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Beggs R.E.,Adelaide and Meath Hospital | Kelly M.E.,Adelaide and Meath Hospital | Eltayeb O.,Adelaide and Meath Hospital | Crotty P.,The Adelaide and Meath Hospital | And 2 more authors.
Journal of the Pancreas | Year: 2012

Context Large cell neuroendocrine carcinomas of the ampulla of Vater are rare and confer a very poor prognosis despite aggressive therapy. There are few case reports of large cell neuroendocrine carcinomas of the ampulla of Vater in the literature and to date no studies have been done to establish optimal management. We describe a pooled case series from published reports of neuroendocrine carcinomas of the ampulla of Vater including a case which presented to our institution. Methods A narrative review was undertaken including all published English case reports of large cell neuroendocrine carcinomas of the ampulla of Vater. Our primary outcome was to determine overall survival. Results Twenty cases of large cell neuroendocrine carcinomas of the ampulla of Vater were identified. Seventy-six percent of patients were reported to have died of disease with mean survival of 11.8 months. Twenty percent of the tumours were associated with an adenoma. The approximate median survivals were 15 months for those with an associated adenoma and 11 months without. Conclusions This pooled analysis demonstrates both the rarity and poor prognosis of large cell neuroendocrine carcinomas of the ampulla of Vater. Although surgical resection is the mainstay of treatment, we review common adjuvant chemotherapy regimes. Prognosis may be improved when these tumours are associated with adenomas, however, more studies are needed. Source


Ng K.C.,Trinity College Dublin | Mansour E.,The Adelaide and Meath Hospital | Eguare E.,The Adelaide and Meath Hospital
JBR-BTR | Year: 2011

Foreign body ingestion is a common problem in clinical practice. Majority of foreign bodies, once passed beyond the stomach, will be evacuated through the gastrointestinal tract within days without any difficulty. Retained foreign body is rare and the objects in question are mostly long, large, or have a sharp end. We report a case of retention of a small, blunt, spherical glass-like object in the ileum of an 87-year-old lady having benefited from a Hartmann's procedure which was incidentally discovered on a computed tomography scan 2 months before its spontaneous evacuation through the stoma. Source


Kinsella J.A.,The Adelaide and Meath Hospital | O'Brien W.,Gosford Hospital | Mullins G.M.,Gosford Hospital | Brewer J.,Pacific Laboratory Medicine Services | Whyte S.,Gosford Hospital
Journal of Clinical Neuroscience | Year: 2010

Primary angiitis of the central nervous system (PACNS), also called primary CNS vasculitis, is an idiopathic inflammatory condition affecting only intracranial and spinal cord vessels, particularly medium-sized and smaller arteries and arterioles. Angiography and histopathology typically do not reveal evidence of systemic vasculitis.1,2 Histopathology usually reveals granulomatous inflammation affecting arterioles and small arteries of the parenchyma and/or leptomeninges, similar to that seen in Takayasu's or giant cell arteritis.1-3 We report a patient with biopsy-proven PACNS with giant cells and cerebral mass effect on MRI. Magnetic resonance angiography and cerebral angiography appeared normal and there was no evidence of extracranial vasculitis. © 2009 Elsevier Ltd. All rights reserved. Source


Alkindi S.,Sultan Qaboos University | Smith O.P.,The Adelaide and Meath Hospital | Enright H.,The Adelaide and Meath Hospital
Sultan Qaboos University Medical Journal | Year: 2011

Heparin is one of the most frequently used anticoagulants. It is easy to use, but can be associated with life-threatening side effects. One of these is heparin-induced thrombocytopenia syndrome (HITS), which develops in about 3-5% of patients exposed to heparin and is associated with thrombosis in 1% of cases. We report here the successful treatment of five patients with HITS who were treated with alternative anticoagulants namely danaparoid or hirudin. The median time between their exposure to heparin and onset of symptoms and or signs was 10.2 days (range 7-14 days). Platelet counts decreased to a mean of 38.4 × 10 9 /l (12-82 × 10 9/l). All five patients had evidence of thrombosis; four patients had clinical and radiological evidence of pulmonary emboli, one patient had confirmed deep vein thrombosis (DVT) and one patient had extensive skin necrosis of the thighs and abdomen. Platelet aggregation test were positive in two patients, inconclusive in one patient and negative in two patients. Two patients were anticoagulated with danaparoid and three with hirudin until their platelet counts returned to normal between 4 and 14 days (average 6 days) following the recognition of the syndrome. Our patients had significant morbidity, but no mortality. Immediate withdrawal of heparin is of paramount importance and introduction of alternative anticoagulant is necessary in the presence of thrombosis. Source


Gyberg V.,Karolinska University Hospital | Gyberg V.,Karolinska Institutet | Bacquer D.,European Society of Cardiology | Bacquer D.,Ghent University | And 57 more authors.
Cardiovascular Diabetology | Year: 2015

Background: In order to influence every day clinical practice professional organisations issue management guidelines. Cross-sectional surveys are used to evaluate the implementation of such guidelines. The present survey investigated screening for glucose perturbations in people with coronary artery disease and compared patients with known and newly detected type 2 diabetes with those without diabetes in terms of their life-style and pharmacological risk factor management in relation to contemporary European guidelines. Methods: A total of 6187 patients (18-80years) with coronary artery disease and known glycaemic status based on a self reported history of diabetes (previously known diabetes) or the results of an oral glucose tolerance test and HbA1c (no diabetes or newly diagnosed diabetes) were investigated in EUROASPIRE IV including patients in 24 European countries 2012-2013. The patients were interviewed and investigated in order to enable a comparison between their actual risk factor control with that recommended in current European management guidelines and the outcome in previously conducted surveys. Results: A total of 2846 (46%) patients had no diabetes, 1158 (19%) newly diagnosed diabetes and 2183 (35%) previously known diabetes. The combined use of all four cardioprotective drugs in these groups was 53, 55 and 60%, respectively. A blood pressure target of <140/90mmHg was achieved in 68, 61, 54% and a LDL-cholesterol target of <1.8mmol/L in 16, 18 and 28%. Patients with newly diagnosed and previously known diabetes reached an HbA1c <7.0% (53mmol/mol) in 95 and 53% and 11% of those with previously known diabetes had an HbA1c >9.0% (>75mmol/mol). Of the patients with diabetes 69% reported on low physical activity. The proportion of patients participating in cardiac rehabilitation programmes was low (≈40%) and only 27% of those with diabetes had attended diabetes schools. Compared with data from previous surveys the use of cardioprotective drugs had increased and more patients were achieving the risk factor treatment targets. Conclusions: Despite advances in patient management there is further potential to improve both the detection and management of patients with diabetes and coronary artery disease. © 2015 Gyberg et al. Source

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