The communication of a secondary care diagnosis of autoimmune hepatitis to primary care practitioners: a population-based study

Background Autoimmune Hepatitis is a chronic liver disease which affects young people and can result in liver failure leading to death or transplantation yet there is a lack of information on the incidence and prevalence of this disease and its natural history in the UK. A means of obtaining this information is via the use of clinical databases formed of electronic primary care records. How reliably the diagnosis is coded in such records is however unknown. The aim of this study therefore was to assess the proportion of consultant hepatologist diagnoses of Autoimmune Hepatitis which were accurately recorded in General Practice computerised records. Methods Our study population were patients with Autoimmune Hepatitis diagnosed by consultant hepatologists in the Queens Medical Centre, Nottingham University Hospitals (UK) between 2004 and 2009. We wrote to the general practitioners of these patients to obtain the percentage of patients who had a valid READ code specific for Autoimmune Hepatitis. Results We examined the electronic records of 51 patients who had biopsy evidence and a possible diagnosis of Autoimmune Hepatitis. Forty two of these patients had a confirmed clinical diagnosis of Autoimmune Hepatitis by a consultant hepatologist: we contacted the General Practitioners of these patients obtaining a response rate of 90.5% (39/42 GPs). 37/39 of these GPs responded with coding information and 89% of these patients (33/37) used Read code J638.00 (Autoimmune Hepatitis) to record a diagnosis. Conclusions The diagnosis of Autoimmune Hepatitis made by a Consultant Hepatologist is accurately communicated to and electronically recorded by primary care in the UK. As a large proportion of cases of Autoimmune Hepatitis are recorded in primary care, this minimises the risk of introducing selection bias and therefore selecting cases using these data will be a valid method of conducting population based studies on Autoimmune Hepatitis

Prediction of survival among patients receiving transarterial chemoembolization for hepatocellular carcinoma: A response-based approach

Background and aims: The heterogeneity of intermediate-stage hepatocellular carcinoma (HCC) and the widespread use of transarterial chemoembolization (TACE) outside recommended guidelines have encouraged the development of scoring systems that predict patient survival. The aim of this study was to build and validate statistical models that offer individualized patient survival prediction using response to TACE as a variable. Approach and results: Clinically relevant baseline parameters were collected for 4,621 patients with HCC treated with TACE at 19 centers in 11 countries. In some of the centers, radiological responses (as assessed by modified Response Evaluation Criteria in Solid Tumors [mRECIST]) were also accrued. The data set was divided into a training set, an internal validation set, and two external validation sets. A pre-TACE model ("Pre-TACE-Predict") and a post-TACE model ("Post-TACE-Predict") that included response were built. The performance of the models in predicting overall survival (OS) was compared with existing ones. The median OS was 19.9 months. The factors influencing survival were tumor number and size, alpha-fetoprotein, albumin, bilirubin, vascular invasion, cause, and response as assessed by mRECIST. The proposed models showed superior predictive accuracy compared with existing models (the hepatoma arterial embolization prognostic score and its various modifications) and allowed for patient stratification into four distinct risk categories whose median OS ranged from 7 months to more than 4 years. Conclusions: A TACE-specific and extensively validated model based on routinely available clinical features and response after first TACE permitted patient-level prognosticatio

Histo-morphometric Analysis of an Idiopathic 'Kink' in the Transverse Colon

Presence of kinked transverse colon is not a very common phenomenon. Its presence may not cause physiological disturbance. However, at times when it requires endoscopy, the abrupt looped course of the transverse colon might set a risk of entrapment of the device, which in turn might lead to severe complications and undue discomfort to the patient. An idiopathic kink in the transverse colon of an adult male cadaver was noted and its morphometric and histopathological analysis was performed. The exact location and gross morphometric measurements of the kinks in the transverse colon was recorded. Small pieces of the colon at the regions of kinks were removed, processed, and stained with Haemetoxylin and Eosin, Alcian Blue- Periodic Acid Schiff (PAS) stain and Masson Trichrome stain for histopathological examination. Transverse colon presented with an abrupt loop towards its splenic end by the presence of proximal and distal kinks. Histopathological features of the mucosa at the areas of kink showed foci of surface erosions composed of parallelly placed tubular glands lined by columnar cells, interspersed by goblet cells. Submucosa was oedematous with few congested vessels. Presence of such unusual kink and the loop together may be the cause for forceful forward push of the device introduced into it during colonoscopy and might result in the damage of its mucosa

The communication of a secondary care diagnosis of autoimmune hepatitis to primary care practitioners: a population-based study

Abstract Background: Autoimmune Hepatitis is a chronic liver disease which affects young people and can result in liver failure leading to death or transplantation yet there is a lack of information on the incidence and prevalence of this disease and its natural history in the UK

Bilateral Vascular Variations at the Renal Hilum: A Case Report

Imaging technology with its advancement in the field of urology is the boon for the patients who require minimally invasive approaches for various kidney disorders. These approaches require a precise knowledge of the normal and variant anatomy of vascular structures at the hilum of the kidney in terms of their pattern of arrangement and division. The present paper describes a bilateral anomalous arrangement of the structures at the renal hilum as well as their peculiar branching pattern which is of clinical and surgical relevance. Multiple branching of the renal vessels was observed in both kidneys due to which the hila were congested. The right renal artery immediately after its origin divided into 2 branches. The upper branch represented an aberrant artery whereas the lower branch gave 5 divisions. The left renal artery also divided into 2 branches much before the hilum as anterior and posterior divisions. The anterior branch took an arched course and gave 6 branches. The posterior branch gave 3 terminal branches before entering the renal substance. In addition to anomalous hilar structures, normal architecture of both kidneys was altered and the hilum of the left kidney was found on its anterior surface

Scholars Journal of Medical Case Reports ISSN 2347-9507 (Print) Incomplete duplicated (bifid) left ureter -A case report

Abstract: The ureter is subjected to natural variation such as duplication. The partial duplication forming bifidity is one of its rare congenital anomalies. We report here a case of unilateral left bifid ureter encountered during cadaveric dissection. The bifidity in the present case was at its greater extent and in the form of Y shaped with superior and inferior segments. Proximally, both the segments arose from the renal hilum. At pelvic brim, superior segment crossed the inferior segment superficially from medial to lateral. Both the segments united in the lesser pelvis at the level of bifurcation of internal iliac artery, about 1.5 inches above its opening into urinary bladder. Bifid ureter may be associated with the renal stones and other pathological conditions like gonadal dysgenesis. Knowledge of bifid ureter with the extent of bifidity is important during diagnostic approaches of associated disorders. Since the ureter is closely related to neighbouring vessels and organs, its detailed anatomy is essential in surgical and radiological interventional approaches

Anomalous origin of dorsalis pedis artery and its clinical significance

Arterial variations of the lower limb have been reported in the past. However, we report in here a very unusual variation. During routine dissections, an anomalous origin of the dorsalis pedis artery (DPA) was noted on the right foot of an adult male cadaver. In here, the arteries of the crural region arose from the popliteal artery, as usual. However, the anterior tibial artery (ATA) was very slender. The peroneal artery (PA) was larger than usual and reached the anterior compartment of the leg by piercing the interosseous membrane at its lower part. In the foot, the ATA joined with the PA to form the DPA. Knowledge of such type of variations in the anatomy of DPA is important for angiographers, vascular surgeons and reconstructive surgeons who operate upon these regions

Presence of an accessory spleen in the gastrosplenic ligament: Its histological observation and clinical consequences

Accessory or supernumerary spleens are congenital in occurrence. Its presence may result in differential diagnosis or exhibit continued symptoms after therapeutic splenectomy. We report here a case of accessory spleen (AS), which was remarkably larger in size was found within the gastro-splenic ligament, adherent to its anterior layer. It received an independent vascular supply from splenic vessels supplying the main spleen (MS). Its histological architecture was in close resemblance to that of MS, but with the deficiency of white pulp. Failure to remove AS during main splenectomy done for pathological conditions may result in failure of resolving the condition due to which the pathological condition persists. Occurrence of ASs may also be confused for enlarged lymph nodes or neoplastic growth in the tail of pancreas, gastrointestinal tract and adrenal glands

Prediction of Survival Among Patients Receiving Transarterial Chemoembolization for Hepatocellular Carcinoma: A Response-Based Approach

Background and Aims: The heterogeneity of intermediate-stage hepatocellular carcinoma (HCC) and the widespread use of transarterial chemoembolization (TACE) outside recommended guidelines have encouraged the development of scoring systems that predict patient survival. The aim of this study was to build and validate statistical models that offer individualized patient survival prediction using response to TACE as a variable. Approach and Results: Clinically relevant baseline parameters were collected for 4,621 patients with HCC treated with TACE at 19 centers in 11 countries. In some of the centers, radiological response (as assessed by modified Response Evaluation Criteria in Solid Tumors [mRECIST]) was also accrued. The data set was divided into a training set, an internal validation set, and two external validation sets. A new pre-TACE model ("Pre-TACE-Predict") and a post-TACE model ("Post-TACE-Predict") that included response were built. The performance of the models in predicting overall survival (OS) was compared with existing ones. Median OS was 19.9 months. The factors influencing survival were tumor number and size, alpha-fetoprotein, albumin, bilirubin, vascular invasion, etiology, and response as assessed by mRECIST. The proposed models showed superior predictive accuracy compared to existing models (the HAP score and its various modifications) and allowed for patient stratification into four distinct risk categories whose median OS ranged from 7 months to more than 4 years. Conclusion: A TACE-specific and extensively validated model based on routinely available clinical features and response after first TACE permitted patient-level prognostication