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Agustin C, Goudie S, Kane P. Supporting authors to publish in gold open access through global institutional transformational agreements: Will this become the new normal in medical radiation sciences? J Med Imaging Radiat Sci 2022. [DOI: 10.1016/j.jmir.2022.10.164] [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: 12/03/2022]
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2
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Driever EG, von Meijenfeldt FA, Adelmeijer J, de Haas RJ, van den Heuvel MC, Nagasami C, Weisel JW, Fondevila C, Porte RJ, Blasi A, Heaton N, Gregory S, Kane P, Bernal W, Zen Y, Lisman T. Nonmalignant portal vein thrombi in patients with cirrhosis consist of intimal fibrosis with or without a fibrin-rich thrombus. Hepatology 2022; 75:898-911. [PMID: 34559897 PMCID: PMC9300169 DOI: 10.1002/hep.32169] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Revised: 08/31/2021] [Accepted: 09/07/2021] [Indexed: 12/11/2022]
Abstract
BACKGROUND AND AIM Portal vein thrombosis (PVT) is a common complication of cirrhosis. The exact pathophysiology remains largely unknown, and treatment with anticoagulants does not lead to recanalization of the portal vein in all patients. A better insight into the structure and composition of portal vein thrombi may assist in developing strategies for the prevention and treatment of PVT. APPROACH AND RESULTS Sixteen prospectively and 63 retrospectively collected nonmalignant portal vein thrombi from patients with cirrhosis who underwent liver transplantation were included. Histology, immunohistochemistry, and scanning electron microscopy were used to assess structure and composition of the thrombi. Most recent CT scans were reanalyzed for thrombus characteristics. Clinical characteristics were related to histological and radiological findings. All samples showed a thickened, fibrotic tunica intima. Fibrin-rich thrombi were present on top of the fibrotic intima in 9/16 prospective cases and in 21/63 retrospective cases. A minority of the fibrotic areas stained focally positive for fibrin/fibrinogen (16% of cases), von Willebrand factor (VWF; 10%), and CD61 (platelets, 21%), while most of the fibrin-rich areas stained positive for those markers (fibrin/fibrinogen, 100%; VWF, 77%; CD61, 100%). No associations were found between clinical characteristics including estimated thrombus age and use of anticoagulants and presence of fibrin-rich thrombi. CONCLUSION We demonstrate that PVT in patients with cirrhosis consists of intimal fibrosis with an additional fibrin-rich thrombus in only one-third of cases. We hypothesize that our observations may explain why not all portal vein thrombi in patients with cirrhosis recanalize by anticoagulant therapy.
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Affiliation(s)
- Ellen G Driever
- Surgical Research LaboratoryDepartment of SurgeryUniversity Medical Center GroningenGroningenthe Netherlands
| | - Fien A von Meijenfeldt
- Surgical Research LaboratoryDepartment of SurgeryUniversity Medical Center GroningenGroningenthe Netherlands
| | - Jelle Adelmeijer
- Surgical Research LaboratoryDepartment of SurgeryUniversity Medical Center GroningenGroningenthe Netherlands
| | - Robbert J de Haas
- Department of RadiologyUniversity Medical Center GroningenGroningenthe Netherlands
| | - Marius C van den Heuvel
- Department of Pathology and Medical BiologyUniversity Medical Center GroningenGroningenthe Netherlands
| | - Chandrasekaran Nagasami
- Department of Cell and Developmental BiologyUniversity of Pennsylvania School of MedicinePhiladelphiaPennsylvaniaUSA
| | - John W Weisel
- Department of Cell and Developmental BiologyUniversity of Pennsylvania School of MedicinePhiladelphiaPennsylvaniaUSA
| | - Constantino Fondevila
- Department of SurgeryHospital ClínicInstitute d'Investigacions Biomèdica Agustí Pi i Sunyer (IDIBAPS)University of BarcelonaBarcelonaSpain
| | - Robert J Porte
- Department of SurgerySection of Hepatobiliary Surgery and Liver TransplantationUniversity Medical Center GroningenGroningenthe Netherlands
| | - Anabel Blasi
- Anesthesiology DepartmentHospital ClínicInstitute d'Investigacions Biomèdica Agustí Pi i Sunyer (IDIBAPS)University of BarcelonaBarcelonaSpain
| | - Nigel Heaton
- Liver Transplant SurgeryInstitute of Liver StudiesKing's College HospitalLondonUK
| | | | - Pauline Kane
- Department of RadiologyKing's College HospitalLondonUK
| | - William Bernal
- Liver Intensive Care UnitInstitute of Liver StudiesKing's College HospitalLondonUK.,Institute of Liver StudiesKing's College HospitalLondonUK
| | - Yoh Zen
- Department of PathologyInstitute of Liver StudiesKing's College HospitalLondonUK
| | - Ton Lisman
- Surgical Research LaboratoryDepartment of SurgeryUniversity Medical Center GroningenGroningenthe Netherlands.,Department of SurgerySection of Hepatobiliary Surgery and Liver TransplantationUniversity Medical Center GroningenGroningenthe Netherlands
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Farman M, Kane P, Gregory S, Prachalias A, Joshi D. Intracavity rendezvous procedure. Endoscopy 2021; 53:E466-E467. [PMID: 33540433 DOI: 10.1055/a-1346-7555] [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] [Indexed: 12/10/2022]
Affiliation(s)
- Muhammad Farman
- Institute of Liver Studies, King's College Hospital NHS Foundation Trust, London, UK
| | - Pauline Kane
- Department of Radiology, King's College Hospital NHS Foundation Trust, London, UK
| | - Stephen Gregory
- Department of Radiology, King's College Hospital NHS Foundation Trust, London, UK
| | - Andreas Prachalias
- Institute of Liver Studies, King's College Hospital NHS Foundation Trust, London, UK
| | - Deepak Joshi
- Institute of Liver Studies, King's College Hospital NHS Foundation Trust, London, UK
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O'Cearbhaill R, Park J, Halton E, Diamonte C, Mead E, Lakhman Y, Kane P, Riviere I, Brentjens R. A phase I clinical trial of autologous chimeric antigen receptor (CAR) T cells genetically engineered to secrete IL-12 and to target the MUC16ecto antigen in patients (pts) with MUC16ecto+ recurrent high-grade serous ovarian cancer (HGSOC). Gynecol Oncol 2020. [DOI: 10.1016/j.ygyno.2020.06.089] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Dhawan A, Chaijitraruch N, Fitzpatrick E, Bansal S, Filippi C, Lehec SC, Heaton ND, Kane P, Verma A, Hughes RD, Mitry RR. Alginate microencapsulated human hepatocytes for the treatment of acute liver failure in children. J Hepatol 2020; 72:877-884. [PMID: 31843649 DOI: 10.1016/j.jhep.2019.12.002] [Citation(s) in RCA: 41] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2019] [Revised: 12/03/2019] [Accepted: 12/05/2019] [Indexed: 12/11/2022]
Abstract
BACKGROUND & AIMS Liver transplantation (LT) is the most effective treatment for patients with acute liver failure (ALF), but is limited by surgical risks and the need for life-long immunosuppression. Transplantation of microencapsulated human hepatocytes in alginate is an attractive option over whole liver replacement. The safety and efficacy of hepatocyte microbead transplantation have been shown in animal models. We report our experience of this therapy in children with ALF treated on a named-patient basis. METHODS Clinical grade human hepatocyte microbeads (HMBs) and empty microbeads were tested in immunocompetent healthy rats. Subsequently, 8 children with ALF, who were awaiting a suitable allograft for LT, received intraperitoneal transplantation of HMBs. We monitored complications of the procedure, assessing the host immune response and residual function of the retrieved HMBs, either after spontaneous native liver regeneration or at the time of LT. RESULTS Intraperitoneal transplantation of HMBs in healthy rats was safe and preserved synthetic and detoxification functions, without the need for immunosuppression. Subsequently, 8 children with ALF received HMBs (4 neonatal haemochromatosis, 2 viral infections and 2 children with unknown cause at time of infusion) at a median age of 14.5 days, range 1 day to 6 years. The procedure was well tolerated without complications. Of the 8 children, 4 avoided LT while 3 were successfully bridged to LT following the intervention. HMBs retrieved after infusions (at the time of LT) were structurally intact, free of host cell adherence and contained viable hepatocytes with preserved functions. CONCLUSION The results demonstrate the feasibility and safety of an HMB infusion in children with ALF. LAY SUMMARY Acute liver failure in children is a rare but devastating condition. Liver transplantation is the most effective treatment, but it has several important limitations. Liver cell (hepatocyte) transplantation is an attractive option, as many patients only require short-term liver support while their own liver recovers. Human hepatocytes encapsulated in alginate beads can perform the functions of the liver while alginate coating protects the cells from immune attack. Herein, we demonstrated that transplantation of these beads was safe and feasible in children with acute liver failure.
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Affiliation(s)
- Anil Dhawan
- Paediatric Liver GI and Nutrition Center, King's College Hospital, London, United Kingdom; Dhawan Lab at the Mowat Labs, Institute of Liver Studies, King's College London at King's College Hospital, London, United Kingdom.
| | - Nataruks Chaijitraruch
- Paediatric Liver GI and Nutrition Center, King's College Hospital, London, United Kingdom; Paediatric Gastroenterology and Hepatology, Department of Paediatrics, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Emer Fitzpatrick
- Paediatric Liver GI and Nutrition Center, King's College Hospital, London, United Kingdom
| | - Sanjay Bansal
- Paediatric Liver GI and Nutrition Center, King's College Hospital, London, United Kingdom
| | - Celine Filippi
- Dhawan Lab at the Mowat Labs, Institute of Liver Studies, King's College London at King's College Hospital, London, United Kingdom
| | - Sharon C Lehec
- Dhawan Lab at the Mowat Labs, Institute of Liver Studies, King's College London at King's College Hospital, London, United Kingdom
| | - Nigel D Heaton
- Liver Transplant Surgery, Institute of Liver Studies, King's College Hospital, London, United Kingdom
| | - Pauline Kane
- Department of Radiology, King's College Hospital, London, United Kingdom
| | - Anita Verma
- Department of Infection Sciences and Microbiology, King's College Hospital, London, United Kingdom
| | - Robin D Hughes
- Dhawan Lab at the Mowat Labs, Institute of Liver Studies, King's College London at King's College Hospital, London, United Kingdom
| | - Ragai R Mitry
- Dhawan Lab at the Mowat Labs, Institute of Liver Studies, King's College London at King's College Hospital, London, United Kingdom
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Palmer IS, Thiex N, Allen R, Alley E, Anderson N, Bell J, Carpenter N, Cunningham W, Deuschle L, Kane P, Marts R, Rottinghaus G, Rutta S, Torma L, Vindiola A, Wenger J, Whanger P, Williams A, Wo C. Determination of Selenium in Feeds and Premixes: Collaborative Study. J AOAC Int 2020. [DOI: 10.1093/jaoac/80.3.469] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Abstract
A total of 17 laboratories participated in a collaborative study for the determination of selenium in feeds and premixes using either a fluorometric or a continuous hydride generation atomic absorption (HGAA) method. Each collaborator analyzed 16 blind duplicate samples of feed and premixes from various feed manufacturers. The amount of Se in these materials ranged from 0.2 to 5500 μg/g. Six laboratories used only the fluorometric procedure, 8 laboratories used only the hydride generation atomic absorption procedure, and 3 laboratories used both procedures. One laboratory in the fluorometric study and 3 laboratories in the HGAA study were initially excluded because of invalid data. Poor agreement between the blind duplicates indicated probable sample interchange and/or dilution error. The data from 8 laboratories were submitted to statistical analysis, including data from 2 laboratories participating in both studies. The repeatability standard deviation (RSDr) for samples analyzed by the fluorometric procedure ranged from 5.9 to 33%, and the reproducibility standard deviation (RSDR) ranged from 12 to 33%. RSDf for samples analyzed by HGAA ranged from 2.8 to 18%, and RSDR ranged from 4.0 to 36%. Both fluorometric and continuous hydride generation atomic absorption methods for the determination of Se in feeds and premixes have been adopted first action by AOAC INTERNATIONAL.
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Affiliation(s)
- Ivan S Palmer
- South Dakota State University, Department of Chemistry and Biochemistry, Brookings, SD 57007
| | - Nancy Thiex
- South Dakota State University, Department of Chemistry and Biochemistry, Brookings, SD 57007
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Oriani A, Guo P, Gadoud A, Dunleavy L, Kane P, Murtagh FEM. What are the main symptoms and concerns reported by patients with advanced chronic heart failure?-a secondary analysis of the Palliative care Outcome Scale (POS) and Integrated Palliative care Outcome Scale (IPOS). Ann Palliat Med 2019; 8:775-780. [PMID: 31594366 DOI: 10.21037/apm.2019.08.10] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/01/2019] [Accepted: 08/12/2019] [Indexed: 11/06/2022]
Abstract
There is a lack of valid disease-specific patient-reported outcome measures (PROMs) for detecting symptoms and concerns in patients with advanced chronic heart failure (CHF). The Palliative care Outcome Scale (POS) and Integrated Palliative care Outcome Scale (IPOS) are specifically developed to capture the main symptoms and concerns of people severely affected by advanced disease. The aim of this study was to determine whether POS and IPOS captures the main symptoms and concerns self-reported by patients with advanced CHF. A secondary analysis of existing POS/IPOS data collected in three longitudinal studies was conducted. POS and IPOS start with an open-ended question for patients to report their main problems and concerns, followed by subsequent closed questions on a range of symptoms and other concerns. Descriptive statistics were used to report the results. The 102 participants from the three datasets had median age 81 years (SD ±9.84 years); 62% male; 87% white. A total of 107 concerns were reported in the first, open POS/IPOS question seeking the patient's main concerns. Of these, 83 (77%) were reflected in the subsequent IPOS/POS closed questions. The high correspondence between the free-text responses and the closed questions indicates that most issues are captured by the POS/IPOS items. In conclusion, the generic versions of POS and IPOS do capture the main problems and concerns of patients with advanced CHF. Minor adaptations and further psychometric validation of POS and IPOS are needed in this population.
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Affiliation(s)
- Anna Oriani
- Palliative and Supportive Care Clinic, Oncology Institute of Southern Switzerland, Bellinzona, Canton Ticino, Switzerland. ;
| | - Ping Guo
- Cicely Saunders Institute of Palliative Care, Policy & Rehabilitation, Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, King's College London, London, UK
| | - Amy Gadoud
- International Observatory on End of Life Care, Lancaster University, Lancaster, UK
| | - Lesley Dunleavy
- International Observatory on End of Life Care, Lancaster University, Lancaster, UK
| | - Pauline Kane
- Cicely Saunders Institute of Palliative Care, Policy & Rehabilitation, Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, King's College London, London, UK
| | - Fliss E M Murtagh
- Cicely Saunders Institute of Palliative Care, Policy & Rehabilitation, Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, King's College London, London, UK; Wolfson Palliative Care Research Centre, Hull York Medical School, University of Hull, York, UK
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8
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Batlevi C, Palomba M, Park J, Mead E, Santomasso B, Riviere I, Wang X, Senechal B, Furman R, Yang J, Kane P, Hall M, Bernal Y, Lund N, Diamonte C, Pineda J, Halton E, Moskowitz C, Younes A, Sadelain M, Brentjens R. PHASE I CLINICAL TRIAL OF CD19-TARGETED 19-28Z/4-1BBL “ARMORED” CAR T CELLS IN PATIENTS WITH RELAPSED OR REFRACTORY NHL AND CLL INCLUDING RICHTER TRANSFORMATION. Hematol Oncol 2019. [DOI: 10.1002/hon.124_2629] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Affiliation(s)
- C.L. Batlevi
- Department of Medicine; Memorial Sloan Kettering Cancer Center; New York United States
| | - M.L. Palomba
- Department of Medicine; Memorial Sloan Kettering Cancer Center; New York United States
| | - J. Park
- Department of Medicine; Memorial Sloan Kettering Cancer Center; New York United States
| | - E. Mead
- Department of Medicine; Memorial Sloan Kettering Cancer Center; New York United States
| | - B. Santomasso
- Department of Medicine; Memorial Sloan Kettering Cancer Center; New York United States
| | - I. Riviere
- Michael G. Harris Cell Therapy and Cell Engineering Facility; New York NY United States
| | - X. Wang
- Michael G. Harris Cell Therapy and Cell Engineering Facility; New York NY United States
| | - B. Senechal
- Michael G. Harris Cell Therapy and Cell Engineering Facility; New York NY United States
| | - R. Furman
- Department of Medicine; Weil Cornell Medical Center; New York United States
| | - J. Yang
- Department of Medicine; Memorial Sloan Kettering Cancer Center; New York United States
| | - P. Kane
- Department of Medicine; Memorial Sloan Kettering Cancer Center; New York United States
| | - M. Hall
- Department of Medicine; Memorial Sloan Kettering Cancer Center; New York United States
| | - Y. Bernal
- Department of Medicine; Memorial Sloan Kettering Cancer Center; New York United States
| | - N. Lund
- Department of Medicine; Memorial Sloan Kettering Cancer Center; New York United States
| | - C. Diamonte
- Department of Medicine; Memorial Sloan Kettering Cancer Center; New York United States
| | - J. Pineda
- Department of Medicine; Memorial Sloan Kettering Cancer Center; New York United States
| | - E. Halton
- Department of Medicine; Memorial Sloan Kettering Cancer Center; New York United States
| | - C. Moskowitz
- Department of Medicine; University of Miami Sylvester Cancer Center; Miami United States
| | - A. Younes
- Department of Medicine; Memorial Sloan Kettering Cancer Center; New York United States
| | - M. Sadelain
- Center for Cell Engineering; New York NY United States
| | - R. Brentjens
- Department of Medicine; Memorial Sloan Kettering Cancer Center; New York United States
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9
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Fang C, Cortis K, Yusuf GT, Gregory S, Lewis D, Kane P, Peddu P. Complications from percutaneous microwave ablation of liver tumours: a pictorial review. Br J Radiol 2019; 92:20180864. [PMID: 30845823 DOI: 10.1259/bjr.20180864] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Percutaneous microwave ablation of liver tumours is a well-established technique that has been proven to be effective in the curative and palliative treatment of small volume primary and secondary liver tumours. Microwave ablation is designed to achieve larger areas of necrosis compared to radiofrequency ablation and has a good safety profile among liver tumour treatments. Mortality is unreported and major complications are rare. Knowledge of potential complications is essential for interventional radiologists performing liver ablation in order to reduce patient morbidity. The aim of this review is to illustrate major complications post microwave ablation in a pictorial format as well as a discussion on how best to avoid these complications.
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Affiliation(s)
- Cheng Fang
- 1 Department of Radiology, King's College Hospital , London , England
| | - Kelvin Cortis
- 2 Medical Imaging Department, Mater Dei Hospital , Valletta , Malta
| | - Gibran T Yusuf
- 1 Department of Radiology, King's College Hospital , London , England
| | - Stephen Gregory
- 1 Department of Radiology, King's College Hospital , London , England
| | - Dylan Lewis
- 1 Department of Radiology, King's College Hospital , London , England
| | - Pauline Kane
- 1 Department of Radiology, King's College Hospital , London , England
| | - Praveen Peddu
- 1 Department of Radiology, King's College Hospital , London , England
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10
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Mazzarelli C, Cannon MD, Hudson M, Heaton N, Sarker D, Kane P, Quaglia A, Suddle A. Hepatocellular Carcinoma as a Complication of Vascular Disease of the Liver After Fontan Procedure. Hepatology 2019; 69:911-913. [PMID: 30055116 DOI: 10.1002/hep.30194] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [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: 01/15/2018] [Accepted: 06/25/2018] [Indexed: 12/07/2022]
Affiliation(s)
- Chiara Mazzarelli
- Institute of Liver Studies, King's College Hospital, London, United Kingdom.,Hepatology and Gastroenterology Unit, ASST Ospedale Niguarda, Milan, Italy
| | - Mary D Cannon
- Institute of Liver Studies, King's College Hospital, London, United Kingdom
| | - Mark Hudson
- Liver Transplantation Unit, Freeman Hospital, Newcastle, United Kingdom
| | - Nigel Heaton
- Institute of Liver Studies, King's College Hospital, London, United Kingdom
| | - Debashis Sarker
- Department of Research Oncology, Division of Cancer Studies, King's College London, United Kingdom
| | - Pauline Kane
- Department of Radiology, King's College Hospital, London, United Kingdom
| | - Alberto Quaglia
- Institute of Liver Studies, King's College Hospital, London, United Kingdom
| | - Abid Suddle
- Institute of Liver Studies, King's College Hospital, London, United Kingdom
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11
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De Vito C, Papathomas G T, Pedica F, Kane P, Amir A, Heaton N, Quaglia A. Synchronous Unicentric Castleman Disease and Inflammatory Hepatocellular Adenoma: a Case Report. Ann Hepatol 2019; 18:263-268. [PMID: 31113603 DOI: 10.5604/01.3001.0012.7936] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2017] [Accepted: 03/13/2018] [Indexed: 02/04/2023]
Abstract
Systemic symptoms such as fever and fatigue are non-specific manifestations spanning from inflammation to neoplasia. Here we report the case of a 34 year-old man who presented with systemic symptoms for four months. CT-scan and MRI revealed a 3.4 cm arterialized hepatic lesion and a 7 cm paraduodenal mass. Surgical resection of both lesions and histological examination revealed an inflammatory hepatocellular adenoma and a unicentric plasma cell type of Castleman disease. Moreover, a diffuse AA amyloid deposition in the liver was observed. Resection of both lesions was associated with an improvement of the symptoms. To our knowledge, this is the first report of a synchronous presentation of a unicentric plasma cell type of Castleman disease, inflammatory hepatocellular adenoma and AA amyloidosis.
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Affiliation(s)
- Claudio De Vito
- Institute of Liver Studies, King's College Hospital, London, UK; Division of Clinical Pathology, Geneva University Hospitals, Geneva, Switzerland; Equal Contribution.
| | - Thomas Papathomas G
- Department of Histopathology, King's College Hospital, London, UK; Equal Contribution
| | - Federica Pedica
- Pathology Unit, San Raffaele Scientific Institute, Milano, Italy
| | - Pauline Kane
- Institute of Liver Studies, King's College Hospital, London, UK
| | - Ali Amir
- Institute of Liver Studies, King's College Hospital, London, UK
| | - Nigel Heaton
- Institute of Liver Studies, King's College Hospital, London, UK
| | - Alberto Quaglia
- Institute of Liver Studies, King's College Hospital, London, UK
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12
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Nanda P, Duffin J, Kane P, Varma A. P01.166 Survival with pineal region tumours - Is the outlook changing? Neuro Oncol 2018. [DOI: 10.1093/neuonc/noy139.208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- P Nanda
- James Cook University Hospital, Middlesbrough, United Kingdom
| | - J Duffin
- James Cook University Hospital, Middlesbrough, United Kingdom
| | - P Kane
- James Cook University Hospital, Middlesbrough, United Kingdom
| | - A Varma
- James Cook University Hospital, Middlesbrough, United Kingdom
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13
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Kinsella JA, Irani SR, Hollingsworth R, O'Shaughnessy D, Kane P, Foster M, Schott JM, Lunn MP. Use of intravenous immunoglobulin for the treatment of autoimmune encephalitis: audit of the NHS experience. JRSM Open 2018; 9:2054270418793021. [PMID: 30202534 PMCID: PMC6122256 DOI: 10.1177/2054270418793021] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
Objectives The treatments of limbic and other autoimmune encephalitis include
immunosuppression, symptomatic treatment, and in the case of paraneoplastic
syndromes, appropriate therapy for underlying neoplasms. When immunotherapy
is considered, intravenous immunoglobulin is one option for treatment,
either alone or in combination with corticosteroids. To date, however,
evidence for the use of intravenous immunoglobulin in this context comes
from case series/expert reviews as no controlled trials have been performed.
We aimed to analyse the NHS England Database of intravenous immunoglobulin
usage, which was designed to log use and guide procurement, to explore usage
and therapeutic effect of intravenous immunoglobulin in autoimmune
encephalitis in England. Design We conducted a retrospective audit and review of the NHS England Database on
intravenous immunoglobulin use. Setting NHS England Database of intravenous immunoglobulin use which covers secondary
and tertiary care prescribing and use of intravenous immunoglobulin for all
patients in hospitals in England. Participants Hospital in-patients with confirmed or suspected autoimmune/limbic
encephalitis between September 2010 and January 2017. Results A total of 625 patients who were 18 years of age or older were treated with
intravenous immunoglobulin for autoimmune encephalitis, of whom 398 were
determined as having 'highly likely' or 'definite' autoimmune/limbic
encephalitis. Ninety-six percent were treated with a single course of
intravenous immunoglobulin. The availability and accuracy of reporting of
outcomes was very poor, with complete data only available in 27% of all
cases. Conclusions This is the first review of data from this unique national database. Whilst
there was evidence for clinical improvement in many cases of patients
treated with intravenous immunoglobulin, the quality of outcome data was
generally inadequate. Methods to improve quality, accuracy and completeness
of reporting are crucial to maximise the potential value of this resource as
an auditing tool.
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Affiliation(s)
- J A Kinsella
- Dementia Research Centre, UCL Institute of Neurology, London WC1N 3BG, UK.,Department of Neurology, St. Vincent's University Hospital, University College Dublin, Dublin 4, Ireland
| | - S R Irani
- Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, Oxford OX3 9DU, UK
| | - R Hollingsworth
- Medical Data Solutions and Services (MDSAS), Manchester M12 4JD, UK
| | - D O'Shaughnessy
- Medical Data Solutions and Services (MDSAS), Manchester M12 4JD, UK
| | - P Kane
- Medical Data Solutions and Services (MDSAS), Manchester M12 4JD, UK
| | - M Foster
- Medical Data Solutions and Services (MDSAS), Manchester M12 4JD, UK
| | - J M Schott
- Dementia Research Centre, UCL Institute of Neurology, London WC1N 3BG, UK
| | - M P Lunn
- MRC Centre for Neuromuscular Diseases, UCL Institute of Neurology, London WC1N 3BG, UK
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14
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Zabron A, Quaglia A, Fatourou E, Peddu P, Lewis D, Heneghan M, Willars C, Auzinger G, Heaton N, Wendon J, Kane P, Karani J, Bernal W. Clinical and prognostic associations of liver volume determined by computed tomography in acute liver failure. Liver Int 2018; 38:1592-1601. [PMID: 29461676 DOI: 10.1111/liv.13725] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2017] [Accepted: 02/11/2018] [Indexed: 02/13/2023]
Abstract
BACKGROUND Liver volume (LV) can be non-invasively determined from the analysis of computed tomography (CT) images, and in patients with acute liver injury (ALI) or failure (ALF), it can reflect the balance of structural collapse with hepatic regeneration. We examined its relation to cause of liver injury, measures of liver function and histopathological findings, and utility in prediction of complications and mortality. METHODS Two hundred and seventy-three patients with ALF/ALI admitted to a specialist intensive care unit were studied. One hundred and ninety-nine patients (73%) had non-acetaminophen (NA) aetiologies and 74 (27%) had acetaminophen-induced disease. LV and proportion of predicted LV (PLV%) were determined from admission CT imaging. RESULTS LV and PLV% showed marked variation when aetiologic groups were compared (P < .0001), including loss in cases with indeterminate cause (LV 939 cm3 [IQR 680-1259], PLV% 56% [42-84]) and increase in Budd-Chiari syndrome (1891 cm3 [1601-2094], 121% [111-131]). Progression to high-grade encephalopathy was more common with smaller LV and PLV. A < 1000 cm3 threshold identified NA patients who later developed it with 93% (95%CI 83-98) specificity and odds ratio 10.6 (3.3-34.5) at median 5 days prior to onset, and risk of death in those with NA-drug-induced (DILI) or indeterminate disease with 91% (71-99) specificity and 63% (50-75) sensitivity. CONCLUSION In patients with ALF/ALI, LV shows marked variation by the cause of disease, and in prognostic importance. In indeterminate and DILI cases, loss of volume to <1000 cm3 may indicate irreversible liver injury and regenerative failure and serve as an early clinical predictor for the development of high-grade encephalopathy and death.
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Affiliation(s)
- Abigail Zabron
- Liver Intensive Therapy Unit, Institute of Liver Studies, Kings College Hospital, London, UK
| | - Alberto Quaglia
- Histopathology, Institute of Liver Studies, Kings College Hospital, London, UK
| | - Evangelia Fatourou
- Liver Intensive Therapy Unit, Institute of Liver Studies, Kings College Hospital, London, UK
| | - Praveen Peddu
- Radiology, Institute of Liver Studies, Kings College Hospital, London, UK
| | - Dylan Lewis
- Radiology, Institute of Liver Studies, Kings College Hospital, London, UK
| | - Michael Heneghan
- Hepatology, Institute of Liver Studies, Kings College Hospital, London, UK
| | - Christopher Willars
- Liver Intensive Therapy Unit, Institute of Liver Studies, Kings College Hospital, London, UK
| | - Georg Auzinger
- Liver Intensive Therapy Unit, Institute of Liver Studies, Kings College Hospital, London, UK
| | - Nigel Heaton
- Liver Transplant Surgery, Institute of Liver Studies, Kings College Hospital, London, UK
| | - Julia Wendon
- Liver Intensive Therapy Unit, Institute of Liver Studies, Kings College Hospital, London, UK
| | - Pauline Kane
- Radiology, Institute of Liver Studies, Kings College Hospital, London, UK
| | - John Karani
- Radiology, Institute of Liver Studies, Kings College Hospital, London, UK
| | - William Bernal
- Liver Intensive Therapy Unit, Institute of Liver Studies, Kings College Hospital, London, UK
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Affiliation(s)
- Emma Roche-Kelly
- Department of Anaesthetics, King's College Hospital, London SE5 9RS, UK
| | - Cheng Fang
- Department of Radiology, King's College Hospital, London SE5 9RS, UK
| | - Dylan Lewis
- Department of Radiology, King's College Hospital, London SE5 9RS, UK
| | - Pauline Kane
- Department of Radiology, King's College Hospital, London SE5 9RS, UK
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16
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Aravind P, Thillai K, Suddle A, Heaton N, Karani J, Kane P, Peddu P, Lewis D, Sarker D, Ross PJ. Application of ALBI and PALBI score as prognostic variables in hepatocellular carcinoma patients treated with transarterial-chemoembolization. J Clin Oncol 2017. [DOI: 10.1200/jco.2017.35.4_suppl.241] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
241 Background: Albumin-Bilirubin Score(ALBI) is simple prognostic tool to stratify HCC patients on liver function. It is proposed as more accurate predicting score of hepatic dysfunction compared with Child-Pugh (CP) grading. Platelet-Albumin-Bilirubin Score (PALBI) incorporating platelet count may offer further prognostic sensitivity. We sought to correlate ALBI, PALBI and CP grade with overall survival in HCC patients who underwent transarterial-chemoembolization (TACE). Methods: 431 HCC patients who received TACE between 2006 and 2012 at a Liver Centre, UK was included. Serum albumin, bilirubin and platelet were used to calculate ALBI and PALBI scores. Patients were classified into three groups using previously described formulas. Survival outcomes (Median OS) were measured using Kaplan-Meier method. Results: Median age of study population was 62 years. Patients classified by ALBI score, Group 1 was 208 patients (48%), 2 was 196 (45.4%) and 3 was 27 (6.3%). Median OS for Group 1 was 26.1 months (m) (95% CI 19.5-32.6), 2 was 18.6m (95% CI 14.9-21.5) and 3 was 11.7m (95% CI 6.1-17.3) (p < 0.001). PALBI Group 1 was 179 (41.5%), 2 was 150 (34.8%) and 3 was102 (23.7%). PALBI group 1 had median OS 25.5m (95% CI 17.9-33.1), 2 had 22.3m (95% CI 18.3-26.3), 3 had 10m (95% CI 5.9-14.3) (p < 0.001). Majority were class CP-A. (A = 365, B = 63, C = 2). CP-A patients were re-stratified on ALBI and PALBI status. ALBI Group 1 (N = 204) OS 26.0m (95% CI 19.5-32.6), 2 (N = 151) OS 19.1m (95% CI 14.7-23.5), 3 (N = 7) OS 7.6m (95% CI2.27-12.9) (p = 0.04). Survival of CP-A patients by PALBI was significantly different - Group1 (N = 175) OS 28.8m (95%CI 20.79-36.74), 2 (N = 140) OS 22.6m (95%CI 18.89-26.25) and 3 (N = 50) OS 8.9m (95%CI 6.25-11.5) (p < 0.001). Conclusions: Significant comparable survival difference was seen in ALBI and PALBI groups. CP-A patients with group 3 ALBI or PALBI had significantly poorer survival than groups 1 and 2 suggesting increased sensitivity determining hepatic dysfunction compared with CP status. Our results suggest ALBI and PALBI scores likely more accurate stratifying method for mild liver disease and guide treatment. Further prospective studies using both scores are warranted.
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Affiliation(s)
| | | | - Abid Suddle
- Department of Hepatology, King's College Hospital, London, United Kingdom
| | - Nigel Heaton
- Department of Liver Studies, King's College Hospital, London, United Kingdom
| | - John Karani
- Kings College Hospital NHS Trust, London, United Kingdom
| | - Pauline Kane
- King's College Hosptial NHS Foundation Trust, London, United Kingdom
| | - Praveen Peddu
- Kings College Hospital NHS Trust, London, United Kingdom
| | - Dylan Lewis
- Kings College Hospital NHS Trust, London, United Kingdom
| | - Debashis Sarker
- Department of Oncology, King's College Hospital, London, United Kingdom
| | - Paul J. Ross
- Guy's and St Thomas' Hospital, London, United Kingdom
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17
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Husainy MA, Fang C, Nicolescu A, Lewis D, Kane P, Vincent RP. Success in adrenal venous sampling between two protocols: experience at a tertiary centre. J Clin Pathol 2016; 70:91-92. [PMID: 27849157 DOI: 10.1136/jclinpath-2016-204081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2016] [Revised: 10/03/2016] [Accepted: 10/27/2016] [Indexed: 11/04/2022]
Affiliation(s)
- Mohammad Ali Husainy
- Department of Radiology, King's College Hospital NHS Foundation Trust, London, UK
| | - Cheng Fang
- Department of Radiology, King's College Hospital NHS Foundation Trust, London, UK
| | - Ana Nicolescu
- Department of Radiology, King's College Hospital NHS Foundation Trust, London, UK
| | - Dylan Lewis
- Department of Radiology, King's College Hospital NHS Foundation Trust, London, UK
| | - Pauline Kane
- Department of Radiology, King's College Hospital NHS Foundation Trust, London, UK
| | - Royce P Vincent
- Department of Clinical Biochemistry (Viapath), King's College Hospital NHS Foundation Trust, London, UK
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18
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Ramsenthaler C, Kane P, Gao W, Siegert RJ, Edmonds PM, Schey SA, Higginson IJ. Prevalence of symptoms in patients with multiple myeloma: a systematic review and meta-analysis. Eur J Haematol 2016; 97:416-429. [PMID: 27528496 DOI: 10.1111/ejh.12790] [Citation(s) in RCA: 91] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/16/2016] [Indexed: 12/11/2022]
Abstract
OBJECTIVES Multiple myeloma (MM) is an incurable haematological disease. Due to novel agents, overall survival has improved in this group, yet there are no systematic reviews to understand the symptom profiles resulting from disease and treatment-related toxicities. We aimed to synthesise data on the prevalence of symptoms in patients with MM. METHODS A systematic database and grey literature search were conducted in six databases. Random-effects meta-analysis with inverse variance weighting to pool prevalence data was performed. RESULTS Thirty-six studies were included of which 34 studies (N = 3023) provided data for meta-analysis. Twenty-seven distinct symptoms were reported, with the majority of studies focusing on pain (n = 27), fatigue (n = 19) and problems with functioning (n = 15). The most prevalent symptoms were fatigue (98.8%, 95% CI 98.1-99.2%), pain (73%, 39.9-91.7), constipation (65.2%, 22.9-92.2) and tingling in the hands/feet with 53.4% (0.4-99.7). The most common problems were decreased physical functioning (98.9%, 98.2-99.3), decreased cognitive functioning (80.2%, 40-96.1) and financial difficulties (78.4%, 39.1-95.4). These problems were present in newly diagnosed to advanced disease stage. CONCLUSIONS Optimal quality of life and good symptom management in this incurable disease can only be achieved by routinely assessing symptoms throughout the disease trajectory.
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Affiliation(s)
- Christina Ramsenthaler
- Department of Palliative Care, Policy and Rehabilitation, Cicely Saunders Institute, Faculty of Life Sciences and Medicine, King's College London, London, UK. .,Department of Palliative Medicine, Munich University Hospital, Munich, Germany.
| | - Pauline Kane
- Department of Palliative Care, Policy and Rehabilitation, Cicely Saunders Institute, Faculty of Life Sciences and Medicine, King's College London, London, UK
| | - Wei Gao
- Department of Palliative Care, Policy and Rehabilitation, Cicely Saunders Institute, Faculty of Life Sciences and Medicine, King's College London, London, UK
| | - Richard J Siegert
- Department of Palliative Care, Policy and Rehabilitation, Cicely Saunders Institute, Faculty of Life Sciences and Medicine, King's College London, London, UK.,Department of Psychology, Faculty of Health and Environmental Sciences, Auckland University of Technology, Auckland, New Zealand
| | - Polly M Edmonds
- Department of Palliative Care, King's College Hospital NHS Foundation Trust, London, UK
| | - Stephen A Schey
- Department of Haematological Medicine, King's College Hospital NHS Foundation Trust, London, UK
| | - Irene J Higginson
- Department of Palliative Care, Policy and Rehabilitation, Cicely Saunders Institute, Faculty of Life Sciences and Medicine, King's College London, London, UK
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19
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Aravind P, Thillai K, Suddel A, Karani J, Lewis D, Heaton N, Kane P, Alkadhimi G, Sarker D, Ross P. P-098 Prognostic significance of comorbidities in elderly patients with Hepatocellular carcinoma (HCC) treated with Transarterial Chemoembolization: a Single Centre Experience. Ann Oncol 2016. [DOI: 10.1093/annonc/mdw199.93] [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: 11/12/2022] Open
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20
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Aravind P, Thillai K, Heaton N, Suddel A, Kane P, Karani J, Peddu P, Lewis D, Alkadhimi G, Sarker D, Ross P. PD-021 A single centre experience of the prognostic variables in hepatocellular carcinoma (HCC) patients treated with transarterial chemoembolization. Ann Oncol 2016. [DOI: 10.1093/annonc/mdw200.21] [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: 11/12/2022] Open
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21
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Aravind P, Thillai K, Sarker D, Heaton N, Karani J, Suddle A, Kane P, Lewis D, Peddu P, Al-Kadhimi G, Ross PJ. Prognostic significance of the hepatoma arterial embolization prognostic (HAP) score in hepatocellular carcinoma (HCC) patients treated with transarterial chemoembolization: A single centre experience. J Clin Oncol 2016. [DOI: 10.1200/jco.2016.34.15_suppl.e15617] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
| | | | - Debashis Sarker
- Department of Oncology, King's College Hospital, London, United Kingdom
| | - Nigel Heaton
- Department of Oncology, King's College Hospital, London, United Kingdom
| | - John Karani
- Kings College Hospital NHS Trust, London, United Kingdom
| | - Abid Suddle
- Department of Oncology, King's College Hospital, London, United Kingdom
| | - Pauline Kane
- King's College Hosptial NHS Foundation Trust, London, United Kingdom
| | - Dylan Lewis
- Kings College Hospital NHS Trust, London, United Kingdom
| | - Praveen Peddu
- Kings College Hospital NHS Trust, London, United Kingdom
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22
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Thillai K, Repana D, Korantzis I, Kane P, Prachalias A, Ross P. Clinical outcomes for patients with liver-limited metastatic colorectal cancer: Arguing the case for specialist hepatobiliary multidisciplinary assessment. Eur J Surg Oncol 2016; 42:1331-6. [PMID: 27174600 DOI: 10.1016/j.ejso.2016.03.031] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [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: 10/05/2015] [Revised: 03/22/2016] [Accepted: 03/31/2016] [Indexed: 12/18/2022] Open
Abstract
In patients with liver-limited metastatic colorectal cancer, hepatic resection can offer a significant survival benefit over systemic therapy alone. Specialist hepatobiliary multidisciplinary meetings are currently believed to provide the best forum to discuss the management for these patients. A retrospective analysis was undertaken of patients diagnosed with liver-limited metastatic colorectal cancer over 6 months within a cancer network in the United Kingdom. In addition, patients who were diagnosed but not referred to the hepatobiliary meeting were discussed within a virtual multi-disciplinary setting. Contributors were blinded and proposed management recorded. 159 newly diagnosed patients with liver-limited metastatic colorectal cancer were identified. 68 (43%) were referred at initial diagnosis and 38 (24%) referred following systemic treatment. 35 (51%) who were discussed at baseline underwent a subsequent hepatectomy or radiofrequency ablation, as did 18 (47%) patients referred after chemotherapy. Of the remaining 53 (33%) patients not referred, imaging was available for 31 (58%). Decisions regarding potential liver-directed therapy were discussed within a multi-disciplinary setting. 13 (42%) were identified as resectable or potentially resectable and 11 (36%) may have been suitable for a clinical trial. In reality, none of these 31 patients (100%) underwent surgery or ablation. Whilst the majority of patients with liver-limited metastatic colorectal cancer were referred appropriately, this study demonstrates that a significant number with potentially resectable disease are not being discussed at specialist meetings. A review of all diagnosed cases would ensure that an increased number of patients are offered hepatic resection or ablation.
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Affiliation(s)
- K Thillai
- Department of Medical Oncology, Guy's and St Thomas' NHS Trust, London, United Kingdom
| | - D Repana
- Department of Medical Oncology, Guy's and St Thomas' NHS Trust, London, United Kingdom
| | - I Korantzis
- Department of Medical Oncology, Guy's and St Thomas' NHS Trust, London, United Kingdom
| | - P Kane
- Institute of Liver Studies, King's College Hospital, London, United Kingdom
| | - A Prachalias
- Institute of Liver Studies, King's College Hospital, London, United Kingdom
| | - P Ross
- Department of Medical Oncology, Guy's and St Thomas' NHS Trust, London, United Kingdom; Institute of Liver Studies, King's College Hospital, London, United Kingdom.
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23
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Husainy M, Fang C, Nicolescu A, Lewis D, Vincent R, Kane P. Improving the radiological and biochemical success in adrenal venous sampling. J Vasc Interv Radiol 2016. [DOI: 10.1016/j.jvir.2015.12.378] [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: 10/22/2022] Open
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24
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Maharaj R, Pingitore A, Menon K, Kane P, Wendon J, Bernal W. Images of the Month: MDMA-Induced Acute Liver Failure and Transient Abdominal Pneumatosis. Am J Gastroenterol 2015; 110:963. [PMID: 26148253 DOI: 10.1038/ajg.2014.399] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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25
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Barnes C, Varma A, Kane P. P07 * ARE ALL PATIENTS WITH SUSPECTED BRAIN TUMOUR ON CRANIAL IMAGING REFERRED PROMPTLY FOR MDT DISCUSSION? Neuro Oncol 2014. [DOI: 10.1093/neuonc/nou249.7] [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: 11/13/2022] Open
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26
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Hamdan A, Kane P. P05 * VARIABILITY IN FOLLOW UP IMAGING GUIDELINES AFTER THE COMPLETION OF PRIMARY THERAPY IN GLIOBLASTOMA MULTIFORME. Neuro Oncol 2014. [DOI: 10.1093/neuonc/nou249.5] [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: 11/13/2022] Open
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27
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Hamdan A, Kane P. P16.13 * UNCERTAINTY AND VARIABILITY IN SURVEILLANCE IMAGING AFTER COMPLETION OF PRIMARY TREATMENT IN GLIOBLASTOMA MULTIFORME. Neuro Oncol 2014. [DOI: 10.1093/neuonc/nou174.309] [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: 11/13/2022] Open
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28
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Kane P, Jasperse M, Boland P, Herst P. A pathway to empowerment: evaluating a cancer education and support programme in New Zealand. Eur J Cancer Care (Engl) 2014; 23:668-74. [PMID: 24661502 DOI: 10.1111/ecc.12188] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/06/2014] [Indexed: 11/29/2022]
Abstract
Support programmes often benefit cancer patients and their families. This study evaluates how the Living Well Cancer Education Programme (LWCEP), from the Cancer Society of New Zealand, meets the needs of its clients. A purposeful sample of 21 participants representing the normal range of demographic characteristics (age, gender, diagnosis and geographical location) for the programme, participated in semi-structured interviews. Demographic data were subjected to a frequency analysis. Main data were collected and analysed using a constructivist grounded theory approach regarding the experiences of the participants with being on the programme and recommendations for future development. Of the 21 participants, 14 were cancer patients (eight women and six men) and seven were support people (five women and two men). The LWCEP was described as a safe, supportive and stimulating environment, provided a powerful sense of belonging, empowered participants to gain perspective, enhance their confidence and communication skills and make increasingly informed choices. Consistent with a previous evaluation focussing on the facilitators of the LWCEP, there was a strong desire for better promotion of the programme to the wider community, establishment of a better referral pathway and the potential to offer two separate programmes depending on the stage of a patient's journey.
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Affiliation(s)
- P Kane
- Department of Radiation Therapy, School of Medicine and Health Science, University of Otago Wellington, Wellington South, New Zealand
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Inchingolo R, Ljutikov A, Deganello A, Kane P, Karani J. Outcomes and indications for intervention in non-operative management of paediatric liver trauma: a 5 year retrospective study. Clin Radiol 2014; 69:157-62. [PMID: 24558659 DOI: 10.1016/j.crad.2013.09.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
AIM To determine the applicability of accurate computed tomography (CT) evaluation and embolization as non-operative management for liver trauma in a paediatric population. MATERIAL AND METHODS A retrospective observational study of 37 children (mean age 10.5 years) with hepatic trauma (28 blunt, 9 penetrating) admitted to a trauma referral centre over a 5 year period. All patients were evaluated with CT and scored with an Association for the Surgery of Trauma score. Inpatient information was reviewed for demographics, associated injuries, modes of management, efficacy and complications of management, and outcome.Statistical analysis was performed. RESULTS There were seven contusions, two grade I, two grade II, nine grade III, and 17 grade IV liver lacerations. Only two patients (grade IV, penetrating) underwent surgery for the management of bowel perforation. All children had non-surgical treatment of their liver trauma: three cases (grade IV) had primary angiography due to CT evidence of active bleeding and embolization was performed in two of these. Seven patients (two grade III, five grade IV)had angiography during the follow-up for evidence of a complicating pseudoaneurysm and embolization was performed in six of them. Embolization was successful in all the children; one minor complication occurred (cholecystitis). Endoscopic retrograde cholangiopancreatography (ERCP) plus stenting was performed in two cases for a bile leak. All 37 children had a positive outcome. CONCLUSION The present study demonstrates that non-operative management of hepatic trauma is applicable to children and may have a higher success rate than in adults.
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30
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Thillai K, Repana D, Korantzis I, Prachalias A, Kane P, Ross PJ. Clinical outcomes for patients with liver-limited metastatic colorectal cancer: Arguing the case for specialist hepatobiliary multidisciplinary assessment. J Clin Oncol 2014. [DOI: 10.1200/jco.2014.32.3_suppl.637] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
637 Background: In patients (pts) with liver-limited metastatic colorectal cancer (mCRC), surgical resection or radiofrequency ablation (RFA) can lead to a significant overall survival benefit. Specialist hepato-biliary (HPB) multidisciplinary meetings (MDMs) are currently believed to provide the best forum to discuss this cohort of pts and assess their suitability for surgery or RFA. Methods: A retrospective analysis was undertaken of pts diagnosed with liver-limited mCRC over a period of 6 months within a specified cancer network in the United Kingdom. In addition to discussed cases, pts who were diagnosed but not referred to the HPB MDM were also discussed within the MDM setting. For these pts, contributors were blinded and decisions were made regarding resectability and appropriateness for RFA based on patient imaging and clinical history. Results: In a six month period, 159 pts were diagnosed with liver-limited mCRC within our cancer network. Of these, 68 (43%) were referred at the time of initial diagnosis, with a further 38 (24%) referred after commencing systemic treatment. 35 (56%) who were discussed at the time of their original diagnosis went on to have either a hepatectomy or RFA, as did 18 (51%) patients referred after initiating systemic treatment. 81 pts (78%) referred to the HPB MDM had synchronous liver metastases. Of the remaining 53 (33%) patients who were not referred to the HPB MDM, the average age was 70.2 years and 38 (86%) had synchronous liver metastases. Imaging was available for 31 (58%) of these pts. Decisions regarding resectability or RFA were made within the MDM based solely on history and radiology findings. Of these cases, 13 (41.9%) were identified as resectable or potentially resectable and 11 (35.5%) may have been suitable for a clinical trial. None of these 31 pts (100%) had hepatic surgery or RFA. Conclusions: Whilst the majority of pts with liver-limited mCRC were referred appropriately, this study highlights that a number of pts with potentially resectable disease are not being discussed at a specialist HPB MDM. A review of all diagnosed cases would ensure that an increased number of pts are offered hepatic resection or RFA.
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Affiliation(s)
- Kiruthikah Thillai
- Department of Medical Oncology, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | - Dimitra Repana
- Department of Medical Oncology, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | - Ippokratis Korantzis
- Department of Medical Oncology, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | | | - Pauline Kane
- King's College Hosptial NHS Foundation Trust, London, United Kingdom
| | - Paul J. Ross
- Department of Medical Oncology, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
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Kane P, Lodge P, Hopkins K, Greenslade L, Tookman A. 'Living and dying well with end-stage liver disease': time for palliative care? Hepatology 2013; 57:2092. [PMID: 22987304 DOI: 10.1002/hep.26078] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2012] [Accepted: 07/11/2012] [Indexed: 12/07/2022]
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32
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Zen C, Zen Y, Mitry RR, Corbeil D, Karbanová J, O'Grady J, Karani J, Kane P, Heaton N, Portmann BC, Quaglia A. Mixed phenotype hepatocellular carcinoma after transarterial chemoembolization and liver transplantation. Liver Transpl 2011; 17:943-54. [PMID: 21491582 DOI: 10.1002/lt.22314] [Citation(s) in RCA: 77] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
We investigated the phenotype of hepatocellular carcinoma (HCC) in livers removed during transplantation after local ablation therapy by transarterial chemoembolization (TACE). This study involved 80 HCC nodules (40 treated with TACE and 40 not treated with local ablation before transplantation) observed in 64 explanted livers and included clinicopathological evaluations as well as single and double immunohistochemistry and reverse-transcription polymerase chain reaction (RT-PCR) for cytokeratin 19 (CK19), epithelial cell adhesion molecule (EpCAM), neural cell adhesion molecule (NCAM), and CD133. HCCs with complete necrosis post-TACE without viable tumors were excluded from the analysis. Cholangiolar, glandular, or spindle cell areas suggestive of a mixed hepatocholangiocellular phenotype were seen in 14 post-TACE HCCs and in none of the non-TACE HCCs (P < 0.001). According to single-epitope immunohistochemistry of post-TACE HCCs, CD133, CK19, EpCAM, and NCAM were expressed in 14 (35%), 8 (20%), 12 (30%), and 8 (20%), respectively. Only EpCAM was detected in 4 non-TACE HCC cases (10%). RT-PCR experiments using tissues obtained by laser microdissection showed that 4 of 5 investigated post-TACE HCCs expressed at least 1 of the markers, which were coexpressed in 3 of 5 tumors, whereas CD133 and EpCAM were individually expressed in 2 non-TACE HCCs. Double immunostaining showed that CD133(+) cells frequently coexpressed CK19, EpCAM, or NCAM. Interestingly, the recurrence rate for patients with CD133(+) post-TACE HCC was significantly higher than the rate for patients with CD133(-) post-TACE HCC (P = 0.025). In conclusion, HCC with the combined hepatocholangiocellular phenotype appears to be more frequent in post-TACE HCC versus untreated HCC. Further studies are needed to investigate the potential relationships between TACE and HCC subpopulations with a chemoembolization-resistant phenotype and their clinical significance.
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Affiliation(s)
- Chikako Zen
- Institute of Liver Studies, King's College Hospital, London, United Kingdom
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Sethi H, Peddu P, Prachalias A, Kane P, Karani J, Rela M, Heaton N. Selective embolization for bleeding visceral artery pseudoaneurysms in patients with pancreatitis. Hepatobiliary Pancreat Dis Int 2010; 9:634-8. [PMID: 21134834] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND Pancreatitis is associated with arterial complications in 4%-10% of patients, with untreated mortality approaching 90%. Timely intervention at a specialist center can reduce the mortality to 15%. We present a single institution experience of selective embolization as first line management of bleeding pseudoaneurysms in pancreatitis. METHODS Sixteen patients with pancreatitis and visceral artery pseudoaneurysms were identified from searches of the records of interventional angiography from January 2000 to June 2007. True visceral artery aneurysms and pseudoaneurysms arising as a result of post-operative pancreatic or biliary leak were excluded from the study. RESULTS In 50% of the patients, bleeding complicated the initial presentation of pancreatitis. Alcohol was the offending agent in 10 patients, gallstones in 3, trauma, drug-induced and idiopathic pancreatitis in one each. All 16 patients had a contrast CT scan and 15 underwent coeliac axis angiography. The pseudoaneurysms ranging from 0.9 to 9.0 cm affected the splenic artery in 7 patients: hepatic in 3, gastroduodenal and right gastric in 2 each, and left gastric and pancreaticoduodenal in 1 each. One patient developed spontaneous thrombosis of the pseudoaneurysm. Fourteen patients had effective coil embolization of the pseudoaneurysm. One patient needed surgical exclusion of the pseudoaneurysm following difficulty in accessing the coeliac axis radiologically. There were no episodes of re-bleeding and no in-hospital mortality. CONCLUSIONS Pseudoaneurysms are unrelated to the severity of pancreatitis and major hemorrhage can occur irrespective of their size. Co-existent portal hypertension and sepsis increase the risk of surgery. Angiography and selective coil embolization is a safe and effective way to arrest the hemorrhage.
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Affiliation(s)
- Harsheet Sethi
- Department of Hepatobiliary Surgery, Institute of Liver Studies, Kings College London School of Medicine at Kings College Hospital, Denmark Hill, London SE5 9RS, UK
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Yang L, Samarasinghe YP, Kane P, Amiel SA, Aylwin SJB. Visceral adiposity is closely correlated with neck circumference and represents a significant indicator of insulin resistance in WHO grade III obesity. Clin Endocrinol (Oxf) 2010; 73:197-200. [PMID: 20050862 DOI: 10.1111/j.1365-2265.2009.03772.x] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVE Although associations between visceral adiposity (intra-abdominal fat mass) and insulin resistance are well established, previous data include few subjects with WHO grade III obesity [body mass index (BMI) > 40 kg/m(2)]. We have investigated the relationship between visceral adiposity and insulin resistance using computed tomography (CT)-quantified fat mass and the homeostasis model assessment for insulin resistance (HOMA-IR) in patients with severe obesity. PATIENTS AND METHODS Eighteen nondiabetic subjects with BMI > 40 kg/m(2) were recruited. BMI, and waist, hip and neck circumferences were measured. Fasting plasma insulin and glucose were measured to calculate HOMA-IR. A single slice CT scan was taken at L4 and visceral and abdominal subcutaneous adipose tissue (VAT and ASAT, respectively) quantified using 'SliceOmatic' image analysis software. RESULTS A close correlation was demonstrated between VAT and HOMA-IR (r(2) = 0.46, P = 0.002), whereas ASAT showed no relationship. Neck circumference correlated with both VAT (r(2) = 0.67, P < 0.0001) and HOMA-IR (r(2) = 0.35, P = 0.01). Waist circumference only correlated significantly with VAT (r(2) = 0.25, P = 0.03). CONCLUSIONS Visceral adiposity remains a strongly significant indicator of insulin resistance in WHO grade III obesity. Neck circumference surpasses other anthropometric measurements as a powerful marker of both VAT and insulin resistance.
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Affiliation(s)
- L Yang
- Endocrinology Department, King's College Hospital, Denmark Hill, London, UK
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Ramanathan R, Sehgal R, Rajasenan K, Crandall T, Balaban E, Pinkerton R, Kane P, Potter D, Lembersky B. 6058 Phase I/II study of weekly intermittent capecitabine with bevacizumab and oxaliplatin on an every-2-week schedule for patients with untreated advanced colorectal cancer (CRC) final results. EJC Suppl 2009. [DOI: 10.1016/s1359-6349(09)71153-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: 10/20/2022] Open
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Lembersky BC, Sehgal R, Rajasenan KK, Crandall TL, Balaban EP, Pinkerton RA, Kane P, Potter DM, Kinney C, Ramanathan RK. Phase II study of bevacizumab (BEV), weekly (wkly) intermittent capecitabine (Cap), and oxaliplatin (Ox) on an every-2-week schedule for patients (Pts) with untreated advanced colorectal cancer (CRC). J Clin Oncol 2008. [DOI: 10.1200/jco.2008.26.15_suppl.4061] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Ramanathan RK, Rajasenan K, Crandall T, Balaban EP, Pinkerton RA, Kane P, Potter DM, Dranko S, Schmotzer A, Lembersky BC. Phase II study of the A-ICOX regimen [bevacizumab (Bev), weekly intermittent capecitabine (Cap) and oxaliplatin (Ox)] for untreated advanced colorectal cancer (CRC). J Clin Oncol 2007. [DOI: 10.1200/jco.2007.25.18_suppl.4092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
4092 Background: FOLFOX in combination with Bev is a standard regimen for treating advanced CRC. Cap on a d 1–14 schedule every 3 weeks is now being substituted for 5-flurouracil (CapOx); however optimal doses and schedules of Cap in combination with Ox and Bev needs continued evaluation. Intermittent weekly Cap (3,500 mg/m2, d 1–7) with Ox (85 mg/m2) every 2 weeks compared to the standard CapOx regimen in untreated advanced CRC has shown superior response and time-to-progression in Europe (Scheithauer W et al. J Clin Oncol. 21,1307; 2003). Methods: This phase II trial is designed to evaluate the A-ICOX regimen in US patients with CRC. The primary endpoint is to detect a 50% improvement in median progression free survival (PFS) from 8 to 12 months. With a sample of 40 patients, a 1-sided level 0.1 log-rank test has 81% power to detect this difference. Patients with advanced untreated CRC are eligible for study. Cap is administered at the dose of 2,500 mg/m2 in two divided doses on d 1–7 (n=11) and has been increased to 3000 mg/m2 dose (n=26), based on tolerability of the lower dose. The dose of Ox is 85 mg/m2 and Bev is 5 mg/kg. Cycles are repeated every 2 weeks. Results: Thirty-seven of 40 pts have been enrolled, with 30 evaluable for toxicity and response. Patient characteristics: Male (n=19); ECOG performance status 0 (n=18), 1 (n=12); median age 63 (range 38–80 years). Median cycles administered 4 (range 1–17). Partial responses were seen in 10 pts (33%), and metastasectomy was performed in 8 pts (27%). The PFS analysis is premature at this point. Gr 3/4 hematological toxicity occurred in only 2 pts (7 %). Other gr 3/4 adverse events have included: diarrhea (10 %), hand-foot syndrome (7 %), peripheral neuropathy (7%), nausea (7%) and vomiting (7 %). Conclusions: The first US experience of the A-ICOX regimen shows it to be very well tolerated, and Cap (3,000 mg/m2, d 1–7) in combination with Ox and Bev therapy can be safely administered. The incidence of subsequent metastasectomy, a marker of activity, is encouraging. A phase III trial of the A-ICOX regimen is now being conducted against standard Q-3 weekly CapOx/Bev. (Study supported by Genentech and Roche Pharmaceuticals) [Table: see text]
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Affiliation(s)
| | - K. Rajasenan
- University of Pittsburgh Cancer Institute, Pittsburgh, PA
| | - T. Crandall
- University of Pittsburgh Cancer Institute, Pittsburgh, PA
| | - E. P. Balaban
- University of Pittsburgh Cancer Institute, Pittsburgh, PA
| | | | - P. Kane
- University of Pittsburgh Cancer Institute, Pittsburgh, PA
| | - D. M. Potter
- University of Pittsburgh Cancer Institute, Pittsburgh, PA
| | - S. Dranko
- University of Pittsburgh Cancer Institute, Pittsburgh, PA
| | - A. Schmotzer
- University of Pittsburgh Cancer Institute, Pittsburgh, PA
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Tucker O, Battula N, Kane P, Karani J, Heaton N, Muiesan P. Liver transplantation with caval thrombectomy and cavoatrial shunt in acute Budd-Chiari syndrome. Liver Transpl 2007; 13:624-5. [PMID: 17394168 DOI: 10.1002/lt.21057] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Affiliation(s)
- Olga Tucker
- The Liver Transplant Unit, Institute of Liver Studies, King's College Hospital, London, United Kingdom
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Houben CH, Ade-Ajayi N, Patel S, Kane P, Karani J, Devlin J, Harrison P, Davenport M. Traumatic pancreatic duct injury in children: minimally invasive approach to management. J Pediatr Surg 2007; 42:629-35. [PMID: 17448757 DOI: 10.1016/j.jpedsurg.2006.12.025] [Citation(s) in RCA: 84] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND The management of children with main pancreatic duct injuries is controversial. We report a series of patients with pancreatic trauma who were treated using minimally invasive techniques. METHODS Retrospective review of children with pancreatic trauma treated at a UK tertiary referral institution between 1999 and 2004. RESULTS Fifteen children (11 boys) were admitted with pancreatic trauma. Twelve (80%) were less than 50th centile for body weight. Contrast-enhanced computed tomography (CT) scans were used to define organ injury, supplemented by magnetic resonance cholangiopancreatography (MRCP) in 7. Twelve (80%) underwent diagnostic endoscopic retrograde cholangiopancreatography (ERCP) with a median time after injury of 11 (range, 6-29) days. The degree of pancreatic injury was defined by ERCP and CT/MRCP as grade II (n = 2), grade III (n = 4), grade IV (n = 9) (American Association for the Surgery of Trauma grades). Nine children had a transductal pancreatic stent inserted endoscopically. Computed tomography/ultrasound-guided drainage was performed in 4 children for acute fluid collections. Two children later underwent endoscopic cyst-gastrostomy, one of whom later required conversion to an open cyst-gastrostomy. CONCLUSION Body habitus may predispose to pancreatic duct trauma. Contrast-enhanced CT scan (and MRCP) should dictate the need for ERCP. Transductal pancreatic stenting allows internal drainage of peripancreatic collections and may reestablish duct continuity, although a proportion still requires percutaneous or endoscopic cyst-gastrostomy drainage. Open surgery for pancreatic trauma should now be an exception.
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Affiliation(s)
- Christophe H Houben
- Department of Pediatric Surgery, Kings College Hospital, Denmark Hill, SE5 9RS London, UK
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Affiliation(s)
- Olga Tucker
- Liver Transplant Unit, Institute of Liver Studies, King's College Hospital, London, United Kingdom.
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Abstract
A case of meningioma that developed at a site of a previously performed burr hole is reported. To the best of our knowledge, this is the first reported case of a meningioma arising at a previous burr hole site. The possible reasons for its causation are discussed.
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Affiliation(s)
- D Rodrigues
- Department of Neurosurgery, James Cook University Hospital, Middlesbrough, UK.
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Totman J, O'Gorman R, Kane P, Karani J. Authors' reply. Br J Radiol 2005. [DOI: 10.1259/bjr/20302154] [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: 11/05/2022] Open
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Abstract
A case of a 64-year-old man with metastatic malignant mesothelioma is described in detail. When he presented to us he gave a history suggestive of transient ischaemic attack (TIA) 2 weeks before and 3 days after admission he developed weakness of the left upper limb. Computed tomographic scan of the brain revealed a solitary metastasis in the right cerebrum. A few days later, he developed subcutaneous metastasis in the chin. Malignant mesothelioma is considered to metastasize rarely and to spread locally. We suggest that distant metastasis in malignant mesothelioma is not uncommon and may be considered to behave like other forms of lung cancer. Treatment modalities should be studied in such patients.
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Affiliation(s)
- N Krishnaraj
- Department of Respiratory Medicine, The James Cook University Hospital, Middlesbrough, Cleveland, UK.
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Martí-Bonmatí L, Fog AF, de Beeck BO, Kane P, Fagertun H. Safety and efficacy of Mangafodipir trisodium in patients with liver lesions and cirrhosis. Eur Radiol 2003; 13:1685-92. [PMID: 12835986 DOI: 10.1007/s00330-002-1784-5] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2002] [Revised: 10/15/2002] [Accepted: 11/18/2002] [Indexed: 10/26/2022]
Abstract
Mangafodipir trisodium (Mn-DPDP, Teslascan) is a well-tolerated liver contrast agent. Although the enhancement characteristics of the cirrhotic liver after Mangafodipir trisodium administration have been studied, at present there is no published data on the impact that cirrhosis might have on the safety and efficacy profiles of this agent. Our objective is to evaluate by means of a retrospective comparison the safety and efficacy of Mangafodipir trisodium in patients with underlying cirrhosis who were examined for suspicion of focal liver lesions. A total of 923 patients received Mangafodipir trisodium (5 micromol/kg) in 11 prospective randomized European clinical trials. Adverse events and discomfort were recorded and graded in all patients. The efficacy analyses were performed on the subsets consisting of 617 patients with independent lesion counts (detection), and on the subset with 399 patients with independent and onsite final lesion diagnosis (characterization). Of the 399 patients, 149 had histologic confirmation. One hundred eighty of 923 patients (19.5%) had cirrhosis. There were no main differences between cirrhotic and non-cirrhotic patients. Adverse events were observed in 64 patients (6.9%), 6.7% in the cirrhotic group and 7.0% in the non-cirrhotic group, a non-significant difference. Adverse events in most patients were mild or moderate. The presence and intensity of the events did not differ between groups. Discomfort was recorded in 79 patients (8.6%), equally distributed in cirrhotic (6.1%) and non-cirrhotic (9.2%) patients. Regarding lesion count, significantly more lesions were found in the post- than in the precontrast images in both the cirrhotic and non-cirrhotic groups ( p<0.0001). This increase was not influenced by the presence of liver cirrhosis ( p=0.94). Lesion characterization was significantly improved in cirrhotic patients after administration of Mangafodipir trisodium ( p=0.002) but not in non-cirrhotic patients ( p=0.13). Mangafodipir trisodium is a safe and well-tolerated useful contrast agent in patients with cirrhosis.
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Affiliation(s)
- Luis Martí-Bonmatí
- Department of Radiology, Doctor Peset University Hospital, 46017 Valencia, Spain.
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Kane P. Obituary for David Horrobin: Work inspired and continues to nurture positive clinical outcomes. West J Med 2003. [DOI: 10.1136/bmj.326.7398.1089] [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: 11/04/2022]
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Gilbert J, Ketchen M, Kane P, Mason T, Baister E, Monaghan M, Barr S, Harris PE. The treatment of de novo acromegalic patients with octreotide-LAR: efficacy, tolerability and cardiovascular effects. Pituitary 2003; 6:11-8. [PMID: 14674719 DOI: 10.1023/a:1026273509058] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
AIM Somatostatin analogues are normally used as adjunctive therapy to surgery and radiotherapy in management of acromegaly. We studied the effects of de novo OCT-LAR treatment on growth hormone (GH) suppression, tumour size, cardiovascular function, clinical symptoms, signs and quality of life in 9 newly diagnosed acromegalic patients. METHODS Patients commenced OCT-LAR 20 mg IM monthly for 2 months. Dose increased to 30 mg monthly if mean serum GH (MGH) > 5 mU/l (2 microg/litre) (7 patients). Treatment continued for 6 months. Cardiac function assessed by echocardiography at baseline and day 169. Left ventricular (LV) mass and ejection fraction (EF) calculated from 2D M-mode studies. RESULTS Serum GH demonstrated suppression in 8/9 patients (mean suppression 64.9% +/- 29.7%, range; 4-95.2%). MGH suppressed < 5 mU/ (2 microg/litre) in 3 (33%) patients. IGF-I and IGFBP3 normalised in 1 (12.5%) and 3 (38%) patients respectively. Tumour shrinkage seen in 30% patients. Eight patients were assessed by echocardiography. At baseline, 7 patients demonstrated abnormalities in LV mass and EF. At day 169, 6 patients demonstrated a fall and 1 an increase in LV mass. Overall there was no significant change in LV mass. A significant increase in EF was observed (p = 0.02). There were significant improvements in health perception (p = 0.01), fatigue (p < 0.05) and perspiration (p = 0.0039). CONCLUSIONS These data demonstrate OCT-LAR provides adequate control of acromegaly in a proportion of patients treated over 6 months. This is associated with improved LV function, evidenced by increased EF. Improved results are expected with longer-term treatment. OCT-LAR may be considered as primary treatment for acromegaly in selected patients.
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Affiliation(s)
- J Gilbert
- Department of Endocrinology, King's College Hospital, Bessemer Rd, London SE5 9RS
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Ruzicka LT, Kane P. Infant and child mortality: the implications for fertility behaviour. Popul Res Leads 2002:1-11. [PMID: 12342137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/26/2023]
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Wy LA, Carlson HE, Kane P, Li X, Lei ZM, Rao CV. Pregnancy-associated Cushing's syndrome secondary to a luteinizing hormone/human chorionic gonadotropin receptor-positive adrenal carcinoma. Gynecol Endocrinol 2002; 16:413-7. [PMID: 12587537] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/28/2023] Open
Abstract
Cushing's syndrome occurring during pregnancy is frequently due to an adrenal neoplasm. Adrenal gland tumors occasionally respond to luteinizing hormone (LH) or human chorionic gonadotropin (hCG). We report a case of Cushing's syndrome during and following pregnancy due to an adrenal carcinoma which expressed the LH/hCG receptor. The presence of these receptors may have led to the growth and function of the tumor during pregnancy.
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Affiliation(s)
- L A Wy
- Department of Medicine, State University of New York at Stony Brook, Stony Brook, NY 11794-8154, USA
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Abstract
PURPOSE The aim of this study was to prospectively assess the accuracy of the most promising imaging and tumor marker tests in liver metastasis diagnosis on follow-up of asymptomatic colorectal cancer patients during a median of 57 months after primary tumor resection. METHODS One hundred patients, who were considered free of liver metastases after primary colorectal cancer resection and conventional follow-up, were screened for liver metastases by computerized tomography, magnetic resonance and ultrasound scans, ultrasound Doppler and isotope assessment of changes in hepatic arterial and portal venous flow, and serum estimation of carcinoembryonic antigen. Patients were followed up during a median of 41 months to identify those who developed liver metastases. RESULTS The most sensitive technique was computerized tomography (sensitivity 0.67, specificity 0.91). Computerized tomography and magnetic resonance but not ultrasound were 100 percent accurate in differentiating liver metastases from other hepatic lesions. Techniques based on changes in hepatic arterial and portal venous flow had lower diagnostic accuracies (Doppler perfusion index, sensitivity 0.58, specificity 0.57; hepatic perfusion index, sensitivity 0.50, specificity 0.55), whereas ultrasound scanning identified only 43 percent (sensitivity 0.43, specificity 0.96) and serum carcinoembryonic antigen 33 percent (sensitivity 0.33, specificity 0.81) of patients with asymptomatic liver metastasis. Sensitivity could be improved by using tests in combination but this reduced specificity. CONCLUSIONS Computerized tomography was the most sensitive test for asymptomatic colorectal liver metastases, but only 67 percent of affected patients were identified.
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Affiliation(s)
- C Glover
- Department of Surgery, Faculty of Medicine, Imperial College School of Science, Technology, and Medicine, Chelsea and Westminster Hospital, London, United Kingdom
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Abstract
Reproductive health, defined in the 1994 UN Cairo Conference on Population and Development, is discussed and its limits identified. Mortality and morbidity impacts of components of male and female reproductive health are quantified. Use is made of survey data and the estimates of deaths and disease burdens provided by the Global Burden of Disease Inquiry. Maternal causes are the greatest contributors to the total disease burden among women aged 15-44 years. In developing countries, up to half of those who want to delay or avoid further pregnancy are not using contraception. Worldwide, induced abortion accounts for 61,000 deaths annually. Sexually transmitted diseases and other illnesses also result from unsafe sexual practices, resulting in at least 1 million deaths each year. These deaths-and an overall disease burden of 50 million disability-adjusted life years-are entirely preventable. Constraints include, lack a of international commitment to improving reproductive health, social and economic factors, lack of biomedical research, insensitive social science research, and inadequate knowledge. Men and women have the right to demand better services and the knowledge and conditions in which to use them. Those in the more developed countries have the responsibility of ensuring adequate financial and technical support to make reproductive health possible everywhere.
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Affiliation(s)
- P Kane
- Department of Psychiatry, Royal Melbourne Hospital, University of Melbourne, Victoria, Australia
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