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Miller V.,Neurogastroenterology Unit | Carruthers H.R.,Neurogastroenterology Unit | Morris J.,Wythenshawe Hospital | Hasan S.S.,Hypnotherapy Unit | And 2 more authors.
Alimentary Pharmacology and Therapeutics | Year: 2015

Background: Gut-focused hypnotherapy improves the symptoms of irritable bowel syndrome (IBS) with benefits being sustained for many years. Despite this, the technique has not been widely adopted by healthcare systems, possibly due to relatively small numbers in published studies and uncertainty about how it should be provided. Aim: To review the effect of hypnotherapy in a large cohort of refractory IBS patients. Methods: One thousand IBS patients fulfilling Rome II criteria, mean age 51.6 years (range 17-91 years), 80% female, receiving 12 sessions of hypnotherapy over 3 months, were studied. The primary outcome was a 50 point reduction in the IBS Symptom Severity Score. The fall in scores for Noncolonic Symptoms, Quality of Life and Anxiety or Depression, were secondary outcomes. The Federal Drug Administration's recommended outcome of a 30% or more reduction in abdominal pain was also recorded. Results: Overall, 76% met the primary outcome which was higher in females (females: 80%, males: 62%, P < 0.001) and those with anxiety (anxious: 79%, non-anxious: 71%, P = 0.010). The mean reduction in other scores was: IBS Symptom Severity Score, 129 points (P < 0.001), Noncolonic Symptom Score, 65 (P < 0.001) and Quality of Life Score, 66 (P < 0.001). Sixty-seven per cent reported a 30% or more reduction in abdominal pain scores. Pain days fell from 18 to 9 per month. Patients with anxiety and depression fell from 63% to 34% and 25% to 12% respectively (P < 0.001). Outcome was unaffected by bowel habit subtype. Conclusion: These results provide further evidence that gut-focused hypnotherapy is an effective intervention for refractory IBS. © 2015 John Wiley & Sons Ltd.

Leroi I.,University of Manchester | Ahearn D.J.,Wythenshawe Hospital | Andrews M.,Lancashire Care Foundation Trust | Mcdonald K.R.,University of Manchester | And 2 more authors.
Age and Ageing | Year: 2011

Background: although non-motor symptoms of Parkinson's disease (PD) are known to adversely affect disability and health-related quality of life, the impact that specific disorders of reward and motivation have remains unclear. Impulse control disorders are more likely in those with a younger disease onset although there is no strong evidence to date that apathy is related to age of onset or correlated with a longer duration of disease. Objective: to examine the effects of apathy and impulse controls disorders on disability and health-related quality of life. Methods: a total of 99 non-demented participants with PD (35 with impulse control disorders, 26 with apathy and 38 with neither behavioural complication) were assessed using the Unified Parkinson's Disease Rating Scale (Activities of Daily Living component) and the Schwab-England scale to evaluate disability, and the PDQ (eight items) to assess quality of life. Results: quality of life was reduced in both behavioural groups compared with participants without either condition. Disability was greater in the group with apathy. Variation in disability score (56%, P < 0.001) was explained by greater levels of apathy, depression, motor impairment and longer disease duration. Variation in quality of life score (54%, P < 0.001) was explained by higher levels of impulsivity, depression, dopaminergic load, motor complications, working memory problems and younger age at onset. Conclusion: apathy and impulsivity negatively impact on disability and health-related quality of life, emphasising the importance of effective diagnosis and management of these PD-related behavioural disturbances. © The Author 2011. Published by Oxford University Press on behalf of the British Geriatrics Society.

Nonaka D.,Christie Hospital | Nonaka D.,University of Manchester | Bishop P.W.,Wythenshawe Hospital
American Journal of Surgical Pathology | Year: 2014

A group of tumors referred to as atypical fibroxanthoma (AFX) and pleomorphic dermal sarcoma (PDS) predominantly occur in sun-damaged skin of the elderly, particularly in the head and neck region. Although this group of tumors is often regarded as of mesenchymal phenotype, the matter of histogenesis has not been entirely resolved. Evans H and Smith JL reported in 1980 that prognosis was not significantly different irrespective of whether there was a definite squamous cell carcinoma component or not, supporting a view that these are all carcinomata in nature (sarcomatoid carcinoma [SC]). There are a number of clinicopathologic studies of AFX in the literature but information on morphologically similar sarcoma-like tumors with immunohistochemical evidence of epithelial differentiation is sparse. One hundred sarcoma-like tumors (SLTs) of head and neck skin of the elderly, treated by surgical excision, were studied. Clinical information was obtained, and pathology reports and hematoxylin and eosin sections were reviewed to document size (maximum dimension), extent of invasion, mitotic count, vascular and perineural invasion, margin status, ulceration, necrosis, and the presence of actinic keratosis in adjacent/overlying skin. Immunostains examined included: pan-cytokeratins (CKs) (AE1/AE3, MNF116), high-molecular weight CKs (34βE12, CK5/6, CK14), p63, and melanocytic (S100, Melan A, HMB-45, MITF), vascular (CD31, CD34), and muscle markers (SMA, desmin, h-caldesmon) to exclude melanoma and definite sarcoma entities. The tumors were divided into AFX/PDS (G1), the SC group, which was subdivided into SLT with only p63 positivity (G2a) and SLT with CK positivity regardless of p63 status (G2b), and SLT with a minor morphologic squamous cell carcinoma component (G3). Clinicopathologic findings of each group were compared, in relation to outcomes. Age at diagnosis ranged from 51 to 96 years (median, 79 y), with M:F=11.5:1. There were 53 tumors in G1 (19AFX, 34PDS), 37 in G2 (25 in G2a, 12 in G2b), and 10 in G3. There was no statistically significant difference in clinical and pathologic parameters or survival among all 3 groups. CKs and p63 expression, size, extent of invasion, vascular invasion, perineural invasion, mitotic count, and ulcer did not affect outcome, whereas margin status and necrosis did by both univariate and multivariate analysis and by only univariate analysis, respectively. Sixty patients had multiple nonmelanomatous skin cancers. Actinic keratosis was observed in overlying/adjacent epidermis in 51 cases. Eight patients had prior radiotherapy to head skin cancers; 1 patient developed 2 separate tumors (G1 and G3) after radiotherapy. Four patients died of tumor (1 G1, 2 G2b, and 1 G3); of these, 3 cases had positive margin, and 1 had narrow margin. Our results have shown similarities of various clinicopathologic parameters between AFX/PDS and SC, raising the possibility that both entities are related, and some of the former entities may represent complete dedifferentiation (complete loss of epithelial phenotype) with a gain of mesenchymal phenotype. In addition, the difference between AFX and PDS appears to be the extent of invasiveness (stage) rather than a different histogenesis. Further investigations are needed. However, from a practical point of view, efforts should be made to excise this group of tumors with clear margins, as margin status appears to be the most important prognostic factor regardless of the presence or absence of epithelial differentiation. Copyright © 2014 by Lippincott Williams & Wilkins.

Lowrie A.G.,Ninewells Hospital | Lees V.C.,Wythenshawe Hospital
Journal of Hand Surgery: European Volume | Year: 2014

The use of the digital flexor sheath to reconstruct damaged structures in the fingers is an intriguing but under-investigated subject. The sheath is anchored firmly to the phalanges and palmar plates and has well-vascularized outer and synovial inner layers. The middle layer is strong and fibrous and not all of it is required for its main biomechanical function of maintaining the moment arm of the flexor tendons. These characteristics have led to several descriptions of different reconstructive uses. In sheath reconstruction, flaps can be used to repair damaged A2 and A4 pulleys. As an anchor, the sheath is useful for tenodeses and tendon transfers. It has been used in the correction of ulnar claw and swan neck deformities. In ligament reconstruction, the A1 pulley has been used to reconstruct the transverse intermetacarpal ligament in cleft hand and ray amputations. The sheath has also been used to cover tendon repairs and periosteal defects with the aim of decreasing adhesions. There is potential for further use of the flexor sheath in reconstructive surgery.The digital flexor sheath can be used to restore various finger functions providing its physiological roles are recognized and preserved. This review considers the different techniques described and their potential uses. © The Author(s) 2013.

Late onset bowel dysfunction post-pelvic radiotherapy is an increasingly common clinical scenario which is related to improved oncological treatments and cancer survival. 50% of patients develop bowel symptoms after pelvic radiotherapy which affects quality of life. Historically, bowel symptoms post-pelvic radiotherapy have been labelled 'chronic radiation proctitis', although it is increasingly recognised that these symptoms are due to dysfunction of the gastrointestinal (GI) tract at numerous points. The evidence-base is poor and comprises often small, heterogenous, single centre unblinded studies. This article critically reviews the evidence for the medical treatment options for 'chronic radiation proctitis', which include anti-inflammatory drugs, antibiotics, sucralfate, formalin and hyperbaric oxygen. The difficulties in extrapolation from the literature to clinical practise are also explored. From the available evidence, rectal sucralfate appears to have greater efficacy than anti-inflammatory agents, which are more effective if used with oral metronidazole. Furthermore, hyperbaric oxygen is emerging as promising treatment for radiation toxicity. However, bowel dysfunction post-pelvic radiotherapy is a complex clinical condition which reflects multi-site GI tract pathologies both related and unrelated to previous oncological treatments. From this review article a clear need for an adjustment to both diagnosis and treatment of these patients, as well as for further research, emerges. © The Author(s), 2010.

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