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Publication Endometrial ablation and steam vaporisation : the true first generation ablative technique(Wiley, 2015-11-21) Olah, Karl S.; South Warwickshire University NHS Foundation Trust; Obstetrics and Gynaecology; Medical and Dental; Olah, Karl S.This BJOG Perspectives article explores the history of endometrial ablation and steam vaporisation as techniques to treat women with menstrual disorders, drawing on the work of G. F. Blacker in 1902.Publication Then and now : outcomes of surgical treatment for early cervical cancer 1902(Wiley, 2015-09-25) Jeevan, David; Olah, Karl; South Warwickshire University NHS Foundation Trust; Obstetrics and Gynaecology; Medical and Dental; Jeevan, David; Olah, KarlThis BJOG Perspectives article provides a historical snapshot of the surgical techniques available in the early twentieth century for the treatment of cervical cancer, drawing on the work of Thomas Wilson (BJOG. 1902;1(5):526-46. doi: 10.1111/j.1471-0528.1902.tb10544.x.).Publication Vaginal sub-total hysterectomy — an early minimally invasive procedure(Wiley, 2015-11-21) Olah, Karl S.; South Warwickshire University NHS Foundation Trust; Obstetrics and Gynaecology; Medical and Dental; Olah, Karl S.This BJOG Perspectives article summarises an early minimally invasive procedure developed by Arthur J. Wallace (1867–1913).Publication Realist evaluation of faculty development for clinical educators : what works for who, in what context and why(Wiley, 2016-06-16) Sorinola, O.; Thistlethwaite, J.; Davies, D.; Peile, E.; South Warwickshire University NHS Foundation Trust; University of Warwick; University of Technology Sydney, Australia; Obstetrics and Gynaecology; Medical and Dental; Sorinola, O.E-poster presentation abstract EP12.079 in the section 'Quality Improvement, Education, Simulation and Patient Safety (EP12)' of the RCOG World Congress 2016, 20–22 June 2016, ICC Birmingham, United Kingdom.Publication Two years experience of cervical HPV testing and genotyping indicates that colposcopic predictive value is reduced to 50% – an analysis of histology outcome before and after the introduction of HPV genotyping(Wiley, 2016-06) Olah, K.; South Warwickshire University NHS Foundation Trust; Obstetrics and Gynaecology; Medical and Dental; Olah, K.E-poster presentation abstract EP3.003 in the section 'Oncology and Colposcopy (EP3)' of the RCOG World Congress 2016, 20–22 June 2016, ICC Birmingham, United Kingdom.Publication Re: Laparoscopic morcellation : an acceptable risk or an Achilles heel? Are there safer alternatives to morcellation?(Wiley, 2016-03-21) Olah, Karl S.; South Warwickshire University NHS Foundation Trust; Obstetrics and Gynaecology; Medical and Dental; Olah, Karl S.This BJOG Exchange comment piece responds to Garry R. Laparoscopic morcellation: an acceptable risk or an Achilles heel? BJOG. 2015 Mar;122(4):458-60. doi: 10.1111/1471-0528.13045. Epub 2014 Sep 19.Publication Recurrent pelvic organ prolapse : International Urogynecological Association Research and Development Committee opinion(Springer, 2016-07-05) Ismail, Sharif; Duckett, Jonathan; Rizk, Diaa; Sorinola, Olanrewaju; Kammerer-Doak, Dorothy; Contreras-Ortiz, Oscar; Al-Mandeel, Hazem; Svabik, Kamil; Parekh, Mitesh; Phillips, Christian; Brighton and Sussex University Hospitals NHS Trust; Brighton and Sussex Medical School; Medway Hospital NHS Trust; South Warwickshire University NHS Foundation Trust; et al.; Obstetrics and Gynaecology; Medical and Dental; Sorinola, OlanrewajuIntroduction and hypothesis: This committee opinion paper summarizes available evidence about recurrent pelvic organ prolapse (POP) to provide guidance on management. Method: A working subcommittee from the International Urogynecological Association (IUGA) Research and Development Committee was formed. The literature regarding recurrent POP was reviewed and summarized by individual members of the subcommittee. Recommendations were graded according to the 2009 Oxford Levels of Evidence. The summary was reviewed by the Committee. Results: There is no agreed definition for recurrent POP and evidence in relation to its evaluation and management is limited. Conclusion: The assessment of recurrent POP should entail looking for possible reason(s) for failure, including persistent and/or new risk factors, detection of all pelvic floor defects and checking for complications of previous surgery. The management requires individual evaluation of the risks and benefits of different options and appropriate patient counseling. There is an urgent need for an agreed definition and further research into all aspects of recurrent POP. Keywords: Cost; Definition; Diagnosis; Etiology; Incidence; Pelvic organ prolapse; Prevalence; Recurrent; Treatment.Publication Lymphoepithelioma-like carcinoma of the vagina : case report and literature review of a rare cancer(Elsevier, 2018-09) Mohamad Roji, A.; Walji, N.; McCluggage, W. G.; Taylor, A.; Olah, K.; Anwar, S.; University Hospitals Coventry and Warwickshire NHS Trust; Belfast Health and Social Care Trust; Royal Marsden Hospital, London; South Warwickshire University NHS Foundation Trust; University Hospitals Birmingham NHS Foundation Trust; Obstetrics and Gynaecology; Medical and Dental; Olah, K.Poster abstract IGCS8-0771 of the 17th Biennial Meeting of the International Gynecologic Cancer Society, Kyoto, Japan, September 14-16, 2018.Publication Assessment of pre-operative factors in breast cancer patients to avoid the use of one step nucleic acid amplification analysis of the sentinel lymph node(Elsevier, 2018-07) Park, T.-K.; Athwal, R.; Harries, S.; Clarke, D.; Jones, L.; South Warwickshire University NHS Foundation Trust; Breast Surgery; Medical and Dental; Park, T.-K.; Athwal, R.; Harries, S.; Clarke, D.; Jones, L.Poster abstract 0358 of the Association of Surgeons in Training (ASiT) 2018 Conference, 6-8 April 2018, Edinburgh, UK.Publication Prepectoral immediate implant-based reconstruction using Braxon® acellular dermal matrix – national audit from the United Kingdom(American Association for Cancer Research, 2019-02-15) Chandarana, M.; Harries, S.; University Hospitals of North Midlands, Stoke-on-Trent; South Warwickshire University NHS Foundation Trust; Breast Surgery; Medical and Dental; Harries, S.Poster abstract P5-16-05 of the 2018 San Antonio Breast Cancer Symposium; December 4-8, 2018; San Antonio, Texas.Publication Caesarean myomectomy: TE or not TE?(Wiley, 2018-03) Olah, Karl; South Warwickshire University NHS Foundation Trust; Obstetrics and Gynaecology; Medical and Dental; Olah, KOver the last 5 years there has been a plethora of studies looking at the complications and feasibility of performing myomectomy at the time of caesarean section (Li et al. Acta Obstet Gynecol Scand 2009;88:183–6; Akkurt et al. J Matern-Fetal Neonatal Med 2017;30:1855–60). Few if any of these studies have come from the UK or the USA, and while the commandment ‘thou should never touch a fibroid at a caesarean section’ seems to have originated in the developed world, the rules are being questioned elsewhere, with results that universally show, despite the expected increase in operating time, no significant increase in morbidity besides an increase need for blood transfusion and, most importantly, no excess of hysterectomy being required.Publication Uterine anomalies - Latin anatomy reigns(Wiley, 2018-07-13) Olah, Karl; South Warwickshire University NHS Foundation Trust; Gynaecology; Medical and Dental; Olah, KarlPaper discussing classification of uterine anomalies.Publication Recognizing and avoiding significant maternal hyponatremia(Jaypee Brothers Medical Publishers, 2020) Thaker, Shilpa; South Warwickshire University NHS Foundation Trust; Obstetrics and Gynaecology; Medical and Dental; Thaker, ShilpaHyponatremia during peripartum period is a recognized but underreported complication. Hyponatremia has significant adverse effects on mother as well as infant. Hyponatremia can be dilutional or nondilutional. Dilutional or hypervolemic hyponatremia is more common during the labor and postpartum period. The blood sodium concentration during pregnancy is lower, 130–140 mmol/L, which is being considered normal compared to 135–145 mmol/L in nonpregnant women. Thus, when the blood sodium level is below 130 mmol/L, we should consider it as hyponatremia of pregnancy. Oxytocin can play a major role to cause dilutional hyponatremia if large volumes of hypotonic fluids are consumed or infused intravenously simultaneously. Hyponatremia during labor is such a complex problem that it can be the result of several factors. In hyponatremia, there is progressive dysfunction of the neurological system, which in association with cerebral edema results in various symptoms. Symptoms may vary from headache, nausea, vomiting, lethargy, muscle cramps, and disorientation, progressing to seizures, coma, respiratory arrest, and death. A proper clinical history and various blood tests including serum sodium are important to diagnose the severity of hyponatremia. Women in labor should be advised to drink water only up to their thirst impulse; excessive fluid intake should be avoided. The treatment depends on cause, severity, and duration of hyponatremia, as well as clinical status of patient, and associated comorbidities. Once acute water intoxication and hyponatremia have been diagnosed, it is necessary to correct the hyponatremia by water restriction and to watch sodium concentration in the blood. Severe hyponatremia (sodium <125 mmol/L + symptoms) is a medical emergency. The primary idea of treatment should be to improve symptoms instead to normalize the blood sodium level. Keywords: Fluid balance, Fluid restriction, Hyponatremia, Labor, Oxytocin, Peripartum.Publication Professor Sir John Dewhurst: scientist, historian. Unravelling the obstetric history of Katharine of Aragon and Anne Boleyn(Wiley, 2020-02) Olah, Karl S. J.; South Warwickshire University NHS Foundation Trust; Obstetrics and Gynaecology; Medical and Dental; Olah, KarlAn article on Professor Sir John Dewhurst, former President of the Royal College of Obstetricians and Gynaecologists.Publication Effusive-constrictive cholesterol pericarditis: a case report(Oxford University Press, 2020-12-11) Shergill, Simran; Davies, James; Cairns, Naomi; South Warwickshire University NHS Foundation Trust; Cardiology; Medical and Dental; Shergill, Simran; Davies, James; Cairns, NaomiBackground: Cholesterol pericarditis (CP) remains a rare pericardial disease characterized by chronic pericardial effusions with high cholesterol concentrations with or without the formation of cholesterol crystals. Effusions are often large and can cause ventricular compression and subsequent pericardial adhesion formation. CP can be idiopathic but has associations with rheumatoid arthritis (RA), tuberculosis and hypothyroidism. Case summary: We present a case of a 72-year-old male with a background of seropositive RA with a finding of an incidental pericardial effusion on computed tomography thorax abdomen and pelvis. Transthoracic echocardiogram demonstrated a large effusion with echocardiographic features of tamponade. On review, he was breathless with a raised venous pressure, bilateral ankle oedema, and pulsus paradoxus was present. Pericardial drainage was performed with fluid analysis demonstrating a cholesterol concentration of 8.3 mmol/L and numerous cholesterol crystal formation. Interval imaging demonstrated recurrence of the effusion with pericardial thickening and progressive constriction. He remained asymptomatic and underwent a successful pericardial window. At present, he is under close clinical outpatient surveillance with symptoms guiding a future pericardiectomy if warranted. Discussion: CP can present as an emergent situation with signs and symptoms of acute heart failure with prompt pericardiocentesis required in cases of clinical tamponade. However, the disease course is often one of chronicity with relapsing large effusions that tend to recur following drainage, with the development of pericardial constriction necessitating pericardiectomy for definitive management.Publication Mapping catheter-related mitral valve injury: a case report(Oxford University Press, 2020-09-18) Shergill, Simran; Clarke, Nigel R A.; South Warwickshire University NHS Foundation Trust; Cardiology; Medical and Dental; Shergill, Simran; Clarke, Nigel R A.Background: An increasing number of catheter ablations are performed for symptomatic tachyarrhythmias and commonly involve the left atrium, increasing the risk of catheter interaction with the mitral valve (MV) complex. Mitral valve trauma at the time of atrial fibrillation (AF) ablations remains a rare yet emergent situation that requires prompt diagnosis and management to prevent the long-term sequelae of heart failure secondary to MV dysfunction. Case summary: We present a case of a 69-year-old female with symptomatic paroxysmal AF and atrial flutter who underwent a combined ablation procedure. During the pulmonary vein isolation procedure, the mapping catheter became entangled within the MV apparatus but was freed. She presented to our hospital 2 weeks later with dyspnoea, lethargy, and a cough. Clinical examination revealed a pansystolic murmur and right moderate pleural effusion. Transthoracic echocardiogram (TTE) demonstrated a flail posterior MV leaflet with severe eccentric mitral regurgitation (MR). She underwent urgent valve repair at the regional cardiothoracic centre. Upon review 2 months later, she was symptom free with surveillance TTE demonstrating a preserved left ventricular systolic function with a trace of MR. Discussion: Mitral valve injury secondary to catheter entrapment at the time of left-sided ablations is a rare yet serious complication and can present as an emergent situation requiring prompt recognition and early surgical management to salvage valve and cardiac function.Publication Cardiotocograph (CTG) changes and maternal and neonatal outcomes in chorioamnionitis and/or funisitis confirmed on histopathology(Elsevier, 2021-05) Sukumaran, Suganya; Pereira, Vanita; Mallur, Srinivas; Chandraharan, Edwin; South Warwickshire University NHS Foundation Trust; Mid and South Essex NHS Foundation Trust; Obstetrics & Gynaecology; Medical and Dental; Sukumaran, Suganya; Pereira, Vanita; Mallur, SrinivasObjective: To assess the cardiotocographic changes and maternal and neonatal outcomes in cases of chorioamnionitis and or funisitis confirmed on histopathology. Study design: A retrospective analysis of histopathology reports confirming chorioamnionitis and/or funisitis was carried out from 2014 to 2020 in a single centre. The preterm births (<37 weeks) were excluded. The maternal records were reviewed to determine the maternal and neonatal outcomes such as the mode of delivery, intrapartum and postpartum complications, umbilical cord arterial pH, and admission to the special care baby unit (SCBU). The CTG features were analysed on admission and during the intrapartum period. The study was approved by the Audit and Clinical Effectiveness department within the centre. Results: Out of the 57 cases of histologically confirmed chorioamnionitis and/or funisitis, 42 women (73.7 %) had intrapartum pyrexia and none of the mothers had an increased temperature at the point of fetal tachycardia (persistent increase in baseline fetal heart rate (FHR) by >10 % compared to the original baseline FHR). 43 (75.4 %) CTGs showed evidence of uterine tachysystole or hyperstimulation. 15 (26.3 %) cases had meconium stained amniotic fluid (MSAF). 54 (94.7 %) women had a caesarean section, and their babies were admitted to special care baby unit after delivery. 54 (94.7 %) babies had an umbilical artery of more than 7.1. 47 (87 %) of the women were readmitted with wound infection. All CTG traces showed a > 10 % increase in the baseline FHR and variable decelerations with overshoot were noted in cases where funisitis was confirmed in 25 cases (92.6 %). Loss of cycling was noted in 54 CTGs (94.7 %) and a sinusoidal pattern was identified in 27 (47.3 %). Conclusion: Rising (>10 %) baseline during labour along with loss of cycling with or without features of tachysystole or hyperstimulation should be considered in labour as features of ongoing chorioamnionitis. Chorioamnionitis confirmed on histopathology is associated with an increase in caesarean section rate due to fetal heart rate changes, increased risk of wound infection in mothers, and increased admission of the babies to SCBU.Publication What's in a name? A candid assessment of a new candida therapy.(Wiley, 2022-02) Olah, Karl S. J.; South Warwickshire University NHS Foundation Trust; Obstetrics & Gynaecology; Medical and Dental; Olah, KarlA mini commentary on R Sobel et al., pp. 412–420 in the same issue. See https://doi.org/10.1111/1471-0528.16972.Publication Minimal efforts to adopt minimally invasive techniques: Is gynaecology falling behind?(Wiley, 2023-02) Olah, Karl S. J.; South Warwickshire University NHS Foundation Trust; Obstetrics and Gynaecology; Medical and Dental; Olah, Karl S. J.Commentary on the adoption of minimally invasive techniques in gynaecology