Challenges and opportunities for HSCT outcome registries: perspective from international HSCT registries experts.

Patient registries, frequently referred to as outcome registries, are 'organized systems' that use observational study methods to collect uniform data. Registries are used to evaluate specified outcomes for a population defined by a particular disease, condition or exposure that serves one or more predetermined scientific, clinical or policy purposes. Outcome registries were established very early in the development of hematopoietic SCT (HSCT).

Establishing axillary Sentinel Lymph Node Biopsy (SLNB) for early breast cancer in the United Kingdom: a survey of the national training program.

Introduction: The UK National training programme (NEWSTART) for SLNB in breast cancer was established in 2004, aimed at providing structured, standardised training with a focus on multidisciplinary team (MDT) delivery.

Methodology: A questionnaire was devised and after approval by the Association of Breast Surgeons (ABS) executive committee they were sent to all full members of the ABS.

Results: Most (97%) of breast surgeons are convinced by the evidence for SLNB as standard of care for early breast cancer.

Angiogenic effects of stromal cell-derived factor-1 (SDF-1/CXCL12) variants in vitro and the in vivo expressions of CXCL12 variants and CXCR4 in human critical leg ischemia.

Purpose: Critical leg ischemia (CLI) is associated with a high morbidity and mortality. Therapeutic angiogenesis is still being investigated as a possible alternative treatment option for CLI. CXCL12, a chemokine, is known to have two spliced variants, CXCL12alpha and CXCL12beta, but the significance remains unknown.

Role of vascular endothelial growth factor in women with PCO and PCOS: a systematic review.

The aim of this study was to investigate the strategic role of vascular endothelial growth factor (VEGF) in the pathophysiology of polycystic ovary syndrome (PCOS) and to critically review the published trials that have evaluated VEGF in women with PCOS. An electronic database search of Medline, Embase, Cinahl and Cochrane library was conducted. Studies were included if they evaluated VEGF either in the circulation or in granulosa lutein cell culture media in in-vitro laboratory studies of women with a polycystic ovary (PCO) or PCOS.

Characterization of W1745C and S1783A: 2 novel mutations causing defective collagen binding in the A3 domain of von Willebrand factor.

Investigation of 3 families with bleeding symptoms demonstrated a defect in the collagen-binding activity of von Willebrand factor (VWF) in association with a normal VWF multimeric pattern. Genetic analysis showed affected persons to be heterozygous for mutations in the A3 domain of VWF: S1731T, W1745C, and S1783A. One person showed compound heterozygosity for W1745C and R760H.

Why should disorders of the ear, nose and throat be treated by the same specialty? Can this situation persist?

The surgical specialty of otorhinolaryngology has its origins in the nineteenth century. Subsequently, the specialty also incorporated allied disciplines such as plastics and head and neck surgery. Following World War II, the survival of the specialty was threatened by the advent of antibiotics and the rise of the general surgeon.

Nephrogenic systemic fibrosis: a sufficient reason to avoid gadolinium-based contrast in all patients with renal impairment?

Nephrogenic systemic fibrosis (NSF) was recently linked to gadolinium-based contrast (GBC) exposure in patients with renal failure. As result, the U.S.

Clinical outcomes in secondary hyperparathyroidism and the potential role of calcimimetics.

Cinacalcet, a type II calcimimetic agent that interacts with the calcium-sensing receptor on the parathyroid gland and increases its sensitivity to calcium, has proved an effective therapy for the treatment of the biochemical derangements that comprise uraemic secondary hyperparathyroidism. These patients experience high cardiovascular attrition with evidence that this is associated with vascular calcification, arterial stiffening and increased pulse wave velocity, and with some of the disturbances of bone and mineral metabolism in uraemia. Thus, it is possible that improved biochemical control in calcimimetic-treated patients might lead to better clinical outcomes.

Impact of HIV and AIDS on surgical practice.

Introduction: Surgical intervention has become a common component in the management of patients infected with the human immunodeficiency virus (HIV) or suffering from the clinical consequences of acquired immunodeficiency syndrome (AIDS). We investigated the evolution of this involvement at a tertiary referral centre for this condition over a 16-year period.

Patients And Methods: Detailed retrospective examination of the medical records of HIV-positive patients treated at the Royal Free Hospital between 1986 and 2002 was undertaken.

Hogarth's 'Gin Lane' and 'Beer Street'.

The original intention of this paper was to draw on the link between art and medicine through the appreciation of a pair of prints created by Hogarth in 1750. This was done firstly, by viewing them as a direct health promotional campaign to curb alcoholism, and secondly, by studying Hogarth's use of the depiction of disease as a means to achieve this. However, in analysing his motivation another more permanent link, still resonant in today's society, was revealed--that between health and social structure.

Chronic abdominal pregnancy following rupture from a bicornuate uterus.

The authors report a rare occurrence of a chronic abdominal pregnancy secondary to a ruptured bicornuate uterus. It is unusual in that rupture of the uterine horn probably occurred 2 weeks prior to diagnosis. Management was laparotomy to remove the fetus with resection and repair of the uterus.

A systematic review comparing the functional neuroanatomy of patients with depression who respond to placebo to those who recover spontaneously: is there a biological basis for the placebo effect in depression?

Background: Functional neuroimaging research indicates that depression, and treatment, are associated with neurobiological changes. Changes associated with natural recovery or the placebo effect are unknown. The aim of this study is to assess whether the placebo effect in depression is associated with specific functional neuroimaging changes.

Systemic juvenile idiopathic arthritis: diagnosis, management, and outcome.

Systemic juvenile idiopathic arthritis is a heterogeneous form of arthritis in childhood and represents 10-20% of all juvenile idiopathic arthritides in the Caucasian populations of Northern America and Europe. Up to 30% of patients will still have active disease after 10 years, and morbidity within this group is high. Secondary complications (e.

Laser Doppler perfusion imaging: a method for measuring female sexual response.

To develop a new noninvasive technique to measure vulval blood flow changes during sexual arousal; 18 healthy volunteers between the age of 20 and 33 years were studied. Each subject underwent two experimental sessions at least 2 weeks apart to coincide with the proliferative and luteal phases of her menstrual cycle. An initial laser Doppler perfusion imaging (LDPI) scan of the vulva was performed.

CMV as a cofactor enhancing progression of AIDS.

Background: Cytomegalovirus (CMV) has been proposed as a cofactor driving HIV pathogenicity since the late 1980s. Potential mechanisms which CMV could use as a cofactor have been described in vitro and potential criteria for assessing cofactor activity in vivo have been proposed.

Objective: To determine if recent publications have added new information to these in vitro or in vivo studies since the author last reviewed this subject in 1998.

The role of cardiopulmonary fitness and its genetic influences on surgical outcomes.

Background: Outcome after major surgery remains poor in some patients. There is an increasing need to identify this cohort and develop strategies to reduce postsurgical morbidity and mortality. Central to outcome is the ability to mount cardiovascular output in response to the increased oxygen demand associated with major surgery.

Acute mesenteric ischaemia.

Acute Mesenteric Ischaemia (AMI) is an uncommon vascular emergency where the diagnosis is often difficult and overlooked and delay in diagnosis results in a grave outcome. Although extravascular events like intussusception, volvulus, strangulated hernia and adhesive obstruction in neglected cases can result intestinal gangrene, this contribution will be limited to acute mesenteric ischaemia as a primary event. AMI consists of four pathologic processes (arterial thrombosis, arterial embolism, Non Occlusive Mesenteric Ischaemia (NOMI) and mesenteric venous thrombosis (MVT)) with similar clinical presentation and one potentially fatal pathological endpoint- intestinal gangrene.

Management of secondary hyperparathyroidism.

Secondary hyperparathyroidism (SHPT) remains an inevitable consequence of untreated chronic uremia. It is the result of a combination of phosphate (P) retention, failure of calcitriol synthesis, and hypocalcemia. Therapies used to correct these abnormalities, namely active vitamin D replacement, calcium (Ca) supplementation, and phosphate (P) restriction, have moderate efficacy but are prone to unacceptable side-effects.

Intermittent claudication: exercise-increased walking distance is not related to improved cardiopulmonary fitness.

Objectives: To assess if exercise training improves the symptoms of intermittent claudication by improvement in cardiopulmonary fitness.

Methods: Claudication distance (CD), maximum walking distance (MWD), calf endurance (repetitive heel raises), cardiovascular fitness (VO2 peak), and ankle-brachial pressure index (ABPI) were measured in 16 subjects with intermittent claudication before, and following an 8-week treadmill training programme.

Results: Training resulted in a median increase in CD of 65.

The retrojugular approach to carotid endarterectomy--a safer technique?

The conventional technique of carotid endarterectomy involves approaching the carotid sheath, anterior and medial to the internal jugular vein with division of the facial vein. Mobilisation of the ansa cervicalis and identification of the hypoglossal nerve is usually required. We describe our results of retrojugular approach in a consecutive nonrandomised cohort of 50 carotid endarterectomy patients.