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Wednesday, 30 October 2019
Let's Talk Research 2020 - Call for papers is now open!
Thursday, 24 October 2019
CCC publication: Addition of docetaxel to hormonal therapy in low- and high-burden metastatic hormone sensitive prostate cancer: long-term survival results from the STAMPEDE trial
Citation: Annals of Oncology. 2019, 30(12), 1992-2003. 2019 Sep 27 [Epub ahead of print]
Author: M D; Matheson, D; Millman, R; Parker, C C; Ritchie, A W S; Rush, H; Russell, J M; Brown, J; Beesley, S; Birtle, A; Capaldi, L; Gale, J; Gibbs, S; Lydon, A; Nikapota, A; Omlin, A; O'Sullivan, J M; Parikh, O; Protheroe, A; Rudman, S; Srihari, N N; Simms, M; Tanguay, J S; Tolan, S; Wagstaff, J; Wallace, J; Wylie, J; Zarkar, A; Sydes, M R; Parmar, M K B; James, N D
Abstract: BACKGROUND: STAMPEDE has previously reported that the use of upfront docetaxel improved overall survival (OS) for metastatic hormone naïve prostate cancer patients starting long-term androgen deprivation therapy. We report on long-term outcomes stratified by metastatic burden for M1 patients.
METHODS: We randomly allocated patients in 2 : 1 ratio to standard-of-care (SOC; control group) or SOC + docetaxel. Metastatic disease burden was categorised using retrospectively-collected baseline staging scans where available. Analysis used Cox regression models, adjusted for stratification factors, with emphasis on restricted mean survival time where hazards were non-proportional.
RESULTS: Between 05 October 2005 and 31 March 2013, 1086 M1 patients were randomised to receive SOC (n = 724) or SOC + docetaxel (n = 362). Metastatic burden was assessable for 830/1086 (76%) patients; 362 (44%) had low and 468 (56%) high metastatic burden. Median follow-up was 78.2 months. There were 494 deaths on SOC (41% more than the previous report). There was good evidence of benefit of docetaxel over SOC on OS (HR = 0.81, 95% CI 0.69-0.95, P = 0.009) with no evidence of heterogeneity of docetaxel effect between metastatic burden sub-groups (interaction P = 0.827). Analysis of other outcomes found evidence of benefit for docetaxel over SOC in failure-free survival (HR = 0.66, 95% CI 0.57-0.76, P < 0.001) and progression-free survival (HR = 0.69, 95% CI 0.59-0.81, P < 0.001) with no evidence of heterogeneity of docetaxel effect between metastatic burden sub-groups (interaction P > 0.5 in each case). There was no evidence that docetaxel resulted in late toxicity compared with SOC: after 1 year, G3-5 toxicity was reported for 28% SOC and 27% docetaxel (in patients still on follow-up at 1 year without prior progression).
CONCLUSIONS: The clinically significant benefit in survival for upfront docetaxel persists at longer follow-up, with no evidence that benefit differed by metastatic burden. We advocate that upfront docetaxel is considered for metastatic hormone naïve prostate cancer patients regardless of metastatic burden.
© The Author(s) 2019. Published by Oxford University Press on behalf of the European Society for Medical Oncology.
KEYWORDS: STAMPEDE trial; docetaxel; hormone naive; metastatic; prostate cancer; randomised control trial
Link to PubMed record
Author: M D; Matheson, D; Millman, R; Parker, C C; Ritchie, A W S; Rush, H; Russell, J M; Brown, J; Beesley, S; Birtle, A; Capaldi, L; Gale, J; Gibbs, S; Lydon, A; Nikapota, A; Omlin, A; O'Sullivan, J M; Parikh, O; Protheroe, A; Rudman, S; Srihari, N N; Simms, M; Tanguay, J S; Tolan, S; Wagstaff, J; Wallace, J; Wylie, J; Zarkar, A; Sydes, M R; Parmar, M K B; James, N D
Abstract: BACKGROUND: STAMPEDE has previously reported that the use of upfront docetaxel improved overall survival (OS) for metastatic hormone naïve prostate cancer patients starting long-term androgen deprivation therapy. We report on long-term outcomes stratified by metastatic burden for M1 patients.
METHODS: We randomly allocated patients in 2 : 1 ratio to standard-of-care (SOC; control group) or SOC + docetaxel. Metastatic disease burden was categorised using retrospectively-collected baseline staging scans where available. Analysis used Cox regression models, adjusted for stratification factors, with emphasis on restricted mean survival time where hazards were non-proportional.
RESULTS: Between 05 October 2005 and 31 March 2013, 1086 M1 patients were randomised to receive SOC (n = 724) or SOC + docetaxel (n = 362). Metastatic burden was assessable for 830/1086 (76%) patients; 362 (44%) had low and 468 (56%) high metastatic burden. Median follow-up was 78.2 months. There were 494 deaths on SOC (41% more than the previous report). There was good evidence of benefit of docetaxel over SOC on OS (HR = 0.81, 95% CI 0.69-0.95, P = 0.009) with no evidence of heterogeneity of docetaxel effect between metastatic burden sub-groups (interaction P = 0.827). Analysis of other outcomes found evidence of benefit for docetaxel over SOC in failure-free survival (HR = 0.66, 95% CI 0.57-0.76, P < 0.001) and progression-free survival (HR = 0.69, 95% CI 0.59-0.81, P < 0.001) with no evidence of heterogeneity of docetaxel effect between metastatic burden sub-groups (interaction P > 0.5 in each case). There was no evidence that docetaxel resulted in late toxicity compared with SOC: after 1 year, G3-5 toxicity was reported for 28% SOC and 27% docetaxel (in patients still on follow-up at 1 year without prior progression).
CONCLUSIONS: The clinically significant benefit in survival for upfront docetaxel persists at longer follow-up, with no evidence that benefit differed by metastatic burden. We advocate that upfront docetaxel is considered for metastatic hormone naïve prostate cancer patients regardless of metastatic burden.
© The Author(s) 2019. Published by Oxford University Press on behalf of the European Society for Medical Oncology.
KEYWORDS: STAMPEDE trial; docetaxel; hormone naive; metastatic; prostate cancer; randomised control trial
Link to PubMed record
CCC publication: Transanal endoscopic microsurgery for rectal lesions in a specialist regional early rectal cancer centre: the Mersey experience
Citation: Colorectal Disease. 2019, 21(10), 1164-74
Author: Ondhia, M; Tamvakeras, P; O'Toole, P; Montazerri, A; Andrews, T; Farrell, C; Ahmed, S; Slawik, S; Merseyside Early Rectal Cancer Network
Abstract: AIM: Organ-preserving local excision by transanal endoscopic microsurgery (TEM) for early rectal cancer offers significantly lower morbidity as compared to formal rectal cancer resection with acceptable outcomes. This study presents our 6-year experience of TEM for rectal lesions referred to a specialist early rectal cancer centre in the UK.
METHOD: Data were collected for all patients referred for TEM of suspected early rectal cancer to a regional specialist early rectal cancer multidisciplinary team (MDT) over a 6-year period.
RESULTS: One hundred and forty-one patients who underwent full-thickness TEM for suspected or confirmed early rectal cancer were included. Thirty patients were referred for TEM following incomplete endoscopic polypectomy. Final pathology was benign in 77 (54.6%) cases and malignant in 64 (45.4%). Of the 61 confirmed adenocarcinomas, TEM resections were pT0 in 17 (27.9%), pT1 in 32 (51.7%), pT2 in 11 (18.0%) and pT3 in 1 (1.6%). Thirty-eight of 61 patients (62.3%) had one or more poor histological prognostic features and these patients were offered further treatment. Twenty-three of 61 (37.7%) patients with rectal adenocarcinoma required no further treatment following TEM. Forty-three cases of rectal adenocarcinoma were available for establishing recurrence rates. Two of 43 patients (4.7%) developed a recurrence at a median follow-up of 28.7 months (12.1-66.5 months). The overall estimated 5-year overall survival rate was 87.9% and the disease-free survival rate was 82.9%.
CONCLUSION: Acceptable outcomes are possible for TEM surgery with appropriate patient selection, effective technique, expert histopathology, appropriate referral for adjuvant treatment and meticulous follow-up. This can be achieved through an early rectal cancer MDT in a dedicated specialist regional centre.
Colorectal Disease © 2019 The Association of Coloproctology of Great Britain and Ireland.
KEYWORDS: Early rectal cancer; local excision rectal cancer
Link to PubMed record
Author: Ondhia, M; Tamvakeras, P; O'Toole, P; Montazerri, A; Andrews, T; Farrell, C; Ahmed, S; Slawik, S; Merseyside Early Rectal Cancer Network
Abstract: AIM: Organ-preserving local excision by transanal endoscopic microsurgery (TEM) for early rectal cancer offers significantly lower morbidity as compared to formal rectal cancer resection with acceptable outcomes. This study presents our 6-year experience of TEM for rectal lesions referred to a specialist early rectal cancer centre in the UK.
METHOD: Data were collected for all patients referred for TEM of suspected early rectal cancer to a regional specialist early rectal cancer multidisciplinary team (MDT) over a 6-year period.
RESULTS: One hundred and forty-one patients who underwent full-thickness TEM for suspected or confirmed early rectal cancer were included. Thirty patients were referred for TEM following incomplete endoscopic polypectomy. Final pathology was benign in 77 (54.6%) cases and malignant in 64 (45.4%). Of the 61 confirmed adenocarcinomas, TEM resections were pT0 in 17 (27.9%), pT1 in 32 (51.7%), pT2 in 11 (18.0%) and pT3 in 1 (1.6%). Thirty-eight of 61 patients (62.3%) had one or more poor histological prognostic features and these patients were offered further treatment. Twenty-three of 61 (37.7%) patients with rectal adenocarcinoma required no further treatment following TEM. Forty-three cases of rectal adenocarcinoma were available for establishing recurrence rates. Two of 43 patients (4.7%) developed a recurrence at a median follow-up of 28.7 months (12.1-66.5 months). The overall estimated 5-year overall survival rate was 87.9% and the disease-free survival rate was 82.9%.
CONCLUSION: Acceptable outcomes are possible for TEM surgery with appropriate patient selection, effective technique, expert histopathology, appropriate referral for adjuvant treatment and meticulous follow-up. This can be achieved through an early rectal cancer MDT in a dedicated specialist regional centre.
Colorectal Disease © 2019 The Association of Coloproctology of Great Britain and Ireland.
KEYWORDS: Early rectal cancer; local excision rectal cancer
Link to PubMed record
CCC publication: ALK immunohistochemistry positive, FISH negative NSCLC is infrequent, but associated with impaired survival following treatment with crizotinib
Citation: Lung Cancer. 2019, 138, 13-18
Author: Mellemgaard, A; Dingemans, A M C; Speel, E J M; de Langen, A J; Hashemi, S M S; Bahce, I; van der Drift, M A; Looijen-Salamon, M G; Gosney, J; Postmus, P E; Samii, S M S; Duplaquet, F; Weynand, B; Durando, X; Penault-Llorca, F; Finn, S; Grady, A O; Oz, B; Akyurek, N; Buettner, R; Wolf, J; Bubendorf, L; Duin, S; Marondel, I; Heukamp, L C; Timens, W; Schuuring, E M D; Pauwels, P; Smit, E F
Abstract: OBJECTIVE: Metastasized non-small cell lung cancer (NSCLC) with an anaplastic lymphoma kinase (ALK) rearrangement is usually sensitive to a range of ALK-tyrosine kinase inhibitors. ALK-positive NSCLC have been identified in pivotal phase III trials with fluorescence in situ hybridization (ALK FISH+). These tumors are also expressing the fusion product (ALK immunohistochemistry (IHC)+). However, discrepant cases occur, including ALK IHC + FISH-. The aim of this study was to collect ALK IHC + cases and compare within this group response to crizotinib treatment of ALK FISH + cases with ALK FISH- cases.
MATERIALS AND METHODS: In this European prospective multicenter research study patients with Stage IV ALK IHC + NSCLC treated with crizotinib were enrolled. Tumor slides were validated centrally for ALK IHC and ALK FISH.
RESULTS: Registration of 3523 ALK IHC tests revealed a prevalence of 2.7% (n = 94) ALK IHC + cases. Local ALK FISH analysis resulted in 48 concordant (ALK IHC+/FISH+) and 16 discordant (ALK IHC+/FISH-) cases. Central validation revealed 37 concordant and 7 discordant cases, 5 of which had follow-up. Validation was hampered by limited amount of tissue in biopsy samples. The PFS at 1 year for ALK concordant and discordant was 58% and 20%, respectively (HR = 2.4; 95% CI: 0.78-7.3; p = 0.11). Overall survival was significantly better for concordant cases than discordant cases after central validation (HR=4.5; 95% CI= 1.2-15.9; p=0.010.
CONCLUSION: ALK IHC + FISH- NSCLC is infrequent and associated with a worse outcome on personalized treatment. A suitable predictive testing strategy may be to screen first with IHC and then confirm with FISH instead of considering ALK IHC equivalent to ALK FISH according to the current guidelines.
Copyright © 2019 Elsevier B.V. All rights reserved.
KEYWORDS: alk; fluorescence in situ hybridisation; immunohistochemistry; non-small cell lung cancer; prognosis; treatment
Link to PubMed record
Author: Mellemgaard, A; Dingemans, A M C; Speel, E J M; de Langen, A J; Hashemi, S M S; Bahce, I; van der Drift, M A; Looijen-Salamon, M G; Gosney, J; Postmus, P E; Samii, S M S; Duplaquet, F; Weynand, B; Durando, X; Penault-Llorca, F; Finn, S; Grady, A O; Oz, B; Akyurek, N; Buettner, R; Wolf, J; Bubendorf, L; Duin, S; Marondel, I; Heukamp, L C; Timens, W; Schuuring, E M D; Pauwels, P; Smit, E F
Abstract: OBJECTIVE: Metastasized non-small cell lung cancer (NSCLC) with an anaplastic lymphoma kinase (ALK) rearrangement is usually sensitive to a range of ALK-tyrosine kinase inhibitors. ALK-positive NSCLC have been identified in pivotal phase III trials with fluorescence in situ hybridization (ALK FISH+). These tumors are also expressing the fusion product (ALK immunohistochemistry (IHC)+). However, discrepant cases occur, including ALK IHC + FISH-. The aim of this study was to collect ALK IHC + cases and compare within this group response to crizotinib treatment of ALK FISH + cases with ALK FISH- cases.
MATERIALS AND METHODS: In this European prospective multicenter research study patients with Stage IV ALK IHC + NSCLC treated with crizotinib were enrolled. Tumor slides were validated centrally for ALK IHC and ALK FISH.
RESULTS: Registration of 3523 ALK IHC tests revealed a prevalence of 2.7% (n = 94) ALK IHC + cases. Local ALK FISH analysis resulted in 48 concordant (ALK IHC+/FISH+) and 16 discordant (ALK IHC+/FISH-) cases. Central validation revealed 37 concordant and 7 discordant cases, 5 of which had follow-up. Validation was hampered by limited amount of tissue in biopsy samples. The PFS at 1 year for ALK concordant and discordant was 58% and 20%, respectively (HR = 2.4; 95% CI: 0.78-7.3; p = 0.11). Overall survival was significantly better for concordant cases than discordant cases after central validation (HR=4.5; 95% CI= 1.2-15.9; p=0.010.
CONCLUSION: ALK IHC + FISH- NSCLC is infrequent and associated with a worse outcome on personalized treatment. A suitable predictive testing strategy may be to screen first with IHC and then confirm with FISH instead of considering ALK IHC equivalent to ALK FISH according to the current guidelines.
Copyright © 2019 Elsevier B.V. All rights reserved.
KEYWORDS: alk; fluorescence in situ hybridisation; immunohistochemistry; non-small cell lung cancer; prognosis; treatment
Link to PubMed record
CCC publication: A prognostic model to personalize monitoring regimes for patients with incidental asymptomatic meningiomas
Citation: Neuro-oncology. 2019 Oct 11 [Epub ahead of print]
Author: Islim, Abdurrahman I; Kolamunnage-Dona, Ruwanthi; Mohan, Midhun; Moon, Richard D C; Crofton, Anna; Haylock, Brian J; Rathi, Nitika; Brodbelt, Andrew R; Mills, Samantha J; Jenkinson, Michael D
Abstract: BACKGROUND: Asymptomatic meningioma is a common incidental finding with no consensus on the optimal management strategy. We aimed to develop a prognostic model to guide personalized monitoring of incidental meningioma patients.
METHODS: A prognostic model of disease progression was developed in a retrospective cohort (2007-2015), defined as: symptom development, meningioma-specific mortality, meningioma growth or loss of window of curability. Secondary endpoints included non-meningioma-specific mortality and intervention.
RESULTS: Included were 441 patients (459 meningiomas). Over a median of 55 months (interquartile range, 37-80), 44 patients had meningioma progression and 57 died (non-meningioma-specific). Forty-four had intervention (at presentation, n = 6; progression, n = 20; nonprogression, n = 18). Model parameters were based on statistical and clinical considerations and included: increasing meningioma volume (hazard ratio [HR] 2.17; 95% CI: 1.53-3.09), meningioma hyperintensity (HR 10.6; 95% CI: 5.39-21.0), peritumoral signal change (HR 1.58; 95% CI: 0.65-3.85), and proximity to critical neurovascular structures (HR 1.38; 95% CI: 0.74-2.56). Patients were stratified based on these imaging parameters into low-, medium- and high-risk groups and 5-year disease progression rates were 3%, 28%, and 75%, respectively. After 5 years of follow-up, the risk of disease progression plateaued in all groups. Patients with an age-adjusted Charlson comorbidity index ≥6 (eg, an 80-year-old with chronic kidney disease) were 15 times more likely to die of other causes than to receive intervention at 5 years following diagnosis, regardless of risk group.
CONCLUSIONS: The model shows that there is little benefit to rigorous monitoring in low-risk and older patients with comorbidities. Risk-stratified follow-up has the potential to reduce patient anxiety and associated health care costs.
© The Author(s) 2019. Published by Oxford University Press on behalf of the Society for Neuro-Oncology.
KEYWORDS: asymptomatic; incidental; meningioma; prognosis; risk score
Link to PubMed record
Author: Islim, Abdurrahman I; Kolamunnage-Dona, Ruwanthi; Mohan, Midhun; Moon, Richard D C; Crofton, Anna; Haylock, Brian J; Rathi, Nitika; Brodbelt, Andrew R; Mills, Samantha J; Jenkinson, Michael D
Abstract: BACKGROUND: Asymptomatic meningioma is a common incidental finding with no consensus on the optimal management strategy. We aimed to develop a prognostic model to guide personalized monitoring of incidental meningioma patients.
METHODS: A prognostic model of disease progression was developed in a retrospective cohort (2007-2015), defined as: symptom development, meningioma-specific mortality, meningioma growth or loss of window of curability. Secondary endpoints included non-meningioma-specific mortality and intervention.
RESULTS: Included were 441 patients (459 meningiomas). Over a median of 55 months (interquartile range, 37-80), 44 patients had meningioma progression and 57 died (non-meningioma-specific). Forty-four had intervention (at presentation, n = 6; progression, n = 20; nonprogression, n = 18). Model parameters were based on statistical and clinical considerations and included: increasing meningioma volume (hazard ratio [HR] 2.17; 95% CI: 1.53-3.09), meningioma hyperintensity (HR 10.6; 95% CI: 5.39-21.0), peritumoral signal change (HR 1.58; 95% CI: 0.65-3.85), and proximity to critical neurovascular structures (HR 1.38; 95% CI: 0.74-2.56). Patients were stratified based on these imaging parameters into low-, medium- and high-risk groups and 5-year disease progression rates were 3%, 28%, and 75%, respectively. After 5 years of follow-up, the risk of disease progression plateaued in all groups. Patients with an age-adjusted Charlson comorbidity index ≥6 (eg, an 80-year-old with chronic kidney disease) were 15 times more likely to die of other causes than to receive intervention at 5 years following diagnosis, regardless of risk group.
CONCLUSIONS: The model shows that there is little benefit to rigorous monitoring in low-risk and older patients with comorbidities. Risk-stratified follow-up has the potential to reduce patient anxiety and associated health care costs.
© The Author(s) 2019. Published by Oxford University Press on behalf of the Society for Neuro-Oncology.
KEYWORDS: asymptomatic; incidental; meningioma; prognosis; risk score
Link to PubMed record
CCC publication: Ambulatory emergency oncology: A key tenet of future emergency oncology care
Citation: International Journal of Clinical Practice. 2020, 74(1), e13436. 2019 Oct 21 [Epub ahead of print]
Author: Cooksley, Tim; Marshall, Will; Ahn, Shin; Lasserson, Daniel S; Marshall, Ernie; Rice, Terry W; Klotz, Adam
Abstract: The challenges of emergency oncology alongside its increasing financial burden has led to an interest in developing optimal care models for meeting patients' needs. Ambulatory care is recognized as a key tenet in ensuring the safety and sustainability of acute care services. Increased access to ambulatory care has successfully reduced ED utilization and improved clinical outcomes in high risk non-Oncological populations. Individualised management of acute cancer presentations is a key challenge for emergency oncology services so that it can mirror routine cancer care. There are an increasing number of acute cancer presentations, such as low risk febrile neutropenia and incidental pulmonary embolism, that can be risk assessed for care in an emergency ambulatory setting. Modelling of ambulatory emergency oncology services will be dependent on local service deliveries and pathways, but are key for providing high quality, personalised and sustainable emergency oncology care. These services will also be at the forefront of much needed emergency oncology to define the optimal management of ambulatory-sensitive presentations.
© 2019 John Wiley & Sons Ltd.
KEYWORDS: Ambulatory Care; Emergency Oncology; Febrile neutropenia; Incidental pulmonary embolism; MASCC
Link to PubMed record
Author: Cooksley, Tim; Marshall, Will; Ahn, Shin; Lasserson, Daniel S; Marshall, Ernie; Rice, Terry W; Klotz, Adam
Abstract: The challenges of emergency oncology alongside its increasing financial burden has led to an interest in developing optimal care models for meeting patients' needs. Ambulatory care is recognized as a key tenet in ensuring the safety and sustainability of acute care services. Increased access to ambulatory care has successfully reduced ED utilization and improved clinical outcomes in high risk non-Oncological populations. Individualised management of acute cancer presentations is a key challenge for emergency oncology services so that it can mirror routine cancer care. There are an increasing number of acute cancer presentations, such as low risk febrile neutropenia and incidental pulmonary embolism, that can be risk assessed for care in an emergency ambulatory setting. Modelling of ambulatory emergency oncology services will be dependent on local service deliveries and pathways, but are key for providing high quality, personalised and sustainable emergency oncology care. These services will also be at the forefront of much needed emergency oncology to define the optimal management of ambulatory-sensitive presentations.
© 2019 John Wiley & Sons Ltd.
KEYWORDS: Ambulatory Care; Emergency Oncology; Febrile neutropenia; Incidental pulmonary embolism; MASCC
Link to PubMed record
CCC publication: Radiographer non-medical prescribing: independence and implications for practice
Citation: Journal of Prescribing Practice. 2019, 1(10) 506-11
Author: Cain
Abstract: Non-medical prescribing is not a new initiative in healthcare. The modernisation of the NHS, strained workforces in radiotherapy and clinical oncology and the recognition that the role of the radiographer extends across the entire patient pathway has motivated development of therapeutic radiographer roles. For advanced, expert and consultant radiographers, this includes non–medical, supplementary, and independent prescribing authority. Limitations in current prescribing legislation have the potential to negatively impact these services. However, the overall benefits of non-medical prescribing for the patient, professional and entire workforce are undeniable. Radiographer non-medical prescribing is pertinent to the maintenance and continued improvement of cancer services.
Author: Cain
Abstract: Non-medical prescribing is not a new initiative in healthcare. The modernisation of the NHS, strained workforces in radiotherapy and clinical oncology and the recognition that the role of the radiographer extends across the entire patient pathway has motivated development of therapeutic radiographer roles. For advanced, expert and consultant radiographers, this includes non–medical, supplementary, and independent prescribing authority. Limitations in current prescribing legislation have the potential to negatively impact these services. However, the overall benefits of non-medical prescribing for the patient, professional and entire workforce are undeniable. Radiographer non-medical prescribing is pertinent to the maintenance and continued improvement of cancer services.
Thursday, 17 October 2019
WUTH publication: The Supracondylar Process: A Rare Case of Ulnar Nerve Entrapment and Literature Review
Citation: Journal of hand and microsurgery. 2019, 11(Suppl 1), S06-S10
Author: May-Miller P, Robinson S, Sharma P, Shahane S
Abstract: A fit and well 33-year-old male mechanic was referred to the clinic complaining of locking of right elbow and paraesthesia and pain affecting the forearm and hand. Radiographs demonstrated a right-sided supracondylar process. The patient had locking of his right elbow, which caused shooting pains both distally and proximally. The ulnar nerve was irritable proximal to the cubital tunnel, and there was some weakness of the ulnar nerve supplied muscles of the hand and forearm. The patient had a subjective feeling of altered sensation over the medial one and a half digits. The magnetic resonance imaging (MRI) suggested that there was anomalous anatomy around the elbow and that compression of the ulnar and or the median nerve by a fibrous band appeared to be the cause of his symptoms. A surgical exploration was arranged. The incision was posterior to the medial epicondyle. A fascial/muscular band was identified from the tip of the supratrochlear spur to the olecranon and was seen to kink the ulnar nerve. This was corrected upon its release. The supratrochlear spur was excised with an osteotome, and bone wax applied to the humerus. On review 6 weeks postoperatively, his function had returned to normal.
© Thieme Medical Publishers.
KEYWORDS: ligament of Struthers; supracondylar process; ulnar nerve
Link to PubMed record
Author: May-Miller P, Robinson S, Sharma P, Shahane S
Abstract: A fit and well 33-year-old male mechanic was referred to the clinic complaining of locking of right elbow and paraesthesia and pain affecting the forearm and hand. Radiographs demonstrated a right-sided supracondylar process. The patient had locking of his right elbow, which caused shooting pains both distally and proximally. The ulnar nerve was irritable proximal to the cubital tunnel, and there was some weakness of the ulnar nerve supplied muscles of the hand and forearm. The patient had a subjective feeling of altered sensation over the medial one and a half digits. The magnetic resonance imaging (MRI) suggested that there was anomalous anatomy around the elbow and that compression of the ulnar and or the median nerve by a fibrous band appeared to be the cause of his symptoms. A surgical exploration was arranged. The incision was posterior to the medial epicondyle. A fascial/muscular band was identified from the tip of the supratrochlear spur to the olecranon and was seen to kink the ulnar nerve. This was corrected upon its release. The supratrochlear spur was excised with an osteotome, and bone wax applied to the humerus. On review 6 weeks postoperatively, his function had returned to normal.
© Thieme Medical Publishers.
KEYWORDS: ligament of Struthers; supracondylar process; ulnar nerve
Link to PubMed record
Tuesday, 15 October 2019
WUTH publication: Assessment of steroid use as a key performance indicator in inflammatory bowel disease-analysis of data from 2385 UK patients
Citation: Alimentary pharmacology and therapeutics. 2019, 50(9), 1009-18 Epub 2019 Oct 8
Author: Selinger CP, Parkes GC, Bassi A, Limdi JK, Ludlow H, Patel P, Smith M, Saluke S, Ndlovu Z, George B, Saunders J, Adamson M, Fraser A, Robinson J, Donovan F, Parisi I, Tidbury J, Gray L, Pollok R, Scott G, Raine T
Abstract: BACKGROUND: Patients with IBD are at risk of excess corticosteroids.
AIMS: To assess steroid excess in a large IBD cohort and test associations with quality improvement and prescribing.
METHODS: Steroid exposure was recorded for outpatients attending 19 centres and associated factors analysed. Measures taken to avoid excess were assessed.
RESULTS: Of 2385 patients, 28% received steroids in the preceding 12 months. 14.8% had steroid excess or dependency. Steroid use was significantly lower at 'intervention centres' which participated in a quality improvement programme (exposure: 23.8% vs 31.0%, P < .001; excess 11.5% vs 17.1%, P < .001). At intervention centres, steroid use fell from 2015 to 2017 (steroid exposure 30.0%-23.8%, P = .003; steroid excess 13.8%-11.5%, P = .17). Steroid excess was judged avoidable in 50.7%. Factors independently associated with reduced steroid excess in Crohn's disease included maintenance with anti-TNF agents (OR 0.61 [95% CI 0.24-0.95]), treatment in a centre with a multi-disciplinary team (OR 0.54 [95% CI 0.20-0.86]) and treatment at an intervention centre (OR 0.72 [95% CI 0.46-0.97]). Treatment with 5-ASA in CD was associated with higher rates of steroid excess (OR 1.72 [95% CI 1.24-2.09]). In ulcerative colitis (UC), thiopurine monotherapy was associated with steroid excess (OR 1.97 [95% CI 1.19-3.01]) and treatment at an intervention centre with less steroid excess (OR 0.72 [95% CI 0.45-0.95]).
CONCLUSIONS: This study validates steroid assessment as a meaningful quality measure and provides a benchmark for this performance indicator in a large cohort. A programme of quality improvement was associated with lower steroid use.
Link to PubMed record
Author: Selinger CP, Parkes GC, Bassi A, Limdi JK, Ludlow H, Patel P, Smith M, Saluke S, Ndlovu Z, George B, Saunders J, Adamson M, Fraser A, Robinson J, Donovan F, Parisi I, Tidbury J, Gray L, Pollok R, Scott G, Raine T
Abstract: BACKGROUND: Patients with IBD are at risk of excess corticosteroids.
AIMS: To assess steroid excess in a large IBD cohort and test associations with quality improvement and prescribing.
METHODS: Steroid exposure was recorded for outpatients attending 19 centres and associated factors analysed. Measures taken to avoid excess were assessed.
RESULTS: Of 2385 patients, 28% received steroids in the preceding 12 months. 14.8% had steroid excess or dependency. Steroid use was significantly lower at 'intervention centres' which participated in a quality improvement programme (exposure: 23.8% vs 31.0%, P < .001; excess 11.5% vs 17.1%, P < .001). At intervention centres, steroid use fell from 2015 to 2017 (steroid exposure 30.0%-23.8%, P = .003; steroid excess 13.8%-11.5%, P = .17). Steroid excess was judged avoidable in 50.7%. Factors independently associated with reduced steroid excess in Crohn's disease included maintenance with anti-TNF agents (OR 0.61 [95% CI 0.24-0.95]), treatment in a centre with a multi-disciplinary team (OR 0.54 [95% CI 0.20-0.86]) and treatment at an intervention centre (OR 0.72 [95% CI 0.46-0.97]). Treatment with 5-ASA in CD was associated with higher rates of steroid excess (OR 1.72 [95% CI 1.24-2.09]). In ulcerative colitis (UC), thiopurine monotherapy was associated with steroid excess (OR 1.97 [95% CI 1.19-3.01]) and treatment at an intervention centre with less steroid excess (OR 0.72 [95% CI 0.45-0.95]).
CONCLUSIONS: This study validates steroid assessment as a meaningful quality measure and provides a benchmark for this performance indicator in a large cohort. A programme of quality improvement was associated with lower steroid use.
Link to PubMed record
Monday, 7 October 2019
WUTH publication: Xanthogranulomatous pyelonephritis with associated renal cell carcinoma
Citation: BMJ Case Reports. 2019, 12(10), e232097
Author: Moss BF, Potter L, Cliff A, Kumar M
Abstract: Xanthogranulomatous pyelonephritis is associated with obstruction, stones and infection. CT is the mainstay of diagnosis, but appearances can mimic other conditions, including renal cell carcinoma. Nephrectomy is commonly recommended, but conservative treatment with antibiotics has been described after tissue diagnosis. We present a case of xanthogranulomatous pyelonephritis with concomitant renal cell carcinoma, which was an association that was suggested in 1988 and supported by subsequently reported cases. Conservative management of biopsy or cytology proven xanthogranulomatous pyelonephritis is unsafe, as an area of synchronous malignant tumour may be missed: we recommend it only in patients unfit for nephrectomy.
© BMJ Publishing Group Limited 2019. No commercial re-use. See rights and permissions. Published by BMJ.
KEYWORDS: oncology; renal intervention; renal medicine; urological surgery; urology
Link to PubMed record
Author: Moss BF, Potter L, Cliff A, Kumar M
Abstract: Xanthogranulomatous pyelonephritis is associated with obstruction, stones and infection. CT is the mainstay of diagnosis, but appearances can mimic other conditions, including renal cell carcinoma. Nephrectomy is commonly recommended, but conservative treatment with antibiotics has been described after tissue diagnosis. We present a case of xanthogranulomatous pyelonephritis with concomitant renal cell carcinoma, which was an association that was suggested in 1988 and supported by subsequently reported cases. Conservative management of biopsy or cytology proven xanthogranulomatous pyelonephritis is unsafe, as an area of synchronous malignant tumour may be missed: we recommend it only in patients unfit for nephrectomy.
© BMJ Publishing Group Limited 2019. No commercial re-use. See rights and permissions. Published by BMJ.
KEYWORDS: oncology; renal intervention; renal medicine; urological surgery; urology
Link to PubMed record
Friday, 4 October 2019
WUTH publication: Need for A Central Renal Registry in Pakistan
Citation: Therapeutic apheresis and dialysis. 2019 Oct 3 [Epub ahead of print]
Author: Abid A, Abid H, Jamil A
Abstract: KEYWORDS: Acute kidney injury, Chronic kidney disease, Nephrology, Public health, Pakistan, Renal registry
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Author: Abid A, Abid H, Jamil A
Abstract: KEYWORDS: Acute kidney injury, Chronic kidney disease, Nephrology, Public health, Pakistan, Renal registry
Link to PubMed record
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