Ladak A.,North Manchester General Hospital |
Bramley M.,North Manchester General Hospital |
Titi S.,The Royal Oldham Hospital
Korean Journal of Pathology | Year: 2014
Pigmented extramammary Paget's disease (PEMPD) is an uncommon intraepithelial adenocarcinoma and a rare variant of Paget's disease affecting skin that is rich in apocrine sweat glands such as the axilla, perianal region and vulva. It most commonly occurs in postmenopausal women and presents as a superficial pigmented scaly macule, mimicking a melanocytic lesion. The histological presentation is adenocarcinoma in situ with an increased number of melanocytes scattered between the Paget's cells. Therefore, PEMPD may be misdiagnosed as a melanocytic tumour both clinically and histologically. The tumour cells are usually positive for cytokeratin 7, epithelial membrane antigen, Cam 5.2, HER2, and mucicarmine stain while S100 and human melanoma black-45 highlight the processes of reactive dendritic cells. The association between Paget's cells and intratumoural reactive melanocytes is still unclear. We report our first case of PEMPD associated with an intradermal naevus involving the axilla in a 63-year-old woman. © 2014 The Korean Society of Pathologists/The Korean Society for Cytopathology.
PubMed | The Royal Oldham Hospital and Democritus University of Thrace
Type: | Journal: Annals of vascular surgery | Year: 2016
Our aim was to present our preliminary experience with the recently introduced Treovance aortic stent-graft device (Bolton Medical, Barcelona, Spain) in the treatment of abdominal aortic aneurysm (AAA).Eight patients underwent treatment of an infrarenal AAA (mean maximum diameter, 56.46.8mm) with the Treovance device. Iliac tortuosity was considered mild, moderate, or severe when 1 angulation of 45-90, 1 angulation 90, or 2 angulations 90, respectively, were present.Mild angulation of the infrarenal neck (10-45) was present in 7 patients, whereas the remaining patient had severe infrarenal neck angulation (65). Three patients had severe iliac tortuosity. Primary technical success was achieved in all but 1 patient in whom a type Ia endoleak was identified on completion angiogram. The endoleak was successfully treated with a proximal aortic cuff. A femoral access complication occurred in 1 patient. Mean follow-up was 6.8months (range, 1-12). No device-related serious adverse events or rupture occurred during the given follow-up period. The only type II endoleak identified resolved spontaneously within 12months.The Treovance abdominal stent-graft system seems to guarantee an accurate, safe, and effective deployment in AAA even through angulated and tortuous iliac vessels. Although our preliminary results are promising, follow-up data are needed to establish the durability of this new-generation endovascular device in standard or challenging anatomies.
Hajibandeh S.,University of Liverpool |
Antoniou S.A.,University of Crete |
Torella F.,University of Liverpool |
Antoniou G.A.,The Royal Oldham Hospital
Cochrane Database of Systematic Reviews | Year: 2016
Background: Controversy exists as to whether revascularisation of the left subclavian artery (LSA) confers improved outcomes in patients undergoing thoracic endovascular aortic repair (TEVAR). Even though preemptive revascularisation of the LSA has theoretical advantages, including a reduced risk of ischaemic damage to vital organs, such as the brain and the spinal cord, it is not without risks. Current practice guidelines recommend routine revascularisation of the LSA in patients undergoing elective TEVAR where achievement of a proximal seal necessitates coverage of the LSA, and in patients who have an anatomy that compromises perfusion to critical organs. However, this recommendation was based on very low-quality evidence. Objectives: To assess the comparative efficacy of routine LSA revascularisation versus either selective or no revascularisation in patients with descending thoracic aortic disease undergoing TEVAR with coverage of the LSA origin. Search methods: The Cochrane Vascular Trials Search Co-ordinator (TSC) searched the Specialised Register (June 2015). In addition, the TSC searched the Cochrane Register of Studies (CENTRAL (2015, Issue 5)).Trials databases were also searched (June 2015). Selection criteria: We had planned to consider all randomised controlled trials (RCTs) that compared routine revascularisation of the LSA with selective or no revascularisation, in patients undergoing TEVAR. Data collection and analysis: Two review authors independently assessed the title and abstract of articles identified through literature searches. An independent third review author was consulted in the event of disagreement. We had planned for two review authors to independently extract data and assess the risk of bias of identified trials using the criteria recommended in the Cochrane Handbook for Systematic Reviews of Interventions. Main results: We did not identify any RCTs relevant to our review topic. Therefore, no quantitative analysis was conducted. Authors' conclusions: High quality RCT evidence for or against routine or selective revascularisation of the LSA in TEVAR is not currently available. It is not possible to draw conclusions with regard to the optimal management of LSA coverage in TEVAR, and whether routine revascularisation, which was defined as the intervention of interest in our review, confers beneficial effects, as indicated by reduced mortality, cerebrovascular events, and spinal cord ischaemia. This review highlights the need for continued research to provide RCT evidence and define the role of LSA revascularisation in the context of TEVAR with coverage of the LSA. © 2016 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.
Cross P.A.,Queen Elizabeth Hospital |
Hodgson C.,Queen Elizabeth Hospital |
Crossley J.,Royal Hallamshire Hospital |
Crossley B.,The Royal Oldham Hospital
Cytopathology | Year: 2015
Technical external quality assurance (EQA) schemes are well established for histopathology and cervical cytology but, to date, sadly lacking for diagnostic cytology (DC). This timely review redresses the balance by describing the development and evaluation of a technical EQA scheme for DC available to the UK, Europe and beyond. © 2015 John Wiley & Sons Ltd.
PubMed | University of Crete, University of Liverpool and The Royal Oldham Hospital
Type: Review | Journal: Vascular | Year: 2016
Our objective was to undertake a comprehensive review of the literature and conduct an analysis of the outcomes of percutaneous endovascular aneurysm repair.MEDLINE; EMBASE; CINAHL; CENTRAL; the World Health Organization International Clinical Trials Registry; ClinicalTrials.gov; and ISRCTN Register, and bibliographic reference lists were searched to identify all studies providing comparative outcomes of the percutaneous technique for endovascular aneurysm repair. Success rate and access-related complications were defined as the primary outcome parameters. Combined overall effect sizes were calculated using fixed effect or random effects models. We conducted a network meta-analysis of different techniques for femoral access applying multivariate meta-analysis assuming consistency.Three randomised controlled trials and 18 observational studies were identified. Percutaneous access was associated with a lower frequency of groin infection (p<0.0001) and lymphocele (p=0.007), and a shorter procedure time (p<0.0001) and hospital length of stay (p=0.03) compared with open surgical access. Moreover, percutaneous endovascular aneurysm repair did not increase the risk of haematoma, pseudoaneurysm, and arterial thrombosis or dissection.Percutaneous access demonstrates advantages over conventional surgical exposure for endovascular aneurysm repair, as indicated by access-related complications and hospital length of stay. Further research is required to define its impact on resource utilization, cost-effectiveness and quality of life.
Dickson J.M.,University of Liverpool |
Moberly N.J.,University of Exeter |
Marshall Y.,The Royal Oldham Hospital |
Reilly J.,University of Liverpool
Clinical Psychology and Psychotherapy | Year: 2011
Although the supervisory relationship is thought to be critical in training clinical psychologists, little is known about factors affecting the supervisory alliance. We conducted an Internet survey of British clinical doctoral trainees (N = 259) in which participants rated their supervisory working alliance, parental style during childhood, pathological adult attachment behaviours and attachment style for themselves and their supervisors. Trainees' ratings of the working alliance were associated with perceptions of supervisors' attachment style, but not with perceptions of trainees' own attachment styles. Path analysis supported a causal chain linking parental indifference, compulsive self-reliance, insecure supervisor attachment style and lower ratings of the working alliance. Our results broadly replicate data from a US sample and suggest that attachment theory is helpful in understanding clinical supervisory processes. © 2010 John Wiley & Sons, Ltd.
Hankir A.K.,The Royal Oldham Hospital
BMJ case reports | Year: 2012
In the early 19th century, Lombroso introduced the concept of hereditary taint to describe the coexistence of 'madness' and creativity. In a recent investigation, Rust et al reported a study designed to test the traditionally assumed relationship between creativity and schizophrenia. They uncovered an association between creative originality and the positive cognitive aspects of schizotypal thinking. Poetry is not only the 'product' of psychopathology but it can also be utilised as a form of therapy: "My name is David Holloway, I am a 33 year old poet/blogger with paranoid schizophrenia. A poet called Charles Bukowski has described poetry as the 'ultimate psychiatrist', and I am a firm believer in this. The strongest part of my personality is my belief in the power of love. My recovery has relied heavily on medication, diet and exercise. However it is the power of poetry that has been my true inspiration."
Barkat M.,University of Liverpool |
Torella F.,University of Liverpool |
Antoniou G.A.,The Royal Oldham Hospital
Vascular Health and Risk Management | Year: 2016
A significant proportion of patients with severe lower limb peripheral arterial disease require revascularization. Over the past decade, an endovascular-first approach even for complex disease has gained widespread use among vascular specialists. An important limitation of percutaneous transluminal balloon angioplasty or stenting remains the occurrence of restenosis. Drug-coated balloons have emerged as an exciting technology developed to overcome the limitations of standard balloon angioplasty and stenting. Drug-eluting devices inhibit neointimal growth of vascular smooth muscle cells with the potential of preventing restenosis. This review provides a synopsis of the up-to-date evidence on the role of drug-coated balloons in the treatment of lower limb peripheral arterial disease. Bibliographic searches were conducted using MEDLINE, EMBASE, and the Cochrane Library electronic database. Eleven randomized clinical trials, two systematic reviews, and a published registry providing the best available evidence were identified. Current evidence suggests that angioplasty with drug-coated balloon is reliable, safe, and efficient in increasing patency rates and reducing target lesion revascularization and restenosis. However, it remains unknown whether these improved results can translate into beneficial clinical outcomes, as current randomized clinical trials have failed to demonstrate a significant benefit in limb salvage and mortality. Further randomized trials focusing on clinical and functional outcomes of drug-eluting balloons and on cost versus clinical benefit are required. © 2016 Barkat et al.
PubMed | The Royal Oldham Hospital and Fairfield Hospital
Type: | Journal: VASA. Zeitschrift fur Gefasskrankheiten | Year: 2017
Insufficient evidence exists to support the safety of carotid endarterectomy (CEA) following intravenous thrombolysis (IVT) for acute ischaemic stroke. Our study aimed to report a single-centre experience of patients treated over a five-year period.Departmental computerised databases were interrogated to identify patients who suffered an ischaemic stroke and subsequently underwent thrombolysis followed by CEA. Mortality and stroke within 30 days of surgery were defined as the primary outcome end points.Over a five-year period, 177 out of a total of 679 carotid endarterectomies (26 %) were performed in patients presenting with acute ischaemic stroke. Twenty-five patients (14 %) received IVT prior to CEA in the form of alteplase. Sixty percent of patients were male with a mean age of 68 years. Sixteen patients (64 %) underwent CEA within 14 days of IVT and the median interval between thrombolysis and CEA was 7.5 days (range, 3-50 days). One female patient died of a further intraoperative stroke within 30 days of surgery, yielding a mortality rate of 4 %. Two patients (8 %) suffered from cardiac complications postoperatively resulting in a short high dependency unit stay. Another two patients (8 %) developed local wound complications, which were managed conservatively without the need for re-operation. The median hospital length of stay was 4.5 days (range, 1-33 days).Our experience indicates that CEA post-thrombolysis has a low incidence of mortality. Further high quality evidence is required before CEA can be routinely recommended following IVT for acute ischaemic stroke..
PubMed | The Royal Oldham Hospital
Type: | Journal: Vascular | Year: 2017
Introduction Acute mesenteric ischaemia is associated with a significant morbidity and mortality. Endovascular techniques have emerged as a viable alternative treatment option to conventional surgery. Our objective was to conduct a systematic review of the literature and perform a meta-analysis of reported outcomes. Methods Our review conformed to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement standards and the protocol was registered in PROSPERO (CRD42016035667). We searched electronic information sources (MEDLINE, EMBASE, CINAHL, CENTRAL) and bibliographic lists of relevant articles to identify studies reporting outcomes of endovascular treatment for acute mesenteric ischaemia of embolic or thrombotic aetiology. We defined 30-day or in-hospital mortality and bowel resection as the primary outcome measures. We used the Newcastle-Ottawa scale to assess the methodological quality of observational studies. We calculated combined overall effect sizes using random effects models; results are reported as the odds ratio and 95% confidence interval. Results We identified 19 observational studies reporting on a total of 3362 patients undergoing endovascular treatment for acute mesenteric ischaemia. The pooled estimate of peri-interventional mortality was 0.245 (95% confidence interval 0.197-0.299), that of the requirement for bowel resection 0.326 (95% confidence interval 0.229-0.439), and the pooled estimate for acute kidney injury was 0.132 (95% confidence interval 0.082-0.204). Eight studies reported comparative outcomes of endovascular versus surgical treatment for acute mesenteric ischaemia (endovascular group, 3187 patients; surgical group, 4998 patients). Endovascular therapy was associated with a significantly lower risk of 30-day mortality (odds ratio 0.45, 95% confidence interval 0.30-0.67, P=0.0001), bowel resection (odds ratio 0.45, 95% confidence interval 0.34-0.59, P<0.00001) and acute renal failure (odds ratio 0.58, 95% confidence interval 0.49-0.68, P<0.00001). No differences were identified in septic complications or the development of short bowel syndrome. Conclusion Endovascular treatment for acute mesenteric ischaemia is associated with a considerable mortality and requirement of bowel resection. However, endovascular therapy confers improved outcomes compared to conventional surgery, as indicated be reduced mortality, risk of bowel resection and acute renal failure. An endovascular-first approach should be considered in patients presenting with acute mesenteric ischaemia.