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Taunton, United Kingdom

Varughese M.,Musgrove Park Hospital
Medical Oncology | Year: 2010

Thrombotic microangiopathy is a rare haematological emergency which encompasses the conditions of haemolytic uraemic syndrome (HUS) and thrombotic thrombocytopenic purpura (TTP). It is an unusual but recognised complication of chemotherapy. It has not previously been described in conjunction with docetaxel or trastuzumab therapy. We report a 47-year-old patient with localised breast cancer who developed thrombotic microangiopathy (HUS/TTP) acutely following concurrent neoadjuvant therapy with trastuzumab and docetaxel. We demonstrate from our case that mild confusion occurring on a background of mild anaemia and thrombocytopenia may sometimes be the only clue to the diagnosis. Clinicians should be aware of the possibility of thrombotic microangiopathy associated with trastuzumab and docetaxel therapy, as early intervention can improve clinical outcome. © Humana Press Inc. 2009. Source


Wennike N.,Musgrove Park Hospital
Acute Medicine | Year: 2013

Pulmonary embolism (PE) in pregnancy carries a significant mortality. Pregnant patients often present via the acute medical take with symptoms of possible PE and require timely assessment and investigation. The symptoms of PE are sometimes very difficult to differentiate from those of normal pregnancy and the vast majority of patients will require imaging. The radiation risks to mother and foetus from imaging may cause considerable anxiety (to both patients and healthcare providers) and need to be explained to patients in the context of a potentially life-threatening condition so they can be actively involved in decision-making on how best to proceed. When PE is diagnosed in pregnancy, there are obstetric considerations around the time of delivery and women should receive specialist follow-up. Copyright © 2013 Rila Publications. Source


Virgo P.F.,Southmead Hospital | Gibbs G.J.,Musgrove Park Hospital
Annals of Clinical Biochemistry | Year: 2012

Flow cytometry has had an impact upon all areas of clinical pathology and now, in the 21st century, it is truly coming of age. This study reviews the application of ow cytometry within clinical pathology with an emphasis upon haematology and immunology. The basic principles of ow cytometry are discussed, including the principles and considerations of the ow-cell and hydrodynamic focusing, detector layout and function, use of uorochromes and multicolour ow cytometry (spectral overlap and colour compensation), alongside the strategies available for sample preparation, data acquisition and analysis, reporting of results, internal quality control, external quality assessment and ow sorting. The practice of ow cytometry is discussed, including the principles and pitfalls associated with leukocyte immunophenotyping for leukaemia and lymphoma diagnosis, immune deciency, predicting and monitoring response to monoclonal antibody therapy, rare event detection and screening for genetic disease. Each section is illustrated with a case study. Future directions are also discussed. Source


Siau K.,Musgrove Park Hospital
International Journal of Cardiology | Year: 2011

The association between myocardial infarction and lower limb symptoms is rare and poorly recognised. To our knowledge, we present the third reported case in the English literature of a patient presenting with isolated lower limb pain as the initial symptom of a myocardial infarction. We describe the clinical case and discuss the potential pathophysiology behind this atypical presentation. © 2009 Elsevier Ireland Ltd. All rights reserved. Source


Morrison J.,Musgrove Park Hospital
Cochrane database of systematic reviews (Online) | Year: 2012

Epithelial ovarian cancer presents at an advanced stage in the majority of women. These women require surgery and chemotherapy for optimal treatment. Conventional treatment is to perform surgery first and then give chemotherapy. However, it is not yet clear whether there are any advantages to using chemotherapy before surgery. To assess whether there is an advantage to treating women with advanced epithelial ovarian cancer with chemotherapy before cytoreductive surgery (neoadjuvant chemotherapy (NACT)) compared with conventional treatment where chemotherapy follows maximal cytoreductive surgery. For the original review we searched, the Cochrane Central Register of Controlled Trials (CENTRAL, Issue 3, 2006), MEDLINE (Silver Platter, from 1966 to 1 Sept 2006), EMBASE via Ovid (from 1980 to 1 Sept 2006), CANCERLIT (from 1966 to 1 Sept 2006), PDQ (search for open and closed trials) and MetaRegister (most current search Sept 2006). For this update randomised controlled trials (RCTs) were identified by searching the Cochrane Central Register of Controlled Trials (CENTRAL, Issue 3, 2011) and the Cochrane Gynaecological Cancer Specialised Register (2011), MEDLINE (August week 1, 2011), EMBASE (to week 31, 2011), PDQ (search for open and closed trials) and MetaRegister (August 2011). RCTs of women with advanced epithelial ovarian cancer (Federation of International Gynaecologists and Obstetricians (FIGO) stage III/IV) who were randomly allocated to treatment groups that compared platinum-based chemotherapy before cytoreductive surgery with platinum-based chemotherapy following cytoreductive surgery. Data were extracted by two review authors independently, and the quality of included trials was assessed by two review authors independently. One high-quality RCT met the inclusion criteria. This multicentre trial randomised 718 women with stage IIIc/IV ovarian cancer to NACT followed by interval debulking surgery (IDS) or primary debulking surgery (PDS) followed by chemotherapy. There were no significant differences between the study groups with regard to overall survival (OS) (670 women; HR 0.98; 95% CI 0.82 to 1.18) or progression-free survival (PFS) (670 women; HR 1.01; 95% CI 0.86 to 1.17).Significant differences occurred between the NACT and PDS groups with regard to some surgically related serious adverse effects (SAE grade 3/4) including haemorrhage (12 in NACT group vs 23 in PDS group; RR 0.50; 95% CI 0.25 to 0.99), venous thromboembolism (none in NACT group vs eight in PDS group; RR 0.06; 95% CI 0 to 0.98) and infection (five in NACT group vs 25 in PDS group; RR 0.19; 95% CI 0.07 to 0.50). Quality of life (QoL) was reported to be similar for the NACT and PDS groups.Three ongoing RCTs were also identified. We consider the use of NACT in women with stage IIIc/IV ovarian cancer to be a reasonable alternative to PDS, particularly in bulky disease. With regard to selecting who will benefit from NACT, treatment should be tailored to the patient and should take into account resectability, age, histology, stage and performance status. These results cannot be generalised to women with stage IIIa and IIIb ovarian cancer; in these women, PDS is the standard. We await the results of three ongoing trials, which may change these conclusions. Source

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