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Vadera S, Osborne T, Shah V, Stephenson JA. Opportunistic screening for osteoporosis by abdominal CT in a British population. Insights Imaging 2023; 14:57. [PMID: 37005941 PMCID: PMC10067782 DOI: 10.1186/s13244-023-01400-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Accepted: 03/08/2023] [Indexed: 04/04/2023] Open
Abstract
BACKGROUND It has previously been shown that CT scans performed for other indications can be used to identify patients with osteoporosis. This has not yet been tested in a British population. We sought to evaluate the use of vertebral CT attenuation measures for predicting osteoporosis in a British cohort, using dual-energy X-ray absorptiometry (DEXA) as a reference standard. METHODS Patients who underwent abdominal CT in 2018 and concomitantly underwent DEXA within a six-month interval were retrospectively included. CT attenuation values in Hounsfield units (HU) were measured by placement of a region-of-interest at the central portion of the L1 vertebral body and then compared to their corresponding DEXA score. Receiver operating characteristic (ROC) curves were generated to evaluate the performance of a logistic regression model and to determine sensitivity and specificity thresholds. RESULTS 536 patients (394 females, mean age 65.8) were included, of which 174 had DEXA-defined osteoporosis. L1 attenuation measures were significantly different (p < 0.01) between the three DEXA-defined groups of osteoporosis (118 HU), osteopenia (143 HU) and normal bone density (178 HU). The area under the ROC curve was 0.74 (95% CI 0.69-0.78). A threshold of 169 HU was 90% sensitive, and a threshold of 104 HU was 90% specific for diagnosing osteoporosis. CONCLUSIONS Routine abdominal CT can be used to opportunistically screen for osteoporosis without additional cost or radiation exposure. The thresholds identified in this study are comparable with previous studies in other populations. We recommend radiologists engage with primary care and rheumatology providers to determine appropriate cut-off values for further investigation.
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Affiliation(s)
- Sonam Vadera
- Gastrointestinal Imaging Group, Department of Radiology, University Hospitals of Leicester, Leicester General Hospital, Leicester, UK
| | - Timothy Osborne
- Gastrointestinal Imaging Group, Department of Radiology, University Hospitals of Leicester, Leicester General Hospital, Leicester, UK
| | - Vikas Shah
- Gastrointestinal Imaging Group, Department of Radiology, University Hospitals of Leicester, Leicester General Hospital, Leicester, UK
| | - James A Stephenson
- Gastrointestinal Imaging Group, Department of Radiology, University Hospitals of Leicester, Leicester General Hospital, Leicester, UK.
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Bryan CJ, Rush SC, Fuessel-Herrmann D, Bryan AO, Morrow CE, Haskell J, Jones MJ, Bowerfind C, Stephenson JA. Threat Appraisal, Recovery Operations, and PTSD Symptoms Among US Air Force Rescue Personnel. J Spec Oper Med 2023; 23:18-22. [PMID: 36764287 DOI: 10.55460/p58k-bdyt] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 03/01/2023] [Indexed: 02/12/2023]
Abstract
BACKGROUND Research among military personnel and veterans indicates that subjective appraisal of warzone stressors explains the relation of combat exposure to posttraumatic stress disorder (PTSD), but not the relation of exposure to injury and death to PTSD. Studies have primarily been limited to conventional forces using aggregate measures of warzone stressor exposure. Threat appraisal may play a different role in the emergence of PTSD among military personnel for whom dangerous deployment experiences are more closely associated with exposure to injury and death, such as US Air Force Pararescuemen and Combat Rescue officers. MATERIALS AND METHODS In a sample of 207 rescue personnel, correlations among various types of warzone stressor exposure, threat appraisal, and postdeployment PTSD symptoms were examined. RESULTS The relative strongest correlates of threat appraisal were stressors related to injury, death, and human remains. Although exposure to these stressors was also correlated with PTSD symptom severity, partial correlations of stressor exposure and PTSD symptoms were no longer significant when adjusting for threat appraisal. CONCLUSION Results support the contributing role of threat appraisal to PTSD among military personnel whose primary duties entail exposure to injury and death under hostile and dangerous conditions.
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Oyebola T, Mavilakandy A, Stephenson JA, Boyce R, Bhardwaj N, Garcea G. Sarcopenia: An Assessment into the Prevalence and Disease Burden in Chronic Pancreatitis Patients. J Frailty Sarcopenia Falls 2023; 8:38-43. [PMID: 36873829 PMCID: PMC9975973 DOI: 10.22540/jfsf-08-038] [Citation(s) in RCA: 1] [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] [Accepted: 11/13/2022] [Indexed: 03/04/2023] Open
Abstract
Objectives To evaluate the prevalence of sarcopenia in patients referred to a Multidisciplinary Chronic Pancreatitis (CP) Clinic at the University Hospitals of Leicester. Methods All patients who had undergone CT scans were identified. Controls were identified from CT colonograms with no features of malignancy or pancreatic pathology. The psoas muscle index (PMI) was calculated using the formula: total psoas muscle cross-sectional area at the third lumbar vertebral level (cm2)/ the patient's height squared (m2). PMI cut-offs were <6.31cm2/m2 and <3.91cm2/m2 for males and females, respectively. Results 58 CP CT scans were available for analysis along with 62 control scans. 71.9% of CP patients had a PMI below the cut-off for their gender, compared to 45.2% of the controls. The mean PMI (±SD) for male CP patients and male controls were 5.54cm2/m2 (±1.60) and 6.73 cm2/m2 (±1.54), (P=0.0023). The mean PMI (±SD) for female CP patients and female controls were 3.82 cm2/m2 (+/-1.46) and 4.98 cm2/m2 (+/-1.43), (P=0.0021). Conclusions CP patients had a mean PMI below the cut-off value, suggesting that CP patients are largely sarcopenic. As malnutrition is a significant feature of CP, optimisation of nutrition may help to ameliorate sarcopenia in CP patients.
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Affiliation(s)
- Taiwo Oyebola
- Leicester Medical School, Lancaster Rd, Leicester, United Kingdom.,Leicester HPB Unit, University Hospitals of Leicester NHS Trust, United Kingdom
| | - Akash Mavilakandy
- Leicester Medical School, Lancaster Rd, Leicester, United Kingdom.,Leicester HPB Unit, University Hospitals of Leicester NHS Trust, United Kingdom.,Department of Cardiovascular sciences, University of Leicester, United Kingdom
| | - James A Stephenson
- Gastrointestinal Imaging Group, Department of Radiology, University Hospitals of Leicester NHS Trust, Leicester General Hospital, United Kingdom
| | - Ruth Boyce
- Leicester HPB Unit, University Hospitals of Leicester NHS Trust, United Kingdom
| | - Neil Bhardwaj
- Leicester HPB Unit, University Hospitals of Leicester NHS Trust, United Kingdom
| | - Giuseppe Garcea
- Leicester HPB Unit, University Hospitals of Leicester NHS Trust, United Kingdom
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Khasawneh F, Osborne T, Danaher P, Barnes D, Chapman CJ, Stephenson JA, Singh B. Faecal immunochemical testing reduces demand and improves yield of Leicester's 2-week pathway for change in bowel habit. Colorectal Dis 2022; 25:640-646. [PMID: 36478367 DOI: 10.1111/codi.16445] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Revised: 10/09/2022] [Accepted: 10/10/2022] [Indexed: 12/30/2022]
Abstract
AIM We look at the effect of introducing the faecal immunochemical test (FIT) in the straight-to-test 2-week pathway for change in bowel habit (CIBH). METHOD The FIT in primary care triages 2-week wait (2WW) colorectal referrals for patients aged 60 years and above for straight-to-test CT colonography (CTC). We compare the impact of the FIT on numbers of 2WW CTCs, in the year before and after FIT, in both colorectal cancer (CRC) detection and cost-effectiveness at both 4 μg Hb/g faeces and 10 μg Hb/g faeces. RESULTS At a threshold of 4 μg Hb/g faeces, the positive predictive value of the FIT for diagnosis of CRC is 5.0% with a negative predictive value of 99.8% and a polyp detection rate of 25.5%. The introduction of the FIT resulted in a reduction in the number of CTCs performed through the CIBH pathway from a mean of 143.9 per month prior to the FIT to 66.8 CTCs per month once the FIT was well established. Given a FIT threshold of 10 μg Hb/g the number of CTCs would be predicted to fall by 70.4% to 42.6 CTCs per month resulting in higher CRC and polyp detection rate, and an estimated annual cost saving of £238 258 in our institution. CONCLUSION The FIT use in primary care improves the yield of 2WW referrals for CIBH alone and reduces the burden and cost of investigations to exclude CRC. Improvements may be possible by increasing the cut-off employed, without adversely affecting the risk of missing a cancer.
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Affiliation(s)
- Farah Khasawneh
- University Hospitals of Leicester NHS Trust, University of Leicester, Leicester, UK
| | | | - Paul Danaher
- GP Principal at Groby Road Medical Centre, Leicester, UK
| | - Daniel Barnes
- University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Caroline J Chapman
- Nottingham University Hospitals, NHS Trust, University of Nottingham, Nottingham, UK
| | | | - Baljit Singh
- University Hospitals of Leicester NHS Trust, Leicester, UK
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Miller AS, Boyce K, Box B, Clarke MD, Duff SE, Foley NM, Guy RJ, Massey LH, Ramsay G, Slade DAJ, Stephenson JA, Tozer PJ, Wright D. The Association of Coloproctology of Great Britain and Ireland consensus guidelines in emergency colorectal surgery. Colorectal Dis 2021; 23:476-547. [PMID: 33470518 PMCID: PMC9291558 DOI: 10.1111/codi.15503] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2020] [Revised: 12/08/2020] [Accepted: 12/12/2020] [Indexed: 12/15/2022]
Abstract
AIM There is a requirement for an expansive and up to date review of the management of emergency colorectal conditions seen in adults. The primary objective is to provide detailed evidence-based guidelines for the target audience of general and colorectal surgeons who are responsible for an adult population and who practise in Great Britain and Ireland. METHODS Surgeons who are elected members of the Association of Coloproctology of Great Britain and Ireland Emergency Surgery Subcommittee were invited to contribute various sections to the guidelines. They were directed to produce a pathology-based document using literature searches that were systematic, comprehensible, transparent and reproducible. Levels of evidence were graded. Each author was asked to provide a set of recommendations which were evidence-based and unambiguous. These recommendations were submitted to the whole guideline group and scored. They were then refined and submitted to a second vote. Only those that achieved >80% consensus at level 5 (strongly agree) or level 4 (agree) after two votes were included in the guidelines. RESULTS All aspects of care (excluding abdominal trauma) for emergency colorectal conditions have been included along with 122 recommendations for management. CONCLUSION These guidelines provide an up to date and evidence-based summary of the current surgical knowledge in the management of emergency colorectal conditions and should serve as practical text for clinicians managing colorectal conditions in the emergency setting.
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Affiliation(s)
- Andrew S. Miller
- Leicester Royal InfirmaryUniversity Hospitals of Leicester NHS TrustLeicesterUK
| | | | - Benjamin Box
- Northumbria Healthcare Foundation NHS TrustNorth ShieldsUK
| | | | - Sarah E. Duff
- Manchester University NHS Foundation TrustManchesterUK
| | | | | | | | | | | | | | - Phil J. Tozer
- St Mark’s Hospital and Imperial College LondonHarrowUK
| | - Danette Wright
- Western Sydney Local Health DistrictSydneyNew South WalesAustralia
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Arasaradnam RP, Bhala N, Evans C, Greenaway J, Logan R, Penman I, Seward E, Singh B, Smith S, Stephenson JA, Waugh N. Faecal immunochemical testing in the COVID-19 era: balancing risk and costs. Lancet Gastroenterol Hepatol 2020; 5:717-719. [PMID: 32526209 PMCID: PMC7279754 DOI: 10.1016/s2468-1253(20)30185-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Accepted: 05/27/2020] [Indexed: 02/07/2023]
Affiliation(s)
- Ramesh P Arasaradnam
- Department of Gastroenterology, University Hospital Coventry and Warwickshire, Coventry CV2 2DX, UK; Warwick Medical School, University of Warwick, Warwick, UK.
| | - Neeraj Bhala
- Department of Gastroenterology, University Hospital Birmingham Foundation Trust, Birmingham, UK
| | - Charles Evans
- Department of Colorectal Surgery, University Hospital Coventry and Warwickshire, Coventry CV2 2DX, UK
| | - John Greenaway
- Department of Gastroenterology, South Tees NHS Trust, Teesside, UK
| | - Robert Logan
- Department of Gastroenterology, Kings College Hospital, London, UK
| | - Ian Penman
- Department of Gastroenterology, Royal Edinburgh Hospital, Edinburgh, UK
| | - Edward Seward
- Department of Gastroenterology, University College London, London, UK
| | - Baljit Singh
- Department of Colorectal Surgery, University Hospital Leicester NHS Trust, Leicester, UK
| | - Steve Smith
- Midlands and North West NHS England Bowel Cancer Screening Programme Hub, Rugby, UK
| | - James A Stephenson
- Department of Radiology, University Hospital Leicester NHS Trust, Leicester, UK
| | - Norman Waugh
- Warwick Medical School, University of Warwick, Warwick, UK
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8
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Delf J, Jepson S, Ramachandran S, Elabassy M, Morgan B, Kenningham R, Mullineux JH, Stephenson JA. Predictors for 30-day mortality and complications following radiologically inserted gastrostomies: a single centre, large cohort review. Clin Radiol 2020; 75:375-382. [PMID: 32000984 DOI: 10.1016/j.crad.2019.12.020] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2019] [Accepted: 12/23/2019] [Indexed: 11/19/2022]
Abstract
AIM To measure the 30-day mortality and delayed complication rates following radiologically inserted gastrostomy (RIG) placement and determine the predictive risk factors for 30-day mortality and delayed complications to aide pre-procedure informed consent. MATERIALS AND METHODS Retrospective analysis was undertaken of RIG insertions between July 2012 and August 2017 at a single tertiary centre, which included 373 patients (56% male; median age: 65 years, range: 19-92 years). Data were collected from electronic databases on patient demographics, RIG indication, all-cause mortality, complication rates, patient co-morbidities, and biochemical/haematological parameters. Multivariate analysis was performed to identify predictive risk factors for complications and mortality. RESULTS The RIG procedural success rate was 97.9%. The overall 30-day mortality rate was 7.8%; associated with pre-procedural haemoglobin <130 g/l in men (p=0.030, odds ratio [OR] 23.38), white cell count >11×109/l (p=0.001, OR 4.18), C-reactive protein >10 mg/l (p=0.003, OR 10.10) and international normalised ratio (INR) >1.2 (p=0.03, OR 4.63). Inpatient RIG referrals were associated with 10% 30-day mortality; compared to 1.1% for outpatients (p=0.028, OR 9.51). The incidence of immediate and delayed complications was 2.4% and 42.1%, respectively. Neuromuscular disease was associated with gastrostomy dislodgement (p=0.0001, OR 4.99) and fracture (p=0.0009, OR 13.45), cerebrovascular disease with gastrostomy dislodgement (p=0.009, OR 2.51), cardiovascular disease with sepsis 30-days post-RIG (p=0.02, OR 2.94), and diabetes mellitus with gastrostomy dislodgement (p=0.0001, OR 29.45), fracture (p=0.027, OR 5.63) and stoma site infections (p=0.0003, OR 7.16). CONCLUSION RIG 30-day mortality was significantly associated with inpatient procedures compared to outpatient, and a range of biochemical/haematological parameters that suggest infection pre-intervention. It is advised that the markers of infection and catabolism are investigated pre-intervention, which may reduce mortality and complication rates.
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Affiliation(s)
- J Delf
- University Hospitals of Leicester NHS Trust, United Kingdom.
| | - S Jepson
- University Hospitals of Leicester NHS Trust, United Kingdom; Gastrointestinal Imaging Group, Digestive Disease Centre, University Hospitals of Leicester, United Kingdom
| | - S Ramachandran
- University Hospitals of Leicester NHS Trust, United Kingdom
| | - M Elabassy
- University Hospitals of Leicester NHS Trust, United Kingdom; Gastrointestinal Imaging Group, Digestive Disease Centre, University Hospitals of Leicester, United Kingdom
| | - B Morgan
- University Hospitals of Leicester NHS Trust, United Kingdom; Gastrointestinal Imaging Group, Digestive Disease Centre, University Hospitals of Leicester, United Kingdom
| | - R Kenningham
- University Hospitals of Leicester NHS Trust, United Kingdom; Gastrointestinal Imaging Group, Digestive Disease Centre, University Hospitals of Leicester, United Kingdom
| | - J H Mullineux
- University Hospitals of Leicester NHS Trust, United Kingdom; Gastrointestinal Imaging Group, Digestive Disease Centre, University Hospitals of Leicester, United Kingdom
| | - J A Stephenson
- University Hospitals of Leicester NHS Trust, United Kingdom; Gastrointestinal Imaging Group, Digestive Disease Centre, University Hospitals of Leicester, United Kingdom
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9
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Hussain T, Lam V, Farhad M, Lee S, Stephenson JA, Kockelbergh R, Rajesh A. Can subcentimetre ultrasound detected angiomyolipomas be safely disregarded? Clin Radiol 2020; 75:287-292. [PMID: 31916983 DOI: 10.1016/j.crad.2019.12.006] [Citation(s) in RCA: 2] [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] [Received: 07/16/2019] [Accepted: 12/04/2019] [Indexed: 01/20/2023]
Abstract
AIM To optimise follow-up by dismissing lesions on baseline ultrasound (US) if renal lesions conform to US criteria of an angiomyolipoma (AML). METHOD AND MATERIALS The present study was a 10-year retrospective review of patients who were found to have incidental hyperechoic renal lesions on US to ascertain the outcome from subsequent imaging, clinical encounters, and cancer registrations. Exclusions included renal calculi, tuberous sclerosis, Von-Hippel-Lindau, or a known cancer. RESULTS After excluding 39 patients, 1,493 patients were identified. One hundred and sixty had more than one lesion with 87 patients having bilateral lesions. Regardless of indication, 889 patients had subsequent imaging within 5 years (59.5%). The average size of all AMLs was 13.2 mm. In the group with lesions that were <10 mm (807), 438 had imaging follow-up with an average follow-up time of 1.5 years. Mean lesion size in this group was 7 mm, with an average increase of <0.5 mm on follow-up. No lesions were found to be malignant on subsequent imaging nor did any of these patients have a subsequent renal cancer diagnosis registered at local multidisciplinary team meetings. CONCLUSION No incidental subcentimetre hyperechoic renal lesion with imaging characteristics of an AML demonstrated significant growth or developed into a malignancy on follow-up.
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Affiliation(s)
- T Hussain
- Department of Radiology, University Hospitals of Leicester NHS Trust, Leicester General Hospital, Gwendolen Road, Leicester LE5 4PW, UK
| | - V Lam
- Department of Radiology, University Hospitals of Leicester NHS Trust, Leicester General Hospital, Gwendolen Road, Leicester LE5 4PW, UK
| | - M Farhad
- Department of Radiology, University Hospitals of Leicester NHS Trust, Leicester General Hospital, Gwendolen Road, Leicester LE5 4PW, UK
| | - S Lee
- Department of Radiology, University Hospitals of Leicester NHS Trust, Leicester General Hospital, Gwendolen Road, Leicester LE5 4PW, UK
| | - J A Stephenson
- Department of Radiology, University Hospitals of Leicester NHS Trust, Leicester General Hospital, Gwendolen Road, Leicester LE5 4PW, UK
| | - R Kockelbergh
- Department of Urology, University Hospitals of Leicester NHS Trust, Leicester General Hospital, Gwendolen Road, Leicester LE5 4PW, UK
| | - A Rajesh
- Department of Radiology, University Hospitals of Leicester NHS Trust, Leicester General Hospital, Gwendolen Road, Leicester LE5 4PW, UK.
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Ivan CV, Stephenson JA, Shah V, Sandrasegaran K, Rajesh A. An Update on Acute Pancreatitis. Journal of Gastrointestinal and Abdominal Radiology 2020. [DOI: 10.1055/s-0040-1701366] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
Abstract
AbstractIn recent years, there have been further advances in understanding of the acute pancreatic inflammation and its complications. Among these are emerging concepts such as peripancreatic necrosis and main duct injury secondary to necrotizing pancreatitis. To remain relevant to the clinical teams, radiologists need to be aware of these advances in knowledge and their reports should provide key points of information that may impact patient management. This article provides an up to date review of acute pancreatitis.
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Affiliation(s)
- Catalin V. Ivan
- Gastrointestinal Imaging Group, Department of Radiology, University Hospitals of Leicester, Leicester General Hospital, Leicester, United Kingdom
| | - James A. Stephenson
- Gastrointestinal Imaging Group, Department of Radiology, University Hospitals of Leicester, Leicester General Hospital, Leicester, United Kingdom
| | - Vikas Shah
- Gastrointestinal Imaging Group, Department of Radiology, University Hospitals of Leicester, Leicester General Hospital, Leicester, United Kingdom
| | - Kumaresan Sandrasegaran
- Department of Radiology, University of Cincinnati Medical Center, Cincinnati, Ohio United States
- Department of Radiology, Mayo College of Medicine Phoenix, Arizona, United States
| | - Arumugam Rajesh
- Gastrointestinal Imaging Group, Department of Radiology, University Hospitals of Leicester, Leicester General Hospital, Leicester, United Kingdom
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Stephenson JA, Hudson S, Siddiqui S, Delf J, Verma R. Concordance between ultrasound and MRCP – does it matter who performs the ultrasound? Clin Radiol 2019. [DOI: 10.1016/j.crad.2019.09.011] [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: 11/15/2022]
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Wu Y, Das B, Al-Kaiem M, Shah V, Verma R, Stephenson JA. Emergency CT for acute non-traumatic abdominal pain: does sub-specialist GI radiologist reporting reduce discrepancy rates? Clin Radiol 2019. [DOI: 10.1016/j.crad.2019.09.004] [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: 11/27/2022]
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Lee S, Hudson SR, Ivan CV, Hussain T, Verma R, Rajesh A, Stephenson JA. Lumps and Bumps of the Abdominal Wall and Lumbar Region—Part 1: Hernias, What the Radiologist Should Know. Journal of Gastrointestinal and Abdominal Radiology 2019. [DOI: 10.1055/s-0038-1676156] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
Abstract
AbstractAbdominal hernias represent common conditions and occur when a structure of the abdominal cavity protrudes through a defect in the abdominal wall. Recently, there has been an increase in demand from the clinical teams to confirm the clinical suspicion of an abdominal wall hernia, and to assess preoperatively large or complex hernias through imaging. This pictorial review aims to present the different appearances of abdominal wall and lumbar region hernias on imaging.
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Affiliation(s)
- Sangoh Lee
- Gastrointestinal Imaging Group, Department of Radiology, University Hospitals of Leicester NHS Trust, Leicester General Hospital, Leicester, United Kingdom
| | - Sarah R. Hudson
- Gastrointestinal Imaging Group, Department of Radiology, University Hospitals of Leicester NHS Trust, Leicester General Hospital, Leicester, United Kingdom
| | - Catalin V. Ivan
- Gastrointestinal Imaging Group, Department of Radiology, University Hospitals of Leicester NHS Trust, Leicester General Hospital, Leicester, United Kingdom
| | - Tahir Hussain
- Gastrointestinal Imaging Group, Department of Radiology, University Hospitals of Leicester NHS Trust, Leicester General Hospital, Leicester, United Kingdom
| | - Ratan Verma
- Gastrointestinal Imaging Group, Department of Radiology, University Hospitals of Leicester NHS Trust, Leicester General Hospital, Leicester, United Kingdom
| | - Arumugam Rajesh
- Gastrointestinal Imaging Group, Department of Radiology, University Hospitals of Leicester NHS Trust, Leicester General Hospital, Leicester, United Kingdom
| | - James A. Stephenson
- Gastrointestinal Imaging Group, Department of Radiology, University Hospitals of Leicester NHS Trust, Leicester General Hospital, Leicester, United Kingdom
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Lee S, Ivan CV, Hudson SR, Hussain T, Gaba S, Verma R, Rajesh A, Stephenson JA. Lumps and Bumps of the Abdominal Wall and Lumbar Region—Part 2: Beyond Hernias. Journal of Gastrointestinal and Abdominal Radiology 2018. [DOI: 10.1055/s-0038-1676256] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
Abstract
AbstractAbdominal masses can often clinically mimic hernias, especially when they are located close to hernial orifices. Imaging findings can be challenging and nonspecific with numerous differential diagnoses. We present a variety of pathology involving the abdominal wall and lumbar region, which were referred as possible hernias. This demonstrates the wide-ranging pathology that can present as abdominal wall lesions or mimics of hernias that the radiologist should be alert to.
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Affiliation(s)
- Sangoh Lee
- Department of Radiology, University Hospitals of Leicester, Leicester General Hospital, Leicester, United Kingdom
| | - Catalin V. Ivan
- Department of Radiology, University Hospitals of Leicester, Leicester General Hospital, Leicester, United Kingdom
| | - Sarah R. Hudson
- Department of Radiology, University Hospitals of Leicester, Leicester General Hospital, Leicester, United Kingdom
| | - Tahir Hussain
- Department of Radiology, University Hospitals of Leicester, Leicester General Hospital, Leicester, United Kingdom
| | - Suchi Gaba
- Department of Radiology, University Hospitals of North Midlands, Royal Stoke University Hospital, Stoke-on-Trent, United Kingdom
| | - Ratan Verma
- Department of Radiology, University Hospitals of Leicester, Leicester General Hospital, Leicester, United Kingdom
| | - Arumugam Rajesh
- Department of Radiology, University Hospitals of Leicester, Leicester General Hospital, Leicester, United Kingdom
| | - James A. Stephenson
- Department of Radiology, University Hospitals of Leicester, Leicester General Hospital, Leicester, United Kingdom
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15
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Stephenson JA, Pancholi J, Ivan CV, Mullineux JH, Patel H, Verma R, Elabassy M. Straight-to-test faecal tagging CT colonography for exclusion of colon cancer in symptomatic patients under the English 2-week-wait cancer investigation pathway: a service review. Clin Radiol 2018; 73:836.e1-836.e7. [PMID: 29970243 DOI: 10.1016/j.crad.2018.05.013] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2018] [Accepted: 05/09/2018] [Indexed: 11/24/2022]
Abstract
AIM To present the initial 12 months of data of a straight-to-test (STT) computed tomography colonography (CTC) protocol as the first-line investigation for change in bowel habit (CIBH) and iron deficiency anaemia (IDA) in patients over 60 referred directly from primary care. MATERIALS AND METHODS In 12 months, 1,792 STT CTC for IDA and CIBH were performed. No colonoscopies were performed as the primary investigation in this cohort. Data from this cohort were gathered prospectively. RESULTS The colorectal cancer (CRC) detection rate was 4.9% and polyp detection rate was 13.5%. The CRC rate increased related to age (p=0.001), the CRC detection rate was 2.6% in patients aged 60-69 years, compared to 4.9%, 7.4%, and 11.4% in the 70-79, 80-89, and >90 years age groups. The CRC rate was higher in patients with IDA compared to CIBH (6.8% versus 3.9%, p=0.017). There were significantly more left-sided cancers (p=0.0165). Non-colonic cancers were found in 4.3% of patients and 6.8% had incidental findings that required further investigation and 11.9% had a new, potentially significant, incidental finding. CONCLUSION These results are comparable to colonoscopy in terms of diagnostic accuracy and similar to those of CTC in published multicentre trials. This exciting model of care within radiology enables earlier testing, reduces waiting times, with fewer outpatient appointments, and results in good clinician and patient satisfaction.
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Affiliation(s)
- J A Stephenson
- Gastrointestinal Imaging Group, Department of Radiology, University Hospitals of Leicester, Leicester General Hospital, Leicester LE5 4PW, UK
| | - J Pancholi
- Gastrointestinal Imaging Group, Department of Radiology, University Hospitals of Leicester, Leicester General Hospital, Leicester LE5 4PW, UK
| | - C V Ivan
- Gastrointestinal Imaging Group, Department of Radiology, University Hospitals of Leicester, Leicester General Hospital, Leicester LE5 4PW, UK
| | - J H Mullineux
- Gastrointestinal Imaging Group, Department of Radiology, University Hospitals of Leicester, Leicester General Hospital, Leicester LE5 4PW, UK
| | - H Patel
- Gastrointestinal Imaging Group, Department of Radiology, University Hospitals of Leicester, Leicester General Hospital, Leicester LE5 4PW, UK
| | - R Verma
- Gastrointestinal Imaging Group, Department of Radiology, University Hospitals of Leicester, Leicester General Hospital, Leicester LE5 4PW, UK
| | - M Elabassy
- Gastrointestinal Imaging Group, Department of Radiology, University Hospitals of Leicester, Leicester General Hospital, Leicester LE5 4PW, UK.
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Ivan CV, Mullineux JH, Shah V, Verma R, Rajesh A, Stephenson JA. Peripheral vision: abdominal pathology missed outside the centre of gaze. Br J Radiol 2018; 91:20180142. [PMID: 29927632 DOI: 10.1259/bjr.20180142] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Radiology misses have been the subject of much debate on both sides of the Atlantic in recent years. There is now greater focus in trying to reduce radiology errors by continuous education and changing the working environment to try and protect the radiologist, and ultimately the patient from potential harm. Duty of candour is a relevant and sensitive area. Developing robust validated reporting pathways within the healthcare structure is very important so as to encourage a "learning from discrepancies" culture and to put the patient and their families at the center of reporting and acknowledging errors in radiology. Having reflected in our daily practice and while writing this pictorial review, we have concluded that during reporting MRI scans, routine assessment of the localizer images, focusing outside the area of interest and having a more structured approach to image interrogation are key actions which may help reduce the number of omissions. We present a myriad of cases where pathology was "missed" outside the center of gaze in relation to the abdomen or outside the abdomen on abdominal MRI, and suggest key high yield sequence related review areas to minimize the chance of missing potentially significant pathology.
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Affiliation(s)
- Catalin Vasile Ivan
- 1 Department of Radiology, Gastrointestinal Imaging Group, University Hospitals of Leicester, Leicester General Hospital , Leicester , UK
| | - Joseph H Mullineux
- 1 Department of Radiology, Gastrointestinal Imaging Group, University Hospitals of Leicester, Leicester General Hospital , Leicester , UK
| | - Vikas Shah
- 1 Department of Radiology, Gastrointestinal Imaging Group, University Hospitals of Leicester, Leicester General Hospital , Leicester , UK
| | - Ratan Verma
- 1 Department of Radiology, Gastrointestinal Imaging Group, University Hospitals of Leicester, Leicester General Hospital , Leicester , UK
| | - Arumugam Rajesh
- 1 Department of Radiology, Gastrointestinal Imaging Group, University Hospitals of Leicester, Leicester General Hospital , Leicester , UK
| | - James A Stephenson
- 1 Department of Radiology, Gastrointestinal Imaging Group, University Hospitals of Leicester, Leicester General Hospital , Leicester , UK
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Mullineux JH, Ivan CV, Pancholi J, Verma R, Rajesh A, Verma S, Stephenson JA. Benign Sclerosing and Fibrosing Conditions of the Abdomen and Their Potential Mimics. J Clin Imaging Sci 2018; 8:21. [PMID: 29963328 PMCID: PMC5998607 DOI: 10.4103/jcis.jcis_19_18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2018] [Accepted: 04/18/2018] [Indexed: 11/07/2022] Open
Abstract
The process of abnormal reparative or reactive processes in the abdominal cavity, can lead to sclerosis and fibrous deposition. The relatively recent discovery of an IgG4 subgroup of immune mediated sclerosing disease 1,2 has thrown some light on the pathophysiology of these conditions. Firstly, our pictorial review aims to describe imaging findings to enhance the general radiologist's recognition and interpretation of this varied group of benign sclerotic and fibrotic abdominal processes. Secondly, along with the imaging findings, we bring into discussion the potential mimics of these pathologic processes to minimise interpretational errors. Moreover, some of the mimics of these processes are in the spectrum of malignant disease. Most importantly, to ensure a correct diagnosis thorough clinical and histopathological assessment are required to support the imaging findings presented in this review.
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Affiliation(s)
- Joseph H Mullineux
- Department of Radiology, Gastrointestinal Imaging Group, University Hospitals of Leicester, Leicester General Hospital, Leicester, LE5 4PW, UK
| | - Catalin V Ivan
- Department of Radiology, Gastrointestinal Imaging Group, University Hospitals of Leicester, Leicester General Hospital, Leicester, LE5 4PW, UK
| | - Jay Pancholi
- Department of Radiology, Gastrointestinal Imaging Group, University Hospitals of Leicester, Leicester General Hospital, Leicester, LE5 4PW, UK
| | - Ratan Verma
- Department of Radiology, Gastrointestinal Imaging Group, University Hospitals of Leicester, Leicester General Hospital, Leicester, LE5 4PW, UK
| | - Arumugam Rajesh
- Department of Radiology, Gastrointestinal Imaging Group, University Hospitals of Leicester, Leicester General Hospital, Leicester, LE5 4PW, UK
| | - Sadhna Verma
- Department of Radiology, University of Cincinnati Medical Center, Cincinnati, Ohio, USA
| | - James A Stephenson
- Department of Radiology, Gastrointestinal Imaging Group, University Hospitals of Leicester, Leicester General Hospital, Leicester, LE5 4PW, UK
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Al-Leswas D, Eltweri AM, Chung WY, Arshad A, Stephenson JA, Al-Taan O, Pollard C, Fisk HL, Calder PC, Garcea G, Metcalfe MS, Dennison AR. Intravenous omega-3 fatty acids are associated with better clinical outcome and less inflammation in patients with predicted severe acute pancreatitis: A randomised double blind controlled trial. Clin Nutr 2018; 39:2711-2719. [PMID: 32921364 DOI: 10.1016/j.clnu.2018.04.003] [Citation(s) in RCA: 9] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2017] [Revised: 02/08/2018] [Accepted: 04/02/2018] [Indexed: 02/07/2023]
Abstract
BACKGROUND AND AIMS Omega-3 fatty acids (FA) can ameliorate the hyper-inflammatory response that occurs in conditions such as severe acute pancreatitis (SAP) and this may improve clinical outcome. We tested the hypothesis that parenteral omega-3 FA from a lipid emulsion that includes fish oil could be beneficial in patients with predicted SAP by reducing C-reactive protein (CRP) concentration (primary outcome), and modulating the inflammatory response and improving clinical outcome (secondary outcomes). METHODS In a phase II randomized double-blind single-centre controlled trial, patients with predicted SAP were randomised to receive a daily infusion of fish oil containing lipid emulsion (Lipidem® 20%, BBraun) for 7 days (n = 23) or a daily infusion of a lipid emulsion without fish oil (Lipofundin® MCT 20%, BBraun) (n = 22). RESULTS On admission, both groups had comparable pancreatitis predicted severity and APACHE II scores. Administration of fish oil resulted in lower total blood leukocyte number (P = 0.04), CRP (P = 0.013), interleukin-8 (P = 0.05) and intercellular adhesion molecule 1 (P = 0.01) concentrations, multiple organ dysfunction score, sequential organ failure assessment score (P = 0.004), early warning score (P = 0.01), and systemic inflammatory response syndrome (P = 0.03) compared to the control group. The fish oil group had fewer new organ failures (P = 0.07), lower critical care admission rate (P = 0.06), shorter critical care stay (P = 0.03) and shorter total hospital stay (P = 0.04). CONCLUSIONS It is concluded that intravenous administration of a fish oil containing lipid emulsion, a source of omega-3 FA, improves clinical outcomes in patients with predicted SAP, benefits that may be linked to reduced inflammation. CLINICALTRIALS. GOV NUMBER NCT01745861. EU CLINICAL TRIALS REGISTER EudraCT (2010-018660-16).
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Affiliation(s)
- D Al-Leswas
- Department of Surgery, University Hospitals of Leicester NHS Trust, Leicester LE1 5WW, UK.
| | - A M Eltweri
- Department of Surgery, University Hospitals of Leicester NHS Trust, Leicester LE1 5WW, UK
| | - W-Y Chung
- Department of Surgery, University Hospitals of Leicester NHS Trust, Leicester LE1 5WW, UK
| | - A Arshad
- Department of Surgery, University Hospitals of Leicester NHS Trust, Leicester LE1 5WW, UK
| | - J A Stephenson
- Department of Surgery, University Hospitals of Leicester NHS Trust, Leicester LE1 5WW, UK
| | - O Al-Taan
- Department of Surgery, University Hospitals of Leicester NHS Trust, Leicester LE1 5WW, UK
| | - C Pollard
- Department of Surgery, University Hospitals of Leicester NHS Trust, Leicester LE1 5WW, UK
| | - H L Fisk
- Human Development and Health Academic Unit, Faculty of Medicine, University of Southampton, Southampton SO16 6YD, UK
| | - P C Calder
- Human Development and Health Academic Unit, Faculty of Medicine, University of Southampton, Southampton SO16 6YD, UK; NIHR Southampton Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust and University of Southampton, Southampton SO16 6YD, UK
| | - G Garcea
- Department of Surgery, University Hospitals of Leicester NHS Trust, Leicester LE1 5WW, UK; Department of Cancer Studies, University of Leicester, Leicester, LE1 7RH, UK
| | - M S Metcalfe
- Department of Surgery, University Hospitals of Leicester NHS Trust, Leicester LE1 5WW, UK; Department of Cancer Studies, University of Leicester, Leicester, LE1 7RH, UK
| | - A R Dennison
- Department of Surgery, University Hospitals of Leicester NHS Trust, Leicester LE1 5WW, UK; Department of Cancer Studies, University of Leicester, Leicester, LE1 7RH, UK
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Ivan CV, Mullineux JH, Verma R, Shah V, De A, Elabassy M, Rajesh A, Stephenson JA. Reply to Akingboye et al. Colorectal Dis 2018; 20:76-77. [PMID: 29027365 DOI: 10.1111/codi.13916] [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: 10/03/2017] [Accepted: 10/03/2017] [Indexed: 02/08/2023]
Affiliation(s)
- C V Ivan
- Gastrointestinal Imaging Group, Department of Radiology, University Hospitals of Leicester, Leicester General Hospital, Leicester, UK
| | - J H Mullineux
- Gastrointestinal Imaging Group, Department of Radiology, University Hospitals of Leicester, Leicester General Hospital, Leicester, UK
| | - R Verma
- Gastrointestinal Imaging Group, Department of Radiology, University Hospitals of Leicester, Leicester General Hospital, Leicester, UK
| | - V Shah
- Gastrointestinal Imaging Group, Department of Radiology, University Hospitals of Leicester, Leicester General Hospital, Leicester, UK
| | - A De
- Gastrointestinal Imaging Group, Department of Radiology, University Hospitals of Leicester, Leicester General Hospital, Leicester, UK
| | - M Elabassy
- Gastrointestinal Imaging Group, Department of Radiology, University Hospitals of Leicester, Leicester General Hospital, Leicester, UK
| | - A Rajesh
- Gastrointestinal Imaging Group, Department of Radiology, University Hospitals of Leicester, Leicester General Hospital, Leicester, UK
| | - J A Stephenson
- Gastrointestinal Imaging Group, Department of Radiology, University Hospitals of Leicester, Leicester General Hospital, Leicester, UK
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Morrow CE, Bryan CJ, Stephenson JA, Bryan AO, Haskell J, Staal M. Posttraumatic Stress, Depression, and Insomnia Among U.S. Air Force Pararescuemen. Military Psychology 2017. [DOI: 10.1037/mil0000021] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Affiliation(s)
| | - Craig J. Bryan
- National Center for Veterans Studies, Salt Lake City, Utah and Department of Psychology, University of Utah
| | | | - AnnaBelle O. Bryan
- National Center for Veterans Studies, Salt Lake City, Utah and Department of Social and Behavioral Science, University of Utah
| | | | - Mark Staal
- Pope Army Air Field, Fayetteville, North Carolina
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Ivan CV, Mullineux JH, Verma R, Shah V, De A, Elabassy M, Rajesh A, Stephenson JA. Assessment of the inferior mesenteric vein diameter as a surrogate marker to evaluate response to neoadjuvant chemoradiotherapy for locally advanced rectal adenocarcinoma. Colorectal Dis 2017; 19:1076-1080. [PMID: 28696522 DOI: 10.1111/codi.13811] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [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: 01/10/2017] [Accepted: 05/17/2017] [Indexed: 02/08/2023]
Abstract
AIM Neoadjuvant chemoradiotherapy for locally advanced rectal cancer aims to downstage prior to definitive management. Repeat imaging assessment of the tumour post-therapy has implications for treatment. Our aim was to assess if the inferior mesenteric vein (IMV) diameter measured on CT can be used as a surrogate marker for evaluation of tumour response to neoadjuvant treatment. METHOD IMV diameter was assessed in patients with and without locally advanced rectal cancer, pre- and post-radiotherapy, to ascertain if IMV diameter is a surrogate marker of tumour response. RESULTS IMV diameter was 5.9 mm in patients with rectal cancer vs 4.7 mm in patients without (P = 0.0001). The baseline IMV diameter was significantly higher for cases with local lymphadenopathy [N0 5.2 mm vs N1/2 6 mm (P = 0.0059)] and extramural venous invasion (EMVI) [negative 5.4 mm vs positive 6.4 mm (P = 0.0001)]. Post-radiotherapy there was a significant decrease in the IMV diameter in cases with treatment response compared to non-responders: the percentage change in IMV diameter was a 17.54% decrease vs 1.39% increase (P = 0.0001). These results were reproduced on comparing between magnetic resonance tumour regression grades using ANOVA (P = 0.0001). There was also a significant decrease in IMV diameter when assessing lymph node (LN) and EMVI response vs non-responders (P = 0.0001 and 0.0001 respectively). CONCLUSION Patients with rectal cancer have a dilated IMV compared with patients without rectal cancer. We confirm that IMV diameter is a potential surrogate marker of LN status and EMVI at baseline. IMV diameter is also a marker of tumour, LN and EMVI response to chemoradiotherapy.
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Affiliation(s)
- C V Ivan
- Gastrointestinal Imaging Group, Department of Radiology, University Hospitals of Leicester, Leicester General Hospital, Leicester, UK
| | - J H Mullineux
- Gastrointestinal Imaging Group, Department of Radiology, University Hospitals of Leicester, Leicester General Hospital, Leicester, UK
| | - R Verma
- Gastrointestinal Imaging Group, Department of Radiology, University Hospitals of Leicester, Leicester General Hospital, Leicester, UK
| | - V Shah
- Gastrointestinal Imaging Group, Department of Radiology, University Hospitals of Leicester, Leicester General Hospital, Leicester, UK
| | - A De
- Gastrointestinal Imaging Group, Department of Radiology, University Hospitals of Leicester, Leicester General Hospital, Leicester, UK
| | - M Elabassy
- Gastrointestinal Imaging Group, Department of Radiology, University Hospitals of Leicester, Leicester General Hospital, Leicester, UK
| | - A Rajesh
- Gastrointestinal Imaging Group, Department of Radiology, University Hospitals of Leicester, Leicester General Hospital, Leicester, UK
| | - J A Stephenson
- Gastrointestinal Imaging Group, Department of Radiology, University Hospitals of Leicester, Leicester General Hospital, Leicester, UK
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Morgan B, Stephenson JA, Griffin Y. Minimising the impact of errors in the interpretation of CT images for surveillance and evaluation of therapy in cancer. Clin Radiol 2016; 71:1083-94. [PMID: 27522436 DOI: 10.1016/j.crad.2016.07.001] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2016] [Revised: 06/22/2016] [Accepted: 07/01/2016] [Indexed: 12/18/2022]
Abstract
Radiological error is inevitable and usually multifactorial. Error can be secondary to radiologist-specific causes, including cognitive and perceptive errors or ambiguity of report, or system-related causes, including inadequate, misleading, or incorrect clinical information, poor imaging technique, excessive workload, and poor working conditions. In this paper, we discuss a systematic approach to reduce errors in oncological radiology reporting, thus reducing risk to the patient. Rather than attempt to discuss all types of error, we concentrate on the most important and commonly occurring errors that we have encountered over 20 years of practice, based on weekly discrepancy reviews of our practice and independent reviews of clinical and research imaging from other institutions. This review focuses on computed tomography (CT) reporting for staging, surveillance, and response assessment of cancer patients, but the messages apply to all imaging methods.
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Affiliation(s)
- B Morgan
- University of Leicester Imaging Department, Department of Radiology, Leicester Royal Infirmary, Leicester, LE1 5WW, UK.
| | - J A Stephenson
- Department of Radiology, University Hospitals of Leicester, Leicester Royal Infirmary, Infirmary Square, Leicester, LE1 5WW, UK
| | - Y Griffin
- Department of Radiology, University Hospitals of Leicester, Leicester Royal Infirmary, Infirmary Square, Leicester, LE1 5WW, UK
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Aslam MI, Mykoniatis I, Mann C, Stephenson JA, Verma R, Chaudhri S, Singh B. Dynamic MRI to assess pelvic floor reconstruction with Strattice mesh after extralevator abdominoperineal excision for rectal cancer--a video vignette. Colorectal Dis 2016; 18:313-4. [PMID: 26663586 DOI: 10.1111/codi.13235] [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: 08/17/2015] [Accepted: 10/25/2015] [Indexed: 02/08/2023]
Affiliation(s)
- M I Aslam
- Department of Colorectal Surgery, University Hospitals of Leicester NHS Trust, Leicester General Hospital, Gwendoline Road, Leicester, LE5 4PW, UK.
| | - I Mykoniatis
- Department of Colorectal Surgery, University Hospitals of Leicester NHS Trust, Leicester General Hospital, Gwendoline Road, Leicester, LE5 4PW, UK
| | - C Mann
- Department of Colorectal Surgery, University Hospitals of Leicester NHS Trust, Leicester General Hospital, Gwendoline Road, Leicester, LE5 4PW, UK
| | - J A Stephenson
- Department of Radiology, University Hospitals of Leicester NHS Trust, Leicester General Hospital, Gwendoline Road, Leicester, LE5 4PW, UK
| | - R Verma
- Department of Radiology, University Hospitals of Leicester NHS Trust, Leicester General Hospital, Gwendoline Road, Leicester, LE5 4PW, UK
| | - S Chaudhri
- Department of Colorectal Surgery, University Hospitals of Leicester NHS Trust, Leicester General Hospital, Gwendoline Road, Leicester, LE5 4PW, UK
| | - B Singh
- Department of Colorectal Surgery, University Hospitals of Leicester NHS Trust, Leicester General Hospital, Gwendoline Road, Leicester, LE5 4PW, UK
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O'Neill T, Stephenson JA, Das B, Verma R. Quality assurance (QA) of computed tomography colonography (CTC) for the bowel cancer screening program (BCSP). Clin Radiol 2015. [DOI: 10.1016/j.crad.2015.06.059] [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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Stephenson JA, Shah V. The social media experiment. What is the name of a fifth metacarpal (MC) neck fracture? Clin Radiol 2015. [DOI: 10.1016/j.crad.2015.06.023] [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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Hussain T, Stephenson JA, Naqvi SG, Verma R, Barnes D. Unprovoked venous thromboembolism (VTE) – are we over investigating? Clin Radiol 2015. [DOI: 10.1016/j.crad.2015.06.049] [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: 11/28/2022]
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Bryan CJ, Wolfe AL, Morrow CE, Stephenson JA, Haskell J, Bryan AO. Associations Among Back and Extremity Pain With Alcohol, Tobacco, and Caffeine Use Among US Air Force Pararescuemen. J Spec Oper Med 2015; 15:66-71. [PMID: 26360356 DOI: 10.55460/azl6-zqy7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 09/01/2015] [Indexed: 06/05/2023]
Abstract
BACKGROUND Caffeine, tobacco, and alcohol are the most widely used substances globally, but the majority of research on the associations among legal substance use and physical health has focused on the general population, not elite military personnel. The purpose of the current study was to describe patterns of tobacco, alcohol, and caffeine use and to examine the relationship of legal substance use with self-reported physical health complaints among US Air Force Pararescuemen (PJs) and Combat Rescue Officers (CROs). METHODS Participants were 196 US PJs and CROs. Participants completed self-report measures of legal drug use and somatic symptoms. Generalized linear modeling with robust maximum likelihood estimation was used for multivariate regression analyses. Chi-square analyses were conducted for univariate comparisons of categorical variables. RESULTS Reported rates of tobacco use (28.2%), alcohol consumption (83.2%), and regular caffeine consumption (88.8%) were similar to the general population. Daily caffeine intake was significantly higher among participants reporting they were bothered a lot by back pain [Wald χ2(2)=11.39; ρ=.003] and extremity pain [Wald χ2(2)=11.39; ρ=.003], even when controlling for age and deployment history. Participants with severe extremity pain also reported drinking approximately twice as many alcoholic beverages per week (mean, 5.46; standard error [SE], 0.91) than participants who were bothered a little (mean, 2.88; SE, 0.54) or not bothered at all (mean, 2.88; SE, 0.52) by extremity pain. CONCLUSION Back and extremity pain is associated with greater caffeine and alcohol consumption among PJs.
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Abstract
Endoscopic mucosal resection is commonly the treatment regime of choice for large sessile colonic polyps. We describe the computed tomography findings of a 51 year old female who presented with transient severe abdominal pain without systemic upset post endoscopic mucosal polyp resection, which resolved with conservative management. This is the second case in the literature that demonstrates 'normal' appearances post endoscopic mucosal resection. The clinical team and radiologist need to be aware of these findings when making management decisions in patients who present with acute pain post endoscopic mucosal resection.
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Affiliation(s)
- James A Stephenson
- Department of Imaging, University Hospitals of Leicester, Leicester Royal Infirmary, Leicester, UK
| | - Jonathan Crookdake
- Department of Imaging, University Hospitals of Leicester, Leicester Royal Infirmary, Leicester, UK
| | - Steven Jepson
- Department of Imaging, University Hospitals of Leicester, Leicester Royal Infirmary, Leicester, UK
| | - Peter Wurm
- Digestive Disease Centre, University Hospitals of Leicester, Leicester Royal Infirmary, Leicester, UK
| | - Mosheir Elabassy
- Department of Imaging, University Hospitals of Leicester, Leicester Royal Infirmary, Leicester, UK
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Armstrong EL, Bryan CJ, Stephenson JA, Bryan AO, Morrow CE. Warzone stressor exposure, unit support, and emotional distress among U.S. Air force pararescuemen. J Spec Oper Med 2014; 14:26-34. [PMID: 24952037 DOI: 10.55460/p7z9-e8lw] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 06/01/2014] [Indexed: 06/03/2023]
Abstract
OBJECTIVES Combat exposure is associated with increased mental health symptom severity among military personnel, whereas unit support is associated with decreased severity. However, to date no studies have examined these relationships among U.S. Air Force pararescuemen (PJs), who have a unique and specialized career field that serves in both medical and combatant capacities. DESIGN Cross-sectional self-report survey. METHODS Self-reported survey data regarding depression symptoms, posttraumatic stress disorder (PTSD) symptoms, perceived unit support, and exposure to traditional combat experiences (e.g., firefights) and medical consequences of combat (e.g., injuries and human remains) were collected from 194 PJs in seven rescue squadrons. RESULTS Levels of combat exposure were compared with previously published findings from combat units, and levels of medical exposure were compared with previously published findings among military medical professionals. Medical exposure intensity showed a stronger relationship with PTSD severity (?=.365, p=.018) than with combat exposure intensity (?=.136, p=.373), but neither combat nor medical exposure was associated with depression severity (?s<.296, ps>.164). Unit support was associated with less severe PTSD (?=?.402, p<.001) and depression (?=?.259, p=.062) symptoms and did not moderate the effects of combat or medical exposure. CONCLUSIONS Medical stressors contribute more to PTSD among PJs than do traditional combat stressors. Unit support is associated with reduced PTSD and depression severity regardless of intensity of warzone exposure among PJs.
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Stephenson JA, Al-Taan O, Arshad A, West AL, Calder PC, Morgan B, Metcalfe MS, Dennison AR. Unsaturated fatty acids differ between hepatic colorectal metastases and liver tissue without tumour in humans: results from a randomised controlled trial of intravenous eicosapentaenoic and docosahexaenoic acids. Prostaglandins Leukot Essent Fatty Acids 2013; 88:405-10. [PMID: 23647811 DOI: 10.1016/j.plefa.2013.04.002] [Citation(s) in RCA: 3] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2013] [Revised: 03/28/2013] [Accepted: 04/02/2013] [Indexed: 10/26/2022]
Abstract
INTRODUCTION Mediators derived from the n-6 polyunsaturated fatty acid (PUFA) arachidonic acid oxidation have been shown to have tumour promoting effects in experimental models, while n-3 PUFAs are thought to be protective. Here we report fatty acid concentrations in hepatic colorectal metastases compared to liver tissue without tumour in humans. METHODS Twenty patients with colorectal liver metastasis were randomized to receive a 72 h infusion of parenteral nutrition with or without n-3 PUFAs. Histological samples from liver metastases and liver tissue without tumour were obtained from 15 patients at the time of their subsequent liver resection (mean 8 days (range 4-12) post-infusion) and the fatty acid composition determined by gas chromatography. RESULTS There were no significant differences in fatty acid composition between the two intervention groups. When data from all patients were combined, liver tissue without tumour had a higher content of both n-3 and n-6 PUFAs and a lower content of oleic acid and total n-9 fatty acids compared with tumour tissue (p<0.0001, 0.0002,<0.0001 and <0.0001, respectively). The n-6/n-3 PUFA ratio was found to be higher in tumour tissue than tissue without tumour (p<0.0001). CONCLUSIONS Hepatic colorectal adenocarcinoma metastases have a higher content of n-9 fatty acids and a lower content of n-6 and n-3 PUFAs than liver tissue without tumour.
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Affiliation(s)
- James A Stephenson
- Department of Imaging, University Hospitals of Leicester NHS Trust, Gwendolen Road, Leicester LE5 4PW, United Kingdom.
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Al-Taan O, Stephenson JA, Spencer L, Pollard C, West AL, Calder PC, Metcalfe M, Dennison AR. Changes in plasma and erythrocyte omega-6 and omega-3 fatty acids in response to intravenous supply of omega-3 fatty acids in patients with hepatic colorectal metastases. Lipids Health Dis 2013; 12:64. [PMID: 23648075 PMCID: PMC3659039 DOI: 10.1186/1476-511x-12-64] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2013] [Accepted: 05/03/2013] [Indexed: 12/15/2022] Open
Abstract
Background Eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) are functionally the most important omega-3 polyunsaturated fatty acids (PUFAs). Oral supply of these fatty acids increases their levels in plasma and cell membranes, often at the expense of the omega-6 PUFAs arachidonic acid (ARA) and linoleic acid. This results in an altered pattern of lipid mediator production to one which is less pro-inflammatory. We investigated whether short term intravenous supply of omega-3 PUFAs could change the levels of EPA, DHA, ARA and linoleic acid in plasma and erythrocytes in patients with hepatic colorectal metastases. Methods Twenty patients were randomised to receive a 72 hour infusion of total parenteral nutrition with (treatment group) or without (control group) omega-3 PUFAs. EPA, DHA, ARA and linoleic acid were measured in plasma phosphatidylcholine (PC) and erythrocytes at several times points up to the end of infusion and 5 to 12 days (mean 9 days) after stopping the infusion. Results The treatment group showed increases in plasma PC EPA and DHA and erythrocyte EPA and decreases in plasma PC and erythrocyte linoleic acid, with effects most evident late in the infusion period. Plasma PC and erythrocyte EPA and linoleic acid all returned to baseline levels after the 5–12 day washout. Plasma PC DHA remained elevated above baseline after washout. Conclusions Intravenous supply of omega-3 PUFAs results in a rapid increase of EPA and DHA in plasma PC and of EPA in erythrocytes. These findings suggest that infusion of omega-3 PUFAs could be used to induce a rapid effect especially in targeting inflammation. Trial registration http://www.clinicaltrials.gov identifier NCT00942292
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Affiliation(s)
- Omer Al-Taan
- Human Development and Health Academic Unit, Faculty of Medicine, University of Southampton, Southampton General Hospital, Tremona Road, Southampton, United Kingdom
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Stephenson JA, Green CA, Bukhari SS, Griffiths TRL. Changing antibiotic prophylaxis for transrectal ultrasound-guided prostate biopsies: are we putting our patients at risk? BJU Int 2011; 108:E155. [PMID: 21794057 DOI: 10.1111/j.1464-410x.2011.10536_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: 11/28/2022]
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Stephenson JA, Gravante G, Butler NA, Sorge R, Sayers RD, Bown MJ. The Systemic Inflammatory Response Syndrome (SIRS)--number and type of positive criteria predict interventions and outcomes in acute surgical admissions. World J Surg 2011; 34:2757-64. [PMID: 20628742 DOI: 10.1007/s00268-010-0709-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Systemic inflammatory response syndrome (SIRS) is a syndrome that reflects the widespread activation of inflammatory pathways. The goal of this study was to find whether the presence or absence of SIRS on emergency surgical admissions is related to the subsequent clinical outcome in terms of in-hospital interventions, length of stay, and mortality. METHODS The presence of SIRS at admission, final diagnosis of the underlying disease, treatments, and clinical outcomes were prospectively recorded for 1 month. Comparisons of interventions and outcomes were performed between SIRS+ vs. SIRS- patients. In patients with SIRS, the contribution of each positive criterion was evaluated with regards to mortality. RESULTS A total of 179 patients were recruited. The prevalence of SIRS at admission was 35.2%. SIRS+ patients required less diagnostic procedures compared with SIRS- (28.6% vs. 34.5%) but had more therapeutic interventions (39.7% vs. 16.4%), surgical interventions (33.3% vs. 3.4%), intensive treatments (11.1% vs. 0.9%; p < 0.05), longer hospital stay (median 6 days vs. 2 days), and more frequent deaths (11.1% vs. 2.6%). SIRS+ patients with four positive criteria had more surgical interventions, intensive treatments, and fatal outcomes compared with the others. Of importance the most influent factor was the respiratory rate followed by the white cell count and the heart rate/temperature. CONCLUSIONS Patients with SIRS at admission apparently receive more interventions, have longer length of stay, and increased mortality than those patients without SIRS. These findings require separate validation in a larger cohort study.
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Affiliation(s)
- James A Stephenson
- Department of Surgery, University Hospitals of Leicester, Robert Kilpatrick Clinical Sciences Building, Leicester Royal Infirmary, LE2 7LX, Leicester, UK.
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Stephenson JA, Al-Taan O, Spencer L, Metcalfe M, Dennison A, Morgan B. The effect of omega-3 fatty acid infusion on magnetic resonance imaging biomarkers of angiogenesis in colorectal liver metastases: A randomised controlled trial. Eur J Surg Oncol 2010. [DOI: 10.1016/j.ejso.2010.08.078] [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: 10/19/2022] Open
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Abstract
Pancreatic surgery is still associated with a relatively high morbidity and mortality compared with other specialties. This is a result of the complex nature of the organ, the difficult access as a result of the retroperitoneal position and the number of technically challenging anastomoses required. Nevertheless, the past two decades have witnessed a steady improvement in morbidity and a decrease in mortality achieved through alterations of technique (particularly relating to the pancreatic anastomoses) together with hormonal manipulation to decrease pancreatic secretions. Recently minimally invasive pancreatic surgery has been attempted by several centres around the world which has stimulated considerable interest in this approach. The majority of the cases attempted have been distal pancreatectomies, because of the more straightforward nature of the resection and the lack of a pancreatic ductal anastomosis, but more recently reports of laparoscopic pancreaticoduodenectomy have started to appear. The reports of the series to date have been difficult to interpret and although the results are claimed to be equivalent or better than those associated with a traditional approach a careful examination of the literature and comparison with the best results previously reported does not presently support this. In the present review we examined all the reports of pancreatic procedures performed laparoscopically and compared the results with those previously achieved at open surgery.
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Affiliation(s)
- Mark A. Staal
- 1st Special Operations Wing, Hurlburt Field, Florida
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Vorwerk C, Loryman B, Coats TJ, Stephenson JA, Gray LD, Reddy G, Florence L, Butler N. Prediction of mortality in adult emergency department patients with sepsis. Emerg Med J 2009; 26:254-8. [PMID: 19307384 DOI: 10.1136/emj.2007.053298] [Citation(s) in RCA: 66] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
OBJECTIVES To determine the efficacy of the abbreviated Mortality in Emergency Department Sepsis (MEDS) score, the Modified Early Warning (MEW) score and near-patient-test (NPT) lactate levels in predicting 28-day mortality in adult emergency department (ED) patients with sepsis. METHODS A retrospective cohort study of adult ED patients with sepsis admitted to hospital was conducted in a large urban teaching and a district general hospital. Data were collected during four time periods between 1 January 2006 and 31 January 2007. Inclusion criteria were age > or =16 years and an ED diagnosis of sepsis. Primary outcome for all patients was 28-day mortality. Patients were preassigned to risk groups according to their abbreviated MEDS score, MEW score and NPT lactate. RESULTS 307 ED patients with sepsis were included in the study. Among these there were 72 deaths (23%). Mortality rates for the low-, moderate- and high-risk groups of the abbreviated MEDS score were 1/63 (1.6%), 48/205 (23.4%) and 23/39 (59.0%) patients. The MEDS score for low-risk patients was 98.6% (95% CI 92.5% to 99.9%) sensitive and 26.5% (95% CI 21.0% to 32.6%) specific and for high-risk patients it was 31.9% (95% CI 21.4% to 44.0%) sensitive and 93.2% (95% CI 89.2% to 96.1%) specific for death within 28 days. Mortality rates for the low- and high-risk MEW score were 20/159 (12.6%) and 52/148 (35.1%) patients. The MEW score for high-risk patients was 72.2% (95% CI 60.4% to 82.1%) sensitive and 59.2% (95% CI 52.6% to 65.5%) specific for mortality. An NPT lactate level of > or =4 mmol/l was 49.1% (95% CI 35.1% to 63.2%) sensitive and 74.3% (95% CI 64.8% to 82.3%) specific for 28-day mortality. CONCLUSION These results demonstrate the efficacy of the abbreviated MEDS score, the MEW score and NPT venous lactate levels in predicting 28-day mortality in ED patients with sepsis. The abbreviated MEDS score was found to be the best performing risk assessment model which, with prospective validation, may aid early clinical decision-making in ED patients with sepsis and might affect the outcome from sepsis.
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Affiliation(s)
- C Vorwerk
- Emergency Department Academic Unit, Leicester Royal Infirmary, Leicester, UK.
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Abstract
The paper describes the development of a high-speed direct injection (HSDI) diesel engine suitable for passenger car applications. The evolution from a low emissions medium-speed engine, through a four-cylinder 2.3 litre research engine, into a four-cylinder 2.0 litre production engine is presented. The challenge to the engineer has been to develop the HSDI engine to operate with acceptable noise, emissions, smoke and driveability over the wide speed range (up to 5000 r/min) required for passenger cars. The key element in this task was the optimization of the combustion system and fuel injection equipment. The HSDI is shown to have a significant fuel economy advantage over the prechamber indirect injection (IDI) engine. Future developments of the fuel injection system are described which will further enhance the HSDI engine and provide additional noise and emissions control.
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Affiliation(s)
| | - B A Hood
- Perkins Engines Limited, Peterborough
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Affiliation(s)
- S M Friedman
- Vitreous and Retina Consultants, Lakeland, Florida, USA
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Drengler RL, Kuhn JG, Schaaf LJ, Rodriguez GI, Villalona-Calero MA, Hammond LA, Stephenson JA, Hodges S, Kraynak MA, Staton BA, Elfring GL, Locker PK, Miller LL, Von Hoff DD, Rothenberg ML. Phase I and pharmacokinetic trial of oral irinotecan administered daily for 5 days every 3 weeks in patients with solid tumors. J Clin Oncol 1999; 17:685-96. [PMID: 10080615 DOI: 10.1200/jco.1999.17.2.685] [Citation(s) in RCA: 77] [Impact Index Per Article: 3.1] [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] [Indexed: 11/20/2022] Open
Abstract
PURPOSE We conducted a phase I dose-escalation trial of orally administered irinotecan (CPT-11) to characterize the maximum-tolerated dose (MTD), dose-limiting toxicities (DLTs), pharmacokinetic profile, and antitumor effects in patients with refractory malignancies. PATIENTS AND METHODS CPT-11 solution for intravenous (IV) use was mixed with CranGrape juice (Ocean Spray, Lakeville-Middleboro, MA) and administered orally once per day for 5 days every 3 weeks to 28 patients. Starting dosages ranged from 20 to 100 mg/m2/d. RESULTS Grade 4 delayed diarrhea was the DLT at the 80 mg/m2/d dosage in patients younger than 65 years of age and at the 66 mg/m2/d dosage in patients 65 or older. The other most clinically significant toxicity of oral CPT-11 was neutropenia. A linear relationship was found between dose, peak plasma concentration, and area under the concentration-time curve (AUC) for both CPT-11 and SN-38 lactone, implying no saturation in the conversion of irinotecan to SN-38. The mean metabolic ratio ([AUC(SN-38 total) + AUC(SN-38G total)]/AUC(CPT-11 total)) was 0.7 to 0.8, which suggests that oral dosing results in presystemic conversion of CPT-11 to SN-38. An average of 72% of SN-38 was maintained in the lactone form during the first 24 hours after drug administration. One patient with previously treated colorectal cancer and liver metastases who received oral CPT-11 at the 80 mg/m2/d dosage achieved a confirmed partial response. CONCLUSION The MTD and recommended phase II dosage for oral CPT-11 is 66 mg/m2/d in patients younger than 65 years of age and 50 mg/m2/d in patients 65 or older, administered daily for 5 days every 3 weeks. The DLT of diarrhea is similar to that observed with IV administration of CPT-11. The biologic activity and favorable pharmacokinetic characteristics make oral administration of CPT-11 an attractive option for further clinical development.
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Affiliation(s)
- R L Drengler
- University of Texas Health Science Center at San Antonio, USA
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Manderson JA, Hayward IP, Pak E, Horrigan S, Hanley GE, Stephenson JA, Brown L, Campbell JH, Campbell GR. alpha 1-Adrenoceptors on rabbit aortic smooth muscle cells in culture and in experimental intimal thickening. Clin Exp Pharmacol Physiol 1995; 22:912-8. [PMID: 8846512 DOI: 10.1111/j.1440-1681.1995.tb02326.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [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: 02/02/2023]
Abstract
1. This study has defined alpha 1-adrenoceptors and their reactivity in rabbit aorta, following removal of the endothelium and formation of a myointimal thickening, and also in smooth muscle cells (SMC) in cell culture which had undergone serial passaging and changes in phenotype. 2. [3H]-prazosin binding to SMC from control aorta, vessels 2 weeks after endothelial denudation and sub-cultured SMC (passage 3-6) was specific (displaceable with 10 mumol/L phentolamine), and of high affinity to a single class of sites (KD range: 71-114 pmol/L). The maximum binding density (Bmax) of alpha 1-adrenoceptors on SMC from the neointima (11,105 +/- 771 sites/cell) was not significantly different to that of control medial SMC (14,014 +/- 2472 sites/cell). However, SMC cultured to passage 6, showed a 2-fold increase in Bmax (30,227 +/- 4349 sites/cell). 3. The production of inositol phosphates (IP1, IP2 and IP3) by SMC following 10 mumol/L phenylephrine was assayed. Both freshly-dispersed aortic SMC and sub-cultured SMC were stimulated to produce increased inositol phosphates by the addition of phenylephrine which was completely inhibited by pre-incubation with 10 mumol/L phentolamine, suggesting that the stimulation was via alpha 1-adrenoceptors. 4. Maximal contractile responses of isolated thoracic and abdominal aortic rings to KCl (100 mmol/L), 5-HT and phenylephrine were unchanged two weeks after endothelial denudation. However, phenylephrine was significantly less potent (2.7-fold) in both areas of the aorta, while the potency of 5-HT was significantly enhanced (2.7-fold) after endothelial denudation only in the abdominal aorta. 5. The decreased sensitivity of the rabbit aorta to alpha 1-adrenoceptor agonists following endothelial denudation and the formation of a myointimal thickening is not due to changes in affinity or density of alpha 1-adrenoceptors. However multiple passaging of SMC in culture leads to an increase in alpha 1-adrenoceptor density. This change can be related to the altered cytodifferentiation of irreversible synthetic state SMC which are similar to those in atherosclerotic lesions.
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Affiliation(s)
- J A Manderson
- Department of Anatomical Sciences, University of Queensland, Victoria, Australia
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Stephenson JA, Wiley AL. Current techniques in three-dimensional CT simulation and radiation treatment planning. Oncology (Williston Park) 1995; 9:1225-32, 1235; discussion 1235-40. [PMID: 8703693] [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: 02/01/2023]
Abstract
The modern CT simulator is capable of interactive three-dimensional (3D) volumetric treatment planning; this allows radiation oncology departments to operate without conventional X-ray simulators. Treatment planning is performed at the time of virtual simulation by contouring the organs or volumes of interest and determining the isocenter. A digitally reconstructed radiograph (DRR) provides a beam's-eye-view display of the treatment field anatomy and contoured areas of interest. Conformal and noncoplanar teletherapy is facilitated for patients with prostate cancer, lung cancer, and brain tumors. Ongoing developments include 3D dose calculation, dose-volume histogram analysis, and tumor dose escalation.
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Affiliation(s)
- J A Stephenson
- Radiation Therapy Center, Watson Clinic, Lakeland, Florida, USA
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Beart PM, Summers RJ, Stephenson JA, Christie MJ. Excitatory amino acid projections to the nucleus of the solitary tract in the rat: a retrograde transport study utilizing D-[3H]aspartate and [3H]GABA. J Auton Nerv Syst 1994; 50:109-22. [PMID: 7844309 DOI: 10.1016/0165-1838(94)90128-7] [Citation(s) in RCA: 22] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Afferents to the nucleus tractus solitarius utilizing excitatory amino acid transmitters were described in rat brain by autoradiography following microinfusion and retrograde transport of D-[3H]aspartate. Parallel experiments with the injection of [3H]GABA were employed to establish the transmitter-selective nature of the retrograde labelling found with D-[3H]aspartate. Following infusion of D-[3H]aspartate, perikaryal labelling was heaviest in myencephalon, where at least 16 discrete nuclei were labelled. Heaviest labelling was localized bilaterally in the trigeminal nucleus with cells extending through its subdivisions and the entire rostrocaudal axis. Intense labelling was also obtained in the inferior olive, predominantly contralaterally, and non-perikaryal labelling noted. Vestibular, reticular and raphe nuclei contained heavily labelled perikarya. In cervical spinal cord, a moderate density of labelled cells was found in dorsal horn, adjoining the central canal (lamina X) and in the central cervical nucleus, along with appreciable labelling of processes and non-perikaryal labelling. The relative density of labelled perikarya in mesencephalic nuclei was much lower than found in myencephalon, although D-[3H]aspartate produced topographic and precise labelling of a small number of cells in the periaqueductal gray, medial parabrachial nucleus and Koelliker-Fuse nucleus. Only weak labelling was found in cortex and hypothalamus. Labelled cells were not consistently observed in other regions (stria terminalis, amygdala, fastigial nucleus, locus coeruleus and rostral ventrolateral medulla) known to innervate the nucleus tractus solitarius. Lower densities of labelled perikarya were found after the microinjection of [3H]GABA, and the only regions in which a small number of cells were labelled by both D-[3H]aspartate and [3H]GABA were trigeminal nucleus, reticular nuclei and raphe obscurus. An exception was the ventrolateral medulla, where [3H]GABA produced precise labelling in the nucleus ambiguus and facial nucleus consistent with previous evidence for a GABAergic pathway from this area to the nucleus tractus solitarius. Our findings confirm the selectivity of the retrograde transport of D-[3H]aspartate and [3H]GABA. Overall, the transport of D-[3H]aspartate revealed a complex topographic and convergent network of afferent pathways to the nucleus tractus solitarius likely to utilize an excitatory amino acid transmitter.
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Affiliation(s)
- P M Beart
- University of Melbourne, Clinical Pharmacology and Therapeutics Unit, Austin Hospital, Heidelberg, Victoria, Australia
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Abstract
The halogenated pyrimidine, iododeoxyuridine (IUdR), enhances cytotoxicity of ionizing irradiation experimentally. Continuous intraarterial infusion of IUdR was combined with irradiation to maximize drug concentration in tumor and reduce potential systemic toxicity. Percutaneous tumor-specific artery catheterization was utilized in five patients, with delivery of IUdR (20 mg/kg/day) by continuous infusion 5 days prior to irradiation treatments and continued for 10-14 days. Infusion vessels included the internal mammary, the internal iliac, the renal, the common femoral, and the bronchial arteries. Conventional radiotherapy fields, fractionation, and total doses were utilized, and therapy was well tolerated. Low-grade leukopenia and thrombocytopenia was observed several weeks following infusion. A clinically nonsignificant skin reaction was observed within the irradiation fields 2-3 weeks after initiation of irradiation in several patients. No alopecia or stomatitis was observed. This study minimizes initial hepatic dehalogenation of IUdR when given by intraarterial administration. Two patients have been free of disease for over 20 years, with no long-term toxicity from IUdR therapy.
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Affiliation(s)
- G W Wirtanen
- Department of Human Oncology, University of Wisconsin School of Medicine, Madison
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Beart PM, Summers RJ, Stephenson JA, Cook CJ, Christie MJ. Excitatory amino acid projections to the periaqueductal gray in the rat: a retrograde transport study utilizing D[3H]aspartate and [3H]GABA. Neuroscience 1990; 34:163-76. [PMID: 2325847 DOI: 10.1016/0306-4522(90)90310-z] [Citation(s) in RCA: 78] [Impact Index Per Article: 2.3] [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: 12/31/2022]
Abstract
The afferents to the periaqueductal gray utilizing excitatory amino acid transmitters have been described in rat brain by autoradiography following microinfusion and retrograde transport of D[3H]aspartate. Parallel experiments employing injections of [3H]GABA established that the retrograde labelling found with D[3H]aspartate was transmitter-selective. Following infusion of D[3H]aspartate, perikaryal labelling was found in nine subcortical areas, particularly infralimbic and cingulate cortices, with a predominance of ipsilateral labelled perikarya. Heaviest cortical labelling was localized in perirhinal cortex, in an extensive band of cells adjoining the rhinal sulcus. The hypothalamus contained the heaviest perikaryal labelling within brain: D[3H]aspartate labelled cells in 11 hypothalamic and mammillary nuclei. Intense bilateral labelling was obtained in ventromedial hypothalamus, although the number of perikarya was lower contralaterally. D[3H]Aspartate also produced heavy ipsilateral labelling of perikarya in posterior hypothalamus. Labelling patterns in cortex and hypothalamus were precise and topographic, and [3H]GABA never labelled cells in these regions. Other telencephalic and diencephalic areas containing prominent, retrogradely labelled cells were the lateral septum, amygdala, zona incerta and lateral habenula. The relative density of labelled cells in mesencephalic areas was much lower than that found in cortex and hypothalamus, although D[3H]aspartate labelled a moderate number of perikarya in the inferior colliculus and cuneiform nucleus. A smaller number of heavily labelled cells was found in the parabrachial nuclei, Kolliker-Fuse nucleus and laterodorsal tegmental nucleus. Only occasional labelled perikarya were observed in the myencephalon. Low densities of labelled cells were found after the injection of [3H]GABA into the periaqueductal gray, and the only regions in which a small number of perikarya were labelled by both [3H]GABA and D[3H]aspartate were the dorsal raphe and parabrachial nuclei. Overall, the retrograde transport of D[3H]aspartate revealed a complex topographic and convergent network of afferent pathways to the periaqueductal gray likely to utilize an excitatory amino acid transmitter. Our findings confirm the selectivity of this neurochemical mapping technique and provide evidence that hypothalamic, habenular, subthalamic and cuneiform afferents to the periaqueductal gray utilize an acidic amino acid as their transmitter. They also confirm that corticofugal afferents to periaqueductal gray utilize an excitatory amino acid.
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Abstract
The effect of hepatic irradiation (RT) after intraarterial 5-fluorouracil (5-FU) was evaluated in 37 randomized patients with colorectal adenocarcinoma hepatic metastases. Patients underwent percutaneous transbrachial artery catheterization of the hepatic artery followed by 21-day continuous 5-FU infusion (CT). Hepatic irradiation of 25.5 Gy was delivered to 19 patients 14 days after completion of infusion (CT + RT). All patients received subsequent weekly maintenance 5-FU. A 37% (seven of 19) response rate was observed in CT + RT, and a 50% response rate (nine of 18) in CT: median survival was 6 months for CT + RT, and 8 months for CT, (P = 0.106). Improved survival was observed in two subsets of patients. Tumor vascularity was graded angiographically from 0 to 4+; those patients with highest vascularity (4+) had a 20-month median survival (P = 0.0009). Patients with Grade 1, well-differentiated, histologic type had a median survival of 20 months (P = 0.0001). Four patients with both 4+ vascularity and Grade 1 histologic type had 27.5 months' median survival (P = 0.0019). Age, performance status, elevated liver function tests, previous systemic therapy, and time interval between diagnosis and entry on this study did not impact on survival (P greater than 0.05), nor did these variables eliminate the significance of vascularity and grade (P less than 0.05). Survival after intraarterial 5-FU infusion was not improved by this regimen of sequential external irradiation. Regional therapy may benefit those patients with 4+ vascular tumors and/or well-differentiated tumor grade. Future trials are needed to explore the interaction of halogenated pyrimidines with irradiation and determine whether these prognostic factors can aid in patient selection for regional therapy of hepatic metastases.
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Affiliation(s)
- A L Wiley
- Department of Human Oncology, University of Wisconsin Medical Center, Madison
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Abstract
The efficacy and toxicity of abdominopelvic irradiation following chemotherapy and positive second look laparotomy was assessed in 15 patients with advanced ovarian epithelial carcinoma. The patients received 30 Gy abdominal and 50.4 Gy pelvic irradiation. Three of ten patients with minimal disease are disease-free 30+, 72+, and 78+ months following therapy. A fourth patient survives disease-free 24+ months following third laparotomy. No patient with bulky disease is disease-free. Bowel obstruction was encountered in 5 of 15 patients; all episodes were associated with recurrent tumor. Abdominopelvic irradiation can potentially sterilize minimal volume ovarian carcinoma that persists following chemotherapy.
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Abstract
From 1962 through 1987, four children were diagnosed at our institution with primary germ cell malignancies of the extracranial head and neck regions. Ages of the children ranged from 2 to 44 months. Histologic findings included 2 yolk sac carcinoma (endodermal sinus tumor), 1 malignant teratoma with nephroblastoma (Wilm's tumor), and 1 malignant teratoma with neuroblastoma (primitive neuroectodermal) components. Complete clinical and surgical staging was performed to rule out additional sites of disease. All patients initially underwent either biopsy or, when technically feasible, resection. Three patients received combination chemotherapy and two received irradiation. Three patients died of progressive disease. One patient who had yolk sac carcinoma of the temporomandibular region is alive and free of disease 40 months after therapy. Complete surgical resection is indicated for teratomatous tumors, if technically feasible. The malignant components of these tumors are sensitive to both chemotherapy and irradiation and combined therapy may be beneficial.
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Affiliation(s)
- J A Stephenson
- Department of Human Oncology, University of Wisconsin School of Medicine, Madison
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