Patient demographics and treatment for early breast cancer: an observational study.

This study aims to examine relationships between demographic factors and treatment choice for early breast cancer (T2/N<1). Two hundred and two patients were offered modified radical mastectomy (MRM), breast conserving therapy (BCT) or MRM and reconstruction and interviewed at a University Hospital and oncology centre in South Wales. Median age at treatment was 57 (32-90) years. Seventy-one patients (35%) choose MRM, 10 (5%) MRM and reconstruction and 121 (60%) BCT. Median age of women choosing MRM was 61 and 55 for BC (P<0.0001). Single women (P=0.009) and those with no family history of breast cancer (P=0.02) were more likely to choose MRM. There was no difference between treatment choice and method of cancer detection and the age at which the patient left education (P=0.065). Mean histological tumour diameter was smaller for women choosing BC (15 mm) than for women choosing mastectomy (17 mm; P=0.014). There was no association between tumour grade and treatment choice.

Attempts to infect T lymphocyte-deficient mice with Babesia species of cattle.

Nu/nu, nu/+, splenectomised nu/nu and Lasat mice were inoculated with freshly collected bovine blood infected with Babesia divergens and B major. There was no evidence that either parasite became established in mice but B divergens persisted in mice up to 10 days whereas B major lasted only one day. B divergens infection generally persisted longer in splenectomised mice but absence of thymus made no apparent difference to persistence of infection. B divergens underwent morphological changes in mice to vacuolated and ring forms.

Is general practitioner access to breast imaging safe?

AIM: The aim of this study was to assess the consultant radiologist run open-access breast radiology service (OAR) to investigate whether the system was safe or whether cancers were being missed. METHODS: A retrospective review of the national cancer registry database to identify patients presenting with symptomatic breast cancer in the catchment area of the Royal Glamorgan Hospital (RGH) from April 2000 to April 2002 was performed. Pathology, radiology and outpatient records were reviewed to identify patients previously assessed at the RGH. RESULTS: Fifty-four patients with breast cancer were diagnosed via the OAR and 159 by the breast clinic (BC). Twelve patients with breast cancer were diagnosed after their initial presentation. Eight patients had been previously seen for benign breast lesions. Four patients had missed breast cancers (two were initially seen via the BC and two via the OAR). A significant difference in the number of cancers missed by the two referral routes was not observed (p = 0.221). CONCLUSION: OAR is as accurate a means of diagnosing breast cancer as traditional rapid access BCs. Women presenting with discrete lumps with no radiological abnormality should still undergo assessment with clinical fine core-biopsy.

Two-view mammography at the incident round has improved the rate of screen-detected breast cancer in Wales.

AIM: To investigate whether pre-invasive and invasive cancer detection rates were improved in Wales after the introduction of two views at incident screens. METHODS: The records of women attending follow-up screening for 2 years before and 2 years after the introduction of two-view incident screening were analysed. Cancer detection rates were compared before and after introduction of two view screening. RESULTS: At the incident round 98,752 women had one and 95,464 had two views. Five hundred and fifty-five cancers were detected with one view and 744 with two, an increased detection rate from 5.6 to 7.8 cancers per 1000 women screened (p=0.01). Two hundred and thirty-nine small cancers were detected with one view and 323 with two, increasing the detection rate from 2.4 to 3.4 per 1000 women screened (p=0.05). CONCLUSIONS: Two-view mammography at incident rounds detects more cancers and more favourable prognosis small cancers than single-view mammograms.

Quality of clinical case note entries: how good are we at achieving set standards?

INTRODUCTION: High quality entries in case notes are becoming increasingly important. Standards exist on what information entries should contain. We have compared case notes from surgical teams at the Royal Glamorgan Hospital with standards based on guidelines from The Royal College of Surgeons of England. PATIENTS AND METHODS: A total of 120 case notes, randomly selected from the department of general surgery, were reviewed. RESULTS: An 80% compliance was achieved in 25/35 standards and 100% was achieved in 6 (patient's name, date, surgeon's name and type of operation on the operation sheet and consent form signed and dated). The following fell short of 80% compliance: PAS number on every page (75%); entries timed (27%); and clinician's name (16%) and designation (27%) printed. Social history was only recorded in 73% of clerkings and family history in 33%. Results of laboratory tests were signed in 65% of notes and radiological tests were signed in 41%. CONCLUSIONS: Healthcare professionals need to be aware of, and comply with, standards. House officers should be given information about standards at departmental induction or during medical training.

Studies of the structure and binding properties of hamster female protein.

We report here the characterization of hamster female protein (FP), a member of the pentraxin family of plasma proteins, as a molecule composed of glycosylated subunits of 25,655 MW containing a single intrachain disulphide bridge. In the presence of EDTA the subunits are non-covalently associated as pentamers of mass approximately 128,000 MW, and in the presence of calcium they aggregate further, probably to form decamers. This pentamer-decamer transition at physiological ionic strength has not been described in other pentraxins. As previously reported, FP shares the capacity of C-reactive protein (CRP) in other species to bind phosphocholine and we show here that it also resembles human CRP in binding only weakly to agarose, to human AA amyloid fibrils in vitro, and to mouse AA amyloid deposits in vivo. It thus differs markedly from human and mouse serum amyloid P component (SAP) but it is nevertheless deposited in hamster AA amyloid in vivo and clearly is the hamster counterpart of SAP in other species. These results illustrate the subtle diversity among members of the otherwise conserved pentraxin family of vertebrate plasma proteins.