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Publication History View all

  • The Clinical Teacher 08/2012; 9(4):267-8. DOI:10.1111/j.1743-498X.2012.00608.x
  • Medical Education 05/2012; 46(5):528; author reply 529. DOI:10.1111/j.1365-2923.2012.04221.x
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    ABSTRACT: We conducted a retrospective analysis of 11 consecutive patients with various autoimmune cytopenias who failed to respond to conventional treatments and received a fixed-dose regimen of rituximab (100 mg weekly for 4 consecutive weeks). Sustained complete responses were achieved in 4 out of 7 patients with idiopathic thrombocytopenic purpura and in 1 patient with autoimmune pancytopenia. A partial response was observed in 1 patient with autoimmune hemolytic anemia. The immunotherapy had no effect in 1 patient with pure red cell aplasia or in 1 patient with autoimmune neutropenia. No infusion-related or delayed toxicities attributable to rituximab were experienced by any of the patients.
    Haematologica 01/2008; 92(12):1695-8. DOI:10.3324/haematol.11709
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    ABSTRACT: Trigeminal neuralgia (TN) is a rare form of neuropathic facial pain characterised by severe, paroxysmal pains in the face. Little is known about the decision process in treatment of TN, and management with anti-epileptic drugs or surgical procedures carries risks of side effects, recurrence and complications. One hundred fifty-six previously diagnosed TN patients completed an adapted time-trade-off utility measurement questionnaire to ascertain how they valued the potential outcomes from various surgical and medical treatments. The decision analysis revealed that microvascular decompression surgery (MVD) offered the best chance of improved quality of life or highest maximum expected utility (MEU). MVD (MEU=16.08 out of a possible 20) was closely followed by balloon compression (MEU=15.97), percutaneous glycerol rhizolysis (MEU=15.61) and then radiofrequency thermocoagulation (MEU=14.93). Medication offered the least optimal chance of improved quality of life (MEU=14.61). The difference between the highest (MVD) and lowest scoring treatments (medication) was 7.3% (1.46/20). These results were sensitive to some utility values, meaning the preferred treatment is changed by the values patients assign to outcomes. As surgical techniques narrowly offer the highest chance of maximising patient quality of life, all patients with TN should consider surgery. However, surgery is not right for everyone, and patients should be informed about their full range of choices. Treatment decisions must take place after careful consideration of the values patients place on benefits and risks of treatment.
    Pain 11/2007; 131(3):302-10. DOI:10.1016/j.pain.2007.02.009
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    ABSTRACT: Classical trigeminal neuralgia (TN) is a rare neuropathic pain with distinct diagnostic criteria. The aim of this review is to provide recommendations for medical management based on current evidence and provide some pointers on the conduct of future trials. A review of the literature identified four systematic reviews, of which one was a meta-analysis and 18 randomized controlled trials (RCT) on medical management of trigeminal neuralgia. The evidence suggests that carbamazepine is still the first line drug for medical management, but this should be changed to oxcarbazepine if there is poor efficacy and an unacceptable side effect profile. Combination of carbamazepine with lamotrigine or baclofen is the second line treatment when monotherapy fails, but the evidence is weak. An early neurosurgical opinion should be sought when a patient has a neurovascular contact of the trigeminal nerve, poor efficacy and tolerability of drug treatment and no remission periods. Many of the new antiepileptic drugs need to be evaluated in RCTs with innovative designs and robust outcome measures.
    British Journal of Neurosurgery 07/2007; 21(3):253-61. DOI:10.1080/02688690701219175
  • The Lancet Oncology 04/2007; 8(4):279-81. DOI:10.1016/S1470-2045(07)70080-3
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    ABSTRACT: BACKGROUND: High-density lipoproteins (HDL) have been shown to bind and neutralize lipopolysaccharide (LPS) and are regarded as possible therapeutic agents for sepsis and conditions associated with local or systemic inflammation. However, in recent years, a multitude of possible immunomodulatory properties other than LPS neutralization have become evident. DISCUSSION: This review highlights the advances in the understanding of how HDL is protective in both in vitro and in vivo inflammatory settings, including the ability of HDL to modulate adhesion molecule expression, upregulate endothelial nitric oxide synthase and counteract oxidative stress. Also, the active components of HDL and the recent discovery of novel lipid modulators of inflammation are discussed.
    Intensive Care Medicine 02/2007; 33(1):13-24. DOI:10.1007/s00134-006-0432-y
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    Journal of the Royal Society of Medicine 07/2006; 99(6):277; author reply 279-80. DOI:10.1258/jrsm.99.6.277
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    ABSTRACT: Intratubular seminoma (ITS) has been defined as the complete filling of the seminiferous tubules with seminoma cells with no Sertoli cells present. This contrasts with intratubular germ cell neoplasia, unclassified (IGCNU), where the malignant germ cells are interspersed by Sertoli cells. We aimed to determine the relationship between these 2 entities and the association between ITS and invasive classic seminomas. We therefore examined the morphology and immunochemistry of ITS and IGCNU adjacent to germ cell tumors to differentiate the patterns, frequency, and distribution of these lesions. We found that ITS was seen in equal frequency adjacent to seminomas as it was to nonseminomas. The presence of ITS in non-seminomatous germ cell tumors suggests that it is a true in situ lesion rather than representative of intratubular spread of an existing seminoma. However, because it is not specifically associated with seminoma, we suggest that it is not useful to discriminate this lesion from IGCNU and that it merely represents an advanced form of IGCNU on the way to invasive malignancy.
    Human Pathlogy 05/2006; 37(4):458-61. DOI:10.1016/j.humpath.2005.12.007
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    ABSTRACT: Diagnostic and therapeutic advances in growth hormone insensitivity (GHI) have occurred principally in two areas: the molecular characterization of patients with GHI and treatment with recombinant human insulin like growth factor-I (IGF-I). This article discusses the current status of molecular diagnosis across the spectrum of the disorder. Treatment with recombinant human IGF-I in classical cases is summarized, and potential new targets for treatment are discussed together with the potential for therapy using the newly developed compound recombinant human IGF-I/IGF binding protein-3.
    Endocrinology & Metabolism Clinics of North America 10/2005; 34(3):581-95, viii. DOI:10.1016/j.ecl.2005.04.009
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