Imaging in myeloma with focus on advanced imaging techniques.

In recent years, there have been major advances in the imaging of myeloma with whole body MRI incorporating diffusion-weighted imaging, emerging as the most sensitive modality. Imaging is now a key component in the work-up of patients with a suspected diagnosis of myeloma. The International Myeloma Working Group now specifies that more than one focal lesion on MRI or lytic lesion on whole body low-dose CT or fludeoxyglucose (FDG) PET/CT fulfil the criteria for bone damage requiring therapy. The recent National Institute for Health and Care Excellence myeloma guidelines recommend imaging in all patients with suspected myeloma. In addition, there is emerging data supporting the use of functional imaging techniques (WB-DW MRI and FDG PET/CT) to predict outcome and evaluate response to therapy. This review summarises the imaging modalities used in myeloma, the latest guidelines relevant to imaging and future directions.

Brain-focussed ultrasound: what's the "FUS" all about? A review of current and emerging neurological applications.

MR-guided focussed ultrasound surgery (MRgFUS) allows for precise non-invasive thermal ablation of target tissues for a wide range of clinical applications. It is an innovative and rapidly expanding technology, which has already established itself as an effective and safe incisionless alternative in the treatment of various soft tissue tumours, with many more research studies underway to extend its therapeutic envelope. The non-invasiveness of the procedure makes FUS particularly attractive in functional neurosurgery, where existing treatment options are not suitable for all patients. Several clinical trials have demonstrated the feasibility and favourable safety profile of MR-guided focused ultrasound surgery in essential tremor, Parkinson's disease and other neurological conditions. This article reviews the existing evidence base for the neurological applications of FUS and the evidence for its emerging roles in the treatment of a range of brain disorders.

Postoperative infections following colorectal surgery in an English teaching hospital.

A retrospective case note review of postoperative infections within 30 days of colorectal surgery was completed. Surgical site infections (SSIs) were identified in 22% of patients (84/378), with other infections, e.g. urinary tract infections, identified in 18.3% of patients. SSIs, urinary and respiratory tract infections were all associated with increased durations of hospital admission compared with non-infected patients. Consideration should be given to postoperative surveillance for all infections, using antibiotic consumption as an objective outcome measure. Nine percent of patients developed an organ space SSI. Organ space SSIs were associated with the longest additional duration of hospital admission (15.5 days) and were the only infection associated with an increase in mortality at 1 year; 37% (13/35) mortality with an organ space SSI vs 4% (8/225) without an infection (odds ratio = 16, 95% confidence interval = 6, 43). Further research to prevent and treat organ space SSIs should be prioritized.

Management of ED under the "severe distress" criteria in the NHS: a real-life study.

INTRODUCTION: The United Kingdom is unusual in that a significant proportion of patients with erectile dysfunction (ED) have their treatment fully reimbursed by the National Health Service (NHS). This may have consequences for the choice of treatment and for compliance with treatment. AIMS: The aim of this study was to evaluate the use and cost implications of phosphodiesterase type 5 inhibitor in an NHS setting. METHODS: Basic demographics and data on ED management for patients treated from January 2000 to April 2011 were obtained from a prospectively accrued database. We reviewed drug usage and costs as well as switching between drugs. Patients were given the choice of all available therapies and were followed up annually. MAIN OUTCOME MEASURES: Switching, compliance, and costs of treating ED under the "severe distress" criteria in the NHS were reviewed for this study. RESULTS: Two thousand one hundred fifty-nine patients qualified for reimbursed therapy. Two hundred twenty-six patients were excluded from further analysis owing to missing data. Patients were followed up on an annual basis. The mean patient age was 60.2 years (min 23, max 90), and the mean follow-up was 50.8 months (min 1, max 127). Six hundred ninety-six were started on sildenafil, 990 on tadalafil, 163 on vardenafil, and 84 on intracavernosal alprostadil. Eighteen percent of patients initially started on the scheme and stopped medication unilaterally. Of the patients, 12.3% changed their medication during follow-up. The cost of drugs increased year by year from £257,100 in 2007 to £352,519 in 2011. CONCLUSIONS: Our real-life observational study shows that in our institution, dropout of therapy is unusual. We hypothesize that this reflects, in part, the reimbursement issue. We also found that switching between drugs was unusual, although there are several possible explanations for that. Although this is a successful system for the patients, the hospital, which bears the costs of medication, is finding this an increasing economic drain.

The evaluation of apomorphine for the treatment of erectile dysfunction.

INTRODUCTION: Erectile dysfunction (ED) is a common condition affecting men. Apomorphine is one of the oral medications that has been used in the management of ED, though over recent years, its use in the management of ED has dwindled. AREAS COVERED: The authors review the evidence available for the use of apomorphine in the management of ED. A Medline search was performed searching for the articles related to the use of apomorphine in the treatment of ED from 2000 to present. The article reviews the erectogenic properties of apomorphine and evaluates its efficacy, suitability and tolerability in management of patients with ED. EXPERT OPINION: Apomorphine SL is more effective than placebos in treating ED and is generally well tolerated in the sublingual formulation, causing tolerable side effects. Newer nasal-spray formulations provide faster efficacy. Its efficacy in patients with multiple co-morbidities is more limited. However, it is not as effective as PDE5-I in the treatment of ED. Its most significant strength is its safety profile. It may have a niche in the treatment ED in patients who have failed treatment with, or are intolerant to other well-established pharmacological treatment for ED (e.g., PDE5-Is). Apomorphine is not a first-line treatment option for patients with ED, especially as it is no more widely available in the western world.