ORCID Profile
0000-0003-0415-0762
Current Organisation
Liverpool Hospital
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Publisher: Wiley
Date: 19-07-2011
Publisher: Elsevier BV
Date: 09-2022
DOI: 10.1016/J.JVSV.2022.04.017
Abstract: Retrograde movement of lymph owing to damaged and/or incompetent valves in the lymphatic vessels has been considered a pathological feature of lymphedema. This study aimed to determine the prevalence of retrograde lymph flow and the characteristics of patients with this condition using indocyanine green (ICG) lymphography. An audit of 679 patients with upper or lower limb swelling who underwent ICG lymphography was undertaken over a 4-year period. Harvey's technique was applied to identify retrograde flow in the lymph collecting vessel during ICG lymphography. The characteristics of patients with retrograde lymph flow were recorded. Twenty-one patients (3.7% lower limb, n = 19 upper limb, n = 2) were identified as having retrograde flow in lymph collecting vessels out of 566 confirmed lymphedema patients (lower limb, n = 275 upper limb, n = 291). Of the two patients with upper limb lymphedema (ULLE), one had a short segment of retrograde lymph flow in the forearm. The other patient with ULLE and one patient with lower limb lymphedema (LLLE) were previously diagnosed with lymphedema-distichiasis syndrome. Of the remaining 18 patients with LLLE and retrograde lymph flow, nine had initiating insect bites with lymphangitis and three had palpable benign enlarged inguinal lymph nodes evident before lower limb swelling onset. None had cancer-related LLLE. Retrograde lymph flow with valve incompetence in the lymph-collecting vessels was a rare finding in ULLE and a relatively uncommon finding in LLLE, contradicting the conventional understanding of pathological changes in lymphedema. ICG lymphography identified anticipated retrograde lymph flow in two patients with lymphedema distichiasis. In the remaining patients, retrograde lymph flow may have resulted from toxic or asymptomatic lymphangitis but there was no association with secondary cancer-related lymphedema. These findings have implication for conservative management as well as lymphovenous anastomosis surgery where both ends of a transected lymph collecting vessel would be potential targets for anastomoses.
Publisher: Elsevier BV
Date: 06-2012
Publisher: Wiley
Date: 27-04-2009
Publisher: Wiley
Date: 2004
Publisher: Wiley
Date: 15-07-2016
DOI: 10.1002/HED.24120
Abstract: Nodal metastasis from cutaneous squamous cell carcinoma (SCC) is poorly predicted clinically and is associated with a high mortality rate. From 2010 to 2013, patients with high-risk cutaneous SCC were assessed with sentinel node biopsy (SNB) either at the time of primary cutaneous tumor resection or at secondary wide local excision. Of 57 patients, 8 (14%) had nodal metastasis. Significant predictors of metastasis are the number of high-risk factors (p = .008), perineural invasion (PNI p = .05), and lymphovascular invasion (LVI p = .05). During a mean of 19.4 months, 9 patients developed recurrence and 6 died of cutaneous SCC, indicating that over 1300 patients would be required for a randomized controlled trial with 80% power to detect a significant difference in disease-free survival. Lymph node metastasis occurs in 14% of patients with high-risk cutaneous SCC. Larger studies will be required to identify which "high-risk" factors should be considered as an indication for surgical assessment of the nodal basin. © 2015 Wiley Periodicals, Inc. Head Neck 38: E884-E889, 2016.
Publisher: Springer Science and Business Media LLC
Date: 30-06-2015
Publisher: Baishideng Publishing Group Inc.
Date: 2008
DOI: 10.3748/WJG.14.541
Publisher: Elsevier BV
Date: 03-2017
Publisher: Elsevier BV
Date: 09-2014
Publisher: Australian Society of Plastic Surgeons
Date: 20-01-2018
Abstract: Background: Lockout reforms were introduced in February 2014 by the New South Wales government in an attempt to curb alcohol-related violence in Sydney, following a number of fatalities. Changes include 1.30 a.m. venue lockouts and the 3 a.m. cessation of alcohol service. This study aims to assess the results of these reforms through analysis of departmental treatment data. All maxillofacial fractures that required operative management at St Vincent’s Hospital, Sydney, over a two-year period pre and post reforms were analysed.Methods: Medical information, from multiple sources, of patients that required operative management for maxillofacial fractures over a 2-year period (2012-2014) were compared to those between (2014-2016). Data collected included age, gender, demographics, mechanism of injury, pattern of injury, treatment required, association with alcohol, time and place of injury, and long-term complications.Results: 145 maxillofacial fractures were operatively treated prior to the reforms compared to only 58 (p .001) post. Reported incidents occurring in the city significantly fell from 54 to 15 (p .001), with no change in peripheral locations. The operated cases associated with alcohol dropped post reforms (102/145 (70%) vs 33/58 (57%). The number of assaults related to ‘king hits’ significantly reduced from 30 (33%) to just 5 (19.2%).Conclusion: This study demonstrates a clear correlation with the reduction in maxillofacial trauma, alcohol and violence in a localised region of Sydney since the arrival of the lockout reforms. As such, it can provide guidance to other regions in Australia into the effects of such laws and its repercussions on patient care and service.
Publisher: Wiley
Date: 17-11-2017
DOI: 10.1111/ANS.14263
Abstract: Supraclavicular flap (SCF) repair is widely reported in head and neck surgery in select patients and defects. The authors' objective is to present our series of 30 patients who underwent SCF repair for varying defects and to review the scope and outcome of SCF repair in the literature. The authors contributed primary evidence of 30 cases of SCF repair. Our outcomes are compared with those reported in the last 5 years' literature 33 articles published between January 2012 and January 2017 that present original clinical experience of 528 SCFs. SCF is suitable for a wide variety of oral cavity, pharyngeal, skull base and cutaneous defects. Consistent with our experience, SCF is highly reliable even in previously irradiated or dissected necks, so long as the supraclavicular artery is intact. Our case series shows minor complications in 3/30 (10%) and flap loss in 1/30 (3.3%) cases. The literature reports a similar rate of complete flap failure of 3.4% and a slightly higher average minor complication rate of 24.6%. We add our experience of 30 cases of SCF repair to the international literature. We experienced a complication rate lower than the reported average, and maintain that the SCF is an excellent reconstructive option in patients with previously irradiated necks or comorbidities that affect microvasculature and anaesthetic resilience.
Publisher: Oxford University Press (OUP)
Date: 06-11-2020
DOI: 10.1002/BJS.11368
Abstract: This study documents the development and evaluation of a comprehensive multidisciplinary model for the assessment and personalized care of patients with lymphoedema. The Australian Lymphoedema Education Research and Treatment (ALERT) programme originated as an advanced clinic for patients considering surgery for lymphoedema. The programme commenced liposuction surgery in May 2012 and then introduced lymph node transfer in 2013 and lymphovenous anastomosis (LVA) in 2016. An outpatient conservative treatment clinic was established in 2016. ALERT commenced investigations with indocyanine green (ICG) lymphography in late 2015, leading to the creation of a diagnostic assessment clinic offering ICG in 2017. Since 2012, 1200 new patients have been referred to ALERT for assessment of lymphoedema for a total of 5043 episodes of care. The introduction of ICG lymphography in 2015 initially allowed better screening for LVA, but is now used not only to guide surgical options, but also as a diagnostic tool and to guide manual lymphatic drainage massage. The total number of new patients who attended the surgical assessment clinic to December 2018 was 477, with 162 patients (34·0 per cent) undergoing surgery. The ALERT programme has developed a multidisciplinary model of care for personalized lymphoedema treatment options based on clinical, imaging and ICG lymphography. Patients are selected for surgery based on several in idual factors.
Publisher: Springer Science and Business Media LLC
Date: 03-10-2019
DOI: 10.1245/S10434-019-07865-Z
Abstract: Regional nodal metastases from cutaneous squamous cell carcinoma (cSCC) is strongly associated with a poor prognosis, but these metastases are difficult to predict clinically. Sentinel node biopsy (SNB) has been used for a wide range of malignancies to assess for regional nodal metastasis, but is not widely used for cSCC. Patients presenting with high-risk cSCC of the head and neck with clinically N0 necks were offered SNB at the time of primary cSCC excision or secondary wide local excision. Patients with positive sentinel nodes were offered completion lymph node dissection, and all the patients were followed up at regular intervals for up to 5 years. In this study, 105 lesions underwent SNB, and 10 sentinel nodes (9.5%) were positive. In an additional five patients, regional recurrence developed after a negative sentinel node, with a total subclinical nodal metastasis rate of 14.3%. Nodal metastases were significantly associated with reduced disease-specific survival. The significant predictors of metastasis were four or more high-risk features or tumors with a concurrent invasion deeper than 5 mm and PNI. For high-risk cSCC, SNB is a safe and feasible staging technique. The total number of high risk features and certain combinations of high-risk features predicted metastasis better than in idual high-risk features.
Publisher: Elsevier BV
Date: 03-2013
Publisher: Elsevier BV
Date: 06-2020
Publisher: Mary Ann Liebert Inc
Date: 08-2020
Publisher: Elsevier BV
Date: 06-2015
Publisher: Wiley
Date: 03-2006
Publisher: JMIR Publications Inc.
Date: 12-07-2016
DOI: 10.2196/RESPROT.5491
Publisher: Wiley
Date: 08-04-2016
DOI: 10.1111/IWJ.12248
Publisher: Elsevier BV
Date: 08-2009
Publisher: Wiley
Date: 29-11-2012
Publisher: Elsevier BV
Date: 05-2012
Publisher: Australian Society of Plastic Surgeons
Date: 29-09-2021
Abstract: Neurotrophic keratopathy is a corneal disease characterised by reduced corneal sensation. Corneal neurotization is the transfer of healthy donor nerve tissue to the cornea to restore sensation. An 11-year-old male presented with reduced Mackie Stage 1 neurotrophic keratopathy from de-bulking of a cerebellopontine angle arachnoid cyst. He underwent minimally invasive indirect corneal neurotization with a sural nerve autograft to ipsilateral supratrochlear nerve and cornea. Close and objective post-operative monitoring of donor sites, the cornea, visual acuity, and tear production clearly demonstrate the efficacy of this technique, and the timeline of clinical improvement.
Publisher: Elsevier BV
Date: 06-2017
Publisher: Springer Science and Business Media LLC
Date: 27-09-2020
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