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  1. Article ; Online: Incidentalomas in the head & neck.

    McQueen, Andrew / Al-Zuhir, Naail / Ali, Tamir

    The British journal of radiology

    2022  Volume 96, Issue 1142, Page(s) 20220164

    Abstract: Incidental findings (IFs) in the head & neck are a frequent challenge to the reporting radiologist. A combination of complex anatomy, widely varied imaging techniques and the high prevalence of benign pathology, makes safe and appropriate management of ... ...

    Abstract Incidental findings (IFs) in the head & neck are a frequent challenge to the reporting radiologist. A combination of complex anatomy, widely varied imaging techniques and the high prevalence of benign pathology, makes safe and appropriate management of head & neck IFs problematic. The non-head & neck radiologist is unlikely to have prior personal experience of the relevant specialties or current involvement with the pertinent multidisciplinary teams, creating unfamiliarity with both the clinical aspects of head & neck disease and the value of examination techniques. This triumvirate of complex anatomy, pathology and imaging creates the perfect environment for excessive investigation and overdiagnosis. In this article, the most frequently encountered and clinically relevant head & neck IFs are summarised. To reflect daily clinical practice, we will firstly consider anatomic abnormalities identified on cross-sectional imaging and ultrasound, followed by a review of PET-CT incidental findings.
    MeSH term(s) Humans ; Positron Emission Tomography Computed Tomography/methods ; Neck/diagnostic imaging ; Head/diagnostic imaging ; Ultrasonography ; Incidental Findings ; Head and Neck Neoplasms/diagnostic imaging
    Language English
    Publishing date 2022-11-28
    Publishing country England
    Document type Journal Article ; Review
    ZDB-ID 2982-8
    ISSN 1748-880X ; 0007-1285
    ISSN (online) 1748-880X
    ISSN 0007-1285
    DOI 10.1259/bjr.20220164
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  2. Article ; Online: Reducing the unknowns: A systematic review & meta-analysis of the effectiveness of trans-oral surgical techniques in identifying head and neck primary cancer in carcinoma unknown primary.

    Al-Lami, Ali / Gao, Chuanyu / Saddiq, Muhammad / Al Zuhir, Naail / Simo, Ricard / Arora, Asit / Jeannon, Jean-Pierre

    Oral oncology

    2022  Volume 126, Page(s) 105748

    Abstract: Objectives: The use of transoral robotic surgery (TORS), transoral laser microsurgery (TLM) and more recently reported transoral endoscopic electrocautery (TOEC) in identifying the primary cancer in head and neck Carcinoma Unknown Primary (CUP) patients ...

    Abstract Objectives: The use of transoral robotic surgery (TORS), transoral laser microsurgery (TLM) and more recently reported transoral endoscopic electrocautery (TOEC) in identifying the primary cancer in head and neck Carcinoma Unknown Primary (CUP) patients have gained popularity. This review aims to assess the effectiveness of TORS, TLM and TOEC.
    Materials & methods: A systematic review and meta-analysis was carried out. EMBASE, MEDLINE and CINAHL databases were searched from inception to September 2020. All primary studies were considered for inclusion. Primary outcome measure was detection rates of primary cancer of the different techniques. Secondary outcome measures were complications and length of hospital stay.
    Results: 289 studies were identified of which 30 met the inclusion criteria. The primary cancer was identified in 567 /777 patients (pooled results was 64% (95% CI 54-73). The primary identification rates were 45% and 32% in lingual (n = 273) and palatine tonsillectomy (n = 118) respectively. The primary cancer identification rates by surgical techniques are: TORS was 60% (95% CI 49-70), TLM was 80% (95% CI 0.58, 1.01), TOEC was 41% (95% CI 0.05, 0.76). 529/777 (68%) tumours were Human Papilloma Virus (HPV) related. The pooled data of studies that reported on detection rates relating to HPV status were 178/216 (82%) for HPV +ve and 7/59 (12%) for HPV -ve tumours. Coefficient of variation results suggest heterogenous data for TORS and TLM. The commonest complication was haemorrhage (5.3%). The length of reported hospital stay ranged from 1.4 to 7 days.
    Conclusions: This is the largest systematic review in the subject. The quality of studies and heterogeneity of data limit conclusive findings. Lingual tonsillectomy is an effective procedure in CUP work up. Further larger, multicentre, prospective studies of PET CT negative CUP patients is needed to draw conclusive results.
    MeSH term(s) Carcinoma ; Head and Neck Neoplasms/surgery ; Humans ; Neoplasms, Unknown Primary/diagnosis ; Papillomavirus Infections ; Prospective Studies ; Treatment Outcome
    Language English
    Publishing date 2022-02-07
    Publishing country England
    Document type Journal Article ; Meta-Analysis ; Review ; Systematic Review
    ZDB-ID 1120465-5
    ISSN 1879-0593 ; 0964-1955 ; 1368-8375
    ISSN (online) 1879-0593
    ISSN 0964-1955 ; 1368-8375
    DOI 10.1016/j.oraloncology.2022.105748
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  3. Article: Ectopic intrapleural thymoma: a rare location in the thoracic cavity.

    Lopez-Marco, Ana / Al-Zuhir, Naail / Kornaszewska, Malgorzata

    Journal of surgical case reports

    2016  Volume 2016, Issue 1

    Abstract: We present a patient with a large thymoma on the right thoracic cavity developing from the visceral pleura. This is a rare location for this tumour, and only a few had been reported to date in the literature. ...

    Abstract We present a patient with a large thymoma on the right thoracic cavity developing from the visceral pleura. This is a rare location for this tumour, and only a few had been reported to date in the literature.
    Language English
    Publishing date 2016-01-05
    Publishing country England
    Document type Case Reports
    ISSN 2042-8812
    ISSN 2042-8812
    DOI 10.1093/jscr/rjv166
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  4. Article ; Online: Morphometric Assessment as a Predictor of Outcome in Older Vascular Surgery Patients.

    Chowdhury, Mohammed M / Ambler, Graeme K / Al Zuhir, Naail / Walker, Alex / Atkins, Ellie R / Winterbottom, Andrew / Coughlin, Patrick A

    Annals of vascular surgery

    2017  Volume 47, Page(s) 90–97

    Abstract: Background: Frailty is a recognized predictor of poor outcome in patients undergoing surgical intervention. Frailty is intricately linked with body morphology, which can be evaluated using morphometric assessment via computerized tomographic (CT) ... ...

    Abstract Background: Frailty is a recognized predictor of poor outcome in patients undergoing surgical intervention. Frailty is intricately linked with body morphology, which can be evaluated using morphometric assessment via computerized tomographic (CT) imaging. We aimed to assess the predictive power of such objective assessments in a broad cohort of vascular surgical patients.
    Methods: A consecutive series of patients aged over 65 years admitted to a vascular unit, who had undergone CT imaging of the abdomen, were analyzed. Demographic and patient-specific data were collated alongside admission relevant information. Outcomes included mortality, length of stay, health care-related costs, and discharge destination. Images were analyzed for 4 morphometric measurements: (1) psoas muscle area, (2) mean psoas density, (3) subcutaneous fat depth, and (4) intra-abdominal fat depth, all taken at the level of the fourth lumbar vertebra.
    Results: Two hundred and ten patients were initially analyzed. Forty-four patients had significant retroperitoneal and abdominal abnormalities that limited appropriate CT analysis. Decreased subcutaneous fat depth was significantly associated with mortality, readmission within 12 months, and increased cost of health care (P < 0.01, adjusted for confounders). Psoas muscle area was significantly associated with readmission-free survival.
    Conclusions: Morphometric analysis predicts poorer outcome in a broad cohort of vascular surgery patients. Such assessment is likely to enhance patient counseling regarding individual risk as well as enhancing the ability to undertake risk-modified surgical audit.
    MeSH term(s) Aged ; Aged, 80 and over ; Cohort Studies ; Female ; Frail Elderly ; Humans ; Intra-Abdominal Fat/anatomy & histology ; Intra-Abdominal Fat/diagnostic imaging ; Kaplan-Meier Estimate ; Male ; Psoas Muscles/anatomy & histology ; Psoas Muscles/diagnostic imaging ; Risk Assessment ; Risk Factors ; Sarcopenia/diagnosis ; Subcutaneous Fat/anatomy & histology ; Subcutaneous Fat/diagnostic imaging ; Survival Rate ; Tomography, X-Ray Computed ; Vascular Surgical Procedures/adverse effects ; Vascular Surgical Procedures/mortality
    Language English
    Publishing date 2017-09-06
    Publishing country Netherlands
    Document type Journal Article
    ZDB-ID 1027366-9
    ISSN 1615-5947 ; 0890-5096
    ISSN (online) 1615-5947
    ISSN 0890-5096
    DOI 10.1016/j.avsg.2017.08.002
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    Zs.A 2882: Show issues Location:
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  5. Article ; Online: The additional value of the arterial phase in the CT assessment of liver vascular injuries after high-energy blunt trauma.

    Iacobellis, Francesca / Scaglione, Mariano / Brillantino, Antonio / Scuderi, Maria Giuseppina / Giurazza, Francesco / Grassi, Roberto / Noschese, Giuseppe / Niola, Raffaella / Al Zuhir, Naail Yarub Sulaiman / Romano, Luigia

    Emergency radiology

    2019  Volume 26, Issue 6, Page(s) 647–654

    Abstract: Purpose: In the literature, no consensus exists about which CT protocol is to be adopted in patients who underwent high-energy blunt trauma. The aim of the study is to evaluate the additional value of the arterial phase in the CT assessment of vascular ... ...

    Abstract Purpose: In the literature, no consensus exists about which CT protocol is to be adopted in patients who underwent high-energy blunt trauma. The aim of the study is to evaluate the additional value of the arterial phase in the CT assessment of vascular injuries of the liver.
    Methods: Admission CT examinations for patients with traumatic injury of the liver due to high-energy blunt trauma, performed between 2011 and 2017 in two major trauma centres, were retrospectively reviewed. Images were analysed for presence or absence of liver parenchymal injury, intrahepatic contained vascular injuries and active bleeding in the arterial and portal venous phase of the CT study.
    Results: Two hundred twelve patients have been identified. Parenchymal injuries were detected as isolated in 90.6% of cases, whereas they were associated with vascular injuries in 9.4% of cases: contained vascular injuries in 3.3% and active bleeding in 6.1%. Out of all parenchymal injuries detected on the CT portal venous phase, 90.5% were also detectable in the arterial phases (p < 0.0001). All of the contained vascular injuries were visible in the CT arterial phase, whereas they were detectable in 28.5% of cases also during the venous phase (p = 0.02). All 13 cases of active bleeding were detected on the CT venous phase, and 76.9% of these cases were also revealed in the arterial phase, thus confirming their arterial origin (p = 0.22).
    Conclusion: The addiction of the arterial phase to the venous phase in the CT assessment of patients who underwent high-energy blunt trauma allows an accurate identification and characterization of traumatic vascular injuries, so distinguishing between patients suitable for conservative management and those requiring interventional or surgical treatment.
    MeSH term(s) Adult ; Computed Tomography Angiography ; Contrast Media ; Female ; Humans ; Iopamidol/analogs & derivatives ; Liver/blood supply ; Liver/diagnostic imaging ; Liver/injuries ; Male ; Retrospective Studies ; Tomography, X-Ray Computed ; Trauma Centers ; Vascular System Injuries/diagnostic imaging ; Wounds, Nonpenetrating/diagnostic imaging
    Chemical Substances Contrast Media ; iomeprol (17E17JBP8L) ; Iopamidol (JR13W81H44)
    Language English
    Publishing date 2019-08-23
    Publishing country United States
    Document type Journal Article ; Multicenter Study
    ZDB-ID 1425144-9
    ISSN 1438-1435 ; 1070-3004
    ISSN (online) 1438-1435
    ISSN 1070-3004
    DOI 10.1007/s10140-019-01714-y
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  6. Article ; Online: Changing trends in the pattern and outcome of stab injuries at a North London hospital.

    Nair, Manojkumar S / Uzzaman, Mohammed M / Al-Zuhir, Naail / Jadeja, Ashok / Navaratnam, Romi

    Journal of emergencies, trauma, and shock

    2011  Volume 4, Issue 4, Page(s) 455–460

    Abstract: Objective: To study the incidence, pattern and outcome of stab injuries attending a North London Teaching Hospital over a 3-year (2006-2008) period.: Materials and methods: A retrospective review of collected data from the Hospital database was ... ...

    Abstract Objective: To study the incidence, pattern and outcome of stab injuries attending a North London Teaching Hospital over a 3-year (2006-2008) period.
    Materials and methods: A retrospective review of collected data from the Hospital database was conducted. The database contains comprehensive medical records for all patients attended by the trauma team for deliberate stab injuries. It is updated by the surgical team after each admission. All patients with deliberate penetrating injury who were attended by the service between 1 January 2006 and 31 December 2008 were identified. Patients who died in the prehospital phase, those managed exclusively by the emergency department and limb injuries without vascular compromise were excluded from the study.
    Results: Six hundred and nineteen patients with stab injuries (following knife crime) from North London attended the Hospital in the above period. One hundred and thirty-seven paients required surgical admission. Two were cases of self-inflicted knife injuries. Over the 3-year period the percentage of victims below 20 years of age is increasing. Ninety-three percent of knife crime occured between 6 pm and 6 am; recently moving toward week days from weekend period.
    Conclusions: The overall rate of penetrating injuries (stab injuries) is slowly declining. Timely cardiothoracic support facility is vital in saving lives with major cardiac stab injuries. Although alcohol drinking restriction has been lifted, most cases of stabbings are still occurring out-of-hours when surgical personnel are limited.
    Language English
    Publishing date 2011-11-15
    Publishing country India
    Document type Journal Article
    ZDB-ID 2461111-6
    ISSN 0974-519X ; 0974-2700
    ISSN (online) 0974-519X
    ISSN 0974-2700
    DOI 10.4103/0974-2700.86628
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  7. Article ; Online: Independence and mobility after infrainguinal lower limb bypass surgery for critical limb ischemia.

    Ambler, Graeme K / Dapaah, Andrew / Al Zuhir, Naail / Hayes, Paul D / Gohel, Manjit S / Boyle, Jonathan R / Varty, Kevin / Coughlin, Patrick A

    Journal of vascular surgery

    2014  Volume 59, Issue 4, Page(s) 983–987.e2

    Abstract: Background: Critical limb ischemia (CLI) is a common condition associated with high levels of morbidity and mortality. Most work to date has focused on surgeon-oriented outcomes such as patency, but there is increasing interest in patient-oriented ... ...

    Abstract Background: Critical limb ischemia (CLI) is a common condition associated with high levels of morbidity and mortality. Most work to date has focused on surgeon-oriented outcomes such as patency, but there is increasing interest in patient-oriented outcomes such as mobility and independence.
    Objective: This study was conducted to determine the effect of infrainguinal lower limb bypass surgery (LLBS) on postoperative mobility in a United Kingdom tertiary vascular surgery unit and to investigate causes and consequences of poor postoperative mobility.
    Methods: We collected data on all patients undergoing LLBS for CLI at our institution during a 3-year period and analyzed potential factors that correlated with poor postoperative mobility.
    Results: During the study period, 93 index LLBS procedures were performed for patients with CLI. Median length of stay was 11 days (interquartile range, 11 days). The 12-month rates of graft patency, major amputation, and mortality were 75%, 9%, and 6%, respectively. Rates of dependence increased fourfold during the first postoperative year, from 5% preoperatively to 21% at 12 months. Predictors of poor postoperative mobility were female sex (P = .04) and poor postoperative mobility (P < .001), initially and at the 12-month follow-up. Patients with poor postoperative mobility had significantly prolonged hospital length of stay (15 vs 8 days; P < .001).
    Conclusions: Patients undergoing LLBS for CLI suffer significantly impaired postoperative mobility, and this is associated with prolonged hospital stay, irrespective of successful revascularization. Further work is needed to better predict patients who will benefit from revascularization and in whom a nonoperative strategy is optimal.
    MeSH term(s) Aged ; Aged, 80 and over ; Amputation ; Critical Illness ; Dependent Ambulation ; England ; Female ; Humans ; Ischemia/diagnosis ; Ischemia/mortality ; Ischemia/physiopathology ; Ischemia/therapy ; Length of Stay ; Limb Salvage ; Lower Extremity/blood supply ; Male ; Middle Aged ; Mobility Limitation ; Patient Selection ; Peripheral Arterial Disease/diagnosis ; Peripheral Arterial Disease/pathology ; Peripheral Arterial Disease/physiopathology ; Peripheral Arterial Disease/therapy ; Reoperation ; Retrospective Studies ; Risk Factors ; Time Factors ; Treatment Outcome ; Vascular Grafting/adverse effects ; Vascular Grafting/mortality ; Vascular Patency
    Language English
    Publishing date 2014-04
    Publishing country United States
    Document type Journal Article ; Research Support, Non-U.S. Gov't
    ZDB-ID 605700-7
    ISSN 1097-6809 ; 0741-5214
    ISSN (online) 1097-6809
    ISSN 0741-5214
    DOI 10.1016/j.jvs.2013.10.077
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