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Daly C.A.,Royal Brompton Hospital | Clemens F.,London School of Hygiene and Tropical Medicine | Lopez Sendon J.L.,Hospital Universitario Gregorio Maranon | Tavazzi L.,Policlinico S. Matteo | And 10 more authors.
Postgraduate Medical Journal | Year: 2010

Aims: To examine resting heart rate (HR) in a population presenting with stable angina in relation to prior and subsequent pharmacological treatment, comorbid conditions and clinical outcome. Methods and results: The European Heart Survey was a prospective, observational, cohort study of 3779 patients with stable angina newly presenting to cardiology services. Mean baseline resting HR was 73 beats/min (bpm) and 52.3% of patients had a baseline HR > 70 bpm. Over half of patients were on no chronotropic medication at baseline. Patients with chronic respiratory disease or diabetes had higher resting HRs (75-76 bpm), and were more likely to have been receiving calcium channel blockers at baseline assessment. Overall, b-blockers were the most common treatment administered following cardiologist assessment, but were used less frequently in patients with chronic respiratory disease and diabetes, and the dosages used were less than that found to be effective in clinical trials. Mean daily doses of metoprolol, bisoprolol, carvedilol, and atenolol were 75 mg, 6 mg, 19 mg and 55 mg, respectively. Higher HR at baseline was associated with higher rates of cardiovascular mortality and hospitalisation for heart failure. Conclusion: Control of ischaemic symptoms through heart rate modification in patients with angina is currently inadequate, both by primary referring physicians and cardiologists. Given the adverse outcome associated with higher resting heart rates in this as in other studies, and the availability of specific HR reducing strategies, attention should be given to achieving optimal HR control.


Ellanti P.,C o Marjorie White Flynn | Connolly S.S.,C o Marjorie White Flynn | McDermott R.,Adelaide and Meath Incorporating National Childrens Hospital | Crotty P.L.,Adelaide and Meath Incorporating National Childrens Hospital | Grainger R.,C o Marjorie White Flynn
Irish Journal of Medical Science | Year: 2011

Background: Metastatic involvement of the penis is most commonly from a primary malignant genitourinary tumour. It is a rare phenomenon usually reflecting disseminated malignancy associated with a poor prognosis. Metastasis to the penis mimicking priapism is extremely rare, particularly in the absence of disseminated disease. Materials and methods: We describe a case of painful priapism caused by a high-grade urothelial malignancy without disseminated disease. Conclusion: Life expectancy is estimated at less than 1 year in these patients. Our patient remains in clinical and radiologic remission over 36 months from his original radical surgery. © 2010 Royal Academy of Medicine in Ireland.


Dobson L.,Royal College of Surgeons in Ireland | Conway C.,Royal College of Surgeons in Ireland | Hanley A.,Royal College of Surgeons in Ireland | Johnson A.,Royal College of Surgeons in Ireland | And 7 more authors.
Histopathology | Year: 2010

Aims: Accurate determination of HER-2 status is critical to identify patients for whom trastuzumab treatment will be of benefit. Although the recommended primary method of evaluation is immunohistochemistry, numerous reports of variability in interpretation have raised uncertainty about the reliability of results. Recent guidelines have suggested that image analysis could be an effective tool for achieving consistent interpretation, and this study aimed to assess whether this technology has potential as a diagnostic support tool. Methods and results: Across a cohort of 275 cases, image analysis could accurately classify HER-2 status, with 91% agreement between computer-aided classification and the pathology review. Assessment of the continuity of membranous immunoreactivity in addition to intensity of reactivity was critical to distinguish between negative and equivocal cases and enabled image analysis to report a lower referral rate of cases for confirmatory fluorescence in situ hybridization (FISH) testing. An excellent concordance rate of 95% was observed between FISH and the automated review across 136 informative cases. Conclusions: This study has validated that image analysis can robustly and accurately evaluate HER-2 status in immunohistochemically stained tissue. Based on these findings, image analysis has great potential as a diagnostic support tool for pathologists and biomedical scientists, and may significantly improve the standardization of HER-2 testing by providing a quantitative reference method for interpretation. © 2010 Blackwell Publishing Limited.

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