Combination Lenalidomide and Azacitidine: A Novel Salvage Therapy in Patients Who Relapse After Allogeneic Stem-Cell Transplantation for Acute Myeloid Leukemia.

Purpose: Salvage options for patients who relapse after allogeneic stem-cell transplantation (allo-SCT) for acute myeloid leukemia (AML) and myelodysplasia (MDS) remain limited, and novel treatment strategies are required. Both lenalidomide (LEN) and azacitidine (AZA) possess significant antitumor activity effect in AML. Administration of LEN post-transplantation is associated with excessive rates of graft-versus-host disease (GVHD), but AZA has been shown to ameliorate GVHD in murine transplantation models.

Spinal Motocross Injuries in the United Kingdom.

Background: Motocross is a form of motorcycle racing held on established off-road circuits and has been a recreational and competitive sport across the world for >100 years. In the United Kingdom alone, motocross has grown into a phenomenally ambitious and popular franchise. There are >200 motocross clubs across the country, permitting >900 events annually.

Choice of Stent for Percutaneous Coronary Intervention of Saphenous Vein Grafts.

Background: There are limited data on comparison of contemporary drug-eluting stent (DES) platforms, previous generation DES, and bare-metal stents (BMS) for percutaneous coronary intervention in saphenous vein grafts (SVG). We aimed to assess clinical outcomes following percutaneous coronary intervention to SVG in patients receiving bare-metal stents (BMS), first-generation DES, and newer generation DES in a large unselected national data set from the BCIS (British Cardiovascular Intervention Society).

Methods And Results: Patients undergoing percutaneous coronary intervention to SVG in the United Kingdom from January 2006 to December 2013 were divided into 3 groups according to stent use: BMS, first-generation DES, and newer generation DES group.

Review of early hospitalisation after percutaneous coronary intervention.

Background: Percutaneous coronary intervention (PCI) is the most common modality of revascularization in patients with coronary artery disease. Understanding the readmission rates and reasons for readmission after PCI is important because readmissions are a quality of care indicator, in addition to being a burden to patients and healthcare services.

Methods: A literature review was performed.

Anatomic Correlation of Posterior Aortic Root Enlarging Incisions.

Objectives: To clarify the terms surrounding the posterior aortic root enlarging incisions and correlate them anatomically.

Methods: This is a human cadaveric heart study in which measurements were taken along the path of the named incisions in 42 normal and congenitally malformed hearts using calipers.

Results: Our results indicate that there is a variable overlap of the left atrial wall with the anterior mitral leaflet and the aorta and that in individual cases it may not be possible to accurately predict the possibility of enlarging the root without opening the left atrium, though some papers suggest otherwise.

A Classification for Extensor Carpi Ulnaris Groove Morphology as an Aid for Ulnar Sided Wrist Pain.

Background: Distal ulna groove morphology is likely to have a significant role in extensor carpi ulnaris (ECU) tendon stability. The development of a robust anatomical classification system, would be beneficial to further research into ulnar sided wrist pain and would be of use in rationalising treatment regimes.

Methods: Cadaveric specimens as well as MRI scans of patients with non-specific wrist pain were analysed independently by 3 orthopaedic surgeons twice to test the integrity of the classification system.

Fourth consensus of the International Society for Premenstrual Disorders (ISPMD): auditable standards for diagnosis and management of premenstrual disorder.

Whilst professional bodies such as the Royal College and the American College of Obstetricians and Gynecologists have well-established standards for audit of management for most gynaecology disorders, such standards for premenstrual disorders (PMDs) have yet to be developed. The International Society of Premenstrual Disorders (ISPMD) has already published three consensus papers on PMDs covering areas that include definition, classification/quantification, clinical trial design and management (American College Obstetricians and Gynecologists 2011; Brown et al. in Cochrane Database Syst Rev 2:CD001396, 2009; Dickerson et al.

Major Bleeding and Adverse Outcome following Percutaneous Coronary Intervention.

Advances in anti-thrombotic and anti-platelet therapies have improved outcomes in patients undergoing percutaneous coronary interventions (PCIs) through a reduction in ischaemic events, at the expense of peri-procedural bleeding complications. These may occur through either the access site through which the PCI was performed or through non-access-related sites. There are currently over 10 definitions of major bleeding events consisting of clinical events, changes in laboratory parameters and clinical outcomes, where different definitions will differentially influence the reported incidence of major bleeding events.

Major bleeding after percutaneous coronary intervention and risk of subsequent mortality: a systematic review and meta-analysis.

Objectives: To examine the relationship between periprocedural bleeding complications and major adverse cardiovascular events (MACEs) and mortality outcomes following percutaneous coronary intervention (PCI) and study differences in the prognostic impact of different bleeding definitions.

Methods: We conducted a systematic review and meta-analysis of PCI studies that evaluated periprocedural bleeding complications and their impact on MACEs and mortality outcomes. A systematic search of MEDLINE and EMBASE was conducted to identify relevant studies.

High sensitivity and specificity of elevated cerebrospinal fluid kappa free light chains in suspected multiple sclerosis.

Cerebrospinal fluid (CSF) analysis is routinely used in the diagnostic work-up of multiple sclerosis (MS), by detecting CSF-specific oligoclonal bands (OCB). More recently, several studies have reported CSF free light chains (FLC) as an alternative. We show that absolute CSF κFLC concentrations were highly sensitive - more than OCB testing - and specific for clinically isolated syndrome, relapsing remitting and primary progressive MS.

Gynaecomastia correction: A review of our experience.

Introduction: Gynaecomastia is a common problem in the male population with a reported prevalence of up to 36%. Various treatment techniques have been described but none have gained universal acceptance. We reviewed all gynaecomastia patients operated on by one consultant over a 7-year period to assess the morbidity and complication rates associated with the procedure.

Biliary boulders.

Objective: To examine the outcome of endoscopic retrograde cholangiopancreatography (ERCP) in the management of common bile duct (CBD) stones.

Design: A retrospective review of 100 consecutive ERCPs performed for CBD stones.

Results: 100 ERCPs were performed on 84 patients with a median cohort age of 77.

Percutaneous closure of postinfarction ventricular septal defect: in-hospital outcomes and long-term follow-up of UK experience.

Background: Postinfarction ventricular septal defect carries a grim prognosis. Surgical repair offers reasonable outcomes in patients who survive a healing phase. Percutaneous device implantation represents a potentially attractive early alternative.

A sneeze: an unusual trigger for aortic dissection.

We describe a rare case of type B thoracic aortic dissection resulting from a forceful sneeze in a 57-year-old man. The presenting clinical features were not typical and consisted of pleuritic chest pain and breathlessness following a forceful sneeze. There was no haemodynamic compromise.

Rectosigmoid gallstone coleus: a rare emergency presentation.

An elderly woman presented with abdominal pain and vomiting, was known to have gallstones. A CT scan was arranged identifying gallstone ileus and cholecystitis. Ensuing sepsis precipitated fast atrial fibrillation delaying the planned laparotomy.

Concordance between vacuum assisted biopsy and postoperative histology: implications for the proposed Low Risk DCIS Trial (LORIS).

Aim: The recent Breast Cancer Screening Review has estimated that for one life saved three patients are overtreated. The dramatic increase in the diagnosis of Ductal carcinoma in-situ (DCIS) has not lead to the expected decrease in the incidence of invasive cancer. It is not clear if all DCIS progress to invasive cancer if untreated.

Lymphoma presenting as neck lumps: causes of waiting time target breaches and potential solutions.

Objectives: This study aimed to assess the speed of referral, diagnosis and treatment of patients with lymphoma presenting with a neck lump, and to identify where delays are occurring that prevent UK national targets from being met.

Method: The study entailed a retrospective survey of patients presenting with a neck lump secondary to lymphoma between 2006 and 2008 in Gloucestershire, UK.

Results: Forty-seven of 54 patients (87 per cent) were seen within 2 weeks of referral.

Torted gallbladder causing massive distension and gross necrosis; a rare surgical emergency.

Gallbladder torsion is rare and is more frequently seen in elderly women. Published case reports comment that diagnosis of this entity can be made preoperatively through imaging with some advocating removal laparoscopically. This case reports an elderly woman who underwent emergency laparotomy for a massively distended gallbladder with suspected cholecystitis.

Massive gastric dilation complicating diabetic gastroparesis.

A middle-aged man presented at 4:00 with tense distended abdomen, severe pain and numb legs. His medical background included poorly controlled insulin-dependent diabetes. Abdominal x-ray showed a massively distended, featureless viscus on the left side of the abdomen thought to be a sigmoid volvulus.