields
- Peritoneal Malignancy Institute and Colorectal Surgery, Mater Misericordiae University Hospital, Eccles St, Dublin 7, Republic of Ireland
| | - Oonagh Staunton
- Peritoneal Malignancy Institute and Colorectal Surgery, Mater Misericordiae University Hospital, Eccles St, Dublin 7, Republic of Ireland
| | - Seán Paul Teeling
- Lean Academy, Mater Misericordiae University Hospital, Eccles St, Dublin 7, Republic of Ireland and School of Nursing, Midwifery and Health Systems, C145, UCD Health Sciences Centre, University College Dublin, Belfield, Dublin 4, Ireland
| | - Marie Ward
- Centre for Innovative Human Systems, School of Psychology, Trinity College Dublin, the University of Dublin, Dublin 2, Ireland
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15
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Garland SM, Pitisuttithum P, Ngan HYS, Cho CH, Lee CY, Chen CA, Yang YC, Chu TY, Twu NF, Samakoses R, Takeuchi Y, Cheung TH, Kim SC, Huang LM, Kim BG, Kim YT, Kim KH, Song YS, Lalwani S, Kang JH, Sakamoto M, Ryu HS, Bhatla N, Yoshikawa H, Ellison MC, Han SR, Moeller E, Murata S, Ritter M, Sawata M, Shields C, Walia A, Perez G, Luxembourg A. Efficacy, Immunogenicity, and Safety of a 9-Valent Human Papillomavirus Vaccine: Subgroup Analysis of Participants From Asian Countries. J Infect Dis 2019; 218:95-108. [PMID: 29767739 PMCID: PMC5989602 DOI: 10.1093/infdis/jiy133] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [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: 11/15/2017] [Accepted: 03/16/2018] [Indexed: 01/17/2023] Open
Abstract
Background A 9-valent human papillomavirus-6/11/16/18/31/33/45/52/58 (9vHPV) vaccine extends coverage to 5 next most common oncogenic types (31/33/45/52/58) in cervical cancer versus quadrivalent HPV (qHPV) vaccine. We describe efficacy, immunogenicity, and safety in Asian participants (India, Hong Kong, South Korea, Japan, Taiwan, and Thailand) from 2 international studies: a randomized, double-blinded, qHPV vaccine-controlled efficacy study (young women aged 16–26 years; NCT00543543; Study 001); and an immunogenicity study (girls and boys aged 9–15 years; NCT00943722; Study 002). Methods Participants (N = 2519) were vaccinated at day 1 and months 2 and 6. Gynecological samples (Study 001 only) and serum were collected for HPV DNA and antibody assessments, respectively. Injection-site and systemic adverse events (AEs) were monitored. Data were analyzed by country and vaccination group. Results 9vHPV vaccine prevented HPV-31/33/45/52/58–related persistent infection with 90.4%–100% efficacy across included countries. At month 7, ≥97.9% of participants seroconverted for each HPV type. Injection-site AEs occurred in 77.7%–83.1% and 81.9%–87.5% of qHPV and 9vHPV vaccine recipients in Study 001, respectively, and 62.4%–85.7% of girls/boys in Study 002; most were mild to moderate. Conclusions The 9vHPV vaccine is efficacious, immunogenic, and well tolerated in Asian participants. Data support 9vHPV vaccination programs in Asia. Clinical Trials Registration NCT00543543; NCT00943722.
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Affiliation(s)
- S M Garland
- Western Pacific Regional HPV Labnet Reference Laboratory, Department of Infectious Disease and Microbiology, Royal Women's Hospital, Murdoch Children's Research Institute, Royal Children's Hospital and Department of Obstetrics and Gynaecology, University of Melbourne, Parkville, Victoria, Australia
| | | | - H Y S Ngan
- Department of Obstetrics and Gynaecology, the University of Hong Kong, China
| | - C-H Cho
- Department of Obstetrics and Gynecology, Keimyung University School of Medicine, Daegu, South Korea
| | - C-Y Lee
- Department of Gynecology, Chang Gung Memorial Hospital, Chiayi Branch, Taipei
| | - C-A Chen
- Department of Obstetrics and Gynecology, National Taiwan University Hospital, Taipei
| | - Y C Yang
- MacKay Memorial Hospital, Taipei
| | - T-Y Chu
- Tzu Chi Medical Center, Hualien
| | - N-F Twu
- Department of Obstetrics and Gynecology, Taipei Veterans General Hospital, Taipei, Taiwan
| | - R Samakoses
- Department of Pediatrics, Phramongkutklao Hospital, Bangkok, Thailand
| | | | - T H Cheung
- Department of Obstetric and Gynaecology, Chinese University of Hong Kong, China
| | - S C Kim
- Division of Gynecologic Oncology, Ewha Womans University Mokdong Hospital, School of Medicine Ewha Womans University, Seoul, South Korea
| | - L-M Huang
- Department of Pediatrics, National Taiwan University Hospital, Taipei, Taiwan
| | - B-G Kim
- Department of Obstetrics and Gynecology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Y-T Kim
- Department of Obstetrics and Gynecology, University of Ulsan College of Medicine, Asian Medical Center, Seoul, South Korea
| | - K-H Kim
- Department of Pediatrics and Center for Vaccine Evaluation and Study, Ewha Womans University College of Medicine, Seoul, South Korea
| | - Y-S Song
- Obstetrics and Gynecology, College of Medicine, Seoul National University, Seoul, South Korea
| | - S Lalwani
- Bharati Vidyapeeth Deemed University Medical College and Hospital, Pune, India
| | - J-H Kang
- Department of Pediatrics, Seoul St. Mary's Hospital, College of Medicine, the Catholic University of Korea, South Korea
| | - M Sakamoto
- Department of Gynaecology, Sasaki Foundation Kyoundo Hospital and Department of Obstetrics and Gynaecology, School of Medicine, the Jikei University, Tokyo, Japan
| | - H-S Ryu
- Department of Obstetrics and Gynecology, School of Medicine, Ajou University, Suwon, South Korea
| | - N Bhatla
- Department of Obstetrics and Gynaecology, All India Institute of Medical Sciences, New Delhi, India
| | - H Yoshikawa
- Ibaraki Prefectural Central Hospital, Kasama, Ibaraki, Japan
| | | | | | - E Moeller
- Merck & Co., Inc., Kenilworth, New Jersey
| | | | - M Ritter
- Merck & Co., Inc., Kenilworth, New Jersey
| | | | - C Shields
- Merck & Co., Inc., Kenilworth, New Jersey
| | - A Walia
- Merck & Co., Inc., Kenilworth, New Jersey
| | - G Perez
- Merck & Co., Inc., Kenilworth, New Jersey
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Bartels HC, Rogers AC, Postle J, Shields C, Mulsow J, Conneely J, Brennan DJ. Morbidity and mortality in women with advanced ovarian cancer who underwent primary cytoreductive surgery compared to cytoreductive surgery for recurrent disease: a meta-analysis. Pleura Peritoneum 2019; 4:20190014. [PMID: 31417960 PMCID: PMC6693481 DOI: 10.1515/pp-2019-0014] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2019] [Accepted: 06/17/2019] [Indexed: 02/05/2023] Open
Abstract
Background The primary treatment for advanced ovarian cancer is aggressive cytoreductive surgery (CRS), which is associated with considerable morbidity. The aim of this meta-analysis is to compare morbidity associated with primary CRS and secondary CRS for recurrent disease. Methods A literature search was performed using Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines for publications reporting morbidity and mortality in patients undergoing CRS in primary and recurrent ovarian malignancy. Embase, Medline, Pubmed, Pubmed Central, clinicaltrials. gov and Cochrane databases were searched. Two independent reviewers applied inclusion and exclusion criteria to select included papers. A total of 215 citations were reviewed; 6 studies comprising 641 patients were selected for the analysis. Results Results were reported as mean differences or pooled odds ratios (OR) with 95 % confidence intervals (95 % CI). The overall morbidity rate was 38.4 %, and this did not differ between the two groups (p=0.97). This did not change when only Clavien-Dindo grade 3 and 4 morbidities were accounted for (14 % primary CRS, 15 % recurrent, p=0.83). Compared to primary CRS, secondary CRS was associated with a similar operative time (mean 400 min, I2=79 %, p=0.45), rate of bowel resection (I2=75 %, p=0.37) and transfusion requirements (MD – 0.7 L, I2=76 %, p=0.45). The mortality rate in both groups was too low to allow for meaningful meta-analysis, with four deaths in the group undergoing primary cytoreductive surgery (1.0 %) and two deaths in the group with recurrent disease (0.9 %). Conclusions In conclusion, secondary CRS for recurrent ovarian cancer is a safe and feasible option in carefully pre-selected patients with comparable morbidity to primary CRS.
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Affiliation(s)
- Helena C. Bartels
- Ireland East Hospital Gynaeoncology Group, Mater Misericordiae University, Dublin, Ireland
| | - Ailin C. Rogers
- Department of Surgery, Mater Misericordiae University Hospital, Dublin, Ireland
| | - James Postle
- Ireland East Hospital Gynaeoncology Group, Mater Misericordiae University, Dublin, Ireland
| | - Conor Shields
- Department of Surgery, Mater Misericordiae University Hospital, Dublin, Ireland
| | - Jurgen Mulsow
- Department of Surgery, Mater Misericordiae University Hospital, Dublin, Ireland
| | - John Conneely
- Department of Surgery, Mater Misericordiae University Hospital, Dublin, Ireland
| | - Donal J. Brennan
- Ireland East Hospital Gynaeoncology Group, Mater Misericordiae University, Dublin, Ireland
- UCD School of Medicine, National Maternity Hospital, Holles Street, Dublin, Ireland
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Flanagan M, Solon J, Chang K, Deady S, Moran B, Cahill R, Shields C, Mulsow J. Peritoneal metastases from extra-abdominal cancer – A population-based study. Eur J Surg Oncol 2018; 44:1811-1817. [DOI: 10.1016/j.ejso.2018.07.049] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2018] [Revised: 05/10/2018] [Accepted: 07/02/2018] [Indexed: 01/30/2023] Open
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Abstract
In the acquisition event of ordinary delayed matching to sample the monkey sees a sample, displaces it, and finds a food reward underneath; subsequently the retention test consists of a choice between that sample and a distractor, and the strength of the memory laid down by the acquisition event may be assessed by the correctness of choice at the retention test. The present experiments varied the acquisition events and examined the effect of those variations on normal and fornix-transected monkeys' memory. One variation was to proceed as normally but never to bait the sample at acquisition; this variation allowed assessment of the role of the food reward in ordinary matching. Another was to present the sample, baited and to be displaced, as normally, but to present also the distractor, baited but not requiring to be displaced, in a second acquisition event; this “push–match” variation allowed assessment of memory for the displacement. The main result from normal monkeys was that matching to unbaited samples was learned much faster than matching to baited samples. Following fornix transection, final performance levels in matching to baited and to unbaited samples were unimpaired but push–match showed a permanent deficit. These results support earlier indications that fornix-transected monkeys have normal sensory memory but are deficient in the memory of instrumental responses.
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Gaffan D, Saunders RC, Gaffan EA, Harrison S, Shields C, Owen MJ. Effects of Fornix Transection upon Associative Memory in Monkeys: Role of the Hippocampus in Learned Action. ACTA ACUST UNITED AC 2018; 36:173-221. [PMID: 6541361 DOI: 10.1080/14640748408402203] [Citation(s) in RCA: 101] [Impact Index Per Article: 16.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Thirty-three monkeys took part in seven experiments designed to elucidate further the effect of fornix transection on learning and memory. In the first experiment the monkeys had to remember whether stimulus objects had previously been paired with reward or no reward, and they had to use this memory to guide choice between stimulus objects at retention tests according to an arbitrary rule which they had learned: to choose objects previously paired with no reward in preference to objects previously paired with reward. Fornix transection produced a severe and permanent impairment in this task. In the second experiment the monkeys also had to remember object-reward associations but the performance rule was more natural: to choose objects previously paired with reward. Here fornix transection had no effect. The third experiment required the monkeys to remember, given a stimulus object, which of two events of equal valence had previously been the outcome of displacing that object. The two events were either a peanut and a sultana or a black penny and a white penny of equal secondary reinforcing value. Performance was unimpaired by fornix transection. The fourth experiment also demonstrated, in a different paradigm, unimpaired recall of sensory events. The fifth experiment demonstrated an impairment following fornix transection in acquisition of simultaneous spatial-visual conditional discriminations; the sixth demonstrated normal learning by fornix-transected monkeys of a successive spatial-visual conditional discrimination and the seventh demonstrated unimpaired acquisition of a simultaneous auditory-visual conditional discrimination. These results, when considered in detail and together, are incompatible with existing hypotheses of hippocampal function. A new hypothesis is discussed.
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Moreira ED, Giuliano AR, de Hoon J, Iversen OE, Joura EA, Restrepo J, Van Damme P, Vandermeulen C, Ellison MC, Krick A, Shields C, Heiles B, Luxembourg A. Safety profile of the 9-valent human papillomavirus vaccine: assessment in prior quadrivalent HPV vaccine recipients and in men 16 to 26 years of age. Hum Vaccin Immunother 2017; 14:396-403. [PMID: 29211620 PMCID: PMC5806635 DOI: 10.1080/21645515.2017.1403700] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
A 9-valent HPV (9vHPV) vaccine has been developed to protect against HPV type 6/11/16/18/31/33/45/52/58-related infection and disease. Previous safety analyses from 7 clinical trials conducted in 9vHPV vaccine recipients 9–26 years of age, including comparisons of 9vHPV and quadrivalent HPV (qHPV) vaccines in girls and women 16–26 years of age, showed that the 9vHPV vaccine was generally well tolerated. Additional safety analyses were conducted to include the results of new clinical studies. The safety profile of the 9vHPV vaccine in prior qHPV vaccine recipients (n = 3756 from 1 randomized controlled trial and 2 open-label extension studies) and young men (n = 248 9vHPV and n = 248 qHPV vaccine recipients from 1 randomized controlled trial) was evaluated. Vaccine was administered as a 3-dose regimen (at Day 1 and Months 2 and 6), and adverse events (AEs) were monitored. The most common AEs were injection-site events (91.1% and 79.0% in prior qHPV vaccine recipients and young men, respectively), the majority of which were mild. Discontinuations due to an AE were rare (0.2% and 0.0% among prior qHPV vaccine recipients and young men, respectively). In young men, the AE profile of the 9vHPV vaccine was generally similar to that of the qHPV vaccine. Overall, the 9vHPV vaccine was generally well tolerated in prior qHPV vaccine recipients and in young men, with an AE profile generally consistent with that previously reported with the broader clinical program.
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Affiliation(s)
- E D Moreira
- a Centro de Pesquisa Clínica, Associação Obras Sociais Irmã Dulce and Oswaldo Cruz Foundation, Brazilian Ministry of Health , Salvador , Bahia , Brazil
| | - A R Giuliano
- b Department of Cancer Epidemiology , Center for Infection Research (CIRC), Moffitt Cancer Center , Tampa , Florida , USA
| | - J de Hoon
- c Center for Clinical Pharmacology, Department of Pharmaceutical and Pharmacological Sciences , KU Leuven , Leuven , Belgium
| | - O-E Iversen
- d Department of Clinical Science , University of Bergen/Womens Clinic, Haukeland University Hospital , Bergen , Norway
| | - E A Joura
- e Department of Gynecology , Comprehensive Cancer Center, Medical University of Vienna , Vienna , Austria
| | - J Restrepo
- f Fundación Centro de Investigación Clínica CIC , Medellín , Colombia
| | - P Van Damme
- g University of Antwerp, Vaccine & Infectious Disease Institute, Centre for the Evaluation of Vaccination , Antwerp , Belgium
| | - C Vandermeulen
- h Leuven University Vaccinology Center, Department of Pharmaceutical and Pharmacological Sciences , KU Leuven , Leuven , Belgium
| | - M C Ellison
- i Merck & Co. Inc., Kenilworth , New Jersey , USA
| | - A Krick
- i Merck & Co. Inc., Kenilworth , New Jersey , USA
| | - C Shields
- i Merck & Co. Inc., Kenilworth , New Jersey , USA
| | - B Heiles
- i Merck & Co. Inc., Kenilworth , New Jersey , USA
| | - A Luxembourg
- i Merck & Co. Inc., Kenilworth , New Jersey , USA
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Shields C. Nevus, melanocytoma and melanoma: differential diagnosis. Acta Ophthalmol 2017. [DOI: 10.1111/j.1755-3768.2017.02652] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- C. Shields
- Ocular Oncology Service; Wills Eye Hospital; Philadelphia United States
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Shields C. Optic disk melanocytoma and juxtapapillary melanoma. Diagnosis and management. Acta Ophthalmol 2017. [DOI: 10.1111/j.1755-3768.2017.03541] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- C. Shields
- Ocular Oncology Service; Wills Eye Hospital; Philadelphia United States
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Shields C. Uveal melanoma biopsy or not (pro). Acta Ophthalmol 2017. [DOI: 10.1111/j.1755-3768.2017.02341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- C. Shields
- Ocular Oncology Service; Wills Eye Hospital; Philadelphia United States
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Solon JG, O'Neill M, Chang KH, Deady S, Cahill R, Moran B, Shields C, Mulsow J. An 18 year population-based study on site of origin and outcome of patients with peritoneal malignancy in Ireland. Eur J Surg Oncol 2017; 43:1924-1931. [PMID: 28583791 DOI: 10.1016/j.ejso.2017.05.010] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [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] [Received: 01/04/2017] [Revised: 04/15/2017] [Accepted: 05/10/2017] [Indexed: 12/17/2022] Open
Abstract
Peritoneal malignancy (PM) is predominantly metastatic spread from advanced gastrointestinal or gynaecological cancer. PM is generally considered incurable and therefore has rarely been the focus of novel therapeutic strategies. This study assessed patterns and survival outcomes for patients with PM in Ireland. The National Cancer Registry Ireland database was interrogated to identify patients diagnosed with PM during the period 1994-2012. Patient and tumour characteristics were retrieved and survival outcomes calculated. 5791 patients were diagnosed during the study period. Median age at diagnosis was 68 years; females accounted for 62%. The incidence increased annually from 228 in 1994 to 401 in 2012. Primary PM accounted for 3% of cases. Colorectal (22%), ovarian (16%) and gastric (13%) cancers accounted for the majority of cases of secondary PM. Almost 75% of patients had PM at initial presentation. Almost 40% of patients (n = 2274) underwent surgical intervention, while 44% (n = 2560) had tumour directed chemotherapy. The median survival (MS) in patients with secondary PM was 6.6 months, and did not improve significantly during the study period. Outcomes were best in patients with ovarian cancer (MS 15.9 months) and colorectal cancer (MS 14.3 months) and worst in patients with lung (MS 2.4 months) and pancreas (MS 1.9 months) cancers. This is the first population-based study from Ireland to report the incidence and outcomes for PM. PM is more common than previously reported and survival remains poor. These findings highlight the need for greater clinician awareness and the need to focus on new therapeutic approaches to improve patient outcomes.
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Affiliation(s)
- J G Solon
- National Centre for Peritoneal Malignancy, Mater Misericordiae University Hospital, Dublin 7, Ireland
| | - M O'Neill
- National Centre for Peritoneal Malignancy, Mater Misericordiae University Hospital, Dublin 7, Ireland
| | - K H Chang
- National Centre for Peritoneal Malignancy, Mater Misericordiae University Hospital, Dublin 7, Ireland
| | - S Deady
- The National Cancer Registry Ireland, Cork, Ireland
| | - R Cahill
- National Centre for Peritoneal Malignancy, Mater Misericordiae University Hospital, Dublin 7, Ireland
| | - B Moran
- National Centre for Peritoneal Malignancy, Mater Misericordiae University Hospital, Dublin 7, Ireland; Peritoneal Malignancy Institute, Basingstoke, UK
| | - C Shields
- National Centre for Peritoneal Malignancy, Mater Misericordiae University Hospital, Dublin 7, Ireland
| | - J Mulsow
- National Centre for Peritoneal Malignancy, Mater Misericordiae University Hospital, Dublin 7, Ireland.
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O'Kane GM, Ryan É, McVeigh TP, Creavin B, Hyland JM, O'Donoghue DP, Keegan D, Geraghty R, Flannery D, Nolan C, Donovan E, Mehigan BJ, McCormick P, Muldoon C, Farrell M, Shields C, Mulligan N, Kennedy MJ, Green AJ, Winter DC, MacMathuna P, Sheahan K, Gallagher DJ. Screening for mismatch repair deficiency in colorectal cancer: data from three academic medical centers. Cancer Med 2017; 6:1465-1472. [PMID: 28470797 PMCID: PMC5463076 DOI: 10.1002/cam4.1025] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2016] [Revised: 01/03/2017] [Accepted: 01/04/2017] [Indexed: 12/23/2022] Open
Abstract
Reflex immunohistochemistry (rIHC) for mismatch repair (MMR) protein expression can be used as a screening tool to detect Lynch Syndrome (LS). Increasingly the mismatch repair-deficient (dMMR) phenotype has therapeutic implications. We investigated the pattern and consequence of testing for dMMR in three Irish Cancer Centres (CCs). CRC databases were analyzed from January 2005-December 2013. CC1 performs IHC upon physician request, CC2 implemented rIHC in November 2008, and CC3 has been performing rIHC since 2004. The number of eligible patients referred to clinical genetic services (CGS), and the number of LS patients per center was determined. 3906 patients were included over a 9-year period. dMMR CRCs were found in 32/153 (21%) of patients at CC1 and 55/536 (10%) at CC2, accounting for 3% and 5% of the CRC population, respectively. At CC3, 182/1737 patients (10%) had dMMR CRCs (P < 0.001). Additional testing for the BRAF V600E mutation, was performed in 49 patients at CC3 prior to CGS referral, of which 29 were positive and considered sporadic CRC. Referrals to CGS were made in 66%, 33%, and 30% of eligible patients at CC1, CC2, and CC3, respectively. LS accounted for CRC in eight patients (0.8%) at CC1, eight patients (0.7%) at CC2, and 20 patients (1.2%) at CC3. Cascade testing of patients with dMMR CRC was not completed in 56%. Universal screening increases the detection of dMMR tumors and LS kindreds. Successful implementation of this approach requires adequate resources for appropriate downstream management of these patients.
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Affiliation(s)
| | - Éanna Ryan
- Centre for Colorectal Disease, St. Vincent's University Hospital, Dublin 4, Ireland
| | - Terri P McVeigh
- Department of Clinical Genetics, Our Lady's Children's Hospital, Dublin 12, Ireland
| | - Ben Creavin
- Centre for Colorectal Disease, St. Vincent's University Hospital, Dublin 4, Ireland
| | - John Mp Hyland
- Centre for Colorectal Disease, St. Vincent's University Hospital, Dublin 4, Ireland
| | | | - Denise Keegan
- Centre for Colorectal Disease, St. Vincent's University Hospital, Dublin 4, Ireland
| | - Robert Geraghty
- Centre for Colorectal Disease, St. Vincent's University Hospital, Dublin 4, Ireland
| | | | | | | | | | | | | | | | - Conor Shields
- Mater Misericordiae University Hospital, Dublin 7, Ireland
| | - Niall Mulligan
- Mater Misericordiae University Hospital, Dublin 7, Ireland
| | | | - Andrew J Green
- Department of Clinical Genetics, Our Lady's Children's Hospital, Dublin 12, Ireland
| | - Desmond C Winter
- Centre for Colorectal Disease, St. Vincent's University Hospital, Dublin 4, Ireland
| | | | - Kieran Sheahan
- Centre for Colorectal Disease, St. Vincent's University Hospital, Dublin 4, Ireland
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Kazanowski M, Al Furaji H, Cahill RA, Shields C, Mulsow J. Single port laparoscopic staging for peritoneal malignancy - a video vignette. Colorectal Dis 2016; 18:1017. [PMID: 27474879 DOI: 10.1111/codi.13475] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2016] [Accepted: 06/16/2016] [Indexed: 02/08/2023]
Affiliation(s)
- M Kazanowski
- National Centre for Peritoneal Malignancy, Mater Misericordiae University Hospital, Dublin, Ireland
| | - H Al Furaji
- National Centre for Peritoneal Malignancy, Mater Misericordiae University Hospital, Dublin, Ireland
| | - R A Cahill
- National Centre for Peritoneal Malignancy, Mater Misericordiae University Hospital, Dublin, Ireland
| | - C Shields
- National Centre for Peritoneal Malignancy, Mater Misericordiae University Hospital, Dublin, Ireland
| | - J Mulsow
- National Centre for Peritoneal Malignancy, Mater Misericordiae University Hospital, Dublin, Ireland.
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Hennessey DB, Burke JP, Ni-Dhonochu T, Shields C, Winter DC, Mealy K. Risk factors for surgical site infection following colorectal resection: a multi-institutional study. Int J Colorectal Dis 2016; 31:267-71. [PMID: 26507963 DOI: 10.1007/s00384-015-2413-5] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/14/2015] [Indexed: 02/04/2023]
Abstract
INTRODUCTION Surgical site infection (SSI) is an infection occurring in an incisional wound within 30 days of surgery and significantly affects patients undergoing colorectal surgery. This study examined a multi-institutional dataset to determine risk factors for SSI following colorectal resection. METHODS Data on 386 patients who underwent colorectal resection in three institutions were accrued. Patients were identified using a prospective SSI database and hospital records. Data are presented as median (interquartile range), and logistic regression analysis was used to identify risk factors. RESULTS Patients (21.5%) developed a postoperative SSI. The median time to the development of SSI was 7 days (5-10). Of all infections, 67.5% were superficial, 22.9% were deep and 9.6% were organ space. In univariate analysis, an ASA grade of II (RR 0.6, CI 0.3-0.9, P = 0.019), having an elective procedure (RR 0.4, CI 0.2-0.6, P < 0.001), using a laparoscopic approach (RR 0.5, CI 0.3-0.9, P = 0.019), having a daytime procedure (RR 0.3, CI 0.1-0.7, P = 0.006) and having a clean/contaminated wound (RR 0.4, CI 0.2-0.7, P = 0.001) were associated with reduced risk of SSI. In multivariate analysis, an ASA grade of IV (RR 3.9, CI 1.1-13.7, P = 0.034), a procedure duration over 3 h (RR 4.3, CI 2.3-8.2, P < 0.001) and undergoing a panproctocolectomy (RR 6.5, CI 1.0-40.9, P = 0.044) were independent risk factors for SSI. Those who developed an SSI had a longer duration of inpatient stay (22 days [16-31] vs 15 days [10-26], P < 0.001). CONCLUSIONS Patients who develop an SSI have a longer duration of inpatient stay. Independent risk factors for SSI following colorectal resection include being ASA grade IV, having a procedure duration over 3 h, and undergoing a panproctocolectomy.
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Affiliation(s)
- Derek B Hennessey
- Department of Surgery, Wexford General Hospital, Wexford, Ireland. .,St Vincent's University Hospital, Elm Park, Dublin 4, Ireland.
| | - John P Burke
- St Vincent's University Hospital, Elm Park, Dublin 4, Ireland
| | - Tara Ni-Dhonochu
- Mater Misericordiae University Hospital, Eccles St, Dublin 7, Ireland
| | - Conor Shields
- Mater Misericordiae University Hospital, Eccles St, Dublin 7, Ireland
| | | | - Kenneth Mealy
- Department of Surgery, Wexford General Hospital, Wexford, Ireland
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Parc Y, Reboul-Marty J, Lefevre JH, Shields C, Chafai N, Tiret E. Factors influencing mortality and morbidity following colorectal resection in France. Analysis of a national database (2009-2011). Colorectal Dis 2016; 18:205-13. [PMID: 26299627 DOI: 10.1111/codi.13099] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2015] [Accepted: 06/02/2015] [Indexed: 02/08/2023]
Abstract
AIM Correlation between outcome and hospital volume regarding colorectal resection (CRR) has been described, but it suggests that provider variability may have an impact. Our aim was to analyse the influence of institutional characteristics and the impact of volume [high volume (HV) or low volume (LV)] on mortality and morbidity after CRR at a national level. METHOD Data from 2009-2012, including patient demographics, diagnosis, procedure, mode of admission and discharge and hospital type, were obtained. Each hospital admission was classified as one of four levels of severity. RESULTS Of 176,444 patients included, 5408 (3.06%) died and 41,240 (23.37%) had a complication. Multivariate analysis showed that factors influencing morbidity were age over 80 years, severity level, pathology other than diverticular disease, male gender, demanding surgery, open surgery and surgery in an HV institution. Factors influencing mortality were the same except for the impact of volume. In HV centres, surgery was significantly more demanding (54.66% vs 47.17%, P < 0.0001), morbidity more frequent (26.59% vs 22.07%, P < 0.0001), but mortality was lower (2.17% vs 3.43%, P < 0.0001). In total, 6038 (3.4%) patients were transferred after surgery. Transfer rate and mortality after transfer were significantly higher in LV institutions (respectively: 4.3% vs 2.5%, P < 0.0001; and 12% vs 10.3%, P < 0.0001). CONCLUSION High volume centres have higher morbidity, but lower mortality. Six per cent of patients in LV centres required transfer. A national mortality rate after CRR of 3.5% can be expected. Transfer rate and mortality after transfer should be included in the evaluation of institutional mortality. Volume of institution, regardless of type, influences mortality after CRR.
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Affiliation(s)
- Y Parc
- Department of Digestive Surgery, Hôpital Saint-Antoine, Université Pierre & Marie Curie, Paris, France
| | - J Reboul-Marty
- Department of Medical Information, Hôpital Saint-Antoine, Université Pierre & Marie Curie, Paris, France
| | - J H Lefevre
- Department of Digestive Surgery, Hôpital Saint-Antoine, Université Pierre & Marie Curie, Paris, France
| | - C Shields
- Department of Surgery, Mater Misericordiae University Hospital, Dublin, Ireland
| | - N Chafai
- Department of Digestive Surgery, Hôpital Saint-Antoine, Université Pierre & Marie Curie, Paris, France
| | - E Tiret
- Department of Digestive Surgery, Hôpital Saint-Antoine, Université Pierre & Marie Curie, Paris, France
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Desurmont T, Lefèvre JH, Shields C, Colas C, Tiret E, Parc Y. Desmoid tumour in familial adenomatous polyposis patients: responses to treatments. Fam Cancer 2015; 14:31-9. [PMID: 25315103 DOI: 10.1007/s10689-014-9760-1] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
No guidelines for desmoid tumors (DT) management are available and DT have now become the first cause of death in FAP patients who had restorative proctocolectomy. We aimed to assess the results of the different treatments used for DT in Familial Adenomatous Polyposis (FAP) patients. All patients followed for FAP who developed a DT between 1970 and 2010 were collated. We analysed separately the history of DT according to location: mesenteric, parietal or mixed. 79 FAP patients [45 females (56 %); mean age 33.3 ± 12.5] presented 149 DT and were included; 16(20 %) had a DT diagnosed during or before first abdominal surgery and 47 (59 %) had isolated mesenteric DT. 11 patients had only surgical treatment, 17 only medical treatments, 31 had combined treatment and 20 had no treatment with spontaneous DT regression or stabilization. Overall, 80 treatment lines were administered to patients with a progression free or regression rate of 43 % (34/80). Response rates were: chemotherapy 77 % (10/13); Sulindac + tamoxifen 50 % (6/12); Tamoxifen 40 % (6/15); Imatinib 36 % (4/11); Sulindac 28 % (8/29). Among the 42 surgical procedures, an R0 resection was performed in 26 (62 %) allowing the absence of recurrence for 54 %. After a median follow-up of 81 months, 8 patients died of their DT and 6 died of other cause. Overall and DT-specific survival at 20 years were 52 and 79 %, respectively. Chemotherapy was the most efficient treatment. For intra-abdominal DT, we consider it as a first choice treatment and reserve surgery when it is impossible or when DT are life threatening.
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Affiliation(s)
- Thibault Desurmont
- Department of Digestive Surgery, Hôpital Saint-Antoine, Assistance Publique Hôpitaux de Paris, Université Pierre et Marie Curie, Paris VI, 184 rue du Faubourg Saint-Antoine, 75012, Paris, France
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Heaney RM, Shields C, Mulsow J. Outcome following incomplete surgical cytoreduction combined with intraperitoneal chemotherapy for colorectal peritoneal metastases. World J Gastrointest Oncol 2015; 7:445-454. [PMID: 26688707 PMCID: PMC4678391 DOI: 10.4251/wjgo.v7.i12.445] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2015] [Revised: 06/20/2015] [Accepted: 10/09/2015] [Indexed: 02/05/2023] Open
Abstract
Cytoreductive surgery combined with intraperitoneal chemotherapy can improve survival in appropriately selected patients with colorectal peritoneal metastases. Outcomes are best in those patients in whom a complete cytoreduction can be achieved. Unresectable disease is however encountered in approximately one-quarter of patients at laparotomy. The merits, or otherwise, of proceeding with an incomplete cytoreduction in this setting are unclear. We performed a review of published outcomes following incomplete cytoreduction for colorectal peritoneal metastases. Using the electronic databases, PubMed and MEDLINE, a systematic search of available literature published during the period January 1997 to September 2014 was conducted. Following application of exclusion criteria, 19 papers were identified and included in this review. These comprised fifteen case series, 3 case control studies and one randomised control trial. In the nineteen studies included in this review, 2790 patients underwent cytoreductive surgery with or without intraperitoneal chemotherapy for peritoneal metastases of colorectal origin. Of these, 1732 (62%) underwent a complete cytoreduction while 986 (35%) patients underwent an incomplete cytoreduction. Median survival in the complete cytoreduction group ranged from 11 to 62 mo while survival in the latter group ranged from 2.4 to 32 mo. Of the 986 patients with an incomplete cytoreduction, 331 patients received intraperitoneal chemotherapy and survival in this cohort ranged from 4.5 to 32 mo. An incomplete cytoreduction, with or without intraperitoneal chemotherapy, does not appear to confer a survival benefit. The limited available data points to a palliative benefit in a subset of patients. In the absence of high quality data, the decision as to whether or not to proceed with surgery should be made on an individual patient basis.
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Castellsagué X, Giuliano A, Goldstone S, Guevara A, Mogensen O, Palefsky J, Group T, Shields C, Liu K, Maansson R, Luxembourg A, Kaplan S. Immunogenicity and safety of the 9-valent HPV vaccine in men. Vaccine 2015; 33:6892-901. [DOI: 10.1016/j.vaccine.2015.06.088] [Citation(s) in RCA: 65] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2015] [Revised: 06/22/2015] [Accepted: 06/23/2015] [Indexed: 10/23/2022]
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O'Kane G, McVeigh TP, Keegan D, Flannery D, O'Connor K, Farrell MP, Shields C, Meighan B, McCormick P, Winter DC, Mulligan N, Muldoon C, Geraghty R, Green AJ, Kennedy MJ, Sheahan K, Gallagher DJ. Immunohistochemistry to initiate a complex screening cascade in the detection of Lynch syndrome. J Clin Oncol 2015. [DOI: 10.1200/jco.2015.33.15_suppl.3571] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
| | | | | | | | | | - Michael P. Farrell
- Mater Private Hospital and Mater Misericordiae University Hospital, Dublin, Ireland
| | - Conor Shields
- Mater Misericordiae University Hospital, Dublin, Ireland
| | | | | | - Des C Winter
- Centre for Colorectal Disease, St. Vincent's University Hospital, Dublin, Ireland
| | - Niall Mulligan
- Mater Misericordiae University Hospital, Dublin, Ireland
| | - C. Muldoon
- Dept Histopathology, St. James's Hospital, Dublin, Ireland
| | | | - Andrew J. Green
- School of Medicine and Medical Science, University College Dublin, Dublin, Ireland
| | | | - Kieran Sheahan
- Centre for Colorectal Disease, St Vincent;s University Hospital, Elm Park, Dublin 4, Dublin, Ireland
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Shields C, Thorp H, Hendry G, Jayakaran P. Health-related quality of life in persons with dysvascular and traumatic lower limb amputation—a systematic review. Physiotherapy 2015. [DOI: 10.1016/j.physio.2015.03.3514] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Shields C, Baxter D, Mani R. Personal and behavioural correlates of physical activity in individuals with high risk of developing diabetes mellitus. Physiotherapy 2015. [DOI: 10.1016/j.physio.2015.03.1797] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Mulsow J, Shields C. Improving timely detection and recording of colorectal peritoneal metastases. Colorectal Dis 2014; 16:1019-20. [PMID: 25283313 DOI: 10.1111/codi.12794] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2014] [Accepted: 08/18/2014] [Indexed: 02/08/2023]
Affiliation(s)
- J Mulsow
- Peritoneal Malignancy Institute, Mater Misericordiae University Hospital, Dublin 7, Ireland.
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Fearon N, Pierce C, Mohan H, Rogers A, Shields C, Winter D. Take it or leave it: A multi-institutional study of Meckel’s diverticulum. Int J Surg 2014. [DOI: 10.1016/j.ijsu.2014.07.137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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McQueen HA, Shields C, Finnegan DJ, Higham J, Simmen MW. PeerWise provides significant academic benefits to biological science students across diverse learning tasks, but with minimal instructor intervention. Biochem Mol Biol Educ 2014; 42:371-81. [PMID: 24974789 DOI: 10.1002/bmb.20806] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/30/2014] [Revised: 04/08/2014] [Accepted: 05/20/2014] [Indexed: 05/25/2023]
Abstract
We demonstrate that student engagement with PeerWise, an online tool that allows students to author and answer multiple-choice questions (MCQs), is associated with enhanced academic performance across diverse assessment types on a second year Genetics course. Benefits were consistent over three course deliveries, with differential benefits bestowed on groups of different prior ability. A rating scheme, to assess the educational quality of students' questions, is presented and demonstrates that our students are able intuitively to make such quality assessments, and that the process of authoring high quality questions alone does not explain the academic benefits. We further test the benefits of providing additional PeerWise support and conclude that PeerWise works efficiently with minimal intervention, and can be reliably assessed using automatically generated PeerWise scores.
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Affiliation(s)
- H A McQueen
- Institute of cell Biology, School of Biological Sciences, University of Edinburgh, King's Buildings, Mayfield Road, Edinburgh, EH9 3JR, United Kingdom
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Duclos J, Lefevre JH, Lefrançois M, Lupinacci R, Shields C, Chafai N, Tiret E, Parc Y. Immediate outcome, long-term function and quality of life after extended colectomy with ileorectal or ileosigmoid anastomosis. Colorectal Dis 2014; 16:O288-96. [PMID: 24428330 DOI: 10.1111/codi.12558] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2013] [Accepted: 11/29/2013] [Indexed: 02/08/2023]
Abstract
AIM Total/subtotal colectomy with ileorectal (IRA) or ileosigmoid (ISA) anastomosis is associated with various reported rates of morbidity, function and quality of life. Our object was to determine these end-points in a series of patients undergoing these operations in our institution. METHOD All patients who underwent IRA or ISA between 1994 and 2009 were retrospectively reviewed. RESULTS A total of 320 patients (female 49%) with a median age of 54.2 (16.8-90.6) years underwent 338 IRA or ISA (in 18 patients the anastomosis was done twice) for inflammatory bowel disease (n = 96), polyposis (n = 95) and colorectal cancer (n = 97). Mortality and morbidity rates were 1.2% (n = 4) and 19.5% (n = 66) and 47 surgical complications (13.9%) occurred, including 26 (7.7%) cases of anastomotic leakage, leading to 23 re-operations. After a median follow-up of 49 (0-196) months, 262 patients still had a functioning anastomosis; 45 patients had died and 13 had a proctectomy. Information on function was obtained in 51.4% (133/259) of the cohort after a median follow-up of 77 (10-196) months. The mean (± standard deviation) rates of 24 h and nocturnal defaecation were 3.6 ± 2.4 and 0.5 ± 0.9. A disturbance of faecal or flatus continence occurred in 20% and 21% of patients. There was no case of faecal incontinence to solid stool. The mean SF-36 Physical and Mental Health Summary Scales were 46.3 ± 9.3 and 51.9 ± 9.3. Multivariate analysis showed that IRA and inflammatory bowel disease were both independently associated with poorer long-term function. CONCLUSION Colectomy with IRA or ISA is safe with low postoperative morbidity and mortality. The employment of IRA and inflammatory bowel disease appear to be independent negative factors on function in multivariate analysis.
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Affiliation(s)
- J Duclos
- Department of Digestive Surgery, Saint-Antoine Hospital, University Pierre and Marie Curie, Paris VI, Paris, France
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O'Reilly MK, Nason GJ, Liddy S, Fitzgerald CW, Kelly ME, Shields C. DOCSS: doctors on-call smartphone study. Ir J Med Sci 2013; 183:573-7. [PMID: 24338079 DOI: 10.1007/s11845-013-1053-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2013] [Accepted: 12/03/2013] [Indexed: 10/25/2022]
Abstract
INTRODUCTION Smartphones have revolutionised our demands for constant access to information. The usage of smartphones in the clinical setting is becoming widespread. The aim of our study was to assess smartphone ownership and usage across a cohort of interns. METHODS A voluntary novel questionnaire was distributed to interns in two university hospitals. Details regarding smartphone ownership and usage were assessed. Likert scales were utilised for analysis. RESULTS Sixty-one (74.4 %) interns responded to the survey. Sixty (98.4 %) owned a smartphone with iPhone(®) being the most popular (76.7 %). Fifty-five (91.6 %) interns have downloaded medical applications ('apps'), while 29 (52.3 %) reported paying for them. Regarding smartphone use on-call, 30 (50 %) interns agreed it aids diagnoses, 26 (43 %) agree it helped in interpreting laboratory values, 31 (51.7 %) agreed it helped in dosing of medication and 33 (55 %) agreed it was of assistance in medical emergency protocols. Forty-two (70 %), 42 (70 %) and 46 (76.7 %) interns agreed or strongly agreed smartphones have a positive influence on them in terms of levels of stress, confidence and level of knowledge, respectively. CONCLUSION Smartphone usage is widespread among our intern cohort. The introduction of hospital applications with local guidelines would be welcomed; however, this may require informed patient consent regarding their use.
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Affiliation(s)
- M K O'Reilly
- Department of Surgery, Mater Misericordiae University Hospital, Dublin, Ireland
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Lunt DJ, Elderfield H, Pancost R, Ridgwell A, Foster GL, Haywood A, Kiehl J, Sagoo N, Shields C, Stone EJ, Valdes P. Warm climates of the past--a lesson for the future? Philos Trans A Math Phys Eng Sci 2013; 371:20130146. [PMID: 24043873 PMCID: PMC3785815 DOI: 10.1098/rsta.2013.0146] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
This Discussion Meeting Issue of the Philosophical Transactions A had its genesis in a Discussion Meeting of the Royal Society which took place on 10-11 October 2011. The Discussion Meeting, entitled 'Warm climates of the past: a lesson for the future?', brought together 16 eminent international speakers from the field of palaeoclimate, and was attended by over 280 scientists and members of the public. Many of the speakers have contributed to the papers compiled in this Discussion Meeting Issue. The papers summarize the talks at the meeting, and present further or related work. This Discussion Meeting Issue asks to what extent information gleaned from the study of past climates can aid our understanding of future climate change. Climate change is currently an issue at the forefront of environmental science, and also has important sociological and political implications. Most future predictions are carried out by complex numerical models; however, these models cannot be rigorously tested for scenarios outside of the modern, without making use of past climate data. Furthermore, past climate data can inform our understanding of how the Earth system operates, and can provide important contextual information related to environmental change. All past time periods can be useful in this context; here, we focus on past climates that were warmer than the modern climate, as these are likely to be the most similar to the future. This introductory paper is not meant as a comprehensive overview of all work in this field. Instead, it gives an introduction to the important issues therein, using the papers in this Discussion Meeting Issue, and other works from all the Discussion Meeting speakers, as exemplars of the various ways in which past climates can inform projections of future climate. Furthermore, we present new work that uses a palaeo constraint to quantitatively inform projections of future equilibrium ice sheet change.
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Affiliation(s)
- D. J. Lunt
- Cabot Institute, and School of Geographical Sciences, University of Bristol, University Road, Bristol BS8 1SS, UK
| | - H. Elderfield
- Department of Earth Sciences, University of Cambridge, Downing Street, Cambridge CB2 3EQ, UK
| | - R. Pancost
- Cabot Institute, and School of Chemistry, University of Bristol, Cantock's Close, Bristol BS8 1TS, UK
| | - A. Ridgwell
- Cabot Institute, and School of Geographical Sciences, University of Bristol, University Road, Bristol BS8 1SS, UK
| | - G. L. Foster
- Ocean and Earth Science, University of Southampton, European Way, Southampton SO14 3ZH, UK
| | - A. Haywood
- School of Earth and Environment, University of Leeds, Woodhouse Lane, Leeds LS2 9JT, UK
| | - J. Kiehl
- Climate and Global Dynamics, National Center for Atmospheric Research, 1850 Table Mesa Drive, Boulder, CO 80305, USA
| | - N. Sagoo
- Cabot Institute, and School of Geographical Sciences, University of Bristol, University Road, Bristol BS8 1SS, UK
| | - C. Shields
- Climate and Global Dynamics, National Center for Atmospheric Research, 1850 Table Mesa Drive, Boulder, CO 80305, USA
| | - E. J. Stone
- Cabot Institute, and School of Geographical Sciences, University of Bristol, University Road, Bristol BS8 1SS, UK
| | - P. Valdes
- Cabot Institute, and School of Geographical Sciences, University of Bristol, University Road, Bristol BS8 1SS, UK
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Chéreau N, Lefevre JH, Meurette G, Mourra N, Shields C, Parc Y, Tiret E. Surgical resection of retrorectal tumours in adults: long-term results in 47 patients. Colorectal Dis 2013; 15:e476-82. [PMID: 23601092 DOI: 10.1111/codi.12255] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2012] [Accepted: 02/03/2013] [Indexed: 12/11/2022]
Abstract
AIM Retrorectal tumours (RT) are uncommon, and diagnosis and management remain difficult. The aim of this study was to evaluate the results of the surgical management of RT in our institution. METHOD Medical notes of all patients operated on for RT were reviewed. Clinical, radiological, surgical, histological data as well as morbidity and long-term results were noted. RESULTS Forty-seven patients [34 women (72%), mean age 45.8 (range 17-85) years] underwent surgery for RT between 1997 and 2011. The commonest symptoms were pain (n = 31) and suppuration (n = 10). Thirty-nine (83%) patients underwent preoperative magnetic resonance imaging (MRI). Malignant lesions exhibited typical characteristics on MRI including heterogeneity (n = 5, 83%), solid appearance (n = 4, 67%), a low-T1 signal and high-T2 intensity (n = 5, 83%), enhancement after gadolinium injection (n = 5, 83%), irregular margin (n = 4, 67%) and extension above S3 (i = 5, 83%). A Kraske approach was used in 42 (89%) patients with resection of the coccyx in 25 (60%) and an abdominal or combined approach for the remaining five. Four patients developed complications (two haematoma, two abscess), but only one (haematoma) required reoperation. Histological examination showed 38 (80.9%) benign lesions. After a median follow-up of 71 (2-168) months, 5-year disease-free survival was 75% for malignant lesions and 93.1% for benign lesions (P = 0.023). Four (4/42; 9.5%) patients had moderate perineal pain after a Kraske approach, while no anal dysfunction was seen. CONCLUSION Magnetic resonance imaging was the most helpful investigation for retrorectal tumours. The posterior trans-sacrococcygeal approach is the procedure of choice for complete resection for most, especially for benign and cystic lesions without extension above S2.
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Affiliation(s)
- N Chéreau
- Department of Digestive Surgery, Hôpital Saint-Antoine, Paris, France
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Lefèvre JH, Corte H, Tiret E, Boccara D, Chaouat M, Touboul E, Svrcek M, Lefrancois M, Shields C, Parc Y. Abdominoperineal resection for squamous cell anal carcinoma: survival and risk factors for recurrence. Ann Surg Oncol 2012; 19:4186-92. [PMID: 22825769 DOI: 10.1245/s10434-012-2485-1] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2011] [Indexed: 12/15/2022]
Abstract
BACKGROUND Despite the results of combined chemoradiation therapy for anal canal squamous cell carcinoma (SCC), up to 30 % of patients will undergo abdominoperineal resection (APR). The aim of this study was to evaluate oncologic outcomes, survival, and recurrence, following APR for anal canal SCC performed in a single center over a 13-year period. METHODS All patients who underwent APR for anal canal SCC between 1996 and 2009 were retrospectively included. Demographic data, details on treatments, pathological report, and follow-up were noted. Survival curves were plotted using the Kaplan-Meier method and potential prognostic factors were evaluated using Cox proportional hazards models. RESULTS A total of 105 patients (77 women) were included. Indications for APR included tumor persistence (n = 42; 40 %), recurrence (n = 55; 52.4 %), or a contraindication to radiotherapy (n = 8; 7.6 %). Median follow-up was 33.3 months (range, 1.5-174.3 months). Overall survival and disease-free survival were, respectively, 61 and 48 % at 5 years. In multivariate analysis, tumor stage (T3 or T4), positive margin on pathologic examination and existence of distant metastases at the time of the surgery were associated with a poor prognosis. The indication for APR (persistent vs recurrent disease), gender, concurrent HIV infection, or performance of a VRAM flap did not influence OS or DFS. Overall recurrence rate was 42.6 % (n = 43 of 101). The type of recurrence did not exert a significant effect on survival (p = .4571). CONCLUSION This study describes the largest single series of APR for anal carcinoma. Major prognostic factors for survival and recurrence were T status and involved margin. The 5-year overall survival was 60 %.
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Affiliation(s)
- Jérémie H Lefèvre
- Department of Digestive Surgery, Hôpital Saint-Antoine, AP-HP, Université Pierre et Marie Curie, Paris, France.
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Hor T, Zalinski S, Lefevre JH, Shields C, Attal E, Tiret E, Parc Y. Feasibility of laparoscopic restorative proctocolectomy without diverting stoma. Dig Liver Dis 2012; 44:118-22. [PMID: 22014919 DOI: 10.1016/j.dld.2011.09.007] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2011] [Revised: 09/09/2011] [Accepted: 09/15/2011] [Indexed: 12/11/2022]
Abstract
AIM Restorative proctocolectomy performed before the advent of laparoscopy had evolved to frequently omit a diverting stoma. Our aim was to assess the impact of a diverting stoma on postoperative outcomes following laparoscopic restorative proctocolectomy. METHOD Data on all patients undergoing a laparoscopic restorative proctocolectomy at our institution were prospectively collated in a database. RESULTS Between November 2004 and February 2010, 71 patients (38 females) underwent laparoscopic restorative proctocolectomy. Indications included familial adenomatous polyposis (n=34), ulcerative colitis (n=35), indeterminate colitis (n=1) and Lynch syndrome (n=1). Laparoscopic restorative proctocolectomy was performed as a one-stage procedure in 49 patients, and after a sub-total colectomy in 22. Seven patients in each group underwent the formation of a diverting stoma. Nine patients required conversion to open surgery. Sixteen patients experienced at least one postoperative complication. The postoperative morbidity was 29% (n=4/14) and 21% (n=12/21) in patients with and without a stoma (p=0.8), and the rate of fistula was 21% and 5%, respectively (p=0.08). Seven percent of patients with a stoma and 16% without stoma had an intra-abdominal collection (p=0.7). Nine patients required reoperation. The reoperation rate was not influenced by the presence or absence of a diverting stoma. CONCLUSION Laparoscopic restorative proctocolectomy can be performed safely without a diverting stoma in selected patients.
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Affiliation(s)
- Thévy Hor
- Department of Digestive Surgery, Hôpital Saint-Antoine, Assistance Publique-Hôpitaux de Paris, Université Pierre et Marie Curie, Paris VI, Paris, France
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Munnur K, Roberts L, Shields C, Jangwel H, Tong D, Kerr G, Pandelli V, Cooke J, Cheong Y, Chou B, Hamer A, Goods C, Gordon G, Low R, Proimos G, Rowe M, Stevenson I, New G. Is Remote Telemetry Monitoring of Non-Cardiology Patients Worthwhile? Heart Lung Circ 2012. [DOI: 10.1016/j.hlc.2012.05.624] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Shields C, Roberts L, Munnar K, Jangwal H, Tong D, Beale J, Phan M, Burton A, Collins B, Scully C, Rowe M, Cheong Y, Proimos G, Fernando D, Goods C, New G. A Decade of PCI Experience with Off-site Surgical Back-up at Box Hill Hospital: What Have We Learnt? Heart Lung Circ 2012. [DOI: 10.1016/j.hlc.2012.05.363] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Shields C, Andrianopoulos N, Roberts L, Sidharta S, Duffy S, Ajani A, Sebastian M, Clark D, Brennan A, Loane P, Munnar K, Black A, New G. Does Thrombus Aspiration Improve Clinical Outcomes post Primary PCI? Insights from the Melbourne Interventional Group (MIG) Registry. Heart Lung Circ 2012. [DOI: 10.1016/j.hlc.2012.05.382] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Abstract
Introduction. The aim of this study was to develop a new teaching strategy for medical students while creating a national online repository system (Surgent University). Then, the potential of this e-learning modality to facilitate learning of clinical surgery was evaluated. Methods. An online repository and Internet-based interface was designed and hosted on the medical education Web site, www.surgent.ie . Participation was by medical students across 3 Irish universities. Student use of the repository was quantitatively assessed over an 8-week period. They were then invited to complete an anonymous survey assessing the effectiveness of the online repository. Statistical analysis was performed using SPSS version 15, with P < .05 considered significant. Results. Over the study period, the online repository received 6105 uploaded facts by 182 final-year medical students from 3 different universities. The repository Web pages were accessed 54 061 times with 4609 individual searches of the repository. Of the 60 participating students invited to provide survey-based feedback, there were 40 respondents, giving a 66.7% response rate. Of those surveyed, 70% (n = 28) rated the online repository as highly beneficial and 75% (n = 30) as highly relevant. Overall, 87.5% (n = 35) felt that it should be continued, and 70% (n = 28) felt that it should be expanded beyond surgery to include other hospital specialties. Those finding the program interface user-friendly were more likely to find it beneficial ( P = .031) and relevant to their ongoing education ( P = .002). Conclusions. A user-friendly interface allows for high levels of usage, whereas a “student-centered” structure ensures that the facts uploaded are beneficial and relevant to medical students’ education.
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Affiliation(s)
- Mark Corrigan
- Beaumont Hospital, Dublin, Ireland
- Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Seamus McHugh
- Beaumont Hospital, Dublin, Ireland
- Royal College of Surgeons in Ireland, Dublin, Ireland
| | | | | | - Conor Shields
- Mater Misericordiae University Hospital, Dublin, Ireland
| | | | | | - Arnold Hill
- Beaumont Hospital, Dublin, Ireland
- Royal College of Surgeons in Ireland, Dublin, Ireland
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Corrigan M, Shields C, O'Leary D, Fraher J, Winter D, Wang J, Redmond P. Hypertonic Saline Attenuates the Pro-metastatic Effects of LPS by Reducing Tumor Cell Migration, Proliferation and MMP-9 Expression. World J Oncol 2011; 2:289-297. [PMID: 29147264 PMCID: PMC5649713 DOI: 10.4021/wjon420w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/18/2011] [Indexed: 11/17/2022] Open
Abstract
Background Lipopolysaccharide (LPS) promotes tumor metastases. The aim of this study was to determine the ability of a hypertonic environment to attenuate the pro metastatic properties of LPS both in vitro, and in vivo. Methods LPS stimulated, and unstimulated, 4T1 tumor cells were cultured in either an isotonic or hypertonic environment. The effect on invasion, migration, pro-matellomatrixproteinase 9 (proMMP-9) expression, proliferation, and microscopic cell structure was assessed. Lung metastases were induced in C57 mice with systemic hypertonicity in unstimulated and stimulated mice. The metastatic burden was assessed by estimation of lung/body weight ratio, pleural nodules and clonogenic assay. Results In vitro, a hypertonic environment reduced proMMP-9 expression (0.012 versus 1.16, P < 0.001) invasion (0.06 versus 0.119, P = 0.005), tumor cell proliferation (0.035 versus 0.041, P = 0.001), while inducing structural changes to tumor cells reducing overall cell volume. In vivo, the induction of transient systemic hypertonicity reduced metastatic burden as demonstrated by reduced lung nodules (4 versus 8, P = 0.004) and colonies on clonogenic assay (12 versus 43, P = 0.04). Conclusion The in vitro exposure of tumor cells to a hypertonic environment reduces tumor cell migration and proliferation. Transient systemic hypertonicity can reduce the metastatic burden following intra-operative exposure to LPS in vivo.
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Affiliation(s)
- Mark Corrigan
- Departments of Surgery and Anatomy, University College Cork, Ireland
| | - Conor Shields
- Departments of Surgery and Anatomy, University College Cork, Ireland
| | - Donald O'Leary
- Departments of Surgery and Anatomy, University College Cork, Ireland
| | - John Fraher
- Departments of Surgery and Anatomy, University College Cork, Ireland
| | - Desmond Winter
- Department of Surgery, St. Vincent's University Hospital, Dublin, Ireland
| | - Jianghuai Wang
- Departments of Surgery and Anatomy, University College Cork, Ireland
| | - Paul Redmond
- Departments of Surgery and Anatomy, University College Cork, Ireland
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Leyden JE, Doherty GA, Hanley A, McNamara DA, Shields C, Leader M, Murray FE, Patchett SE, Harewood GC. Quality of colonoscopy performance among gastroenterology and surgical trainees: a need for common training standards for all trainees? Endoscopy 2011; 43:935-40. [PMID: 21997723 DOI: 10.1055/s-0030-1256633] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND AND STUDY AIM Cecal intubation and polyp detection rates are objective measures of colonoscopy performance. Minimum cecal intubation rates greater than 90% have been endorsed by the American Society for Gastrointestinal Endoscopy (ASGE) and the Joint Advisory Group (JAG) UK. Performance data for medical and surgical trainee endoscopists are limited, and we used endoscopy quality parameters to compare these two groups. METHODS Retrospective review of all single-endoscopist colonoscopies done by gastroenterology and surgical trainees ("registrars," equivalent to fellows, postgraduate year 5) with more than two years' endoscopy experience, in 2006 and 2007 at a single academic medical center. Completion rates and polyp detection rates for endoscopists performing more than 50 colonoscopies during the study period were audited. Colonoscopy withdrawal time was prospectively observed in a representative subset of 140 patients. RESULTS Among 3079 audited single-endoscopist colonoscopies, seven gastroenterology trainees performed 1998 procedures and six surgery trainees performed 1081. The crude completion rate was 82%, 84% for gastroenterology trainees and 78% for surgery trainees (P < 0.0001). Adjusted for poor bowel preparation quality and obstructing lesions, the completion rate was 89%; 93% for gastroenterology trainees, and 84% for surgical trainees (P < 0.0001). The polyp detection rate was 19% overall, with 21% and 14% for gastroenterology and surgical trainees, respectively (P < 0.0001). The adenoma detection rate in patients over 50 was 12%; gastroenterology trainees 14% and surgical trainees 9% (P = 0.0065). In the prospectively audited procedures, median withdrawal time was greater in the gastroenterology trainee group and polyp detection rates correlated closely with withdrawal time (r = 0.99). CONCLUSION The observed disparity in endoscopic performance between surgical and gastroenterology trainees suggests the need for a combined or unitary approach to endoscopy training for specialist medical and surgical trainees.
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Affiliation(s)
- J E Leyden
- GI Unit, Mater Misericordiae University Hospital, Dublin, Ireland.
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Parc Y, Klouche M, Bennis M, Lefèvre JH, Shields C, Tiret E. The continent ileostomy: an alternative to end ileostomy? Short and long-term results of a single institution series. Dig Liver Dis 2011; 43:779-83. [PMID: 21719365 DOI: 10.1016/j.dld.2011.05.017] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2010] [Revised: 05/17/2011] [Accepted: 05/24/2011] [Indexed: 12/11/2022]
Abstract
INTRODUCTION Total proctocolectomy, ensuring eradication of all diseased colorectal mucosa is the treatment of choice for ulcerative colitis, familial adenomatous polyposis. Before the era of ileal pouch anal anastomosis, definitive ileostomy was required. The aim of this study is to define both early and late morbidity and the functional result of continent ileostomy. METHODS All patients' chart who had a continent ileostomy in our department were reviewed. The functional result was evaluated in 43 patients. RESULTS Forty-nine patients (34 women) with a mean age of 42 years (range: 17-69) underwent a continent ileostomy, 32 following a restorative proctocolectomy. The mean follow-up was 20.5 (range: 3-34) years. Seventeen patients (35%) experienced an early postoperative complication requiring reintervention in two patients. There was no mortality, and conversion to an end ileostomy was not required. Twenty-two patients developed late complications requiring 50 reoperations. The mean number of catheterisations per 24h was 4.4. The SF36 questionnaire showed values close to those of the general population. CONCLUSION Continent ileostomy carries a significant risk of non-severe complications. In selected patients, it represents a valuable alternative to an end ileostomy, in particular when restorative proctocolectomy has failed.
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Affiliation(s)
- Yann Parc
- Department of Digestive Surgery, Hôpital Saint-Antoine, Assistance Publique Hôpitaux de Paris, Université Pierre et Marie Curie, Paris, France.
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