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Westcliff-on-Sea, United Kingdom

Harris A.C.,Southend Hospital | Chaudry M.A.,Royal London Hospital | Menzies D.,ICENI Colchester Laparoscopic | 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.

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.

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.

Unizony S.H.,Harvard University | Dasgupta B.,Southend Hospital | Fisheleva E.,Shire Inc | Rowell L.,Shire Inc | And 5 more authors.
International Journal of Rheumatology | Year: 2013

Overview. The GiACTA trial is a multicenter, randomized, double-blind, and placebo-controlled study designed to test the ability of tocilizumab (TCZ), an interleukin (IL)-6 receptor antagonist, to maintain disease remission in patients with giant cell arteritis (GCA). Design. Approximately 100 centers will enroll 250 patients with active disease. The trial consists of a 52-week blinded treatment phase followed by 104 weeks of open-label extension. Patients will be randomized into one of four groups. Group A (TCZ 162 mg weekly plus a 6-month prednisone-taper); group B (TCZ 162 mg every other week plus a 6-month prednisone-taper); group C (placebo plus a 6-month prednisone-taper); and group D (placebo plus a 12-month prednisone taper). We hypothesize that patients assigned to TCZ in addition to a 6-month prednisone course are more likely to achieve the primary efficacy endpoint of sustained remission (SR) at 52 weeks compared with those assigned to a 6-month prednisone course alone, thus potentially minimizing the long-term adverse effects of corticosteroids. Conclusion. GiACTA will test the hypothesis that interference with IL-6 signaling exerts a beneficial effect on patients with GCA. The objective of this paper is to describe the design of the trial and address major issues related to its development. © 2013 Sebastian H. Unizony et al.

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.

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