Improved immediate breast reconstruction as a result of oncoplastic multidisciplinary meeting.

Introduction: The National Institute for Health and Clinical Excellence guidelines recommend that breast reconstruction should be available to all women undergoing mastectomy and discussed at the initial surgical consultation (2002, and updated 2009). The National Mastectomy and Breast Reconstruction Audit (2009) showed that 21% of mastectomy patients underwent immediate breast reconstruction (IBR) and 11% had delayed breast reconstruction (DBR). Breast reconstruction has been shown to have a positive effect on quality of life postmastectomy.

Pregnancy-associated plasma protein A regulates mitosis and is epigenetically silenced in breast cancer.

Aberrant mitosis is a common feature of cancer, yet little is known about the altered genes causing mitotic defects. We screened human tumours for cells with morphological signatures of highly specific mitotic defects previously assigned to candidate genes in a genome-wide RNA interference screen carried out in HeLa cells (www.mitocheck.

The development of endocrine therapy for women with breast cancer.

The development of endocrine therapies has transformed the treatment of patients with breast cancer. The shift from ablative surgery and aggressive chemotherapies to more targeted, better tolerated therapy has improved both mortality and quality of life for patients with hormone-responsive disease. During the 1970s, the selective oestrogen-receptor modulator, tamoxifen, emerged as a new treatment for women with advanced breast cancer.

Long-term benefits of 5 years of tamoxifen: 10-year follow-up of a large randomized trial in women at least 50 years of age with early breast cancer.

Purpose: The Cancer Research UK "Over 50s" trial compared 5 and 2 years of tamoxifen in women with early breast cancer. Results are reported after median follow-up of 10 years.

Patients And Methods: Between 1987 and 1997, 3,449 patients age 50 to 81 years with operable breast cancer who had been taking 20 mg of tamoxifen for 2 years were randomly assigned to either stop or continue for an additional 3 years, if they were alive and recurrence free.

Targeting DNA replication before it starts: Cdc7 as a therapeutic target in p53-mutant breast cancers.

Treatment options for triple-receptor negative (ER-/PR-/Her2-) and Her2-overexpressing (ER-/PR-/Her2+) breast cancers with acquired or de novo resistance are limited, and metastatic disease remains incurable. Targeting of growth signaling networks is often constrained by pathway redundancy or growth-independent cancer cell cycles. The cell-cycle protein Cdc7 regulates S phase by promoting DNA replication.

Have the organisms that cause breast abscess changed with time?--Implications for appropriate antibiotic usage in primary and secondary care.

Many patients with breast abscess are managed in primary care. Knowledge of current trends in the bacteriology is valuable in informing antibiotic choices. This study reviews bacterial cultures of a large series of breast abscesses to determine whether there has been a change in the causative organisms during the era of increasing methicillin-resistant Staphylococcus aureus (MRSA).

Primitive Neuroectodermal Tumour (PNET) in subcutaneous abdominal wall: a case report.

Primitive neuroectodermal tumour (PNET) is a rare tumour mainly found in children under ten years old. It may be broadly categorised into those occurring from the central or peripheral nervous system of which the majority arise centrally. We report a 61 year-old lady who had previous lobular breast cancer presenting with a rapidly expanding lesion in her anterior right upper abdominal wall.

Long-term effectiveness of adjuvant goserelin in premenopausal women with early breast cancer.

Background: Systematic reviews have found that luteinizing hormone-releasing hormone (LHRH) agonists are effective in treating premenopausal women with early breast cancer.

Methods: We conducted long-term follow-up (median 12 years) of 2706 women in the Zoladex In Premenopausal Patients (ZIPP), which evaluated the LHRH agonist goserelin (3.6 mg injection every 4 weeks) and tamoxifen (20 or 40 mg daily), given for 2 years.

Effect of aspirin and warfarin on early survival after intracerebral haemorrhage.

Background: To determine whether taking aspirin or warfarin at the time of an intracerebral haemorrhage (ICH) has an independent effect on early survival.

Methods: All people with ICH presenting in Christchurch, New Zealand over a three-year period were identified. Independent predictors of mortality at 7, 14 and 28 days were calculated using binary logistic regression.

Older patients with hip fractures: evaluation of a long-term specialist orthopaedic medicine service in their outcomes.

Aims: To evaluate the long-term outcomes of a specialist orthopaedic medicine service in older patients up to 12 months after hip fracture.

Methods: All patients over the age of 65 years admitted with hip fracture under the shared care of geriatricians and orthopaedic surgeons over a 6-month period were identified in an initial audit. A follow-up postal questionnaire was sent to those patients asking about their place of domicile, level of functioning, compliance with osteoporosis treatment, and whether they had sustained further fractures in the 12 months following discharge from hospital.

Radiotherapy waiting times for women with breast cancer: a population-based cohort study.

Background: Waiting times for cancer patients are a national priority in the UK. Previous studies have shown variation between cancer networks in the time between diagnosis and start of radiotherapy for all cancer patients. Studies of the relationship between delay in receiving treatment and survival of breast cancer patients have been inconsistent.

Promise of multiphoton detection in discovery and diagnostic proteomics.

Proteomics has lacked adequate methods for handling the complexity (hundreds of thousands of different proteins) and range of protein concentrations (> or =10(6)) of eukaryotic proteomes. New multiphoton-detection methods for ultrasensitive detection of proteins produce 10,000-fold gains in sensitivity and allow highly quantitative, linear detection of 50 zmol (30,000 molecules) to 500 fmol of proteins in complex samples. The potential of multiphoton detection in top-down proteomics analyses is illustrated with applications in monitoring proteomes in very small numbers of cells, in identifying and monitoring complex functional isoforms of cancer-related proteins, and in super-sensitive immunoassays of serum proteins for high-performance detection of cancer.

Targeted intraoperative radiotherapy (TARGIT) yields very low recurrence rates when given as a boost.

Purpose: Patients undergoing breast-conserving surgery were offered boost radiotherapy with targeted intraoperative radiotherapy (TARGIT) using the Intrabeam system to test the feasibility, safety, and efficacy of the new approach.

Methods And Materials: We treated 302 cancers in 301 unselected patients. This was not a low-risk group.

Breast cancer: multidisciplinary care and clinical outcomes.

A multidisciplinary approach to the management of breast cancer is the standard of care in developed health systems. We performed a systematic review to assess the extent and quality of evidence on whether multidisciplinary care (MDC), or related aspects of care contribute to clinical outcomes in breast cancer, and in particular whether these influence survival. Only two primary studies have looked at MDC and neither of these studies considered long-term outcomes.

Looking for Thom's biomarkers with proteomics.

In recent years, large numbers of putative disease biomarkers have been identified. Combinations of protein biomarkers have been proposed to overcome the lack of single, magic-bullet identifiers of disease conditions. The number of biomarkers in a panel must be kept small to avoid the combinatorial explosion that requires very large, uneconomical sample cohorts for validation.

High-sensitivity blood-based detection of breast cancer by multi photon detection diagnostic proteomics.

We have developed several new methods for blood-based cancer detection by diagnostic proteomics. Ultrasensitive methods of immunoassay using multiphoton-detection (IA/MPD) increase sensitivity by 200- to 1,000-fold (1 femtogram/mL). This has allowed the measurement of cancer biomarkers with very low concentrations in blood that could not be measured for full patient cohorts with conventional immunoassays.

Using the COPE assessment tool with informal carers of people with dementia in New Zealand.

Aims: To evaluate the validity of the COPE index (CI) carer assessment tool within a study exploring perceptions of carer support, health, and wellbeing. To assess the utility and acceptability of the CI with health practitioners and informal carers of people with dementia, following the European COPE protocol.

Methods: Research interviews (one pre- and two post-CI assessment) recorded demographic characteristics of carer (n = 45) and care recipient, formal (service) and informal support use and satisfaction, self-reported health, the General Health Questionnaire (GHQ-30), Burden Interview, Caregiver Competence, and Personal Gain.

Ultra-sensitive immunoassays using multi-photon-detection in diagnostic proteomics of blood.

Multiphoton-detection methods that detect as little as 1000 atoms of (125)I-streptavidin increase the sensitivity of immunoassays by 200- to 1000-fold (1 femtogram/mL). Improved background suppression allows 20- to 100-fold improvements in sensitivity for conventional immunoassays (10-50 femtogram/mL). Quantitation of low abundance biomarkers in blood (PSA, TNFalpha, VEGF, IL-1beta, IL-6, and IL-8), for the first time for complete patient cohorts, indicates that very high analytical sensitivity and new statistical methods are crucial for serum-based diagnostic proteomics.

Older patients in the nephrology clinic--should they be referred?

Aim: To review the outcomes of elderly patients referred to a nephrology clinic and to develop referral guidelines.

Methods: A retrospective audit of patients aged 65 years or older referred over a 24-month period to a nephrology clinic. Outcomes assessed were whether a renal diagnosis was made and if there was any change in management.

Shared care between geriatricians and orthopaedic surgeons as a model of care for older patients with hip fractures.

Aims: To evaluate the effect of shared care between geriatricians and orthopaedic surgeons as a model of care for older patients with hip fractures.

Methods: All patients over the age of 65 years are under the shared care of an orthopaedic surgeon and geriatrician (the Ortho-Medicine Service) when they are admitted to the Orthopaedic Service, Christchurch Hospital, New Zealand. This retrospective case records audit includes all patients over the age of 65 years with hip fracture admitted to this service over a 6-month period from December 2002 to June 2003.