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Farah N, Hammer C, Gatenby P, Pencavel T. HPB P40 Assessing The Cholecystectomy Pathway: Are Standards Being Truly Met? Br J Surg 2022. [DOI: 10.1093/bjs/znac404.135] [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: 12/12/2022]
Abstract
Abstract
Background
Research suggests better outcomes for patients having cholecystectomy <8 days of presenting with symptoms1. Locally collected data from the GI surgery department at Royal Surrey County Hospital (RSCH) reported that 94% of eligible cases with acute biliary pathology underwent cholecystectomy <8 days of presentation. However, Hospital episode statistics (HES) data suggest it's lower.
RSCH participates in a national project evaluating the care of patients presenting acutely with biliary pathology (the CholoeQuic-ER study), and the latest outcomes from that study indicate that we are in the top 5 trusts nationally for acute management of gallstone disease, with a median time from admission to surgery of 3 days, resulting in significant improvements in bed occupancy and patient experience The primary aim was to ascertain what proportion of patients; 1) were eligible for an acute cholecystectomy or deemed unfit. 2) were eligible for cholecystectomy but were not referred during the inpatient admission, 3) were coded as having acute biliary pathology but had an alternative primary diagnosis. The secondary aim was to ascertain whether they met the standard of undertaking cholecystectomy <8 days of presentation with gallstone disease and why there was a discrepancy between the departmental data and HES data.
Methods
The hospital coding department provided a list of patients discharged from RSCH in September 2019 with a coding suggesting acute biliary pathology. ICD-10 codes covering cholelithiasis, cholecystitis, other diseases of the gallbladder and acute pancreatitis were used (the same methodology as the CholeQuic-ER study).
Results
There were 118 patients who were discharged in September 2019 with ICD-10 codes diagnostic of acute biliary pathology. Of the 118 patients, 48 (40.7%) were correctly coded with biliary pathology and 70 (59.3%) were not. Twenty-eight (58.3%) of those patients who were correctly coded had a surgical/ procedural intervention. Twenty (41.7%) of the correctly coded patients did not have surgical/procedural intervention, 9 (45%) discharged with outpatient surgical/AEC review pertaining to the biliary pathology. Nine (45%) discharged with alternative primary diagnosis, 2 (10%) discharged with a primary biliary pathology and no surgical intervention/follow-up. Of the original 118 patients, 70 (59.3%) patients did not have biliary pathology; 31 (44.2%) had no data specifically for September 2019, for the further 39 (55.7%) patients, there was incorrect coding e.g. Pneumonia Using the ICD codes employed by the CholeQuic-ER study, 66.9% of cases identified were inappropriately classified as primary biliary pathology and were not eligible for cholecystectomy.
The final outcomes were 28/48 (58.3%) had underwent appropriate procedure for their primary biliary pathology at index admission. 20/48 (41.7%) did not have definitive treatment at their index admission.
Conclusions
The results demonstrate a high number of patients with acute biliary pathology who did not undergo definitive treatment at their index admission or within 8 days of presentation.
Use of the methodology employed by the CholeQuic-ER study using HES data was inaccurate in correctly identifying patients with acute biliary pathology. Accurate coding of patients requires liaison between coding and clinical teams to help narrow discrepancies between HES data and RSCH data not only in the field of general surgery but in other departments.
We plan to work with the coding department to improve the outcome coding to help reflect the excellent outcomes we are achieving for these patients.
References:
Bamber JR, Stephens TJ, Cromwell DA, Duncan E, Martin GP, Quiney NF, Abercrombie JF, Beckingham, on behalf of the Cholecystectomy Quality Improvement Collaborative. Effectiveness of a quality improvement collaborative in reducing time to surgery for patients requiring emergency cholecystectomy. British Journal of Surgery. 2019; 3:802–811.
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Affiliation(s)
- Nima Farah
- Royal Surrey County Hospital , Guildford , United Kingdom
| | - Clare Hammer
- Royal Surrey County Hospital , Guildford , United Kingdom
| | - Piers Gatenby
- Royal Surrey County Hospital , Guildford , United Kingdom
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Meza-Torres B, Delanerolle G, Okusi C, Mayor N, Anand S, Macartney J, Gatenby P, Glampson B, Chapman M, Curcin V, Mayer E, Joy M, Greenhalgh T, Delaney B, de Lusignan S. Differences in Clinical Presentation With Long COVID After Community and Hospital Infection and Associations With All-Cause Mortality: English Sentinel Network Database Study. JMIR Public Health Surveill 2022; 8:e37668. [PMID: 35605170 PMCID: PMC9384859 DOI: 10.2196/37668] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Revised: 05/06/2022] [Accepted: 05/17/2022] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Most studies of long COVID (symptoms of COVID-19 infection beyond 4 weeks) have focused on people hospitalized in their initial illness. Long COVID is thought to be underrecorded in UK primary care electronic records. OBJECTIVE We sought to determine which symptoms people present to primary care after COVID-19 infection and whether presentation differs in people who were not hospitalized, as well as post-long COVID mortality rates. METHODS We used routine data from the nationally representative primary care sentinel cohort of the Oxford-Royal College of General Practitioners Research and Surveillance Centre (N=7,396,702), applying a predefined long COVID phenotype and grouped by whether the index infection occurred in hospital or in the community. We included COVID-19 infection cases from March 1, 2020, to April 1, 2021. We conducted a before-and-after analysis of long COVID symptoms prespecified by the Office of National Statistics, comparing symptoms presented between 1 and 6 months after the index infection matched with the same months 1 year previously. We conducted logistic regression analysis, quoting odds ratios (ORs) with 95% CIs. RESULTS In total, 5.63% (416,505/7,396,702) and 1.83% (7623/416,505) of the patients had received a coded diagnosis of COVID-19 infection and diagnosis of, or referral for, long COVID, respectively. People with diagnosis or referral of long COVID had higher odds of presenting the prespecified symptoms after versus before COVID-19 infection (OR 2.66, 95% CI 2.46-2.88, for those with index community infection and OR 2.42, 95% CI 2.03-2.89, for those hospitalized). After an index community infection, patients were more likely to present with nonspecific symptoms (OR 3.44, 95% CI 3.00-3.95; P<.001) compared with after a hospital admission (OR 2.09, 95% CI 1.56-2.80; P<.001). Mental health sequelae were more strongly associated with index hospital infections (OR 2.21, 95% CI 1.64-2.96) than with index community infections (OR 1.36, 95% CI 1.21-1.53; P<.001). People presenting to primary care after hospital infection were more likely to be men (OR 1.43, 95% CI 1.25-1.64; P<.001), more socioeconomically deprived (OR 1.42, 95% CI 1.24-1.63; P<.001), and with higher multimorbidity scores (OR 1.41, 95% CI 1.26-1.57; P<.001) than those presenting after an index community infection. All-cause mortality in people with long COVID was associated with increasing age, male sex (OR 3.32, 95% CI 1.34-9.24; P=.01), and higher multimorbidity score (OR 2.11, 95% CI 1.34-3.29; P<.001). Vaccination was associated with reduced odds of mortality (OR 0.10, 95% CI 0.03-0.35; P<.001). CONCLUSIONS The low percentage of people recorded as having long COVID after COVID-19 infection reflects either low prevalence or underrecording. The characteristics and comorbidities of those presenting with long COVID after a community infection are different from those hospitalized. This study provides insights into the presentation of long COVID in primary care and implications for workload.
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Affiliation(s)
- Bernardo Meza-Torres
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
| | - Gayathri Delanerolle
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
| | - Cecilia Okusi
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
| | - Nikhil Mayor
- Royal Surrey NHS Foundation Trust, Guildford, United Kingdom
| | - Sneha Anand
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
| | - Jack Macartney
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
| | - Piers Gatenby
- Royal Surrey NHS Foundation Trust, Guildford, United Kingdom
| | - Ben Glampson
- Imperial College Healthcare NHS Trust, Imperial Clinical Analytics, Research & Evaluation (iCARE), London, United Kingdom
| | - Martin Chapman
- King's College London, Population Health Sciences, London, United Kingdom
| | - Vasa Curcin
- King's College London, Population Health Sciences, London, United Kingdom
| | - Erik Mayer
- Imperial College Healthcare NHS Trust, Imperial Clinical Analytics, Research & Evaluation (iCARE), London, United Kingdom
| | - Mark Joy
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
| | - Trisha Greenhalgh
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
| | - Brendan Delaney
- Department of Surgery & Cancer, Institute of Global Health Innovation, Imperial College London, London, United Kingdom
| | - Simon de Lusignan
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
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Mayor N, Meza-Torres B, Okusi C, Delanerolle G, Chapman M, Wang W, Anand S, Feher M, Macartney J, Byford R, Joy M, Gatenby P, Curcin V, Greenhalgh T, Delaney B, de Lusignan S. Developing a Long COVID Phenotype for Postacute COVID-19 in a National Primary Care Sentinel Cohort: Observational Retrospective Database Analysis. JMIR Public Health Surveill 2022; 8:e36989. [PMID: 35861678 PMCID: PMC9374163 DOI: 10.2196/36989] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Revised: 05/16/2022] [Accepted: 07/19/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Following COVID-19, up to 40% of people have ongoing health problems, referred to as postacute COVID-19 or long COVID (LC). LC varies from a single persisting symptom to a complex multisystem disease. Research has flagged that this condition is underrecorded in primary care records, and seeks to better define its clinical characteristics and management. Phenotypes provide a standard method for case definition and identification from routine data and are usually machine-processable. An LC phenotype can underpin research into this condition. OBJECTIVE This study aims to develop a phenotype for LC to inform the epidemiology and future research into this condition. We compared clinical symptoms in people with LC before and after their index infection, recorded from March 1, 2020, to April 1, 2021. We also compared people recorded as having acute infection with those with LC who were hospitalized and those who were not. METHODS We used data from the Primary Care Sentinel Cohort (PCSC) of the Oxford Royal College of General Practitioners (RCGP) Research and Surveillance Centre (RSC) database. This network was recruited to be nationally representative of the English population. We developed an LC phenotype using our established 3-step ontological method: (1) ontological step (defining the reasoning process underpinning the phenotype, (2) coding step (exploring what clinical terms are available, and (3) logical extract model (testing performance). We created a version of this phenotype using Protégé in the ontology web language for BioPortal and using PhenoFlow. Next, we used the phenotype to compare people with LC (1) with regard to their symptoms in the year prior to acquiring COVID-19 and (2) with people with acute COVID-19. We also compared hospitalized people with LC with those not hospitalized. We compared sociodemographic details, comorbidities, and Office of National Statistics-defined LC symptoms between groups. We used descriptive statistics and logistic regression. RESULTS The long-COVID phenotype differentiated people hospitalized with LC from people who were not and where no index infection was identified. The PCSC (N=7.4 million) includes 428,479 patients with acute COVID-19 diagnosis confirmed by a laboratory test and 10,772 patients with clinically diagnosed COVID-19. A total of 7471 (1.74%, 95% CI 1.70-1.78) people were coded as having LC, 1009 (13.5%, 95% CI 12.7-14.3) had a hospital admission related to acute COVID-19, and 6462 (86.5%, 95% CI 85.7-87.3) were not hospitalized, of whom 2728 (42.2%) had no COVID-19 index date recorded. In addition, 1009 (13.5%, 95% CI 12.73-14.28) people with LC were hospitalized compared to 17,993 (4.5%, 95% CI 4.48-4.61; P<.001) with uncomplicated COVID-19. CONCLUSIONS Our LC phenotype enables the identification of individuals with the condition in routine data sets, facilitating their comparison with unaffected people through retrospective research. This phenotype and study protocol to explore its face validity contributes to a better understanding of LC.
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Affiliation(s)
- Nikhil Mayor
- Royal Surrey NHS Foundation Trust, Guildford, United Kingdom
| | - Bernardo Meza-Torres
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
- Department of Clinical and Experimental Medicine, University of Surrey, Guildford, United Kingdom
| | - Cecilia Okusi
- Department of Surgery & Cancer, Institute of Global Health Innovation, Imperial College London, London, United Kingdom
| | - Gayathri Delanerolle
- Department of Surgery & Cancer, Institute of Global Health Innovation, Imperial College London, London, United Kingdom
| | - Martin Chapman
- Population Health Sciences, Kings College London, London, United Kingdom
| | - Wenjuan Wang
- Population Health Sciences, Kings College London, London, United Kingdom
| | - Sneha Anand
- Department of Surgery & Cancer, Institute of Global Health Innovation, Imperial College London, London, United Kingdom
| | - Michael Feher
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
| | - Jack Macartney
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
| | - Rachel Byford
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
| | - Mark Joy
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
| | - Piers Gatenby
- Royal Surrey NHS Foundation Trust, Guildford, United Kingdom
| | - Vasa Curcin
- Population Health Sciences, Kings College London, London, United Kingdom
| | - Trisha Greenhalgh
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
| | - Brendan Delaney
- Department of Surgery & Cancer, Institute of Global Health Innovation, Imperial College London, London, United Kingdom
| | - Simon de Lusignan
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
- Royal College of General Practitioners Research and Surveillance Centre, London, United Kingdom
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Shah S, Feher M, McGovern A, Sherlock J, Whyte MB, Munro N, Hinton W, Gatenby P, de Lusignan S. Diabetic retinopathy in newly diagnosed Type 2 diabetes mellitus: Prevalence and predictors of progression; a national primary network study. Diabetes Res Clin Pract 2021; 175:108776. [PMID: 33753173 DOI: 10.1016/j.diabres.2021.108776] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [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: 12/17/2020] [Revised: 03/02/2021] [Accepted: 03/15/2021] [Indexed: 12/23/2022]
Abstract
AIMS To determine, inreal-world primary care settings, the prevalence of, and risk factors for, retinopathy atType 2 diabetes mellitus diagnosis and report cumulative incidence and progression of retinopathy seven years after diabetes diagnosis. METHODS Retrospective cohort analysis of people with newly diagnosed Type 2 diabetesrecorded bythe Royal College of General Practitioners Research and Surveillance Centre(between 2005 and 2009, n=11,399).Outcomes included; retinopathy prevalence atdiabetesdiagnosis (baseline) and cumulative incidence or progression of retinopathy at seven years. Retinopathy prevalence was compared with the United Kingdom Prospective Diabetes Study (UKPDS-1998). Factors influencing retinopathy incidence and progression were analysed using logistic regression. RESULTS Baseline retinopathy prevalencewas 18% (n=2,048) versus 37% in UKPDS. At seven years, 11.6% (n=237) of those with baseline retinopathyhad progression of retinopathy. In those without baseline retinopathy, 46.4% (n=4,337/9,351) developed retinopathy by seven years. Retinopathy development (OR: 1.05 [95%CI: 1.02-1.07] per mmol/mol increase) and progression (OR: 1.05 [1.04-1.06]) at seven years was associated with higher HbA1catdiabetesdiagnosis. Obesity (OR: 0.88 [0.79-0.98]) and high socioeconomic status (OR: 0.63 [0.53-0.74]) were negatively associated with retinopathy development at seven years. CONCLUSIONS Baseline retinopathy prevalence has declined since UKPDS. Additionally, HbA1c at diabetes diagnosis remains important for retinopathy development and progression.
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Affiliation(s)
- Savan Shah
- Department of Clinical and Experimental Medicine, School of Biosciences and Medicine, University of Surrey, Guildford GU2 7XH, UK.
| | - Michael Feher
- Department of Clinical and Experimental Medicine, School of Biosciences and Medicine, University of Surrey, Guildford GU2 7XH, UK; Nuffield Department of Primary Care Health Sciences, Radcliffe Primary Care Building, Radcliffe Observatory Quarter, Woodstock Road, University of Oxford, Oxford OX2 6GG, UK
| | - Andrew McGovern
- Department of Clinical and Experimental Medicine, School of Biosciences and Medicine, University of Surrey, Guildford GU2 7XH, UK; University of Exeter Medical School, The Institute of Clinical and Biological Sciences, RILD Building, RD&E Hospital, Wonford, Barrack Road, Exeter EX2 5DW, UK
| | - Julian Sherlock
- Department of Clinical and Experimental Medicine, School of Biosciences and Medicine, University of Surrey, Guildford GU2 7XH, UK
| | - Martin B Whyte
- Department of Clinical and Experimental Medicine, School of Biosciences and Medicine, University of Surrey, Guildford GU2 7XH, UK
| | - Neil Munro
- Department of Clinical and Experimental Medicine, School of Biosciences and Medicine, University of Surrey, Guildford GU2 7XH, UK; Diabetes Centre, Dumfries & Galloway Royal Infirmary, A75, Cargenbridge, Dumfries DG2 8RX, UK
| | - William Hinton
- Department of Clinical and Experimental Medicine, School of Biosciences and Medicine, University of Surrey, Guildford GU2 7XH, UK; Nuffield Department of Primary Care Health Sciences, Radcliffe Primary Care Building, Radcliffe Observatory Quarter, Woodstock Road, University of Oxford, Oxford OX2 6GG, UK
| | - Piers Gatenby
- Department of Clinical and Experimental Medicine, School of Biosciences and Medicine, University of Surrey, Guildford GU2 7XH, UK
| | - Simon de Lusignan
- Department of Clinical and Experimental Medicine, School of Biosciences and Medicine, University of Surrey, Guildford GU2 7XH, UK; Nuffield Department of Primary Care Health Sciences, Radcliffe Primary Care Building, Radcliffe Observatory Quarter, Woodstock Road, University of Oxford, Oxford OX2 6GG, UK
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Morgan E, Soerjomataram I, Gavin AT, Rutherford MJ, Gatenby P, Bardot A, Ferlay J, Bucher O, De P, Engholm G, Jackson C, Kozie S, Little A, Møller B, Shack L, Tervonen H, Thursfield V, Vernon S, Walsh PM, Woods RR, Finley C, Merrett N, O'Connell DL, Reynolds JV, Bray F, Arnold M. International trends in oesophageal cancer survival by histological subtype between 1995 and 2014. Gut 2021; 70:234-242. [PMID: 32554620 DOI: 10.1136/gutjnl-2020-321089] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [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: 03/11/2020] [Revised: 04/24/2020] [Accepted: 05/12/2020] [Indexed: 01/03/2023]
Abstract
INTRODUCTION Survival from oesophageal cancer remains poor, even across high-income countries. Ongoing changes in the epidemiology of the disease highlight the need for survival assessments by its two main histological subtypes, adenocarcinoma (AC) and squamous cell carcinoma (SCC). METHODS The ICBP SURVMARK-2 project, a platform for international comparisons of cancer survival, collected cases of oesophageal cancer diagnosed 1995 to 2014, followed until 31st December 2015, from cancer registries covering seven participating countries with similar access to healthcare (Australia, Canada, Denmark, Ireland, New Zealand, Norway and the UK). 1-year and 3-year age-standardised net survival alongside incidence rates were calculated by country, subtype, sex, age group and period of diagnosis. RESULTS 111 894 cases of AC and 73 408 cases of SCC were included in the analysis. Marked improvements in survival were observed over the 20-year period in each country, particularly for AC, younger age groups and 1 year after diagnosis. Survival was consistently higher for both subtypes in Australia and Ireland followed by Norway, Denmark, New Zealand, the UK and Canada. During 2010 to 2014, survival was higher for AC compared with SCC, with 1-year survival ranging from 46.9% (Canada) to 54.4% (Ireland) for AC and 39.6% (Denmark) to 53.1% (Australia) for SCC. CONCLUSION Marked improvements in both oesophageal AC and SCC survival suggest advances in treatment. Less marked improvements 3 years after diagnosis, among older age groups and patients with SCC, highlight the need for further advances in early detection and treatment of oesophageal cancer alongside primary prevention to reduce the overall burden from the disease.
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Affiliation(s)
- Eileen Morgan
- Section of Cancer Surveillance, International Agency for Research on Cancer, Lyon, France
- Northern Ireland Cancer Registry, Queen's University Belfast, Belfast, UK
| | - Isabelle Soerjomataram
- Section of Cancer Surveillance, International Agency for Research on Cancer, Lyon, France
| | - Anna T Gavin
- Northern Ireland Cancer Registry, Queen's University Belfast, Belfast, UK
| | - Mark J Rutherford
- Biostatistics Research Group, Department of Health Sciences, University of Leicester, Leicester, UK
| | - Piers Gatenby
- Department of Clinical and Experimental Medicine, University of Surrey, Guildford, Surrey, UK
| | - Aude Bardot
- Section of Cancer Surveillance, International Agency for Research on Cancer, Lyon, France
| | - Jacques Ferlay
- Section of Cancer Surveillance, International Agency for Research on Cancer, Lyon, France
| | - Oliver Bucher
- Department of Epidemiology and Cancer Registry, CancerCare Manitoba, Winnipeg, Manitoba, Canada
| | - Prithwish De
- Surveillance and Cancer Registry, Ontario Health (Cancer Care Ontario), Toronto, Ontario, Canada
| | - Gerda Engholm
- Cancer Surveillance and Pharmacoepidemiology, Danish Cancer Society Research Center, Copenhagen, Denmark
| | - Christopher Jackson
- Cancer Society of New Zealand, Wellington, New Zealand
- Department of Medicine, Otago Medical School, Dunedin, New Zealand
| | - Serena Kozie
- Saskatchewan Cancer Agency, Regina, Saskatchewan, Canada
| | - Alana Little
- Cancer Information and Analysis, Cancer Institute NSW, Alexandria, New South Wales, Australia
| | - Bjorn Møller
- Department of Registration, Cancer Registry of Norway, Oslo, Norway
| | - Lorraine Shack
- Cancer Control Alberta, Alberta Health Services, Edmonton, Alberta, Canada
| | - Hanna Tervonen
- Cancer Information and Analysis, Cancer Institute NSW, Alexandria, New South Wales, Australia
| | - Vicky Thursfield
- Victorian Cancer Registry, Cancer Council Victoria, Melbourne, Victoria, Australia
| | - Sally Vernon
- National Cancer Registration and Analysis Service, Public Health England, Cambridge, UK
| | | | - Ryan R Woods
- BC Cancer Agency, Vancouver, British Columbia, Canada
| | - Christian Finley
- Department of Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Neil Merrett
- School of Medicine, Western Sydney University, Sydney, New South Wales, Australia
| | - Dianne L O'Connell
- Cancer Research Division, Cancer Council NSW, Sydney, New South Wales, Australia
| | - John V Reynolds
- National Centre for Oesophageal Cancer, St James's Hospital and Trinity College Dublin, Dublin, Ireland
| | - Freddie Bray
- Section of Cancer Surveillance, International Agency for Research on Cancer, Lyon, France
| | - Melina Arnold
- Section of Cancer Surveillance, International Agency for Research on Cancer, Lyon, France
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Dunstan M, Smith R, Schwab K, Scala A, Gatenby P, Whyte M, Rockall T, Jourdan I. Is 3D faster and safer than 4K laparoscopic cholecystectomy? A randomised-controlled trial. Surg Endosc 2020; 34:1729-1735. [PMID: 31321536 PMCID: PMC7093366 DOI: 10.1007/s00464-019-06958-w] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2019] [Accepted: 07/01/2019] [Indexed: 12/13/2022]
Abstract
BACKGROUND Laparoscopic surgery has well-established benefits for patients; however, laparoscopic procedures have a long and difficult learning curve, in large part due to the lack of stereoscopic depth perception. Developments in high-definition and stereoscopic imaging have attempted to overcome this. Three-dimensional high-definition (3D HD) systems are thought to improve operating times compared to two-dimensional high-definition systems. However their performance against new, ultra-high-definition ('4K') systems is not known. METHODS Patients undergoing laparoscopic cholecystectomy were randomised to 3D HD or 4K laparoscopy. Operative videos were recorded, and the time from gallbladder exposure to separation from the liver (minus on table cholangiogram) was calculated. Blinded video assessment was performed to calculate intraoperative error scores. RESULTS One hundred and twenty patients were randomised, of which 109 were analysed (3D HD n = 54; 4K n = 55). No reduction in operative time was detected with 3D HD compared to 4K laparoscopy (median [IQR]; 23.41 min [17.00-37.98] vs 20.90 min [17.67-33.03]; p = 0.91); nor was there any decrease observed in error scores (60 [56-62] vs 58 [56-60]; p = 0.27), complications or reattendance. Stone spillage occurred more frequently with 3D HD, but there were no other differences in individual error rates. Gallbladder grade and operating surgeon had significant effects on time to complete the operation. Gallbladder grade also had a significant effect on the error score. CONCLUSIONS A 3D HD laparoscopic system did not reduce operative time or error scores during laparoscopic cholecystectomy compared with a new 4K imaging system.
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Affiliation(s)
- Matt Dunstan
- Royal Surrey County Hospital, Minimal Access Therapy Training Unit (MATTU), Leggett Building, Daphne Jackson Road, Manor Park, Guildford, Surrey, GU2 7WG, UK.
| | - Ralph Smith
- Royal Surrey County Hospital, Minimal Access Therapy Training Unit (MATTU), Leggett Building, Daphne Jackson Road, Manor Park, Guildford, Surrey, GU2 7WG, UK
| | - Katie Schwab
- Royal Surrey County Hospital, Minimal Access Therapy Training Unit (MATTU), Leggett Building, Daphne Jackson Road, Manor Park, Guildford, Surrey, GU2 7WG, UK
| | - Andrea Scala
- Royal Surrey County Hospital, Minimal Access Therapy Training Unit (MATTU), Leggett Building, Daphne Jackson Road, Manor Park, Guildford, Surrey, GU2 7WG, UK
| | - Piers Gatenby
- Royal Surrey County Hospital, Minimal Access Therapy Training Unit (MATTU), Leggett Building, Daphne Jackson Road, Manor Park, Guildford, Surrey, GU2 7WG, UK
| | - Martin Whyte
- Faculty of Health and Medical Sciences, University of Surrey, Guildford, Surrey, GU2 7XH, UK
| | - Tim Rockall
- Royal Surrey County Hospital, Minimal Access Therapy Training Unit (MATTU), Leggett Building, Daphne Jackson Road, Manor Park, Guildford, Surrey, GU2 7WG, UK
| | - Iain Jourdan
- Royal Surrey County Hospital, Minimal Access Therapy Training Unit (MATTU), Leggett Building, Daphne Jackson Road, Manor Park, Guildford, Surrey, GU2 7WG, UK
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Rayner LH, Mcgovern A, Sherlock J, Gatenby P, Correa A, Creagh-Brown B, deLusignan S. The impact of therapy on the risk of asthma in type 2 diabetes. Clin Respir J 2019; 13:299-305. [PMID: 30815978 DOI: 10.1111/crj.13011] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 10/01/2018] [Revised: 02/08/2019] [Accepted: 02/24/2019] [Indexed: 01/06/2023]
Abstract
BACKGROUND AND OBJECTIVES There are limited data about the risk of asthma in people with diabetes. We examined the incidence of asthma in subjects with type 2 diabetes (T2DM) compared to controls, and the association with metformin, sulphonylureas and insulin therapy. MATERIALS AND METHODS We conducted a retrospective cohort study using a representative UK primary care database (N = 894 646 adults). We used 1:1 propensity score matching (age, gender, socio-economic deprivation, body mass index and smoking status) to match 29 217 pairs of T2DM cases and controls. We used Cox proportional hazard regression to compare the incidence of asthma in both groups over 8 years of follow-up. In those with T2DM, we used Cox proportional hazard regression to assess for any impact of antidiabetic medications on asthma incidence. RESULTS Individuals with T2DM were less likely to develop asthma than matched controls (hazard ratio [HR] 0.85, 95% CI 0.77-0.93). Insulin increased the risk of incident asthma (HR 1.25, 95% CI 1.01-1.56), whilst metformin and sulphonylureas were associated with reduced risk (HR 0.80, 95% CI 0.69-0.93 and HR 0.76, 95% CI 0.60-0.97, respectively). There was no association with diabetes duration, complications or glycaemic control. CONCLUSIONS T2DM may have a protective effect against asthma development. Insulin use was associated with an increased risk of asthma, while metformin and sulphonylureas reduced the risk in those with T2DM.
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Affiliation(s)
- Louise H Rayner
- Department of Clinical and Experimental Medicine, University of Surrey, Guildford, United Kingdom.,Royal Surrey County Hospital NHS Foundation Trust, Guildford, United Kingdom
| | - Andrew Mcgovern
- Department of Clinical and Experimental Medicine, University of Surrey, Guildford, United Kingdom
| | - Julian Sherlock
- Department of Clinical and Experimental Medicine, University of Surrey, Guildford, United Kingdom
| | - Piers Gatenby
- Department of Clinical and Experimental Medicine, University of Surrey, Guildford, United Kingdom.,Royal Surrey County Hospital NHS Foundation Trust, Guildford, United Kingdom
| | - Ana Correa
- Department of Clinical and Experimental Medicine, University of Surrey, Guildford, United Kingdom
| | - Ben Creagh-Brown
- Department of Clinical and Experimental Medicine, University of Surrey, Guildford, United Kingdom.,Royal Surrey County Hospital NHS Foundation Trust, Guildford, United Kingdom
| | - Simon deLusignan
- Department of Clinical and Experimental Medicine, University of Surrey, Guildford, United Kingdom
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Rayner LH, McGovern AP, Sherlock J, Gatenby P, Correa A, Creagh-Brown B, de Lusignan S. Type 2 diabetes: A protective factor for COPD? Prim Care Diabetes 2018; 12:438-444. [PMID: 29843977 DOI: 10.1016/j.pcd.2018.05.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [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: 03/01/2018] [Revised: 04/30/2018] [Accepted: 05/02/2018] [Indexed: 12/18/2022]
Abstract
BACKGROUND Chronic obstructive pulmonary disease (COPD) and type 2 diabetes (T2DM) are common comorbidities. COPD is a known risk factor for incident T2DM, however few studies have examined the relationship in reverse. The primary aim of this study was to compare the incidence of COPD in people with and without T2DM. MATERIALS AND METHODS We conducted a retrospective case-control study using a long-established English general practice network database (n=894,646). We matched 29,217 cases of T2DM with controls, adjusting for age, gender, smoking status, BMI and social deprivation, to achieve 1:1 propensity matching and compared the rate of incident COPD over eight years of follow-up. We performed a secondary analysis to investigate the effect of insulin, metformin and sulphonylureas on COPD incidence. RESULTS People with T2DM had a reduced risk of COPD compared to matched controls over the follow-up period (HR 0.89, 95%CI 0.79-0.93). 48.5% of those with T2DM were ex-smokers compared with 27.3% of those without T2DM. Active smoking rates were 20.4% and 23.7% respectively. Insulin, metformin and sulphonylureas were not associated with incident COPD. CONCLUSIONS People with T2DM are less likely to be diagnosed with COPD than matched controls. This may be due to positive lifestyle changes, such as smoking cessation in those with T2DM.
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Affiliation(s)
- Louise H Rayner
- Department of Clinical and Experimental Medicine, University of Surrey, UK; Royal Surrey County Hospital NHS Foundation Trust, Guildford, UK.
| | - Andrew P McGovern
- Department of Clinical and Experimental Medicine, University of Surrey, UK
| | - Julian Sherlock
- Department of Clinical and Experimental Medicine, University of Surrey, UK
| | - Piers Gatenby
- Department of Clinical and Experimental Medicine, University of Surrey, UK; Royal Surrey County Hospital NHS Foundation Trust, Guildford, UK
| | - Ana Correa
- Department of Clinical and Experimental Medicine, University of Surrey, UK
| | - Ben Creagh-Brown
- Department of Clinical and Experimental Medicine, University of Surrey, UK; Royal Surrey County Hospital NHS Foundation Trust, Guildford, UK
| | - Simon de Lusignan
- Department of Clinical and Experimental Medicine, University of Surrey, UK
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Kumar S, de Lusignan S, McGovern A, Correa A, Hriskova M, Gatenby P, Jones S, Goldsmith D, Camm AJ. Ischaemic stroke, haemorrhage, and mortality in older patients with chronic kidney disease newly started on anticoagulation for atrial fibrillation: a population based study from UK primary care. BMJ 2018; 360:k342. [PMID: 29444881 DOI: 10.1136/bmj.k342] [Citation(s) in RCA: 58] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
OBJECTIVE To assess the association between anticoagulation, ischaemic stroke, gastrointestinal and cerebral haemorrhage, and all cause mortality in older people with atrial fibrillation and chronic kidney disease. DESIGN Propensity matched, population based, retrospective cohort analysis from January 2006 through December 2016. SETTING The Royal College of General Practitioners Research and Surveillance Centre database population of almost 2.73 million patients from 110 general practices across England and Wales. PARTICIPANTS Patients aged 65 years and over with a new diagnosis of atrial fibrillation and estimated glomerular filtration rate (eGFR) of <50 mL/min/1.73m2, calculated using the chronic kidney disease epidemiology collaboration creatinine equation. Patients with a previous diagnosis of atrial fibrillation or receiving anticoagulation in the preceding 120 days were excluded, as were patients requiring dialysis and recipients of renal transplants. INTERVENTION Receipt of an anticoagulant prescription within 60 days of atrial fibrillation diagnosis. MAIN OUTCOME MEASURES Ischaemic stroke, cerebral or gastrointestinal haemorrhage, and all cause mortality. RESULTS 6977 patients with chronic kidney disease and newly diagnosed atrial fibrillation were identified, of whom 2434 were on anticoagulants within 60 days of diagnosis and 4543 were not. 2434 pairs were matched using propensity scores by exposure to anticoagulant or none and followed for a median of 506 days. The crude rates for ischaemic stroke and haemorrhage were 4.6 and 1.2 after taking anticoagulants and 1.5 and 0.4 in patients who were not taking anticoagulant per 100 person years, respectively. The hazard ratios for ischaemic stroke, haemorrhage, and all cause mortality for those on anticoagulants were 2.60 (95% confidence interval 2.00 to 3.38), 2.42 (1.44 to 4.05), and 0.82 (0.74 to 0.91) compared with those who received no anticoagulation. CONCLUSION Giving anticoagulants to older people with concomitant atrial fibrillation and chronic kidney disease was associated with an increased rate of ischaemic stroke and haemorrhage but a paradoxical lowered rate of all cause mortality. Careful consideration should be given before starting anticoagulants in older people with chronic kidney disease who develop atrial fibrillation. There remains an urgent need for adequately powered randomised trials in this population to explore these findings and to provide clarity on correct clinical management.
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Affiliation(s)
- Shankar Kumar
- Centre for Medical Imaging, University College London, London, UK
| | - Simon de Lusignan
- Department of Clinical and Experimental Medicine, University of Surrey, Guildford, UK
| | - Andrew McGovern
- Department of Clinical and Experimental Medicine, University of Surrey, Guildford, UK
- Exeter Medical School, University of Exeter, Exeter, UK
| | - Ana Correa
- Department of Clinical and Experimental Medicine, University of Surrey, Guildford, UK
- Royal College of General Practitioners Research and Surveillance Centre, London, UK
| | - Mariya Hriskova
- Department of Clinical and Experimental Medicine, University of Surrey, Guildford, UK
- Royal College of General Practitioners Research and Surveillance Centre, London, UK
| | - Piers Gatenby
- Department of Clinical and Experimental Medicine, University of Surrey, Guildford, UK
- Royal Surrey County Hospital NHS Foundation Trust, Guildford, UK
| | - Simon Jones
- Department of Clinical and Experimental Medicine, University of Surrey, Guildford, UK
- Department of Population Health, Division of Healthcare Delivery Science, NYU School of Medicine, New York, USA
| | - David Goldsmith
- Molecular and Clinical Sciences Research Institute, St George's University of London, UK
- Renal and Transplantation Department, Guys and St Thomas' Hospitals NHS Foundation Trust, London, UK
| | - A John Camm
- Molecular and Clinical Sciences Research Institute, St George's University of London, UK
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10
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Abstract
Oesophageal adenocarcinoma is rapidly increasing in Western countries. This tumour frequently presents late in its course with metastatic disease and has a very poor prognosis. Barrett’s oesophagus is an acquired condition whereby the native squamous mucosa of the lower oesophagus is replaced by columnar epithelium following prolonged gastro-oesophageal reflux and is the recognised precursor lesion for oesophageal adenocarcinoma. There are multiple national and society guidelines regarding screening, surveillance and management of Barrett’s oesophagus, however all are limited regarding a clear evidence base for a well-demonstrated benefit and cost-effectiveness of surveillance, and robust risk stratification for patients to best use resources. Currently the accepted risk factors upon which surveillance intervals and interventions are based are Barrett’s segment length and histological interpretation of the systematic biopsies. Further patient risk factors including other demographic features, smoking, gender, obesity, ethnicity, patient age, biomarkers and endoscopic adjuncts remain under consideration and are discussed in full. Recent evidence has been published to support earlier endoscopic intervention by means of ablation of the metaplastic Barrett’s segment when the earliest signs of dysplasia are detected. Further work should concentrate on establishing better risk stratification and primary and secondary preventative strategies to reduce the risk of adenocarcinoma of the oesophagus.
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11
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Martinou E, Gatenby P. Tension enterothorax and hepatothorax due to a diaphragmatic hernia: successful emergency repair of a life-threatening condition. BMJ Case Rep 2017; 2017:bcr-2016-218571. [PMID: 28619969 DOI: 10.1136/bcr-2016-218571] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
A 70-year-old female patient presented with acute severe respiratory distress at a district general hospital. Medical history included type 2 diabetes, recurrent pulmonary embolisms and pre-existing diaphragmatic hernia containing part of the liver. Despite initial treatment with steroid inhalers, her clinical picture rapidly deteriorated requiring emergency intubation and positive pressure ventilation. Imaging investigations revealed tension enterothorax and hepatothorax with tracheal deviation. The patient was transferred and underwent an emergency laparotomy at the Regional Oesophagogastric Unit. A large diaphragmatic hernia (central tendon defect) which contained the duodenum, porta hepatis, right lobe of liver, gallbladder and right colon was reduced and successfully repaired. Her postoperative course was uneventful with no signs of recurrence at 2 months follow-up.This case describes an extremely rare and life-threatening condition of tension enterothorax and hepatothorax, which should be considered in the differential diagnosis of acute respiratory distress with tracheal deviation.
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Affiliation(s)
- Eirini Martinou
- General Surgery, Western Sussex Hospitals NHS Trust, Worthing, UK
| | - Piers Gatenby
- Oesophagogastric Unit, Royal Surrey County Hospital NHS Foundation Trust, Guildford, Surrey, UK
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12
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Hine JL, de Lusignan S, Burleigh D, Pathirannehelage S, McGovern A, Gatenby P, Jones S, Jiang D, Williams J, Elliot AJ, Smith GE, Brownrigg J, Hinchliffe R, Munro N. Association between glycaemic control and common infections in people with Type 2 diabetes: a cohort study. Diabet Med 2017; 34:551-557. [PMID: 27548909 DOI: 10.1111/dme.13205] [Citation(s) in RCA: 61] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/19/2016] [Indexed: 01/03/2023]
Abstract
AIM To investigate the impact of glycaemic control on infection incidence in people with Type 2 diabetes. METHODS We compared infection rates during 2014 in people with Type 2 diabetes and people without diabetes in a large primary care cohort in the UK (the Royal College of General Practitioners Research and Surveillance Centre database). We performed multilevel logistic regression to investigate the impact of Type 2 diabetes on presentation with infection, and the effect of glycaemic control on presentation with upper respiratory tract infections, bronchitis, influenza-like illness, pneumonia, intestinal infectious diseases, herpes simplex, skin and soft tissue infections, urinary tract infections, and genital and perineal infections. People with Type 2 diabetes were stratified by good [HbA1c < 53 mmol/mol (< 7%)], moderate [HbA1c 53-69 mmol/mol (7-8.5%)] and poor [HbA1c > 69 mmol/mol (> 8.5%)] glycaemic control using their most recent HbA1c concentration. Infection incidence was adjusted for important sociodemographic factors and patient comorbidities. RESULTS We identified 34 278 people with Type 2 diabetes and 613 052 people without diabetes for comparison. The incidence of infections was higher in people with Type 2 diabetes for all infections except herpes simplex. Worsening glycaemic control was associated with increased incidence of bronchitis, pneumonia, skin and soft tissue infections, urinary tract infections, and genital and perineal infections, but not with upper respiratory tract infections, influenza-like illness, intestinal infectious diseases or herpes simplex. CONCLUSIONS Almost all infections analysed were more common in people with Type 2 diabetes. Infections that are most commonly of bacterial, fungal or yeast origin were more frequent in people with worse glycaemic control.
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Affiliation(s)
- J L Hine
- Section of Clinical Medicine and Ageing, University of Surrey, Guildford
| | - S de Lusignan
- Section of Clinical Medicine and Ageing, University of Surrey, Guildford
| | - D Burleigh
- Section of Clinical Medicine and Ageing, University of Surrey, Guildford
| | - S Pathirannehelage
- Section of Clinical Medicine and Ageing, University of Surrey, Guildford
| | - A McGovern
- Section of Clinical Medicine and Ageing, University of Surrey, Guildford
| | - P Gatenby
- Section of Clinical Medicine and Ageing, University of Surrey, Guildford
- Royal Surrey County Hospital, Guildford, Surrey, UK
| | - S Jones
- Section of Clinical Medicine and Ageing, University of Surrey, Guildford
| | - D Jiang
- Eli Lilly and Company, Lilly Corporate Center, Indianapolis, IN, USA
| | - J Williams
- Section of Clinical Medicine and Ageing, University of Surrey, Guildford
| | | | - G E Smith
- Public Health England, Birmingham, UK
| | - J Brownrigg
- St George's Vascular Institute, Division of Cardiovascular Sciences, St George's University of London, London, UK
| | - R Hinchliffe
- St George's Vascular Institute, Division of Cardiovascular Sciences, St George's University of London, London, UK
| | - N Munro
- Section of Clinical Medicine and Ageing, University of Surrey, Guildford
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13
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Gatenby P, Bhattacharjee S, Wall C, Caygill C, Watson A. Risk stratification for malignant progression in Barrett’s esophagus: Gender, age, duration and year of surveillance. World J Gastroenterol 2016; 22:10592-10600. [PMID: 28082811 PMCID: PMC5192270 DOI: 10.3748/wjg.v22.i48.10592] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2016] [Revised: 10/17/2016] [Accepted: 11/28/2016] [Indexed: 02/06/2023] Open
Abstract
AIM To clarify risk based upon segment length, diagnostic histological findings, patient age and year of surveillance, duration of surveillance and gender.
METHODS Patients registered with the United Kingdom Barrett’s Oesophagus Registry from 9 United Kingdom centers were included. The outcome measures were (1) development of all grades of dysplasia; (2) development of high-grade of dysplasia or adenocarcinoma; and (3) development of adenocarcinoma. Prevalent cases and subjects with < 1 year of follow-up were excluded. The covariates examined were segment length, previous biopsy findings, age at surveillance, duration of surveillance, year of surveillance and gender.
RESULTS One thousand and one hundred thirty six patients were included (total 6474 patient-years). Fifty-four patients developed adenocarcinoma (0.83% per annum), 70 developed high-grade dysplasia/adenocarcinoma (1.1% per annum) and 190 developed any grade of dysplasia (3.5% per annum). High grade dysplasia and adenocarcinoma increased with age and duration of surveillance. The risk of low-grade dysplasia development was not dependent on age at surveillance. Segment length and previous biopsy findings were also significant factors for development of dysplasia and adenocarcinoma.
CONCLUSION The risk of development of low-grade dysplasia is independent of age at surveillance, but high-grade dysplasia and adenocarcinoma were more commonly found at older age. Segment length and previous biopsy findings are also markers of risk. This study did not demonstrate stabilisation of the metaplastic segment with prolonged surveillance.
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14
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Rayner CJ, Gatenby P. Effect of antireflux surgery for Barrett's esophagus: long-term results. MINERVA CHIR 2016; 71:180-191. [PMID: 26976731] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
INTRODUCTION Barrett's esophagus is a metaplastic change in the lower esophagus that results from long-standing gastro-esophageal reflux disease, associated with a risk of development of esophageal adenocarcinoma. This review examines the role of antireflux surgery in the management of Barrett's esophagus. EVIDENCE ACQUISITION A systematic review of the EMBASE and MEDLINE databases (1974-2016) was undertaken to identify studies with long-term follow-up examining the role of antireflux surgery in Barrett's esophagus. Outcomes examined were: number of subjects, follow-up, rates of progression, regression and adenocarcinoma. Symptomatic outcomes, surgical morbidity and rates of surgical failure were included when available. EVIDENCE SYNTHESIS A total of 2403 articles were identified of which 9 met the inclusion criteria for this study using the PRISMA methodology. Citation tracking identified 3 further studies for inclusion. There were 962 patients included in this study, 731 who were found to have completed endoscopic follow up with a total of 3736 years of follow up. Annual incidence of esophageal adenocarcinoma was found to be 0.18%. Thirty-five percent of patients (260 patients) had regression. Progression was seen in 8% (57 patients) postoperatively. There was no mortality. CONCLUSIONS There is insufficient evidence to recommend surgery over medical therapy to reduce cancer risk in Barrett's esophagus. Regression of features associated with cancer risk was more common after surgery than medical therapy. Surgery has been shown to improve patients' gastroesophageal reflux disease-specific quality of life. Long-term, antireflux surgery represents a cost effective method to manage Barrett's Esophagus with continued endoscopic surveillance.
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Affiliation(s)
- Charles J Rayner
- Department of General Surgery, Royal Surrey County Hospital, Guildford, UK -
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15
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Gatenby P, Soon Y. Barrett’s oesophagus: Evidence from the current meta-analyses. World J Gastrointest Pathophysiol 2014; 5:178-187. [PMID: 25133020 PMCID: PMC4133517 DOI: 10.4291/wjgp.v5.i3.178] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2013] [Revised: 04/05/2014] [Accepted: 05/29/2014] [Indexed: 02/06/2023] Open
Abstract
Guidelines have been published regarding the management of Barrett’s oesophagus (columnar-lined oesophagus). These have examined the role of surveillance in an effort to detect dysplasia and early cancer. The guidelines have provided criteria for enrolment into surveillance and some risk stratification with regard to surveillance interval. The research basis for the decisions reached with regard to cancer risk is weak and this manuscript has examined the available data published from meta-analyses up to 25th April 2013 (much of which has been published since the guidelines and their most recent updates have been written). There were 9 meta-analyses comparing patients with Barrett’s oesophagus to control populations. These have demonstrated that Barrett’s oesophagus is more common in males than females, in subjects who have ever smoked, in subjects with obesity, in subjects with prolonged symptoms of gastro-oesophageal reflux disease, in subjects who do not have infection with Helicobacter pylori and in subjects with hiatus hernia. These findings should inform public health measures in reducing the risk of Barrett’s oesophagus and subsequent surveillance burden and cancer risk. There were 8 meta-analyses comparing different groups of patients with Barrett’s oesophagus with regard to cancer risk. These have demonstrated that there was no statistically significant benefit of antireflux surgery over medical therapy, that endoscopic ablative therapy was effective in reducing cancer risk that there was similar cancer risk in patients with Barrett’s oesophagus independent of geographic origin, that the adenocarcinoma incidence in males is twice the rate in females, that the cancer risk in long segment disease showed a trend to be higher than in short segment disease, that there was a trend for higher cancer risk in low-grade dysplasia over non-dysplastic Barrett’s oesophagus, that there is a lower risk in patients with Helicobacter pylori infection and that there is a significant protective effect of aspirin and statins. There were no meta-analyses examining the role of intestinal metaplasia. These results demonstrate that guidance regarding surveillance based on the presence of intestinal metaplasia, segment length and the presence of low-grade dysplasia has a weak basis, and further consideration should be given to gender and helicobacter status, ablation of the metaplastic segment as well as the chemoprotective role of aspirin and statins.
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16
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Gatenby P, Caygill C, Wall C, Bhatacharjee S, Ramus J, Watson A, Winslet M. Lifetime risk of esophageal adenocarcinoma in patients with Barrett's esophagus. World J Gastroenterol 2014; 20:9611-9617. [PMID: 25071359 PMCID: PMC4110596 DOI: 10.3748/wjg.v20.i28.9611] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2013] [Revised: 12/27/2013] [Accepted: 03/13/2014] [Indexed: 02/06/2023] Open
Abstract
AIM: To investigate the lifetime risk of development of esophageal adenocarcinoma and/or high-grade dysplasia in patients diagnosed with Barrett’s esophagus.
METHODS: Data were extracted from the United Kingdom National Barrett’s Oesophagus Registry on date of diagnosis, patient age and gender of 7877 patients from who had been registered from 35 United Kingdom centers. Life expectancy was evaluated from United Kingdom National Statistics data based upon gender and age at year at diagnosis. These data were then used with published estimates of annual adenocarcinoma and high-grade dysplasia incidences from meta-analyses and large population-based studies to estimate overall lifetime risk of development of these study endpoints.
RESULTS: The mean age at diagnosis of Barrett’s esophagus was 61.6 years in males and 67.3 years in females. The mean life expectancy at diagnosis was 23.1 years in males, 20.7 years in females and 22.2 years overall. Using data from published meta-analyses, the lifetime risk of development of adenocarcinoma was between 1 in 8 and 1 in 14 and the lifetime risk of high-grade dysplasia or adenocarcinoma was 1 in 5 to 1 in 6. Using data from 3 large recent population-based cohort studies the lifetime risk of adenocarcinoma was between 1 in 10 and 1 in 37 and of the combined end-point of high-grade dysplasia and adenocarcinoma was between 1 in 8 and 1 in 20. Age at Barrett’s esophagus diagnosis is reducing and life expectancy is increasing, which will partially counter-balance lower annual cancer incidence.
CONCLUSION: There is a significant lifetime risk of development of high-grade dysplasia and adenocarcinoma in Barrett’s esophagus.
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Coulam C, Clark D, Collins J, Scott J, Schlesselman J, Aoki K, Carp H, Cauchi M, Lim D, Christiansen O, Grunnet N, Cowchock S, Smith J, Daya S, Gatenby P, Cameron K, Gill T, Hin H, Georgieva R, Belchev D, Kilpatrick D, Liston W, Mowbray J, Underwood J, Parazzini F, Crosignani P, Rezenkoff M, Koyama FS. Worldwide Collaborative Observational Study and Meta-Analysis on Allogenic Leukocyte Immunotherapy for Recurrent Spontaneous Abortion1. Am J Reprod Immunol 2013. [DOI: 10.1111/j.1600-0897.1994.tb01095.x] [Citation(s) in RCA: 170] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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18
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Sia TC, Gatenby P, Loganathan A, Bright T. Small bowel obstruction from laparoscopic adjustable gastric banding connecting tube. ANZ J Surg 2013; 83:389-90. [PMID: 23614887 DOI: 10.1111/ans.12118] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Tiong Cheng Sia
- Department of Surgery, Flinders Medical Centre, Bedford Park, South Australia, Australia
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Gatenby P, Ramus J, Caygill C, Shepherd N, Winslet M, Watson A. Routinely diagnosed low-grade dysplasia in Barrett's oesophagus: a population-based study of natural history. Histopathology 2009; 54:814-9. [PMID: 19635100 DOI: 10.1111/j.1365-2559.2009.03316.x] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
AIMS To examine the natural history of columnar-lined oesophagus with routinely diagnosed low-grade dysplasia and ascertain the risk of oesophageal adenocarcinoma development. METHODS AND RESULTS A multicentre retrospective cohort study of 283 patients with low-grade dysplasia. Follow-up data were obtained from examination of hospital records. One hundred and forty-four patients had biopsies prior to low-grade dysplasia diagnosis and 217 had follow-up biopsies after index low-grade dysplasia diagnosis. In these patients the incidence of high-grade dysplasia and adenocarcinoma combined was 4.6% per annum and of adenocarcinoma alone was 2.7% per annum. At most recent follow-up, 43 (19.8%) had persistent low-grade dysplasia, 37 (17.1%) had changes indefinite for dysplasia and 108 (49.8%) had non-dysplastic columnar-lined oesophagus. When prevalent cases were excluded (those occurring within 1 year of index low-grade dysplasia diagnosis), the annual incidence of high-grade dysplasia and adenocarcinoma combined was 2.2% and of adenocarcinoma alone was 1.4%. The relative risk for adenocarcinoma development in low-grade dysplasia compared with non-dysplastic columnar-lined oesophagus was 2.871 (P = 0.002). CONCLUSIONS Low-grade dysplasia has a threefold increased risk of progression to cancer compared with non-dysplastic epithelium, but in the majority of patients dysplasia is not subsequently detected.
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Affiliation(s)
- Piers Gatenby
- UK National Barrett's Oesophagus Registry, University Department of Surgery, Royal Free and University College Medical School, London, UK.
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20
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Abstract
Acute cholecystitis is treated by antibiotics and cholecystectomy. When the gallbladder neck is obstructed in the presence of infection, preventing pus from draining via the cystic duct, an empyema of the gallbladder develops. Under these circumstances, treatment may be either cholecystectomy or, in the presence of significant comorbidity, by drainage via percutaneous cholecystostomy, followed at a later date by cholecystectomy. We present the case of a patient who presented acutely with an attack of cholecystitis and refused to undergo a cholecystectomy owing to previous respiratory arrest following general anaesthesia. She settled with intravenous antibiotic treatment and was discharged. However, she presented shortly afterwards with a further attack of cholecystitis that was refractory to intravenous antibiotics and so was treated initially with percutaneous drainage. This was subsequently replaced with interno-external drainage of the gallbladder (transpapillary cholecystoduodenal stent) with the use of a J-J ureteric stent, which was then fully internalised. She remained well following this procedure and was discharged home. The long-term patency of the stent is not known and we hope that no further intervention will be required, but if necessary the stent could be exchanged endoscopically, by a percutaneous route, or via a combined approach.
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Affiliation(s)
- P Gatenby
- Departments of Hepatopancreaticobiliary Surgery, Imperial College of Science and Technology, London W12 0HS, UK.
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Affiliation(s)
- C Hawkins
- Department of Clinical Immunology, The Canberra Hospital, P.O. Box 11Woden ACT 2606, Australia.
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Abstract
Two patients with Down syndrome and the primary antiphospholipid antibody are described. One patient had a vasculopathy similar to that previously described as Moyamoya. Down syndrome is characterized by immune defects including a tendency to autoimmune phenomena. This report extends the scope of these observations and particularly draws out the potential role of antiphospholipid antibodies. Indeed antiphospholipid antibodies may well explain the well-known association of Down syndrome and stroke.
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Affiliation(s)
- P Gatenby
- Department of Immunopathology, The Canberra Hospital and the Canberra Clinical School, University of Sydney, Garran, ACT, Australia.
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Ponsonby AL, Gatenby P, Glasgow N, Mullins R, Hurwitz M, McDonald T. The association between synthetic bedding and adverse respiratory outcomes among skin-prick test positive and skin-prick test negative children. Allergy 2002; 57:247-53. [PMID: 11906340 DOI: 10.1034/j.1398-9995.2002.1s3234.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND Synthetic bedding has been associated with increased child wheeze and also higher allergen levels in several studies. We aimed to examine whether the association between synthetic bedding and adverse respiratory outcomes was more evident among skin-prick test (SPT) positive children. METHODS A cross-sectional survey involving a population sample of 758 (81% of eligible) school children aged 8-10 years from randomly selected schools in the Australian Capital Territory in 1999. Parental questionnaires for ISAAC respiratory symptoms and child bedding were obtained. SPT results of 10 common allergens were available on 722 of the subjects (77% of those eligible). Synthetic pillow or quilt use was termed synthetic upper bedding. RESULTS Synthetic quilt use was associated with asthma (Adjusted Odds Ratio 1.67 (1.05, 2.65)), recent wheeze (AOR 1.63 (1.03, 2.59)) and allergic rhinoconjunctivitis (AOR 2.11 (1.33, 3.34)) among SPT-positive children. However, these associations were not apparent for SPT-negative children. Similarly, increasing synthetic upper bedding use was associated with more than 12 episodes of wheeze among SPT-positive children (AOR 1.69 (1.08, 2.64), P=0.02, per category) but not SPT-negative children (AOR 0.77 (0.26, 2.21), P=0.6, per category). CONCLUSION The apparent association between synthetic upper bedding and adverse respiratory outcomes was evident among SPT-positive but not SPT-negative children. Prospective intervention studies that aim to examine the effect of upper bedding composition on child asthma among SPT-positive children are required.
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Affiliation(s)
- A-L Ponsonby
- National Center for Epidemiology and Population Health, Australian National University
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Ponsonby AL, Glasgow N, Gatenby P, Mullins R, McDonald T, Hurwitz M, Pradith B, Attewell R. The relationship between low level nitrogen dioxide exposure and child lung function after cold air challenge. Clin Exp Allergy 2001; 31:1205-12. [PMID: 11529889 DOI: 10.1046/j.1365-2222.2001.01168.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND Nitrogen dioxide (NO(2)) or home gas appliance use has been inconsistently associated with adverse respiratory outcomes in childhood. OBJECTIVES (i) To examine the contribution of home gas appliance type and personal NO(2) exposure. (ii) To examine the relationship between NO(2) exposure and child lung function and respiratory history. (iii) To assess whether these relationships vary by house dust mite sensitization status. METHODS A cross-sectional survey of 344 children (71% of the eligible group) with a mean age of 9.1 years from four randomly selected schools in the Australian Capital Territory from July to September 1999. Study measurements included a parental questionnaire, NO(2) exposure by passive gas samplers, skin prick testing for 10 aeroallergens and lung function at rest and after cold air challenge. RESULTS Total NO(2) exposure was low with a mean concentration of 10.1 ppb. No associations were found between NO(2) exposure or gas appliance use and asthma, wheeze or baseline lung function. Personal NO(2) exposure was associated with a reduction in forced expiratory volume in one second (FEV1)/forced vital capacity (FVC) after cold air challenge (adjusted difference - 0.12% (- 0.23% to - 0.01%) per 1 ppb increase). After exclusion of children who had home heating changed because of asthma, gas heater use was also significantly associated with a reduction in this measure (adjusted difference - 2.0% (- 3.7% to - 0.2%)). There was some evidence that these reductions were greater among the non-mite-sensitized children. CONCLUSIONS The effect of low-level NO(2) exposure on these respiratory outcomes was not marked. The possible effect of low-level NO(2) exposure on non-specific bronchial reactivity requires confirmation. Future studies on NO(2) and respiratory health should include measures of house dust mite sensitization and bronchial hyper-responsiveness.
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Affiliation(s)
- A L Ponsonby
- Academic Unit of General Practice and Community Care, Canberra Clinical School, University of Sydney, Jamison Centre, Canberra, Australia.
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25
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Gatenby P. John Mallet Purser (1839-1929). Ir J Med Sci 2001; 170:141-3. [PMID: 11491051 DOI: 10.1007/bf03168828] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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26
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Grennan DM, Parfitt A, Manolios N, Huang Q, Hyland V, Dunckley H, Doran T, Gatenby P, Badcock C. Family and twin studies in systemic lupus erythematosus. Dis Markers 1997; 13:93-8. [PMID: 9160184] [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: 02/04/2023]
Abstract
We have estimated how much of the total genetic predisposition to SLE may be attributable to genes outside the HLA region by comparing figures for concordance of SLE in monozygotic twins with those for concordance in HLA identical siblings in Australia. None of six dizygotic co-twins of white Australian SLE probands was concordant for SLE. One of four (25%) monozygotic co-twins of white Australian SLE probands was concordant for SLE which when added to previously published figures for Caucasoid populations gives an overall concordance rate for SLE in monozygotic twins of 25%. None of 18 HLA identical, same sex siblings of SLE probands, had definite SLE by the study criteria (i.e. less than 6%). The comparison of these figures shows that most of the genetic predisposition to SLE is attributable to genes outside the HLA region.
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Affiliation(s)
- D M Grennan
- University of Sydney's Department of Rheumatology, Royal North Shore Hospital, St. Leonards, Australia
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27
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Cauchi MN, Coulam CB, Cowchock S, Ho HN, Gatenby P, Johnson PM, Lubs ML, McIntyre JA, Ramsden GH, Smith JB. Predictive factors in recurrent spontaneous aborters--a multicenter study. Am J Reprod Immunol 1995; 33:165-70. [PMID: 7646767 DOI: 10.1111/j.1600-0897.1995.tb00880.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
PROBLEM Compare data from several centers relating to success rates in recurrent spontaneous miscarriage and assess the significance of indicators of subsequent pregnancy loss. METHOD Data from 777 couples with unexplained recurrent spontaneous abortion from independent studies at seven centers were analyzed using logistic regression analysis. The following covariates were considered: age of patient, number of previous spontaneous abortions, length of previous abortions history, sub-fertility index (defined as the product of the number of spontaneous abortions and the abortion history), whether a patient was a primary or secondary aborter, and whether a patient had received leukocyte immunotherapy. RESULTS There was a highly significant difference between the seven centers in success rates in the subsequent pregnancy and a highly significant association between success rate and each of the following covariates: the number of previous abortions, the length of the previous abortion history and the sub-fertility index. In particular, for each increase of 10 units in the value of the sub-fertility index, up to a value of 30, the odds in favor of a successful pregnancy decreased by a factor of 0.6, i.e., 40%. There was, however, little evidence of an association between the success rate in the subsequent pregnancy and age, parity, or immunization with cells from the husband. CONCLUSIONS The sub-fertility index may be a useful measure of likelihood of success in a subsequent pregnancy.
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Affiliation(s)
- M N Cauchi
- Department of Pathology, University of Malta
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Abstract
We report clinical, neuroimaging and immunological findings in seven women with antiphospholipid antibodies (APLA) and cerebral ischemia. Two patients had systemic lupus erythematosus (SLE) and five had the antiphospholipid syndrome (APS). Autopsies were done in 3 women who died acutely with focal neurological deficits. Evidence for cerebral embolism was found in all patients: a) pathology demonstrated multiple cerebral infarctions and cerebral emboli from underlying non-bacterial thrombotic endocarditis (NBTE) in the patients who died. b) Three patients had thickened mitral valves and embolic cerebral occlusions were identified with cerebral angiography. c) In one patient, echocardiography detected a thrombus on the posterior leaflet of a prolapsing mitral valve at the time of ictus. Our data provide further evidence to implicate valvular endothelium in the genesis of cerebral ischemia in some patients with APLA.
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Affiliation(s)
- M J Fulham
- Department of Neurology, Royal Prince Alfred Hospital, Sydney, Australia
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29
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Gatenby P. Antiphospholipid antibodies. Med J Aust 1994; 160:171-2. [PMID: 8309383] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Affiliation(s)
- P Gatenby
- Department of Clinical Immunology, Royal Prince Alfred Hospital, Sydney
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Mannucci PM, Gringeri A, Savidge G, Gatenby P, Laurian Y, Pabinger-Fasching I, Martinez-Vazquez JM, Hessey EW, Steel HM. Randomized double-blind, placebo-controlled trial of twice-daily zidovudine in asymptomatic haemophiliacs infected with the human immunodeficiency virus type 1. European-Australian Haemophilia Collaborative Study Group. Br J Haematol 1994; 86:174-9. [PMID: 7912097 DOI: 10.1111/j.1365-2141.1994.tb03270.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
In this double-blind, placebo-controlled trial of HIV-infected asymptomatic haemophiliacs, the efficacy of 2-year zidovudine therapy (1000 mg daily in two divided doses) in preventing progress of HIV infection was prospectively evaluated. Drug tolerance was also studied. 143 haemophiliacs from five European countries and Australia with p24 antigenaemia and/or CD4 cell counts of 0.1-0.4 x 10(9)/l were enrolled. The main measures of outcome were progression to AIDS, CDC group IV disease, symptomatic HIV-related disease, and a decrease in CD4+ T-lymphocyte count to fewer than 0.2 x 10(9)/l. There were no significant treatment differences in the proportion of patients progressing to AIDS, CDC group IV or symptomatic disease. Analysis of time to CD4+ counts less than 0.2 x 10(9)/l showed a non-significant trend in favour of zidovudine. Haemoglobin concentrations were less than 8 g/dl in 4% of zidovudine recipients; neutropenia was less than 0.75 x 10(9) cells/l in 5% of zidovudine recipients; alanine aminotransferase levels were greater than 10 times the upper normal limit in 3% of zidovudine recipients, but also in 4% of placebo recipients. Hence there was a very low prevalence of side-effects in haemophiliacs, despite the use of a higher zidovudine dosage than is currently widely used.
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Affiliation(s)
- P M Mannucci
- Angelo Bianchi Bonomi Haemophilia and Thrombosis Centre, Milano, Italy
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31
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Keller T, McGrath K, Newland A, Gatenby P, Cobcroft R, Gibson J. Indications for use of intravenous immunoglobulin. Recommendations of the Australasian Society of Blood Transfusion consensus symposium. Med J Aust 1993; 159:204-6. [PMID: 8336623 DOI: 10.5694/j.1326-5377.1993.tb137790.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Affiliation(s)
- T Keller
- Red Cross Blood Transfusion Service, Perth, WA
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32
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Panchapakesan J, Daglis M, Gatenby P. Antibodies to 65 kDa and 70 kDa heat shock proteins in rheumatoid arthritis and systemic lupus erythematosus. Immunol Cell Biol 1992; 70 ( Pt 5):295-300. [PMID: 1478694 DOI: 10.1038/icb.1992.37] [Citation(s) in RCA: 29] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
To test the potential role of autoimmunity to the highly conserved heat shock proteins (HSP) in immune arthritides, the sera from 99 patients with rheumatoid arthritis (RA), 48 patients with systemic lupus erythematosus (SLE) and 65 normal controls were examined by ELISA for IgG and IgM antibodies to the 65 kDa and 70 kDa heat shock proteins from Mycobacterium bovis (Bacille Calmette-Guerin; BCG). In RA sera there are significant numbers of individuals with increased IgM anti-65 kDa and anti-BCG reactivity as well as IgG anti-70 kDa when compared with controls. In SLE both IgM and IgG anti-BCG, together with IgM anti-65 kDa, differed significantly from controls. The results were compared with previous reports in similar groups of patients, and it is clear that no consistent pattern of reactivity emerges. While further work may be justified looking carefully at the disease duration and other subsets of both RA and SLE, it is difficult at this stage to conclude that antibodies to autologous HSP that cross-react with mycobacterial HSP play a major role in disease pathogenesis.
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Affiliation(s)
- J Panchapakesan
- Department of Clinical Immunology, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia
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Abstract
The expression of MHC class I and II molecules on cultured rat and human Schwann cells (SCs) was studied to determine whether these molecules could be synthesized by SCs in the absence of T cells. Normal rat and human SCs in vitro expressed low levels of class I MHC, but this was markedly increased by incubation with interferon gamma (IFN-gamma). Untreated SCs of rat or human origin did not express detectable class II MHC molecules, but after 48 hours incubation with IFN-gamma 100 U/ml, 20% of rat SCs and 90% of human SCs were class II positive. Immunoelectron microscopy confirmed the surface expression of MHC molecules on SCs and demonstrated class II MHC within endocytotic vesicles. These findings provide further evidence for an immunological role for SCs as antigen presenting cells or as targets for cytotoxic T cells.
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Affiliation(s)
- P J Armati
- School of Biological Sciences, University of Sydney, N.S.W., Australia
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Gatenby P. Dr. Steevens' Hospital. J Ir Coll Physicians Surg 1989; 18:290-6. [PMID: 11622306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/21/2023]
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35
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Gibson J, Gallagher K, Cameron K, Basten A, Gatenby P, Joshua D, Kronenberg H. Peripheral blood lymphocyte subsets and natural killer cell number and function during alpha-interferon treatment for hairy cell leukemia. Aust N Z J Med 1988; 18:897-9. [PMID: 3074762 DOI: 10.1111/j.1445-5994.1988.tb01658.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Affiliation(s)
- J Gibson
- Haematology Department, Royal Prince Alfred Hospital, Camperdown, N.S.W
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Gibson J, Cameron K, Gallagher K, Basten A, Gatenby P, Joshua D, Kronenberg H. Clinical response of hairy-cell leukaemia to interferon-alpha: results of an Australian study. Med J Aust 1988; 149:293-6. [PMID: 3419374 DOI: 10.5694/j.1326-5377.1988.tb120627.x] [Citation(s) in RCA: 3] [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: 01/05/2023]
Abstract
Twelve patients with documented, progressive hairy-cell leukaemia were treated with human lymphoblastoid interferon-alpha. All patients initially received a three-month course of interferon-alpha (3 x 10(6) U each day) which resulted in two complete remissions and 10 partial remissions. All eight patients who were dependent upon packed red-cell transfusions became independent of them and the three patients with the most severe, pretreatment pancytopenia also became independent of platelet transfusions. The histological appearance of the bone marrow improved in all patients; in three patients, a complete resolution of the leukaemic infiltrate was recorded. Adverse reactions occurred in 10 patients, but these were mild and did not interrupt treatment in seven patients. Moderate reactions that required a temporary reduction in the dose of interferon-alpha were seen in three patients. Ten patients subsequently received maintenance therapy with interferon-alpha (3 x 10(6) U, three times a week). A haematological improvement continued to be seen in all patients, and the results, with a minimum of one year of follow-up, are presented.
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Affiliation(s)
- J Gibson
- Royal Prince Alfred Hospital, Camperdown, NSW
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Lanier LL, Engleman EG, Gatenby P, Babcock GF, Warner NL, Herzenberg LA. Correlation of functional properties of human lymphoid cell subsets and surface marker phenotypes using multiparameter analysis and flow cytometry. Immunol Rev 1983; 74:143-60. [PMID: 6226586 DOI: 10.1111/j.1600-065x.1983.tb01088.x] [Citation(s) in RCA: 127] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
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Pollard JD, McLeod JG, Gatenby P, Kronenberg H. Prediction of response to plasma exchange in chronic relapsing polyneuropathy. A clinico-pathological correlation. J Neurol Sci 1983; 58:269-87. [PMID: 6834080 DOI: 10.1016/0022-510x(83)90222-8] [Citation(s) in RCA: 54] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
The clinical features, results of nerve conduction studies and sural nerve biopsy findings have been compared in 5 patients with chronic relapsing polyneuropathy in whom plasma exchange was used in treatment. In 2 patients who consistently responded to plasma exchange, the dominant pathological findings was segmental demyelination without prominent onion bulb formation, whereas axonal degeneration was more prominent in the cases which did not respond. It is concluded that in cases of chronic relapsing polyneuritis where the clinical, electrophysiological and histological features suggest primary demyelination, plasma exchange may provide a useful adjunct to therapy.
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Pollard JD, Harrison B, Gatenby P. Serum-induced demyelination: an electrophysiological and histological study. Clin Exp Neurol 1981; 18:70-80. [PMID: 6926394] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
Abstract
Serum from rabbits with EAN in the acute phase of the disease has been injected into rat sciatic nerve, and compared to control rabbit serum and serum from patients with demyelinating neuropathy and to normal human control serum. Electrophysiological studies were performed on all rat sciatic nerves so injected, and the nerve was then removed and examined histologically. Control rabbit and human serum and neuropathic human serum, when injected in a 20 microL quantity through a 30 gauge needle, did not produce significant electrophysiological abnormalities. EAN serum, however, produced significant dispersion of the muscle action potential and conduction block. All serum produced some histological evidence of demyelination but that seen with EAN serum was quite profound compared to all other sera. It is concluded that humoral factors are present within animals with EAN which has potent demyelinating potential. We were not able to demonstrate the same effect from patients with demyelinating neuropathy in this test system.
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Gatenby P, Basten A, Adams E. Thymoma and late onset mucocutaneous candidiasis associated with a plasma inhibitor of cell-mediated immune function. J Clin Lab Immunol 1980; 3:209-16. [PMID: 7420408] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
A case is described of chronic mucocutaneous candidiasis in association with thymoma. A plasma inhibitor of certain in vitro tests of cell mediated immune function, both of autologous and of normal cells was isolated from the patient's blood and shown to be stable on heating to 56 degrees C for 1 hour and to freezing and thawing. Isolation of the active fraction of Sephadex G-200 suggested a m.w. of 50,000-65,000 daltons. Despite disappearance of the inhibitor after apparently curative radiotherapy, suggesting the tumour was the origin, the chronic mucocutaneous candidiasis persists. The association of plasma inhibitors of immune function, with and without thymoma and chronic mucocutaneous candidiasis is reviewed and the possible nature of the substance discussed.
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Gatenby P. Treatment of vaccinial eye infection with vidarabine. Lancet 1979; 1:676. [PMID: 85920 DOI: 10.1016/s0140-6736(79)91129-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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Gatenby P. Transfer factor in tropical disease. P N G Med J 1978; 21:65-8. [PMID: 286485] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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