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Tameside, United Kingdom

Tang A.C.S.,University of Manchester | Dalal N.,Tameside General Hospital
Pathology International | Year: 2011

A 78-year-old retired woman was diagnosed with metaplastic breast carcinoma (MBC), a rare tumor, in our hospital. We reviewed 15 articles with a total of 1328 patients to determine the epidemiology, clinical features, biomarkers, histology, management and outcome of patients with this tumor. The mean age at presentation is 58.5years (range 32-83). Eighty-one percent of patients presented either with a breast mass or abnormal mammographic finding. Twenty-three percent of patients had a family history of breast cancer. Estrogen receptors were only found in 12%, progesterone receptors in 10% and HER2 in 6% of patients. The main method of treatment was mastectomy (66.9%) in combination with chemotherapy (57%) and radiotherapy (47%). Five-year disease-free survival ranged between 40% and 84% and 5-year overall survival ranged between 64 and 83%. We have further reviewed the nature of this disease in the light of advancement in genetics, such as microarray gene expression profiling. The relationship of MBC with triple-negative tumor and basal-like tumor is discussed. It is hoped that advances in genetics and biomarkers will bring forward the era of personalized medicine in the treatment of breast carcinoma. © 2011 The Authors. Pathology International © 2011 Japanese Society of Pathology and Blackwell Publishing Asia Pty Ltd. Source

Ambrosch A.,Institute of Laboratory Medicine and Microbiology | Haefner S.,Diabetology and Geriatrics | Jude E.,Tameside General Hospital | Lobmann R.,Diabetology and Geriatrics
International Wound Journal | Year: 2011

Diabetic patients are at increased risk of complicated skin, skin structure and bone infections including infections of diabetic foot ulcerations (DFU). Analyses of epidemiology and microbial pathogenicity show that staphylococci seem to be predestined to induce such infections. In addition, multidrug resistance particularly due to an increasing prevalence of methicillin-resistant Staphylococcus aureus (MRSA) seems to be the challenge for effective antibiotic therapy. With regard to infections with MRSA, classical agents like vancomycin, linezolid, fosfomycin or trimethroprim-sulphametoxazol might be agents of choice in DFU. New-generation drugs including broad-spectrum tetracyclines like tigecycline, first and second generation of cyclic lipopeptides, anti-MRSA β-lactams including ceftobiprole and anti-MRSA antibodies are developed or in progress and the hope for the future. © 2011 The Authors. © 2011 Blackwell Publishing Ltd and Medicalhelplines.com Inc. Source

Eleftheriadou I.,National and Kapodistrian University of Athens | Tentolouris N.,National and Kapodistrian University of Athens | Argiana V.,National and Kapodistrian University of Athens | Jude E.,Tameside General Hospital | Boulton A.J.,Royal Infirmary
Drugs | Year: 2010

Diabetic foot ulcers are often complicated by infection. Among pathogens, Staphylococcus aureus predominates. The prevalence of methicillin-resistant S. aureus (MRSA) in infected foot ulcers is 1530 and there is an alarming trend for increase in many countries. There are also data that recognize new strains of MRSA that are resistant to vancomycin. The risk for MRSA isolation increases in the presence of osteomyelitis, nasal carriage of MRSA, prior use of antibacterials or hospitalization, larger ulcer size and longer duration of the ulcer. The need for amputation and surgical debridement increases in patients infected with MRSA. Infections of mild or moderate severity caused by community-acquired MRSA can be treated with cotrimoxazole (trimethoprimsulfamethoxazole), doxycycline or clindamycin when susceptibility results are available, while severe community-acquired or hospital-acquired MRSA infections should be managed with glycopeptides, linezolide or daptomycin. Dalbavancin, tigecycline and ceftobiprole are newer promising antimicrobial agents active against MRSA that may also have a role in the treatment of foot infections if more data on their efficacy and safety become available. © 2010 Adis Data Information BV. All rights reserved. Source

Shelton C.L.,Tameside General Hospital | Raistrick C.,Surgical Directorate | Warburton K.,9 Poplin Drive | Siddiqui K.H.,Surgical Directorate
Journal of Hospital Infection | Year: 2010

Research has shown that healthcare workers' clothes can become contaminated with pathogens. This study aimed to determine whether hospital doctors can change their attire to reduce the possibility of cross-infection without jeopardising the doctor-patient relationship. In this experimental repeated-measures study, 55 male and 45 female inpatients (mean age: 52.89 years) were randomly selected. Participants were shown photographs of medical dresscodes and asked to rate their appropriateness on a 5-point Likert scale. They were then read a standardised statement regarding the significance of attire to cross-infection and the exercise was repeated. Pre statement, there was no significant difference between the majority of dress options, though casual dress (male and female) and short-sleeved top (female) were considered significantly less appropriate. Post statement, surgical 'scrubs' and short-sleeved top/shirt were deemed most appropriate (P < 0.0001). There was no significant difference between short-sleeved shirt and scrubs for males. For females, scrubs were preferred (P = 0.0005). Participants expressed no significant preference for medical attire, with the exception of a dislike of casual dress. However, once informed of the significance of attire to cross-infection, preference changes to favour dresscodes which may minimise infection risk. © 2009 The Hospital Infection Society. Source

Malone M.,Liverpool Hospital | Malone M.,Podiatric Surgery Unit | Bowling F.L.,University of Manchester | Gannass A.,Podiatric Surgery Unit | And 2 more authors.
Diabetes/Metabolism Research and Reviews | Year: 2013

Background: Osteomyelitis is a major complication in patients with diabetic foot ulceration. Accurate pathogenic identification of organisms can aid the clinician to a specific antibiotic therapy thereby preventing the need for amputation. Methods: All diabetic patients with bone biopsy-confirmed osteomyelitis were included into the study: biopsies were performed either during surgical removal of infected bone or percutaneously under guided fluoroscopy through non-infected tissue. The depth and extent of the ulcer was assessed using a sterile blunt metal probe. Deep wound cultures were taken from the wound base after sharp debridement. Results: Of 66 cases of suspected osteomyelitis in 102 joints, 34 patients had both bone biopsies and deep wound cultures over the study period. Thirty two of 34 (94%), had a history of preceding foot ulceration, and in 25 of the cases a positive probe to bone test was recorded. In a high proportion of patients, at least one similar organism was isolated from both the deep wound culture and bone biopsy procedures (25 of 34 cases, 73.5%, p<0.001). When organisms were isolated from both wound cultures and bone biopsies, the identical strain was identified in both procedures in a significant proportion of cases (16 of 25 cases, 64%, p<0.001, total sample analysis in 16 of 34 cases, 47%). Conclusions: Deep wound cultures correlate well with osseous cultures and provide a sensitive method in assessing and targeting likely pathogens that cause osseous infections. This will help aid the clinician in guiding antibiotic therapy in centers where bone biopsies may not be readily available. © 2013 John Wiley & Sons, Ltd. Source

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