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Biomedical subjects

L Barthelmes

Publications and source records attributed to L Barthelmes.

10 recordsLinked to original sources
PubMed2006

Comparative study of lymphoedema with axillary node dissection versus axillary node sampling with radiotherapy in patients undergoing breast conservation surgery.

AIMS: Our aim was to compare the incidence of lymphoedema in two groups of patients undergoing breast conservation surgery; one undergoing axillary sampling and radiotherapy to patients with positive axillary nodes, and the other undergoing axillary clearance. METHODS: Retrospective review of records of two sequential groups of patients; one undergoing axillary sampling between January 1994 and December 1998 (Group 1) and the other undergoing axillary clearance between January 2000 and December 2002 (Group 2). Both groups had minimum of 2 years follow-up. RESULTS: Three hundred and twelve patients were included in Group 1 and 194 in Group 2. 2.2% of the patients in Group 1 developed lymphoedema compared to 12.3% in Group 2. This was statistically significant with a P value=0.0001. In the node-positive patients, the incidence of lymphoedema in Group 1 was 6.2% compared to 15.4% in Group 2, although the differences were not statistically significant with P=0.17. CONCLUSIONS: The incidence of lymphoedema in the axillary sampling group was low, although the differences were less pronounced in the node-positive patients. The effectiveness of radiotherapy as an alternative to full axillary dissection among patients with positive nodes is currently under investigation in randomised controlled trials.

Axilla↗
PubMed2006

Kylie Minogue's breast cancer: effects on referrals to a rapid access breast clinic in the UK.

We examine the effect of the announcement of Kylie's breast cancer on referrals to a rapid access breast clinic in the United Kingdom. General practitioner referrals were examined, concentrating on June 2005; the month following Kylie's diagnosis. Time series analysis with autoregressive integrated moving average modeling was used to forecast data. There was a significant increase in referrals and radiographic investigations, with no increase in the number of malignant diagnoses. It is encouraging that media campaigns appear to make women more 'breast aware;' however there may also be a detrimental effect with increased radiation exposure, anxiety and cancer phobia.

Adult↗
PubMed2004

Tamoxifen and pregnancy.

Women are conventionally advised to stop tamoxifen before attempting pregnancy. The risks of congenital malformations or late teratogenic manifestations in adulthood are unknown. Following an informed discussion about the uncertainties of tamoxifen exposure on pregnancy women should be offered the choice whether to continue or stop tamoxifen before attempting pregnancy. An unexpected pregnancy in a women taking tamoxifen could continue if the pregnant woman accepts the possibility of a teratogenic effect that tamoxifen could have on the fetus.

Abnormalities, Drug-Induced↗
PubMed2003

Effect of cavity margin shavings to ensure completeness of excision on local recurrence rates following breast conserving surgery.

AIMS: The presence of residual disease at the excision margin after breast conserving surgery is the most important risk factor for local recurrence. One method for assessing tumour margin involvement is to take shavings from the wall of the resulting cavity following wide excision of the lesion. METHODS: We have reviewed our experience of shaving the margin of the cavity as our method to ensure completeness of excision. RESULTS: Of 351 patients treated with breast conservation 61 patients had residual disease in the cavity margin biopsies. Younger age, axillary lymph node status, multi-focal tumours and high grade tumours were significantly correlated with margin involvement. In patients who had clear margins eight patients (2.8%) had developed a local recurrence at follow-up of 55 months (25-89 months). CONCLUSIONS: In our hands the use of cavity margin shavings allows us to achieve an acceptable rate of local control.

Breast Neoplasms↗
PubMed2002

Progression to wet gangrene in penile necrosis and calciphylaxis.

We report a patient who presented with gangrene of the penis due to renal failure and calciphylaxis. In view of his advanced underlying conditions we pursued an expectant approach. Superinfection set in necessitating extensive debridement, demasculinisation and a perineal urethrostomy. Of the 34 reported cases in the literature, 12 (35%) were treated conservatively, 18 (53%) had been treated expectantly with delayed surgery following the development of complications and 4 (12%) underwent early surgery (penectomy). 20 (59%) of the patients subsequently died--8/12 (58%) treated conservatively, 11/18 (61%) treated with expectant surgery and 1/4 (25%) treated with early surgery. Progression to wet gangrene developed in the majority of patients--23/34 patients (68%). Penile gangrene is a symptom of severe systemic disease, where two thirds of affected patients decease within six months of onset of symptoms. Expectant treatment results in superinfection and wet gangrene in the majority of cases who ultimately require extensive surgery and debridement.

Calciphylaxis↗
PubMed2002

Deep venous thrombosis and venous thrombophlebitis associated with alprostadil treatment for erectile dysfunction.

We report a patient who developed deep vein thrombosis of the calf and thrombophlebitis after treatment with intracorporeal alprostadil (Viridal). The reaction recurred on rechallenge with Viridal. This adverse effect has not been reported in the literature but six patients have been reported to the Medicines Control Agency in Great Britain. The history of deep venous thrombosis or thrombophlebitis may not be a formal contraindication to treatment with alprostadil, but the patient should be made aware of this possible complication before embarking on this form of treatment.

Alprostadil↗
PubMed2002

The role of lymph node sampling and radiotherapy in the management of the axilla in early breast cancer.

Management of the axilla in early breast cancer is an issue of ongoing debate. We reviewed our experience in 312 patients who underwent axillary lymph node sampling between 1994 and 1998, of whom 81 patients (24%) had axillary lymph node metastasis. There have been two axillary recurrences, one associated with local recurrence to the breast and one presenting with distant metastasis. There were no patients with isolated axillary disease as their only site of recurrence and no axillary failures in the node-positive group treated with axillary sampling and radiotherapy. Axillary lymph node sampling effectively stages the axilla. This can safely be followed by radiotherapy to the axilla in case of lymph node metastasis. Axillary lymph node sampling forms a sound basis to develop new techniques, such as sentinel lymph node biopsy currently investigated by ongoing trials.

Journal Article↗
PubMed1996

[Defecation flowmetry. A new study technique for evaluating the evacuation function of the rectum].

In a prospective study carried out on 78 patients with chronic constipation (31, with slow transit, 47 with obstructive defecation disorders) the evacuation function of the rectum during defecation was assessed by defecoflowmetry. These patients were compared to a control group of normal volunteers (n = 32). The following parameters were evaluated: defecation and retention volume, defecation fraction, defecation time, maximum flow, mean flow rate and time to maximum flow. As expected, there was no difference in evacuation function between the group of patients with slow transit and the control group. Significant differences, however, existed between the two types of constipation, as well as between obstructive defecation disease and controls, regarding all parameters mentioned above. Evacuation function depends neither on rectal neck pressure nor on intrarectal pressure. In patients with obstructive defecation disorders, three subgroups were discernable: one with prolonged time of defecation and satisfactory evacuation, one with prolonged time of defecation and poor evacuation, and one small group of patients who were not able to defecate. Each group is based on a different underlying pathomechanism. We conclude that changes in evacuation function of the rectum refer either to volume or to time of defecation, or to both. Changes are found only in obstructive type constipation, not in slow transit constipation. Therefore, defeconflowmetry as a dynamic procedure can be used in screening for the classification of chronic constipation.

Adult↗
PubMed1996

The risk of infection of three synthetic materials used in rectopexy with or without colonic resection for rectal prolapse.

The incidence of infection was compared after the use of synthetic implants in abdominal rectopexy with (145 patients) and without (77 patients) synchronous colon resection. Three different materials were used, including polyvinyl alcohol (Ivalon) (n = 87), polyglactin (Vicryl) mesh (n = 109), and Gore-Tex (n = 26). In patients have colonic resection two (3.7%) pelvic infections occurred in the polyvinyl alcohol (Ivalon) group, one abdominal infection with polyglactin (Vicryl) and none with Gore-Tex. In the group without colonic resection, two patients (3.0%) developed infection after polyvinyl alcohol (Ivalon) insertion with one occurring after polyglactin (Vicryl) or Gore-Tex. Overall mortality was 0.4%. Follow-up ranged from 3 to 120 months. There were 3 (1.9%) cases of recurrent prolapse in 151 patients with full-thickness rectal prolapse.

Adult↗