Lambri Yianni | University Of Winchester (original) (raw)
Papers by Lambri Yianni
Surgeon-journal of The Royal Colleges of Surgeons of Edinburgh and Ireland, Apr 1, 2010
Sir, A 44 year old man presented to the emergency department with a 3 hour history of abdominal p... more Sir, A 44 year old man presented to the emergency department with a 3 hour history of abdominal pain. He was febrile with a temperatureof40 C and hadraised inflammatorymarkers, C– reactive protein of 182 mg/l and white cell count of 14.3. On examination he had localized peritonitis in the right lower quadrant. Plain chest and abdominal radiographs were normal. He had surgery for suspected appendicitis but at operation he had a perforated ileal mass (Fig. 1), with pus in all quadrants and a normalappendix. Hehad resectionof the ileal mass withsmall bowel anastomosis, and he made a satisfactory recovery. Histology demonstrated ileal duplication. There was no direct continuity between the duplicated ileum and the normal ileum (Fig. 2). Fig. 2 – Ileal Duplication.
Journal of Crohn's and Colitis, Apr 18, 2017
Background: The revised Porto criteria identify subtypes of paediatric inflammatory bowel disease... more Background: The revised Porto criteria identify subtypes of paediatric inflammatory bowel diseases: ulcerative colitis [UC], atypical UC, inflammatory bowel disease unclassified [IBDU], and Crohn's disease [CD]. Others have proposed another subclassifiction of Crohn's colitis. In continuation of the Porto criteria, we aimed to derive and validate criteria, termed "PIBD-classes, " for standardising the classification of the different IBD subtypes. Methods: This was a multicentre retrospective longitudinal study from 23 centres affiliated with the Port-group of ESPGHAN. Both a hypothesis-driven judgmental approach and mathematical classification and regression tree [CART] modelling were used for creating a diagnostic algorithm. Since small bowel inflammation is easily recognised as CD, we focused here primarily on the phenotype of colitis. Results: In all, 749 IBD children were enrolled: 236 [32%] Crohn's colitis, 272 [36%] UC and 241 [32%] IBDU [age 10.9 ± 3.6 years] with a median follow-up of 2.8 years (interquartile range [IQR] 1.7-4.3). A total of 23 features were clustered in three classes according to their prevalence in UC: six class-1 features [0% prevalence in UC], 12 class-2 features [< 5% prevalence], and five class-3 features [5-10% prevalence]. According to the algorithm, the disease should be classified as UC
Journal of Crohn's and Colitis, 2017
The revised Porto criteria identify subtypes of pediatric inflammatory bowel diseases: ulcerative... more The revised Porto criteria identify subtypes of pediatric inflammatory bowel diseases: ulcerative colitis (UC), atypical UC, Inflammatory Bowel Disease Unclassified (IBDU), and Crohn&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s disease (CD). In continuation of the Porto criteria, we aimed to derive and validate criteria for standardizing the classification of the IBD subtypes. This was a multicenter retrospective longitudinal study from 23 centers affiliated with the Porto-group of ESPGHAN. Both a hypothesis-driven judgmental approach and mathematical CART modeling were utilized for creating a diagnostic algorithm. Since small bowel inflammation is easily recognized as CD, we focused here primarily on the phenotype of colitis. 749 IBD children were enrolled- 236 (32%) Crohn&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s colitis, 272 (36%) UC and 241 (32%( IBDU (age 10.9±3.6 years) with a median follow-up of 2.8 years (IQR 1.7-4.3). A total of 23 features were clustered in 3 classes according to their prevalence in UC: 6 class-1 (0% prevalence in UC), 12 class-2 (&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;5% prevalence) and 5 class-3 (5-10% prevalence). According to the algorithm, the disease should be classified as UC if no features exist in any of the classes. When at least one feature exist, different combinations classify the disease into atypical UC, IBDU and CD. The algorithm differentiated UC from CD and IBDU with 80% sensitivity (95%CI 71-88%) and 84% specificity (77-89%), and CD from IBDU and UC with 78% sensitivity (67-87%) and 94% specificity (89-97%). The validated algorithm can adequately classify children with IBD into small bowel CD, Colonic CD, IBDU, atypical UC and UC.
Purpose: To develop clinical diagnostic criteria for carpal tunnel syndrome (CTS) that modeled th... more Purpose: To develop clinical diagnostic criteria for carpal tunnel syndrome (CTS) that modeled the clinical diagnostic practices of experts. Methods: Fifty-seven clinical findings associated with CTS had been ranked previously in order of diagnostic importance using Delphi as a method of establishing consensus among a panel of expert clinicians. The 8 most highly ranked criteria then were placed into all possible combinations to create 256 unique case histories. Two new panels of experts rated these case histories. One panel made a binary evaluation as to whether the case history did or did not represent CTS. This allowed the development of a logistic regression model that had the probability of carpal tunnel syndrome as the dependent variable and the weighted diagnostic criteria as the independent variables. This model then was validated against the judgments of the second panel of clinicians who estimated the probability of CTS for each of the same case histories. Results: The correlation between the probability of CTS predicted by the model and the panel of clinicians was 0.71. Conclusions: The most important clinical diagnostic criteria for CTS as identified from a larger pool of potential diagnostic items through a consensus approach using Delphi were weighted and found to correlate well with the judgments of a new panel of clinicians. By improving the consistency of the diagnosis of CTS these criteria should lead to more effective treatment and a better understanding of the effect of workplace exposures in the development of this condition. A methodology that emphasizes a rigorous approach to item generation and item reduction through expert consensus, followed by validation, may represent a template for establishing consensus among experts on other controversial clinical issues.
Surgeon-journal of The Royal Colleges of Surgeons of Edinburgh and Ireland, Apr 1, 2010
Sir, A 44 year old man presented to the emergency department with a 3 hour history of abdominal p... more Sir, A 44 year old man presented to the emergency department with a 3 hour history of abdominal pain. He was febrile with a temperatureof40 C and hadraised inflammatorymarkers, C– reactive protein of 182 mg/l and white cell count of 14.3. On examination he had localized peritonitis in the right lower quadrant. Plain chest and abdominal radiographs were normal. He had surgery for suspected appendicitis but at operation he had a perforated ileal mass (Fig. 1), with pus in all quadrants and a normalappendix. Hehad resectionof the ileal mass withsmall bowel anastomosis, and he made a satisfactory recovery. Histology demonstrated ileal duplication. There was no direct continuity between the duplicated ileum and the normal ileum (Fig. 2). Fig. 2 – Ileal Duplication.
Journal of Crohn's and Colitis, Apr 18, 2017
Background: The revised Porto criteria identify subtypes of paediatric inflammatory bowel disease... more Background: The revised Porto criteria identify subtypes of paediatric inflammatory bowel diseases: ulcerative colitis [UC], atypical UC, inflammatory bowel disease unclassified [IBDU], and Crohn's disease [CD]. Others have proposed another subclassifiction of Crohn's colitis. In continuation of the Porto criteria, we aimed to derive and validate criteria, termed "PIBD-classes, " for standardising the classification of the different IBD subtypes. Methods: This was a multicentre retrospective longitudinal study from 23 centres affiliated with the Port-group of ESPGHAN. Both a hypothesis-driven judgmental approach and mathematical classification and regression tree [CART] modelling were used for creating a diagnostic algorithm. Since small bowel inflammation is easily recognised as CD, we focused here primarily on the phenotype of colitis. Results: In all, 749 IBD children were enrolled: 236 [32%] Crohn's colitis, 272 [36%] UC and 241 [32%] IBDU [age 10.9 ± 3.6 years] with a median follow-up of 2.8 years (interquartile range [IQR] 1.7-4.3). A total of 23 features were clustered in three classes according to their prevalence in UC: six class-1 features [0% prevalence in UC], 12 class-2 features [< 5% prevalence], and five class-3 features [5-10% prevalence]. According to the algorithm, the disease should be classified as UC
Journal of Crohn's and Colitis, 2017
The revised Porto criteria identify subtypes of pediatric inflammatory bowel diseases: ulcerative... more The revised Porto criteria identify subtypes of pediatric inflammatory bowel diseases: ulcerative colitis (UC), atypical UC, Inflammatory Bowel Disease Unclassified (IBDU), and Crohn&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s disease (CD). In continuation of the Porto criteria, we aimed to derive and validate criteria for standardizing the classification of the IBD subtypes. This was a multicenter retrospective longitudinal study from 23 centers affiliated with the Porto-group of ESPGHAN. Both a hypothesis-driven judgmental approach and mathematical CART modeling were utilized for creating a diagnostic algorithm. Since small bowel inflammation is easily recognized as CD, we focused here primarily on the phenotype of colitis. 749 IBD children were enrolled- 236 (32%) Crohn&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s colitis, 272 (36%) UC and 241 (32%( IBDU (age 10.9±3.6 years) with a median follow-up of 2.8 years (IQR 1.7-4.3). A total of 23 features were clustered in 3 classes according to their prevalence in UC: 6 class-1 (0% prevalence in UC), 12 class-2 (&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;5% prevalence) and 5 class-3 (5-10% prevalence). According to the algorithm, the disease should be classified as UC if no features exist in any of the classes. When at least one feature exist, different combinations classify the disease into atypical UC, IBDU and CD. The algorithm differentiated UC from CD and IBDU with 80% sensitivity (95%CI 71-88%) and 84% specificity (77-89%), and CD from IBDU and UC with 78% sensitivity (67-87%) and 94% specificity (89-97%). The validated algorithm can adequately classify children with IBD into small bowel CD, Colonic CD, IBDU, atypical UC and UC.
Purpose: To develop clinical diagnostic criteria for carpal tunnel syndrome (CTS) that modeled th... more Purpose: To develop clinical diagnostic criteria for carpal tunnel syndrome (CTS) that modeled the clinical diagnostic practices of experts. Methods: Fifty-seven clinical findings associated with CTS had been ranked previously in order of diagnostic importance using Delphi as a method of establishing consensus among a panel of expert clinicians. The 8 most highly ranked criteria then were placed into all possible combinations to create 256 unique case histories. Two new panels of experts rated these case histories. One panel made a binary evaluation as to whether the case history did or did not represent CTS. This allowed the development of a logistic regression model that had the probability of carpal tunnel syndrome as the dependent variable and the weighted diagnostic criteria as the independent variables. This model then was validated against the judgments of the second panel of clinicians who estimated the probability of CTS for each of the same case histories. Results: The correlation between the probability of CTS predicted by the model and the panel of clinicians was 0.71. Conclusions: The most important clinical diagnostic criteria for CTS as identified from a larger pool of potential diagnostic items through a consensus approach using Delphi were weighted and found to correlate well with the judgments of a new panel of clinicians. By improving the consistency of the diagnosis of CTS these criteria should lead to more effective treatment and a better understanding of the effect of workplace exposures in the development of this condition. A methodology that emphasizes a rigorous approach to item generation and item reduction through expert consensus, followed by validation, may represent a template for establishing consensus among experts on other controversial clinical issues.