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Biomedical subjects

A Stotter

Publications and source records attributed to A Stotter.

At least 19 recordsLinked to original sources
PubMed2002

The use of a prognostic table to aid decision making on adjuvant therapy for women with early breast cancer.

AIM: Understanding the likely net benefit of chemotherapy for the individual patient helps physicians to give objective information. A prognostic table has been constructed detailing the percentage absolute survival advantage offered by polychemotherapy for patients with early breast cancer, according to their age and the Nottingham Prognostic Index of their tumour. This study aims to assess its first year of use in the Leicestershire Breast Unit. METHOD: Demographic, pathological and treatment data were collected prospectively onto the Leicestershire breast cancer database. Patients with a potential survival advantage of 2% or greater in the year 01/05/99 to 30/04/00 (after the prognostic table was used routinely to determine oncology referrals) were identified. Chemotherapy usage was compared with the previous year's patient group. RESULTS: Two hundred and eighty-eight had early breast cancer, requiring surgery, eligible for consideration of adjuvant therapy. Of these, 98% of women with a potential survival advantage of 6% or more received chemotherapy. Ninety-one percent of those with a survival advantage of 4% or more was seen by an oncologist. Of those with a 2% survival advantage, 48% were referred to discuss the issues with an oncologist. Use of the table resulted in increased chemotherapy rates for women with a 4% potential survival advantage. CONCLUSIONS: We have found the prognostic table to be a useful and workable tool and advocate its use.

Adult↗
PubMed1999

Breast cancer: outcome audit of axillary management in 1991.

AIMS: To audit the outcome of axillary treatment of patients diagnosed with invasive breast cancer in 1991, with particular reference to the incidence of regional recurrence and lymphoedema after limited axillary dissection. METHODS: A review of records of patients identified prospectively. RESULTS: Two per cent regional recurrence and 5.7% lymphoedema incidence at 5 years. CONCLUSIONS: There is no indication from these results that axillary treatment, for our patient population, should be more aggressive.

Adult↗
PubMed1998

Staging the axilla in breast cancer: an audit of lymph-node retrieval in one U.K. regional centre.

AIMS: Many surgeons undertake a level 1 axillary dissection in patients with invasive breast cancer. This dissection yields a variable number of lymph nodes for histological study. In this study, we report the consequences of this policy for staging of the axilla. METHODS: Between January 1995 and December 1995, 236 patients with a diagnosis of invasive breast cancer underwent axillary surgery. RESULTS: A median of eight nodes was identified (range 0-30). In only 11 patients less than four nodes were identified. An increase in the number of nodes harvested was associated with a higher proportion of node-positive patients and a higher number of metastatic nodes identified. CONCLUSIONS: We concluded that a standardized approach to axillary dissection consistently yields an adequate sample of lymph nodes for staging purposes. Most importantly, larger node samples yield higher detection rates for metastasis. This has a significant bearing on patient selection for adjuvant chemotherapy when compared with more limited sampling practices, including solitary sentinel node detection and biopsy.

Adult↗
PubMed1998

Anatomical variants during axillary dissection.

BACKGROUND: This study was done to document the variations encountered in the anatomy of the axilla because of the difficulty they can cause during dissection. METHODS: A record was made of the anatomy of the axilla in 100 patients with breast cancer who had an axillary dissection. RESULTS: The variants from the described normal included double axillary veins, abnormal bands of muscle from the latissimus dorsi stretching across the axilla and a medial lying thoracodorsal nerve. CONCLUSION: Damage to important structures in the axilla during axillary dissection can be minimized with an awareness of the possible anatomical variations.

Axilla↗
PubMed1996

Anxiety in patients with symptomatic breast disease: effects of immediate versus delayed communication of results.

Immediate reporting of fine needle aspiration biopsy (FNAB) specimens has been introduced into many breast clinics; in others, women return to a later clinic to receive the result. This delay in communication of results may lead to elevated anxiety. This study compared anxiety levels in two groups having FNAB. One group received results at the initial clinic visit (n = 51), the other having delayed communication (n = 51). Anxiety was measured using the six-item short form of the Spielberger State-Trait Anxiety Inventory (STAI-SSF) and was administered before and after each consultation. Initial anxiety was high in both groups. Women with malignant results had higher post-communication anxiety compared with women with benign results. However, within the group with benign results (the vast majority), immediate communication was associated with a significantly greater fall in STAI-SSF scores from before to after the first consultation (U = 587.0; P < 0.02). There was no difference between the immediate and delayed communication among women with a malignant diagnosis (U = 26.0; P = 0.91). These results provide preliminary support for the more widespread introduction of a cytologist into breast clinics to allow immediate communication of results.

Anxiety↗
PubMed1995

Operative procedures in patients subsequently found to be human immunodeficiency virus positive.

This study investigated the number and range of surgical procedures performed in patients subsequently found to be human immunodeficiency virus (HIV) positive. Procedures were included if they occurred during a period when the patients were likely to have been infected with HIV but unaware of their HIV status. A total of 28 operative procedures were documented in 19 (22 per cent) of 86 patients. Several operations were major and invasive. All patients had recognized risk factors for HIV infection but these had not been elicited in the surgical records. Women and patients who acquired their disease through heterosexual intercourse were more likely to have undergone surgery before a diagnosis of HIV than homosexual men. The incidence of surgical procedures in patients with HIV infection was significantly greater than in the general population of Leicestershire; however, many of these were minor and related to the management of complications associated with HIV. Surgeons are performing operations on patients who are unknowingly infected with HIV. The risk of transmission of HIV to surgeons is remote, but surgeons must be aware of risk factors for HIV infection.

Adult↗
PubMed1993

Mitochondrial myopathy associated with chronic zidovudine therapy in AIDS.

One hundred and eighteen consecutively identified AIDS patients, 88 of whom received zidovudine (1000-1200 mg/day), were followed for 1 year to investigate prospectively the relationship between zidovudine and myopathy. Clinical and biochemical evidence of proximal myopathy was seen in 7 of 41 patients (17%) who had been receiving zidovudine for more than 270 days, but in none of those on short-term therapy and in none of the controls. Serum creatine kinase levels rose a mean of 76 days (range 34-187) before the onset of clinical signs. Creatine kinase returned to normal within 4 weeks of cessation of zidovudine and strength returned within 8 weeks, though loss of muscle bulk persisted. Chronic malaise, anorexia and nausea accompanied the myopathy and remitted within 8 weeks of stopping zidovudine. Muscle histology in four patients with myopathy showed fibre size variation with atrophic, necrotic and degenerating fibres and an absence of inflammation. Ultrastructural studies showed glycogen-packed sarcoplasm, lipid droplets and grossly giant mitochondria. These abnormalities improved substantially after stopping zidovudine. Similar but less marked changes were seen in a zidovudine treated patient without myopathy, but were absent in one AIDS patient not taking the drug. Long-term zidovudine therapy is associated with a mitochondrial myopathy and the constitutional features suggest that it is part of a wider disorder affecting cellular function in other tissues.

Acquired Immunodeficiency Syndrome↗
PubMed1991

Emergency laparotomy in patients with AIDS.

The presentation, operative management and final diagnosis were reviewed in 28 patients with AIDS (27 men and one woman) who underwent emergency laparotomy. On clinical and radiological examination, six patients showed features of toxic megacolon, five patients had small bowel obstruction, six patients had localized peritonitis and three had perforated viscus with generalized peritonitis. The most common disease processes were acute colitis in seven patients (associated with cytomegalovirus (CMV) infection in six), intra-abdominal lymphoma in five patients, acute appendicitis in five patients (associated with CMV infection in two), and atypical mycobacterial (MAI) infection in four patients. Two perioperative deaths occurred; one in a patient with acute pancreatitis and a second with generalized peritonitis. Later deaths were due to progression of AIDS, and patient survival at 1 month, 3 months and 6 months was 89 per cent, 64 per cent and 48 per cent, respectively. Lower operative mortality than in previously reported series may be due to earlier intervention in CMV toxic megacolon. Surgery, however, conferred less benefit in patients with acute abdominal pain from MAI infection or lymphoma. With careful patient selection, emergency laparotomy may achieve worthwhile palliation in patients with AIDS.

Acquired Immunodeficiency Syndrome↗
PubMed1991

Salvage treatment for loco-regional recurrence following breast conservation therapy for early breast cancer.

We reviewed the management of 55 cases of loco-regional recurrence after limited surgery and irradiation for breast cancer. Forty-three patients had disease localized to the breast, with axillary involvement in seven. Four had axillary relapse without tumor recurrence in the breast. Eight had breast recurrence extending to involve the chest wall. Mastectomy was used successfully for 41 first recurrences, and seven were controlled by wide excision; 21 of 48 patients also received chemotherapy and/or hormonal manipulation. Diffuse soft-tissue tumor required systemic therapy first, followed by wide excision when possible. Eighty-nine percent of first recurrences were controlled but disease recurred again in eight patients. Overall, 80% of cases were free of loco-regional disease at a median follow-up of 27 months. Reconstructive surgery was valuable for wound closure after wide resections, and for cosmetic procedures. Despite the previous irradiation, surgery complications were acceptable.

Actuarial Analysis↗
PubMed1990

Role of compartmental resection for soft tissue sarcoma of the limb and limb girdle.

A total of 143 consecutive operations for soft tissue sarcoma of the extremity, performed by one surgeon over a 5-year period, was studied to determine the place of compartmental excision. The surgical aim was to achieve the nearest to radical surgery compatible with preservation of a functional limb. Of the operations, 73 were for previously untreated primary tumour and 70 for local recurrence. Two tumours arose in areas previously irradiated for other malignancies and 35 recurrences had occurred despite prior radiotherapy; of the 106 remaining cases, adjuvant radiotherapy was used for 79. Adjuvant chemotherapy was used only occasionally and was more often regional than systemic. For the majority of tumours, compartmentectomy was inappropriate or inadequate: 49 were extracompartmental in origin and 48 extended beyond their compartment of origin at the time of surgery. The remaining 46 were confined to one compartment; in only 21 of these 46 operations was a radical compartmental excision performed. Compartmental excision was more likely to be performed when the tumour was centrally located within a compartment, was so large that it replaced most of the muscle group, or was high grade or recurrent (particularly when adjuvant radiotherapy had already been used). The general preference was to combine less-than-radical surgery with adjuvant radiotherapy rather than sacrifice entire muscle groups or adjacent, functionally important, structures such as artery or nerve. This reflects the proven efficacy of radiotherapy in controlling microscopic disease. Overall, compartmental excision was considered appropriate in only 15 per cent of operations.

Adolescent↗
PubMed1990

Treatment of extremity soft tissue sarcomas with surgery and radiotherapy.

The results of treatment with a combination of surgery and radiotherapy of 102 patients with nonmetastatic extremity soft tissue sarcoma are reported. Seventy-nine patients were previously untreated and 23 had locally recurrent disease. Sixty-six tumours were situated in the lower limb and 16 in the limb girdles. Fifty-nine were high grade lesions, and 64 were over 5 cm in length. Surgical clearance was "good" (wide or radical) in only 34 cases. Sixty-eight patients received post-operative irradiation, 23 pre-operative irradiation and 11 both pre- and post-operative radiotherapy. Seventeen patients subsequently developed local recurrence and 9 of these remain disease-free after further surgery. Actuarial 5 year local control and disease-free survival rates for new cases were 87 and 65.4%; and for previously recurrent cases these figures fell to 75 and 54.8%. Following a univariate analysis of patient, tumour, surgical and radiotherapeutic factors only previous local recurrence (p less than 0.1 greater than 0.05) was found to significantly increase the risk of further local relapse. Multivariate analysis found high tumour grade [relative risk (RR) 8.4], tumour size greater than 15 cm (RR 3.66), previous local recurrence (RR 6.47) and proximal site (RR 12.7) to be independent poor risk factors for survival.

Actuarial Analysis↗
PubMed1990

Survival following locoregional recurrence after breast conservation therapy for cancer.

We postulated that locoregional recurrence after limited surgery and radiotherapy for breast cancer might be associated with an additional survival hazard, similar to that of a second primary tumor with the same extent of local and regional disease. Using this hypothesis we examined the likely resultant effect on survival. Our calculations indicated that no statistically significant survival deficit due to such recurrence would be detectable until a randomized controlled trial comparing breast conservation with mastectomy had monitored more than 10,000 patients for more than 10 years. A simple mathematical model predicted 5-year survival rates in a cohort of patients treated with breast conservation of 75%, compared to 83% in those without locoregional recurrence. From the date of locoregional recurrence, a 61% 5-year survival rate was predicted, compared to 83% if no hazard was associated with locoregional recurrence. These predictions were compared with the actuarial survival rates of 499 patients with unilateral breast cancer, 49 of whom had developed locoregional recurrence. From the date of initial treatment, the 5-year survival rate of those whose disease recurred was 79%, compared to 88% for those without locoregional recurrence (p = 0.19). The actuarial 5-year survival rate from the date of locoregional recurrence was 63%. The similarity between the patient data and the predictions of the mathematical model indicates that locoregional failure after breast conservation therapy may result in reduced survival. The lack of a significant survival deficit in our cohort or in controlled trials comparing breast conservation therapy with mastectomy is compatible to the small size of the overall effect.

Actuarial Analysis↗