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Biomedical subjects

A T Stotter

Publications and source records attributed to A T Stotter.

14 recordsLinked to original sources
PubMed2002

Optimizing surveillance mammography following breast conservation surgery.

AIMS: Prompt detection and treatment of local recurrence (LR) following breast conservation surgery (BCT) may improve subsequent survival. Following early reports demonstrating increased LR in the first years after surgery, a practice of surveillance mammography starting 1 year from diagnosis has become established. Increasing use of adjuvant chemotherapy with adriamycin-containing regimens has resulted in radiotherapy being postponed, so that the first mammogram coincides with the acute radiotherapy reaction, resulting in patient discomfort and poor quality films. We wished to determine if the 1-year mammogram could safely be omitted. METHODS: We reviewed 1151 consecutive patients treated with BCT for in situ, stage I or II disease over a 10-year period. All patients had clear resection margins and, where indicated, underwent axillary surgery and adjuvant treatment. This consisted of radiotherapy (40 Gy with a 5 Gy boost), chemotherapy and/or tamoxifen. RESULTS: Overall, the 5-year actuarial rate of local recurrence was 4.8%. The cumulative risk of LR at 12 months was 0.3% (three patients) and 1.9% (20 patients) at 24 months. This included all cases of high-grade DCIS (>30 mm in size) and all but one tumour with a Nottingham Prognostic index (NPI) of >6.0 which recurred locally. CONCLUSION: Even including those patients generally accepted to be at high risk of LR, the cumulative risk of LR was only 0.3% at 12 months from surgery. We now therefore schedule routine biennial mammography from time of surgery except for those with high risk of early local recurrence such as extensive, high-grade in situ disease.

Breast Neoplasms↗
PubMed1991

Influence of local recurrence on survival: a controversy reviewed from the perspective of soft tissue sarcoma.

The relationship between local recurrence and survival has been examined using the example of soft tissue sarcomas of the extremities. Studies that appear to indicate that local recurrence does not jeopardize survival are shown to have been inappropriately analysed, to have inadequate patient numbers, or both. A survival deficit due to local tumour recurrence cannot be excluded on present data, and clinical decisions regarding conservative versus radical surgery will therefore continue to involve an element of value judgement.

Humans↗
PubMed1991

Surgery in HIV-positive and AIDS patients: indications and outcome.

We have reviewed the indications for and outcome of surgery in 147 patients who were seropositive for human immunodeficiency virus (HIV), 100 of whom have developed acquired immunodeficiency syndrome (AIDS). There were 256 operations; the commonest indications were anorectal conditions (34%), central venous access (21%), lymph node and soft tissue biopsy (15%) and an important minority underwent laparotomy (4%). Complications occurred in 20% of operations and repeat procedures were required in 35 patients. Both were of equal frequency in the HIV and AIDS populations. Most operations were therefore minor, and achieved satisfactory results with an acceptable morbidity. The possibility of HIV-related infection or malignancy affected the diagnostic and therapeutic approach, particularly in those considered for anorectal surgery or laparotomy. With increasing numbers of HIV-infected patients, knowledge of the types of surgery required and the likely outcome is important to enable provision of a safe and effective surgical service.

Adolescent↗
PubMed1990

The influence of local recurrence of extremity soft tissue sarcoma on metastasis and survival.

One hundred seventy-five consecutive patients with soft tissue sarcoma of the limb and limb girdle were studied using univariate and multivariate analysis. The most important factor determining risk of local recurrence was the quality of treatment of the primary tumor, with wide or radical surgery plus radical radiotherapy obtaining the best local control. Tumor size, site, and histologic grade were not predictive of local recurrence. The important tumor variables predicting survival were tumor size at first presentation and histologic grade. Tumors with greater than 10 cm greatest diameter and high-grade tumors carried a poor prognosis. Local recurrence was significantly associated with reduced survival, but only when (correctly) considered as a time-dependent variable in multivariate analysis. Irradiation was also significantly associated with poor survival. Review of the literature indicates that local recurrence is believed to have little influence on survival. Since the relevant randomized controlled trials have been small, the evidence is inconclusive.

Adolescent↗
PubMed1990

The role of limited surgery with irradiation in primary treatment of ductal in situ breast cancer.

The results of management of ductal carcinoma in situ with limited surgery and radiotherapy are presented at a median follow-up of 92 months. In 44 treated breasts the actuarial 10-year loco-regional control rate was 91%, four patients having recurred. Each loco-regional failure was due to invasive carcinoma and three of the affected patients have developed metastases. No patient developed metastases without previous clinically-evident invasive loco-regional disease. The 10-year disease-specific survival rate was 96%. Previous publications have shown that the 25% or greater risk of local failure after limited excision of ductal carcinoma in situ can be reduced by irradiation of the breast. Our results demonstrate that good loco-regional control is maintained in the longer term.

Adult↗
PubMed1990

The response of peri-aneurysmal fibrosis--the "inflammatory" aneurysm--to surgery and steroid therapy.

It is generally thought that the fibrotic process associated with an "inflammatory" aneurysm abates with operative repair. This paper reports a patient in whom the inflammatory process was accelerated after surgery leading to the development of subacute small bowel obstruction and worsening urinary tract obstruction in the postoperative period. Graft sepsis was suspected but all cultures were negative and his condition deteriorated on broad-spectrum antibiotics. Steroid therapy, however, resulted in a prompt reversal of symptoms, signs and objective evidence of obstruction. The problems of investigation of peri-aneurysmal fibrosis and graft sepsis are discussed. Possible aetiological factors and the relationship between the "inflammatory" aneurysm and idiopathic retroperitoneal fibrosis are considered.

Aorta, Abdominal↗
PubMed1990

The response of general surgeons to HIV in England and Wales.

The prevalence of HIV in the UK has been estimated to be 1 in 1000 of the population. Surgeons are at particular risk of occupational transmission from infected blood. To determine the effect of HIV on surgical practice we sent a questionnaire to 681 general surgeons in England and Wales; 450 replied (66%). Of those who replied, 42% were aware of having operated on an HIV-infected patient at least once, and 28 had recognised self-injury in such circumstances; 79% attempted to identify HIV-infected patients preoperatively, though many depended on clinical suspicion alone, which is known to be unreliable. Of those who had operated on a seropositive patient, 90% reported taking special precautions to avoid blood contact and minimise sharps injuries for such cases. The majority wore double gloves, eye protection and fluid-resistant gowns, but only a minority reported changes in surgical technique. Half had made no changes in procedures or technique when operating on patients not identified as being at risk of HIV infection. Among a wide variety of comments made by the surgeons, the commonest was a call for facilitation of HIV testing prior to surgery. This survey indicates that surgery on HIV-infected patients is not restricted to specialist centres. We review the means of identifying HIV-infected patients, the precautions that can be taken to minimise HIV transmission during surgery, and the possible influences of HIV status on surgical decisions. We conclude that the prevalence of HIV among surgical patients is being underestimated at present, that several simple changes in surgical technique should be adopted generally, and that there is limited value in preoperative HIV testing, though this may become more useful in the foreseeable future.

Accidents, Occupational↗
PubMed1989

Predicting the rate and extent of locoregional failure after breast conservation therapy for early breast cancer.

Five hundred thirty-six cases of early breast cancer (T0 to T2, N0 to N1) treated with breast conservation therapy were monitored for a median interval of 64 months. Fifty-five locoregional failures occurred after a median interval of 40 months; the actuarial failure rate was 9% at 5 years and 19% at 10 years. Factors predicting locoregional failure were sought. Young patients had a higher risk of failure than older patients, although their actuarial survival rates were not different. Locoregional failure was defined as advanced if tumor involved skin or was fixed to the chest wall, the diameter was greater than 5 cm, or unresectable nodes were present. There was a significantly higher incidence of advanced recurrence with higher initial tumor stage. Overall, the 5-year survival rate after treatment of locoregional recurrence was 63%. Advanced locoregional failure, however, resulted in a median survival time of 37 months. Further study is required to explain the increased failure rate in younger women. Advanced locoregional failure rarely occurred after treatment of Stage 0 or Stage I tumors, supporting the selection of patients with early disease for breast conservation therapy.

Actuarial Analysis↗
PubMed1986

Simulation in surgical training using freeze dried material.

The acquisition of manual dexterity and surgical skills is usually achieved in the operating theatre under supervision. We describe an efficient way of learning intestinal anastomosis procedures with the use of gamma irradiated, lyophilized porcine or bovine tissues together with a purpose designed holding jig. Preliminary evaluation of this method with untrained subjects showed that they were able to improve their performance. Because the tissues are sterile, health hazards are avoided and no special laboratory facilities are required. This approach has promise as an aid to evaluation as well as training.

Animals↗
PubMed1985

The Rhys-Davies exsanguinator.

A simple device for limb exsanguination is described. It is quick and easy to use, effective and safe, and appropriate to a wide range of circumstances. Strain-gauge plethysmography has been used to measure its efficacy and shows that it is better than limb elevation alone and comparable to use of the Esmarch bandage.

Arm↗
PubMedDate not supplied

Junctional care: the key to prevention of catheter sepsis in intravenous feeding.

Investigation of an outbreak of infection related to intravenous feeding catheters, predominantly with Staphylococcus epidermidis, suggested that the probable origin was the connections in the delivery system. Equipment and policy changes were then instituted: a catheter with integral hub was used, the connections were reduced from two to one, and improved antisepsis at the connection was devised. These actions resulted in a sustained, significant reduction in the catheter sepsis rate, supporting the hypothesis that junctional care is vital to the avoidance of catheter infection.

Catheters, Indwelling↗