Harris A.C.,Southend Hospital |
Chaudry M.A.,Royal London Hospital |
Menzies D.,Colchester General Hospital |
Conn P.C.,Colchester General Hospital
Surgical Laparoscopy, Endoscopy and Percutaneous Techniques | Year: 2012
Case Report: We report a case of an epidermoid cyst within an intrapancreatic accessory spleen that was treated by laparoscopic excision. A 39-year-old man with no abdominal symptoms was incidentally found to have a cystic pancreatic lesion on computed tomography scan undertaken for suspected deep vein thrombosis. Further computed tomography and magnetic resonance imaging confirmed similar findings and the laparoscopic resection of the distal pancreas and spleen was undertaken as malignancy could not be excluded. Microscopic analysis revealed a well-circumscribed epidermoid cyst within a thin splenic rim in the tail of the pancreas. DISCUSSION:: Such histologic diagnoses are extremely rare, and this is the 26th case report to our knowledge in English language journals. These lesions should be treated surgically to exclude malignancy. This is the first case reported in the United Kingdom and the first to be excised by pure laparoscopic means, which we believe provides effective and successful surgical management. Copyright © 2012 by Lippincott Williams & Wilkins.
Fulvestrant plus anastrozole or placebo versus exemestane alone after progression on non-steroidal aromatase inhibitors in postmenopausal patients with hormone-receptor-positive locally advanced or metastatic breast cancer (SoFEA): A composite, multicentre, phase 3 randomised trial
Johnston S.R.D.,Royal Marsden NHS Foundation Trust |
Kilburn L.S.,The Institute of Cancer Research |
Ellis P.,Kings Health Partners |
Dodwell D.,St James's Hospital |
And 17 more authors.
The Lancet Oncology | Year: 2013
Background: The optimum endocrine treatment for postmenopausal women with advanced hormone-receptor-positive breast cancer that has progressed on non-steroidal aromatase inhibitors (NSAIs) is unclear. The aim of the SoFEA trial was to assess a maximum double endocrine targeting approach with the steroidal anti-oestrogen fulvestrant in combination with continued oestrogen deprivation. Methods: In a composite, multicentre, phase 3 randomised controlled trial done in the UK and South Korea, postmenopausal women with hormone-receptor-positive breast cancer (oestrogen receptor [ER] positive, progesterone receptor [PR] positive, or both) were eligible if they had relapsed or progressed with locally advanced or metastatic disease on an NSAI (given as adjuvant for at least 12 months or as first-line treatment for at least 6 months). Additionally, patients had to have adequate organ function and a WHO performance status of 0-2. Participants were randomly assigned (1:1:1) to receive fulvestrant (500 mg intramuscular injection on day 1, followed by 250 mg doses on days 15 and 29, and then every 28 days) plus daily oral anastrozole (1 mg); fulvestrant plus anastrozole-matched placebo; or daily oral exemestane (25 mg). Randomisation was done with computer-generated permuted blocks, and stratification was by centre and previous use of an NSAI as adjuvant treatment or for locally advanced or metastatic disease. Participants and investigators were aware of assignment to fulvestrant or exemestane, but not of assignment to anastrozole or placebo. The primary endpoint was progression-free survival (PFS). Analyses were by intention to treat. This trial is registered with ClinicalTrials.gov, numbers NCT00253422 (UK) and NCT00944918 (South Korea). Findings: Between March 26, 2004, and Aug 6, 2010, 723 patients underwent randomisation: 243 were assigned to receive fulvestrant plus anastrozole, 231 to fulvestrant plus placebo, and 249 to exemestane. Median PFS was 4·4 months (95% CI 3·4-5·4) in patients assigned to fulvestrant plus anastrozole, 4·8 months (3·6-5·5) in those assigned to fulvestrant plus placebo, and 3·4 months (3·0-4·6) in those assigned to exemestane. No difference was recorded between the patients assigned to fulvestrant plus anastrozole and fulvestrant plus placebo (hazard ratio 1·00, 95% CI 0·83-1·21; log-rank p=0·98), or between those assigned to fulvestrant plus placebo and exemestane (0·95, 0·79-1·14; log-rank p=0·56). 87 serious adverse events were reported: 36 in patients assigned to fulvestrant plus anastrozole, 22 in those assigned to fulvestrant plus placebo, and 29 in those assigned to exemestane. Grade 3-4 adverse events were rare; the most frequent were arthralgia (three in the group assigned to fulvestrant plus anastrozole; seven in that assigned to fulvestrant plus placebo; eight in that assigned to exemestane), lethargy (three; 11; 11), and nausea or vomiting (five; two; eight). Interpretation: After loss of response to NSAIs in postmenopausal women with hormone-receptor-positive advanced breast cancer, maximum double endocrine treatment with 250 mg fulvestrant combined with oestrogen deprivation is no better than either fulvestrant alone or exemestane. Funding: Cancer Research UK and AstraZeneca. © 2013 Johnston et al. Open Access article distributed under the terms of CC BY-NC-SA.
Fahie-Wilson M.,Southend Hospital |
Smith T.P.,Park University
Best Practice and Research: Clinical Endocrinology and Metabolism | Year: 2013
Serum prolactin is frequently measured when investigating patients with reproductive disorders and elevated concentrations are found in up to 17% of such cases. Clinical laboratories rely predominantly on automated analysers to quantify prolactin levels using sandwich immunometric methodologies. Though generally robust and reliable, such immunoassays are susceptible to interference from a high molecular mass prolactin/IgG autoantibody complex termed macroprolactin. While macroprolactin remains reactive to varying degrees in all prolactin immunoassays, it exhibits little if any biological activity in vivo and consequently its presence is considered clinically irrelevant. Macroprolactinaemia, defined as hyperprolactinaemia due to excess macroprolactin with normal concentrations of bioactive monomeric prolactin, may lead to misdiagnosis and mismanagement of hyperprolactinemic patients if not recognised. Current best practice recommends that all sera with elevated total prolactin concentrations are sub-fractionated using polyethylene glycol precipitation to provide a more meaningful clinical measurement of the bioactive monomeric prolactin content. Manufacturers of prolactin assays should strive to minimise interference from macroprolactin in their assays. Clinical laboratories should introduce screening procedures to exclude macroprolactinaemia in all patients identified as having hyperprolactinaemia. Clinicians should be aware of this potential diagnostic pit fall and insist on PEG screening of all hyperprolactinaemic sera. © 2013 Elsevier Ltd. All rights reserved.
Jeffery J.,Derriford Hospital |
Millar H.,Derriford Hospital |
MacKenzie P.,Southend Hospital |
Fahie-Wilson M.,Southend Hospital |
And 2 more authors.
Clinical Biochemistry | Year: 2010
Objectives: To report detailed investigations in a case of elevated serum B12 due to the presence of an IgG-B12 complex, to determine the prevalence of this phenomenon and to review the literature. Design and methods: 431 samples with elevated B12 (median 1250 ng/L, range 901-114,480 ng/L) were treated with polyethylene glycol to precipitate immunoglobulin complexes. Samples with > 50% of precipitable B12 (PPB12) were further investigated by protein G adsorption, gel filtration chromatography and measurement of B12 on different analytical platforms. Results: Median PPB12 was 22.6%, but in 35 samples (8.1%), median PPB12 was more than 50%. Investigation of 27 of these samples with protein G-Sepharose confirmed the presence of an IgG-B12 complex in 24, and in 15 cases, B12 fell to within the reference range. After treatment of serum with reagents releasing B12 from binding proteins, immunoreactivity co-eluted with free B12. Immunoreactivity of the IgG-bound form of B12 was confirmed using five B12 assays in common use in the UK. Conclusions: At least 8% of samples with elevated vitamin B12 contain an immunoglobulin complexed form of circulating B12; this possibility should be considered in the interpretation of results. © 2009 The Canadian Society of Clinical Chemists.
Webster R.,SteelHouse |
Fahie-Wilson M.,Southend Hospital |
Barker P.,Addenbrookes Hospital NHS Trust |
Chatterjee V.K.,Addenbrookes Hospital NHS Trust |
Halsall D.J.,Addenbrookes Hospital NHS Trust
Annals of Clinical Biochemistry | Year: 2010
Interference in immunoassay caused by endogenous immunoglobulin is a cause of incorrect laboratory results that can drastically affect patient management. Two cases of immunoglobulin interference in serum follicle-stimulating hormone (FSH) assays are presented. These cases illustrate two common mechanisms for false-positive interference in two-site (sandwich) immunoassays. The first case describes a circulating autoimmune FSH immunoglobulin complex ('macro'-FSH), which has not been previously described for FSH, and the second a cross-linking antibody directed against the assay reagents. Immunoglobulin interferencewas detected and characterized using a combination ofmethod comparison, immunosubtraction and size exclusion chromatography.
PubMed | Anglia and Southend Hospital
Type: Journal Article | Journal: RMD open | Year: 2016
Giant cell arteritis (GCA) is a chronic systemic vasculitis affecting large-sized and medium-sized vessels. Glucocorticoids are currently the mainstay of treatment for GCA and associated large vessel vasculitis (LVV) but are associated with frequent adverse events. Methotrexate has only demonstrated a modest benefit while anti-TNF biological agents (infliximab and etanercept) have been inefficacious. Elevated levels of interleukin-6 (IL-6), a proinflammatory cytokine, has been associated with GCA. Tocilizumab (TCZ), a humanised antihuman IL-6 receptor antibody, has been used successfully in several reports as a treatment for GCA and LVV. We report the potentially long-term successful use of TCZ in 8 cases of refractory LVV. All of our patients achieved a good clinical response to TCZ and C reactive protein reduced from an average of 70.3 to 2.5. In all cases, the glucocorticoid dose was reduced, from an average of 24.6mg prednisolone prior to TCZ treatment to 4.7mg, indicating that TCZ may enable a reduction in glucocorticoid-associated adverse events. However, regular TCZ administration was needed for disease control in most cases. TCZ was discontinued in one case due to the development of an empyema indicating the need for careful monitoring of infection when using this treatment.
Karia N.,Southend Hospital
Clinical Ophthalmology | Year: 2010
This paper reviews the current thinking about retinal vein occlusion. It gives an overview of its pathophysiology and discusses the evidence behind the various established and emerging treatment paradigms. © 2010 Karia.
Makki D.,Southend Hospital |
Khazim R.,Southend Hospital |
Zaidan A.A.,Southend Hospital |
Ravi K.,Southend Hospital |
Toma T.,Southend Hospital
Spine Journal | Year: 2010
Background context: The current criterion standard for zygapophyseal (facet) joint pain diagnosis is placebo-controlled triple comparative local anesthetic facet joint or medial branch blocks. Single photon emission computerized tomography (SPECT) scanning is a less invasive modality that has been widely used in patients with spinal pain for the diagnosis of facet joint arthritis. Previous studies have shown that SPECT results correlate well with response to facet joints steroid injections. Purpose: To evaluate the prevalence of SPECT scan-positive facet joints and other spinal areas in different age groups in a hospital-wide population with spinal pain. Study design: Retrospective study. Methods: This study included 534 patients who underwent a SPECT scan for spinal pain over 7.5 years in our hospital. All referrals from all doctors for any cervical or lumbar spinal pain were included, and the results were reviewed. Results: A total of 486 patients (91.1%) had at least one positive abnormality on SPECT scan; 81.3% had increased uptake in different structures and regions of the spine. This included 42.8% increased uptake in the facet joint 29.8% in the vertebral bodies/end plates, and 5.9% in sacroiliac joints. The prevalence of increased uptake in the lumbosacral and cervical spine was 44% and 37%, respectively. When patients were divided into five age groups (below 40, 40-49, 50-59, 60-69, and 70 years and older), there was a significantly higher increased prevalence in advancing age groups. Conclusions: In a hospital-wide population with spinal pain, there is a 42.88% prevalence of increased uptake in the facet joint on SPECT. The incidence increases significantly with advancing age. SPECT can play a role in investigating patients with spinal pain. © 2010 Elsevier Inc. All rights reserved.
Weisz N.,Southend Hospital
BMJ case reports | Year: 2012
A 13-year-old school boy presented with right-sided buttock pain, features of sepsis and Staphylococcus aureus positive blood cultures. On examination, he was febrile and in severe pain, with limited hip rotation and positive sacroiliac stress tests. Initial imaging with pelvic x-ray, hip ultrasound and MRI were normal. Despite this, a diagnosis of septic arthritis of the hip was presumed, and the patient underwent a washout of the right hip. When the imaging was reviewed in more detail, it was noted that a section of the sacroiliac joint was abnormal. Subsequent pelvic MRI confirmed that this was, in fact, septic sacroiliitis. The patient made a good recovery following washout of the right sacroiliac joint and 6 weeks of antibiotics.
Weisz N.,Southend Hospital
BMJ Case Reports | Year: 2012
A 13-year-old school boy presented with right-sided buttock pain, features of sepsis and Staphylococcus aureus positive blood cultures. On examination, he was febrile and in severe pain, with limited hip rotation and positive sacroiliac stress tests. Initial imaging with pelvic x-ray, hip ultrasound and MRI were normal. Despite this, a diagnosis of septic arthritis of the hip was presumed, and the patient underwent a washout of the right hip. When the imaging was reviewed in more detail, it was noted that a section of the sacroiliac joint was abnormal. Subsequent pelvic MRI confirmed that this was, in fact, septic sacroiliitis. The patient made a good recovery following washout of the right sacroiliac joint and 6 weeks of antibiotics. Copyright 2012 BMJ Publishing Group. All rights reserved.