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Effect of angioembolisation versus surgical packing on mortality in traumatic pelvic haemorrhage: A systematic review and meta-analysis

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World Journal of Emergency Medicine 2018年第2期9卷 85-92页

作者： Ahmed El Muntasar Ethan Toner Oddai A.Alkhazaaleh Danaradja Arumugam Nikhil Shah Shahab Hajibandeh Shahin Hajibandeh Department of General Surgery Royal Blackburn Hospital Department of Trauma and Orthopaedics WrightingtonWigan and Leigh NHS Foundation Trust Department of General Surgery Salford Royal Hospital Department of General Surgery North Manchester General Hospital

BACKGROUND: The management of complex pattern of bleeding associated with pelvic trauma remains a big challenge for trauma surgeons. We aimed to conduct a comprehensive meta-analysis to compare the outcomes of angioembolisation and pelvic packing in patients with pelvic ***: We conducted a systematic search of electronic information sources, including MEDLINE; EMBASE; CINAHL; the CENTRAL; the World Health Organization International Clinical Trials Registry; Clinical ***; ISRCTN Register, and bibliographic reference lists. The primary outcome was defined as mortality. Combined overall effect sizes were calculated using randomeffects models. Results are reported as the odds ratio(OR) and 95% confidence interval(CI).RESULTS: We identified 3 observational studies reporting a total of 120 patients undergoing angioembolisation(n=60) or pelvic packing(n=60) for pelvic trauma. Reporting of the Injury Severity Score(ISS) was variable, with higher ISS in the pelvic packing group. The risk of bias was low in two studies, and moderate in one. The pooled analysis demonstrated that angioembolisation did not significantly reduce mortality in patients with pelvic trauma compared to surgery(OR=1.99; 95% CI= 0.83–4.78, P=0.12). There was mild between-study heterogeneity(I^2=0%, P=0.65).CONCLUSION: Our analysis found no significant difference in mortality between angioembolisation and pelvic packing in patients with traumatic pelvic haemorrhage. The current level of evidence in this context is very limited and insufficient to support the superiority of a treatment modality. Future research is required.

关键词： Pelvic trauma Pelvic packing Angiography Embolisation

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Gemcitabine-induced haemolytic uremic syndrome,although infrequent,can it be prevented:A case report and review of literature

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World Journal of Clinical Cases 2018年第12期6卷 531-537页

作者： Esther U Cidon Pilar A Martinez Tamas Hickish Department of Medical Oncology Royal Bournemouth and Christchurch Hospital NHS Foundation Trust Department of Oncology Clinical University HospitalValladolid Department of Medical Oncology Royal Bournemouth and Christchurch Hospital NHS Foundation Trust and Bournemouth University

Gemcitabine is an antineoplastic used to treat several malignancies including pancreatic cancer. Its toxicity profile is well known with myelotoxicity, increased vascular permeability and peripheral oedema as most frequent adverse events. However, several cases of acute renal failure have been reported and haemolytic uremic syndrome(HUS) seems to be the underlying process. The cause of HUS remains unknown but its consequences can be lethal. Therefore, a high grade of suspicion is crucial to diagnose it and promptly treat it. This hopefully will reduce its morbidity. HUS is characterized by progressive renal failure associated with microangiopathic haemolytic anaemia and thrombocytopenia. The primary event is damage to endothelial cells and thrombotic microangiopathy(TMA) is the histopathological lesion. TMA affects mainly renal microvasculature. However, some cases evolve with central nervous or cardiovascular systems involvement. We present here a case of gemcitabine-induced HUS, with renal and cardiovascular system affected at the time of diagnosis which to our knowledge this is the first time of such case to be reported.

关键词： Thrombocytopenia Haemolytic uremic syndrome Thrombotic microangiopathy Gemcitabine Microangiopathic haemolytic anaemia

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Ampullary cancer of intestinal origin and duodenal cancer-A logical clinical and therapeutic subgroup in periampullary cancer

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World Journal of Gastrointestinal Oncology 2017年第10期9卷 407-415页

作者： Manju D Chandrasegaram Anthony J Gill Jas Samra Tim Price John Chen Jonathan Fawcett Neil D Merrett the Prince Charles hospital School of Medicine University of Queensland Sydney Medical School University of Sydney Cancer Diagnosis and Pathology Group Kolling Institute of Medical Research Royal North Shore Hospital Department of Surgery Royal North Shore Hospital Queen Elizabeth hospital University of Adelaide Flinders Medical Centre royal Adelaide hospital Princess Alexandra hospital Department of Upper GI Surgery Bankstown Hospital Discipline of Surgery Western Sydney University

Periampullary cancers include pancreatic, ampullary, biliary and duodenal cancers. At presentation, the majority of periampullary tumours have grown to involve the pancreas, bile duct, ampulla and duodenum. This can result in difficulty in defining the primary site of origin in all but the smallest tumors due to anatomical proximity and architectural distortion. This has led to variation in the reported proportions of resected periampullary cancers. Pancreatic cancer is the most common cancer resected with a pancreaticoduodenectomy followed by ampullary(16%-50%), bile duct(5%-39%), and duodenal cancer(3%-17%). Patients with resected duodenal and ampullary cancers have a better reported median survival(29-47 mo and 22-54 mo) compared to pancreatic cancer(13-19 mo). The poorer survival with pancreatic cancer relates to differences in tumour characteristics such as a higher incidence of nodal, neural and vascular invasion. While small ampullary cancers can present early with biliary obstruction, pancreatic cancers need to reach a certain size before biliary obstruction ensues. This larger size at presentation contributes to a higher incidence of resection margin involvement in pancreatic cancer. Ampullary cancers can be subdivided into intestinal or pancreatobiliary subtype cancers with histomolecular staining. This avoids relying on histomorphology alone, as even some poorly differentiated cancers preserve the histomolecular profile of their mucosa of origin. Histomolecular profiling is superior to anatomic location in prognosticating survival. Ampullary cancers of intestinal subtype and duodenal cancers are similar in their intestinal origin and form a logical clinical and therapeutic subgroup of periampullary cancers. They respond to 5-FU based chemotherapeutic regimens such as capecitabine-oxaliplatin. Unlike pancreatic cancers, KRAS mutation occurs in only approximately a third of ampullary and duodenal cancers. Future clinical trials should group ampullary cancer

关键词： Periampullary cancer Pancreatobiliary subtype Intestinal subtype Ampullary cancer Duodenal cancer Epidermal growth factor receptor Pancreatic cancer Chemotherapy Pancreaticoduodenectomy KRAS

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Mucinous cyst exhibiting severe dysplasia in gastric heterotopic pancreas associated withe gastrointestinal stromal tumour

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World Journal of Gastroenterology 2007年第43期13卷 5781-5782页

作者： Antony Kaufman David Storey Cheok Soon Lee Rajmohan Murali Department of Anatomical Pathology Sydney Cancer Centre Royal Prince Alfred Hospital Camperdown New South Wales Australia Department of Surgery Royal Prince Alfred Hospital Camperdown New South Wales Australia Department of Anatomical Pathology Sydney Cancer Centre Royal Prince Alfred Hospital Camperdown New South Wales Australia Sydney Melanoma Unit Sydney Cancer Centre Royal Prince Alfred Hospital Camperdown New South Wales Australia

Heterotopic pancreatic tissue within the stomach is rare and dysplasia within heterotopic pancreatic tissue is very rare. We present the first report of a patient with concurrent occurrence of heterotopic pancreas in ... 详细信息

关键词： Dysplasia Gastrointestinal stromal tumour Heterotopic pancreas Mucinous cyst Stomach

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Human albumin solution for patients with cirrhosis and acute on chronic liver failure: Beyond simple volume expansion

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World Journal of Hepatology 2016年第7期8卷 345-354页

作者： Christopher Valerio Eleni Theocharidou Andrew Davenport Banwari Agarwal Intensive Care Unit Royal Free Hospital Royal Free Hampstead NHS Trust University College London the royal Free Sheila Sherlock Liver Centre Royal Free Hospital Royal Free Hampstead NHS Trust and Institute of Liver and Digestive Health University College London UCL Centre for Nephrology Royal Free Hospital

To provide an overview of the properties of human serum albumin(HSA), and to review the evidence for the use of human albumin solution(HAS) in critical illness, sepsis and cirrhosis. A MEDLINE search was performed using the terms "human albumin", "critical illness", "sepsis" and "cirrhosis". The references of retrieved articles were reviewed manually. Studies published between 1980 and 2014 were selected based on quality criteria. Data extraction was performed by all authors. HSA is the main plasma protein contributing greatly to its oncotic pressure. HSA demonstrates important binding properties for endogenous and exogenous toxins, drugs and drug metabolites that account for its anti-oxidant and anti-inflammatory properties. In disease states, hypoalbuminaemia is secondary to decreased HSA production, increased loss or transcapillary leakage into the interstitial space. HSA function can be also altered in disease with reduced albumin binding capacity and increased production of modified isoforms. HAS has been used as volume expander in critical illness, but received criticism due to cost and concerns regarding safety. More recent studies confirmed the safety of HAS, but failed to show any survival benefit compared to the cheaper crystalloid fluids, therefore limiting its use. On the contrary, in cirrhosis there is robust data to support the efficacy of HAS for the prevention of circulatory dysfunction post-large volume paracentesis and in the context of spontaneous bacterial peritonitis, and for the treatment of hepato-renal syndrome and hypervolaemic hyponatraemia. It is likely that not only the oncotic properties of HAS are beneficial in cirrhosis, but also its functional properties, as HAS replaces the dysfunctional HSA. The role of HAS as the resuscitation fluid of choice in critically ill patients with cirrhosis, beyond the established indications for HAS use, should be addressed in future studies.

关键词： Human serum albumin Human albumin solution Critical illness Cirrhosis Resuscitation fluid Large-volume paracentesis Hepatorenal syndrome Spontaneous bacterial peritonitis

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An enhanced functional ability questionnaire(faVIQ) to measure the impact of rehabilitation services on the visually impaired

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International Journal of Ophthalmology(English edition) 2014年第1期7卷 77-85页

作者： James Stuart Wolffsohn Jonathan Jackson Olivia Anne Hunt Charles Cottriall Jennifer Lindsay Richard Gilmour Anne Sinclair Robert Harper Aston University Life and Health SciencesOphthalmic Research Group Australian College of Optometry royal Victoria hospital Oxford Eye hospital royal Victoria hospital Belfast Altnagelvin Area hospital Low Vision Clinic Fife Low Vision Centre for the Blind Manchester royal Eye hospital and Manchester Academic and Health Science Centre Central Manchester University Hospitals NHS Foundation Trust

AIM: To develop a short,enhanced functional ability Quality of Vision(faVIQ) instrument based on previous questionnaires employing comprehensive modern statistical techniques to ensure the use of an appropriate response scale,items and scoring of the visual related difficulties experienced by patients with visual impairment. · METHODS: Items in current quality-of-life questionnaires for the visually impaired were refined by a multi-professional group and visually impaired focus groups. The resulting 76 items were completed by 293 visually impaired patients with stable vision on two occasions separated by a month. The faVIQ scores of 75 patients with no ocular pathology were compared to 75 age and gender matched patients with visual impairment. ·RESULTS: Rasch analysis reduced the faVIQ items to 27. Correlation to standard visual metrics was moderate(r =0.32-0.46) and to the NEI-VFQ was 0.48. The faVIQ was able to clearly discriminate between age and gender matched populations with no ocular pathology and visual impairment with an index of 0.983 and 95% sensitivity and 95% specificity using a cut off of 29.·CONCLUSION: The faVIQ allows sensitive assessment of quality-of-life in the visually impaired and should support studies which evaluate the effectiveness of low vision rehabilitation services.

关键词： quality of life visual impairment low vision functional ability sensitivity specificity

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Ineffective oesophageal motility:Manometric subsets exhibit different symptom profiles

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World Journal of Gastroenterology 2008年第23期14卷 3719-3724页

作者： Horst Gunter Haack Ross David Hansen Allison Malcolm John Edward Kellow Department of Gastroenterology Gastrointestinal Investigation UnitRoyal North Shore HospitalUniversity of SydneyAustralia

AIM:To compare the demographic and clinical features of different manometric subsets of ineffective oesophageal motility(IOM;defined as ≥ 30% wet swallows with distal contractile amplitude < 30 mmHg) ,and to determine whether the prevalence of gastro-oesophageal reflux differs between IOM subsets. METHODS:Clinical characteristics of manometric subsets were determined in 100 IOM patients(73 female,median age 58 years) and compared to those of 100 age-and gender-matched patient controls with oesophageal symptoms,but normal manometry. Supine oesophageal manometry was performed with an eight-channel DentSleeve water-perfused catheter,and an ambulatory pH study assessed gastro-oesophageal reflux. RESULTS:Patients in the IOM subset featuring a majority of low-amplitude simultaneous contractions(LASC) experienced less heartburn(prevalence 26%) ,but more dysphagia(57%) than those in the IOM subset featuring low-amplitude propagated contractions(LAP;heartburn 70%,dysphagia 24%;both P ≤ 0.01) . LASC patients also experienced less heartburn and more dysphagia than patient controls(heartburn 68%,dysphagia 11%;both P < 0.001) . The prevalence of heartburn and dysphagia in IOM patients featuring a majority of non-transmitted sequences(NT) was 54%(P = 0.04 vs LASC) and 36%(P < 0.01 vs controls) ,respectively. No differences inage and gender distribution,chest pain prevalence,acid exposure time(AET) and symptom/reflux association existed between IOM subsets,or between subsets and controls. CONCLUSION:IOM patients with LASC exhibit a different symptom profile to those with LAP,but do not differ in gastro-oesophageal reflux prevalence. These findings raise the possibility of different pathophysiological mechanisms in IOM subsets,which warrants further investigation.

关键词： Age Dysphagia Heartburn Ineffective oesophageal motility Oesophageal manometry Simultaneous contractions

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Disability management and rehabilitation for persons with multiple sclerosis

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Neural Regeneration Research 2010年第4期5卷 301-309页

作者： Fary Khan Orla Gray Department of Medicine University of MelbourneParkville Department of Rehabilitation Medicine Royal Melbourne HospitalParkville

Multiple sclerosis is the commonest cause of chronic neurological disability in young adults. Patients typically have a normal life span, though with accrued time multiple disabilities with a significant impact on quality of life. This article presents the current literature on symptomatic treatment and rehabilitation for persons with multiple sclerosis. A comprehensive multidisciplinary approach addresses the acute, intermediate and long-term medical, psychological and social issues faced by these individuals. Prevention of medical complications, maintenance and restoration of functional independence, addressing psychosocial factors and issues relating to quality of life are integral to the rehabilitation processes.

关键词： multiple sclerosis disability management rehabilitation multidisciplinary effectiveness literature review neurodegenerative disease neural regeneration

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Differences in proximal (cardia) versus distal (antral) gastric carcinogenesis via retinoblastoma pathway

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World Journal of Gastroenterology 2004年第1期10卷 17-21页

作者： ChristianGulmann HelenHegarty AntoinetteGrace MaryLeader ElaineKay Stephen Patchett Department of Pathology Beaumont Hospital and Royal College of Surgeons in IrelandDublinIreland Department of Gastroenterology Beaumont HospitalDublinIreland

AIM: Disruption of cell cycle regulation is a critical event in carcinogenesis, and alteration of the retinoblastoma (pRb)tumour suppressor pathway is frequent. The aim of this study was to compare alterations in this pathway in proximal and distal gastric carcinogenesis in an effort to explain the observed striking epidemiological differences. METHODS: Immunohistochemistry was performed to investigate expression of p16 and pRb in the following groups of both proximal (cardia) and distal (antral) tissue samples: (a) biopsies showing normal mucosa, (b) biopsies showing intestinal metaplasia and, (c) gastric cancer resection specimens including uninvolved mucosa and tumour. RESULTS: In the antrum there were highly significant trends for increased p16 expression with concomitant (and in the group of carcinomas inversely proportional) decreased pRb expression from normal mucosa to intestinal metaplasia to uninvolved mucosa (from cancer resections) to carcinoma. In the cardia, there were no differences in p16 expression between the various types of tissue samples whereas pRb expression was higher in normal mucosa compared with intestinal metaplasia and tissue from cancer resections. CONCLUSION: Alterations in the pRb pathway appear to play a more significant role in distal gastric carcinogenesis. It may be an early event in the former location since the trend towards p16 overexpression with concomitant pRb underexpression was seen as early as between normal mucosa and intestinal metaplasia. Importantly, the marked differences in expression of pRb and p16 between the cardia and antrum strongly support the hypothesis that tumours of the two locations are genetically different which may account for some of the observed epidemiological differences.

关键词：胃癌眼癌肿瘤病理学细胞周期免疫组织化学

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Complete pathological response following down-staging chemoradiation in locally advanced pancreatic cancer:Challenging the boundaries

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World Journal of Gastroenterology 2007年第47期13卷 6433-6435页

作者： AZ Khan V Pitsinis SS Mudan Department of Gastrointestinal Surgery Royal Marsden HospitalFulham RoadLondonUnited Kingdom

Pancreatic cancer is an aggressive malignancy,relatively resistant to chemotherapy and radiotherapy,which usually presents late. Disease specific mortality approaches unity despite advances in adjuvant therapy. We present the first reported case of complete pathological response following neoadjuvant therapy in a locally advanced pancreatic adenocarcinoma.

关键词： Chemotherapy Pancreatic cancer Pathology

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