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Venyo A.K.-G.,North Manchester General Hospital
Advances in Urology | Year: 2014

Background. Nested variant of urothelial carcinoma was added to the WHO's classification in 2004. Aims. To review the literature on nested variant of urothelial carcinoma. Results. About 200 cases of the tumour have been reported so far and it has the ensuing morphological features: large numbers of small confluent irregular nests of bland-appearing, closely packed, haphazardly arranged, and poorly defined urothelial cells infiltrating the lamina propria and the muscularis propria. The tumour has a bland histomorphologic appearance, has an aggressive biological behaviour, and has at times been misdiagnosed as a benign lesion which had led to a significant delay in the establishment of the correct diagnosis and contributing to the advanced stage of the disease. Immunohistochemically, the tumour shares some characteristic features with high-risk conventional urothelial carcinomas such as high proliferation index and loss of p27 expression. However, p53, bcl-2, or EGF-r immunoreactivity is not frequently seen. The tumour must be differentiated from a number of proliferative lesions of the urothelium. Conclusions. Correct and early diagnosis of this tumour is essential to provide early curative treatment to avoid diagnosis at an advanced stage. A multicentre trial is required to identify treatment options that would improve the outcome of this tumour. © 2014 Anthony Kodzo-Grey Venyo.


Hogan C.,North Manchester General Hospital | Denning D.W.,University of Manchester
Seminars in Respiratory and Critical Care Medicine | Year: 2011

While allergic bronchopulmonary aspergillosis (ABPA) is well recognized as a fungal complication of asthma, severe asthma with fungal sensitization (SAFS) is not. In ABPA the total immunoglobulin E (IgE) is usually >1,000 IU/mL, whereas in SAFS it is <1,000 IU/mL, and either skin prick tests or fungus-specific IgE tests are positive. ABPA may present with any severity of asthma, and occasionally with no asthma or cystic fibrosis, the other common underlying disease. SAFS is a problem in patients with poorly controlled asthma and occasionally presents in the intensive care unit (ICU). Production of mucous plugs and coughing paroxysms is more common in ABPA. Certain underlying genetic defects seem to underpin these remarkable phenotypic differences. From a management perspective both ABPA and SAFS respond to both high doses of corticosteroids and oral antifungal agents, with ∼60% response rate in both ABPA and SAFS with itraconazole. In 50% of patients itraconazole boosts inhaled corticosteroid exposure, sometimes leading to cushingoid features. Second-line therapy data are scant, but we have shown that 70 to 80% of patients who tolerate either voriconazole or posaconazole also respond. Other useful therapies include nebulized hypertonic saline to aid expectoration of thick sputum and long-term azithromycin for its anti-inflammatory effect on the airways. Omaluzimab is useful in some patients with SAFS and occasionally in ABPA. Complications of ABPA include bronchiectasis, typically central in distribution, and chronic pulmonary aspergillosis. Most patients with ABPA and SAFS can be stabilized for long periods with inhaled corticosteroids and itraconazole or another antifungal agent. Novel immunotherapies are on the horizon. Copyright © 2011 by Thieme Medical Publishers, Inc.


Ustianowski A.,North Manchester General Hospital
Current Opinion in Pulmonary Medicine | Year: 2012

PURPOSE OF REVIEW: After decades of neglect, the importance of establishing an aetiological diagnosis for community-acquired and atypical pneumonias has increased dramatically in recent years - driven by the movement towards more rational use of antibiotics, the further spread of antimicrobial resistance, and advances in point-of-care assays that circumvent the diagnostic delays that result from the centralization of laboratories. RECENT FINDINGS: There have been very few developments in patient sampling, or the direct visualization, culture, and serological detection of respiratory pathogens. There has, however, been significant interest in the development of improved and more clinically useful assays for the detection of pathogen nucleic acids and proteins, and also in the potential utility of the assessment of host response for tailoring therapy. SUMMARY: The majority of patients have yet to benefit from any advances. However, nucleic acid, newer protein, and possibly host-response assays have significant potential to influence patient care in the near future. © 2012 Lippincott Williams & Wilkins, Inc.


Many factors contribute to patellofemoral instability. Surgical intervention may include additional procedures to reconstruct the medial patellofemoral ligament (MPFL). This review attempts to ascertain from the literature whether there is a threshold for when an isolated MPFL reconstruction will suffice and when an additional procedure would be required. © 2016 Wolters Kluwer Health, Inc.


Gordon M.,University of Salford | Gordon M.,North Manchester General Hospital | Darbyshire D.,University of Manchester | Baker P.,Foundation School
Medical Education | Year: 2012

Context Many quality improvement education programmes have been introduced over the last decade with the purpose of enhancing patient safety. The importance of non-technical skills training is becoming increasingly prominent, but the extent to which educational interventions have been used and the theoretical underpinnings of such interventions remain unclear. These issues were investigated through a systematic review of the literature. Methods: Any studies involving an educational intervention to improve non-technical skills amongst undergraduate or postgraduate staff in an acute health care environment were considered. A standardised search of online databases was carried out independently by two authors and consensus reached on the inclusion of studies. Data extraction and multimodal quality assessment were completed independently, followed by a content analysis of interventions and the extraction of key themes. Results: A total of 22 studies met the inclusion criteria. Measured outcomes were variable, as was the strength of conclusions. Theoretical underpinning of interventions was not described in any studies. Content analysis revealed reasonable consistency with the emergence of five key themes: error; communication; teamwork and leadership; systems, and situational awareness. Teaching was often multidisciplinary and methods used included simulation and role-play exercises, and observation. Conclusions: The methodological quality of published studies is reasonable, although the reporting of specific interventions is poor. Although a recognised model to support the design of patient safety education is lacking, a number of theories have been applied to guide educators in future instructional design. Further published work should clearly describe interventions and their theoretical underpinnings, and should aim to further explore which specific aspects of interventions are effective and why. Such research should also try to assess whether such interventions can impact patient outcomes. © 2012 Blackwell Publishing Ltd.


Venyo A.K.-G.,North Manchester General Hospital
Advances in Urology | Year: 2014

Background. Lymphoma of the urinary bladder (LUB) is rare. Aims. To review the literature on LUB. Methods. Various internet databases were used. Results. LUB can be either primary or secondary. The tumour has female predominance; most cases occur in middle-age women. Secondary LUB occurs in 10% to 25% of leukemias/lymphomas and in advanced-stage systemic lymphoma. Less than 100 cases have been reported. MALT typically affects adults older than 60 years; 75% are female. Diffuse large B-cell lymphoma is also common and may arise from transformation of MALT. LUB presents with haematuria, dysuria, urinary frequency, nocturia, and abdominal or back pain. Macroscopic examination of LUBs show large discrete tumours centred in the dome or lateral walls of the bladder. Positive staining of LUB varies by the subtype of lymphoma; B-cell lymphomas are CD20 positive. MALT lymphoma is positively stained for CD20, CD19, and FMC7 and negatively stained for CD5, CD10, and CD11c. LUB stains negatively with Pan-keratin, vimentin, CK20, and CK7. MALT lymphoma exhibits t(11; 18)(q21: 21). Radiotherapy is an effective treatment for the MALT type of LUB with no recurrence. Conclusions. LUB is diagnosed by its characteristic morphology and immunohistochemical characteristics. Radiotherapy is a useful treatment. © 2014 Anthony Kodzo-Grey Venyo.


Butt U.,North Manchester General Hospital | Charalambous C.P.,Blackpool Victoria NHS Trust
Arthroscopy - Journal of Arthroscopic and Related Surgery | Year: 2013

Purpose: Systematic review of the literature to characterize safety profile and complication rates associated with arthroscopic coracoid transfer procedures. Methods: We conducted a combined search of Medline, EMBASE, and the CINAHL databases from 1985 to November 2012. Articles were selected and data extracted according to standard criteria. Results: Only 3 studies met the inclusion criteria, and these originated from the pioneers of this technique. These studies described the results of 172 arthroscopic coracoid transfer procedures with an overall complication rate of 19.8% ± 5.6%. Conversion to open surgery was necessary in 6/172 (3.5%) patients. Repeated surgery was described in 5/172 (2.9% ± 2.5%) cases, all for screw removal. The overall rate of recurrent instability was 3/172 cases (1.7% ± 2%). Hardware-related complications occurred in 4/172 patients (2.3% ± 2.3%). Coracoid grafts failed to unite in 14/172 patients (8.1% ± 4.1%); graft osteolysis was seen in 7/172 patients (4.1% ± 2.6%). The coracoid graft fractured in 2/172 cases (1.2% ± 1.6%); one of these occurred intraoperatively and one occurred early postoperatively. There was one transient nerve palsy (0.6% ± 1.1%). Conclusions: Results of arthroscopic coracoid transfer surgery for anterior shoulder instability are sparse, with the available studies originating from the pioneers of this technique. Early results suggest that arthroscopic coracoid transfer is a technically feasible procedure that is able to restore shoulder stability. However, this technique seems to be associated with a high complication rate and a steep learning curve. Results from the wider orthopaedic shoulder arthroscopic community are awaited. Extensive cadaveric training and experience with the open technique is recommended before performing the arthroscopic procedure. Level of Evidence: Systematic review of Level IV studies. © 2013 by the Arthroscopy Association of North America.


OBJECTIVES: Nutritional deficiencies and immune dysfunction in cancer patients may contribute to postoperative septic morbidity. This trial compared the effects of perioperative enteral immunonutrition (EIN) versus standard enteral nutrition (SEN) on systemic and mucosal immunity in patients undergoing pancreaticoduodenectomy for periampullary cancer.METHODS: Thirty-seven patients were randomized (EIN, n = 17; SEN, n = 20) to receive feed for 14 days preoperatively and 7 days postoperatively. Mediators of systemic immunity (interleukin 1α, tumor necrosis factor α, lymphocytes subsets, and complement components) and of mucosal immunity in duodenal biopsies, nutritional markers and parameters were evaluated.RESULTS: The groups were comparable for demographics, the concentrations of mediators of systemic and mucosal immunity at time of recruitment, and for the duration and amount of feed received. Preoperative EIN rather than SEN was associated with significant reductions in plasma tumor necrosis factor α and total hemolytic complement. Enteral immunonutrition–fed patients had significantly higher total lymphocyte count on the third postoperative day and significantly greater rise in CD4/CD8 ratio from day 3 to day 7 postoperatively compared with SEN-fed patients.CONCLUSIONS: The perioperative administration of EIN rather than SEN is associated with a favorable modulation of the inflammatory response and enhancement of systemic immunity in patients undergoing pancreaticoduodenectomy for periampullary cancer. © 2014 by Lippincott Williams & Wilkins.


Venyo A.K.-G.,North Manchester General Hospital
International Journal of Surgical Oncology | Year: 2015

Background. Clear cell adenocarcinoma of the urethra (CCAU) is extremely rare and a number of clinicians may be unfamiliar with its diagnosis and biological behaviour. Aims. To review the literature on CCAU. Methods. Various internet databases were used. Results/Literature Review. (i) CCAU occurs in adults and in women in the great majority of cases. (ii) It has a particular association with urethral diverticulum, which has been present in 56% of the patients; is indistinguishable from clear cell adenocarcinoma of the female genital tract but is not associated with endometriosis; and probably does not arise by malignant transformation of nephrogenic adenoma. (iii) It is usually, readily distinguished from nephrogenic adenoma because of greater cytological a-typicality and mitotic activity and does not stain for prostate-specific antigen or prostatic acid phosphatase. (iv) It has been treated by anterior exenteration in women and cystoprostatectomy in men and at times by radiotherapy; chemotherapy has rarely been given. (v) CCAU is aggressive with low 5-year survival rates. (vi) There is no consensus opinion of treatment options that would improve the prognosis. Conclusions. Few cases of CCAU have been reported. Urologists, gynaecologists, pathologists, and oncologists should report cases of CCAU they encounter and enter them into a multicentric trial to determine the best treatment options that would improve the prognosis. © 2015 Anthony Kodzo-Grey Venyo.


Ustianowski A.,North Manchester General Hospital | Zumla A.,University College London
Infectious Disease Clinics of North America | Year: 2012

An elevated eosinophil count is a common, frequently underrecognized finding in travelers returning from the tropics and elsewhere. Although there are multiple causes of eosinophilia in a traveler, it is often related to an acquired helminth infection. In some cases these infections can be benign and self-limiting, but in others it may lead to severe sequelae for the individual or others. This article outlines the etiology and diagnosis of eosinophilia concentrating on helminth infections. © 2012 Elsevier Inc..

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