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Bourne T.,Imperial College London | Bottomley C.,Chelsea and Westminster Hospital
Fertility and Sterility | Year: 2012

In 2011, the first systematic review of the evidence behind the diagnostic criteria for miscarriage was published. It states, "findings were limited by the small number and poor quality of the studies," and concluded that further studies were, "urgently required before setting future standards for the accurate diagnosis of early embryonic demise." This implies that data used to define criteria to diagnose miscarriage are unreliable. The 2011 Irish Health Service executive review into miscarriage misdiagnosis highlighted this issue. In parallel to these publications a multicenter prospective study was published examining cut-off values for mean sac diameter (MSD) and embryo size to define miscarriage. The authors also published evidence on expected findings when ultrasonography is repeated at an interval. This led to guidance on diagnostic criteria for miscarriage in the UK changing. These new criteria state miscarriage be considered only when: an empty gestation sac has an MSD of ≥25 mm (with no obvious yolk sac), or embryonic crown rump length ≥7 mm (the latter without evidence of fetal heart activity). If in doubt, repeating scans at an interval is emphasized. It is axiomatic that decisions about embryonic viability must not be open to doubt. So it is surprising how little evidence exists to support previous guidance. Any clinician working in this area knows of women being wrongly informed that their pregnancy has failed. This cannot be acceptable and guidance in this area must be "failsafe.". Copyright © 2012 American Society for Reproductive Medicine, Published by Elsevier Inc.

Fell J.M.E.,Chelsea and Westminster Hospital
Archives of Disease in Childhood | Year: 2013

Eosinophilic oesophagitis (EO) is a chronic immune/ antigen-mediated oesophageal disease, with the immune reaction most likely directed to foods but on occasion also to aeroallergens. Clinically, it is characterised by symptoms of oesophageal dysfunction in subjects who typically have other indicators of an atopic tendency. Older children (and adults) frequently present with dysphagia and can have strictures (which may require dilatation). The diagnosis is dependent on an eosinophilpredominant oesophageal inflammation, with 15 or more eosinophils per high-powered field, now generally accepted as a necessary cut-off level of infiltration, which together with other clinical data (eg, oesophageal pH/impedance studies) can help discriminate EO from other potential causes of symptoms such as gastrooesophageal reflux disease. Recommended therapies, which may need to be long term, are dietary antigen exclusion (with elemental feeds or an exclusion diet) and/or topical corticosteroids.

Joshi D.,Kings College | O'Grady J.,Kings College | Dieterich D.,Mount Sinai Hospital | Gazzard B.,Chelsea and Westminster Hospital | Agarwal K.,Kings College
The Lancet | Year: 2011

Introduction of effective combined antiretroviral therapy has made HIV infection a chronic illness. Substantial reductions in the number of AIDS-related deaths have been accompanied by an increase in liver-related morbidity and mortality due to co-infection with chronic hepatitis B and C viruses. Increases in non-alcoholic fatty liver disease and drug-induced hepatotoxicity, together with development of hepatocellular carcinoma, also potentiate the burden of liver disease in individuals with HIV infection. We provide an overview of the key causes, disease mechanisms of pathogenesis, and recommendations for treatment options including the evolving role of liver transplantation. © 2011 Elsevier Ltd.

Raveendran S.S.,Chelsea and Westminster Hospital
Aesthetic surgery journal / the American Society for Aesthetic Plastic surgery | Year: 2012

A better understanding of volume distribution between the superficial (subcutaneous) and deep (subplatysmal) planes of the neck may be useful when deciding on the best course of management for patients presenting for cervical contouring. The authors investigate the normal distribution of fat in the superficial and deep planes of the neck in a cadaver model, to determine the proportion of the submandibular gland that contributes to submental fullness. Fat in the superficial and deep neck planes of 29 adult cadavers was dissected and weighed. The submandibular glands were also dissected and the cervical portion of each gland was shaved off, weighed, and compared to the weight of the whole gland. The mean weight of superficial fat collected from the specimens was 15.0 g in males (n = 14; range, 2.2-35.7 g) and 14.3 g in females (n = 15; range, 1.6-37.3 g); the mean weight of subplatysmal fat was 5.5 g in males (range, 1.3-15.2 g) and 3.7 g in females (range, 0.6-15.1 g). Mean weight was not statistically significantly different between the sexes, nor between the 2 racial/ethnic groups (Caucasian, n = 14; Southeast Asian, n = 15). Approximately 40% of the submandibular gland was found to lie inferior to the lower border of the mandible in the specimens examined. The authors found no anatomical evidence of submandibular gland ptosis, even in the oldest specimens. The study provides a comprehensive analysis of the distribution of adipose tissue in the superficial and deep planes of the neck, as well as the contribution of the submandibular glands to submental volume. This objective evaluation of neck volume may help guide clinicians in the surgical planning process and provide a foundation for designing new cervicofacial rejuvenation techniques.

Fox P.A.,Chelsea and Westminster Hospital
Sexual Health | Year: 2012

There is a growing range of treatment options for anal intraepithelial neoplasia (AIN). In HIV-positive patients, sustained treatment is often required to achieve clearance. The treatments considered are topically applied fluorouracil, imiquimod, cidofovir and trichloroacetic acid, the potential treatments of topical lopinavir and photodynamic therapy with aminolevulenic acid, and the surgical methods of electrosurgery, infrared coagulation and laser. Destructive treatment methods, possibly including TCA, are more effective than self applied topical treatments. Combining or alternating different treatments should be considered. Journal compilation CSIRO © 2012.

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