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Walters H, Lee-Warder L, Mentias Y, Arullendran P. Cartilage grafts mimicking cholesteatoma recurrence on diffusion-weighted magnetic resonance imaging: a case series. J Laryngol Otol 2023; 137:938-941. [PMID: 36750228 DOI: 10.1017/s0022215123000117] [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] [Indexed: 02/09/2023]
Abstract
BACKGROUND Cholesteatomas present a high risk for residual and recurrent disease, and the surveillance of post-operative patients can be challenging. Diffusion-weighted magnetic resonance imaging is becoming the preferred method for investigating recidivism; however, false positive imaging findings increase the risk of patients undergoing unnecessary second look surgery. CASE REPORTS This study reports two patients with false positive diffusion restriction associated with cartilage grafts that mimicked cholesteatoma and resulted in second look surgery with no disease found at operation. This study also discusses the related medical literature, including potential causes of abnormal diffusion restriction and methods to negate this. CONCLUSION Caution should be exercised when considering second look surgery in the presence of a cartilage graft and a high confidence of disease clearance. A multi-disciplinary approach is recommended for the operating surgeon to review the images with a radiologist.
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Affiliation(s)
- H Walters
- ENT Department, Sunderland Royal Hospital, Sunderland, UK
| | - L Lee-Warder
- ENT Department, Sunderland Royal Hospital, Sunderland, UK
| | - Y Mentias
- ENT Department, Sunderland Royal Hospital, Sunderland, UK
| | - P Arullendran
- ENT Department, Sunderland Royal Hospital, Sunderland, UK
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Smitherman EA, Chahine RA, Beukelman T, Lewandowski LB, Rahman AKMF, Wenderfer SE, Curtis JR, Hersh AO, Abulaban K, Adams A, Adams M, Agbayani R, Aiello J, Akoghlanian S, Alejandro C, Allenspach E, Alperin R, Alpizar M, Amarilyo G, Ambler W, Anderson E, Ardoin S, Armendariz S, Baker E, Balboni I, Balevic S, Ballenger L, Ballinger S, Balmuri N, Barbar‐Smiley F, Barillas‐Arias L, Basiaga M, Baszis K, Becker M, Bell‐Brunson H, Beltz E, Benham H, Benseler S, Bernal W, Beukelman T, Bigley T, Binstadt B, Black C, Blakley M, Bohnsack J, Boland J, Boneparth A, Bowman S, Bracaglia C, Brooks E, Brothers M, Brown A, Brunner H, Buckley M, Buckley M, Bukulmez H, Bullock D, Cameron B, Canna S, Cannon L, Carper P, Cartwright V, Cassidy E, Cerracchio L, Chalom E, Chang J, Chang‐Hoftman A, Chauhan V, Chira P, Chinn T, Chundru K, Clairman H, Co D, Confair A, Conlon H, Connor R, Cooper A, Cooper J, Cooper S, Correll C, Corvalan R, Costanzo D, Cron R, Curiel‐Duran L, Curington T, Curry M, Dalrymple A, Davis A, Davis C, Davis C, Davis T, De Benedetti F, De Ranieri D, Dean J, Dedeoglu F, DeGuzman M, Delnay N, Dempsey V, DeSantis E, Dickson T, Dingle J, Donaldson B, Dorsey E, Dover S, Dowling J, Drew J, Driest K, Du Q, Duarte K, Durkee D, Duverger E, Dvergsten J, Eberhard A, Eckert M, Ede K, Edelheit B, Edens C, Edens C, Edgerly Y, Elder M, Ervin B, Fadrhonc S, Failing C, Fair D, Falcon M, Favier L, Federici S, Feldman B, Fennell J, Ferguson I, Ferguson P, Ferreira B, Ferrucho R, Fields K, Finkel T, Fitzgerald M, Fleming C, Flynn O, Fogel L, Fox E, Fox M, Franco L, Freeman M, Fritz K, Froese S, Fuhlbrigge R, Fuller J, George N, Gerhold K, Gerstbacher D, Gilbert M, Gillispie‐Taylor M, Giverc E, Godiwala C, Goh I, Goheer H, Goldsmith D, Gotschlich E, Gotte A, Gottlieb B, Gracia C, Graham T, Grevich S, Griffin T, Griswold J, Grom A, Guevara M, Guittar P, Guzman M, Hager M, Hahn T, Halyabar O, Hammelev E, Hance M, Hanson A, Harel L, Haro S, Harris J, Harry O, Hartigan E, Hausmann J, Hay A, Hayward K, Heiart J, Hekl K, Henderson L, Henrickson M, Hersh A, Hickey K, Hill P, Hillyer S, Hiraki L, Hiskey M, Hobday P, Hoffart C, Holland M, Hollander M, Hong S, Horwitz M, Hsu J, Huber A, Huggins J, Hui‐Yuen J, Hung C, Huntington J, Huttenlocher A, Ibarra M, Imundo L, Inman C, Insalaco A, Jackson A, Jackson S, James K, Janow G, Jaquith J, Jared S, Johnson N, Jones J, Jones J, Jones J, Jones K, Jones S, Joshi S, Jung L, Justice C, Justiniano A, Karan N, Kaufman K, Kemp A, Kessler E, Khalsa U, Kienzle B, Kim S, Kimura Y, Kingsbury D, Kitcharoensakkul M, Klausmeier T, Klein K, Klein‐Gitelman M, Kompelien B, Kosikowski A, Kovalick L, Kracker J, Kramer S, Kremer C, Lai J, Lam J, Lang B, Lapidus S, Lapin B, Lasky A, Latham D, Lawson E, Laxer R, Lee P, Lee P, Lee T, Lentini L, Lerman M, Levy D, Li S, Lieberman S, Lim L, Lin C, Ling N, Lingis M, Lo M, Lovell D, Lowman D, Luca N, Lvovich S, Madison C, Madison J, Manzoni SM, Malla B, Maller J, Malloy M, Mannion M, Manos C, Marques L, Martyniuk A, Mason T, Mathus S, McAllister L, McCarthy K, McConnell K, McCormick E, McCurdy D, Stokes PM, McGuire S, McHale I, McMonagle A, McMullen‐Jackson C, Meidan E, Mellins E, Mendoza E, Mercado R, Merritt A, Michalowski L, Miettunen P, Miller M, Milojevic D, Mirizio E, Misajon E, Mitchell M, Modica R, Mohan S, Moore K, Moorthy L, Morgan S, Dewitt EM, Moss C, Moussa T, Mruk V, Murphy A, Muscal E, Nadler R, Nahal B, Nanda K, Nasah N, Nassi L, Nativ S, Natter M, Neely J, Nelson B, Newhall L, Ng L, Nicholas J, Nicolai R, Nigrovic P, Nocton J, Nolan B, Oberle E, Obispo B, O'Brien B, O'Brien T, Okeke O, Oliver M, Olson J, O'Neil K, Onel K, Orandi A, Orlando M, Osei‐Onomah S, Oz R, Pagano E, Paller A, Pan N, Panupattanapong S, Pardeo M, Paredes J, Parsons A, Patel J, Pentakota K, Pepmueller P, Pfeiffer T, Phillippi K, Marafon DP, Phillippi K, Ponder L, Pooni R, Prahalad S, Pratt S, Protopapas S, Puplava B, Quach J, Quinlan‐Waters M, Rabinovich C, Radhakrishna S, Rafko J, Raisian J, Rakestraw A, Ramirez C, Ramsay E, Ramsey S, Randell R, Reed A, Reed A, Reed A, Reid H, Remmel K, Repp A, Reyes A, Richmond A, Riebschleger M, Ringold S, Riordan M, Riskalla M, Ritter M, Rivas‐Chacon R, Robinson A, Rodela E, Rodriquez M, Rojas K, Ronis T, Rosenkranz M, Rosolowski B, Rothermel H, Rothman D, Roth‐Wojcicki E, Rouster – Stevens K, Rubinstein T, Ruth N, Saad N, Sabbagh S, Sacco E, Sadun R, Sandborg C, Sanni A, Santiago L, Sarkissian A, Savani S, Scalzi L, Schanberg L, Scharnhorst S, Schikler K, Schlefman A, Schmeling H, Schmidt K, Schmitt E, Schneider R, Schollaert‐Fitch K, Schulert G, Seay T, Seper C, Shalen J, Sheets R, Shelly A, Shenoi S, Shergill K, Shirley J, Shishov M, Shivers C, Silverman E, Singer N, Sivaraman V, Sletten J, Smith A, Smith C, Smith J, Smith J, Smitherman E, Soep J, Son M, Spence S, Spiegel L, Spitznagle J, Sran R, Srinivasalu H, Stapp H, Steigerwald K, Rakovchik YS, Stern S, Stevens A, Stevens B, Stevenson R, Stewart K, Stingl C, Stokes J, Stoll M, Stringer E, Sule S, Sumner J, Sundel R, Sutter M, Syed R, Syverson G, Szymanski A, Taber S, Tal R, Tambralli A, Taneja A, Tanner T, Tapani S, Tarshish G, Tarvin S, Tate L, Taxter A, Taylor J, Terry M, Tesher M, Thatayatikom A, Thomas B, Tiffany K, Ting T, Tipp A, Toib D, Torok K, Toruner C, Tory H, Toth M, Tse S, Tubwell V, Twilt M, Uriguen S, Valcarcel T, Van Mater H, Vannoy L, Varghese C, Vasquez N, Vazzana K, Vehe R, Veiga K, Velez J, Verbsky J, Vilar G, Volpe N, von Scheven E, Vora S, Wagner J, Wagner‐Weiner L, Wahezi D, Waite H, Walker J, Walters H, Muskardin TW, Waqar L, Waterfield M, Watson M, Watts A, Weiser P, Weiss J, Weiss P, Wershba E, White A, Williams C, Wise A, Woo J, Woolnough L, Wright T, Wu E, Yalcindag A, Yee M, Yen E, Yeung R, Yomogida K, Yu Q, Zapata R, Zartoshti A, Zeft A, Zeft R, Zhang Y, Zhao Y, Zhu A, Zic C. Childhood-Onset Lupus Nephritis in the Childhood Arthritis and Rheumatology Research Alliance Registry: Short-Term Kidney Status and Variation in Care. Arthritis Care Res (Hoboken) 2023; 75:1553-1562. [PMID: 36775844 PMCID: PMC10500561 DOI: 10.1002/acr.25002] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Revised: 07/14/2022] [Accepted: 08/16/2022] [Indexed: 11/10/2022]
Abstract
OBJECTIVE The goal was to characterize short-term kidney status and describe variation in early care utilization in a multicenter cohort of patients with childhood-onset systemic lupus erythematosus (cSLE) and nephritis. METHODS We analyzed previously collected prospective data from North American patients with cSLE with kidney biopsy-proven nephritis enrolled in the Childhood Arthritis and Rheumatology Research Alliance (CARRA) Registry from March 2017 through December 2019. We determined the proportion of patients with abnormal kidney status at the most recent registry visit and applied generalized linear mixed models to identify associated factors. We also calculated frequency of medication use, both during induction and ever recorded. RESULTS We identified 222 patients with kidney biopsy-proven nephritis, with 64% class III/IV nephritis on initial biopsy. At the most recent registry visit at median (interquartile range) of 17 (8-29) months from initial kidney biopsy, 58 of 106 patients (55%) with available data had abnormal kidney status. This finding was associated with male sex (odds ratio [OR] 3.88, 95% confidence interval [95% CI] 1.21-12.46) and age at cSLE diagnosis (OR 1.23, 95% CI 1.01-1.49). Patients with class IV nephritis were more likely than class III to receive cyclophosphamide and rituximab during induction. There was substantial variation in mycophenolate, cyclophosphamide, and rituximab ever use patterns across rheumatology centers. CONCLUSION In this cohort with predominately class III/IV nephritis, male sex and older age at cSLE diagnosis were associated with abnormal short-term kidney status. We also observed substantial variation in contemporary medication use for pediatric lupus nephritis between pediatric rheumatology centers. Additional studies are needed to better understand the impact of this variation on long-term kidney outcomes.
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Hahn T, Daymont C, Beukelman T, Groh B, Hays K, Bingham CA, Scalzi L, Abel N, Abulaban K, Adams A, Adams M, Agbayani R, Aiello J, Akoghlanian S, Alejandro C, Allenspach E, Alperin R, Alpizar M, Amarilyo G, Ambler W, Anderson E, Ardoin S, Armendariz S, Baker E, Balboni I, Balevic S, Ballenger L, Ballinger S, Balmuri N, Barbar-Smiley F, Barillas-Arias L, Basiaga M, Baszis K, Becker M, Bell-Brunson H, Beltz E, Benham H, Benseler S, Bernal W, Beukelman T, Bigley T, Binstadt B, Black C, Blakley M, Bohnsack J, Boland J, Boneparth A, Bowman S, Bracaglia C, Brooks E, Brothers M, Brown A, Brunner H, Buckley M, Buckley M, Bukulmez H, Bullock D, Cameron B, Canna S, Cannon L, Carper P, Cartwright V, Cassidy E, Cerracchio L, Chalom E, Chang J, Chang-Hoftman A, Chauhan V, Chira P, Chinn T, Chundru K, Clairman H, Co D, Confair A, Conlon H, Connor R, Cooper A, Cooper J, Cooper S, Correll C, Corvalan R, Costanzo D, Cron R, Curiel-Duran L, Curington T, Curry M, Dalrymple A, Davis A, Davis C, Davis C, Davis T, De Benedetti F, De Ranieri D, Dean J, Dedeoglu F, DeGuzman M, Delnay N, Dempsey V, DeSantis E, Dickson T, Dingle J, Donaldson B, Dorsey E, Dover S, Dowling J, Drew J, Driest K, Du Q, Duarte K, Durkee D, Duverger E, Dvergsten J, Eberhard A, Eckert M, Ede K, Edelheit B, Edens C, Edens C, Edgerly Y, Elder M, Ervin B, Fadrhonc S, Failing C, Fair D, Falcon M, Favier L, Federici S, Feldman B, Fennell J, Ferguson I, Ferguson P, Ferreira B, Ferrucho R, Fields K, Finkel T, Fitzgerald M, Fleming C, Flynn O, Fogel L, Fox E, Fox M, Franco L, Freeman M, Fritz K, Froese S, Fuhlbrigge R, Fuller J, George N, Gerhold K, Gerstbacher D, Gilbert M, Gillispie-Taylor M, Giverc E, Godiwala C, Goh I, Goheer H, Goldsmith D, Gotschlich E, Gotte A, Gottlieb B, Gracia C, Graham T, Grevich S, Griffin T, Griswold J, Grom A, Guevara M, Guittar P, Guzman M, Hager M, Hahn T, Halyabar O, Hammelev E, Hance M, Hanson A, Harel L, Haro S, Harris J, Harry O, Hartigan E, Hausmann J, Hay A, Hayward K, Heiart J, Hekl K, Henderson L, Henrickson M, Hersh A, Hickey K, Hill P, Hillyer S, Hiraki L, Hiskey M, Hobday P, Hoffart C, Holland M, Hollander M, Hong S, Horwitz M, Hsu J, Huber A, Huggins J, Hui-Yuen J, Hung C, Huntington J, Huttenlocher A, Ibarra M, Imundo L, Inman C, Insalaco A, Jackson A, Jackson S, James K, Janow G, Jaquith J, Jared S, Johnson N, Jones J, Jones J, Jones J, Jones K, Jones S, Joshi S, Jung L, Justice C, Justiniano A, Karan N, Kaufman K, Kemp A, Kessler E, Khalsa U, Kienzle B, Kim S, Kimura Y, Kingsbury D, Kitcharoensakkul M, Klausmeier T, Klein K, Klein-Gitelman M, Kompelien B, Kosikowski A, Kovalick L, Kracker J, Kramer S, Kremer C, Lai J, Lam J, Lang B, Lapidus S, Lapin B, Lasky A, Latham D, Lawson E, Laxer R, Lee P, Lee P, Lee T, Lentini L, Lerman M, Levy D, Li S, Lieberman S, Lim L, Lin C, Ling N, Lingis M, Lo M, Lovell D, Lowman D, Luca N, Lvovich S, Madison C, Madison J, Manzoni SM, Malla B, Maller J, Malloy M, Mannion M, Manos C, Marques L, Martyniuk A, Mason T, Mathus S, McAllister L, McCarthy K, McConnell K, McCormick E, McCurdy D, Stokes PMC, McGuire S, McHale I, McMonagle A, McMullen-Jackson C, Meidan E, Mellins E, Mendoza E, Mercado R, Merritt A, Michalowski L, Miettunen P, Miller M, Milojevic D, Mirizio E, Misajon E, Mitchell M, Modica R, Mohan S, Moore K, Moorthy L, Morgan S, Dewitt EM, Moss C, Moussa T, Mruk V, Murphy A, Muscal E, Nadler R, Nahal B, Nanda K, Nasah N, Nassi L, Nativ S, Natter M, Neely J, Nelson B, Newhall L, Ng L, Nicholas J, Nicolai R, Nigrovic P, Nocton J, Nolan B, Oberle E, Obispo B, O’Brien B, O’Brien T, Okeke O, Oliver M, Olson J, O’Neil K, Onel K, Orandi A, Orlando M, Osei-Onomah S, Oz R, Pagano E, Paller A, Pan N, Panupattanapong S, Pardeo M, Paredes J, Parsons A, Patel J, Pentakota K, Pepmueller P, Pfeiffer T, Phillippi K, Marafon DP, Phillippi K, Ponder L, Pooni R, Prahalad S, Pratt S, Protopapas S, Puplava B, Quach J, Quinlan-Waters M, Rabinovich C, Radhakrishna S, Rafko J, Raisian J, Rakestraw A, Ramirez C, Ramsay E, Ramsey S, Randell R, Reed A, Reed A, Reed A, Reid H, Remmel K, Repp A, Reyes A, Richmond A, Riebschleger M, Ringold S, Riordan M, Riskalla M, Ritter M, Rivas-Chacon R, Robinson A, Rodela E, Rodriquez M, Rojas K, Ronis T, Rosenkranz M, Rosolowski B, Rothermel H, Rothman D, Roth-Wojcicki E, Rouster-Stevens K, Rubinstein T, Ruth N, Saad N, Sabbagh S, Sacco E, Sadun R, Sandborg C, Sanni A, Santiago L, Sarkissian A, Savani S, Scalzi L, Schanberg L, Scharnhorst S, Schikler K, Schlefman A, Schmeling H, Schmidt K, Schmitt E, Schneider R, Schollaert-Fitch K, Schulert G, Seay T, Seper C, Shalen J, Sheets R, Shelly A, Shenoi S, Shergill K, Shirley J, Shishov M, Shivers C, Silverman E, Singer N, Sivaraman V, Sletten J, Smith A, Smith C, Smith J, Smith J, Smitherman E, Soep J, Son M, Spence S, Spiegel L, Spitznagle J, Sran R, Srinivasalu H, Stapp H, Steigerwald K, Rakovchik YS, Stern S, Stevens A, Stevens B, Stevenson R, Stewart K, Stingl C, Stokes J, Stoll M, Stringer E, Sule S, Sumner J, Sundel R, Sutter M, Syed R, Syverson G, Szymanski A, Taber S, Tal R, Tambralli A, Taneja A, Tanner T, Tapani S, Tarshish G, Tarvin S, Tate L, Taxter A, Taylor J, Terry M, Tesher M, Thatayatikom A, Thomas B, Tiffany K, Ting T, Tipp A, Toib D, Torok K, Toruner C, Tory H, Toth M, Tse S, Tubwell V, Twilt M, Uriguen S, Valcarcel T, Van Mater H, Vannoy L, Varghese C, Vasquez N, Vazzana K, Vehe R, Veiga K, Velez J, Verbsky J, Vilar G, Volpe N, von Scheven E, Vora S, Wagner J, Wagner-Weiner L, Wahezi D, Waite H, Walker J, Walters H, Muskardin TW, Waqar L, Waterfield M, Watson M, Watts A, Weiser P, Weiss J, Weiss P, Wershba E, White A, Williams C, Wise A, Woo J, Woolnough L, Wright T, Wu E, Yalcindag A, Yee M, Yen E, Yeung R, Yomogida K, Yu Q, Zapata R, Zartoshti A, Zeft A, Zeft R, Zhang Y, Zhao Y, Zhu A, Zic C. Intraarticular steroids as DMARD-sparing agents for juvenile idiopathic arthritis flares: Analysis of the Childhood Arthritis and Rheumatology Research Alliance Registry. Pediatr Rheumatol Online J 2022; 20:107. [PMID: 36434731 PMCID: PMC9701017 DOI: 10.1186/s12969-022-00770-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Accepted: 11/08/2022] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Children with juvenile idiopathic arthritis (JIA) who achieve a drug free remission often experience a flare of their disease requiring either intraarticular steroids (IAS) or systemic treatment with disease modifying anti-rheumatic drugs (DMARDs). IAS offer an opportunity to recapture disease control and avoid exposure to side effects from systemic immunosuppression. We examined a cohort of patients treated with IAS after drug free remission and report the probability of restarting systemic treatment within 12 months. METHODS We analyzed a cohort of patients from the Childhood Arthritis and Rheumatology Research Alliance (CARRA) Registry who received IAS for a flare after a period of drug free remission. Historical factors and clinical characteristics and of the patients including data obtained at the time of treatment were analyzed. RESULTS We identified 46 patients who met the inclusion criteria. Of those with follow up data available 49% had restarted systemic treatment 6 months after IAS injection and 70% had restarted systemic treatment at 12 months. The proportion of patients with prior use of a biologic DMARD was the only factor that differed between patients who restarted systemic treatment those who did not, both at 6 months (79% vs 35%, p < 0.01) and 12 months (81% vs 33%, p < 0.05). CONCLUSION While IAS are an option for all patients who flare after drug free remission, it may not prevent the need to restart systemic treatment. Prior use of a biologic DMARD may predict lack of success for IAS. Those who previously received methotrexate only, on the other hand, are excellent candidates for IAS.
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Affiliation(s)
- Timothy Hahn
- Department of Pediatrics, Penn State Children's Hospital, 500 University Dr, Hershey, 90 Hope Drive, P.O. Box 855, Hershey, PA, 17033-0855, USA.
| | - Carrie Daymont
- grid.240473.60000 0004 0543 9901Department of Pediatrics, Penn State Children’s Hospital, 500 University Dr, Hershey, 90 Hope Drive, P.O. Box 855, Hershey, PA 17033-0855 USA
| | - Timothy Beukelman
- grid.265892.20000000106344187Department of Pediatrics, University of Alabama at Birmingham, CPPN G10, 1600 7th Ave South, Birmingham, AL 35233 USA
| | - Brandt Groh
- grid.240473.60000 0004 0543 9901Department of Pediatrics, Penn State Children’s Hospital, 500 University Dr, Hershey, 90 Hope Drive, P.O. Box 855, Hershey, PA 17033-0855 USA
| | | | - Catherine April Bingham
- grid.240473.60000 0004 0543 9901Department of Pediatrics, Penn State Children’s Hospital, 500 University Dr, Hershey, 90 Hope Drive, P.O. Box 855, Hershey, PA 17033-0855 USA
| | - Lisabeth Scalzi
- grid.240473.60000 0004 0543 9901Department of Pediatrics, Penn State Children’s Hospital, 500 University Dr, Hershey, 90 Hope Drive, P.O. Box 855, Hershey, PA 17033-0855 USA
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Gendy D, Walters H, O'Mahony E, Zaman S. The scope for radiology to contribute to the NHS net zero target: findings from a survey of radiology staff in the UK. Clin Radiol 2022; 77:e667-e672. [PMID: 35688772 DOI: 10.1016/j.crad.2022.05.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Accepted: 05/04/2022] [Indexed: 11/29/2022]
Abstract
AIM To assess attitudes towards the climate emergency among radiology staff and to identify current practices that may contribute towards the National Health Service (NHS) net zero target. MATERIALS AND METHODS An online survey of radiology staff was conducted assessing current attitudes to the climate emergency. Further questions focused on staff travel, home working, virtual conferences, and recycling. RESULTS Two hundred and forty-two responses were received from all staff groups within radiology. There were high levels of concern about the climate emergency among radiology staff. Active travel accounts for a relatively small proportion of commuting related to provision of radiology services. Some energy-saving measures are implemented commonly in radiology departments but these are likely to account for only a small proportion of energy use within a department. CONCLUSION There is significant scope for reducing the carbon footprint of radiology services by reducing travel, both for work and for radiology education. We discuss the potential for large savings related to energy-saving measures.
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Affiliation(s)
- D Gendy
- St Helens and Knowsley NHS Trust, Warrington Road, Prescot, L35 5DR, UK
| | - H Walters
- Oxford University NHS Trust, Headley Way, Headington, Oxford, OX3 9DU, UK
| | - E O'Mahony
- Bristol Royal Hospital for Children, Paul O'Gorman Building, Upper Maudlin Street, Bristol, BS2 8BJ, UK
| | - S Zaman
- St Helens and Knowsley NHS Trust, Warrington Road, Prescot, L35 5DR, UK.
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Soulsby WD, Balmuri N, Cooley V, Gerber LM, Lawson E, Goodman S, Onel K, Mehta B, Abel N, Abulaban K, Adams A, Adams M, Agbayani R, Aiello J, Akoghlanian S, Alejandro C, Allenspach E, Alperin R, Alpizar M, Amarilyo G, Ambler W, Anderson E, Ardoin S, Armendariz S, Baker E, Balboni I, Balevic S, Ballenger L, Ballinger S, Balmuri N, Barbar-Smiley F, Barillas-Arias L, Basiaga M, Baszis K, Becker M, Bell-Brunson H, Beltz E, Benham H, Benseler S, Bernal W, Beukelman T, Bigley T, Binstadt B, Black C, Blakley M, Bohnsack J, Boland J, Boneparth A, Bowman S, Bracaglia C, Brooks E, Brothers M, Brown A, Brunner H, Buckley M, Buckley M, Bukulmez H, Bullock D, Cameron B, Canna S, Cannon L, Carper P, Cartwright V, Cassidy E, Cerracchio L, Chalom E, Chang J, Chang-Hoftman A, Chauhan V, Chira P, Chinn T, Chundru K, Clairman H, Co D, Confair A, Conlon H, Connor R, Cooper A, Cooper J, Cooper S, Correll C, Corvalan R, Costanzo D, Cron R, Curiel-Duran L, Curington T, Curry M, Dalrymple A, Davis A, Davis C, Davis C, Davis T, De Benedetti F, De Ranieri D, Dean J, Dedeoglu F, DeGuzman M, Delnay N, Dempsey V, DeSantis E, Dickson T, Dingle J, Donaldson B, Dorsey E, Dover S, Dowling J, Drew J, Driest K, Du Q, Duarte K, Durkee D, Duverger E, Dvergsten J, Eberhard A, Eckert M, Ede K, Edelheit B, Edens C, Edens C, Edgerly Y, Elder M, Ervin B, Fadrhonc S, Failing C, Fair D, Falcon M, Favier L, Federici S, Feldman B, Fennell J, Ferguson I, Ferguson P, Ferreira B, Ferrucho R, Fields K, Finkel T, Fitzgerald M, Fleming C, Flynn O, Fogel L, Fox E, Fox M, Franco L, Freeman M, Fritz K, Froese S, Fuhlbrigge R, Fuller J, George N, Gerhold K, Gerstbacher D, Gilbert M, Gillispie-Taylor M, Giverc E, Godiwala C, Goh I, Goheer H, Goldsmith D, Gotschlich E, Gotte A, Gottlieb B, Gracia C, Graham T, Grevich S, Griffin T, Griswold J, Grom A, Guevara M, Guittar P, Guzman M, Hager M, Hahn T, Halyabar O, Hammelev E, Hance M, Hanson A, Harel L, Haro S, Harris J, Harry O, Hartigan E, Hausmann J, Hay A, Hayward K, Heiart J, Hekl K, Henderson L, Henrickson M, Hersh A, Hickey K, Hill P, Hillyer S, Hiraki L, Hiskey M, Hobday P, Hoffart C, Holland M, Hollander M, Hong S, Horwitz M, Hsu J, Huber A, Huggins J, Hui-Yuen J, Hung C, Huntington J, Huttenlocher A, Ibarra M, Imundo L, Inman C, Insalaco A, Jackson A, Jackson S, James K, Janow G, Jaquith J, Jared S, Johnson N, Jones J, Jones J, Jones J, Jones K, Jones S, Joshi S, Jung L, Justice C, Justiniano A, Karan N, Kaufman K, Kemp A, Kessler E, Khalsa U, Kienzle B, Kim S, Kimura Y, Kingsbury D, Kitcharoensakkul M, Klausmeier T, Klein K, Klein-Gitelman M, Kompelien B, Kosikowski A, Kovalick L, Kracker J, Kramer S, Kremer C, Lai J, Lam J, Lang B, Lapidus S, Lapin B, Lasky A, Latham D, Lawson E, Laxer R, Lee P, Lee P, Lee T, Lentini L, Lerman M, Levy D, Li S, Lieberman S, Lim L, Lin C, Ling N, Lingis M, Lo M, Lovell D, Lowman D, Luca N, Lvovich S, Madison C, Madison J, Manzoni SM, Malla B, Maller J, Malloy M, Mannion M, Manos C, Marques L, Martyniuk A, Mason T, Mathus S, McAllister L, McCarthy K, McConnell K, McCormick E, McCurdy D, Stokes PMC, McGuire S, McHale I, McMonagle A, McMullen-Jackson C, Meidan E, Mellins E, Mendoza E, Mercado R, Merritt A, Michalowski L, Miettunen P, Miller M, Milojevic D, Mirizio E, Misajon E, Mitchell M, Modica R, Mohan S, Moore K, Moorthy L, Morgan S, Dewitt EM, Moss C, Moussa T, Mruk V, Murphy A, Muscal E, Nadler R, Nahal B, Nanda K, Nasah N, Nassi L, Nativ S, Natter M, Neely J, Nelson B, Newhall L, Ng L, Nicholas J, Nicolai R, Nigrovic P, Nocton J, Nolan B, Oberle E, Obispo B, O’Brien B, O’Brien T, Okeke O, Oliver M, Olson J, O’Neil K, Onel K, Orandi A, Orlando M, Osei-Onomah S, Oz R, Pagano E, Paller A, Pan N, Panupattanapong S, Pardeo M, Paredes J, Parsons A, Patel J, Pentakota K, Pepmueller P, Pfeiffer T, Phillippi K, Marafon DP, Phillippi K, Ponder L, Pooni R, Prahalad S, Pratt S, Protopapas S, Puplava B, Quach J, Quinlan-Waters M, Rabinovich C, Radhakrishna S, Rafko J, Raisian J, Rakestraw A, Ramirez C, Ramsay E, Ramsey S, Randell R, Reed A, Reed A, Reed A, Reid H, Remmel K, Repp A, Reyes A, Richmond A, Riebschleger M, Ringold S, Riordan M, Riskalla M, Ritter M, Rivas-Chacon R, Robinson A, Rodela E, Rodriquez M, Rojas K, Ronis T, Rosenkranz M, Rosolowski B, Rothermel H, Rothman D, Roth-Wojcicki E, Rouster-Stevens K, Rubinstein T, Ruth N, Saad N, Sabbagh S, Sacco E, Sadun R, Sandborg C, Sanni A, Santiago L, Sarkissian A, Savani S, Scalzi L, Schanberg L, Scharnhorst S, Schikler K, Schlefman A, Schmeling H, Schmidt K, Schmitt E, Schneider R, Schollaert-Fitch K, Schulert G, Seay T, Seper C, Shalen J, Sheets R, Shelly A, Shenoi S, Shergill K, Shirley J, Shishov M, Shivers C, Silverman E, Singer N, Sivaraman V, Sletten J, Smith A, Smith C, Smith J, Smith J, Smitherman E, Soep J, Son M, Spence S, Spiegel L, Spitznagle J, Sran R, Srinivasalu H, Stapp H, Steigerwald K, Rakovchik YS, Stern S, Stevens A, Stevens B, Stevenson R, Stewart K, Stingl C, Stokes J, Stoll M, Stringer E, Sule S, Sumner J, Sundel R, Sutter M, Syed R, Syverson G, Szymanski A, Taber S, Tal R, Tambralli A, Taneja A, Tanner T, Tapani S, Tarshish G, Tarvin S, Tate L, Taxter A, Taylor J, Terry M, Tesher M, Thatayatikom A, Thomas B, Tiffany K, Ting T, Tipp A, Toib D, Torok K, Toruner C, Tory H, Toth M, Tse S, Tubwell V, Twilt M, Uriguen S, Valcarcel T, Van Mater H, Vannoy L, Varghese C, Vasquez N, Vazzana K, Vehe R, Veiga K, Velez J, Verbsky J, Vilar G, Volpe N, von Scheven E, Vora S, Wagner J, Wagner-Weiner L, Wahezi D, Waite H, Walker J, Walters H, Muskardin TW, Waqar L, Waterfield M, Watson M, Watts A, Weiser P, Weiss J, Weiss P, Wershba E, White A, Williams C, Wise A, Woo J, Woolnough L, Wright T, Wu E, Yalcindag A, Yee M, Yen E, Yeung R, Yomogida K, Yu Q, Zapata R, Zartoshti A, Zeft A, Zeft R, Zhang Y, Zhao Y, Zhu A, Zic C. Social determinants of health influence disease activity and functional disability in Polyarticular Juvenile Idiopathic Arthritis. Pediatr Rheumatol Online J 2022; 20:18. [PMID: 35255941 PMCID: PMC8903717 DOI: 10.1186/s12969-022-00676-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Accepted: 02/07/2022] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Social determinants of health (SDH) greatly influence outcomes during the first year of treatment in rheumatoid arthritis, a disease similar to polyarticular juvenile idiopathic arthritis (pJIA). We investigated the correlation of community poverty level and other SDH with the persistence of moderate to severe disease activity and functional disability over the first year of treatment in pJIA patients enrolled in the Childhood Arthritis and Rheumatology Research Alliance Registry. METHODS In this cohort study, unadjusted and adjusted generalized linear mixed effects models analyzed the effect of community poverty and other SDH on disease activity, using the clinical Juvenile Arthritis Disease Activity Score-10, and disability, using the Child Health Assessment Questionnaire, measured at baseline, 6, and 12 months. RESULTS One thousand six hundred eighty-four patients were identified. High community poverty (≥20% living below the federal poverty level) was associated with increased odds of functional disability (OR 1.82, 95% CI 1.28-2.60) but was not statistically significant after adjustment (aOR 1.23, 95% CI 0.81-1.86) and was not associated with increased disease activity. Non-white race/ethnicity was associated with higher disease activity (aOR 2.48, 95% CI: 1.41-4.36). Lower self-reported household income was associated with higher disease activity and persistent functional disability. Public insurance (aOR 1.56, 95% CI 1.06-2.29) and low family education (aOR 1.89, 95% CI 1.14-3.12) was associated with persistent functional disability. CONCLUSION High community poverty level was associated with persistent functional disability in unadjusted analysis but not with persistent moderate to high disease activity. Race/ethnicity and other SDH were associated with persistent disease activity and functional disability.
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Affiliation(s)
- William Daniel Soulsby
- University of California, San Francisco, 550 16th Street, 4th Floor, Box #0632, San Francisco, CA, 94158, USA.
| | - Nayimisha Balmuri
- grid.239915.50000 0001 2285 8823Hospital for Special Surgery, New York, NY USA ,grid.5386.8000000041936877XWeill Cornell Medicine, New York, NY USA
| | - Victoria Cooley
- grid.5386.8000000041936877XWeill Cornell Medicine, New York, NY USA
| | - Linda M. Gerber
- grid.5386.8000000041936877XWeill Cornell Medicine, New York, NY USA
| | - Erica Lawson
- grid.266102.10000 0001 2297 6811University of California, San Francisco, 550 16th Street, 4th Floor, Box #0632, San Francisco, CA 94158 USA
| | - Susan Goodman
- grid.239915.50000 0001 2285 8823Hospital for Special Surgery, New York, NY USA ,grid.5386.8000000041936877XWeill Cornell Medicine, New York, NY USA
| | - Karen Onel
- grid.239915.50000 0001 2285 8823Hospital for Special Surgery, New York, NY USA ,grid.5386.8000000041936877XWeill Cornell Medicine, New York, NY USA
| | - Bella Mehta
- grid.239915.50000 0001 2285 8823Hospital for Special Surgery, New York, NY USA ,grid.5386.8000000041936877XWeill Cornell Medicine, New York, NY USA
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Mahmood R, Negasan C, Manzoor A, Enwere P, Arnada-Martinez A, Walters H, Yeong K, Lisk R. 33 Improving Mortality with An Integrated Model of Care for Cervical Spine Fracture in Patients Over 75 Years Old. Age Ageing 2020. [DOI: 10.1093/ageing/afz183.33] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Introduction
Cervical spine injury is a potentially life threatening trauma. Given the increase in the number of patients presenting to the emergency department (ED) who are elderly and who have fallen and sustained trauma, it has become ever so challenging to manage this cohort of patients. In addition to diagnostic challenges in the elderly population, a robust, integrated care pathway and comprehensive geriatric assessment with involvement of a geriatrician is essential to provide effective care to these patients who require cervical collar after cervical spine injury to prevent morbidity and mortality.
Intervention
Data was gathered about the patient’s demographics, nature of cervical spine injury, care required from January 2013 till November 2016 (pre intervention) and from November 2016 till October 2017 (post intervention). Current practice was reviewed which showed significant variability in care provision to patients with cervical spine injury including collar care.
An integrated care pathway was designed with involvement of multidisciplinary team (MDT) members to standardise the care of this cohort of patients in our hospital. This included early identification of patients with cervical spine injury, co locating all patients, developing nursing expertise for cervical collar care, sitting up early to prevent complications like aspiration, pressure area care, early nutritional support, training staff in post discharge collar care with developing interface with primary care team. Outcome measures in patients over 75 years including length of stay (LOS) inpatient mortality and at 6 and 12 months were recorded respectively.
Results
Total: 54 patients, average age: 86.6 years
Conclusions
Cervical spine injuries are common in older patients, who are at greater risk of falls and thus sustaining injuries. Early identification and management of these patients in a clinical area with multidisciplinary approach with appropriate expertise is key to reducing LOS and adverse outcome including mortality.
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Affiliation(s)
- R Mahmood
- Ashford and St Peters NHS Foundation Trust
| | - C Negasan
- Ashford and St Peters NHS Foundation Trust
| | - A Manzoor
- Ashford and St Peters NHS Foundation Trust
| | - P Enwere
- Ashford and St Peters NHS Foundation Trust
| | | | - H Walters
- Ashford and St Peters NHS Foundation Trust
| | - K Yeong
- Ashford and St Peters NHS Foundation Trust
| | - R Lisk
- Ashford and St Peters NHS Foundation Trust
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Bacon HJ, Walters H, Vancia V, Waran N. The recognition of canine pain behaviours, and potentially hazardous Catch-Neuter-Return practices by animal care professionals. Anim Welf 2019. [DOI: 10.7120/09627286.28.3.299] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
The assessment of animal welfare is reliant upon the application of animal- and resource-based indicators. Animal-based indicators (physical, physiological and behavioural) are considered to be more representative of an animal's welfare state but are more difficult for an assessor to
interpret. In order to build a robust composite framework for the assessment of welfare of dogs (Canis familiaris) within Catch-Neuter-Return (CNR) programmes, including both resource- and animal-based indicators, it is necessary to first evaluate whether appropriate capture and handling
techniques plus behavioural, animal-based indicators can be reliably assessed by staff working in CNR programmes. Results of a video-based survey of experienced dog management staff and CNR practitioners are reported and indicate that staff experienced in canine CNR are reliably able to agree
on acceptable and unacceptable handling and capture techniques. However, there is only fair agreement between observers in positively recognising pain. Thus, dog welfare in CNR may be at risk unless staff are effectively trained at recognising behavioural indicators of poor welfare including
pain behaviours. This paper suggests that non-invasive, visual indicators of pain, such as facial tension and body posture, may be a reliable and effective approach to recognising post-operative pain in street dogs.
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Klenofsky B, Youn C, Walters H, Navis A, Boniece I. An interesting PRESentation of NMO. Mult Scler Relat Disord 2018; 25:163-164. [DOI: 10.1016/j.msard.2018.07.042] [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] [Received: 04/04/2018] [Revised: 07/24/2018] [Accepted: 07/25/2018] [Indexed: 11/24/2022]
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Affiliation(s)
- ME Edmonds
- ME Edmonds Diabetic Department, King's College Hospital, London, UK
| | - H Walters
- Department of Radiology, King's College Hospital, London, UK
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Pieniazek J, Williams M, Latham R, Walters H, Wickersham T, Levine R, Lebrun J, Caldwell D, Lee J. Evaluation of an Algal Beta-1,3-Glucan on Broiler Growth Performance and Immune Response. ACTA ACUST UNITED AC 2016. [DOI: 10.3923/ijps.2016.201.210] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Cochrane B, Quinn S, Walters H, Young I. Investigating the adverse respiratory effects of beta-blocker treatment: six years of prospective longitudinal data in a cohort with cardiac disease. Intern Med J 2012; 42:786-93. [DOI: 10.1111/j.1445-5994.2011.02563.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Ward C, Rydell-Tormanen K, Westergren-Thorsson G, Eriksson LT, Walters H. Infection and remodelling: a 21st century model of bronchiectasis? Eur Respir J 2011; 38:758-60. [DOI: 10.1183/09031936.00072811] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Minodier P, Noël G, Salles M, Retornaz K, Walters H, Combes JC, Garnier JM. [Mefloquine versus halofantrine in children suffering from acute uncomplicated falciparum malaria]. Arch Pediatr 2005; 12 Suppl 1:S67-71. [PMID: 15893244 DOI: 10.1016/s0929-693x(05)80017-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
AIM OF THE STUDY To evaluate mefloquine versus halofantrine in children suffering from acute uncomplicated falciparum malaria. MATERIAL AND METHODS Prospective non randomized study in hospitalized children during one year. Acute falciparum malaria was defined by fever and a positive thin and/or thick smear. Malaria was presumed to have been contracted in Comoros archipelago and/or Madagascar 6 months previously. Patients were excluded, when quinine had to be used, according to World Health Organization's severity criteria. RESULTS Forty-nine children were included: 29 were treated with halofantrine and 20 with mefloquine. Patients features in the two groups of treatment were identical, with exception for the mean time between first clinical signs and diagnosis (shorter in mefloquine group). Fever's and hospitalization's duration under treatment were similar. An increase in QTc interval was frequently observed in patients treated with halofantrine (56 versus 0%), although patients with mefloquine experienced vomiting (45 versus 0%). Relapses seemed to be more frequent with halofantrine (14 versus 0%). DISCUSSION Halofantrine and mefloquine are efficient for falciparum malaria treatment in our pediatric series, despite a high rate of adverse events. Mefloquine's tolerance may probably be improved with changes in regimen and dose. Relapses are more frequent with a single first treatment of halofantrine, than with mefloquine. Unfortunately, features of a second halofantrine treatment are not defined.
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Affiliation(s)
- P Minodier
- Urgences pédiatriques, CHU Nord, chemin des Bourrelly, 13915 Marseille cedex 20, France.
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Zheng L, Al Kerithy M, Orsida B, Walters H, Williams T, Hamid Q, Kotsimbos T, Snell G. Differential expression of the novel immuno-regulatory growth factors IL-11 and IL-17 in lung transplant recipients. J Heart Lung Transplant 2003. [DOI: 10.1016/s1053-2498(02)00753-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [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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Heussel CP, Mart-Bonmati L, L'Hermine C, Schmutz G, Chevallier P, Ollif J, Walters H, Heindel W, Koehler K, Matos C, van Beers B, Loose R, Lenz M, Meurer K, Kauczor HU. Gadodiamide and gadopentetate dimeglumine in MRI versus spiral CT in the diagnosis of liver lesions. Acad Radiol 2002; 9 Suppl 2:S463-5. [PMID: 12188309 DOI: 10.1016/s1076-6332(03)80264-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- C P Heussel
- Klinik und Poliklinik für Radiologie, Johannes Gutenberg-Universität, Mainz, Germany
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Abstract
BACKGROUND Oral corticosteroids are used as a treatment for asthma, however they are often associated with serious side effects. Dapsone is a sulfone with anti-inflammatory properties, therefore it may have a beneficial effect in the treatment of asthma and act as a corticosteroid-sparing agent. OBJECTIVES The objective of this review is to assess the safety and efficacy of adding dapsone to oral corticosteroids in adults with stable asthma who are dependent on oral corticosteroids with the intention of eventually minimizing or eliminating the use of these steroids. SEARCH STRATEGY The Cochrane Airways group trials register and reference lists of potential articles were searched. SELECTION CRITERIA Randomised controlled trials investigating the addition of dapsone compared to placebo in stable corticosteroid dependent asthmatics. DATA COLLECTION AND ANALYSIS No trials were found that met the selection criteria. MAIN RESULTS No meta-analyses could be performed. REVIEWER'S CONCLUSIONS No randomised controlled trials have been published, so there is no reliable evidence to show whether dapsone is beneficial or otherwise in the management of steroid-dependent asthmatic patients. There is a need for well designed randomised controlled trials to be performed. These must be carried out double-blind, since oral corticosteroid reduction requires a judgement on the part of the physician, who may be open to bias if the treatment allocation is known.
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Affiliation(s)
- A Dewey
- School of Postgraduate Medicine, University of Portsmouth, Gloucester House, Cosham, Hants, UK, PO6 3LY.
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Reid D, Snell G, Ward C, Krishnaswamy R, Ward R, Zheng L, Williams T, Walters H. Iron overload and nitric oxide-derived oxidative stress following lung transplantation. J Heart Lung Transplant 2001; 20:840-9. [PMID: 11502406 DOI: 10.1016/s1053-2498(01)00282-0] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Reactive oxygen species (ROS) may contribute to airway injury and the development of the bronchiolitis obliterans syndrome (BOS) following lung transplantation (LT). Chemically active iron released from ferritin stores and nitric oxide (NO)-derived radicals may add to the oxidative burden. METHODS We determined the concentrations of ferritin and the aqueous NO derivative nitrite (NO2(-)) within bronchoalveolar lavage fluid (BALF) of 14 stable LT recipients (ST) and 7 subjects with BOS and 21 normal controls. We also assessed the relationship between BALF ferritin and hemosiderin-laden macrophages (HLMs) using a hemosiderin score (HS) and determined BALF albumin concentration as a marker of microvascular leakage. RESULTS BALF ferritin concentrations and HSs were significantly elevated in LT recipients overall compared with normal controls (p < 0.05). BALF NO2(-) levels were elevated in BOS subjects and STs compared with normal controls (p = 0.002 and p = 0.09, respectively), but there was no difference between transplant groups. BALF albumin concentrations were elevated in BOS patients compared with normal controls (p = 0.02) and ST (p = 0.05), but there was no difference between STs and controls. There was a significant relationship between BALF ferritin concentration and HS in LT recipients overall (r(s) = 0.7, p < 0.001). In BOS subjects, but not ST, BALF ferritin was significantly related to BALF albumin (r(s) = 0.8, p = 0.05) and there was a weak relationship with NO2(-) concentration (r(s) = 0.6, p = 0.1). BALF NO2(-) was strongly related to BALF % neutrophils in BOS subjects (r(s) = 0.9, p < 0.01), but there was no such relationship in STs. CONCLUSIONS Our findings suggest that the allograft could be subject to significant iron-generated oxidative stress, which may be exacerbated by NO and neutrophil-derived ROS, particularly in BOS. Microvascular leakage may be a feature of established chronic rejection, which potentiates the iron overload and contributes to further airway damage and remodeling.
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Affiliation(s)
- D Reid
- Department of Respiratory Medicine, Alfred Hospital, Melbourne, Victoria, Australia
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Reid DW, Walters H. Inhaled triamcinolone and chronic obstructive pulmonary disease. N Engl J Med 2001; 344:1554; author reply 1554-6. [PMID: 11368047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/16/2023]
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20
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Affiliation(s)
- B Amir-Ansari
- Clinical Departments of Nephrology and. Radiology, King's College Hospital, London SE5 9RS, UK
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21
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Allen RM, Abdulwadud OA, Jones MP, Abramson M, Walters H. A reliable and valid asthma general knowledge questionnaire useful in the training of asthma educators. Patient Educ Couns 2000; 39:237-242. [PMID: 11040723 DOI: 10.1016/s0738-3991(99)00051-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
Using the responses of 115 adults attending an asthma educator training course, the Asthma General Knowledge Questionnaire for Adults (AGKQA) was found to be an acceptably valid and reliable measure for assessing knowledge related to the management of asthma by adults. Content and face validity: expert assessors considered the AGKQA to be a relevant and plausible test of the asthma general knowledge content of the programme. Criterion-related validity: the pretraining scores of educators were significantly higher (P < 0.001) than those of adults with no experience of asthma; total scores for the AGKQA and an asthma knowledge questionnaire developed for parents of children with asthma correlated strongly, 0.72. Test-retest reproducibility: the Spearman rank correlation for the test-retest score was 0.72 (P < 0.02), kappas for concordance of item responses were moderate to very good for two thirds of the items. Internal consistency for the total scale was also acceptable, KR20 0.66.
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Affiliation(s)
- R M Allen
- Department of Thoracic Medicine, Royal North Shore Hospital, St. Leonards, NSW, Australia
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22
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Sriprasad S, Mulvin D, Walters H, Coptcoat MJ. Management of renal angiomyolipoma: a report of 53 cases. BJU Int 1999; 84:543-4. [PMID: 10576953] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/14/2023]
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23
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Al-Hamali S, Baskerville P, Fraser S, Walters H, Markus HS. Detection of distal emboli in patients with peripheral arterial stenosis before and after iliac angioplasty: a prospective study. J Vasc Surg 1999; 29:345-51. [PMID: 9950992 DOI: 10.1016/s0741-5214(99)70387-3] [Citation(s) in RCA: 22] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE Embolism is believed to be the major cause of end-organ damage after angioplasty and endoluminal procedures. Recently, Doppler ultrasound scanning has been used to detect asymptomatic cerebral emboli. We determined whether asymptomatic embolic signals (ES) could be detected distal to a significant iliac artery stenosis of >60% both before and soon after iliac percutaneous transluminal angioplasty (PTA). METHODS A 2-MHz Doppler scan probe was used to monitor for ES in the common femoral artery before and after 10 successful iliac artery PTAs and at various standardized times in the following 24 hours. The same protocol was used to study 10 patients in the control group after renal PTA. In addition, a single recording was performed in a second nonoperative control group of 10 patients who had no evidence of peripheral vascular disease. The Doppler scan signals were recorded on tape for a later blinded analysis. RESULTS In the 24 hours before iliac PTA, asymptomatic ES were detected in four of 10 patients during a 1-hour recording but in no controls (P =.025). After iliac PTA, ES were detected at 30 minutes in nine of 10 iliac subjects but in only one of 10 renal subjects (P =.0003) and at 2 hours in eight of 10 iliac subjects but in only one of 10 renal subjects (P =.001). The occurrence of ES became less frequent, and ES were present at a lower frequency in eight of 10 iliac PTA subjects at 4 hours and in five of 10 at 24 hours but in no renal PTA subjects at these time points. CONCLUSIONS ES can be detected in the common femoral artery with Doppler ultrasound scanning in patients with iliac artery stenosis both before and soon after iliac PTA despite preangioplasty aspirin and intra-angioplasty heparin therapies. The occurrences of ES were particularly frequent in the 2 hours after PTA. This technique can be used further to study factors that control plaque stability and to evaluate the effect of therapeutic interventions.
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Affiliation(s)
- S Al-Hamali
- Department of Clinical Neuroscience, King's College School of Medicine, United Kingdom
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24
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Woods R, Abramson M, Raven M, Bailey M, Weiner M, Walters H. Reply. Eur Respir J 1999. [DOI: 10.1034/j.1399-3003.1999.13a43-1.x] [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: 11/23/2022]
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25
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Wabnitz PA, Walters H, Tyler MJ, Wallace JC, Bowie JH. First record of host defence peptides in tadpoles. The magnificent tree frog Litoria splendida. J Pept Res 1998; 52:477-81. [PMID: 9924992 DOI: 10.1111/j.1399-3011.1998.tb01252.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Tadpoles of the Magnificent Tree Frog Litoria splendida produce host defence peptides early in their development and well before metamorphosis. Peptides were identified and characterized using high performance liquid chromatography and electrospray mass spectrometry. No host defence peptides were identified in the eggs. The neuropeptide caerulein was detected 10 d after egg deposition, and the antibiotic peptides caerin 1.1, caerin 1.6 and caerin 3.1 first appeared at 14 d. The concentration of peptides increases with the onset of metamorphosis at 84 d, when the host-defence peptide profile is the same as that of the adult.
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Affiliation(s)
- P A Wabnitz
- Department of Chemistry, The University of Adelaide, South Australia, Australia
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26
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Abstract
Excessive surface fibrosis or fat limits effective electrode insertion in patients requiring epicardial pacing. We present chronic performance of a modified transvenous steroid lead used as an epi-intramyocardial electrode in a patient following repair of a univentricular heart after failure of both standard and steroid-eluting epicardial leads. Low implant threshold values remained stable during a 3-year postimplant interval demonstrating an effective and innovative approach to epicardial pacing.
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Affiliation(s)
- P P Karpawich
- Children's Hospital of Michigan, Wayne State University School of Medicine, Detroit, USA
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27
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Walters H. Antibiotic prophylaxis in dental surgery. Dent Update 1997; 24:271-6. [PMID: 9515340] [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] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Prevention of infection can be a minefield of uncertainty. There is little consensus of opinion on the objective criteria for diagnosing wound infection, and experts disagree on whether antibiotics should be routinely provided as prophylaxis in dental surgery. This article sets out the arguments for and against the prophylactic use of antibiotics in dental procedures.
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Muthukrishnan A, Walters H, Douglas PS. An audit of antibiotic prescribing by general practitioners in the initial management of acute dental infection. Dent Update 1996; 23:316-8. [PMID: 9452621] [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] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
A sub-regional audit showed a high rate of referral of acute dentoalveolar infections as emergencies. In Torbay Hospital alone, 21 patients required admission following such referrals in a period of 3 months. A questionnaire was therefore sent out to all general medical and general dental practitioners in the area covered by Torbay Hospital in order to survey their choice of antibiotics in the initial management of acute dentoalveolar infections. The results showed that the prescribing patterns of general medical practitioners differed significantly from those of general dental practitioners and that practitioners were reluctant to prescribe metronidazole as a first choice, even in patients allergic to penicillin. The authors conclude that awareness about the use of antibiotics, particularly among general dental practitioners, needs to be increased.
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Affiliation(s)
- A Muthukrishnan
- Department of Oral and Maxillofacial Surgery, Royal Gwent Hospital, Newport
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Abstract
OBJECTIVE This study examined the 7-year developmental and academic outcome of speech/language-impaired and control children selected from a community sample. METHOD Speech/language and psychiatric measures were administered to the children at ages 5 and 12.5 years. Using children's age 5 speech/language test results, a cluster analysis was performed to ascertain whether specific linguistic subgroups would emerge. The long-term consistency of these subgroups was explored. The association between time 1 speech/language clusters and linguistic, cognitive and academic measures at time 2 were examined. RESULTS Four groups were identified in the cluster analysis: high overall, poor articulation, poor comprehension, and low overall. Children with pervasive language problems continued to perform poorly on linguistic, cognitive, and academic measures, while those with comprehension problems fared slightly better but still had more difficulties than those with normal language. The poor articulation cluster had few articulation errors at follow-up. CONCLUSIONS Empirically supported speech/language classifications identified as early as age 5 continued to be relevant into late childhood. Pervasive speech/language impairment in early childhood was associated with increased risk of poor linguistic and academic outcome at follow-up, while isolated articulatory problems improved over time. These findings reveal the urgent need for early intervention among children with pervasive speech/language impairment.
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Affiliation(s)
- J H Beitchman
- Clarke Institute of Psychiatry, Toronto, Ontario, Canada
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Beitchman JH, Wilson B, Brownlie EB, Walters H, Inglis A, Lancee W. Long-term consistency in speech/language profiles: II. Behavioral, emotional, and social outcomes. J Am Acad Child Adolesc Psychiatry 1996; 35:815-25. [PMID: 8682763 DOI: 10.1097/00004583-199606000-00022] [Citation(s) in RCA: 131] [Impact Index Per Article: 4.7] [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] [Indexed: 02/01/2023]
Abstract
OBJECTIVE This study examined the 7-year behavioral, emotional, and social outcome of speech/language-impaired and control children selected from a community sample. METHOD Speech/language and psychosocial measures were administered to the children at ages 5 and 12.5 years. Using children's age 5 speech/language test results, a cluster analysis was performed to ascertain whether specific linguistic subgroups would emerge. The association between speech/language cluster at age 5 and psychosocial functioning at age 12.5 was examined. RESULTS Children with receptive and pervasive speech/language problems at age 5 demonstrated greater behavioral disturbance than children without such impairment. Controlling for initial behavioral status, early childhood language profile was still associated with behavioral and social competence ratings, 7 years later. Children without receptive language problems showed superior social adjustment. CONCLUSIONS Empirically supported speech/language classifications identified as early as age 5 were associated with behavioral disturbance in late childhood. Receptive and pervasive speech/language impairment in early childhood was associated with the greatest risk at follow-up. Early auditory comprehension problems may be a specific risk factor for later aggressive and hyperactive symptoms. These findings identify the need for effective intervention with speech/language-impaired children.
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34
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Wong W, Fynn SP, Higgins RM, Walters H, Evans S, Deane C, Goss D, Bewick M, Snowden SA, Scoble JE, Hendry BM. Transplant renal artery stenosis in 77 patients--does it have an immunological cause? Transplantation 1996; 61:215-9. [PMID: 8600626 DOI: 10.1097/00007890-199601270-00009] [Citation(s) in RCA: 121] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Transplant renal artery stenosis (TRAS) is a common complication after transplantation and is an important cause of graft dysfunction. Damage from graft rejection, trauma, and atherosclerosis have been implicated as possible causes. We reviewed all 917 patients transplanted in our unit since 1978 to study the prevalence, clinical features, and possible causes of TRAS. Seventy-seven patients with TRAS were identified. The detected incidence was 2.4% before the introduction of color doppler ultrasonography (CDU) and rose to 12.4% after CDU was introduced in 1985, giving an overall incidence of 8.4% during a mean follow-up period of 6.9 years. The TRAS group was compared with a control group of 77 transplanted patients matched for age, year of transplant, sex, and number of previous grafts. Mean ages for the study and control groups were 43.6 +/- 15 and 44.8 +/- 13.7 yr. A total of 25% of cases of TRAS were diagnosed within the first 8 wk of transplantation and in 60% within the first 30 wk (median = 23 wk). All patients were treated with angioplasty, 28 patients had recurrence of TRAS requiring multiple angioplasties (maximum 5) and 1 went on to have surgery. Angioplasty resulted in a significant fall in plasma creatinine. Patient and graft survival were significantly worse in the TRAS group: 69% vs. 83% (P < 0.05) and 56% vs. 74% (P < 0.05) (TRAS vs. Control), respectively. There was a significantly higher incidence of rejection, especially cellular rejection in the TRAS group, 0.67 vs. 0.35 episodes per patient (P < 0.01) (TRAS vs. Control). Recurrence but not occurrence of TRAS was associated with the use of cyclosporine.
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Affiliation(s)
- W Wong
- Department of Radiology, King's College Hospital, London, United Kingdom
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35
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Walters H. Dilemmas of life and death. J R Soc Med 1995; 88:663-664. [PMID: 20894981 PMCID: PMC1295396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/29/2023] Open
Affiliation(s)
- H Walters
- Department of Maxillofacial Surgery, Torbay Hospital, Laws Bridge, Torquay, Devon TQ2 7AA, England
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Walters H. The meaning of words in the New Health Service. J R Soc Med 1995; 88:365-6. [PMID: 7562801 PMCID: PMC1295262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
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Abstract
Several publications reporting lingual nerve damage in the region of 11% caused the author to undertake a retrospective personal clinical audit of 100 cases which demonstrated a comparable complication rate of 10%. This audit prompted a re-evaluation of the detailed surgical anatomy, the design and manufacture of a new type of periosteal elevator and lingual nerve retractor and a modification of the surgical technique. A subsequent prospective personal clinical audit of 1001 consecutive wisdom tooth operations has resulted in a 20-fold improvement (0.5%) in the incidence of lingual nerve damage. The technique and instrumentation has been used under local anaesthesia and under general anaesthesia by surgeons of varying experience and has a group audit complication rate of only 1% in 300 consecutive cases. The value of clinical audit has become self evident.
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Affiliation(s)
- H Walters
- Department of Maxillofacial Surgery, Torbay Hospital, Torquay, Devon
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38
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Walters H. What is the future for dental specialists? Two sides of the coin. Br Dent J 1994; 177:396-7. [PMID: 7803142 DOI: 10.1038/sj.bdj.4808622] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
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39
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Ross S, Godden D, Douglas G, Legge J, Friend J, Booth H, Hartley-Sharpe C, Walters H, Godley CC, McCallum R, Bucknall CE, Kendrick S, Higham JH. Asthma trends Causes of wheeze and asthma may differ. BMJ 1994. [DOI: 10.1136/bmj.309.6954.603] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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40
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Booth H, Hartley-Sharpe C, Walters H. Asthma trends. Different nebulizers may explain Australian findings. BMJ 1994; 309:603. [PMID: 8086955 PMCID: PMC2541397] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
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41
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Walters H. Whither the treatment for the TMJ? Br J Oral Maxillofac Surg 1994; 32:263. [PMID: 7947576 DOI: 10.1016/0266-4356(94)90218-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
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42
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Gardiner P, Ward C, Allison A, Ashcroft T, Simpson W, Walters H, Kelly C. Pleuropulmonary abnormalities in primary Sjögren's syndrome. J Rheumatol 1993; 20:831-7. [PMID: 8336308] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
Sixteen patients with primary Sjögren's syndrome (1 degree SS) who complained of dyspnea were investigated with high resolution computerized tomography of the thorax, bronchoalveolar lavage, and transbronchial biopsy. Six patients had evidence of interstitial fibrosis, 5 had a peribronchiolar lymphocytic infiltration and 3 had pleural thickening. We conclude that significant pulmonary disease is not uncommon in patients with 1 degree SS.
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Affiliation(s)
- P Gardiner
- Chest Unit, Newcastle General Hospital, UK
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Deane C, Cowan N, Giles J, Walters H, Rifkin I, Severn A, Parsons V. Arteriovenous fistulas in renal transplants: color Doppler ultrasound observations. Urol Radiol 1991; 13:211-7. [PMID: 1598744 DOI: 10.1007/bf02924625] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
One hundred twenty-six new renal transplants were scanned regularly with color Doppler ultrasound (CDU). In 22 (17.5%) of the grafts there was evidence of postbiopsy arteriovenous (AV) fistula during the first 6 months postoperatively. In 14 cases the fistula closed spontaneously. In the remaining eight, the fistula was still present up to 24 months later (four cases) or until the graft failed (four cases). Additionally, 163 established grafts were scanned for evidence of vascular abnormality. AV fistulas were observed in 15 grafts (8%). Circulatory complications of fistulas observed include vascular steal and a possible association with graft vein and artery stenosis.
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Affiliation(s)
- C Deane
- Department of Medical Engineering and Physics, King's College School of Medicine and Dentistry, Dulwich Hospital, London, UK
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Olliff S, Negus R, Deane C, Walters H. Renal transplant vein stenosis: demonstration and percutaneous venoplasty of a new vascular complication in the transplant kidney. Clin Radiol 1991; 43:42-6. [PMID: 1999072 DOI: 10.1016/s0009-9260(05)80353-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Stenosis of the renal transplant vein has been demonstrated in eight patients undergoing investigation for renal dysfunction arising 3 weeks to 3 years after transplantation. The stenoses were diagnosed by duplex Doppler ultrasound in three cases and by angiography in the presence of arterio-venous fistula in five cases. In four patients percutaneous venous dilatation was performed with technical success in three. In two patients this was repeated for recurrent stenosis but sustained improvement in renal function was not observed. Progression of the venous stenoses was documented with one patient suffering graft loss due to complete venous occlusion.
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Affiliation(s)
- S Olliff
- Department of Radiology, Dulwich Hospital, London
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45
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Abstract
Lower limb ischaemia as the only or main clinical manifestation of aortic dissection is a rare event. Two cases are presented where this occurred resulting in attempted embolectomy before the correct diagnosis was made. The diagnosis should be considered when embolectomy fails to retrieve thrombus and when angiography demonstrates spiral lucencies within the lumen of large vessels or non-filling of major vascular branches. The value of pre-operative angiography is emphasized.
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Affiliation(s)
- N Raby
- Department of Radiology, Dulwich Hospital, Denmark Hill, London
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46
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Deane C, Cairns T, Walters H, Palmer A, Parsons V, Roberts V, Taube D. Diagnosis of renal transplant artery stenosis by color Doppler ultrasonography. Transplant Proc 1990; 22:1395. [PMID: 2202116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Affiliation(s)
- C Deane
- Department of Medical Engineering, Dulwich Hospital, London, United Kingdom
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Abstract
A method of superselective embolization of 0.64 mm or 0.89 mm coils using a coaxial catheter system is described. The normally functioning parts of an organ can be easily preserved. A number of clinical cases are briefly described which illustrate the application of this method. It is particularly suited to the control of bleeding points in diseased organs or precious organs such as transplants where embolization of a larger volume of tissue would have serious consequences.
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Affiliation(s)
- S Olliff
- Department of Diagnostic Radiology, King's College Hospital, London
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Abstract
We have studied the effects of filtering mucus from bronchoalveolar lavage (BAL) fluid on its cellular contents. We examined BAL fluid from 18 patients without excessive endobronchial mucus, and from three patients with bronchiectasis. In the non-bronchiectatic subjects there was a fall of 18% in mean absolute cell count from 2.66 +/- SD 1.9 x 10(9) l-1 to 2.18 +/- 1.4 x 10(9) l-1 (P less than 0.05) as a result of filtration. This was due to a selective loss of macrophages and there were no significant changes in the absolute numbers of either lymphocytes or neutrophils. The differential macrophage count fell from a mean of 82 +/- 14% to 76 +/- 16%, while the mean differential lymphocyte count rose from 14 +/- 7% to 19 +/- 9% and the mean differential neutrophil count increased slightly from 4 +/- 4% to 5 +/- 4%. In the three patients with bronchiectasis the absolute cell counts were grossly raised, due almost entirely to an excess of neutrophils. In these patients, filtration reduced the absolute macrophage count by 61% and the absolute neutrophil count by 27%. Overall, change in absolute cell count correlated significantly with mucus volume (r = 0.76, P less than 0.05). Removal of mucus by filtration affects absolute cell count and may have a selective effect on cell numbers. If filtration of BAL fluid is unavoidable, its effect on cell counts should be clearly established if data from different centres are to be meaningfully compared.
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Affiliation(s)
- C Kelly
- Department of Medicine, Newcastle General Hospital, U.K
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Gilbey SG, Walters H, Edmonds ME, Archer AG, Watkins PJ, Parsons V, Grenfell A. Vascular calcification, autonomic neuropathy, and peripheral blood flow in patients with diabetic nephropathy. Diabet Med 1989; 6:37-42. [PMID: 2522372 DOI: 10.1111/j.1464-5491.1989.tb01136.x] [Citation(s) in RCA: 28] [Impact Index Per Article: 0.8] [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] [Indexed: 01/01/2023]
Abstract
The possibility that digital gangrene in patients with diabetic nephropathy might be due to abnormalities of peripheral blood flow secondary to vascular calcification has been investigated. Twenty patients with renal failure due to diabetic nephropathy were studied. Peripheral blood flow was measured using venous occlusion plethysmography, together with an assessment of medial arterial calcification on plain radiographs of the hands and feet, and transcutaneous oxygen tension (TcPO2). Hallux blood flow was markedly raised (median 22.5, range 11.5-56.5, ml min-1 100-ml-1) compared with non-diabetic control subjects (4.7, 1.1-10.5, ml min-1 100-ml-1; p less than 0.01) and similar to that in diabetic patients with autonomic neuropathy (29.5, 16.7-49.6, ml min-1 100-ml-1). Although vascular calcification was common and extensive in the patients with diabetic nephropathy, TcPO2 measurements in the supine foot were normal and did not indicate tissue ischaemia. We conclude that despite extensive vascular calcification high peripheral blood flow occurs in the feet of these patients at rest together with normal transcutaneous oxygen tension.
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Affiliation(s)
- S G Gilbey
- Diabetic Department, King's College Hospital, London, UK
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50
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Abstract
This study assessed the effect of bronchoalveolar lavage (BAL) on nonspecific bronchial responsiveness in 31 patients. Of these, 20 had airflow obstruction; 11 control subjects had normal pulmonary function. Bronchial responsiveness to methacholine, expressed as the dose of inhaled methacholine required to provoke a 20 percent fall in forced expiratory volume in one second (PD20 FEV1), was measured before and after BAL. We found no evidence for the induction of responsiveness by BAL in 11 control subjects with negative methacholine tests prior to the procedure. There were small but significant falls in FEV1 following BAL in both the control group and in patients with airflow obstruction. Thus, BAL does not appear to induce nonspecific bronchial hyperresponsiveness in subjects without airflow obstruction, nor does it affect airway responsiveness in emphysema patients. Among asthmatics, bronchial responsiveness can be increased as a result of BAL; this increase was greatest in patients who were most responsive initially.
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Affiliation(s)
- C Kelly
- Department of Medicine, Newcastle General Hospital, University of Newcastle upon Tyne, England
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