PubMed Health⌕ Search

Biomedical subjects

Bryan Warren

Publications and source records attributed to Bryan Warren.

7 recordsLinked to original sources
PubMed2005

Oesophagectomy remains the gold standard for treatment of high-grade dysplasia in Barrett's oesophagus.

AIM: The goal of surveillance in Barrett's oesophagus is to detect high-grade dysplasia (HGD). The natural history of HGD is unclear, but because of the reported high risk of coexistent invasive carcinoma, oesophagectomy is currently the gold standard treatment. Recent reports suggest the risk of coexistent tumour may be lower and that the optimum treatment for HGD is continuing surveillance or mucosal ablation treatment, reserving oesophagectomy for those patients with invasive malignancy. To re-examine the role of oesophagectomy we looked at the incidence of invasive cancer in patients undergoing resection for HGD and their subsequent outcome. METHODS: Prospective analysis of 240 patients undergoing oesophagectomy over 6 years under a single surgeon in a single centre. Analysis was focused on patients undergoing oesophagectomy for HGD picked up during Barrett's surveillance endoscopy. The incidence of invasive cancer, morbidity, mortality and survival of this subgroup is reported. RESULTS: Preoperatively, 17 patients were diagnosed with HGD and underwent oesophagectomy. Eleven of 17 (65%) patients had coexistent invasive cancer and six patients had HGD alone in the resected specimens. There was no in-patient mortality, four patients had significant respiratory complications and three patients had radiological/clinical anastomotic leaks. All 6 patients with HGD only are alive to date (3-68 months) and 3 of 11 patients with invasive cancer have died of recurrent disease. CONCLUSION: We continue to advocate oesophagectomy for HGD as the optimum treatment in the light of the high rate of coexistent invasive cancer. Oesophagectomy for HGD can be performed with low morbidity and minimal mortality in a specialist centre. We hypothesize that the lower rates of invasive cancer found in HGD reported by other groups result from interobserver variation in grading of HGD, variability in histological sampling of the resected oesophagus and variability in the endoscopic technique of acquisition of biopsy samples.

Adenocarcinoma↗
PubMed2005

RDP58 is a novel and potentially effective oral therapy for ulcerative colitis.

BACKGROUND: RDP58 is a novel anti-inflammatory d-amino acid decapeptide that inhibits synthesis of proinflammatory cytokines by disrupting cell signaling at the pre-MAPK MyD88-IRAK-TRAF6 protein complex. We therefore evaluated its efficacy and safety in parallel multicenter, double-blind, randomized concept studies in ulcerative colitis (UC). METHODS: In the first trial, 34 patients with mild to moderate active UC were randomized (1:2) to placebo (n = 13) or RDP58 100 mg (n = 21). In the second trial, 93 similar patients were randomized (1:1:1) to placebo (n = 30) RDP58 200 mg (n = 31), or RDP 300 mg (n = 32). In both studies, treatment success was defined as a simple clinical colitis activity index score of no more than 3 at 28 days. Sigmoidoscopy and rectal biopsy (at baseline and 28 days) and safety measures (baseline and 28 and 56 days) were other endpoints. RESULTS: Treatment success on RDP 100 mg was 29% versus 46% on placebo (P = 0.46). There were no significant differences in sigmoidoscopy or histology score. In the second study, treatment success on the higher doses of RDP58 (200 and 300 mg) was 71% and 72%, respectively, versus 43% on placebo (P = 0.016). Improvements in sigmoidoscopy scores (41% on 200 mg and 46% on 300 mg versus 32% on placebo) did not reach significance, but histology scores improved significantly (P = 0.002) versus placebo. Overall, adverse events were no different between placebo (3.3 +/- 2.4) and RDP58 (2.7 +/- 1.4, 300-mg group). CONCLUSIONS: RDP58 at a dose of 200 or 300 mg, but not 100 mg, was effective in mild-to-moderate UC. RDP58 was safe and well tolerated, and its novel action makes it an attractive potential therapy.

Administration, Oral↗
PubMed2005

Identity theft prevention in the healthcare setting.

How a healthcare security department has undertaken a program to prevent employees, patients, and visitors from becoming victims of Identity Theft as well as providing help for victims of this crime in mitigating their losses. An Identity Theft affidavit for ID theft victims is illustrated.

Forms and Records Control↗
PubMed2004

Preliminary risk assessments of healthcare facilities.

While a professional security survey is still the preferred method for risk analysis and prevention, a quick "self assessment" can demonstrate the need for security when resources for more comprehensive methods are not available. The article presents a methodology for conducting self-assessments for a large urban hospital and a smaller rural hospital.

Hospital Administration↗
PubMed2003

Raman spectroscopy, a potential tool for the objective identification and classification of neoplasia in Barrett's oesophagus.

Histopathology remains the gold standard technique for the diagnosis of intraepithelial neoplasia (dysplasia) in Barrett's oesophagus, but it is highly subjective and relies on blind biopsy targeting. The aim of this study was to evaluate Raman spectroscopy, a rapid, non-invasive, molecular, specific analytical technique, for the objective identification and classification of Barrett's neoplasia in vitro. A secondary objective was to demonstrate the need for a rigorous gold standard in the development of new diagnostic techniques. Forty-four patients with a mean age of 69 years (range 34-89 years) undergoing surveillance for Barrett's oesophagus were included in the study. Three consultant pathologists independently assessed snap-frozen oesophageal biopsy specimens. Raman spectra were measured on 87 histopathologically homogeneous samples. Spectral classification models were developed using multivariate analysis for the prediction of pathology. Histopathology and Raman classification results were compared. Raman spectral prediction with a consensus pathology classification model gave sensitivities between 73% and 100% and specificities of 90-100%. A high level of agreement (kappa = 0.89) was demonstrated between the three-subset biopsy targeting model and consensus pathology opinion. This compares favourably with the agreement measured between an independent pathologist and the consensus pathology opinion for the same spectra (kappa = 0.76). Raman spectroscopy appears to provide a highly sensitive and specific technique for the identification and classification of neoplasia in Barrett's oesophagus.

Adult↗
PubMedDate not supplied

Indeterminate colitis.

Explore the source record for details and available documents.

Antibodies, Antineutrophil Cytoplasmic↗