Glenfield Hospital

About: Glenfield Hospital is a healthcare organization based out in Leicester, United Kingdom. It is known for research contribution in the topics: Population & Extracorporeal membrane oxygenation. The organization has 1382 authors who have published 1812 publications receiving 99238 citations. The organization is also known as: Glenfield General Hospital.

The role of thoracic surgery in the management of mesothelioma: an expert opinion on the limited evidence.

Abstract: Surgery has a key role at different points in the management of Malignant Pleural Mesothelioma. Diagnosis with video assisted thoracoscopy offers excellent sensitivity and specificity and a direct view of the pleural cavity to verify the extent of the tumor. Nodal involvement can be assessed by mediastinoscopy and either talc pleurodesis or partial pleurectomy can be used for symptom control in advanced stage disease. Extra Pleural Pneumonectomy (EPP) and Extended Pleurectomy Decortication (EPD) are used to prolong survival although the benefit of radical surgery has not has been fully clarified; EPP failed to show its benefit in the MARS trial and EPD is currently under investigation in the MARS2 trial. More randomized prospective trial data are needed to fully understand the role of radical surgery in the treatment of pleural mesothelioma.

Tumor necrosis factor-alpha: a promising therapeutic target for asthma?

Abstract: Asthma is a disease that encompasses a variety of features including airway smooth muscle abnormalities, airway inflammation, and structural changes in the airway. Historically, it has been classified depending on the severity of the disease, the frequency of symptoms, and the level of treatment required to control them. Severe or refractory asthma accounts for approximately 10% of the patient population with asthma and for about 30% of the healthcare costs of this disease. It is often associated with conditions that might lead to activation of innate immunity in the lung, and it has been suggested that some of the features of severe asthma might be due to upregulation of the tumor necrosis factor-alpha (TNFalpha) pathway. In support of this, studies have shown that severe asthma is associated with an increased presence of TNFalpha within the airway and an increase in TNFalpha expression on peripheral blood mononuclear cells. Moreover, TNFalpha has the ability to induce several of the pro-inflammatory changes associated with severe asthma. Interest in the role of TNFalpha in severe asthma has increased following reports that antagonism with etanercept or infliximab is associated with improvement in asthma control in patients with severe asthma. In this article, we discuss the biology, function, and clinical effects of TNFalpha with particular reference to severe asthma.

Variation in Telangiectasia Predisposing Genes Is Associated With Overall Radiation Toxicity

Abstract: Purpose In patients receiving radiotherapy for breast cancer where the heart is within the radiation field, cutaneous telangiectasiae could be a marker of potential radiation-induced heart disease. We hypothesized that single nucleotide polymorphisms (SNPs) in genes known to cause heritable telangiectasia-associated disorders could predispose to such late, normal tissue vascular damage. Methods and Materials The relationship between cutaneous telangiectasia as a late normal tissue radiation injury phenotype in 633 breast cancer patients treated with radiotherapy was examined. Patients were clinically assessed for the presence of cutaneous telangiectasia and genotyped at nine SNPs in three candidate genes. Candidate SNPs were within the endoglin ( ENG ) and activin A receptor, type II-like 1 ( ACVRL1 ) genes, mutations in which cause hereditary hemorrhagic telangiectasia and the ataxia-telangiectasia mutated ( ATM ) gene associated with ataxia-telangiectasia. Results A total of 121 (19.1%) patients exhibited a degree of cutaneous telangiectasiae on clinical examination. Regression was used to examine the associations between the presence of telangiectasiae in patients who underwent breast-conserving surgery, controlling for the effects of boost and known brassiere size (n=388), and individual geno- or haplotypes. Inheritance of ACVRL1 SNPs marginally contributed to the risk of cutaneous telangiectasiae. Haplotypic analysis revealed a stronger association between inheritance of a ATM haplotype and the presence of cutaneous telangiectasiae, fibrosis and overall toxicity. No significant association was observed between telangiectasiae and the coinheritance of the candidate ENG SNPs. Conclusions Genetic variation in the ATM gene influences reaction to radiotherapy through both vascular damage and increased fibrosis. The predisposing variation in the ATM gene will need to be better defined to optimize it as a predictive marker for assessing radiotherapy late effects.

Pulmonary rehabilitation for obstructive lung disease.

Abstract: Pulmonary rehabilitation (PR) is a highly effective, established therapy to improve exercise intolerance, impaired quality of life and limb muscle weakness associated with a range of chronic respiratory diseases. The evidence base for PR is largest in the area of chronic obstructive pulmonary disease (COPD), yet its role in other obstructive lung diseases such as asthma is less well defined. Despite several features being common across both COPD and asthma, factors such as younger age or employment may affect the potential applicability of traditional PR models for patients with asthma. This review examines the current evidence regarding PR for the obstructive lung diseases of COPD and asthma. It offers appraisal of some of the strengths and weaknesses of existing literature, identifies areas in need of future research and details some of the issues facing clinicians responsible for the clinical management and rehabilitation of patients with these diseases.

The role of surgery in diagnosis and treatment of malignant pleural mesothelioma.

Abstract: The role of surgery in the management of mesothelioma has largely been confined to obtaining a tissue diagnosis or to effect symptom control by pleurodesis. Noninvasive, image-guided methods of obtaining pleural tissue are reducing the need for surgical biopsy, and increased use of thoracoscopy under sedation by pulmonologist is also reducing surgical involvement. However, the increasing incidence of the disease together with reports of long-term survivors has resulted in a more aggressive surgical approach toward therapy. Surgical debulking may have a role in symptom control beyond that of pleurodesis. Radical surgery, with the aim of macroscopic clearance of the tumor, may not be of prognostic benefit alone but, as part of a multimodality treatment regime, may result in long-term survivors. Adjuvant treatments with chemotherapy and radiotherapy appear to prolong survival, whereas photodynamic therapy may be detrimental. Selection criteria for radical treatment need to be refined and a radical multimodality protocol must be subjected to a randomized, controlled evaluation.