8 results on '"Alexander Bull"'
Search Results
2. P-OGC13 Chest drainage after oesophageal resection: A systematic review
- Author
-
Alexander Bull, Philip Pucher, Jesper Lagergren, and James Gossage
- Subjects
Surgery - Abstract
Background Modern enhanced recovery protocols discourage drain use due to negative impacts on patient comfort, mobility, and recovery, and lack of proven clinical benefit. After oesophagectomy, however, drains are still routinely placed. This review aimed to assess the evidence for, and how best to use chest drains after oesophageal surgery. Methods A systematic literature search was performed in Medline, Embase and Cochrane collaboration databases. Studies reporting outcomes for different types or uses of thoracic drainage, or outcomes related to drains after trans-thoracic oesophagectomy were included. Studies were collated into domains based on variations in number, position, type, removal criteria, diagnostic use and complications of drains. Methodological quality was assessed with Newcastle-Ottawa and Jadad scores. Results Among 434 potentially relevant studies, 27 studies met the inclusion criteria and these included 2564 patients. Studies that examined the number of drains showed pain reduction with a single drain compared to multiple drains (3 studies, n = 103), and transhiatal placement compared to intercostal (6 studies, n = 425). Amylase levels may aid diagnosis of anastomotic leak (9 studies, n = 888). Narrow calibre Blake drains may effectively drain both air and fluid (2 studies, n = 163). Drain removal criteria by daily drainage volumes of up to 300ml did not impact subsequent effusion rates (2 studies, n = 130). Complications related directly to drains were reported by 3 studies (n = 59). Conclusions Available evidence on the impact of thoracic drainage after oesophagectomy is limited, but has the potential to negatively affect outcomes. Further research is required to determine optimum drainage strategies.
- Published
- 2021
3. P-OGC12 Nasogastric tube drainage and pyloric intervention after oesophageal resection: UK practice variation and effect on outcomes
- Author
-
Alexander Bull, Philip Pucher, Nick Maynard, Tim Underwood, Jesper Lagergren, and James Gossage
- Subjects
Surgery - Abstract
Background Over 1,500 patients with oesophageal cancer undergo a resection in the UK each year. At surgery, patients commonly have a nasogastric tube (NGT) placed and may undergo a pyloric intervention. There is conflicting evidence on the use of both NGTs and pyloric interventions during oesophageal resections. We performed a national survey of oesophageal centres and assessed practice variation. Methods An electronic survey was distributed to all resection centres in England, Wales and Scotland. Variations in practice regarding NGTs and pyloric intervention were assessed, and compared to nationally reported centre volumes and length-of-stay data Results Most centres (31/39, 79%) responded to the survey. All centres reported routine NGT use. The majority of centres (19/31, 61%) did not perform pyloric interventions. When used, surgical pyloroplasty was the most frequent strategy (8/31, 26%). Routine post-operative radiological assessment was utilised in 9/31 (29%) of centres. Criteria for NGT removal and dietary progression was highly variable, with every centre reporting different protocols. There were no significant differences in practice between high and low volume centres. There were also no trends seen when comparing centres above vs at-or-below the median length-of-stay. The majority (68%) of centres were willing to take part in a trial assessing NGT use and pyloric interventions. Conclusions Pyloric intervention use varies widely, with no clear link to outcomes. NGT use remains standard practice despite evidence for safe omission. Surgeons require and recognise the need for a trial to assess requirement for NGTs and pyloric intervention after oesophageal resection.
- Published
- 2021
4. Nasogastric tube drainage and pyloric intervention after oesophageal resection: UK practice variation and effect on outcomes
- Author
-
Philip H. Pucher, Alexander Bull, Nick Maynard, James A. Gossage, Timothy J. Underwood, and Jesper Lagergren
- Subjects
medicine.medical_specialty ,business.industry ,General surgery ,Psychological intervention ,Tube drainage ,General Medicine ,Pyloroplasty ,United Kingdom ,Resection ,Low volume ,Esophagectomy ,Oncology ,Enhanced recovery ,Radiological weapon ,Intervention (counseling) ,Medicine ,Drainage ,Humans ,Surgery ,business ,Intubation, Gastrointestinal ,Pylorus - Abstract
Background: Over 1500 patients with oesophageal cancer undergo a resection in the UK each year. At surgery, patients commonly have a nasogastric tube (NGT) placed and may undergo a pyloric intervention. There is conflicting evidence on the use of both NGTs and pyloric interventions during oesophageal resections. We performed a national survey of oesophageal centres and assessed practice variation.Material and methods: An electronic survey was distributed to all resection centres in England, Wales and Scotland. Variations in practice regarding NGTs and pyloric intervention were assessed, and compared to nationally reported centre volumes and length-of-stay data.Results: Most centres (31/39, 79%) responded to the survey. All centres reported routine NGT use. The majority of centres (19/31, 61%) did not perform pyloric interventions. When used, surgical pyloroplasty was the most frequent strategy (8/31, 26%). Routine post-operative radiological assessment was utilised in 9/31 (29%) of centres. Criteria for NGT removal and dietary progression was highly variable, with every centre reporting different protocols. There were no significant differences in practice between high and low volume centres. There were also no trends seen when comparing centres above vs at-or-below the median length-of-stay. The majority (68%) of centres were willing to take part in a trial assessing NGT use and pyloric interventions.Conclusions: Pyloric intervention use varies widely, with no clear link to outcomes. NGT use remains standard practice despite evidence for safe omission. Surgeons require and recognise the need for a trial to assess requirement for NGTs and pyloric intervention after oesophageal resection.
- Published
- 2021
5. Chest drainage after oesophageal resection: A systematic review
- Author
-
Alexander Bull, Philip H Pucher, James A. Gossage, and Jesper Lagergren
- Subjects
medicine.medical_specialty ,business.industry ,General surgery ,Gastroenterology ,MEDLINE ,Amylase levels ,Anastomotic Leak ,General Medicine ,Anastomosis ,Jadad scale ,Resection ,Esophagectomy ,medicine ,Drainage ,Humans ,Drain removal ,business ,Device Removal ,Patient comfort - Abstract
Summary Background Modern enhanced recovery protocols discourage drain use due to negative impacts on patient comfort, mobility, and recovery, and lack of proven clinical benefit. After oesophagectomy, however, drains are still routinely placed. This review aimed to assess the evidence for, and how best to use chest drains after oesophageal surgery. Methods A systematic literature search was performed in Medline, Embase and Cochrane collaboration databases. Studies reporting outcomes for different types or uses of thoracic drainage, or outcomes related to drains after trans-thoracic oesophagectomy were included. Studies were collated into domains based on variations in number, position, type, removal criteria, diagnostic use and complications of drains. Methodological quality was assessed with Newcastle-Ottawa and Jadad scores. Results Among 434 potentially relevant studies, 27 studies met the inclusion criteria and these included 2564 patients. Studies that examined the number of drains showed pain reduction with a single drain compared to multiple drains (3 studies, n = 103), and transhiatal placement compared to intercostal (6 studies, n = 425). Amylase levels may aid diagnosis of anastomotic leak (9 studies, n = 888). Narrow calibre Blake drains may effectively drain both air and fluid (2 studies, n = 163). Drain removal criteria by daily drainage volumes of up to 300 mL did not impact subsequent effusion rates (2 studies, n = 130). Complications related directly to drains were reported by 3 studies (n = 59). Conclusion Available evidence on the impact of thoracic drainage after oesophagectomy is limited, but has the potential to negatively affect outcomes. Further research is required to determine optimum drainage strategies.
- Published
- 2021
6. Does the Disclosure of a Valuation Allowance Reinforce Misguided Incentives of a Progressive Capitalization of Deferred Taxes from Loss Carryforwards?
- Author
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Andreas Haaker and Alexander Bull
- Subjects
Incentive ,Public economics ,Economics ,Deferred tax ,TheoryofComputation_GENERAL ,High valuation ,Profit (economics) ,Capitalization ,Valuation (finance) - Abstract
This paper analyzes the incentive problems of the disclosure of a so-called valuation allowance of deferred taxes. Since the disclosure of a relatively high valuation allowance indicates a negative profit development, misguided incentives of a progressive capitalization of deferred taxes from loss carryforwards would have to occur in order to avoid a negative signal. As a result, this would especially increase the loss potential in times of crisis, which would probably lead to a failure of the company.
- Published
- 2012
7. De Novo Postinfectious Glomerulonephritis Secondary to Nephritogenic Streptococci as the Cause of Transplant Acute Kidney Injury: A Case Report and Review of the Literature
- Author
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Alexander Bullen and Mita M. Shah
- Subjects
Surgery ,RD1-811 - Abstract
Acute kidney injury is common among kidney transplant recipients. Postinfectious glomerulonephritis secondary to nephritogenic streptococci is one of the oldest known etiologies of acute kidney injury in native kidneys but rarely reported among kidney transplant recipients. This report is of a biopsy-proven case of acute kidney injury in a renal allograft recipient caused by de novo poststreptococcal glomerulonephritis.
- Published
- 2018
- Full Text
- View/download PDF
8. Renal Oxygenation in the Pathophysiology of Chronic Kidney Disease
- Author
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Zhi Zhao Liu, Alexander Bullen, Ying Li, and Prabhleen Singh
- Subjects
hypoxia ,renal oxygen consumption ,hypoxia inducible factor (HIF) ,AMPK ,chronic kidney disease pathophysiology ,Physiology ,QP1-981 - Abstract
Chronic kidney disease (CKD) is a significant health problem associated with high morbidity and mortality. Despite significant research into various pathways involved in the pathophysiology of CKD, the therapeutic options are limited in diabetes and hypertension induced CKD to blood pressure control, hyperglycemia management (in diabetic nephropathy) and reduction of proteinuria, mainly with renin-angiotensin blockade therapy. Recently, renal oxygenation in pathophysiology of CKD progression has received a lot of interest. Several advances have been made in our understanding of the determinants and regulators of renal oxygenation in normal and diseased kidneys. The goal of this review is to discuss the alterations in renal oxygenation (delivery, consumption and tissue oxygen tension) in pre-clinical and clinical studies in diabetic and hypertensive CKD along with the underlying mechanisms and potential therapeutic options.
- Published
- 2017
- Full Text
- View/download PDF
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