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Becerra P.,Hospital Of Referencia La Equina | Valdes Vazquez M.A.,Hospital Of Referencia La Equina | Dudhia J.,Lane College | Fiske-Jackson A.R.,Lane College | And 3 more authors.
Journal of Orthopaedic Research | Year: 2013

This study aimed to investigate immediate cell survival and distribution following different administration routes of mesenchymal stem cells (MSCs) into naturally occurring tendon injuries. Ten million MSCs, labeled with technetium-99m hexamethylpropyleneamine oxime, were implanted into 13 horses with naturally occurring tendon or ligament injuries intra-lesionally, intravenously and by regional perfusion, and traced for up to 48 h using planar gamma scintigraphy. Labeling efficiencies varied between 1.8% and 18.5% (mean 9.3%). Cells were retained in the damaged area after intra-lesional administration but only 24% of cells were still present within the tendon after 24 h. After intravenous injection, cells largely distributed to the lung fields, with no detectable cells in the tendon lesions. Significant labeling of the tendon lesions was observed in 11/12 horses following regional perfusion but at a lower level to intra-lesional injection. The highest cell numbers were retained after intra-lesional injection, although with considerable cell loss, while regional perfusion may be a viable alternative for MSC delivery. Cells did not "home" to damaged tendon in large numbers after intravenous administration. Cells were detected in the lungs most frequently after intravascular administration, although with no adverse effects. Low cell retention has important implications for designing effective clinical therapies for human clinical use. © 2013 Orthopaedic Research Society.


Aries J.,Smithfield Trust | Montoto S.,Smithfield Trust
Current Hematologic Malignancy Reports | Year: 2014

Hodgkin lymphoma (HL) is more frequent in patients with Human Immunodeficiency Virus (HIV) infection than in immunocompetent patients. The relationship between the immune system and HL is complex. Whilst the incidence of HL in HIV patients has most likely increased since the introduction of combined anti-retroviral therapy (cART), there is no doubt that the outcomes for patients with HIV and HL (HIV-HL) have improved since its introduction. Improved CD4 counts and risk-adapted treatment schedules have resulted in outcomes for patients with HIV-HL that are comparable to those in HIV-negative patients with HL. Thus, HIV-HL should be treated in the same way as HL in immunocompetent patients, including the use of salvage chemotherapy and autologous transplant in the relapsed setting in HIV-HL. Along the same lines, patients with HIV-HL should not be excluded from trials based on their immune status alone. © 2014, Springer Science+Business Media New York.


Snidvongs S.,Smithfield Trust | Mehta V.,Smithfield Trust
Postgraduate Medical Journal | Year: 2012

Chronic pain is pain that persists past the normal time of healing, and is seen as a common problem with a significant socioeconomic impact. Pharmacological management for chronic non-cancer pain also involves the prescription of opioids, with the aim of an improved quality of life for the patient. New guidelines have been published to aid prescribing clinicians improve opioid safety and patient care, and include recommendations on when to refer patients to a pain specialist. In recent years there has been a rapid increase in opioid prescription in the UK and USA, prompting further concern regarding opioid abuse and side effects. Opioid use may also result in physical dependence and tolerance. Earlier recognition and diagnosis of unwanted effects of long term opioid use is needed, such as opioid induced suppression of the hypothalamicepituitarye gonadal axis, and opioid induced immunosuppression. Patients may themselves discontinue opioids, however, due to minor side effects. Recent advances in opioid prescription include the increasing use of transdermal preparations and extended release, oral, once daily preparations. New formulations of existing drugs have been developed, as well as a new chemical entity. Abuse deterrent formulations and delivery systems may prevent the artificial acceleration of drug delivery and reduce the potential for opioid addiction. Overdose concerns and the potential for fatal overdose may necessitate mandatory training for all clinicians who prescribe opioids. Despite the widespread use of opioids in the management of chronic non-cancer pain, significant research gaps remain. An improvement in the evidence base for its prescription is required.


O'Mmahoney E.,Smithfield Trust | Murray I.,Royal Marsden Foundation NHS Trust
Nuclear Medicine Communications | Year: 2013

AIM: The aim of our study was to assess improvements in spatial resolution and noise control from the application of the Astonish resolution recovery algorithm for single photon emission computed tomography imaging. Secondary aims were to compare acquisitions made with low-energy general purpose collimators with those obtained using low-energy high-resolution collimators in this context and evaluate the potential of a finer matrix to improve image quality further. MATERIALS AND METHODS: A Tc-filled Jaszczak phantom with hot spheres was used to assess contrast and noise. A National Electrical Manufacturers Association triple line source single photon emission computed tomography resolution phantom was used to measure spatial resolution. Acquisitions were made using both low-energy high-resolution and low-energy general purpose collimators. RESULTS: Compared with standard ordered subsets expectation maximization reconstructions, the resolution recovery algorithm resulted in a higher spatial resolution (8 vs. 14 mm full-width at half-maximum) leading to reduced partial volume effects in the smaller Jaszczak spheres. Higher image contrast was achieved alongside lower levels of noise. An edge enhancement artefact was observed in the resolution recovery corrected images. An overestimate of the target-to-background activity was also observed for the larger spheres. CONCLUSION: The use of such an algorithm results in images characterized by increased spatial resolution and reduced noise. However, small sources of the order of 2-3 cm can be significantly overenhanced. © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins.


DaCosta J.,Imperial College London | DaCosta J.,Smithfield Trust | Younis S.,Imperial College London
Drug, Healthcare and Patient Safety | Year: 2014

Vitreomacular traction and vitreomacular traction with macular hole are conditions associated with visual disturbance and decreased visual acuity. Recent studies have demonstrated that ocriplasmin is effective and safe in specific patient groups with vitreomacular traction, and hence is recommended as a treatment option. We present here a case report of a patient treated with intravitreal ocriplasmin associated with severe loss of vision and delayed resolution of vitreomacular traction. This report highlights that it is important for patients to be made fully aware of the risks of intravitreal ocriplasmin and the prognosis for visual improvement. © 2015 DaCosta and Younis.


The aim of the study was to evaluate the impact of age on the efficacy of extracorporeal shock wave lithotripsy (SWL), in a comparative study based on the principles of matched-pair analysis. Over a period of 4 years, 2,311 patients were treated with SWL in a tertiary referral center. Patient and stone data were recorded in a prospective electronic database. Among these patients, 115 (4.97%) were older than 70 years of age and fulfilled the criteria for inclusion in the study (Group A). For the purposes of the comparative analysis, Group A patients were matched for gender and stone parameters (side, location of stone, and diameter ±2 mm) with a control group of patients under the age of 70 (Group B). Following matching, the patients' electronic medical records were reviewed, to identify SWL success rates at 3 months and McNemar's test was used to compare the efficacy of SWL between the two groups. Matching was possible in all cases. The results indicate that there were no statistically significant differences in the mean number of SWL sessions or in the mean number of impulses per session between the two groups. The overall stone clearance rate achieved by SWL alone was 71.3% for Group A and 73.9% for group B. Discordant pairs were found in 37 cases (in 17 pairs only patients in Group A became stone-free, while in 20 pairs only patients in Group B became stone-free). By using McNemar's test, the difference in stone clearance rates between the two groups was not found to be statistically significant (p = 0.742). A total of 22 patients (19.1%) in Group A and 17 patients (14.7%) in Group B underwent an adjuvant procedure to achieve stone clearance. McNemar's test also revealed the absence of any statistically significant difference in SWL success rates between older and younger patients in the subgroups of patients presenting with either ureteric or renal stones (p = 0.727 and p = 0.571, respectively). In conclusion, SWL is still considered one of the first-line tools for geriatric patients suffering from urolithiasis, as increased age alone does not seem to adversely affect the efficacy of SWL.


Philippou P.,Smithfield Trust | Moraitis K.,Smithfield Trust | Masood J.,Smithfield Trust | Junaid I.,Smithfield Trust | Buchholz N.,Smithfield Trust
Urology | Year: 2012

The recent evolution in the management of vesical lithiasis is a result of the major advancements of modern endourology. The ideal method for achieving stone clearance, however, remains an issue of debate and evidence-based recommendations are lacking. Contemporary literature focuses on management options, such as extracorporeal shockwave lithotripsy, transurethral, percutaneous and minimally-invasive surgery, as well as state-of-the-art energy sources. Issues of particular interest include the results of comparative studies, the management of lithiasis in the paediatric population and the recent challenge of the traditional dogma that dictated BPH surgery for the management of vesical lithiasis secondary to bladder outlet obstruction. © 2012 Elsevier Inc.


Uzzaman M.M.,Smithfield Trust | Ratnasingham K.,Smithfield Trust | Ashraf N.,Smithfield Trust
Hernia | Year: 2012

Purpose Lichtenstein inguinal hernia repair is associated with a low incidence of recurrence; however, the use of heavyweight mesh has been linked with chronic pain and foreign body sensation. It is hypothesized that the use of lightweight mesh may reduce these problems. This study aims to use meta-analysis to compare lightweight and heavyweight mesh for Lichtenstein inguinal hernia repair. Methods Information was gathered from randomized controlled trials that compared lightweight and heavyweight mesh for Lichtenstein inguinal hernia repair. The Cochrane Library, Medline, EMBASE, trial registries, conference proceedings and reference lists were searched. Primary outcome measures were chronic pain, foreign body sensation and hernia recurrence. Secondary outcome measures were duration of surgery, mean visual analogue scale (VAS) pain scores, surgical-site infection, testicular atrophy and haematoma/seroma. The pooled Peto odds ratio (OR) was calculated for categorical data and weighted mean difference (WMD) for continuous data. Results Six trials with 1936 hernias were included. Lightweight mesh was associated with reduced chronic pain (OR = 0.67, 95% CI = 0.50-0.90; p<0.01) and foreign body sensation (OR = 0.43, 95% CI = 0.21-0.93; p<0.05). Lightweight mesh was also associated with lower VAS pain scores at 3 months after surgery (WMD = -0.35, 95% CI = -0.39 to -0.31; p<0.0001). There were no differences in hernia recurrence (OR = 1.19, 95% CI = 0.54-2.64; p = 0.66) or other post-operative complications between the two groups. Conclusions The use of lightweight mesh in Lichtenstein inguinal hernia repair is associated with less chronic pain, and foreign body sensation compared with heavyweight mesh without any difference in recurrence. © Springer-Verlag 2011.


Philippou P.,Smithfield Trust | Yap T.,Smithfield Trust | Chinegwundoh F.,Smithfield Trust
Urologia Internationalis | Year: 2012

Introduction: The experience of a tertiary centre in the management of recurrent prostate cancer after radiotherapy by salvage cryotherapy is presented. Patients and Methods: Between February 2006 and August 2008, 19 patients underwent salvage cryotherapy for radiorecurrent prostate cancer. Post-radiotherapy recurrence was confirmed by prostatic biopsy. The 'Phoenix definition' was used to define biochemical failure after salvage cryotherapy. Results: The mean age at cryotherapy was 69.2 years and the mean time from radiotherapy to cryotherapy was 72.3 months. Patient characteristics prior to cryotherapy included a mean PSA level of 6.84 ng/ml and a median Gleason score of 7. The mean post-cryotherapy follow-up was 33.3 months. The 2-year biochemical disease-free survival rate was 58%. The median post-cryotherapy PSA nadir was 0.20 ng/ml (range 0.005-8.260). There were no procedure-related or cancer-related deaths. Complications included incontinence (10.5%), erectile dysfunction (89%) and fistula formation (5.3%). Conclusions: The relatively high rates of biochemical response support the use of cryotherapy as a salvage procedure for radiorecurrent prostate cancer. © 2012 S. Karger AG, Basel.


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