Fertility and pregnancy in adrenal insufficiency.

Despite the availability of adrenal hormone replacement therapy, patients with adrenal insufficiency can be affected by reduced fertility and parity. Patients with well-managed adrenal insufficiency are expected to have uneventful pregnancies and favourable outcomes, but an increased risk of maternal and neonatal complications has been reported in some cases. Many physiological changes occur to the hypothalamic-pituitary-adrenal (HPA) axis during pregnancy, often making a new diagnosis and management of adrenal insufficiency challenging.

Pregnancy After Breast Cancer - Prognostic Safety and Pregnancy Outcomes According to Oestrogen Receptor Status: A Systematic Review.

Purpose: Breast cancer is the primary cause of cancer-related death in women. Women diagnosed with estrogen receptor (ER)-positive breast cancer have prolonged treatment durations. Owing to the paucity of research and lack of consensus regarding conception planning and pregnancy for patients with ER-positive breast cancer, we aimed to assess pregnancy and survival outcomes in women with ER-positive breast cancer during and after treatment.

Does metformin improve reproduction outcomes for non-obese, infertile women with polycystic ovary syndrome? Meta-analysis and systematic review.

Background: Polycystic ovary syndrome (PCOS) affects 10-12% of women of reproductive age. The prevalence of infertility in women with PCOS is high at between 70 and 80%. Treatment initially includes recommendations to follow preconception guidelines, such as lifestyle changes, folic acid therapy and halting the consumption of tobacco and alcohol.

ENSAT registry-based randomized clinical trials for adrenocortical carcinoma.

Adrenocortical carcinoma (ACC) is an orphan disease lacking effective systemic treatment options. The low incidence of the disease and high cost of clinical trials are major obstacles in the search for improved treatment strategies. As a novel approach, registry-based clinical trials have been introduced in clinical research, so allowing for significant cost reduction, but without compromising scientific benefit.

Discrepancy between post-treatment infarct volume and 90-day outcome in the ESCAPE randomized controlled trial.

Background: Some patients with ischemic stroke have poor outcomes despite small infarcts after endovascular thrombectomy, while others with large infarcts sometimes fare better.

Aims: We explored factors associated with such discrepancies between post-treatment infarct volume (PIV) and functional outcome.

Methods: We identified patients with small PIV (volume ≤ 25th percentile) and large PIV (volume ≥ 75th percentile) on 24-48-h CT/MRI in the ESCAPE randomized-controlled trial.

Adrenal crisis: prevention and management in adult patients.

Adrenal crisis is an acute life-threatening emergency contributing to the excess mortality that is reported in patients with adrenal insufficiency. The incidence of adrenal crisis is estimated to be 8 per 100 patient years in patients with adrenal insufficiency. Patients with adrenal crisis present systemically unwell with nonspecific signs and symptoms often leading to misdiagnosis and delayed treatment.

Factors impacting on the action of glucocorticoids in patients receiving glucocorticoid therapy.

Glucocorticoids (GCs) are steroid hormones, which are essential for life. They are secreted by the adrenal cortex under the control of the hypothalamic-pituitary-adrenal (HPA) axis. Glucocorticoids are essential for the normal function of most organ systems and, in both, excess and deficiency can lead to significant adverse consequences.

Time for a Time Window Extension: Insights from Late Presenters in the ESCAPE Trial.

Background And Purpose: The safety and efficacy of endovascular therapy for large-artery stroke in the extended time window is not yet well-established. We performed a subgroup analysis on subjects enrolled within an extended time window in the Endovascular Treatment for Small Core and Proximal Occlusion Ischemic Stroke (ESCAPE) trial.

Materials And Methods: Fifty-nine of 315 subjects (33 in the intervention group and 26 in the control group) were randomized in the ESCAPE trial between 5.

Infarct in a New Territory After Treatment Administration in the ESCAPE Randomized Controlled Trial (Endovascular Treatment for Small Core and Anterior Circulation Proximal Occlusion With Emphasis on Minimizing CT to Recanalization Times).

Background And Purpose: Infarct in a new previously unaffected territory (INT) is a potential complication of endovascular treatment. We applied a recently proposed methodology to identify and classify INTs in the ESCAPE randomized controlled trial (Endovascular Treatment for Small Core and Anterior Circulation Proximal Occlusion With Emphasis on Minimizing CT to Recanalization Times).

Methods: The core laboratory identified INTs on 24-hour follow-up imaging, blinded to treatment allocation, after assessing all baseline imaging.

Analysis of Workflow and Time to Treatment on Thrombectomy Outcome in the Endovascular Treatment for Small Core and Proximal Occlusion Ischemic Stroke (ESCAPE) Randomized, Controlled Trial.

Background: The Endovascular Treatment for Small Core and Proximal Occlusion Ischemic Stroke (ESCAPE) trial used innovative imaging and aggressive target time metrics to demonstrate the benefit of endovascular treatment in patients with acute ischemic stroke. We analyze the impact of time on clinical outcome and the effect of patient, hospital, and health system characteristics on workflow within the trial.

Methods And Results: Relationship between outcome (modified Rankin Scale) and interval times was modeled by using logistic regression.

Intra-Arterial Therapy and Post-Treatment Infarct Volumes: Insights From the ESCAPE Randomized Controlled Trial.

Background And Purpose: The goal of reperfusion therapy in acute ischemic stroke is to limit brain infarction. The objective of this study was to investigate whether the beneficial effect of endovascular treatment on functional outcome could be explained by a reduction in post-treatment infarct volume.

Methods: The Endovascular Treatment for Small Core and Anterior Circulation Proximal Occlusion With Emphasis on Minimizing CT to Recanalization Times (ESCAPE) trial was a multicenter randomized open-label trial with blinded outcome evaluation.

Complications of bariatric surgery--What the general surgeon needs to know.

Obesity is an important cause of physical and psychosocial morbidity and it places a significant burden on health system costs and resources. Worldwide an estimated 200 million people over 20 years are obese and in the U.K.

High coexpression of both EGFR and IGF1R correlates with poor patient prognosis in resected non-small-cell lung cancer.

Background: Recent experimental and biomarker evidence indicates that the epidermal growth factor receptor (EGFR) and insulin-like growth factor receptor 1 (IGF1R) interact in the pathogenesis of malignant epithelial tumors, including lung cancer. This study examines the expression of both receptors and their prognostic significance in surgically resected non-small-cell lung cancer (NSCLC).

Methods: EGFR and IGF1R expression were evaluated in 184 patients with NSCLC (83 squamous cell carcinomas [SCCs], 83 adenocarcinomas [ADCs], and 18 other types) using immunohistochemical (IHC) analysis.

Omega-3 fatty acid supplementation in patients with recurrent self-harm. Single-centre double-blind randomised controlled trial.

Background: Trials have demonstrated benefits of long-chain omega-3 essential fatty acid (n-3 EFA) supplementation in a variety of psychiatric disorders.

Aims: To assess the efficacy of n-3 EFAs in improving psychological well-being in patients with recurrent self-harm.

Method: Patients (n=49) presenting after an act of repeated self-harm were randomised to receive 1.

Acute fulminant colitis caused by idiopathic mesenteric inflammatory veno-occlusive disease.

Mesenteric inflammatory veno-occlusive disease (MIVOD) is an uncommon but important cause of bowel inflammation. MIVOD is characterised by lymphocytic inflammation and non-thrombotic occlusion of the mesenteric venules and veins. We present the case of a young man who presented with acute fulminant colitis, requiring colectomy.

Are elective surgical operations cancelled due to increasing medical admissions?

Background: Cancellation of operations increases theatre costs and decreases efficiency. We examined the causes of theatre cancellations in general surgery.

Methods: The Beaumont hospital database (ORSUS system) and theatre records were examined retrospectively between April 1997 and March 2002.

Value of MR pancreatography in the evaluation of patients with chronic pancreatitis.

Aim: To determine the diagnostic accuracy of magnetic resonance (MR) pancreatography and to define its role in the imaging work-up of patients with severe chronic pancreatitis.

Material And Methods: Thirty-two patients (13 men and 19 women; 15-84 years old; mean age, 48 years) with severe chronic pancreatitis diagnosed using cross-sectional imaging, examination using contrast medium (endoscopic retrograde cholangiopancreatography, pseudocyst injection) and/or surgical findings underwent MR pancreatography performed using a two-dimensional multi-slice fast spin echo technique. All patients underwent transabdominal pancreatic sonography and computed tomography (CT) was performed in 12 patients.

Percutaneous gastrostomy in patients who fail or are unsuitable for endoscopic gastrostomy.

Purpose: Percutaneous endoscopic gastrostomy (PEG) is not possible or fails in some patients. We aimed to categorize the reasons for PEG failure, to study the success of percutaneous radiologic gastrostomy (PRG) in these patients, and to highlight the associated technical difficulties and complications.

Methods: Forty-two patients (28 men, 14 women; mean age 60 years, range 18-93 years) in whom PEG failed or was not possible, underwent PRG.

Diagnostic accuracy of magnetic resonance cholangiopancreatography and ultrasound compared with direct cholangiography in the detection of choledocholithiasis.

Aim: To determine the diagnostic accuracy of magnetic resonance cholangiopancreatography (MRCP) and trans-abdominal ultrasound in the detection of choledocholithiasis, and to compare bile duct stone characteristics using endoscopic retrograde cholangiopancreatography (ERCP), MRCP and ultrasound.

Materials And Methods: Of 191 consecutive patients referred for diagnostic ERCP, choledocholithiasis was diagnosed in 34 patients using direct cholangiography. The latter took the form of ERCP (n = 29), intraoperative cholangiography (n = 3) or percutaneous transhepatic cholangiography (n = 2).

Expression of CD44 in uterine cervical squamous neoplasia: a predictor of microinvasion?

Objective: CD44, an integral membrane glycoprotein, may have an important role in early tumorigenesis, specifically, facilitating early tumor progression. Reports of the expression of CD44 in early uterine cervical squamous carcinogenesis are conflicting. We examined the expression of CD44 in microinvasive carcinoma of the cervix (MIC), as yet unreported, and compared it to that in cervical intraepithelial neoplasia (CIN) 1 and CIN 3 to further elucidate its role in early squamous carcinogenesis.

The diagnostic accuracy of magnetic resonance cholangiopancreatography and ultrasound compared with direct cholangiography in the detection of choledocholithiasis.

Aim: To determine the diagnostic accuracy of magnetic resonance cholangiopancreatography (MRCP) and ultrasound (US) in the diagnosis of choledocholithiasis in a large group of patients with bile duct stones confirmed at direct cholangiography. Also, to compare bile duct stones confirmed at direct cholangiography. Also, to compare bile duct stone characteristics using the three different investigations, endoscopic retrograde cholangiopancreatography (ERCP), MRCP and US.

A prospective comparison of magnetic resonance cholangiopancreatography with endoscopic retrograde cholangiopancreatography in the evaluation of patients with suspected biliary tract disease.

Aim: To determine the diagnostic accuracy of magnetic resonance cholangiopancreatography (MRCP) compared with direct cholangiography in the detection of biliary tract disease.

Patients And Methods: MRCP was performed in 100 patients in whom direct cholangiographic correlation (ERCP, n = 98; PTC, n = 9; intraoperative cholangiography, n = 3) was available for comparison. The MRCP examinations were performed using a two-dimensional multi-slice, fast spin echo (FSE) technique and a local surface coil.