What is achieved by mammographic surveillance after breast conservation treatment for breast cancer?

BACKGROUND: After breast conservation surgery for breast cancer, patients are followed up by regular clinical examination and mammography, at intervals which vary according to local practice. However, the optimum interval remains unclear with current guidelines suggesting mammography should be carried out every 1 to 2 years. This study has investigated this aspect and, in particular, whether mammography or clinical examination or both allowed an early detection of recurrence of the disease in the conserved breast. METHODS: A total of 695 patients who had undergone breast conservation surgery were identified from a database of prospectively recorded data during the period 1990 to 1995. Clinical examination and annual mammography were performed in accordance with local protocol. The results of clinical examination, mammography, and local recurrence rates were evaluated. RESULTS: A total of 2,181 mammograms were undertaken in the 695 patients studied. Local recurrence of disease in the conserved breast occurred in 21 patients (3%), at a mean follow-up of 3.5 years. The first identification of tumor recurrence was by clinical examination in 11 patients with local recurrence, and by the surveillance mammography in the other 10 patients with local recurrence. Overall, mammography detected the local recurrence in 13 of 20 (65%) patients who underwent this examination. In the other patients, the recurrence was detected on clinical examination only. In addition, in 52 patients, mammography was falsely positive, giving a false positive rate of 2.3%. Contralateral cancers in the opposite breast were detected in 2 patients. CONCLUSIONS: The detection of local disease after breast conservation surgery requires both clinical examination and mammography. In the context of our follow-up policy, in 52% of patients with local recurrence, this was first identified by clinical examination. Disease recurrence was identified in the other 48% of patients by mammographic surveillance. Overall, mammography will identify or confirm local recurrence in two thirds of women. However, in a small number of cases (2.3% in our series) mammography will give false positive results. New imaging modalities to assist in the diagnosis of local recurrence of disease after breast conservation surgery are required.

The transfer of skill from short tennis to lawn tennis.

The purpose of this study was to establish if short tennis skills transferred to lawn tennis. The experiment was conducted in two parts. In the first experiment 16 children (average age 8.9 years) were coached for 20 h (2 h/day for 2 weeks). The experimental group (n = 8) received 10 h of short tennis coaching followed by 10h of tennis coaching. The control group (n = 8) received tennis coaching only. In the second experiment 14 children (average age 8.5 years) were coached for 8h in group strokes alone (only ground strokes were tested and analysed). The experimental group (n = 7) received 4h of short tennis coaching and 4h of tennis coaching; the control group (n = 7) received tennis coaching only. Prior to coaching, all children were tested on the Dyer Backboard Test. The tests were video-taped for later analysis of technique. The video was analysed by three coaches in terms of backswing, positioning (position where player stood in reference to the bounce of the ball), follow-through, and placement (accuracy with which the ball was hit). The experimental group improved more than the control group on the Dyer Backboard Test (p < 0.05) in Experiment 1. In Experiment 2 both groups improved (p < 0.05) with coaching; there was no difference (p > 0.05) between the two groups following coaching. This implied that the short tennis skills positively transferred to tennis.(ABSTRACT TRUNCATED AT 250 WORDS)

Sources of variation in back and leg dynamometry.

Three investigations were carried out to examine the concurrent validity and the reliability of a portable dynamometer (Takei Kiki Kogyo) for the measurement of back and leg strength. First, leg extension strength of 19 subjects was measured using the Takei dynamometer and compared to the isometric knee extension strength of the dominant (right) leg measured using a computer-controlled dynamometer (Lido Active, Davis, CA). The back extension strength of 18 subjects was also compared between the two dynamometers. Second, back and leg strengths of 36 subjects, aged 19-30 years, were measured twice using the Takei dynamometer. Six days separated the test and retest. Third, back and leg strengths of four subjects, aged 21-30 years, were measured at six different times of the solar day. Significant relations (p < 0.001) were obtained between the Takei and Lido dynamometers for leg strength (r = 0.90) and back strength (r = 0.79). Significant test-retest correlations (p < 0.001) were found for leg strength (r = 0.80) and back strength (r = 0.91). Group mean (+/- SD) leg strength values of test (1450.4 +/- 428.6 N) and retest (1432.8 +/- 449.1 N) did not differ ((p > 0.05). A small (4.5%) but significant difference was found between the test (1057.2 +/- 309.9 N) and retest (1106.2 +/- 334.4 N) mean values for back strength (p < 0.05). A time of day effect was evident for back and leg strength (p < 0.05); on average the peak times occurred at 16:53 h and 18:20 h, respectively.(ABSTRACT TRUNCATED AT 250 WORDS)

Analysis of the work rates and heart rates of association football referees.

This study aimed to describe the work-rate profiles of referees during soccer matches and record heart-rate responses during these games. Using video-recordings 14 referees were observed and their heart rates during the games were monitored by short-range radio telemetry. These included 11 football league matches. The exercise intensity was largely submaximal with a change in activity every 6 s. The mean distance covered during the game was 9.44 km; a significant fall in work rate was noted in the second half (P < 0.05). The mean heart rate of 165 beats min-1 did not vary between first and second halves. The work rate and heart rate varied more between individuals than with the importance of the match, but this variation was small. It was considered that refereeing top level soccer places high physiological demands on the official. This has implications for training and fitness assessment.

A comparison of circadian rhythms in work performance between physically active and inactive subjects.

This study compared circadian rhythms in physiological, subjective, and performance measures between groups exhibiting different levels of habitual physical activity. Fourteen male subjects, aged 19-29 years, were assigned to a physically active (group I, n = 7) or a physically inactive (group II, n = 7) group on the basis of leisure-time physical activity. Rectal temperature, oral temperature, resting pulse rate, subjective arousal and sleepiness were measured at 02:00, 06:00, 10:00, 14:00, 18:00 and 22:00 in a counter-balanced sequence for each subject. Whole-body flexibility, back and leg strength, grip strength (right and left), flight time in a vertical jump, PWC150, and self-chosen work-rate were also recorded at each time point. At least 8h separated each test session. Subjects avoided exercise 48h prior to, and during the experiment. Data were subjected to the group cosinor method. Group I evidenced 1.5-2.5 times greater rhythm amplitudes than Group II for oral temperature, subjective arousal, sleepiness, flexibility, left and right grip strength, submaximal heart rate, and self-chosen work-rate (p < 0.05). Oral temperature and arousal for Group I were lower than Group II only at 06:00. Early morning troughs in most of the performance measures were significantly greater for Group I (p < 0.05). The groups did not differ with respect to phasing of the rhythms (p < 0.05). These results confirm with physical performance measures that rhythm amplitudes are higher for physically fit subjects. This could be attributed to greater early-morning troughs in the measures for active individuals. Since the subjects were sedentary immediately prior to testing, it is plausible that these findings are training effects of physical activity.