Publications by authors named "Dhya Al-Leswas"

14 Publications

  • Page 1 of 1

Margin Accentuation Irreversible Electroporation in Stage III Pancreatic Cancer: A Systematic Review.

Cancers (Basel) 2021 Jun 27;13(13). Epub 2021 Jun 27.

Hepato-Pancreato-Biliary and Transplant Unit, Freeman Hospital, Newcastle upon Tyne NE7 7DN, UK.

The present systematic review aimed to summarise the available evidence on indications and oncological outcomes after MA IRE for stage III pancreatic cancer (PC). A literature search was performed in the Pubmed, MEDLINE, EMBASE, SCOPUS databases using the PRISMA framework to identify all MA IRE studies. Nine studies with 235 locally advanced (LA) (82%, 192/235) or Borderline resectable (BR) PC (18%, 43/235) patients undergoing MA IRE pancreatic resection were included. Patients were mostly male (56%) with a weighted-mean age of 61 years (95% CI: 58-64). Pancreatoduodenectomy was performed in 51% (120/235) and distal pancreatectomy in 49% (115/235). R0 resection rate was 73% (77/105). Clavien Dindo grade 3-5 postoperative complications occurred in 19% (36/187). Follow-up intervals ranged from 3 to 29 months. Local and systematic recurrences were noted in 8 and 43 patients, respectively. The weighted-mean progression free survival was 11 months (95% CI: 7-15). The weighted-mean overall survival was 22 months (95% CI 20-23 months) and 8 months (95% CI 1-32 months) for MA IRE and IRE alone, respectively. Early non-randomised data suggest MA IRE during pancreatic surgery for stage III pancreatic cancer may result in increased R0 resection rates and improved OS with acceptable postoperative morbidity. Further, larger studies are warranted to corroborate this evidence.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.3390/cancers13133212DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8268790PMC
June 2021

Systematic review and meta-analyses of cholecystectomy as a treatment of biliary hyperkinesia.

Clin J Gastroenterol 2021 Jun 11. Epub 2021 Jun 11.

Consultant Upper GI Surgeon, North Cumbria University Hospitals NHS Trust, Carlisle, UK.

Biliary hyperkinesia is typically diagnosed in patients with biliary-like pain and no evidence of gall stones on imaging modalities but who have had biliary scintigraphy scan (HIDA) that shows ejection fraction ≥ 80%. This study aims to identify whether the removal of the gall bladder can alleviate the symptoms associated with biliary hyperkinesia. Systematic search following PRISMA guidelines was done from inception to January 2020 using PubMed/Medline, OVID, Embase, Cochrane database of systemic reviews, Cochrane central register of controlled trials, The Database of Abstracts of Reviews of Effects (DARE) and Cochrane library databases. Results were expressed as risk ratios (RR) for dichotomous outcomes together with 95% confidence intervals (CI) or mean differences (MD) or standardized MD (SMD) for continuous outcomes. A meta-analysis was done using random-effect model in RevMan 5.4 software. Thirteen studies met the inclusion criteria and were included in the review. A total of 332 patients diagnosed with biliary hyperkinesia underwent cholecystectomy, of whom 303 (91.3%) reported symptomatic improvement RR 8.67 (95% CI 4.95, 15.16) P = 0.01. Six studies described abnormal histological features in 163/181 (90.05%) with high GB EF. RR 7.88 (95% CI 3.94, 15.75) P = 0.08. Chronic cholecystitis n = 155 (95%), cholesterolosis n = 7 (4.3%), and one showed features of acute cholecystitis. Patients with typical biliary colic symptoms without gallstones and markedly high ejection fraction might benefit from having cholecystectomy to alleviate their symptoms.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s12328-021-01463-xDOI Listing
June 2021

The socio-economic impact of chronic pancreatitis: a systematic review.

J Eval Clin Pract 2014 Jun 24;20(3):203-7. Epub 2014 Mar 24.

Department of Hepatobiliary and Pancreatic Surgery, University Hospitals of Leicester, Leicester, UK.

Rationale, Aims And Objectives: Chronic pancreatitis (CP) is a progressive inflammatory disorder with pain being the most frequent symptom. It is associated with loss of function, pancreatogenic diabetes and digestive enzyme deficiency. The impact of local complications and loss of pancreatic function results in unknown and unreported costs. This study attempts to identify both the direct and indirect costs associated with CP.

Methods: A MEDLINE literature review was performed for all relevant articles relating to any aspect of direct and indirect costs as a result of CP.

Results: In the UK, there are 12,000 admissions per annum of patients with CP at an estimated cost of £55.8 million. The costs for loss of pancreatic function are estimated at £45-90 million and $75.1 million for endocrine and exocrine function, respectively. Chronic pain contributes $638 million per year in costs. The protracted course of CP and paucity of monetary data make quantifying direct and indirect costs difficult. An estimate of direct and indirect costs is at £285.3 million per year. This equates to £79,000 per person per year.

Conclusions: Patients with CP consume a disproportionately high volume of resources.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1111/jep.12117DOI Listing
June 2014

A randomized controlled trial investigating the effects of parenteral fish oil on survival outcomes in critically ill patients with sepsis: a pilot study.

JPEN J Parenter Enteral Nutr 2015 Mar 9;39(3):301-12. Epub 2014 Jan 9.

University Hospitals of Leicester, Leicester, UK.

Introduction: Death from sepsis in the intensive care unit (ITU) is frequently preceded by the development of multiple organ failure as a result of uncontrolled inflammation. Treatment with ω-3 has been demonstrated to attenuate the effects of uncontrolled inflammation and may be clinically beneficial.

Method: A randomized control trial investigating the effects of parenteral ω-3 was carried out. Consecutive patients diagnosed with sepsis were entered into the study and randomized to receive either parenteral ω-3 or standard medical care only. The primary outcome measure was a reduction in organ dysfunction using the Sequential Organ Failure Assessment (SOFA) score as a surrogate marker. The secondary outcome measures were mortality, length of stay, mean C-reactive protein (CRP), and days free of organ dysfunction/failure.

Results: Sixty patients were included in the study. The baseline demographics were matched for the two cohorts. Patients treated with parenteral ω-3 were associated with a significant reduction in new organ dysfunction (Δ-SOFA 2.2 ± 2.2 vs. 1.0 ± 1.5, P = .005 and maximum-SOFA 10.1 ± 4.2 vs. 8.1 ± 3.2, P = .041) and maximum CRP (186.7 ± 78 vs. 141.5 ± 62.6, P = .019). There was no significant reduction in the length of stay between cohorts. Patients treated with ω-3 in the strata of less severe sepsis had a significant reduction in mortality (P = .042).

Conclusion: The treatment of critically ill septic patients with parenteral ω-3 is safe. It is associated with a significant reduction in organ dysfunction. It may be associated with a reduction in mortality in patients with less severe sepsis.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1177/0148607113518945DOI Listing
March 2015

Contrast-enhanced ultrasound detects perfusion defects in an ex vivo porcine liver model: a useful tool for the study of hepatic reperfusion.

J Artif Organs 2013 Dec 29;16(4):475-82. Epub 2013 Jun 29.

Department of Hepatobiliary and Pancreatic Surgery, Leicester General Hospital, University Hospitals of Leicester, Gwendolen Road, Leicester, LE5 4PW, UK,

Following transplantation, areas of hypoperfusion can be associated with metabolic changes and poor organ recovery. Our study evaluated contrast-enhanced ultrasound (CEUS) agents for the detection of such areas. Livers were collected from ten pigs, connected to extracorporeal circuits and perfused using autologous blood. After 1 and 4 h livers were scanned with an ultrasound machine following the administration of CEUS agents. Biopsies from perfused and non-perfused areas were collected. The entire parenchyma enhanced strongly on non-contrast ultrasound at 1 h with no perfusion defects. Four hours later multiple perfusion defects manifested not evident with non-contrast ultrasound. Histology confirmed non-perfused areas corresponded to ischemic zones. In our model the addition of CEUS revealed perfusion defects after 4 h. This might facilitate detection and characterization of perfusion defects in transplanted livers.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s10047-013-0717-1DOI Listing
December 2013

Contrast-enhanced ultrasound in the preoperative, intraoperative and postoperative assessment of liver lesions.

Hepatol Res 2013 Aug 20;43(8):809-19. Epub 2013 Jun 20.

Department of General Surgery, William Harvey Hospital, Ashford.

The use of contrast agents (CA) with liver ultrasound (US) has gained recently an established role for the diagnosis of various hepatic diseases due to their safety, high versatility and low costs (contrast-enhanced ultrasound: CEUS). The purpose of this review is to provide a state-of-the-art summary of the available evidence for their use in the characterization of focal liver lesions. A published work search was conducted for all preclinical and clinical studies involving CA on hepatic US imaging. CEUS increases the sensitivity for lesion detection and the specificity to differentiate between benign and malignant diseases due to the enhanced visualization of the tumor microcirculation. Results achieved seem at least equivalent to those of spiral computed tomography or magnetic resonance imaging. The association of CA with intraoperative ultrasound has changed the surgical approach in 25% of patients and guarantees complete ablations by a single session in most of them. CEUS provides detailed information about tumor vasculature, improves the preoperative characterization and therefore the therapeutic strategy, and can evaluate the intraoperative completeness of the ablation.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1111/hepr.12044DOI Listing
August 2013

The development of a multiorgan ex vivo perfused model: results with the porcine liver-kidney circuit over 24 hours.

Artif Organs 2013 May 13;37(5):457-66. Epub 2013 Mar 13.

Department of Hepatobiliary and Pancreatic Surgery, Leicester General Hospital, University of Leicester, Leicester, UK.

We already developed an ex vivo liver-kidney model perfused for 6 h in which the kidney acted as a homeostatic organ to improve the circuit milieu compared to liver alone. In the current study, we extended the multiorgan perfusions to 24 h to evaluate the results and eventual pitfalls manifesting with longer durations. Five livers and kidneys were harvested from female pigs and perfused over 24 h. The extracorporeal circuit included a centrifugal pump, heat exchanger, and oxygenator. The primary end point of the study was the evaluation of the organ functions as gathered from biochemical and acid-base parameters. In the combined liver-kidney circuit, the organs survived and maintained an acceptable homeostasis for different lengths of time, longer for the liver (up to 19-23 h of perfusions) than the kidney (9-13 h of perfusions). Furthermore, glucose and creatinine values decreased significantly over time (from the 5th and 9th hour of perfusion onward). The addition of a kidney to the perfusion circuit improved the biochemical environment by removing excess products from ongoing metabolic processes. The consequence is a more physiological milieu that could improve results from future experimental studies. However, it is likely that long perfusions require some nutritional support over the hours to maintain the organ's vitality and functionality throughout the experiments.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1111/aor.12003DOI Listing
May 2013

The autologous normothermic ex vivo perfused porcine liver-kidney model: improving the circuit's biochemical and acid-base environment.

Am J Surg 2012 Oct;204(4):518-26

Department of Hepatobiliary and Pancreatic Surgery, Leicester General Hospital, University of Leicester, Gwendolen Rd., Leicester LE5 4PW, UK.

Background: The ex vivo porcine liver perfused model isolates the organ from extrinsic regulatory mechanisms, facilitating an improved understanding of the organ physiology and reaction to various conditions. We have assessed the influence of the addition of a porcine kidney to the circuit.

Methods: Eight livers were harvested and perfused for 6 hours. In 5 additional experiments a kidney also was connected in parallel. Hourly arterial blood gases were collected to analyze glucose, acid base, and renal parameters. The primary end point was an evaluation of the influence of the kidney on glucose, pH, and electrolyte levels.

Results: In the combined porcine liver-kidney circuit all the parameters significantly improved compared with the liver circuit alone. This was particularly evident for glucose values because normoglycemia was reached by the end of the perfusion, and for pH and electrolyte values that were maintained at initial levels.

Conclusions: The addition of a porcine kidney to the perfusion circuit improves the biochemical milieu. This might produce more consistent and reliable results, particularly during studies requiring a steady-state environment.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.amjsurg.2011.11.016DOI Listing
October 2012

Targeted microbubbles in the experimental and clinical setting.

Am J Surg 2012 Sep;204(3):355-66

Department of Hepatobiliary and Pancreatic Surgery, NHS Trust, Leicester General Hospital, Gwendolen Rd., Leicester, LE5 4PW, UK.

Background: Microbubbles have improved ultrasonography imaging techniques over the past 2 decades. Their safety, versatility, and easiness of use have rendered them equal or even superior in some instances to other imaging modalities such as computed tomography and magnetic resonance imaging. Herein, we conducted a literature review to present their types, general behavior in tissues, and current and potential use in clinical practice.

Methods: A literature search was conducted for all preclinical and clinical studies involving microbubbles and ultrasonography.

Results: Different types of microbubbles are available. These generally improve the enhancement of tissues during ultrasonography imaging. They also can be attached to ligands for the target of several conditions such as inflammation, angiogenesis, thrombosis, apoptosis, and might have the potential of carrying toxic drugs to diseased sites, thereby limiting the systemic adverse effects.

Conclusions: The use of microbubbles is evolving rapidly and can have a significant impact on the management of various conditions. The potential for their use as targeting agents and gene and drug delivery vehicles looks promising.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.amjsurg.2011.10.024DOI Listing
September 2012

Addition of a kidney to the normothermic ex vivo perfused porcine liver model does not increase cytokine response.

J Artif Organs 2012 Sep 4;15(3):290-4. Epub 2012 Apr 4.

Department of Hepatobiliary and Pancreatic Surgery, Leicester General Hospital, University of Leicester, Gwendolen Road, Leicester LE5 4PW, UK.

The addition of a kidney to the ex vivo liver perfused model may facilitate the circuit homeostatic balance of important biochemical parameters (i.e. pH changes, urea and creatinine, or glucose levels) but might also increase the inflammatory reaction produced. In this study, we compared the production of various cytokines between liver-kidney and liver-alone circuits. Seven livers were harvested from female pigs and perfused for 6 h. In five additional experiments, a kidney was also harvested and connected in parallel. Blood samples for interleukins (IL) 1, 2, 4, 6, 8, 10, and 12, interferon (IFN)-γ and tumor necrosis factor (TNF)-α were collected before perfusion and at hours 1, 2, 4 and 6 postperfusion. In the combined liver-kidney circuit, a significant increase was present only for IL-6 and IL-8, but this did not differ significantly from those recorded in the liver-alone circuit. All other cytokines were not modified from baseline levels. The addition of a kidney to the perfusion circuit does not stimulate a greater inflammatory reaction than that of the liver alone and therefore further confirms the safety of the experimental setups in view of more delicate experiments requiring strict homeostatic conditions.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s10047-012-0641-9DOI Listing
September 2012

Potential applications of fish oils rich in n-3 fatty acids in the palliative treatment of advanced pancreatic cancer.

Br J Nutr 2011 Sep 12;106(6):795-800. Epub 2011 Jul 12.

Department of Hepatobiliary and Pancreatic Surgery, Leicester General Hospital, Leicester, UK.

The palliative treatment of patients with advanced pancreatic cancer (APC) has undergone little advancement in the last 15 years. Novel therapies that have been investigated to extend survival have shown little benefit over existing chemotherapy regimens. Patients with APC often experience significant weight loss, which is one of the primary factors involved in declining quality of life. Recently, the ability of n-3 fatty acid rich oral preparations to attenuate or reverse tumour-related weight loss has been investigated in this patient group with encouraging results. Laboratory investigation has also yielded promising results suggesting a potential direct tumouricidal effect of n-3 fatty acids as well as the putative potentiation of existing chemotherapy regimes. The present review aims to examine the potential applications of fish oils rich in n-3 fatty acids in patients with APC, present a selection of the studies carried out to date and outline avenues of possible further clinical investigation.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1017/S0007114511003060DOI Listing
September 2011

Pooled survival and response data from phase III randomized controlled trials for gemcitabine-based regimes in the treatment of advanced pancreatic cancer.

Am J Clin Oncol 2013 Aug;36(4):411-4

Department of Hepatobiliary and Pancreatic Surgery, Leicester General Hospital, Leicester, UK.

Although gemcitabine remains current first-line chemotherapy for patients with advanced pancreatic cancer, median survival times have not improved significantly since its introduction 15 years ago. Of the phase III trials which have investigated alternative regimens to single-agent gemcitabine, most have used combination regimens as the investigational arm. Accurate data on median overall, progression-free survival and objective response rates is important, for two principle reasons: advising patients about their prognosis and when powering phase II trials and evaluating the results of single-armed trials. This study aims to pool results from published randomized trials to date. Twenty-one randomized phase III trials involving a total of 6348 patients were identified from 1997 to 2010. Only one trial investigating a novel agent in combination with gemcitabine showed a significantly prolonged median and progression-free survival compared with single-agent gemcitabine. Pooled median and progression-free survivals for the single-agent gemcitabine arm involving 3171 patients across all studies were 6.15 and 3.3 months, respectively. Length of survival for patients with advanced pancreatic cancer remains disappointing. Further trials of novel agents to complement or replace gemcitabine are indicated.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1097/COC.0b013e3182124216DOI Listing
August 2013

Hepatic haemangioma masquerading as the gallbladder in a case of gallbladder agenesis: a case report and literature review.

HPB Surg 2010 19;2010. Epub 2010 Jul 19.

Department of Hepatobiliary and Pancreatic Surgery, Leicester General Hospital, Gwendolen Road, Leicester LE5 4PW, UK.

Gallbladder agenesis is uncommon. In contrast, liver haemangiomas are the most common type of benign liver lesions. We describe the first documented case of gallbladder agenesis where the clinical presentation was consistent with biliary colic, and radiological investigation suggested the presence of gallstones. Subsequent operative findings revealed a solitary haemangioma of the liver sited in the normal position of the gallbladder fossa but with absence of the gallbladder. It is important that clinicians should keep gallbladder agenesis in mind when the gallbladder appears abnormal on preoperative imaging studies and cannot be found at laparoscopy. As symptoms will improve in 98% of cases, it is very important to avoid unnecessary intervention in patients who have a negative laparoscopy. The clinical presentation, investigations, and operative findings are discussed with a review of other relevant reported cases in the literature.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1155/2010/971609DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2913526PMC
December 2010

Biopsy of solid liver tumors: adverse consequences.

Hepatobiliary Pancreat Dis Int 2008 Jun;7(3):325-7

Department of Surgery, University Hospital Aintree, Lower Lane, Liverpool, L9 7AL, UK.

Background: Percutaneous radiologically-guided liver biopsy is used routinely worldwide in all secondary-level hospital centers. While it has an undoubted role in the investigation and management of acute and chronic inflammatory conditions of the liver, its role in hepatic oncology is doubtful and probably dangerous.

Method: We report on two patients who underwent preoperative biopsy of potentially resectable liver tumors.

Results: At the time of surgery, there was evidence of seeding at the biopsy site in both cases. In case 1, potentially curative liver resection was rendered incurable because of gross peritoneal carcinomatosis lying adjacent to the site of liver biopsy. In case 2, the patient underwent curative liver resection, but there was histopathological evidence of peritoneal disease beyond the liver capsule along the falciform ligament at the site of the previous biopsy.

Conclusions: No patient with a suspicious liver tumor which is thought to be malignant and has any possibility of being a potential candidate for liver surgery, should be subjected to pre-operative diagnostic biopsy in a non-specialist center.
View Article and Find Full Text PDF

Download full-text PDF

Source
June 2008
-->