Pre-operative lymphoscintigraphy before sentinel lymph node biopsy for breast cancer.

Pre-operative lymphoscintigram for axillary sentinel lymph node biopsy (SLNB) may not be required for successful SLNB. The 117 consecutive patients who underwent SLNB had pre-operative lymphoscintigraphy. The operating surgeon was blinded to the results of the lymphoscintigram before SLNB. After SLNB was complete, the surgeon was unblinded to the results of the lymphoscintigram; re-exploration carried out if more nodes were predicted on the lymphoscintigram. 116 patients (99%) had successful SLNB before unblinding. In 85 patients (73%), operative findings corresponded with scintigraphic findings. In 26 patients (22%), the lymphoscintigram predicted more sentinel nodes than had been found; further nodes were identified and excised in only 4 patients (3%). None were positive for cancer. SLNB was successful in 99% of cases without pre-operative lymphoscintigraphy. Only 3% of patients had further nodes identified as a result of the lymphoscintigram. Pre-operative lymphoscintigraphy does not improve the ability to perform axillary SLNB during breast cancer surgery.

Timing of breast cancer surgery in relation to menstrual cycle phase: no effect on 3-year prognosis: the ITS Study.

The effect of breast cancer surgery timing during the menstrual cycle on prognosis remains controversial. We conducted a multicentre prospective study to establish whether timing of interventions influences prognosis. We report 3-year overall and disease-free survival (OS/DFS) results for 'primary analysis' patients (regular cycles, no oral contraceptives within previous 6 months). Data were collected regarding timing of interventions in relation to patients' last menstrual period (LMP) and first menstrual period after surgery (FMP). Hormone profiles were also measured. Cox's proportional hazards model incorporated LMP in continuous form. Exploratory analyses used menstrual cycle categorisations of Senie, Badwe and Hrushesky. Hormone profiles with LMP and FMP data were also used to define menstrual cycle phase. Four hundred and twelve 'primary analysis' patients were recruited. Three-year OS from first surgery was 90.7, 95% confidence interval (CI) [87.9, 93.6%]. Menstrual cycle according to LMP was not statistically significant (OS: hazard ratio (HR)=1.02, 95%CI [0.995,1.042], P=0.14; DFS: HR=1.00, 95%CI [0.980,1.022], P=0.92). Timing of surgery in relation to menstrual cycle phase had no significant impact on 3-year survival. This may be due to 97% of patients receiving some form of adjuvant therapy. Survival curves to 10 years indicate results may remain true for longer-term survival.

Follow up of patients with colorectal polyps: are the BSG guidelines being adhered to?

OBJECTIVE: The publication of the BSG guidelines in 2002 provided a framework for the follow up of patients with colorectal polyps. The aim of the present study was to determine whether they had, or were being correctly adhered to in a moderately sized District General Hospital. METHOD: A total of 598 patients were on the waiting list for colonoscopy at Airedale General Hospital (AGH) in February 2005. Of these, 203 were being followed up as a result of the previous finding of a polyp. RESULTS: Only 14.8% of patients had been or were being followed up according to the BSG guidelines. The majority of the 85.2% of patients who did not comply with follow up did so as a result of over investigation. Seventy-eight per cent of the low-risk group and 55% of the intermediate-risk group had been colonoscoped, or were waiting to have colonoscopy, too soon or too frequently according to the BSG guidelines. Twenty-four patients with hyperplastic polyps were being followed up incorrectly, as were 17 patients discovered to have a polyp pathology on flexible sigmoidoscopy. It was established that 131 extra colonoscopies had been, or were planned to be performed unnecessarily. CONCLUSION: These data have major implications with regard to patient safety, service provision and cost to the NHS.

Hepatic artery aneurysm: an unusual cause for gastrointestinal haemorrhage.

Aneurysms of the hepatic artery are rare. The presenting features include abdominal pain, which may be associated with a mass. More acutely, patients present with signs of hypovolaemia secondary to rupture. The patient reported here presented with gastrointestinal haemorrhage of unknown aetiology. A computed tomography scan showed an aneurysm of a visceral artery. Subsequent angiography confirmed the presence of a leak in the hepatic artery. The patient refused surgical intervention and improved with supportive treatment only.

In Situ Studies of the Interaction of Dislocations with Point Defects during Annealing of Ion Implanted Si/SiGe/Si (001) Heterostructures.

: Strained layer heterostructures provide ideal systems with which to study the dynamics of dislocation motion via in situ transmission electron microscopy, as the geometry, strain state, and kinetics can be characterized and directly controlled. We discuss how these structures are used to study dislocation-point defect interactions, emphasizing the experimental requirements necessary for quantification of dislocation motion. Following ion implantation, different concentrations and types of point defects are introduced within the SiGe epilayer depending on the implantation species, energy, and current density. By annealing samples in situ in the transmission electron microscope (TEM) following implantation, we can directly observe dislocation motion and quantify the effect of dislocation-point defect interactions on dislocation velocities. We find that dislocation motion is impeded if the implantation dose peak lies within the epilayer, as dislocations pin at point defect atmospheres. Shallow BF2 implantation into the sample capping layer results in more complicated behavior. For low current density implants, dislocation velocities may be dramatically increased; at higher current densities the magnitude of this increase is significantly smaller. Implantation of different ions separately implicates fluorine as the species responsible for the observed increases in dislocation velocities, presumably due to an electrical effect on the rate of dislocation kink nucleation.

Clinical economics review: the health-care economic implications of minimal access gastrointestinal surgery.

This article reviews some of the health-care economic data that have been acquired in recent assessments of minimal access surgery of the digestive tract, with particular reference to laparoscopic cholecystectomy and laparoscopic surgery for gastro-oesophageal reflux disease.