St George's Hospital Research Articles

Effective radiation doses of CT examinations in Japan: a nationwide questionnaire-based study.

The aims of this study were to estimate the effective radiation doses from CT examinations of both adults and children in Japan and to study the impact of various scan parameters on the effective doses. A questionnaire, which contained detailed questions on the CT scan parameters employed, was distributed to 3000 facilities throughout Japan. For each scanner protocol, the effective doses for head (non-helical and helical), chest and upper abdomen acquisitions were estimated using ImPACT CT Patient Dosimetry Calculator software v. 1.0.4 (St George's Hospital, London, UK). The mean effective doses for chest and abdominal examinations using 80-110 kV were significantly lower than those using 120 kV. However, there was no statistically significant difference in the mean effective doses for head scans between facilities employing 80-110 kV and 120 kV. In chest and abdominal examinations, the mean effective doses using CT scanners from Western manufacturers [Siemens (Forchheim, Germany), Philips (Eindhoven, Netherlands) and GE Medical Systems (Milwaukee, WI)] were significantly lower than those of examinations using Japanese scanners [Hitachi (Kashiwa, Japan) and Toshiba (Otawara, Tochigi, Japan)], except for in paediatric chest examinations. The mean effective doses for adult head, chest and abdominal CT examinations were 2.9, 7.7 and 10.0 mSv, respectively, whereas the corresponding mean effective doses for paediatric examinations were 2.6, 7.1 and 7.7 mSv, respectively. Facilities using CT scanners by Western manufacturers commonly adopt low-tube-voltage techniques, and low-tube-voltage CT may be useful for reducing the radiation doses to the patients, particularly for the body region.

Transcranial Direct Current Stimulation as a Treatment for Depression in the Hemodialysis Setting

Received July 27, 2015; revised November 8, 2015; accepted November 19, 2015. From School of Psychiatry, University of New South Wales, Sydney, Australia (AB, CKL, SBH); NSW Institute of Psychiatry, Westmead, Australia (AB); Department of Psychiatry, St George Hospital, Kogarah, Australia (AB, CKL, SH); Department of Renal Medicine, St George Hospital, Kogarah, Australia (IK); Black Dog Institute, Sydney, Australia (CKL,DM, SBH); Faculty ofMedicine, University ofNewSouth Wales, Sydney, Australia (IK); Prince of Wales Hospital, Randwick, Australia (AB). Send correspondence and reprint requests to Alison Bautovich, M.B.B.S., B.Sc. (Med), School of Psychiatry, University of New SouthWales, Black Dog Institute Building, Hospital Road, Randwick NSW 2031, Australia; e-mail: a.bautovich@unsw.edu.au Crown Copyright & 2016 Published by Elsevier Inc. on behalf of The Academy of Psychosomatic Medicine. All rights reserved. Introduction

P53 can be stabilised by a combination of Nutlin-3 and irradiation in human papillomavirus-positive oropharyngeal carcinoma cells, with no apparent effect on cell growth or clonogenic survival

P53 can be stabilised by a combination of Nutlin-3 and irradiation in human papillomavirus-positive oropharyngeal carcinoma cells, with no apparent effect on cell growth or clonogenic survival

Editorial introductions

Editorial introductions

The differentiation of progressive supranuclear palsy.

The Department of Aged Care, St George & Calvary Hospitals, 3 Chapel Street, Kogarah NSW 2217, Sydney, Australia Neuroscience Research Australia & University of New South Wales, Sydney, Australia *Author for correspondence: Tel.: +612 9113 2183; Fax: +612 9113 3979; Nicholas.Cordato@sesiahs.health.nsw.gov.au

Prospective diagnostic test accuracy comparison of computed tomography during arterial portography and Primovist magnetic resonance imaging in the pre-operative assessment of colorectal cancer liver metastases

ObjectivesTo assess and compare the accuracy and inter-observer agreement for the detection of liver lesions using Primovist magnetic resonance imaging (pMRI) and computed tomography during arterial portography (CTAP). MethodsPatients evaluated at St George Hospital Liver Unit for colorectal liver metastases (CRCLM) underwent CTAP as part of standard staging. pMRI was added to the pre-operative assessment. Two radiologists reported CTAP and two reported pMRI. The sensitivity and specificity of CTAP and pMRI were calculated using histopathology as the gold standard. ResultsComplete data were available for 62 patients corresponding to 219 lesions confirmed on histopathology. Agreement on the detection of lesions between the two radiologists that reported pMRI was higher than for CTAP (Kappa = 0.80 versus 0.74). Specificity of lesion detection for pMRI was 0.88 and 0.83 for CTAP (P = 0.112). Sensitivity for pMRI was 0.83 and 0.81 for CTAP. For patients who had chemotherapy before evaluation, pMRI had a significantly higher specificity than CTAP (0.79 versus 0.63, P = 0.011). ConclusionspMRI is less invasive, has a good inter-observer agreement, has comparable sensitivity and specificity to CTAP in the pre-chemotherapy population and demonstrates better specificity in patients assessed post-chemotherapy. pMRI is a valid alternative to CTAP in the assessment of CRCLM.

Impacts of low peritoneal cancer index on the survival outcomes of patient with peritoneal carcinomatosis of colorectal origin

IntroductionThe combination of cytoreductive surgery (CRS) and perioperative chemotherapy (PIC) have been proposed as an innovative technique for peritoneal carcinomatosis and is currently considered as a standard treatment for colorectal peritoneal carcinomatosis (CRPC) in selected patients. Peritoneal cancer index (PCI) has been suggested to be the most important prognostic factors for the outcomes of patients with CRPC. In this paper, we have studied patients with CRPC and a very low PCI of 5 or less and their survival outcomes. MethodsThis is a retrospective study of prospectively collected data of 60 consecutive patients with CRPC and PCI ≤ 5, who underwent CRS and PIC by the same surgical team at St George hospital in Sydney, Australia between January 1996 and April 2015. Clinical outcomes of these patients were analysed. ResultsHospital mortality was 0%. 14 patients (23.4%) had grade III/IV morbidity. The median follow-up was 22.2 months (range = 0.1–104.2). The median survival was 80.6 months (95% confidence interval (CI) = 35.1–126.1), with an overall 1-year, 3-year, and 5-year survival rate of 96.1%, 72.6% and 54.7% respectively. Among 60 patients, 31 patients experienced the recurrence of the disease (51.7%). The median disease-free survival was 10.8 months (95% CI = 7.2–14.4). ConclusionThis innovative approach combining CRS and PIC has shown encouraging outcomes and offers hope for patients with CRPC. Our results suggest that CRS and PIC can be performed safely to provide significant survival benefits for patients with low volume of disease. Early referral to specialist centre for evaluation is warranted for better survival outcomes.

Differences in intestinal metaplasia in Barrett's esophagus patients in an ethnically diverse south London population.

Barrett's esophagus (BE) is the replacement of any portion of the normal distal squamous epithelial mucosa by metaplastic columnar epithelium and is the only known precursor for esophageal adenocarcinoma. We undertook a study to identify ethnic differences for the presence of intestinal metaplasia (IM) in BE in patients in an ethnically diverse south London population. Retrospective analysis was done using the endoscopy database of St George's Hospital NHS Trust, which serves a large ethnically diverse London population. Gastroscopy records between 2009 and 2012 were retrieved, and patients with an endoscopic diagnosis of BE were identified. Patients of Indian subcontinent Asian origin (ISCA) were further identified. The presence of IM was retrieved from hospital pathology databases and was the primary outcome measured. Multivariate logistic regression analysis was performed to determine the odds of having IM by ethnic origin. ISCAs were 70% less likely to have IM compared to non-ISCAs (OR 0.32, 95% CI: 0.16-0.61, p = 0.001). This is the first study to identify differences in histological findings in ISCAs with BE living in the UK. Our findings may be useful for the future risk stratification of BE patients. Identification of environmental factors responsible for this difference would be of great therapeutic value.

Cytoreductive surgery and perioperative intraperitoneal chemotherapy for peritoneal carcinomatosis in the elderly.

BackgroundPeritoneal carcinomatosis is life-threatening without cytoreductive surgery (CRS) and perioperative intraperitoneal chemotherapy (PIC). Only a few studies in the literature addressed the relationship between age and outcomes of peritonectomy. This study was designed to review the clinical outcomes in elderly patients who underwent CRS and PIC.MethodsThis is a retrospective study of prospectively collected data of 611 consecutive patients with peritoneal carcinomatosis who underwent CRS and PIC by the same surgical team at St George Hospital in Sydney, Australia, between January 1996 and December 2013. Patients were divided into two groups; group 1 (<65 years old, n = 487) and group 2 (≥ 65 years old, n = 124). Subgroup analysis was performed in patients who were ≥75 years old (n = 20). A significant difference was defined as p < 0.05.ResultsThere was no significant statistical difference in terms of mean total hospital stay, intensive care unit stay, high dependency unit stay and complication rates. Postoperative mortality was 2 and 3 % in groups 1 and 2, respectively. Overall survival did not reach a statistical significance between the two groups. In subgroup analysis, patients showed similar morbidity results to patients who were <65 years old.ConclusionsCRS and PIC can be safely done in the elderly. Age alone should not be the single exclusion criterion but rather taken into consideration along with other factors to determine the suitability of elderly patients.

Insights from outside BJOG

BJOG: An International Journal of Obstetrics & GynaecologyVolume 122, Issue 10 p. 1279-1283 Insights from outside BJOG Insights from outside BJOG Athol Kent, Athol KentSearch for more papers by this authorShona Kirtley, Shona KirtleySearch for more papers by this author Athol Kent, Athol KentSearch for more papers by this authorShona Kirtley, Shona KirtleySearch for more papers by this author First published: 26 August 2015 https://doi.org/10.1111/1471-0528.13600 The Research Snippets are extracts from a monthly service called the Journal Article Summary Service. It is a service that summarises new articles in obstetrics and gynaecology published over the preceding month. If you would like to have information on how to subscribe, please email the editor Athol Kent at atholkent@mweb.co.za or visit the website www.getjass.com. The remaining sections of Insights from outside BJOG are written by Shona Kirtley, Research Information Specialist, Centre for Statistics in Medicine, Botnar Research Centre, Oxford, UK. This Insights from outside BJOG was edited by Aris Papageorghiou, Consultant in Fetal Medicine and Obstetrics, St George's Hospital, London and BJOG Executive Scientific Editor. Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat Volume122, Issue10September 2015Pages 1279-1283 RelatedInformation

Pulmonary rehabilitation in chronic obstructive pulmonary disease: Outcomes in a 12 week programme

Objective. The optimal time-frame for pulmonary rehabilitation (PR) in patients diagnosed with chronic obstructive pulmonary disease (COPD) is still debated. A 12 week programme was designed looking at whether the benefits were reached at or before a 12 week period of PR for COPD patients. Method. Seventy-five patients (59 males, 16 females) aged 40 75 years were referred from the local general hospital in Malta. Baseline assessments were carried out on all patients 2 weeks before initiation of the programme. Sixty patients were eligible to start a twice-weekly, 12 week multidisciplinary programme delivered after the screening process. The Six-Minute Walk Test (6MWT), dyspnoea score using the Borg scale, spirometry testing, plethysmography, COPD Assessment Tool (CAT) score, St George's Respiratory Questionnaire (SGRQ) and Hospital and Anxiety scale score were monitored at 4 weekly intervals throughout the 12 weeks of PR for these COPD patients. Results. The 6MWT distance increased by a mean total of 132.45 m (p < 0.001) by 12 weeks, with the highest change recorded in the first 4 weeks for the milder COPD patients. Lung function test improvements were marginal. Borg scale readings at rest and following exertion decreased significantly from weeks 0 to 4 but remained fairly constant thereafter. The Body mass index, airway Obstruction, Dyspnoea, and Exercise capacity (BODE) index, SGRQ and CAT score values decreased significantly throughout the weeks irrespective of the initial Medical Research Council score. Anxiety scoring decreased significantly by 12 weeks, while the depression rating improved by 8 weeks. Conclusion. These findings show that 12 weeks of PR in this cohort of COPD patients resulted in clinically significant changes in functional outcome measures which are supported by statistically significant changes in health-related quality of life measures. In milder COPD cases, by 4 weeks of PR gains in exercise tolerance had already resulted. The more severe group required more time to obtain improvements. Therefore, hospitals could organize shorter PR programmes for larger numbers of patients with milder COPD.

Repeat cytoreductive surgery and hyperthermic intraperitoneal chemotherapy for recurrent diffuse malignant peritoneal mesothelioma

IntroductionCytoreductive surgery (CRS) combined with hyperthermic intraperitoneal chemotherapy (HIPEC) has shown to improve survival outcomes for patients with diffuse malignant peritoneal mesothelioma (DMPM). Patients and methodsThis is a retrospective study of prospectively collected data of 44 consecutive patients with DMPM who underwent CRS and HIPEC by the same surgical team at St George Hospital in Sydney, Australia. A total of 58 operations were performed. Clinical data were divided according to the number of operation and HIPEC the patient had undergone (Group 1 = initial CRS and HIPEC; Group 2 = 2nd CRS and HIPEC; Group 3 included 3rd CRS and HIPEC; Group 4 = 4th CRS and HIPEC). A significant difference was defined as p < 0.05. ResultsThere were no significant differences in mortality and morbidity results among the four groups. The median survival for those who only had one operation was 22 months (95% confidence interval (CI) = 0–47.2), whereas the median survival for those who had a second operation was 62 months (95% CI = 22.9–101.1). However, such a difference did not translate into a statistical significance (p = 0.141). ConclusionWe report an encouraging median survival of 62 months in patients who had recurrence of disease and had repeat CRS and HIPEC with similar morbidity and mortality with the initial operation. Due to the learning curve of this technique, patients with recurrent mesothelioma should be referred to specialised tertiary care centres for evaluation. Selected patients may experience prolonged survival after repeat CRS and HIPEC.

BJOG Editors‐in‐chief since 1902

Frances Henry Champneys was born on 25 March 1848 in Whitechapel, London. His father was the very Reverend William Weldon Champneys, vicar of St Mary's Whitechapel and Dean of Lichfield. One of five brothers, he went to Winchester School as a scholar, where he was taught by SB Wesley, organist to the school and cathedral. Later, he had an organ in his house, directed a choir and wrote hymns. He won an exhibition (scholarship) to Brasenose College, Oxford, where he captained the college boat and took a first class in natural science. He studied medicine at St Bartholomew's Hospital and, having gained the Radcliffe travelling fellowship in 1872, studied in Vienna, Leipzig and Dresden. He graduated B.M. Oxon and became MRCS in 1875, when he was appointed registrar at St Bart's. The following year he married Virginia Dalrymple, and struggled financially until, in 1880, he was elected assistant obstetric physician to St George's Hospital. With John Williams he also took over the General Lying in Hospital (founded in Lambeth in 1767), and immediately established Listerian antiseptic midwifery for the first time in an English hospital, dramatically reducing the incidence of puerperal infections. He was promoted to obstetric physician at St George's in 1885, and from there went on to gain an MD in 1888. In 1891 he returned to St Bart's as physician accoucheur, where he practiced until retirement in 1913 at the age of 65 years. Champneys was prominent in the Royal College of Physicians and the Royal Medical and Chirurgical Society. When the latter joined with 17 other societies to form the Royal Society of Medicine, he became honorary treasurer, and then president in 1912. He was also elected president of the British Medical Association section of Obstetrics and Gynaecology in 1904. He played a leading part in formulating the rules of the newly formed (in 1903) Central Midwives Board, becoming its chairman in that year, and continuing in that role until he died 26 years later. He believed that the practice of midwives should be limited in scope and that they should defer to doctors. This view was not always shared by rank-and-file midwives, who ‘found the chairman harsh in his judgements and scathing towards those who were not submissive enough to the board’. Champneys was also crown nominee on the General Medical Council from 1911 to 1926, and strove to improve the training of medical students in practical midwifery. In 1929 he was involved in founding the British College of Obstetricians and Gynaecologists, became a foundation fellow of the College, and was elected vice-patron. He campaigned against the scourge of venereal disease as vice chairman of the ‘British Social Hygiene Council’. Champneys and Virginia had three sons (one of whom was killed in the First World War) and a daughter. He was created a baronet in 1910, succeeded in the title by his youngest and only surviving son, a doctor who became deputy Chief Medical Officer. Champneys died in 1930, remembered as short but good-looking, energetic, talkative, and ‘bubbling over with laughter’. Philip Steer is Emeritus Editor, BJOG. For a full disclosure of interests, please go to www.BJOG.org. Image source: Wellcome Library, London, ICV No 26591. Reproduced under CC BY 4.0 License.■

Insights from outside BJOG

BJOG: An International Journal of Obstetrics & GynaecologyVolume 122, Issue 8 p. 1037-1041 Insights from outside BJOG Insights from outside BJOG Athol Kent, Athol KentSearch for more papers by this authorShona Kirtley, Shona KirtleySearch for more papers by this author Athol Kent, Athol KentSearch for more papers by this authorShona Kirtley, Shona KirtleySearch for more papers by this author First published: 24 June 2015 https://doi.org/10.1111/1471-0528.13499 The Research Snippets are extracts from a monthly service called the Journal Article Summary Service. It is a service that summarises new articles in obstetrics and gynaecology published over the preceding month. If you would like to have information on how to subscribe, please email the editor Athol Kent at atholkent@mweb.co.za or visit the website www.getjass.com. The remaining sections of Insights from outside BJOG are written by Shona Kirtley, Research Information Specialist, Centre for Statistics in Medicine, Botnar Research Centre, Oxford, UK. This Insights from outside BJOG was edited by Aris Papageorghiou, Consultant in Fetal Medicine and Obstetrics, St George's Hospital, London and BJOG Executive Scientific Editor. Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat Volume122, Issue8July 2015Pages 1037-1041 RelatedInformation

OC-082 The results of a multi-centre study of surgery for full thickness rectal prolapse: Abstract OC-082 Table 1

Introduction Rectal prolapse is a disabling condition which is under-reported and affects the quality of life of our ageing population. Despite this there is ‘no accepted standard procedure’1a given patient should receive. The perceived risk of surgery has meant that elderly patients often undergo a perineal operation with an abdominal operation being reserved for younger patients or those with recurrence. Randomised controlled trials have found it challenging to recruit patients making comparison between outcomes difficult for abdominal and perineal operations. Method The Surrey and South West London Pelvic floor group was founded in 2014 and includes the following hospitals – Ashford and St Peters Hospital, Croydon University Hospital, East Surrey Hospital, Epsom and St Heliers Hospital, Frimley Park Hospital, Kingston Hospital, Royal Berkshire Hospital, St Georges Hospital and Wexham Park Hospital. All patients who underwent surgery for full thickness rectal prolapse between April 2011 and March 2013 were included. Data was collected retrospectively from the notes using a standardised proforma. Results 244 patients underwent surgery for full thickness rectal prolapse in the study period. Seven patients were excluded due to incomplete data leaving 237 patients. All but four patients were female. Median age at time of operation was 78.4 years with an average ASA of 2.1. The recorded overall recurrence for all surgery was 17.7%. Median length of stay (LOS) was 2 days. Conclusion In this retrospective multicentre study abdominal operations for full thickness rectal prolapse had a significantly lower rate of recurrence than the perineal approach. This was despite there being a higher proportion of patients in the abdominal group who had had previous surgery for rectal prolapse. Although patients in the abdominal group were younger and fitter there was no difference in length of stay and complication rates. The rates of recurrence for perineal operations were similar1but the recurrence rate after abdominal operations was higher than previousy reported in the literature.1This may be a reflection of the individual learning curves for laparoscopic rectal prolapse surgery during the study period (2011–2013). Disclosure of interest None Declared. Reference Senapati A, Gray RG, Middleton LJ, et al.; PROSPER Collaborative Group. PROSPER: a randomised comparison of surgical treatments for rectal prolapse. Colorectal Dis. 2013;15(7):858–68

Editorial introductions

Current Opinion in Infectious Diseases was launched in 1988. It is part of a successful series of review journals whose unique format is designed to provide a systematic and critical assessment of the literature as presented in the many primary journals. The field of infectious diseases is divided into 11 sections that are reviewed once a year. Each section is assigned a Section Editor, a leading authority in the area, who identifies the most important topics at that time. Here we are pleased to introduce the Section Editors for this issue. SECTION EDITORS Paul T. HeathPaul T. HeathPaul T. Heath is a Professor and Honorary Consultant in Paediatric Infectious Diseases at St George's, University of London, UK, and St George's Vaccine Institute in London, UK. His training in paediatrics and infectious diseases was at the Royal Children's Hospital, Melbourne, Australia, the John Radcliffe Hospital, Oxford, UK, and St George's Hospital, London, UK. His particular research interests are in: the epidemiology of vaccine preventable diseases, clinical vaccine trials (particularly in at-risk groups), and in perinatal infections. He has published over 150 original or review papers in these areas. He sits on national committees concerned with neonatal infections, meningitis, group B streptococcus prevention, and on immunisation policies in children. He is a Fellow of the Royal Australasian College of Physicians, a Fellow of the Royal College of Paediatrics and Child Health, a member of the research committee of the European Society of Paediatric Infectious Diseases and a member of the Science Board of the international Brighton Collaboration on vaccine safety. Dennis L. StevensDennis L. StevensDr Stevens received his PhD in Microbiology from Montana State University, USA, and his MD from the University of Utah College of Medicine, USA. Following a residency in internal medicine at the University of Utah, Dr Stevens completed an infectious disease fellowship at Brooke Army Medical Center in San Antonio, Texas, USA. Since 1979 he has been Chief of Infectious Diseases at the Veterans Affairs Medical Center in Boise, Idaho, USA. Dr Stevens is Professor of Medicine at the University of Washington School of Medicine, USA, and his major clinical interests have been in Staphylococcal and Streptococcal toxic shock syndromes and in skin and soft tissue infections, including necrotizing fasciitis and gas gangrene. His research interests are centered around gram positive bacteria and the role of extracellular toxins in the pathogenesis of severe soft tissue infection caused by Streptococcus pyogenes, Clostridium perfringens, and methicillin-resistant Staphylococcus aureus. His current research efforts investigate the mechanisms of toxin induced shock and organ dysfunction, including cardiomyopathy, the effects of toxins on endothelial cells, granulocytes, and platelets, and the importance of the mechanisms of action of antibiotics in treating gram positive infections. Dr Stevens has published over 170 original research papers, 89 book chapters, 143 abstracts and three books: Streptococcal Infections: Clinical Aspects, Microbiology and Molecular Pathogenesis (co-authored with Dr Edward Kaplan), An Atlas of Infectious Diseases: Skin and Soft Tissue, Bone and Joint Infections and Netter's Textbook of Infectious Diseases (co- authored with Dr Elaine Jong). Dr Stevens is a member of the American Society of Microbiology, a Fellow in the American College of Physicians, a Fellow in the Infectious Disease Society of America and a member of the Association of American Physicians. In 2000, Dr Stevens received the Infectious Disease Society of America's Society Citation Award and in 2001 The William Altemier Award from the Surgical Infectious Disease Society. Dr Stevens has served as a consultant for the CDC Working Group on Invasive Group A streptococcal infections and for the WHO and NIH on similar matters. Dr Stevens is currently Chairman of the Infectious Disease Society of America Guidelines Committee on Skin and Soft Tissue Infections.

Principles of Operative Surgery: Viva Practice for the MRCS (3rd edn)

This is the latest addition to the Master Pass series of texts designed to support candidates preparing for examinations and the third edition offering viva practice for the intercollegiate MRCS. The authors are based in the departments of surgery at St George's Hospital in London and the John Radcliffe Hospital in Oxford. They have carefully assembled and updated the material to include topics collected from candidates who have sat the MRCS during the last 3 years with others from examiners who have set questions. Indeed, they point out in the preface that a number are questions that have actually been used, while others are included as teaching points. In addition, they recommend that the book be used with the assistance of a colleague playing the role of an examiner to improve its effectiveness. It opens with valuable tips for success in the viva, including a simple but practical framework for describing an operation from pre-operative preparation, in theatre and on to postoperative care. More than 60 surgical topics are covered in alphabetical order from, for example, acute limb ischaemia, appendicitis and ATLS through paediatric inguinal hernia, robot-assisted laparoscopic surgery and sutures and needles to vasectomy and wound healing. Each is completed in no more than four pages in a relatively simple, easy-to-read manner. Following this, there are short sections on controlled clinical trials, medical statistics and surgical audit with a helpful concluding list of guidance for further reading. Presented in an economical format in paperback, this book should fit into a white coat pocket (for the sadly diminishing number who wear them these days) with the consequent potential of being a helpful aide-memoire to reinforce live clinical scenarios on the ward, in the accident and emergency department and in the operating theatre. Although its stated aim is to assist MRCS candidates, it is also likely to prove helpful for those preparing for certifying examinations of the American Board of General Surgery, the fellowship of the Royal Australasian College of Surgeons and Canadian Board examinations. In addition, those approaching undergraduate surgical finals will also find it helpful as will those needing to update their general surgical knowledge in preparation for postgraduate examinations in dental and oral surgery.

Aged persons mental health service in rural Victoria.

Australian Journal of Rural HealthVolume 25, Issue 1 p. 68-70 Short Report Aged persons mental health service in rural Victoria Samantha M. Loi FRANZCP, MBBS, Corresponding Author Samantha M. Loi FRANZCP, MBBS samantha.loi2@svha.org.au Academic Unit for Psychiatry of Old Age, Department of Psychiatry, Normanby House, St George's Hospital, Kew, Victoria, Australia North West Aged Mental Health, Melbourne Health, Parkville, Victoria, Australia Ramsay Health, Aged Persons Mental Health Service, Mildura, Victoria, AustraliaCorrespondence: Dr Samantha M. Loi, Academic Unit for Psychiatry of Old Age, Department of Psychiatry, Normanby House, St George's Hospital, 283 Cotham Road, Kew, Victoria, 3101, Australia. Email: samantha.loi2@svha.org.auSearch for more papers by this authorLeesa Bradshaw RPN, Leesa Bradshaw RPN Ramsay Health, Aged Persons Mental Health Service, Mildura, Victoria, AustraliaSearch for more papers by this authorVicky Gilbert Psychiatric Services Officer, Vicky Gilbert Psychiatric Services Officer Ramsay Health, Aged Persons Mental Health Service, Mildura, Victoria, AustraliaSearch for more papers by this author Samantha M. Loi FRANZCP, MBBS, Corresponding Author Samantha M. Loi FRANZCP, MBBS samantha.loi2@svha.org.au Academic Unit for Psychiatry of Old Age, Department of Psychiatry, Normanby House, St George's Hospital, Kew, Victoria, Australia North West Aged Mental Health, Melbourne Health, Parkville, Victoria, Australia Ramsay Health, Aged Persons Mental Health Service, Mildura, Victoria, AustraliaCorrespondence: Dr Samantha M. Loi, Academic Unit for Psychiatry of Old Age, Department of Psychiatry, Normanby House, St George's Hospital, 283 Cotham Road, Kew, Victoria, 3101, Australia. Email: samantha.loi2@svha.org.auSearch for more papers by this authorLeesa Bradshaw RPN, Leesa Bradshaw RPN Ramsay Health, Aged Persons Mental Health Service, Mildura, Victoria, AustraliaSearch for more papers by this authorVicky Gilbert Psychiatric Services Officer, Vicky Gilbert Psychiatric Services Officer Ramsay Health, Aged Persons Mental Health Service, Mildura, Victoria, AustraliaSearch for more papers by this author First published: 06 May 2015 https://doi.org/10.1111/ajr.12179Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat No abstract is available for this article. Volume25, Issue1February 2017Pages 68-70 RelatedInformation

1039 Which Optical Features Differentiate Benign and Neoplastic Biliary Lesions As Assessed by Balloon Assisted Cholangioscopy?

1039 Which Optical Features Differentiate Benign and Neoplastic Biliary Lesions As Assessed by Balloon Assisted Cholangioscopy? Mathew J. Keegan*, Rajvinder Singh, Peter Lim, Philip I. Craig Gastroenterology and Hepatology, St George Hospital, Sydney, Australia, Sydney, NSW, Australia; Medicine, UNSW, Sydney, NSW, Australia; Gastroenterology and Hepatology, Lyell McEwin Hospital, Adelaide, SA, Australia Background: Balloon assisted cholangioscopy (BAC) allows direct visualisation of biliary mucosa under both white light (WL) and narrow band imaging (NBI). We have previously reported in patients with indeterminate biliary strictures on the diagnostic accuracy of BAC appearance to assist differentiation between benign and neoplastic biliary lesions and on the shortcomings of relying on histology alone (Gastrointest Endosc [in press]). However, while there are accepted endoscopic criteria for the prediction of neoplastic histology in extra-biliary mucosal lesions no such criteria exist for cholangioscopy. Aim: To identify cholangioscopic optical criteria using WL and NBI which differentiate benign from neoplastic biliary lesions. Methods: A prospective observational study in a single, tertiary referral hospital with all BAC procedures performed by a single endoscopist. 44 videos from patients undergoing BAC for indeterminate biliary strictures were assessed (18 neoplastic). The final diagnosis for indeterminate biliary strictures was obtained by either endoscopic or operative histopathology or, by long-term clinical and radiological follow-up. Potential descriptors distinguishing benign from neoplastic lesions were collated from the endoscopic literature and anecdotal experience including characteristics pertaining to lesion margins, mucosal appearance, pit patterns and vessels. Results: Of 48 initial criteria assessed, data from 14 criteria found to be significant at multivariate analysis (MV) to differentiate benign and neoplastic strictures are presented (Table 1). Six descriptors were useful in predicting benign lesions while 8 descriptors helped predict neoplastic lesions. Individual optical descriptors were then combined to improve the diagnostic yield for benign and neoplastic biliary lesions (Table 2). Conclusions: 1) Specific optical criteria and two predictive scores have been identified which appear useful in differentiating benign from neoplastic biliary lesions; 2) These optical criteria are a useful adjunct to histology to help diagnose indeterminate biliary strictures; 3) These findings should be validated in a larger patient cohort and by other experienced endoscopists.

Predictors of responses and sexual function for women in the St George breast boost randomized trial (StGBBT)

s / The Breast 24 (2015) 302e307 304 Resonance Imaging (CEMRI) is currently the most sensitive imaging technique for breast cancer detection; however, it suffers from many drawbacks including high cost, timely accessibility, patient contraindications and low specificity. Previous studies have shown that contrast enhanced spectral mammography (CESM) may have similar diagnostic capability to CEMRI without these associated costs (2). Methods: The study included patients with biopsy proven breast cancer aged 21 years, fit for surgery, and excluded patients with contra-indications to intravenous contrast or CEMRI, candidates for neo-adjuvant chemotherapy, or who had pure in situ carcinoma. Participants underwent both CESM and CEMRI. Studies were independently double read and results benchmarked against the final surgical histopathology, core biopsy histology or one year follow-up imaging. CESM and CEMRI were compared for 1) detection of additional lesions 2) ability to size the index lesion 3) influence on surgical plan and 4) participant satisfaction. Results: A minimum of 19 participants was analysed for each study objective. For the detection of additional lesions (n1⁄421), the addition of CESM to conventional imaging increased sensitivity from 50% to 67% with specificity unchanged (47%). Addition of CEMRI to standard imaging increased sensitivity from 50% to 100% but with considerable reduction in specificity (47% to 7%). The geometric mean of index lesion size at pathology was similar for CESM and CEMRI (n1⁄424). For 19 patients, CESM and CEMRI had identical influence on the surgery plan. Participants preferred CESM to CEMRI (n1⁄434, p1⁄40.0005). Conclusions: Results so far suggest CESM has similar diagnostic capacity to CEMRI and is preferred by patients.