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Stevenage, United Kingdom

Killen H.,East and North Hertfordshire NHS Trust
BMJ case reports | Year: 2014

The coexistence of lung nodules on a CT scan with worsening respiratory symptoms in the context of previous malignant melanoma would usually signify metastatic disease. The cause of the lung nodules in this 69-year-old woman turned out to be diffuse idiopathic neuroendocrine cell hyperplasia (DIPNECH) with tumourlets. DIPNECH is extremely rare, with fewer than 100 cases reported in the literature worldwide. The key to making this diagnosis was that the nodules were not avid on a positron emission tomography-CT scan, as would have been expected in metastatic melanoma. This led to a biopsy diagnosis. At the time of writing, the patient remains symptomatic with stable disease. Source

Darzy K.H.,East and North Hertfordshire NHS Trust
Current Opinion in Endocrinology, Diabetes and Obesity | Year: 2013

PURPOSE OF REVIEW: Progressive and irreversible neuro-endocrine dysfunction following radiation-induced damage to the hypothalamic-pituitary (h-p) axis is the most common complication in cancer survivors with a history of cranial radiotherapy involving the h-p axis and in patients with a history of conventional or stereotactic pituitary radiotherapy for pituitary tumours. This review examines the controversy about the site and pathophysiology of radiation damage while providing an epidemiological perspective on the frequency and pattern of radiation-induced hypopituitarism. RECENT FINDINGS: Contrary to the previously held belief that h-p axis irradiation with doses less than 40 Gy result in a predominant hypothalamic damage with time-dependent secondary pituitary atrophy, recent evidence in survivors of nonpituitary brain tumours suggests that cranial radiation causes direct pituitary damage with compensatory increase in hypothalamic release activity. Sparing the hypothalamus from significant irradiation with sterteotactic radiotherapy for pituitary tumours does not appear to reduce the long-term risk of hypopituitarism. SUMMARY: Radiation-induced h-p dysfunction may occur in up to 80% of patients followed long term and is often associated with an adverse impact on growth, body image, skeletal health, fertility, sexual function and physical and psychological health. A detailed understanding of pathophysiological and epidemiological aspects of radiation-induced h-p axis dysfunction is important to provide targeted and reliable long-term surveillance to those at risk so that timely diagnosis and hormone-replacement therapy can be provided. © 2013 Wolters Kluwer Health | Lippincott Williams &Wilkins. Source

Patel A.,Imperial College NHS Trust | Li L.,East and North Hertfordshire NHS Trust | Anand A.,Imperial College NHS Trust
Injury | Year: 2014

Background Both-bone diaphyseal forearm fractures constitute up to 5.4% of all fractures in children in the United Kingdom. Most can be managed with closed reduction and cast immobilisation. Surgical fixation options include flexible intramedullary nailing and plating. However, the optimal method is controversial. The main purpose of this study was to systematically search for and critically appraise articles comparing functional outcomes, radiographic outcomes and complications of nailing and plating for both-bone diaphyseal forearm fractures in children under 18 years. Methods A comprehensive search of Medline, Embase and Cochrane databases using specific search terms and limits was conducted. Articles identified were thoroughly screened using strict eligibility criteria and eight retrospective non-randomised comparative studies were identified and reviewed. Results There were no statistically significant differences in functional outcome or time to fracture union between plating and IM nailing. No consistent difference was found in complication rate, fracture angulation, shortening or rotation. Better cosmesis and shorter duration of surgery was noted in the IM nailing group. Post-operative radial bow was significantly abnormal in the IM nailing groups, but did not affect forearm movement. Conclusion Based on similar functional and radiographic outcomes, nailing seems to be a safe and effective option when compared to plating for paediatric forearm fractures. However, critical appraisal of the studies in this review identified some methodological deficiencies and further prospective, randomised trials are recommended. © 2014 Elsevier Ltd. Source

Gale N.K.,University of Birmingham | Heath G.,University of Birmingham | Cameron E.,Aston University | Rashid S.,East and North Hertfordshire NHS Trust | Redwood S.,University of Birmingham
BMC Medical Research Methodology | Year: 2013

Background: The Framework Method is becoming an increasingly popular approach to the management and analysis of qualitative data in health research. However, there is confusion about its potential application and limitations. Discussion. The article discusses when it is appropriate to adopt the Framework Method and explains the procedure for using it in multi-disciplinary health research teams, or those that involve clinicians, patients and lay people. The stages of the method are illustrated using examples from a published study. Summary. Used effectively, with the leadership of an experienced qualitative researcher, the Framework Method is a systematic and flexible approach to analysing qualitative data and is appropriate for use in research teams even where not all members have previous experience of conducting qualitative research. © 2013 Gale et al.; licensee BioMed Central Ltd. Source

Chakravorty I.,1St Georges Hospital | Chahal K.,East and North Hertfordshire NHS Trust | Austin G.,East and North Hertfordshire NHS Trust
International Journal of COPD | Year: 2011

Introduction: Chronic obstructive pulmonary disease (COPD) patients with mucus hypersecretion tend to demonstrate increased frequency of infective exacerbations and a steeper slope of decline in lung function. Enhanced mucociliary clearance with high-frequency chest wall oscillation (HFCWO) devices previously used in cystic fibrosis and bronchiectasis patients may offer the opportunity for community-based, self-managed therapy to improve quality of life and lung function. Study design and methods: A randomized controlled crossover pilot study of HFCWO compared with conventional treatment was conducted in 22 patients with moderate to severe COPD and mucus hypersecretion. Patients spent 4 weeks using an HFCWO (SmartVest®) device and 4 weeks in a conventional phase with a 2-week washout. Eleven patients started with HFCWO and changed to conventional treatment, whereas the other eleven patients started conventional treatment and crossed over to HFCWO. Results: The patients were elderly with a mean age of 71 (standard deviation [SD] 10) years and were at the upper end of the normal range of body mass index (25 [SD 4.2] kg/m 2). The majority of patients had moderate to severe COPD with a mean percentage predicted forced expiratory volume in 1 second of 41 (SD 15.6) and percentage predicted forced vital capacity of 73 (SD 17.7). Baseline sputum production was negatively correlated to lung function and positively to St George's Respiratory Questionnaire. Symptom scores and St George's Respiratory Questionnaire symptom dimension improved significantly (-8, P,< 0.05). Sputum production showed a declining trend in the HFCWO phase, although not reaching statistical significance. The HFCWO device was well tolerated with good reported compliance. Conclusion: This pilot study demonstrated that patients with advanced COPD and mucus hypersecretion at increased risk of declining lung function tolerated the HFCWO treatment well, leading to improvement in quality of life and reduced symptoms. © 2011 Chakravorty et al, publisher and licensee Dove Medical Press Ltd. Source

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