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2.
Eur J Radiol Open ; 5: 102-107, 2018.
Article in English | MEDLINE | ID: mdl-30094296

ABSTRACT

AIMS: Ablation therapies are an innovative nephron-sparing alternative to radical nephrectomy for early stage renal cancers, although determination of treatment success is challenging. We aimed to undertake a systematic review of the literature to determine whether assessment of tumour perfusion may improve response assessment or alter clinical management when compared to standard imaging. MATERIAL AND METHODS: Two radiologists performed independent primary literature searches for perfusion imaging in response assessment following ablative therapies (radiofrequency ablation and cryotherapy) focused on renal tumours. RESULTS: 5 of 795 articles were eligible, totaling 110 patients. The study designs were heterogeneous with different imaging techniques, perfusion calculations, reference standard and follow-up periods. All studies found lower perfusion following treatment, with a return of 'high grade' perfusion in the 7/110 patients with residual or recurrent tumour. One study found perfusion curves were different between successfully ablated regions and residual tumour. CONCLUSIONS: Studies were limited by small sample size and heterogeneous methodology. No studies have investigated the impact of perfusion imaging on management. This review highlights the current lack of evidence for perfusion imaging in response assessment following renal ablation, however it suggests that there may be a future role. Further prospective research is required to address this.

3.
Br J Plast Surg ; 58(5): 708-13, 2005 Jul.
Article in English | MEDLINE | ID: mdl-15925340

ABSTRACT

Appearance related distress in both clinical and general populations is associated with the increasing identification of surgery as a solution, leading to referrals for cosmetic surgery and pressure on NHS resources. Cosmetic surgery guidelines are designed to control this growing demand, but lack a sound evidence base. Where exceptions are provided on the basis of psychological need, this may recruit patients inappropriately into a surgical pathway, and creates a demand for psychological assessment which transfers the resource problem from one service to another. The model described below evaluates the impact of a designated psychology service to a plastic surgery unit. Developing an operational framework for delivering cosmetic guidelines, which assesses patients using clearly defined and measurable outcomes, has significantly reduced numbers of patients proceeding to the NHS waiting list and provided a systematic audit process. The associated cost savings have provided a way of funding a psychologist within the plastic surgery service so that psychological assessment becomes routine, alternative methods of treatment are easily available and all patients have access to psychological input as part of the routine standard of care.


Subject(s)
Models, Organizational , Plastic Surgery Procedures/psychology , Psychology, Clinical/economics , Surgery, Plastic/organization & administration , Financing, Government , Health Care Rationing/methods , Health Services Research , Humans , Patient Selection , Practice Guidelines as Topic , Psychometrics , Referral and Consultation , State Medicine/economics , Stress, Psychological/diagnosis , Surgery, Plastic/economics , United Kingdom , Unnecessary Procedures
4.
Br J Plast Surg ; 57(5): 456-7, 2004 Jul.
Article in English | MEDLINE | ID: mdl-15191829

ABSTRACT

Neurofibromatosis is a relatively common inherited disease of the nervous system, with a frequency of almost 1 in 3000. It is associated with a wide range of vascular abnormalities. A 62-year-old man with neurofibromatosis presented to us with a sacral haematoma. This was due to spontaneous rupture of a pre-existing neurofibromata. Upon admission the patient was in hypovolaemic shock and required aggressive resuscitation prior to surgery. Haemorrhage following trauma or spontaneous rupture is an uncommon complication of neurofibromatosis. The management is discussed with emphasis on the cause and control of bleeding from these lesions.


Subject(s)
Hematoma/etiology , Hemorrhage/etiology , Neurofibroma/complications , Hematoma/surgery , Hemorrhage/surgery , Humans , Male , Middle Aged , Neurofibroma/surgery , Rupture, Spontaneous , Sacrum
5.
J Hand Surg Br ; 26(1): 4-7, 2001 Feb.
Article in English | MEDLINE | ID: mdl-11162004

ABSTRACT

A new technique of syndactyly release is described. The technique differs from the standard methods in that more digital flaps are used, and these are longer and are not defatted. A single stitch is applied to secure the tip of the flap and the defects between the flaps are not closed or grafted, hence the term "open" technique. Eight patients had 12 webs released using this operation. We compare this technique with 12 patients who had a total of 19 webs released using the standard technique. Patients were assessed for six parameters of operative success.


Subject(s)
Fingers/surgery , Skin Transplantation , Syndactyly/surgery , Adolescent , Child , Child, Preschool , Cicatrix/etiology , Female , Follow-Up Studies , Humans , Infant , Male , Postoperative Complications/etiology , Retrospective Studies , Suture Techniques , Treatment Outcome , Wound Healing/physiology
7.
Burns ; 25(7): 659-62, 1999 Nov.
Article in English | MEDLINE | ID: mdl-10563695

ABSTRACT

Toxic shock syndrome is associated with burn injuries in children and is a cause of significant morbidity in this group. Despite multiple cases of toxic shock syndrome in adults being reported since its original description it has not been reported in adult burn patients. We report a case of toxic shock syndrome in an adult following 25% flame burns.


Subject(s)
Burns/complications , Shock, Septic/diagnosis , Skin Transplantation/adverse effects , Staphylococcal Infections/diagnosis , Surgical Wound Infection/diagnosis , Adult , Burns/surgery , Female , Follow-Up Studies , Humans , Injury Severity Score , Shock, Septic/etiology , Shock, Septic/therapy , Staphylococcal Infections/etiology , Staphylococcal Infections/therapy , Surgical Wound Infection/therapy , Treatment Outcome
8.
Anal Biochem ; 226(2): 325-30, 1995 Apr 10.
Article in English | MEDLINE | ID: mdl-7793635

ABSTRACT

Polymerase chain reaction (PCR) has been widely applied to the detection of microorganisms. Overall sensitivity of PCR tests may be substantially reduced due to a large excess of nontarget DNA and inhibitory substances in the sample. We used a 5'-biotinylated 513-bp probe from the 3' region of the IS 900 element specific for Mycobacterium paratuberculosis (Mptb) to capture target Mptb DNA from crude sample DNA extracts. Captured target DNA was separated using streptavidin-coated magnetic particles (Dynal). Since the IS 900 element shares homology over this region with IS 902 in Mycobacterium avium subsp. silvaticum (Mavs), target DNA from this other pathogen was also retained. Highly specific PCR for the detection of either organism directed to the 5' regions of IS 900 or IS 902 was then performed directly on the solid phase. Hybridization capture of target DNA using sequence adjacent to the desired specific PCR site applied to Mptb increased overall sensitivity of detection in tissue and fecal extracts 10- to 100-fold. False positives due to contamination artifact were substantially excluded since the capture probe did not retain amplicons from the detection PCR. Development of the method to involve covalent 5' immobilization of capture probes on heat-resistant polymers should, in the future, provide a simple system with broad potential applications.


Subject(s)
DNA, Bacterial/analysis , Mycobacterium avium subsp. paratuberculosis/isolation & purification , Mycobacterium avium/isolation & purification , Polymerase Chain Reaction/methods , Animals , Base Sequence , Cattle , Crohn Disease/genetics , Crohn Disease/microbiology , DNA Primers/genetics , DNA Transposable Elements , False Positive Reactions , Feces/microbiology , Humans , Intestines/microbiology , Molecular Sequence Data , Mycobacterium avium/genetics , Mycobacterium avium subsp. paratuberculosis/genetics , Nucleic Acid Hybridization/genetics , Sensitivity and Specificity
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