Jocelyn Brookes | University College London (original) (raw)

Papers by Jocelyn Brookes

Phlebology: The Journal of Venous Disease

Objective To propose and develop a histopathological criteria to help diagnose vascular malformat... more Objective To propose and develop a histopathological criteria to help diagnose vascular malformations. Methods All patients who underwent surgical resection and had a confirmed histopathological diagnosis of vascular malformations from 01 March 2018-26 February 2020 were included. A criteria based on 10 parameters was developed to help diagnose vascular malformations. Discrepancies between clinical and histopathological diagnosis were evaluated. Results A total of 18 cases were identified. There was a discrepancy between the clinical diagnosis and the initially reported histopathological diagnosis in 16 cases (88.9%). This was reduced to 7 (38.9%) and 6 cases (33.3%) with first and second time revised histopathological analysis using proposed criteria. Conclusions The discrepancy between clinical and histopathological diagnoses of vascular malformations has highlighted the requirement of an agreed criteria for histopathologists to help formulate their diagnosis. The proposed criteri...

Phlebology: The Journal of Venous Disease

Objective The study aimed to evaluate the early follow-up quality of life (QoL), pain and mental ... more Objective The study aimed to evaluate the early follow-up quality of life (QoL), pain and mental health of patients with congenital vascular malformation (CVM) from a variety of treatment options. Methods All patients with CVM who received care and had follow-up between February 1st 2018 and January 31st 2020 were included. The health-related QoL, pain, and mental health were assessed with RAND Health Care 36-Item Short Form Survey (SF-36), visual analogue score for pain (VAS-P) and Hospital Anxiety and Depression Scale (HADS). Paired t-test was used for all analyses. p < .05 were considered significant. Results In total, 110 patients with a mean age of 36.9 years were included in this study. In all patients following care, significant improvement was found in the bodily pain domain of SF-36 and VAS-P (both p = .01). This was largely driven by high-flow vascular malformation patients who responded better to embolo-sclerotherapy, which revealed significant improvement in the bodil...

Journal of Vascular Surgery: Venous and Lymphatic Disorders

British Journal of Oral and Maxillofacial Surgery, 2015

Arteriosclerosis, Thrombosis, and Vascular Biology

Background: Congenital vascular malformations (CVMs) are vascular lesions that result from develo... more Background: Congenital vascular malformations (CVMs) are vascular lesions that result from developmental errors during embryogenesis. They can occur anywhere in the body, causing pain, bleeding, ulcers, disfiguration, organ failure or limb loss. Depending on intralesional blood flow dynamics, CVMs can be broadly classified into low-flow (LF), which involve veins, lymphatics, capillaries or a mixture, and high-flow (HF), which involve arteries and veins. Accurate diagnosis and monitoring of LF and HF CVMs remains challenging and requires a wide range of imaging modalities. Aim: We sought to identify potential diagnostic serum biomarkers, particularly those pertaining to the processes of inflammation and angiogenesis. Methods: Sera were isolated from the peripheral bloods of consented healthy controls ( n = 10) and patients diagnosed as having either LF ( n = 10) or HF ( n = 10) CVMs. Various mediators of inflammation and angiogenesis were analysed in the sera using the Inflammation 2...

Poster: "ECR 2015 / C-2043 / Prophylactic placement of carotid endovascular covered stents t... more Poster: "ECR 2015 / C-2043 / Prophylactic placement of carotid endovascular covered stents to prevent carotid blowout syndrome: safety and efficacy in a single centre. " by: "S. R. Rice, L. Williams, C. Hopper, J. Brookes; London/UK"

European Journal of Vascular and Endovascular Surgery, 2021

Journal of Nuclear Medicine, 2011

Inflammation and angiogenesis are hypothesized to be important factors contributing to plaque vul... more Inflammation and angiogenesis are hypothesized to be important factors contributing to plaque vulnerability, whereas calcification is suggested to confer stability. To investigate this in vivo, we combined CT angiography and PET and compared the findings with immunohistochemistry for patients undergoing carotid endarterectomy. Methods: Twenty-one consecutive patients (18 men, 3 women; mean age 6 SD, 68.3 6 7.3) undergoing carotid endarterectomy were recruited for combined carotid 18 F-FDG PET/CT angiography. Plaque 18 F-FDG uptake was quantified with maximum standardized uptake value, and CT angiography quantified percentage plaque composition (calcium and lipid). Surgical specimens underwent ex vivo CT aiding image registration, followed by immunohistochemical staining for CD68 (macrophage density) and vascular endothelial growth factor (angiogenesis). Relationships between imaging and immunohistochemistry were assessed with Spearman rank correlation and multivariable regression. Results: The mean (6SD) surgically excised carotid plaque 18 F-FDG metabolism was 2.4 (60.5) versus 2.2 (60.3) contralaterally (P 5 0.027). There were positive correlations between plaque 18 F-FDG metabolism and immunohistochemistry with CD68 (r 5 0.55; P 5 0.011) and vascular endothelial growth factor (r 5 0.47; P 5 0.031). There was an inverse relationship between plaque 18 F-FDG metabolism and plaque percentage calcium composition on CT (r 5 20.51; P 5 0.018) and between calcium composition and immunohistochemistry with CD68 (r 5 20.57; P 5 0.007). Regression showed that maximum standardized uptake value and calcium composition were independently significant predictors of angiogenesis, and calcium composition was a predictor of macrophage density. Conclusion: We provide in vivo evidence that increased plaque metabolism is associated with increased biomarkers of angiogenesis and inflammation, whereas plaque calcification is inversely related to PET and histologic biomarkers of inflammation.

The Journal of Clinical Endocrinology & Metabolism, 2004

The high mortality rate from aortic dissection of women with Turner syndrome (TS) achieving ovum ... more The high mortality rate from aortic dissection of women with Turner syndrome (TS) achieving ovum donation pregnancies has highlighted the need for a refinement of cardiac screening protocols. Echocardiography and magnetic resonance imaging (MRI) are used to assess the risk factors, aortic root dilatation, bicuspid aortic valve, and coarctation, but the relative merits of each modality are unclear. Cardiovascular screening was performed in 128 unselected women with TS (mean age ؎ SD, 31.1 ؎ 8.5 yr) using echocardiography (n ‫؍‬ 120) and MRI (n ‫؍‬ 115) and in 36 age-matched normal control women. Clinical history, anthropometric measurements, blood pressure, and metabolic parameters were recorded. Echocardiography was normal in 53% of women with TS; MRI was normal in 34%. Aortic root dilatation was identified in 16% of women by echocardiography, 33% on MRI criteria, and 7% by both modalities. Height-adjusted echocardiographic aortic root dimensions were greater in TS than controls (2.90 vs. 2.62 cm; P ‫؍‬ 0.010). Bicuspid aortic valve and increasing age were associated with greater aortic dimensions; the latter effect was more marked in TS than controls. On MRI, ascending aortic diameter was greater in TS than control women (2.83 vs. 2.52 cm; P ‫؍‬ 0.029), but descending aortic diameter and ascending/descending aortic ratio were not, because these may be affected by the presence of coarctation. The two techniques are complementary and identify different aspects of cardiovascular pathology. Ascending/descending ratio on MRI circumvents issues of stature, but may be influenced by descending aortic abnormalities. We present reference ranges for absolute aortic dimensions in a TS population to aid future interpretation of these measurements.

Supplemental material, sj-jpg-1-vas-10.1177_1708538120937616 for Incidence of major complication ... more Supplemental material, sj-jpg-1-vas-10.1177_1708538120937616 for Incidence of major complication following embolo-sclerotherapy for upper and lower extremity vascular malformations by Chung Sim Lim, Nicholas Evans, Ishapreet Kaur, Anthie Papadopoulou, Mohamed Khalifa, Janice Tsui, George Hamilton and Jocelyn Brookes in Vascular

Vascular, 2021

OBJECTIVE Current data on the nature and rate of major complications for embolo-sclerotherapy (ES... more OBJECTIVE Current data on the nature and rate of major complications for embolo-sclerotherapy (EST) of vascular malformations are scarce. However, even fewer studies focus on vascular malformations specific to the head and neck, which confer an increased specific risk of airway compromise, neurologic and ophthalmologic injury. More understanding is required surrounding the type and incidence of complications to improve treatment planning and informed consent. Therefore, this study aimed to review major complications secondary to EST of head and neck vascular malformations over a 5-year period in a single specialized multidisciplinary centre for vascular anomalies. METHODS All interventions were decided by the multidisciplinary team. Demographic, procedural and complication data between 1st January 2013 and 31st December 2017 were prospectively documented in a dedicated database and analysed. EST of high-flow vascular malformations (HFVMs) was performed by selective catheter angiogra...

Journal of Medical Genetics, 1997

Fetal Diagnosis and Therapy, 1999

The feasibility and significance of three-dimensional (3D) visualization of the postmortem fetus ... more The feasibility and significance of three-dimensional (3D) visualization of the postmortem fetus using magnetic resonance imaging (MRI) was investigated. 3D reconstruction of sectional MRI data sets from 8 postmortem fetuses was performed. Fetal configurations and internal structures, both normal and pathological, were clearly demonstrated by 3D display. This new technique provides high quality fetal 3D images for postmortem morphological diagnosis and interactive visual teaching. It may eventually have applications in prenatal diagnosis and the preoperative simulation of fetal surgery.

Hepatology, 2013

1 on behalf of the EASL-CLIF-Consortium Refractory hepatic encephalopathy (HE) remains a major ca... more 1 on behalf of the EASL-CLIF-Consortium Refractory hepatic encephalopathy (HE) remains a major cause of morbidity in cirrhosis patients. Large spontaneous portosystemic shunts (SPSSs) have been previously suggested to sustain HE in these patients. We aimed to retrospectively assess the efficacy and safety of patients treated with embolization of large SPSSs for the treatment of chronic therapy-refractory HE in a European multicentric working group and to identify patients who may benefit from this procedure. Between July 1998 and January 2012, 37 patients (Child A6-C13, MELD [Model of Endstage Liver Disease] 5-28) with refractory HE were diagnosed with single large SPSSs that were considered eligible for embolization. On a short-term basis (i.e., within 100 days after embolization), 22 out of 37 patients (59.4%) were free of HE (P < 0.001 versus before embolization) of which 18 (48.6% of patients overall) remained HE-free over a mean follow-up period of 697 6 157 days (P < 0.001 versus before embolization). Overall, we noted improved autonomy, decreased number of hospitalizations, and severity of the worst HE episode after embolization in three-quarters of the patients. Logistic regression identified the MELD score as strongest positive predictive factor of HE recurrence with a cutoff of 11 for patient selection. As to safety, we noted one major nonlethal procedure-related complication. There was no significant increase in de novo development or aggravation of preexisting varices, portal hypertensive gastropathy, or ascites. Conclusion: This multicenter European cohort study demonstrated a role for large SPSSs in chronic protracted or recurrent HE and substantiated the effectiveness and safety of embolization of these shunts, provided there is sufficient functional liver reserve.

Radiology Case Reports, 2021

The appropriate identification and localization of a nidus of a high flow arteriovenous malformat... more The appropriate identification and localization of a nidus of a high flow arteriovenous malformation is crucial to guide targeted interventional therapy. However, the nidus of a complex or previously treated HFAVM can be difficult to non–invasively demonstrate on magnetic resonance imaging alone. We describe a unique case of a 56-year-old female with a complex high flow arteriovenous malformation in which we demonstrated the feasibility of fluorodeoxyglucose positron emission tomography/computed tomography to non–invasively delineate the nidus which subsequently guided successful targeted interventional therapy.

Phlebology: The Journal of Venous Disease

Objective To propose and develop a histopathological criteria to help diagnose vascular malformat... more Objective To propose and develop a histopathological criteria to help diagnose vascular malformations. Methods All patients who underwent surgical resection and had a confirmed histopathological diagnosis of vascular malformations from 01 March 2018-26 February 2020 were included. A criteria based on 10 parameters was developed to help diagnose vascular malformations. Discrepancies between clinical and histopathological diagnosis were evaluated. Results A total of 18 cases were identified. There was a discrepancy between the clinical diagnosis and the initially reported histopathological diagnosis in 16 cases (88.9%). This was reduced to 7 (38.9%) and 6 cases (33.3%) with first and second time revised histopathological analysis using proposed criteria. Conclusions The discrepancy between clinical and histopathological diagnoses of vascular malformations has highlighted the requirement of an agreed criteria for histopathologists to help formulate their diagnosis. The proposed criteri...

Phlebology: The Journal of Venous Disease

Objective The study aimed to evaluate the early follow-up quality of life (QoL), pain and mental ... more Objective The study aimed to evaluate the early follow-up quality of life (QoL), pain and mental health of patients with congenital vascular malformation (CVM) from a variety of treatment options. Methods All patients with CVM who received care and had follow-up between February 1st 2018 and January 31st 2020 were included. The health-related QoL, pain, and mental health were assessed with RAND Health Care 36-Item Short Form Survey (SF-36), visual analogue score for pain (VAS-P) and Hospital Anxiety and Depression Scale (HADS). Paired t-test was used for all analyses. p < .05 were considered significant. Results In total, 110 patients with a mean age of 36.9 years were included in this study. In all patients following care, significant improvement was found in the bodily pain domain of SF-36 and VAS-P (both p = .01). This was largely driven by high-flow vascular malformation patients who responded better to embolo-sclerotherapy, which revealed significant improvement in the bodil...

Journal of Vascular Surgery: Venous and Lymphatic Disorders

British Journal of Oral and Maxillofacial Surgery, 2015

Arteriosclerosis, Thrombosis, and Vascular Biology

Background: Congenital vascular malformations (CVMs) are vascular lesions that result from develo... more Background: Congenital vascular malformations (CVMs) are vascular lesions that result from developmental errors during embryogenesis. They can occur anywhere in the body, causing pain, bleeding, ulcers, disfiguration, organ failure or limb loss. Depending on intralesional blood flow dynamics, CVMs can be broadly classified into low-flow (LF), which involve veins, lymphatics, capillaries or a mixture, and high-flow (HF), which involve arteries and veins. Accurate diagnosis and monitoring of LF and HF CVMs remains challenging and requires a wide range of imaging modalities. Aim: We sought to identify potential diagnostic serum biomarkers, particularly those pertaining to the processes of inflammation and angiogenesis. Methods: Sera were isolated from the peripheral bloods of consented healthy controls ( n = 10) and patients diagnosed as having either LF ( n = 10) or HF ( n = 10) CVMs. Various mediators of inflammation and angiogenesis were analysed in the sera using the Inflammation 2...

Poster: "ECR 2015 / C-2043 / Prophylactic placement of carotid endovascular covered stents t... more Poster: "ECR 2015 / C-2043 / Prophylactic placement of carotid endovascular covered stents to prevent carotid blowout syndrome: safety and efficacy in a single centre. " by: "S. R. Rice, L. Williams, C. Hopper, J. Brookes; London/UK"

European Journal of Vascular and Endovascular Surgery, 2021

Journal of Nuclear Medicine, 2011

Inflammation and angiogenesis are hypothesized to be important factors contributing to plaque vul... more Inflammation and angiogenesis are hypothesized to be important factors contributing to plaque vulnerability, whereas calcification is suggested to confer stability. To investigate this in vivo, we combined CT angiography and PET and compared the findings with immunohistochemistry for patients undergoing carotid endarterectomy. Methods: Twenty-one consecutive patients (18 men, 3 women; mean age 6 SD, 68.3 6 7.3) undergoing carotid endarterectomy were recruited for combined carotid 18 F-FDG PET/CT angiography. Plaque 18 F-FDG uptake was quantified with maximum standardized uptake value, and CT angiography quantified percentage plaque composition (calcium and lipid). Surgical specimens underwent ex vivo CT aiding image registration, followed by immunohistochemical staining for CD68 (macrophage density) and vascular endothelial growth factor (angiogenesis). Relationships between imaging and immunohistochemistry were assessed with Spearman rank correlation and multivariable regression. Results: The mean (6SD) surgically excised carotid plaque 18 F-FDG metabolism was 2.4 (60.5) versus 2.2 (60.3) contralaterally (P 5 0.027). There were positive correlations between plaque 18 F-FDG metabolism and immunohistochemistry with CD68 (r 5 0.55; P 5 0.011) and vascular endothelial growth factor (r 5 0.47; P 5 0.031). There was an inverse relationship between plaque 18 F-FDG metabolism and plaque percentage calcium composition on CT (r 5 20.51; P 5 0.018) and between calcium composition and immunohistochemistry with CD68 (r 5 20.57; P 5 0.007). Regression showed that maximum standardized uptake value and calcium composition were independently significant predictors of angiogenesis, and calcium composition was a predictor of macrophage density. Conclusion: We provide in vivo evidence that increased plaque metabolism is associated with increased biomarkers of angiogenesis and inflammation, whereas plaque calcification is inversely related to PET and histologic biomarkers of inflammation.

The Journal of Clinical Endocrinology & Metabolism, 2004

The high mortality rate from aortic dissection of women with Turner syndrome (TS) achieving ovum ... more The high mortality rate from aortic dissection of women with Turner syndrome (TS) achieving ovum donation pregnancies has highlighted the need for a refinement of cardiac screening protocols. Echocardiography and magnetic resonance imaging (MRI) are used to assess the risk factors, aortic root dilatation, bicuspid aortic valve, and coarctation, but the relative merits of each modality are unclear. Cardiovascular screening was performed in 128 unselected women with TS (mean age ؎ SD, 31.1 ؎ 8.5 yr) using echocardiography (n ‫؍‬ 120) and MRI (n ‫؍‬ 115) and in 36 age-matched normal control women. Clinical history, anthropometric measurements, blood pressure, and metabolic parameters were recorded. Echocardiography was normal in 53% of women with TS; MRI was normal in 34%. Aortic root dilatation was identified in 16% of women by echocardiography, 33% on MRI criteria, and 7% by both modalities. Height-adjusted echocardiographic aortic root dimensions were greater in TS than controls (2.90 vs. 2.62 cm; P ‫؍‬ 0.010). Bicuspid aortic valve and increasing age were associated with greater aortic dimensions; the latter effect was more marked in TS than controls. On MRI, ascending aortic diameter was greater in TS than control women (2.83 vs. 2.52 cm; P ‫؍‬ 0.029), but descending aortic diameter and ascending/descending aortic ratio were not, because these may be affected by the presence of coarctation. The two techniques are complementary and identify different aspects of cardiovascular pathology. Ascending/descending ratio on MRI circumvents issues of stature, but may be influenced by descending aortic abnormalities. We present reference ranges for absolute aortic dimensions in a TS population to aid future interpretation of these measurements.

Supplemental material, sj-jpg-1-vas-10.1177_1708538120937616 for Incidence of major complication ... more Supplemental material, sj-jpg-1-vas-10.1177_1708538120937616 for Incidence of major complication following embolo-sclerotherapy for upper and lower extremity vascular malformations by Chung Sim Lim, Nicholas Evans, Ishapreet Kaur, Anthie Papadopoulou, Mohamed Khalifa, Janice Tsui, George Hamilton and Jocelyn Brookes in Vascular

Vascular, 2021

OBJECTIVE Current data on the nature and rate of major complications for embolo-sclerotherapy (ES... more OBJECTIVE Current data on the nature and rate of major complications for embolo-sclerotherapy (EST) of vascular malformations are scarce. However, even fewer studies focus on vascular malformations specific to the head and neck, which confer an increased specific risk of airway compromise, neurologic and ophthalmologic injury. More understanding is required surrounding the type and incidence of complications to improve treatment planning and informed consent. Therefore, this study aimed to review major complications secondary to EST of head and neck vascular malformations over a 5-year period in a single specialized multidisciplinary centre for vascular anomalies. METHODS All interventions were decided by the multidisciplinary team. Demographic, procedural and complication data between 1st January 2013 and 31st December 2017 were prospectively documented in a dedicated database and analysed. EST of high-flow vascular malformations (HFVMs) was performed by selective catheter angiogra...

Journal of Medical Genetics, 1997

Fetal Diagnosis and Therapy, 1999

The feasibility and significance of three-dimensional (3D) visualization of the postmortem fetus ... more The feasibility and significance of three-dimensional (3D) visualization of the postmortem fetus using magnetic resonance imaging (MRI) was investigated. 3D reconstruction of sectional MRI data sets from 8 postmortem fetuses was performed. Fetal configurations and internal structures, both normal and pathological, were clearly demonstrated by 3D display. This new technique provides high quality fetal 3D images for postmortem morphological diagnosis and interactive visual teaching. It may eventually have applications in prenatal diagnosis and the preoperative simulation of fetal surgery.

Hepatology, 2013

1 on behalf of the EASL-CLIF-Consortium Refractory hepatic encephalopathy (HE) remains a major ca... more 1 on behalf of the EASL-CLIF-Consortium Refractory hepatic encephalopathy (HE) remains a major cause of morbidity in cirrhosis patients. Large spontaneous portosystemic shunts (SPSSs) have been previously suggested to sustain HE in these patients. We aimed to retrospectively assess the efficacy and safety of patients treated with embolization of large SPSSs for the treatment of chronic therapy-refractory HE in a European multicentric working group and to identify patients who may benefit from this procedure. Between July 1998 and January 2012, 37 patients (Child A6-C13, MELD [Model of Endstage Liver Disease] 5-28) with refractory HE were diagnosed with single large SPSSs that were considered eligible for embolization. On a short-term basis (i.e., within 100 days after embolization), 22 out of 37 patients (59.4%) were free of HE (P < 0.001 versus before embolization) of which 18 (48.6% of patients overall) remained HE-free over a mean follow-up period of 697 6 157 days (P < 0.001 versus before embolization). Overall, we noted improved autonomy, decreased number of hospitalizations, and severity of the worst HE episode after embolization in three-quarters of the patients. Logistic regression identified the MELD score as strongest positive predictive factor of HE recurrence with a cutoff of 11 for patient selection. As to safety, we noted one major nonlethal procedure-related complication. There was no significant increase in de novo development or aggravation of preexisting varices, portal hypertensive gastropathy, or ascites. Conclusion: This multicenter European cohort study demonstrated a role for large SPSSs in chronic protracted or recurrent HE and substantiated the effectiveness and safety of embolization of these shunts, provided there is sufficient functional liver reserve.

Radiology Case Reports, 2021

The appropriate identification and localization of a nidus of a high flow arteriovenous malformat... more The appropriate identification and localization of a nidus of a high flow arteriovenous malformation is crucial to guide targeted interventional therapy. However, the nidus of a complex or previously treated HFAVM can be difficult to non–invasively demonstrate on magnetic resonance imaging alone. We describe a unique case of a 56-year-old female with a complex high flow arteriovenous malformation in which we demonstrated the feasibility of fluorodeoxyglucose positron emission tomography/computed tomography to non–invasively delineate the nidus which subsequently guided successful targeted interventional therapy.