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PubMed2000

'Old Kerr's almanac'.

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Clinical Trials as Topic↗
PubMed2005

The medical content of English almanacs 1640-1700.

There has been a great deal of recent interest in popular health care in early modern England, resulting in studies on a range of topics from practitioners through remedial treatment. Over the past decade, the history of books has also attracted growing interest. This is particularly true for the seventeenth century, a period marked by a dramatic rise in all types of printed works. The 1640s are especially significant in the evolution of printed vernacular medical publications, which continued to flourish during the rest of the century. While recent studies on popular medical books have contributed greatly to our understanding of contemporary medical beliefs and practices, they have failed to properly recognize the effect that almanacs had on early modern medicine. Although their primary function was not to disseminate medical information, most provided a great deal of medical information. Furthermore, these cheap, annual publications targeted and were read by a wide cross-section of the public, making them the first true form of British mass media. This article is based on the content of 1,392 almanacs printed between 1640 and 1700, which may make it the largest comparative study of the medical content of any early modern printed works. The project has resulted in two major findings. First of all, almanacs played a major part in the dissemination, continuing popularity, and longevity of traditional astrological and Galenic beliefs and practices. Secondly, at the same time, almanacs played an important early role in the growth of medical materialism in Britain.

Advertising↗
PubMed2001

Sentinel node biopsy in breast cancer: ALMANAC trial.

Sentinel node biopsy of breast cancer is becoming an increasingly popular topic. The concept of the sentinel node being the first lymph node to contain metastatic cancer within a tumor's lymphatic basin was introduced by Cabanas, a South American surgeon, following his work on carcinoma of the penis. Morton and his colleagues then applied this principle to malignant melanomas, and more recently this concept has gained popularity for carcinoma of the breast. In breast cancer patients, the fact that a sentinel node can be localized and the suggestion that the sentinel node is representative of the axillary nodal status has been confirmed by a number of studies across the world. Most authors writing on this subject, however, end with a caution that the results of randomized trials are needed before this new surgical technique can be accepted as part of routine breast cancer management. The Medical Research Council of the United Kingdom has funded the audit phase of a multicenter, two phase, randomized trial called the Axillary Lymphatic Mapping Against Nodal Axillary Clearance (ALMANAC) trial, which will compare standard axillary management with sentinel node-guided axillary management. The aims and protocol of the trial are discussed in detail here.

Axilla↗
PubMed2005

[Sentinel node biopsy in breast cancer: techniques and indications].

Sentinel node biopsy (SNB) has proved to be a useful and accurate procedure for lymph node staging in breast cancer and melanoma and should be standard of care in the treatment of these tumors. In other malignancies (colon, rectum, stomach, esophagus, head and neck and thyroid, cervix uteri) it is still under investigation. SNB in breast cancer was accepted as a sole and reliable diagnostic method in breast cancer from the panel of distinguished experts at the 8th international conference of primary therapy of early breast cancer 2003 in St. Gallen. Combination of the current techniques with radiocolloids and blue dye, applicated superficially (intradermal, subdermal, peri- and subareolar) and deeply (peritumoral, intratumoral, subtumoral) enables high identification rates and negative predictive values. It should be performed by teams consisting of surgeons, pathologists and nuclear medicine specialists with appropriate training and experience. Accepted indications are uni- and multifocal tumors smaller than 3 cm without suspicious findings in the axilla, furthermore SNB is indicated in patients with large ductal carcinoma in situ (>2cm) and/or with assumed microinvasion. Albeit SNB could be shown to be safe after preoperative chemotherapy and in multicentric breast cancer, due to lack of sufficient data it is still under discussion in these cases. Expedience of this procedure in other lymph node basins, along the mammaria interna vessels or in the infra- and supraclavicular region is considered to be at an investigative stage as well. SNB allows the pathologist to focus on a small number of nodes most likely to contain metastases. Application of serial sectioning and immunhistochemistry results in a more accurate staging than routine examination. Detection of additional micrometastases that are found in 10-15% leads to an upgrading from N0 to N1. Broad application and refurbishment led to scientific discussion of prognostic importance of micrometastases and its relevance according axillary dissection and adjuvant systemic treatment. Although many unicentric and multicentric observational studies validated by complete axillary dissection could demonstrate that SNB is accurate and suitable for all operable clinically node-negative breast cancers, longterm results and especially the incidence of axillary recurrence and its sequelae are outstanding. Findings of ongoing large prospective randomized trials like NSABP 32, Z0010 and Z0011 of the American College of Surgeons (ACOSOG), the AMAROS-Trial of the European Organisation of Research and Treatment of Cancer (EORTC) and the ALMANAC-Trial of the British Association of Surgical Oncology (BASO) will give a conclusive answer. Significant improvement in morbidity and quality of life measurements could be revealed several times in unicentric and even in muticentric studies like ALMANAC. Sentinel node biopsy is a team approach, requirements are good cooperation and well-defined stuctures of quality indicators and documentation. Participation in national clinical studies is recommended.

Breast Neoplasms↗
PubMed2004

European studies on breast lymphatic mapping.

Sentinel lymph node (SLN) biopsy is rapidly emerging as a minimally invasive alternative to standard axillary dissection for nodal staging in breast cancer. So far only data from case-control trials are available documenting SLN biopsy to be highly predictive of axillary node status, with a false-negative rate of less than 5%. The procedure has the potential to identify those patients most likely to be helped by axillary dissection (ie, those with positive nodes) and to spare node-negative patients, who cannot benefit, from the morbidity of an operation. No data exist from randomized trials focusing on the oncologic safety of the SLN biopsy alone or the expected reduced postoperative morbidity. Therefore, results from randomized trials validating SLN biopsy in breast cancer are required before accepting the procedure as the standard of care. This review discusses the European multicenter randomized trials addressing the pros and cons of SLN dissection, either as a surrogate for conventional axillary dissection or to examine aspects of the procedure itself. The trials identified are the ALMANAC trial (Axillary Lymphatic Mapping Against Nodal Axillary Clearance); the AMAROS-EORTC trial (After Mapping of the Axilla: Radiotherapy or Surgery); the KiSS study (German Clinical Interdisciplinary Sentinel Study); the Milan trial (European Institute of Oncology); the Fransenod study (French Randomised Sentinel Node Study); and the IBCSG 23-01 trial (International Breast Cancer Study Group Trial 23-01).

Breast Neoplasms↗
PubMed1995

Promoting good health in the age of reform: the medical publications of Henry H. Porter of Philadelphia, 1829-32.

In the early 1830s, the Philadelphia publisher Henry H. Porter rapidly published five journals, six books, and an almanac, works having a particular emphasis on health and personal hygiene. Porter's health publications linked the traditional message about the importance of personal hygiene to health to the messages conveyed by the flourishing American reform movements at the time, and his Journal of Health was among the first American medically oriented periodicals published for the layperson. Yet Porter did not survive in the intensely competitive and financially unstable book trade. This study examines Porter's health publications, attempting to explain why he chose to publish what he did, the message(s) his works contained, the audience(s) he tried to reach, and the failure of his business.

Book Industry↗
PubMed1986

The metro rating game: what can be learned from the recent migrants?

The authors examine nine indicators of quality of life in the 277 U.S. Standard Metropolitan Statistical Areas (SMSAs) in terms of their impact on the decision to migrate. The factors considered were utilized in the 1985 publication "Places Rated Almanac" and include climate, housing, health care, crime, transportation, education, recreation, arts, and economics. "The purpose of this paper is both to analyze several alternative methods by which the nine 'Places Rated' indicators have been combined in previous studies, and to estimate a new system of weights for combining such indicators from a multivariate model of metropolitan out-migration." In this article, the authors examine out-migration of metropolitan households during the years 1975-1980. "Coefficient estimates from a multivariate model of out-migration form the basis for a ranking of metropolitan areas in the third section. Also included are comparisons among this and other studies of both the implicit weights employed against the 'Places Rated' scores...to derive both overall measures of urban life quality, and how such quality varies by city size."

Americas↗