The Role of redo-Sentinel Lymph Node Biopsy in Patients With Prior Ipsilateral Breast Cancer Surgery.

Background: Sentinel Lymph Node Biopsy (SLNB) is used to stage the axilla, but there is limited data in patients with prior ipsilateral breast cancer. This study compares redo-SLNB (reSLNB) and Axillary node sample (ANS) in this sub-cohort of patients.

Materials And Methods: This is a retrospective study looking at patients with a new ipsilateral primary or recurrence with history of breast-conserving surgery.

Detectability of small objects in PET/computed tomography phantom images with Bayesian penalised likelihood reconstruction.

Objectives: This study investigated the subcentimetre lesion detection gains of a Bayesian penalised likelihood reconstruction (BPLR) (Q.Clear, GE Healthcare, Milwaukee, USA) in PET/computed tomography (CT) phantom images and compares observer performance with ordered subset expectation maximisation (OSEM) reconstruction images (VUE Point HD, GE Healthcare).

Methods: Images were presented to three blinded experienced observers to identify lesions and assign confidence ratings.

Oximetry-supported self-management for chronic obstructive pulmonary disease: mixed method feasibility pilot project.

Background: Pulse oximetry could potentially contribute to self-monitoring. NHS Lothian's 'Light Touch' service provided COPD patients with a self-management plan based on symptoms and oximetry. The service was overseen (though not actively monitored) by respiratory-trained community teams who were contactable by a telephone helpline.

Pilot randomised controlled trial of Help4Mood, an embodied virtual agent-based system to support treatment of depression.

Introduction: Help4Mood is an interactive system with an embodied virtual agent (avatar) to assist in self-monitoring of patients receiving treatment for depression. Help4Mood supports self-report and biometric monitoring and includes elements of cognitive behavioural therapy. We aimed to evaluate system use and acceptability, to explore likely recruitment and retention rates in a clinical trial and to obtain an estimate of potential treatment response with a view to conducting a future randomised controlled trial (RCT).

Successful intravenous immunoglobulin treatment of atypical lichen myxedematosus associated with hypothyroidism and central nervous system involvement: case report and discussion of the literature.

Background: Lichen myxedematosus (LM) is a rare idiopathic disorder characterized by papules, plaques, and/or nodules in the skin secondary to mucin deposition and variable dermal fibrosis in the absence of thyroid disease. Case reports are the predominant literature on LM due to its rarity, and the data are limited regarding the disease. No standard treatment regimen exists, and the response to treatment varies.

Effect of low dose exposure to the herbicide atrazine and its metabolite on cytochrome P450 aromatase and steroidogenic factor-1 mRNA levels in the brain of premetamorphic bullfrog tadpoles (Rana catesbeiana).

The transcriptional regulator steroidogenic factor 1 (SF-1) and the enzyme cytochrome P450 aromatase (CYP19) play a central role in modulation of a broad range of tissue-specific developmental processes associated with hormone homeostasis that includes differentiation of the central nervous system. SF-1 and CYP19 expression may be targeted by a variety of endocrine disruptive agents prevalent within the environment. In the present study, we cloned and characterized partial sequences for bullfrog (Rana catesbeiana) SF-1 and CYP19 and examined the effects of a 48h exposure to 1 and 100μg/l of the herbicide atrazine (ATZ) and its major metabolite desethylatrazine (DEA), as well as 5ng/l of the estrogenic chemical, 17α-ethynylestradiol (EE(2)), and 673ng/l of the thyroid hormone, 3,5,3'-triiodothyronine (T(3)), on SF-1 and CYP19 mRNA abundance in the brains of premetamorphic bullfrog tadpoles.

Inhibition of oral midazolam clearance by boosting doses of ritonavir, and by 4,4-dimethyl-benziso-(2H)-selenazine (ALT-2074), an experimental catalytic mimic of glutathione oxidase.

What Is Already Known About This Subject: * The viral protease inhibitor ritonavir is known to inhibit clearance of intravenous midazolam. * ALT-2074, a catalytic mimic of glutathione oxidase, inhibits human cytochrome P450 3A (CYP3A) isoforms in vitro.

What This Study Adds: * Short-term administration of low-dose ritonavir increases area under the plasma concentration curve following oral midazolam by a factor of 28.

TELEMAM: a cluster randomised trial to assess the use of telemedicine in multi-disciplinary breast cancer decision making.

Aim: The TELEMAM trial aimed to assess the clinical effectiveness and costs of telemedicine in conducting breast cancer multi-disciplinary meetings (MDTs).

Methods: Over 12 months 473 MDT patient discussions in two district general hospitals (DGHs) were cluster randomised (2:1) to the intervention of telemedicine linkage to breast specialists in a cancer centre or to the control group of 'in-person' meetings. Primary endpoints were clinical effectiveness and costs.

Attitudes of breast cancer professionals to conventional and telemedicine-delivered multidisciplinary breast meetings.

We surveyed the attitudes of breast cancer professionals to standard face-to-face and future telemedicine-delivered breast multidisciplinary team (MDT) meetings. Interviews, which included the Group Behaviour Inventory, were conducted face-to-face (n = 19) or by telephone (n = 26). The mean total score on the Group Behaviour Inventory was 96 (SD 19) for 33 respondents, which indicated satisfaction with standard MDT meetings, irrespective of role and base hospital.

Mycobacterium avium genes associated with the ability to form a biofilm.

Mycobacterium avium is widely distributed in the environment, and it is chiefly found in water and soil. M. avium, as well as Mycobacterium smegmatis, has been recognized to produce a biofilm or biofilm-like structure.

Effect of helmet wear on the incidence of head/face and cervical spine injuries in young skiers and snowboarders.

Purpose: To evaluate whether helmets increase the incidence and/or severity of cervical spine injury; decrease the incidence of head injury; and/or increase the incidence of collisions (as a reflection of adverse effects on peripheral vision and/or auditory acuity) among young skiers and snowboarders.

Methods: During one ski season (1998-99) at a world class ski resort, all young skiers and snowboarders (<13 years of age) presenting with head, face, or neck injury to the one central medical facility at the base of the mountain were identified. On presentation to the clinic, subjects or their parents completed a questionnaire reviewing their use of helmets and circumstances surrounding the injury event.

Teaching pediatric procedures: the Vancouver model for instructing Seldinger's technique of central venous access via the femoral vein.

The way in which physicians are trained to do invasive practical procedures is an ongoing challenge for educators. Percutaneous insertion of a central line via the femoral vein using the Seldinger technique is an important practical pediatric procedure, and the need for physicians to be educated in the necessary skills is recognized in current training initiatives such as Pediatric Advanced Life Support (PALS) and Advanced Pediatric Life Support. Unfortunately, the majority of instruction in central venous access techniques is theoretic.

A comparison of intubation success for paediatric transport team paramedics using lighted vs regular tracheal tube stylets.

We conducted a prospective randomized study of success rate and time to intubation using Trachlight and Surch-Lite lighted stylets versus a regular tracheal tube stylet, in a training setting. Participants, 18 paediatric transport paramedics, performed two intubations with each of the three devices, using an airway management trainer. There was no significant difference in mean time for intubation between the three devices.

Evaluation of the 3-drug combination, Rifater, versus 4-drug therapy in the ambulatory treatment of tuberculosis in Cape Town.

The subjective impression among clinicians that the use of Rifater was causing delayed sputum conversion and increased drug resistance was tested in a prospective study. Adults in the Cape Town municipal area with a first episode of pulmonary tuberculosis were treated either with Rifater or a regimen consisting of isoniazid, rifampicin, pyrazinamide and ethambutol. All patients who took the treatment as prescribed (67 Rifater, 39 the 4-drug regimen) converted to a negative sputum culture by the time 90 doses had been taken.

Safety profile of benazepril in essential hypertension.

Data from clinical trials with benazepril suggest that the safety profile of benazepril is similar to that of other angiotensin-converting enzyme (ACE) inhibitors. Treatment-related side effects occurred in 20% of benazepril-treated patients and in 18% of patients receiving placebo. The most commonly reported side effects with benazepril were headache, dizziness, and fatigue.

The stress response to induced hypotension for cerebral aneurysm surgery: a comparison of two hypotensive techniques.

Plasma epinephrine (PE), plasma norepinephrine (PNE), plasma renin activity (PRA), mean arterial pressure (MAP) and heart rate (HR) were measured before, during and after induced hypotension in two groups of patients undergoing cerebral aneurysm surgery. In Group I isoflurane was used to maintain anaesthesia and induce hypotension. Mean PE fell significantly during hypotension and remained reduced after hypotension, mean PNE remained unchanged, while mean PRA rose slightly but not significantly during hypotension, falling again after hypotension.

Fatality due to massive overdose of sodium valproate.

A 40-year-old woman admitted after a massive overdose of sodium valproate was found to have a serum valproate level of 18,900 mumol/1 which is the highest ever reported. She underwent cardio-respiratory failure, bone marrow suppression and neurological depression, subsequently dying. On post-mortem there was haemorrhagic pancreatitis but no histological evidence of hepatotoxicity.

Effect of thromboxane synthetase inhibition on vulnerability to ventricular arrhythmia following coronary occlusion.

Release of thromboxane (TXA2) during acute myocardial infarction may be an important contributing factor in the genesis of ventricular fibrillation (VF). We assessed the effect of selective TXA2 inhibition on vulnerability to VF after total occlusion of the anterior descending coronary artery in chloralose-anesthetized cats. Animals were pretreated with vehicle or with CGS-13080, a TXA2 synthetase inhibitor, 3.

Profound reduction in morphine clearance and liver blood flow in shock.

In six patients with septic shock apparent liver blood flow was significantly reduced compared with two patients restudied on recovery from shock and a group of four matched unshocked patients undergoing intensive care (287 +/- 23 ml/min vs 870 +/- 164 ml/min; mean +/- SEM). In the shocked patients the elimination half-life of morphine was significantly prolonged (13.2 +/- 3.

High-dose intravenous IgG in the management of pregnancy in women with idiopathic thrombocytopenic purpura.

Idiopathic thrombocytopenic purpura (ITP) may develop during pregnancy or affect later pregnancies, causing serious risks of bleeding to the mother and fetus. High-dose intravenous immunoglobulin (IGIV) has caused an immediate and predictable rise in platelet count during the infusion in both adults and children with chronic or acute ITP. The rapid rise in platelet counts may be important in preparing pregnant women with ITP for surgery or delivery.