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Manchester, United Kingdom

Stinton C.,University of Warwick | Elison S.,Christie | Howlin P.,Institute of Psychiatry
American Journal on Intellectual and Developmental Disabilities | Year: 2010

Although many researchers have investigated emotional and behavioral difficulties in individuals with Williams syndrome, few have used standardized diagnostic assessments. We examined mental health problems in 92 adults with Williams syndrome using the Psychiatric Assessment Schedule for Adults with Developmental Disabilities-PAS-ADD (Moss, Goldberg, et al., 1996). Factors potentially associated with mental health problems were also explored. The PAS-ADD identified mental health problems in 24% of the sample. The most common were anxiety (16.5%) and specific phobias (12%). Other diagnoses included depression, agoraphobia, and social phobia. No association was found between the presence of mental health problems and either individual (e.g., age, IQ, language level) or external (life events) variables. © American Association on Intellectual and Developmental Disabilities. Source

Douglas C.M.,Christie NHS Foundation Trust | Douglas C.M.,University of Manchester | Bernstein J.M.,Christie NHS Foundation Trust | Bernstein J.M.,Royal Infirmary | And 9 more authors.
Clinical Oncology | Year: 2013

Aims: To evaluate the prognostic significance of potential tumour markers of hypoxia and apoptosis in early squamous cell carcinoma of the glottic larynx managed with radiotherapy. Materials and methods: In total, 382 patients with T1 and T2 squamous cell carcinoma of the glottic larynx (vocal cords) received radical radiotherapy (50-55 Gy, in 16 fractions in 98% of cases). Pre-treatment haemoglobin was available for 328 patients; biopsy samples were available for 286. Immunohistochemistry was carried out for carbonic anhydrase-9 (CA-9), hypoxia inducible factor-1α (HIF-1α) and Bcl-2. Results: At 5 years, locoregional control was achieved in 88.2%, cancer-specific survival in 95.0% and overall survival in 78.7%. Adverse prognostic factors for locoregional tumour recurrence were pre-treatment haemoglobin <13.0 g/dl (P = 0.035, Log rank test; sensitivity 0.28, specificity 0.84) and stage T2 rather than T1 (P = 0.002). The effect of haemoglobin level on locoregional control was not significant when stratified by the median of 14.2 g/dl (P = 0.43) or as a continuous variable (P = 0.59). High CA-9 (P = 0.11), HIF-1α (P = 0.67) and Bcl-2 (P = 0.77) expression had no prognostic significance. Conclusions: High CA-9, HIF-1α and Bcl-2 do not add to the prognostic significance of tumour stage and lower haemoglobin in predicting failure of local control in early glottic larynx squamous cell carcinoma managed with radiotherapy. The effect of haemoglobin was not strong enough to be useful as a prognostic biomarker. © 2012 The Royal College of Radiologists. Source

Ross G.L.,Christie
Journal of Plastic, Reconstructive and Aesthetic Surgery | Year: 2012

Introduction: Immediate reconstruction following prophylactic mastectomy for larger ptotic breasts is difficult. Tissue expansion in these patients often results in poor cosmetic outcomes. Autologous options may not be possible due to clinical unsuitability or patient choice. Using the inferior dermal flap with implant achieves lower pole fullness and allows a one-stop reconstruction in the larger ptotic breast. Methods: The inferior dermal flap and implant was performed on ten patients (20 breasts). Average age was 43 (range 36-53). The average BMI was 37 (range 32-43). The distance from nipple to IMF varied from 15 cm to 26 cm. The average implant size was 533 (range 390-620). Complications were minimal with one patient experiencing delayed wound healing at the T-junction and one patient developing inferior pole erythema postoperatively that settled with antibiotics. Conclusion: The inferior dermal flap and implant provides a one-stop reconstructive option. It is reliable, safe and maintains the breast envelope while giving excellent size, shape and symmetry in the larger ptotic patient. © 2012 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved. Source

Kochhar R.,Christie | Liong S.,Christie | Manoharan P.,Christie | Manoharan P.,University of Manchester
Cancer Biomarkers | Year: 2010

Introduction: Growing subsets of patients with metastatic colorectal cancer (CRC) are being considered for treatment with curative intent. Accurate re-staging of patients with potentially resectable hepatic or pulmonary metastases is therefore crucial for optimal management. This article presents data to assess the role of 18-fluoro-deoxyglucose (^{18}FDG) positron emission tomography/computed tomography (PET/CT) in metastatic CRC. Materials and Methods: A total of 341 patients with potentially resectable liver and/or pulmonary CRC metastases underwent ^{18}FDG PET/CT between 1st April 2007 and 31st August 2008 at our unit. Of these, 157 patients fulfilled the inclusion criteria and were included in this retrospective assessment. Imaging and clinical histories of these patients were evaluated. Findings on PET/CT were compared with pre-PET/CT conventional imaging and overall impact on patient management was assessed. The PET/CT results were confirmed either with histological comparison where available or with serial imaging follow up. Results: On a lesion to lesion basis, PET/CT when compared with pre-PET/CT conventional imaging in patients with metastatic liver and lung lesions had a Spearman correlation coefficient of 0.8 and P value < 0.0001 in both subgroups. PET/CT upstaged disease in 33.1% (52/157), down staged disease in 24.9% (39/157) and was in agreement with pre-PET/CT conventional imaging in the remaining 42% of patients (66/157). Based on PET/CT results surgery was averted in 33.8% patients (53/157). PET/CT had a sensitivity of 87.1%, specificity of 88.0%, positive predictive value of 97.4%, negative predictive value of 56.4% and an overall accuracy of 87.3% in assessing metastatic disease. Conclusion: Assessment with ^{18}FDG PET/CT has a significant impact on the management of CRC patients with hepatic and pulmonary metastases. © 2010 - IOS Press and the authors. All rights reserved. Source

Donaldson S.B.,University of Manchester | Betts G.,University of Manchester | Bonington S.C.,Christie | Homer J.J.,University of Manchester | And 7 more authors.
International Journal of Radiation Oncology Biology Physics | Year: 2011

Purpose: To analyze, in a pilot study, rapidly acquired dynamic contrast-enhanced (DCE)-MRI data with a general two-compartment exchange tracer kinetic model and correlate parameters obtained with measurements of hypoxia and vascular endothelial growth factor (VEGF) expression in patients with squamous cell carcinoma of the head and neck. Methods and Materials: Eight patients were scanned before surgery. The DCE-MRI data were acquired with 1.5-s temporal resolution and analyzed using the two-compartment exchange tracer kinetic model to obtain estimates of parameters including perfusion and permeability surface area. Twelve to 16 h before surgery, patients received an intravenous injection of pimonidazole. Samples taken during surgery were used to determine the level of pimonidazole staining using immunohistochemistry and VEGF expression using quantitative real-time polymerase chain reaction. Correlations between the biological and imaging data were examined. Results: Of the seven tumors fully analyzed, those that were poorly perfused tended to have high levels of pimonidazole staining (r = -0.79, p = 0.03) and VEGF expression (r = -0.82, p = 0.02). Tumors with low permeability surface area also tended to have high levels of hypoxia (r = -0.75, p = 0.05). Hypoxic tumors also expressed higher levels of VEGF (r = 0.82, p = 0.02). Conclusions: Estimates of perfusion obtained with rapid DCE-MRI data in patients with head-and-neck cancer correlate inversely with pimonidazole staining and VEGF expression. © 2011 Elsevier Inc. Source

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