Croydon, United Kingdom
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Mendall M.A.,Mayday University Hospital | Viran Gunasekera A.,Mayday University Hospital | Joseph John B.,Mayday University Hospital | Kumar D.,St. Georges Medical School
Digestive Diseases and Sciences | Year: 2011

Background: Obesity is associated with a proinflammatory state. Aim: To determine whether obesity at diagnosis is a risk factor for Crohn's disease vs. ulcerative colitis and also vs. community controls and whether there is a U-shaped relationship between body mass index at diagnosis and risk of Crohn's disease versus ulcerative colitis. Methods: A total of 524 consecutive inflammatory bowel disease patients attending gastroenterology clinics were administered a questionnaire inquiring about weight at diagnosis and height as well as other risk factors for inflammatory bowel disease. An opportunistic control group of 480 community controls aged 50-70 were randomly selected from the registers of four local general practices as part of another study. Results: Obesity at diagnosis was more common in subjects with Crohn's disease versus ulcerative colitis odds ratio 2.02 (1.18-3.43) p = 0.0096 and also Crohn's disease versus community controls in the 50-70 year age group (odds ratio 3.22 (1.59-6.52) p = 0.001). There was evidence of a 'dose response' with increasing degrees of obesity associated with increased risk. Low BMI at diagnosis was also associated with risk of Crohn's disease versus ulcerative colitis. A U-shaped relationship between BMI and risk of Crohn's was supported by the strong inverse association of BMI at diagnosis (p = 0.0001) and positive association of BMI at diagnosis squared (p = 0.0002) when they were fitted together into the model. Conclusions: Obesity may play a role in the pathogenesis of Crohn's disease and it may be that obesity-related enteropathy is a distinct entity or a sub-type of Crohn's disease. © 2011 Springer Science+Business Media, LLC.


Patel S.R.,Mayday University Hospital | Bate J.,St George's, University of London | Borrow R.,Royal Infirmary | Heath P.T.,St George's, University of London
Archives of Disease in Childhood | Year: 2012

Children treated for acute leukaemia are at increased risk of infection with Streptococcus pneumoniae. The basis for this may include low levels of pneumococcal antibody but this has not been well studied. The authors measured serotype-specifi c pneumococcal IgG antibody concentrations in children treated for acute lymphoblastic leukaemia (ALL) and acute myeloid leukaemia (AML) ≥6 months after completion of standard-dose chemotherapy. Pneumococcal serotype-specifi c IgG antibody concentrations were low. None of the subjects had protective concentrations against all the heptavalentpneumococcal conjugate vaccine serotypes. There was no signifi cant difference in antibody concentrations between subjects with ALL and AML (p≥0.05). Children treated for ALL and AML generally have non-protective antibody concentrations against S pneumoniae . There is signifi cant morbidity associated with pneumococcal disease in this patient group and strategies for vaccination are required.


Oueghlani E.,Moorfields Eye Hospital | O'Sullivan E.,Mayday University Hospital | Pavesio C.E.,Moorfields Eye Hospital
International Ophthalmology | Year: 2010

We describe the first two cases of diffuse unilateral subacute neuroretinitis (DUSN) in the UK successfully treated with albendazole. Two patients are described who presented with unilateral reduction in vision, with clusters of yellow-white retinal lesions fading and reappearing in new locations of the fundus over a period of weeks. Based on the clinical picture, the diagnosis of DUSN was made, even though no subretinal worm could be found. Both patients were treated with albendazole 400 mg daily for 30 days. After 4 weeks the vision in the affected eye improved to 6/9 in each patient and the retinal lesions resolved completely. Over a follow-up period of 28 months and 13 months respectively, there was no recurrence of any lesion and the vision was maintained. DUSN is a sight-threatening disease and the preservation of vision relies on early diagnosis and treatment. Laser photocoagulation of the worm is the treatment of choice, but this was not possible in either case, as no worm could be found; however, oral albendazole proved to be a safe and effective alternative treatment. © 2010 Springer Science+Business Media B.V.


Bate J.,St George's, University of London | Patel S.R.,Mayday University Hospital | Chisholm J.,Great Ormond Street Hospital | Heath P.T.,St George's, University of London
Pediatric Blood and Cancer | Year: 2010

Background. In March 2002, the Royal College of Paediatrics and Child Health (RCPCH) introduced guidelines for re-immunisation of children after completion of standard-dose chemotherapy and after haematopoietic stem cell transplant (HSCT). Aims. To ascertain whether these guidelines form standard unit policy by undertaking a survey of UK paediatric principal treatment centre (PTC) consultants and shared care (SC) consultants. Procedures. In October 2008, a link to an on-line anonymised survey was sent by e-mail to all UK PTC consultants in Children's Cancer and Leukaemia Group (CCLG) centres and to SC consultants linked to eight of these centres. Results. Responses were received from 55 PTC consultants (representing all 21 CCLG centres) and 54 SC consultants. In accordance with the RCPCH guidelines, most PTC and SC consultants recommend initiating re-immunisation at 6 months after completion of standard-dose chemotherapy (99/105, 94.3%). Re-immunisation at the recommended time after HSCT for each transplant type was reported by 93-100% of respondents. Pneumococcal conjugate vaccine (PCV) was recommended after chemotherapy by 58.3% (35/60) of respondents and by 51.7% (30/58) after HSCT. There were distinct differences between PTC and SC consultants in their choice of varicella (VZV) post-exposure prophylaxis. Conclusions. There is a high level of stated compliance with RCPCH guidelines. Recommendations for PCV after chemotherapy and HSCT were lower than expected. This may reflect the absence of specific guidelines after chemotherapy but not in HSCT patients where guidelines do exist. Variation in VZV post-exposure prophylaxis suggests further studies are required. © 2010 Wiley-Liss, Inc.


Abdool Z.,University of Pretoria | Sultan A.H.,Mayday University Hospital | Thakar R.,Mayday University Hospital
British Journal of Radiology | Year: 2012

Endoanal ultrasound is now regarded as the gold standard for evaluating anal sphincter pathology in the investigation of anal incontinence. The advent of three-dimensional ultrasound has further improved our understanding of the twodimensional technique. Endoanal ultrasound requires specialised equipment and its relative invasiveness has prompted clinicians to explore alternative imaging techniques. Transvaginal and transperineal ultrasound have been recently evaluated as alternative imaging modalities. However, the need for technique standardisation, validation and reporting is of paramount importance. We conducted a MEDLINE search (1950 to February 2010) and critically reviewed studies using the three imaging techniques in evaluating anal sphincter integrity. © 2012 The British Institute of Radiology.


Taylor F.G.M.,Mayday University Hospital | Quirke P.,University of Leeds | Heald R.J.,North Hampshire Hospital | Moran B.,North Hampshire Hospital | And 6 more authors.
British Journal of Surgery | Year: 2011

Background: A pathologically involved margin in rectal cancer is defined as tumour within 1 mm of the surgical resection margin. There is no standard definition of a predicted safe margin on magnetic resonance imaging (MRI). The aim of this study was to assess which cut-off (1, 2 or 5 mm) was the best predictor of local recurrence based on preoperative MRI assessment of the circumferential resection margin (CRM). Methods: Data were collected prospectively on the distance between the tumour and mesorectal fascia for patients with documented radiological margin status in the MERCURY study. Positive margin and local recurrence rates were compared for MRI distances from the tumour to the mesorectal fascia of 1 mm or less, more than 1 mm up to 2 mm, more than 2 mm up to 5 mm, and more than 5 mm. The Cox proportional hazard regression method was used to determine the effect of level of margin involvement on time to local recurrence. Results: Univariable analysis showed that, relative to a distance measured by MRI of more than 5 mm, the hazard ratio (HR) for local recurrence was 3.90 (95 per cent confidence interval 1.99 to 7.63; P < 0.001) for a margin of 1 mm or less, 0.81 (0.36 to 1.85; P = 0.620) for a margin of more than 1 mm up to 2 mm, and 0.33 (0.10 to 1.08; P = 0.067) for a margin greater than 2 mm up to 5 mm. Multivariable analysis of the effect of MRI distance to the mesorectal fascia and preoperative treatment on local recurrence showed that a margin of 1 mm or less remained significant regardless of preoperative treatment (HR 3.72, 1.43 to 9.71; P = 0.007). Conclusion: For preoperative staging of rectal cancer, the best cut-off distance for predicting CRM involvement using MRI is 1 mm. Using a cut-off greater than this does not appear to identify patients at higher risk of local recurrence. © 2011 British Journal of Surgery Society Ltd.


Santoro G.A.,Regional Hospital | Wieczorek A.P.,Medical University of Lublin | Dietz H.P.,Sydney Medical School Nepean | Mellgren A.,University of Minnesota | And 4 more authors.
Ultrasound in Obstetrics and Gynecology | Year: 2011

Surgical management of pelvic floor disorders depends on a comprehensive understanding of the structural integrity and function of the pelvic floor. For visualizing this region, ultrasonography has emerged as a procedure that is relatively easy to perform, cost-effective and widely available. In this review, pelvic floor ultrasonography, including two-dimensional (2D), three-dimensional (3D) and 4D imaging as well as transvaginal, endoanal and transperineal techniques, is discussed from a global and multicompartmental perspective, rather than using a compartmentalized approach. The role of the different sonographic modalities in the major disorders of the pelvic floor urinary and fecal incontinence, pelvic organ prolapse and obstructed defecation syndrome is evaluated critically. © 2011 ISUOG. Published by John Wiley & Sons, Ltd.


Saxena R.,Mayday University Hospital
BMJ case reports | Year: 2010

A 7-year-old known asthmatic presented with an acute severe asthma attack to the Accident and Emergency department. Following a poor response to salbutamol and ipratropium nebulisers, he was given intravenous salbutamol and aminophylline. Over the course of the following 3 h, there was improvement in his bronchospasm with decreasing oxygen requirement, however, his respiratory rate showed an upward trend. Serial blood gas estimations showed a worsening metabolic acidosis unresponsive to two fluid boluses of 20 ml/kg of normal saline. Lactate levels were subsequently measured and found to be high, accounting for the metabolic acidosis. High lactate levels were attributed to intravenous salbutamol. His blood gases and lactate level returned to normal within 3 h after stopping intravenous salbutamol. He was recommended on salbutamol nebulisers while still continuing on intravenous aminophylline. He continued to improve and was discharged home after 4 days.


Halsey C.,University of Glasgow | Lumley H.,Mayday University Hospital | Luckit J.,Middlesex University
Mycoses | Year: 2011

Necrotising external otitis (NEO) is a destructive, potentially fatal, infection usually seen in elderly diabetics or the immunocompromised. The commonest causative organism is Pseudomonas but immunocompromised patients are additionally susceptible to opportunistic infections. Here we describe the first reported case of NEO caused by a previously unknown human pathogen -Aspergillus wentii. A review of the literature reveals that fungal NEO is associated with a high rate of cranial nerve palsies suggesting that infections are not being treated rapidly enough to prevent morbidity. Fungal infection should be considered early in immunocompromised patients and microbiological diagnosis should be obtained wherever possible. © 2010 Blackwell Verlag GmbH.


Patel U.B.,Royal Marsden Hospital | Blomqvist L.K.,KarolinskaUniversity Hospital | Taylor F.,Mayday University Hospital | George C.,Epsom General Hospital | And 3 more authors.
American Journal of Roentgenology | Year: 2012

OBJECTIVE. The Magnetic Resonance Imaging and Rectal Cancer European Equivalence (MERCURY) Study validated the use of MRI for posttreatment staging and its correlation with survival outcomes. As a consequence, reassessment of MRI scans after preoperative therapy has implications for surgical planning, the timing of surgery, sphincter preservation, deferral of surgery for good responders, and development of further preoperative treatments for radiologically identified poor responders. CONCLUSION. In this article we report a validated systematic approach to the interpretation of MR images of patients with rectal cancer after chemoradiation. © American Roentgen Ray Society.

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