Treatment outcome and patterns of relapse following adjuvant carboplatin for stage I testicular seminomatous germ-cell tumour: results from a 17-year UK experience.

Background: Following inguinal orchidectomy, management options for patients with stage I seminoma include initial surveillance or treatment with adjuvant radiotherapy or chemotherapy. The anticipated relapse rate for patients followed by surveillance alone is ∼15%, with adjuvant treatment this risk is reduced to ∼4%-5% at 5 years. After carboplatin treatment, follow-up strategies vary and there are no validated, predictive markers of relapse.

Short- and Long-Term Quality of Life and Bowel Function in Patients With MRI-Defined, High-Risk, Locally Advanced Rectal Cancer Treated With an Intensified Neoadjuvant Strategy in the Randomized Phase 2 EXPERT-C Trial.

Objective: Intensified preoperative treatments have been increasingly investigated in locally advanced rectal cancer (LARC), but limited data are available for the impact of these regimens on quality of life (QoL) and bowel function (BF). We assessed these outcome measures in EXPERT-C, a randomized phase 2 trial of neoadjuvant capecitabine combined with oxaliplatin (CAPOX), followed by chemoradiation therapy (CRT), total mesorectal excision, and adjuvant CAPOX with or without cetuximab in magnetic resonance imaging-defined, high-risk LARC.

Methods And Materials: QoL was assessed using the European Organization for Research and Treatment of Cancer QLQ-C30 and QLQ-CR29 questionnaires.

Parkinson's disease and the skin.

The concept that the skin is a mirror of Parkinson's disease dates to the start of the last century. Despite dermatological disorders being recognised as a common non-motor symptom of Parkinson's disease, they are often overlooked. This article reviews the various skin disorders seen in Parkinson's disease and addresses the other dermatological questions that are frequently raised by those attending Parkinson's disease clinics.

A novel diagnostic protocol to identify patients suitable for discharge after a single high-sensitivity troponin.

Objective: To establish whether a novel accelerated diagnostic protocol (ADP) for suspected acute coronary syndrome (ACS) could successfully identify low-risk patients suitable for discharge after a single high-sensitivity troponin T (hs-cTnT) taken at presentation to the emergency department. We also compared the diagnostic accuracy of this ADP with strategies using initial undetectable hs-cTnT.

Methods: This prospective observational study evaluated the ability of the Triage Rule-out Using high-Sensitivity Troponin (TRUST) ADP to identify low-risk patients with suspected ACS.

Focal EEG slowing and chorea: electroclinical clues to the diagnosis of anti-NMDAR encephalitis.

Variations in clinical presentation can lead to delays in the diagnosis and initiation of treatment of anti-N-methyl-D-aspartate receptor encephalitis. Most patients have an EEG study performed early in the course of their illness. Although not specific, there may be clues in the electroclinical features that should alert clinicians and electroencephalographers to the possibility of this diagnosis.

Abnormal anatomy of inferior orbital fissure and herniation of buccal fat pad.

The anatomy of the inferior orbital fissure has been well studied, and its reported dimensions vary little. It is encountered during exploration of the orbital floor and when possible is not disturbed. We describe a case of herniation of buccal fat through the inferior orbital fissure that was found during exploration and repair of the orbital floor.

Pharmacological treatment of children with gastro-oesophageal reflux.

Background: Gastro-oesophageal reflux (GOR) is a common disorder, characterised by regurgitation of gastric contents into the oesophagus. GOR is a very common presentation in infancy in both primary and secondary care settings. GOR can affect approximately 50% of infants younger than three months old (Nelson 1997).

Antiproliferative Effect of Lapatinib in HER2-Positive and HER2-Negative/HER3-High Breast Cancer: Results of the Presurgical Randomized MAPLE Trial (CRUK E/06/039).

Purpose: Not all breast cancers respond to lapatinib. A change in Ki67 after short-term exposure may elucidate a biomarker profile for responsive versus nonresponsive tumors.

Experimental Design: Women with primary breast cancer were randomized (3:1) to 10 to 14 days of preoperative lapatinib or placebo in a multicenter phase II trial (ISRCTN68509377).

Clinical risk factors for underlying gastrointestinal malignancy in iron deficiency anaemia: the IDIOM study.

Objective: Ten percent of adults presenting with iron deficiency anaemia (IDA) have underlying cancer. This analysis - the ron eficiency as an ndicator f alignancy (IDIOM) study - was undertaken to assess whether five simple clinical parameters can usefully predict the likelihood of gastrointestinal (GI) malignancy on subsequent investigation of patients with IDA.

Design: Retrospective observational study, with multivariable analysis of the predictive value of sex, age, haemoglobin concentration (Hb), mean red cell volume (MCV) and iron studies for the risk of underlying GI malignancy.

Parametric model of human body shape and ligaments for patient-specific epidural simulation.

Objective: This work is to build upon the concept of matching a person's weight, height and age to their overall body shape to create an adjustable three-dimensional model. A versatile and accurate predictor of body size and shape and ligament thickness is required to improve simulation for medical procedures. A model which is adjustable for any size, shape, body mass, age or height would provide ability to simulate procedures on patients of various body compositions.

UK audit of glomerular filtration rate measurement from plasma sampling in 2013.

Introduction: An audit was carried out into UK glomerular filtration rate (GFR) calculation. The results were compared with an identical 2001 audit.

Methods: Participants used their routine method to calculate GFR for 20 data sets (four plasma samples) in millilitres per minute and also the GFR normalized for body surface area.

Minimally-invasive endoscopically-assisted neck dissection for lateral cervical metastases of thyroid papillary carcinoma.

Traditional open operations for lateral neck dissection in patients with papillary thyroid carcinoma leave an unsightly scar. We report complete lateral neck dissection and thyroidectomy for papillary thyroid carcinoma using an endoscopically-assisted approach through a small incision, and evaluate its feasibility and safety. Between March 2010 and January 2013, 6 patients with no definite metastases to the lymph nodes at levels II-IV, and 20 with definite metastases to the lymph nodes at levels II-V were selected.

Advances in the understanding of the pathophysiology and management of aortic stenosis: role of novel imaging techniques.

The management of asymptomatic patients with aortic stenosis (AS) is controversial and the mechanisms leading to symptom generation and adverse outcome are not fully understood. Novel imaging techniques offer a noninvasive tool for in vivo assessment of AS and its pathophysiological consequences on the myocardium. Exercise echocardiography provides insight into the mechanisms responsible for exercise limitation and symptom generation.

Adie's pupil following Le Fort I maxillary osteotomy: case report.

Complications after Le Fort I osteotomy are rare. We report, to our knowledge, the first case of bilateral Adie's pupil after Le Fort I osteotomy.

The development of a nurse-led iron deficiency anaemia service in a district general hospital.

Objective: To improve the quality of care provided to patients with iron deficiency anaemia (IDA).

Design: Service development.

Setting: District General Hospital.

The curious case of the disappearing IVC: a case report and review of the aetiology of inferior vena cava agenesis.

We report the case of a previously well 18-year-old male who presented to the Emergency Department with lower limb pain. An ultrasound demonstrated extensive left sided deep vein thrombosis and computed tomography demonstrated inferior vena cava agenesis, leading to the diagnosis of inferior vena cava agenesis associated deep vein thrombosis. The aetiology of inferior vena cava agenesis is explored in depth.

A midline for oxaliplatin infusion: the myth of safety devices.

Oxaliplatin is a platinum compound mainly used in the treatment of colorectal cancer. According to its manufacturer it is not considered vesicant agent though it has been shown to cause severe tissue damage if extravasation occurs in large doses. Several cases of extravasation have been reported; most of them from incorrectly placed peripheral cannula or incorrect use of central venous access devices.

Persistent idiopathic unilateral hypoglossal [corrected] nerve palsy: a case report.

Paralysis of the hypoglossal nerve, the twelfth (XII) cranial nerve, leads to atrophy, deviation of the tongue to the affected side, and varying degrees of fasciculation. The injury to the nerve can occur from its origin to the tongue itself. The causes of hypoglossal nerve palsy are well documented, but idiopathic, isolated nerve palsy that does not recover, is rare.

A national cross sectional survey of heads of midwifery services of uptake, benefits and barriers to use of obstetric early warning systems (EWS) by midwives.

Objective: to identify the extent to which Early Warning Systems (EWS) are used by midwives in the United Kingdom (UK), the maternity settings they are used in, physiological parameters used to 'trigger' referral, training provision, barriers to implementation and role in preventing maternal morbidity.

Design: cross-sectional survey of heads of midwifery services. An email questionnaire was sent in September 2012.

A national survey of obstetric early warning systems in the United Kingdom: five years on.

The Confidential Enquiries into Maternal Deaths in the UK have recommended obstetric early warning systems for early identification of clinical deterioration to reduce maternal morbidity and mortality. This survey explored early warning systems currently used by maternity units in the UK. An electronic questionnaire was sent to all 205 lead obstetric anaesthetists under the auspices of the Obstetric Anaesthetists' Association, generating 130 (63%) responses.