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1. Gastric cancer

Author

Karina A Baxter, Gauri S Chillarge, and Saj Wajed

Subjects
Building and Construction
Abstract

Gastric cancer (GC), although reducing in incidence in recent years, continues to be a common cancer worldwide, especially in developed countries where diets contain more red meat, fats and alcohol. Genetic factors and environmental factors such as Helicobacter pylori and other microbial associations play a role in the development of GC. GCs are more common in men and incidence increases with age. GC is a significant cause of morbidity and mortality. Unfortunately, GC is frequently diagnosed after curative treatment is no longer possible, because the most worrying symptoms develop at later stages of the disease. As a result, prognosis is poor. Common presenting features include upper abdominal discomfort, dyspepsia, acid reflux, unexplained anaemia and weight loss. Upper gastrointestinal endoscopy is the gold standard investigation for diagnosis of GC. The mainstay of curative treatment is surgery. Other treatment options include endoscopic mucosal resection, radiotherapy, chemotherapy and immunotherapy.

Published
2022

2. Regulation of nerve growth and patterning by cell surface protein disulphide isomerase

Author

Geoffrey M.W. Cook, Asanish Kalyanasundaram, Roger J. Keynes, Nol Swaddiwudhipong, Katherine Wiles, Prem Jareonsettasin, Catharina Casper, Ameer Abdullah, Saj Wajed, Serena Patel, Julia Schaeffer, Eleanor Walder, Pei Wei Chua, Catia Sousa, Mansoor Raza, Gioia Riboni-Verri, Andrew Hui, Keynes, Roger J [0000-0002-1557-7684], and Apollo - University of Cambridge Repository

Subjects
0301 basic medicine, Cell, Isomerase, Chick Embryo, somite, 0302 clinical medicine, repeat patterning, Biology (General), Cytoskeleton, spinal nerve, 0303 health sciences, Chemistry, axon guidance, General Neuroscience, General Medicine, Chicken, 3. Good health, Cell biology, medicine.anatomical_structure, Somites, Gene Knockdown Techniques, Medicine, Signal transduction, Signal Transduction, Research Article, Human, QH301-705.5, Science, Growth Cones, Procollagen-Proline Dioxygenase, Protein Disulfide-Isomerases, Nitric Oxide, General Biochemistry, Genetics and Molecular Biology, Cell Line, 03 medical and health sciences, medicine, Animals, Humans, natural sciences, Growth cone, 030304 developmental biology, General Immunology and Microbiology, Neurosciences, Membrane Proteins, Embryonic stem cell, Rats, Somite, 030104 developmental biology, Spinal Nerves, Astrocytes, Forebrain, Rat, Axon guidance, Developmental biology, Chickens, 030217 neurology & neurosurgery, Developmental Biology, Neuroscience
Abstract

Contact repulsion of growing axons is an essential mechanism for spinal nerve patterning. In birds and mammals the embryonic somites generate a linear series of impenetrable barriers, forcing axon growth cones to traverse one half of each somite as they extend towards their body targets. This study shows that protein disulphide isomerase provides a key component of these barriers, mediating contact repulsion at the cell surface in half-somites. Repulsion is reduced bothin vivoandin vitroby a range of methods that inhibit enzyme activity. The activity is critical in initiating a nitric oxide/S-nitrosylation-dependent signal transduction pathway that regulates the growth cone cytoskeleton. Rat forebrain grey matter extracts contain a similar activity, and the enzyme is expressed at the surface of cultured human astrocytic cells and rat cortical astrocytes. We suggest this system is co-opted in the brain to counteract and regulate aberrant nerve terminal growth.

Published
2020

4. Acute gastric outlet obstruction secondary to exclusive paraoesophageal small bowel herniation: a case report

Author

Saj Wajed, Jean-Charles de Schoutheete, and Alex M. Reece-Smith

Subjects
Thorax, Male, medicine.medical_specialty, 030204 cardiovascular system & hematology, 03 medical and health sciences, 0302 clinical medicine, Intestine, Small, Medicine, Humans, Hernia, 030212 general & internal medicine, Paraoesophageal hernia, Digestive System Surgical Procedures, Aged, business.industry, Gastric Outlet Obstruction, Stomach, digestive, oral, and skin physiology, Gastric outlet obstruction, General Medicine, medicine.disease, digestive system diseases, Diaphragm (structural system), Surgery, stomatognathic diseases, medicine.anatomical_structure, Hernia, Hiatal, Hiatus Hernias, business, Tomography, X-Ray Computed
Abstract

Introduction: Herniation of abdominal viscera into the thorax may occur as a consequence of abnormal defects in the diaphragm. In adults, the most common condition relates to herniations through a weakened crural orifice via which the oesophagus normally traverses. These hiatus hernias are classified as types I–IV depending on the extent of visceral involvement.Case report: We present here a case of type IV hiatus hernia with massive mediastinal herniation of the small bowel, yet remarkable in that the stomach itself remained completely intra-abdominal. Gastric outlet obstruction occurred as a consequence of extrinsic proximal small bowel compression.Discussion: To our knowledge this is the first reported case of paraoesophageal hernia exclusively involving small bowel, without involving any part of the stomach, and yet causing gastric outlet obstruction.

Published
2017

5. Preoperative risk factors for conversion from laparoscopic to open cholecystectomy: a validated risk score derived from a prospective U.K. database of 8820 patients

Author

Robert P. Sutcliffe, Marianne Hollyman, James Hodson, Glenn Bonney, Ravi S. Vohra, Ewen A. Griffiths, Stephen Fenwick, Mohamed Elmasry, Quentin Nunes, David Kennedy, Raja B. Khan, Muhammad A.S. Khan, Conor J. Magee, Steven M. Jones, Denise Mason, Ciny P. Parappally, Pawan Mathur, Michael Saunders, Sara Jamel, Samer U.l. Haque, Sara Zafar, Muhammad H. Shiwani, Nehemiah Samuel, Farooq Dar, Andrew Jackson, Bryony Lovett, Shiva Dindyal, Hannah Winter, Saquib Rahman, Kevin Wheatley, Tom Nieto, Soofiyah Ayaani, Haney Youssef, Rajwinder S. Nijjar, Helen Watkin, David Naumann, Sophie Emeshi, Piyush B. Sarmah, Kathryn Lee, Nikita Joji, Jonathan Heath, Rebecca L. Teasdale, Chamindri Weerasinghe, Paul J. Needham, Hannah Welbourn, Luke Forster, David Finch, Jane M. Blazeby, William Robb, Angus G.K. McNair, Alex Hrycaiczuk, Alexandros Charalabopoulos, Sritharan Kadirkamanathan, Cheuk-Bong Tang, Naga V.G. Jayanthi, Nigel Noor, Brian Dobbins, Andrew J. Cockbain, April Nilsen-Nunn, Jonathan de Siqueira, Mike Pellen, Jonathan B. Cowley, Wei-Min Ho, Victor Miu, Timothy J. White, Kathryn A. Hodgkins, Alison Kinghorn, Matthew G. Tutton, Yahya A. Al-Abed, Donald Menzies, Anwar Ahmad, Joanna Reed, Shabuddin Khan, David Monk, Louis J. Vitone, Ghulam Murtaza, Abraham Joel, Stephen Brennan, David Shier, Catherine Zhang, Thusidaran Yoganathan, Steven J. Robinson, Iain J.D. McCallum, Michael J. Jones, Mohammed Elsayed, Liz Tuck, John Wayman, Kate Carney, Somaiah Aroori, Kenneth B. Hosie, Adam Kimble, David M. Bunting, Adeshina S. Fawole, Mohammed Basheer, Rajiv V. Dave, Janahan Sarveswaran, Elinor Jones, Chris Kendal, Michael P. Tilston, Martin Gough, Tom Wallace, Shailendra Singh, Justine Downing, Katherine A. Mockford, Eyad Issa, Nayab Shah, Neal Chauhan, Timothy R. Wilson, Amir Forouzanfar, Jonathan R.L. Wild, Emma Nofal, Catherine Bunnell, Khaliel Madbak, Sudhindra T.V. Rao, Laurence Devoto, Najaf Siddiqi, Zechan Khawaja, James C. Hewes, Laura Gould, Alice Chambers, Daniel U. Rodriguez, Gourab Sen, Stuart Robinson, Francis Bartlett, David M. Rae, Thomas E.J. Stevenson, Kas Sarvananthan, Simon J. Dwerryhouse, Simon M. Higgs, Oliver J. Old, Thomas J. Hardy, Reena Shah, Steve T. Hornby, Ken Keogh, Lucinda Frank, Musallam Al-Akash, Emma A. Upchurch, Richard J. Frame, Michael Hughes, Clare Jelley, Simon Weaver, Sudipta Roy, Toritseju O. Sillo, Giorgios Galanopoulos, Tamzin Cuming, Pedro Cunha, Salim Tayeh, Sarantos Kaptanis, Mohamed Heshaishi, Abdalla Eisawi, Michael Abayomi, Wee S. Ngu, Katie Fleming, Dalvir S. Bajwa, Vivek Chitre, Kamal Aryal, Paul Ferris, Michael Silva, Simon Lammy, Sarah Mohamed, Amir Khawaja, Adnan Hussain, Mudassar A. Ghazanfar, Maria I. Bellini, Hamdi Ebdewi, Mohamed Elshaer, Gianpiero Gravante, Benjamin Drake, Arikoge Ogedegbe, Dipankar Mukherjee, Chanpreet Arhi, Lola Giwa, Nusrat Iqbal, Nicholas F. Watson, Smeer K. Aggarwal, Philippa Orchard, Eduardo Villatoro, Peter D. Willson, Kam W.J. Mok, Thomas Woodman, Jean Deguara, Giuseppe Garcea, Benoy I. Babu, Alistair R. Dennison, Deep Malde, David Lloyd, John P. Slavin, Robert P. Jones, Laura Ballance, Stratos Gerakopoulos, Periyathambi Jambulingam, Sami Mansour, Naomi Sakai, Vikas Acharya, Mohammed M. Sadat, Lawen Karim, David Larkin, Khalid Amin, Amarah Khan, Jennifer Law, Saurabh Jamdar, Stella R. Smith, Keerthika Sampat, Kathryn M. O'shea, Mangta Manu, Fotini M. Asprou, Nabeela S. Malik, Jessica Chang, Marianne Johnstone, Michael Lewis, Geoffrey P. Roberts, Babu Karavadra, Evangelos Photi, James Hewes, Dan Rodriguez, Derek A. O'Reilly, Anthony J. Rate, Hema Sekhar, Lucy T. Henderson, Benjamin Z. Starmer, Peter O. Coe, Sotonye Tolofari, Jenifer Barrie, Gareth Bashir, Jake Sloane, Suroosh Madanipour, Constantine Halkias, Alexander E.J. Trevatt, David W. Borowski, Jane Hornsby, Michael J. Courtney, Suvi Virupaksha, Keith Seymour, Sarah Robinson, Helen Hawkins, Sadiq Bawa, Paul V. Gallagher, Alistair Reid, Peter Wood, Jonathan G. Finch, J.Guy Finch, Jitesh Parmar, Euan Stirland, James Gardner-Thorpe, Ahmed Al-Muhktar, Mark Peterson, Ali Majeed, Farrukh M. Bajwa, Jack Martin, Alfred Choy, Andrew Tsang, Naresh Pore, David R. Andrew, Waleed Al-Khyatt, Christopher Taylor Santosh Bhandari, Adam Chambers, Dhivya Subramanium, Simon K.C. Toh, Nicholas C. Carter, Stuart J. Mercer, Benjamin Knight, Vardhini Vijay, Swethan Alagaratnam, Sidhartha Sinha, Shahab Khan, Shamsi S. El-Hasani, Abdulzahra A. Hussain, Vish Bhattacharya, Nisheeth Kansal, Tani Fasih, Claire Jackson, Midhat N. Siddiqui, Imran A. Chishti, Imogen J. Fordham, Zohaib Siddiqui, Harald Bausbacher, Ileana Geogloma, Kabita Gurung, George Tsavellas, Pradeep Basynat, Ashish K. Shrestha, Sanjoy Basu, Alok Chhabra, Mohan Harilingam, Mohamed Rabie, Mansoor Akhtar, Pradeep Kumar, Sadaf F. Jafferbhoy, Najam Hussain, Soulat Raza, Manzarul Haque, Imran Alam, Rabiya Aseem, Shakira Patel, Mehek Asad, Michael I. Booth, William R. Ball, Christopher P.J. Wood, Ana C. Pinho-Gomes, Ambareen Kausar, Mohammed Obeidallah, Joseph Varghase, Joshil Lodhia, Donal Bradley, Carla Rengifo, David Lindsay, Sivakumar Gopalswamy, Ian Finlay, Stacy Wardle, Naomi Bullen, Syed Y. Iftikhar, Altaf Awan, Javed Ahmed, Paul Leeder, Guiseppe Fusai, Giles Bond-Smith, Alicja Psica, Yogesh Puri, David Hou, Fergus Noble, Karoly Szentpali, Jack Broadhurst, Ravindra Date, Martin R. Hossack, Yan L. Goh, Paul Turner, Vinutha Shetty, Manel Riera, Christina A.W. Macano, Anisha Sukha, Shaun R. Preston, Jennifer R. Hoban, Daniel J. Puntis, Sophie V. Williams, Richard Krysztopik, James Kynaston, Jeremy Batt, Matthew Doe, Andrzej Goscimski, Gareth H. Jones, Claire Hall, Nick Carty, Jamil Ahmed, Sofoklis Panteleimonitis, Rohan T. Gunasekera, Andrea R.G. Sheel, Hannah Lennon, Caroline Hindley, Marcus Reddy, Ross Kenny, Natalie Elkheir, Emma R. McGlone, Rajasundaram Rajaganeshan, Kate Hancorn, Anita Hargreaves, Raj Prasad, David A. Longbotham, Dhakshinamoorthy Vijayanand, Imeshi Wijetunga, Paul Ziprin, Christopher R. Nicolay, Geoffrey Yeldham, Edward Read, James A. Gossage, Rachel C. Rolph, Husam Ebied, Manraj Phull, Mohammad A. Khan, Matthew Popplewell, Dimitrios Kyriakidis, Anwar Hussain, Natasha Henley, Jessica R. Packer, Laura Derbyshire, Jonathan Porter, Shaun Appleton, Marwan Farouk, Melvinder Basra, Neil A. Jennings, Shahda Ali, Venkatesh Kanakala, Haythem Ali, Risha Lane, Richard Dickson-Lowe, Prizzi Zarsadias, Darius Mirza, Sonia Puig, Khalid Al Amari, Deepak Vijayan, Robert Sutcliffe, Ravi Marudanayagam, Zayed Hamady, Abheesh R. Prasad, Abhilasha Patel, Damien Durkin, Parminder Kaur, Laura Bowen, James P. Byrne, Katherine L. Pearson, Theo G. Delisle, James Davies, Mark A. Tomlinson, Michelle A. Johnpulle, Corinna Slawinski, Andrew Macdonald, James Nicholson, Katy Newton, James Mbuvi, Ansar Farooq, Bhavani S. Mothe, Zakhi Zafrani, Daniel Brett, James Francombe, Philip Spreadborough, James Barnes, Melanie Cheung, Ahmed Z. Al-Bahrani, Giuseppe Preziosi, Tomas Urbonas, Justin Alberts, Mekhlola Mallik, Krashna Patel, Ashvina Segaran, Triantafyllos Doulias, Pratik A. Sufi, Caroline Yao, Sarah Pollock, Antonio Manzelli, Saj Wajed, Michail Kourkulos, Roberto Pezzuto, Martin Wadley, Emma Hamilton, Shameen Jaunoo, Robert Padwick, Mazin Sayegh, Richard C. Newton, Madhusoodhana Hebbar, Sameh F. Farag, Madhu Hebbar, John Spearman, Mohammed F. Hamdan, Conrad D'Costa, Christine Blane, Mathew Giles, Mark B. Peter, Natalie A. Hirst, Tanvir Hossain, Arslan Pannu, Yesar El-Dhuwaib, Tamsin E.M. Morrison, Greg W. Taylor, Ronald L.E. Thompson, Ken McCune, Paula Loughlin, Roger Lawther, Colman K. Byrnes, Duncan J. Simpson, Abi Mawhinney, Conor Warren, Damian McKay, Colin McIlmunn, Serena Martin, Matthew MacArtney, Tom Diamond, Phil Davey, Claire Jones, Joshua M. Clements, Ruairi Digney, Wei M. Chan, Stephen McCain, Sadaf Gull, Adam Janeczko, Emmet Dorrian, Andrew Harris, Suzanne Dawson, Dorothy Johnston, Barry McAree, Essam Ghareeb, George Thomas, Martin Connelly, Stephen McKenzie, Krzysztos Cieplucha, Gary Spence, William Campbell, Gareth Hooks, Neil Bradley, Arnold D.K. Hill, John T. Cassidy, Michael Boland, Paul Burke, Deirdre M. Nally, Elmoataz Khogali, Wael Shabo, Edrin Iskandar, Gerry P. McEntee, Maeve A. O'Neill, Colin Peirce, Emma M. Lyons, Adrian W. O'Sullivan, Rohan Thakkar, Paul Carroll, Ivan Ivanovski, Paul Balfe, Matthew Lee, Des C. Winter, Michael E. Kelly, Emir Hoti, Donal Maguire, Priyadarssini Karunakaran, Justin G. Geoghegan, Sean T. Martin, Keith S. Cross, Fiachra Cooke, Saquib Zeeshan, James O. Murphy, Ken Mealy, Helen M. Mohan, Yuwaraja Nedujchelyn, Muhammad F. Ullah, Irfan Ahmed, Francesco Giovinazzo, James Milburn, Sarah Prince, Eleanor Brooke, Joanna Buchan, Ahmed M. Khalil, Elizabeth M. Vaughan, Michael I. Ramage, Roland C. Aldridge, Simon Gibson, Gary A. Nicholson, David G. Vass, Alan J. Grant, David J. Holroyd, Angharad Jones, Cherith M.L.R. Sutton, Patrick O'Dwyer, Frida Nilsson, Beatrix Weber, Tracey K. Williamson, Kushik Lalla, Alice Bryant, Ross Carter, Craig R. Forrest, David I. Hunter, Ahmad H. Nassar, Mavis N. Orizu, Katrina Knight, Haitham Qandeel, Stuart Suttie, Rowena Belding, Andrew McClarey, Alan T. Boyd, Graeme J.K. Guthrie, Pei J. Lim, Andreas Luhmann, Angus J.M. Watson, Colin H. Richards, Laura Nicol, Marta Madurska, Ewen Harrison, Kathryn M. Boyce, Amanda Roebuck, Graeme Ferguson, Pradeep Pati, Michael S.J. Wilson, Faith Dalgaty, Laura Fothergill, Peter J. Driscoll, Kirsty L. Mozolowski, Victoria Banwell, Stephen P. Bennett, Paul N. Rogers, Brendan L. Skelly, Claire L. Rutherford, Ahmed K. Mirza, Taha Lazim, Henry C.C. Lim, Diana Duke, Talat Ahmed, William D. Beasley, Marc D. Wilkinson, Geta Maharaj, Cathy Malcolm, Timothy H. Brown, Guy M. Shingler, Nicholas Mowbray, Rami Radwan, Paul Morcous, Simon Wood, Abbas Kadhim, Duncan J. Stewart, Andrew L. Baker, Nicola Tanner, and Hrishikesh Shenoy

Subjects
Male, Databases, Factual, medicine.medical_treatment, 0302 clinical medicine, Risk Factors, Odds Ratio, Prospective Studies, Prospective cohort study, Framingham Risk Score, Gastroenterology, Age Factors, Gallbladder, Middle Aged, Conversion to Open Surgery, Treatment Outcome, Cholecystectomy, Laparoscopic, 030220 oncology & carcinogenesis, Predictive value of tests, 030211 gastroenterology & hepatology, Female, Original Article, Risk assessment, Dilatation, Pathologic, Adult, medicine.medical_specialty, Digestive System Diseases, MEDLINE, Risk Assessment, 03 medical and health sciences, Sex Factors, Predictive Value of Tests, medicine, Humans, Aged, Common Bile Duct, Chi-Square Distribution, Hepatology, Laparoscopyc cholecystectomy, business.industry, General surgery, Reproducibility of Results, Odds ratio, United Kingdom, Surgery, preoperative assessment, Logistic Models, Multivariate Analysis, Cholecystectomy, business, Chi-squared distribution, risk factors
Abstract

Laparoscopic cholecystectomy is commonly performed, and several factors increase the risk of open conversion, prolonging operating time and hospital stay. Preoperative stratification would improve consent, scheduling and identify appropriate training cases. The aim of this study was to develop a validated risk score for conversion for use in clinical practice.Preoperative patient and disease-related variables were identified from a prospective cholecystectomy database (CholeS) of 8820 patients, divided into main and validation sets. Preoperative predictors of conversion were identified by multivariable binary logistic regression. A risk score was developed and validated using a forward stepwise approach.Some 297 procedures (3.4%) were converted. The risk score was derived from six significant predictors: age (p = 0.005), sex (p 0.001), indication for surgery (p 0.001), ASA (p 0.001), thick-walled gallbladder (p = 0.040) and CBD diameter (p = 0.004). Testing the score on the validation set yielded an AUROC = 0.766 (p 0.001), and a score6 identified patients at high risk of conversion (7.1% vs. 1.2%).This validated risk score allows preoperative identification of patients at six-fold increased risk of conversion to open cholecystectomy.

Published
2016

6. Transthoracic repair of an incarcerated diaphragmatic hernia using hexamethylene diisocyanate cross-linked porcine dermal collagen (Permacol)

Author

Benn Gooch, Neil J. Smart, and Saj Wajed

Subjects
Adult, Male, Pulmonary and Respiratory Medicine, medicine.medical_specialty, medicine.medical_treatment, Paraesophageal Hernias, chemistry.chemical_compound, medicine, Humans, Thoracotomy, Dermal collagen, Surgical approach, business.industry, General surgery, Incarcerated diaphragmatic hernia, General Medicine, Past history, Surgery, stomatognathic diseases, Hernia, Hiatal, Treatment Outcome, chemistry, Hexamethylene diisocyanate, Collagen, Tomography, X-Ray Computed, Cardiology and Cardiovascular Medicine, business, Abdominal surgery
Abstract

It is the general surgeon who commonly repairs paraesophageal hernias nowadays, and they are repaired laparoscopically, making the performance of thoracotomy relatively rare. Whether to use prosthetic materials to repair the hiatus is still under debate, as is the question of which material to use, if any. We report a case of a 38-year-old man who had a large, incarcerated paraesophageal hernia. He had a past history of extensive abdominal surgery for exomphalos, which rendered any abdominal surgical approach a high-risk procedure. We therefore decided to proceed with thoracotomy and repair of the hiatus with hexamethylene diisocyanate (HMDI) cross-linked porcine dermal collagen. He made a good recovery with no complications.

Published
2012

7. The mass effect of a slowly growing GIST

Author

Saj Wajed, Antonio Manzelli, Leandro Siragusa, and Deepali Prakash

Subjects
Male, medicine.medical_specialty, Gastrointestinal Stromal Tumors, Diagnosis, Differential, Lesion, 03 medical and health sciences, 0302 clinical medicine, Rare Disease, Stomach Neoplasms, Surgical oncology, Biomarkers, Tumor, medicine, Humans, Pancreas, Digestive System Surgical Procedures, Pelvis, Aged, Ultrasonography, GiST, business.industry, Stomach, Mass effect, General Medicine, Treatment Outcome, medicine.anatomical_structure, 030220 oncology & carcinogenesis, Splenectomy, Histopathology, Radiology, medicine.symptom, Tomography, X-Ray Computed, business, Splenic Artery, 030217 neurology & neurosurgery, Rare disease
Abstract

Gastrointestinal stromal tumours (GISTs) are typically defined as solid masses arising from the GI tract, most commonly from the stomach and small intestine. They seldom present in a cystic form. Management of cystic masses arising from the GI tract may pose a diagnostic predicament. We had one such case that presented itself with complaints of a slow growing intra-abdominal mass. An ultrasound scan demonstrated a thick-walled cystic lesion arising from the pelvis. Further imaging evaluations in the form of a CT scan revealed a complex large cystic mass arising from left upper quadrant (see Figure 1). Due to the uncertainty of origin of this mass and lack of invasion or lymphadenopathy, it was thought to be benign. After a multidisciplinary meeting, it was concluded that an urgent surgical excision of this benign mass was the best treatment. The surgical treatment of which entailed a 10 hours surgery to resect this 10 kg lesion, which comprised 7 L fluid and 3 kg solid mass. Histopathology aided in the diagnosis of this lesion as a CD117-positive and DOG1-positive GIST.

Published
2018

8. The decision to operate: role of integrated computed tomography positron emission tomography in staging oesophageal and oesophagogastric junction cancer by the multidisciplinary team☆

Author

Mark Napier, Keith Mitchell, Elizabeth Toy, Wei-Lup Wong, Saj Wajed, Richard G. Berrisford, and David Day

Subjects
Adult, Male, Pulmonary and Respiratory Medicine, medicine.medical_specialty, Esophageal Neoplasms, medicine.medical_treatment, Decision Making, medicine, Thoracoscopy, Humans, Minimally Invasive Surgical Procedures, Esophagus, Prospective cohort study, Lymph node, Aged, Neoplasm Staging, Aged, 80 and over, Patient Care Team, medicine.diagnostic_test, Esophageal disease, business.industry, Patient Selection, Induction chemotherapy, General Medicine, Middle Aged, medicine.disease, Surgery, Esophagectomy, medicine.anatomical_structure, Positron emission tomography, Lymphatic Metastasis, Positron-Emission Tomography, Female, Esophagogastric Junction, Radiology, Epidemiologic Methods, Cardiology and Cardiovascular Medicine, business
Abstract

Objective: Our objective was to assess the role of fusion positron emission tomography-computed tomography (PET-CT) in staging patients for minimally invasive oesophagectomy (MIO) with potentially resectable disease from the perspective of a multidisciplinary team (MDT) deciding on operability with conventional staging investigations. Methods: Fifty consecutive patients presenting with potentially operable oesophageal or oesophagogastric junctional tumours were staged with computed tomography (CT) and endoluminal ultrasound (EUS). The MDTcategorised patients as group A (n = 33; CT N0M0) or group B (n = 17; CT N1/possible M1). All patients underwent FDG PET-CT. Patients with localised disease (at T3), including single level N1 disease on PET-CT, were deemed suitable for induction chemotherapy followed by surgery. Results: PET-CTre-categorised 12% of patients as inoperable on grounds of distant metastases (four in group A, two in group B). Five patients did not proceed to resection for other reasons. Two had metastatic disease at thoracoscopy. Resection specimens (n = 37) contained 24 nodes (median). Compared with pN status, positive predictive value of PET-CT was 40% and negative predictive value was 43%. The expected PET-CT N1 group had the highest mean number of involved nodes. Median survival for all patients (n = 50) was 31.9 months for group A compared with 17.3 months for group B (not statistically significant). There was no significant difference between patients who were PETCT N0 or N1 in survival or disease-free survival in patients undergoing surgery (n = 37). Conclusions: PET-CT informs the MDT decision to operate in avoiding futile surgery in stage IV disease or widespread nodal disease. In this study, overall PET-CT N1 status has low positive and negative predictive valuefor overall pN status. # 2008 European Association for Cardio-Thoracic Surgery. Published by Elsevier B.V. All rights reserved.

Published
2008

10. Common variants at the MHC locus and at chromosome 16q24.1 predispose to Barrett's esophagus

Author

Nicholas W. Wood, Chris C. A. Spencer, Konrad Koss, Heike I. Grabsch, Ananth C. Viswanathan, Simon C. Potter, Thomas L. Vaughan, Brian J. Reid, Céline Bellenguez, Kimberley Howarth, Claire Brooks, Michael Gibbons, Geoffrey Liu, David Ferry, Ian Tomlinson, Chuka U. Nwokolo, John de Caestecker, Barrie Rathbone, Francesco Lescai, Anna Rautanen, Weimin Ye, Nicholas I. Church, Nigel C. Bird, Laura J. Hardie, Peter H. Watson, Ross McManus, Peter Donnelly, David Cunningham, Peter Sasieni, Aiden Corvin, Cisca Wijmenga, Sarah Edkins, Amy Strange, Sheldon C. Cooper, Audrey Duncanson, Harvey A. Risch, Ian Sargeant, Christopher Macdonald, Pradeep Bhandari, Sarah E. Hunt, Matthew D. Rutter, John V. Reynolds, Nigel Trudgill, Rebecca Harrison, Anna H. Wu, Scott Sanders, Christopher G. Mathew, Mark S. Anderson, Raf Bisschops, Cathryn Edwards, Avazeh Tashakkori-Ghanbaria, Praful Patel, Wong Ho Chow, Anouk Van Der Winkel, Panos Deloukas, Kishor Vaidya, Manoj Nanji, Nichola L. Gellatly, Leena Peltonen, Iain A. Murray, Matthew A. Brown, Deborah Glancy, Marilie D. Gammon, Robert Plomin, Julie Hapeshi, Elia Stupka, Janusz Jankowski, Liam J. Murray, Alan G. Casson, Hugh McMurtry, Haythem Ali, Douglas A. Corley, Kausila Krishnadath, Hugh Barr, David Johnston, Derek Alderson, Ruth E Langley, Elvira Bramon, Saj Wajed, Sharon Love, Peter D. Siersema, Ernst J. Kuipers, Simon Panter, Mark R. Middleton, Ian D. Penman, Peter Isaacs, Krish Ragunath, David K. Levine, Paul Atherfold, Maikel P. Peppelenbosch, Joost P.H. Drenth, Claire Palles, Art Tucker, Stephen Attwood, Cordelia Langford, Rui Zhang, Matti Pirinen, Colin Freeman, Stephen Sawcer, Stuart MacGregor, Hugh S. Markus, S Paterson, Anna M. Nicholson, M Griffin, Nicola Burch, Colin Rodgers, Helen Winter, Anjan Dhar, Zhan Su, Emma Gray, Jantine W. P. M. van Baal, Richard C. Trembath, David Monk, Paul Mullins, Danielle Morris, Ashref Tawil, Serge Dronov, Hans Prenen, Yeng Ang, Dermot Kelleher, Gavin Band, Leslie Bernstein, Weronica E. Ek, H Smart, Luc J. W. van der Laan, Colin N. A. Palmer, Jenefer M. Blackwell, Wilbert H.M. Peters, David C. Whiteman, Tore Lind, Gosia Trynka, Helen Dallal, Paul Moayyedi, Russell D. Petty, Richard S. Gillies, Nicholas J. Shaheen, Chris Haigh, Sue Cullen, Gareth E. Davies, Julia Brown, Jean-Baptiste Cazier, Juan P. Casas, Yvonne Romero, AGEM - Amsterdam Gastroenterology Endocrinology Metabolism, CCA -Cancer Center Amsterdam, Gastroenterology and Hepatology, Groningen Institute for Gastro Intestinal Genetics and Immunology (3GI), Gastroenterology & Hepatology, and Surgery

Subjects
Male, Linkage disequilibrium, Genome-wide association study, GASTROESOPHAGEAL-REFLUX DISEASE, Barrett’s Esophagus, Gastroenterology, Linkage Disequilibrium, Major Histocompatibility Complex, 0302 clinical medicine, Gene Frequency, Metaplasia, Molecular gastro-enterology and hepatology Membrane transport and intracellular motility [IGMD 2], POPULATION, Gastro-esophageal reflux disease (GERD), Genetics, education.field_of_study, Single nucleotide polymorphisms (SNPs), Middle Aged, CANCER, 3. Good health, Esophageal adenocarcinoma (EAC), medicine.anatomical_structure, 030220 oncology & carcinogenesis, OBESITY, Adenocarcinoma, Female, 030211 gastroenterology & hepatology, medicine.symptom, Molecular gastro-enterology and hepatology Translational research [IGMD 2], Adult, medicine.medical_specialty, SUSCEPTIBILITY LOCI, Population, Locus (genetics), Biology, Polymorphism, Single Nucleotide, Article, Genome-wide association (GWA) study, Barrett Esophagus, 03 medical and health sciences, SDG 3 - Good Health and Well-being, Internal medicine, medicine, Humans, Genetic Predisposition to Disease, Esophagus, GENOME-WIDE ASSOCIATION, education, METAANALYSIS, Aged, Models, Genetic, ADENOCARCINOMA, medicine.disease, digestive system diseases, Genetic Loci, Case-Control Studies, Barrett's esophagus, RISK-FACTORS, METAPLASIA, Human medicine, Chromosomes, Human, Pair 16, Genome-Wide Association Study
Abstract

Barrett's esophagus is an increasingly common disease that is strongly associated with reflux of stomach acid and usually a hiatus hernia, and it strongly predisposes to esophageal adenocarcinoma (EAC), a tumor with a very poor prognosis. We report the first genome-wide association study on Barrett's esophagus, comprising 1,852 UK cases and 5,172 UK controls in the discovery stage and 5,986 cases and 12,825 controls in the replication stage. Variants at two loci were associated with disease risk: chromosome 6p21, rs9257809 (P combined = 4.09 × 10-9; odds ratio (OR) = 1.21, 95% confidence interval (CI) =1.13-1.28), within the major histocompatibility complex locus, and chromosome 16q24, rs9936833 (P combined = 2.74 × 10-10; OR = 1.14, 95% CI = 1.10-1.19), for which the closest protein-coding gene is FOXF1, which is implicated in esophageal development and structure. We found evidence that many common variants of small effect contribute to genetic susceptibility to Barrett's esophagus and that SNP alleles predisposing to obesity also increase risk for Barrett's esophagus. © 2012 Nature America, Inc. All rights reserved.

Published
2012

12. Transgastric drainage of the oesophagus: managing difficult oesophageal injuries

Author

Rakesh Krishnadas, Peter Froeschle, Richard G. Berrisford, and Saj Wajed

Subjects
Pulmonary and Respiratory Medicine, Suction (medicine), Male, medicine.medical_specialty, Drainage procedure, medicine.medical_treatment, Perforation (oil well), Suction, Preoperative care, Abdominal wall, Esophagus, Swallowing, Percutaneous endoscopic gastrostomy, Preoperative Care, medicine, Humans, Aged, business.industry, General Medicine, Middle Aged, Surgery, medicine.anatomical_structure, Treatment Outcome, Chest Tubes, Cardiology and Cardiovascular Medicine, business
Abstract

We describe a technique for maintaining patency of the injured or repaired oesophagus while providing vacuum drainage of the oesophageal lumen. A small midline laparotomy is performed. A lubricated 36F soft chest drain (pull-through end) is introduced into the oesophagus using a percutaneous endoscopic gastrostomy (PEG) set, and pulled out through the stomach wall. The drain is brought out through the abdominal wall and the stomach is anchored to the peritoneum. The transgastric drain is positioned across the oesophageal defect. A feeding jejunostomy is placed. Decontamination and drainage of the chest is performed if the patient’s condition allows. The patient takes sterile water by mouth to maintain drain patency, with10 cm H2O suction applied.We have used this drainage procedure in seven patients (Boerhaave’s syndrome(n = 4), operative injury (n = 3)). In five patients with injuries close to the oesophagogastric junction, this method was used as an adjunct to primary repair. There were no deaths; the oesophageal defect healed in all patients without stricture. All patients are swallowing normally at follow-up. This procedure is presented as an option for patients who are unfit for primary repair, or whose primary repair would benefit from efficient drainage and protection. # 2008 European Association for Cardio-Thoracic Surgery. Published by Elsevier B.V. All rights reserved.

Published
2007

14. Absence of gastroesophageal reflux disease in a majority of patients taking acid suppression medications after Nissen fundoplication

Author

Christopher G. Streets, David J. Bowrey, Rodney J. Mason, Jeffrey A. Hagen, Jeffrey H. Peters, Michael G. Wood, Steven R. DeMeester, Saj Wajed, Anna Kaminski, Peter F. Crookes, Tom R. DeMeester, and Reginald V. Lord

Subjects
Laparoscopic surgery, medicine.medical_specialty, Hepatology, medicine.diagnostic_test, business.industry, medicine.medical_treatment, Gastroenterology, Reflux, Heartburn, Nissen fundoplication, medicine.disease, Internal medicine, Cohort, Regurgitation (digestion), medicine, GERD, medicine.symptom, Esophageal pH monitoring, business
Abstract

Recent studies have shown that many patients use acid suppression medications after antireflux surgery. The aim of this study was to determine the frequency of gastroesophageal reflux disease in a cohort of surgically treated patients with postoperative symptoms and a high prevalence of acid suppression medication use. The study group consisted of 86 patients who had symptoms following Nissen fundoplication that were sufficient to merit evaluation with 24-hour distal esophageal pH monitoring. All completed a detailed symptom questionnaire. The mean postoperative follow-up period was 28 months (median 18 months). Thirty-seven patients (43%) were taking acid suppression medications after fundoplication. Only 23% (20 of 86) of all the patients and only 24% (9 of 37) of those taking acid suppression medications had abnormal esophageal acid exposure on the 24-hour pH study. Heartburn and regurgitation were the only symptoms that were significantly associated with an abnormal pH study. Endoscopic assessment of the fundoplication was the most significant factor associated with an abnormal pH study. Multivariable logistic regression analysis showed that patients with a disrupted, abnormally positioned fundoplication had a 52.6 times increased risk of abnormal esophageal acid exposure. Most patients who use acid suppression medications after antireflux surgery do not have abnormal esophageal acid exposure, and the use of these medications is thus often inappropriate. Because of the limited predictive power of symptoms, objective evidence of reflux disease should be obtained before prescribing acid suppression medication for patients who have undergone antireflux surgery.

Published
2001

15. The myth of dysphagia after antireflux surgery: Analysis of swallowing difficulty in patients with GERD

Author

Reginald V. Lord, Jeffrey A. Hagen, Tom R. DeMeester, S. R. DeMeester, Christopher G. Streets, Cedric G. Bremner, Michael G. Wood, Saj Wajed, Jeffrey H. Peters, Dennis Blom, David J. Bowrey, and Peter F. Crookes

Subjects
Antireflux surgery, medicine.medical_specialty, Hepatology, business.industry, General surgery, Gastroenterology, medicine.disease, Dysphagia, Surgery, Swallowing difficulty, medicine, GERD, In patient, medicine.symptom, business
Published
2000

16. A study of 100 patients with hypertensive lower esophageal sphincter

Author

Abraham Nisim, David J. Bowrey, Cedric G. Bremner, Peter F. Crookes, Tom R. DeMeester, Jeffrey H. Peters, Reginald V. Lord, Ines Gockel, Saj Wajed, Pedram Hamrah, and Dennis Blom

Subjects
medicine.medical_specialty, Hepatology, business.industry, Gastroenterology, Urology, Medicine, business, Hypertensive lower esophageal sphincter
Published
2000

17. Severe ineffective esophageal motility: results of antireflux surgery

Author

Christopher G. Streets, S. R. DeMeester, Jeffrey A. Hagen, Cedric G. Bremner, Peter F. Crookes, Jeffrey H. Peters, Tom R. DeMeester, Saj Wajed, Michael G. Wood, Reginald V. Lord, Dennis Blom, and Bowrey J. David

Subjects
Antireflux surgery, medicine.medical_specialty, Hepatology, business.industry, Internal medicine, Gastroenterology, Medicine, business, Esophageal motility, Surgery
Published
2000

18. Lower esophageal sphincter residual pressure is related to dysphagia or recurrent reflux after nissen fundoplication

Author

Jeffrey H. Peters, Saj Wajed, Michael G. Wood, Peter F. Crookes, Reginald V. Lord, Anna Kaminski, David J. Bowrey, Tom R. DeMeester, Steven R. DeMeester, Rodney J. Mason, Cedric G. Bremner, and Dennis Blom

Subjects
medicine.medical_specialty, Hepatology, business.industry, medicine.medical_treatment, General surgery, Gastroenterology, Recurrent reflux, Nissen fundoplication, Dysphagia, Surgery, Residual pressure, medicine, Esophageal sphincter, medicine.symptom, business
Published
2000

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