Latest news with #JamesPaget
BBC News
08-05-2025
- Health
- BBC News
How is the James Paget hospital coping with crumbling concrete?
How a hospital is coping with crumbling concrete Just now Share Save Alex Dunlop BBC News, Norfolk Reporting from Gorleston-on-Sea Mariam Issimdar BBC News, Norfolk Share Save Qays Najm/BBC Timber beams are being used to reinforce the Raac panels to make them safe At the James Paget hospital on the Norfolk coast, supports are stopping 8,300 panels of concrete in its ceilings and walls from collapsing. Staff will eventually work in a brand new building, but how are they coping as repairs to make the current site safe continue around them? The challenges facing the estates team at James Paget hospital are not unique. It is one of a number of English hospitals built using a cheaper type of concrete that is now at the end of its lifespan. Disintegrating Raac, or Reinforced Autoclaved Aerated Concrete (Raac), is affecting several areas of the hospital including its maternity ward, which has had to close for about six months while the panels are reinforced. The unit will not reopen before the end of August, but in the meantime maternity services have been relocated to the first floor close to theatres and the neonatal unit. Elsewhere, ceilings in 11 out of 14 operating theatres are also being strengthened, with the work being carried out on two theatres at a time. Engineers were so concerned about Raac panels in the hospital kitchen it was made to shut for more than a year, with meals brought in. Qays Najm/BBC Work to reinforce 8,300 ceiling panels made from Raac is being undertaken at the James Paget hospital in Norfolk Qays Najm/BBC Raac panel ceilings at the Gorleston hospital have been disintegrating for several years Stephen Balls, deputy director of estates and facilities, says without the beam supports there is "a real danger" of ceilings falling in. "It's a mammoth task," he says. He speaks from maternity ward 11, where his team has been working for the past few months. "We usually take an 18-week period for our Raac panel mitigation work," he says. "However, we have also taken the opportunity to upgrade our triage area at the same time." Qays Najm/BBC Stephen Balls, who has been in charge of the remedial work, described the work as "a mammoth task" Raac was developed in the 1960s and used in many public buildings, including hospitals, schools and leisure centres, until the 1990s. It is much cheaper and lighter but weaker than reinforced concrete, and over time it deteriorates. Lengthy exposure to water can also make it crumble. The material was only designed to last about 30 years. The James Paget in Gorleston-on-Sea, which serves patients in east Norfolk and north-east Suffolk, is now 43 years old. The majority of the Raac panels at the Paget, some 75% to 80%, are in the ceiling, with the rest in walls. Matt Knight/BBC Problems with Raac do not make themselves apparent until the material breaks, say experts So far, 60% of the work on Raac affected areas has been completed and the total cost of this remedial effort will be about £34m. Mark Flynn, director of strategic projects at the hospital, says the work so far is "going really well", with most of the reinforcement work in non-clinical areas having been done. He says staff and NHS England have provided great support to ensure the hospital remains open and the impact on patient services stays minimal. "I am pleased to say that we are in a position to maintain patient services, for patients and staff," says Mr Flynn. "About 86% of our site is constructed with Raac, and obviously we are continuing to work to maintain safety, and we make sure all of the works are done to a really high standard." Qays Najm/BBC A new kitchen was built after suspect concrete in the ceiling was made safe Ali Guenaoui, catering operations manager, says the whole kitchen ceiling has been made of Raac, causing "a huge, huge, problem". The area has been reopened after the panels' lifespan was extended. Mr Guenaoui says: "It's been challenging, very, because with a big project like that it wasn't going to just be overnight, but I think the team have done a fantastic job. "We had to find a different way of providing food - food coming in and heating it up, which is not our normal style. "We've waited a long time but now we have so many benefits. It was a custom designed kitchen - we told them how we wanted it and they came and did it." Qays Najm/BBC Catering manager, Ali Guenaoui, is delighted with the "beautiful" kitchen that has been built The repairs to the hospital should be done by 2028, according to Mark Flynn, director of strategic projects. By then, work on a new hospital will be under way on a site to the west of the current hospital complex. Qays Najm/BBC Wards and corridors have been stripped out ready for repairs The new hospital, which has a budget of £1.5bn, will also have room to expand as it will be double the footprint of the existing site and have about 600 beds for patients. Funding for the new site has come from the government's New Hospital Programme, while the Raac repairs have been met through separate funding from NHS England. "We're really pleased to have now secured the land for this new hospital," Mr Flynn says. Qays Najm/BBC Mark Flynn says reinforcements to the hospital's ceilings and walls is progressing well "We will have a completely separate construction site for the new hospital, so we hope to minimise the impact as much as possible... during what's going to be a long build period." Once the new site is built, in about a decade's time, the existing hospital site will be demolished. Mr Flynn says: "It's great that we are part of the National Hospital Programme and really fantastic that we've secured the land. "I feel ecstatic, it's brilliant." Perkins & Will/James Paget An artist's impression of what the new hospital could look like Follow Norfolk news on BBC Sounds, Facebook, Instagram and X.
Los Angeles Times
11-03-2025
- Health
- Los Angeles Times
Paget's Disease: Diagnosis, Management, and Insights into the Breast (PDB)
Paget's disease of the breast is a rare kind of breast cancer that mostly affects the skin around the nipple. It happens in only a small number of breast cancer cases because it's linked to certain gene changes and other types of breast tumors. Doctors notice it more in women who have stopped having periods (postmenopausal women). Things like what you eat, where you live, and how often you get check-ups can change your chances of having this disease. Paget's disease of the breast is found more often in countries like the United States and those in Western Europe, compared to places in Asia. This could be because people in those countries have more access to doctors, tests, and information about breast health. Even though this disease is not very common, it's important to pay attention to it because it can be connected to other serious breast tumors. Catching and treating it early helps people have better results and stay healthier in the long run. Table of Contents: Paget's disease of the breast is a rare breast cancer that affects the skin of the nipple and sometimes the areola. It is characterized by a rash or eczema like appearance on the nipple and areola which can be accompanied by itching, redness and discharge. It is often associated with an underlying breast cancer which can be invasive or non-invasive (ductal carcinoma in situ, DCIS). Paget's disease of the breast is named after Sir James Paget, a 19th century British doctor who first described the condition. The pathogenesis of PDB is explained by two theories: The first theory is the epidermotropic theory which suggests that Paget cells come from an underlying ductal carcinoma in situ (DCIS) or invasive breast carcinoma. These cells retain their malignant properties and contribute to the histopathological findings of Paget's disease. These cancer cells are thought to migrate from an underlying carcinoma through the lactiferous ducts to the nipple epidermis. The second theory is the in situ transformation theory which suggests that Paget cells arise as a primary intraepidermal malignancy independent of any underlying breast carcinoma. This theory is supported by cases where no underlying breast tumor is found. Epidermotropic Theory: This is the most widely accepted theory which suggests that malignant ductal cells migrate from an underlying carcinoma through the lactiferous ducts to the epidermis of the nipple. These cells retain their malignant properties and contribute to the histopathological findings of Paget's disease. This theory is supported by the frequent finding of underlying DCIS or invasive carcinoma in patients with PDB. In some cases this underlying carcinoma can be an invasive breast cancer which affects the prognosis and treatment. In Situ Transformation Theory: This is an alternative theory which suggests that malignant cells arise de novo within the epidermis of the nipple possibly due to local field effects or genetic mutations. Although this theory is less accepted, it highlights the complexity of the disease. Further research is needed to understand the molecular mechanisms. Characteristic features are large, pale, vacuolated Paget cells in the epidermis often with HER2 overexpression. The strong association with DCIS or invasive carcinoma emphasizes the need for full evaluation. [2] Recent studies have looked at molecular pathways including HER2 signaling and immune evasion mechanisms as potential targets for treatment. For example HER2 targeted therapy like trastuzumab has shown promise in improving outcomes. Paget's disease of the breast is a rare condition and accounts for about 1-4% of all breast cancer. The exact cause of Paget's disease is not known but it is associated with underlying breast cancer. The risk factors for Paget's disease are similar to breast cancer: Knowing these risk factors is important for early detection and prevention. Regular screenings and genetic counseling can help identify those at higher risk and can be managed proactively. [4] PDB usually presents with changes in the nipple-areola complex: Unilateral symptoms are common but bilateral symptoms are rare and should prompt consideration of other diagnoses. Symptom progression varies; early cases may present with subtle scaling and advanced cases may have ulceration and nipple destruction. Recognizing these stages is important for timely interventions. Case studies show that early detection of these subtle signs can improve prognosis. Diagnosis of PDB is a combination of clinical evaluation, imaging and histopathological assessment. If an underlying cancer is suspected, a sentinel lymph node biopsy may be done to assess the spread of cancer to the axillary lymph nodes. [5] A comparison of imaging modalities shows that MRI is more sensitive than mammography and ultrasound especially in younger patients or those with dense breasts. However, the cost and false positive results should be considered. Advanced techniques like diffusion-weighted imaging (DWI) and contrast-enhanced mammography are emerging as promising tools to improve diagnostic accuracy. Immunohistochemistry: HER2 is overexpressed in 80-100% of cases, ER and PR status varies depending on the underlying cancer. Advances in molecular diagnostics including next-generation sequencing is helping us understand the genetic basis of PDB. For example, TP53 and PIK3CA mutations have been linked to disease progression and potential targets for therapy. Treatment of PDB depends on the extent of disease and presence of underlying cancer. Treatment options are surgery, radiation and systemic therapy. Radiation Therapy: Reduces local recurrence, especially after BCS. Whole breast radiation therapy is usually recommended after BCS to make sure any remaining cancer cells are killed and reduce the risk of recurrence. Oncoplastic surgery has improved the cosmetic outcome for BCS patients. Nipple-sparing mastectomy is also becoming popular, balancing oncological safety and aesthetic preservation. 3D imaging and intraoperative margin assessment has further improved surgical precision. Emerging therapies like antibody-drug conjugates (e.g. trastuzumab deruxtecan) and immune checkpoint inhibitors are being studied in clinical trials and may add to the treatment options for PDB. Combination therapy targeting both HER2 and PD-1/PD-L1 are showing promising results in early phase trials and may be the future of personalized medicine. Prognosis of Paget's disease of the breast depends on the underlying cancer and stage of the disease. If the underlying cancer is non-invasive (DCIS), prognosis is good, 5 year survival is over 90%. If the underlying cancer is invasive, prognosis is poor, 5 year survival is 50-60%. Prognosis is poorer if the cancer has spread to the nodes or other parts of the body. Early detection and comprehensive treatment is key to better outcomes. Advances in imaging and targeted therapy has improved the management of Paget's disease and hope for better survival and quality of life. In peripartum women presenting with nipple-areola complex changes, PDB should be included in the differential diagnosis. PDB is often associated with tumors in the same breast tissue so it is important to evaluate the same breast for any underlying tumors. Diagnostic delays are common because PDB looks like benign conditions. Multidisciplinary management is important to balance maternal and fetal well being while ensuring prompt treatment [2]. Case reports have shown the challenges of managing PDB during pregnancy and the importance of individualized care plan. Imaging modalities like ultrasound which is non-ionizing radiation is preferred during pregnancy. Modern Treatment TrendsBreast conserving approach is the trend now with improvements in imaging, surgery and adjuvant therapy. Personalized treatment plan based on tumor biology and patient preference has resulted to better functional and cosmetic outcome. AI is also being integrated in imaging and pathology to aid in earlier detection and more accurate diagnosis of PDB. Patient education and awareness is key in the diagnosis and treatment of Paget's disease of the breast. Women should be aware of the signs and symptoms of Paget's disease, a rash or eczema like appearance on the nipple and areola, itching, redness and discharge. Women should also be aware of their risk for breast cancer and take steps to reduce their risk, get regular mammograms and do breast self exam. Educational campaigns and resources can help women to seek medical attention if they notice any changes in their breast tissue. Early intervention can make a big difference in prognosis and treatment outcome. Multidisciplinary approach is important in the diagnosis and treatment of Paget's disease of the breast. A team of healthcare professionals including breast surgeon, medical oncologist, radiation oncologist and pathologist should work together to develop a treatment plan that is individualized to the patient. Treatment may include surgery, radiation therapy, chemotherapy and hormone therapy depending on the underlying cancer and stage of the disease. Team work among specialists ensures comprehensive care of all aspects of the disease. This team based approach not only improves clinical outcome but also the overall well being of the patient and provide holistic treatment experience. Paget's disease of the breast is a rare but significant malignancy that requires high index of suspicion for early diagnosis. Mammary Paget disease which involves the nipple-areola complex requires thorough understanding of its clinical presentation and underlying pathology. Advances in imaging, histopathology and systemic therapy has improved diagnostic accuracy and treatment outcome. Breast conserving surgery when possible is a trend towards less invasive management which is patient centered. Future research should focus on the molecular mechanism of PDB and identification of new therapeutic targets to further improve outcome. Development of AI driven diagnostic tool and precision therapy will be the game changer in PDB management in the coming years. [1] Hudson-Phillips, S., Cox, K., Patel, P., & Al Sarakbi, W. (2023). Paget's disease of the breast: diagnosis and management. British journal of hospital medicine (London, England : 2005), 84(1), 1–8. [2] Gilmore, R., Prasath, V., & Habibi, M. (2020). Paget Disease of the Breast in Pregnancy and Lactation. Advances in experimental medicine and biology, 1252, 133–136. [3] Karakas C. (2011). Paget's disease of the breast. Journal of carcinogenesis, 10, 31. [4] Dalton, J. C., & Plichta, J. K. (2024). Paget's disease of the breast: Insights from imaging to guide surgical management. American journal of surgery, 231, 16–17. [5] Sakorafas, G. H., Blanchard, K., Sarr, M. G., & Farley, D. R. (2001). Paget's disease of the breast. Cancer treatment reviews, 27(1), 9–18.
