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Oxford, United Kingdom

White R.,Churchill Hospital
Proceedings of the Nutrition Society | Year: 2010

There are many factors that can influence nutritional intake. Food availability, physical capability, appetite, presence of gastrointestinal symptoms and perception of food are examples. Drug therapy can negatively influence nutritional intake through their effect on these factors, predominantly due to side effects. This review aims to give a brief overview of each of these factors and how drug therapy can affect them. Specific examples are given for each section and an indication of the impact on nutritional status. This article aims to assist the clinician in the identification of the effects of drug therapy on nutritional intake and provides advice on appropriate intervention. A drug history and side effect review should form an integral part of nutritional assessment. Early identification and effective therapeutic use of alternative drug therapy can also positively influence nutritional intake. © 2010 The Author. Source

Roberts I.S.D.,John Radcliffe Hospital | Traill Z.C.,Churchill Hospital
Histopathology | Year: 2014

Aims: Post-mortem imaging is a potential alternative to traditional medicolegal autopsy. We investigate the reduction in number of invasive autopsies required by use of post-mortem CT ± coronary angiography. Methods and results: A total of 120 adult deaths referred to the Coroner were investigated by CT, with coronary angiography employed only for the second series of 60 cases, in order to determine the added value of angiography. The confidence of imaging cause of death was classified as definite (no autopsy), probable, possible or unascertained. Invasive autopsy was not required in 38% of cases without coronary angiography and 70% of cases with angiography. Full autopsy, including brain dissection, was required in only 9% of cases. There was complete agreement between autopsy and radiological causes of death in the cases with a 'probable' imaging cause of death, indicating that cases for which imaging provides an accurate cause of death without autopsy were identified correctly. In two patients, CT demonstrated unsuspected fractures, not detected at subsequent autopsy. Conclusions: A two-thirds reduction in the number of invasive coronial autopsies can be achieved by use of post-mortem CT plus coronary angiography. At the same time, use of post-mortem CT may improve accuracy of diagnosis, particularly for traumatic deaths. © 2013 John Wiley & Sons Ltd. Source

Venning V.A.,Churchill Hospital
Dermatologic Clinics | Year: 2011

Linear IgA disease is one of the rarer subepidermal blistering diseases. Linear IgA disease is a chronic, acquired, autoimmune blistering disease that is characterized by subepidermal blistering and linear deposition of IgA basement membrane antibodies. The disease affects both children and adults and, although there are some differences in their clinical presentations, there is considerable overlap with shared immunopathology and immunogenetics. © 2011 Elsevier Inc. Source

Manceau G.,University Pierre and Marie Curie | Karoui M.,University Pierre and Marie Curie | Werner A.,Louisiana State University Health Sciences Center | Mortensen N.J.,Churchill Hospital | Hannoun L.,University Pierre and Marie Curie
The Lancet Oncology | Year: 2012

Elderly people represent almost all patients diagnosed with and treated for rectal cancer, and this trend is likely to become more apparent in the future. Surgical management and treatment decisions for this disease are becoming increasingly complex, but only a few reports deal specifically with older patients. In this systematic review, we provide an overview of published studies of outcomes after curative surgery for rectal cancer in elderly people (>70 years). We identified 48 studies providing information about postoperative results, survival, surgical approach, stoma formation, functional results, and quality of life after rectal resection for cancer. We found that advanced chronological age should not, by itself, exclude patients from curative rectal surgery or from other surgical options that are available for younger patients. Although overall survival is lower in elderly patients than in younger patients, cancer-specific survival does not decrease with age. However, the level of evidence for most studies was weak, emphasising the need for high-quality clinical trials for this population. © 2012 Elsevier Ltd. Source

Introduction: One-third of patients with nonseminomatous germ cell tumour (NSGCT) present at clinical stage I (CS1), without evidence of metastatic disease on imaging and with normal postoperative tumour markers. The management of CS1 NSGCT following orchiectomy is controversial. Methods: A Medline literature review was undertaken in December 2009. Management options include surveillance (with treatment for relapse), adjuvant cisplatin-based combination chemotherapy, or retroperitoneal lymph node dissection (RPLND). Results: Only 30% of stage I NSGCT patients relapse during surveillance. Therefore, the 70% of patients who are cured by orchiectomy alone could be unnecessarily exposed to adjuvant treatment-related toxicity, including transient infertility, ototoxicity, possible development of second malignancy, and cardiovascular or neurologic symptoms. To reduce this overtreatment, the European Association of Urology (EAU) 2009 guidelines advise a "risk-adapted treatment approach," recommending adjuvant two-cycle bleomycin, etoposide, and cisplatin (BEP) chemotherapy only for high-risk cases. Risk factors for relapse include the presence of vascular invasion (VI) by tumour cells in the primary tumour, which can help to predict relapse in 48% of patients, while 15% without VI and other risk factors eventually relapse. The reported 5-yr survival with surveillance and salvage treatment of relapse for men with non-risk-stratified CS1 NSGCT is 99%, while the risk-adapted 5-yr survival with adjuvant chemotherapy is >99%. The EAU guidelines propose two cycles of adjuvant chemotherapy (or RPLND) for those patients with VI, while those without VI are recommended to undergo surveillance. But this approach will result in 52% of patients receiving unnecessary treatment, while a few under surveillance will still relapse. Conclusion: Based on minimising toxicity and excellent published outcomes, it is proposed that all CS1 NSGCT patients be managed by careful surveillance with salvage treatment only for relapse. Another option may be to give high-risk patients a single cycle of BEP to reduce toxicity. © 2010 European Association of Urology. Source

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