Derriford Hospital

About: Derriford Hospital is a healthcare organization based out in Plymouth, United Kingdom. It is known for research contribution in the topics: Population & Transplantation. The organization has 2892 authors who have published 3137 publications receiving 84438 citations.

Long term follow-up and risk of breast cancer after a radial scar or complex sclerosing lesion has been identified in a benign open breast biopsy.

Abstract: Aims Radial scars (RS)/complex sclerosing lesions (CSL) are rare, benign breast lesions of unknown aetiology Associations with breast cancer have been suggested particularly with larger lesions This study aims to identify the risk of developing subsequent breast cancer after excision of a benign RS/CSL with respect to lesion size and compared to expected rates in the normal UK population Methods A prospective cohort analysis was performed on patients diagnosed with RS/CSL in benign, open breast biopsy specimens over a 20-year period The rate of subsequent breast cancer development was compared to expected rates in the normal UK population Subjects were divided into two groups according to lesion size and the rates of subsequent breast cancer compared Results 149 women without proliferative breast disease were followed for an average of 68 months Five women developed subsequent cancer, equating to a rate of 084% per year This compares to 032% per year in the normal population (RR 26, 95% CI 086–60) There were two subsequent cancers in the RS group and three subsequent cancers in the CSL group, P = 064 Conclusions The study finds no evidence to suggest that lesions greater than 10 mm (CSL) have any greater risk of developing cancer after excision than those below 10 mm (RS) Women treated for RS/CSL do not need any additional follow-up beyond routine mammographic breast screening Additional surveillance should only be performed if there is associated pathology indicating an increased risk of subsequent malignancy

Twenty-year experience with salvage total laryngectomy: lessons learned.

Abstract: Objective The purpose of this study was to evaluate the outcome of salvage total laryngectomy and identify areas for further improvement. Method A retrospective analysis of all patients who underwent salvage total laryngectomy between January 1999 and December 2018 was performed. Results Thirty-one patients were identified. The most common primary tumour site was the glottis (83.8 per cent). Early stage (T1–T2) disease was identified in 83.9 per cent of cases. Overall survival at 2 and 5 years post-salvage total laryngectomy was 71 per cent and 45 per cent, respectively. Disease-free survival at 2 and 5 years post-salvage total laryngectomy was 65 per cent and 42 per cent, respectively. The rate of post-salvage total laryngectomy pharyngocutaneous fistula was 29 per cent. Conclusion More than half of patients will not survive beyond five years after salvage total laryngectomy. Regional recurrence was the most common form of failure and death. From this study, elective lateral and central neck dissection is advocated in patients with early laryngeal cancer who present with an advanced recurrence.

Transvaginal placement of surgical mesh for pelvic organ prolapse: more FDA concerns—positive reactions are possible

Abstract: Recently (July 13, 2011), the United States Food and Drug Administration (FDA) issued a document entitled “FDA Safety Communication: UPDATE on Serious Complications Associated with Transvaginal Placement of Surgical Mesh for Pelvic Organ Prolapse” [1]. This was stated as an update of a previous document issued on October 20, 2008, entitled “A Public Health Notification and Additional Patient Information on serious complications associated with surgical mesh placed through the vagina (transvaginal placement) to treat pelvic organ prolapse (POP) and SUI (stress urinary incontinence)”. Accompanying the recent FDA concerns was a 15-page document entitled “Urogynecologic Surgical Mesh: Update on the Safety and Effectiveness of Transvaginal Placement for Pelvic Organ Prolapse” which has a literature review identifying 27 key references [2]. The FDA’s aims in this update are to inform that: (1) “serious complications with surgical mesh for transvaginal repair of POP are not rare” (a change from the previous FDA notification) and (2) “it is not clear that transvaginal POP repair with mesh is more effective than traditional non-mesh repair in all patients with POP and it may expose patients to greater risk”. From January 1, 2008 through December 31, 2010, using the Manufacturer and User Device Experience (MAUDE) database, the FDA received 2,874 additional reports of complications associated with surgical mesh devices used to repair POP and SUI, with 1,503 reports associated with POP repairs and 1,371 associated with SUI repairs. The scope of the current safety communication was limited to POP surgery. The FDA noted mesh exposure (“erosion”) as the most common mesh-related complication and with mesh shrinkage (“contraction”), the leading cause of symptoms including bleeding, pelvic pain, dyspareunia, or apareunia. The results of the literature review [2], summarized in the FDA Safety Communication [1], were: (1) mesh used in transvaginal POP repair introduces risks not present in traditional non‐mesh surgery for POP repair; (2) mesh placed abdominally for POP repair appears to result in lower rates of mesh complications compared to transvaginal POP surgery with mesh; (3) there is no evidence that Further contributions to this debate can be found at doi:10.1007/ s00192-011-1581-2, doi:10.1007/s00192-011-1596-8 and doi:10.1007/s00192-011-1597-7.

The molecular specificity of insulin autoantibodies.

Abstract: Insulin autoantibodies (IAA) are one of several markers for Type I (autoimmune) diabetes, but alone deserve special attention. Unlike the other markers, their ligand is unique to the beta cell. IAA are the first markers to appear during the symptomless period which precedes diabetes and they are present in the vast majority of young children destined to develop diabetes. The primary and tertiary structures of insulin have been known for decades. Binding studies with insulin variants have shown epitope restriction that can distinguish Type 1 diabetes-predictive from non-predictive IAA-positive sera, thereby improving specificity for the test. With two major international Type 1 diabetes prevention trials underway, there is a pressing need to refine markers that reliably indicate the presence of, and remission from, autoimmune insulitis. The binding regions of antibodies are assembled from three multi-gene families, and some of their diversity derives from random mutation during their antigen-driven maturation. There is evidence that mature IAA derive from germline-encoded 'natural' antibodies, and that the gene segments utilised by IAA may be influenced by clinical context. Monoclonal anti-idiotypic (anti-Id) antibodies can serve as probes for antibody variable region determinants, and antibodies to the different epitopes of beef and porcine insulins have already been analysed with monoclonal reagents. Used as antibodies in a radioimmunoassay format, monoclonal anti-Ids will identify and measure autoantibody idiotopes as if they were ligands. The challenge now is to replace the conventional radiobinding assays for IAA, which only detect and titrate, with radioimmunoassays that can be standardised in absolute units. There is sufficient evidence for the existence of Type 1 diabetes-predictive IAA idiotopes to justify the development of idiotope-specific radioimmunoassays which ignore Type 1 diabetes-unrelated IAA.