Diagnosis and management of chyle leak following axillary dissection.

Chyle leak following oncological breast and axillary surgery is a rare complication with small number of reported cases in the literature and little formal guidance regarding management. We present a review of the current literature and further related guidance from other specialties, along with suggested strategies for identification, diagnosis and management of this uncommon but potentially significant complication.

Pleomorphic LCIS what do we know? A UK multicenter audit of pleomorphic lobular carcinoma in situ.

Aims: Pleomorphic lobular carcinoma in situ (PLCIS) is a relatively newly described pathological lesion that is distinguished from classical LCIS by its large pleomorphic nuclei. The lesion is uncommon and its appropriate management has been debated. The aim of this study is to review data from a large series of PLCIS to examine its natural history in order to guide management plans.

Phenotype-driven molecular autopsy for sudden cardiac death.

A phenotype-driven approach to molecular autopsy based in a multidisciplinary team comprising clinical and laboratory genetics, forensic medicine and cardiology is described. Over a 13 year period, molecular autopsy was undertaken in 96 sudden cardiac death cases. A total of 46 cases aged 1-40 years had normal hearts and suspected arrhythmic death.

Breast cancer risk and imprinting methylation in blood.

Background: Altered DNA methylation of imprinted genes has been implicated in a range of cancers. Imprinting is established early in development, and some are maintained throughout the life course in multiple tissues, providing a plausible mechanism linking known early life factors to cancer risk. This study investigated methylation status of seven imprinted differentially methylated regions-PLAGL1/ZAC1, H19-ICR1, IGF2-DMR2, KvDMR-ICR2, RB1, SNRPN-DMR1 and PEG3-in blood samples from 189 women with the most common type of invasive breast cancer (invasive ductal carcinoma-IDC), 41 women with in situ breast cancer (ductal carcinoma in situ-DCIS) and 363 matched disease-free controls.

Comparison of two methods of eliciting time preference for future health states.

Mean estimates of time preference rates for health vary widely in the literature. If these studies are to inform discounting practice and analyses of health-affecting behaviour, it is crucial to understand why this is the case. One reason for the variation in time preference rates is the use of different elicitation methods.

Docetaxel as adjuvant and neoadjuvant treatment for patients with breast cancer.

Developments in the role of adjuvant and neoadjuvant chemotherapy for the treatment of patients with breast cancer have focused on the taxes, in particular, docetaxel. This paper discusses the rationale for the introduction of docetaxel into the management of patients following surgery and also its role in those patients with locally-advanced disease, focussing on key clinical trials. The addition of docetaxel to standard adjuvant chemotherapeutic regimens does seem to result in an increased survival in some patients with early-stage disease.

Measuring quality of life and utilities in esophageal cancer.

For many years indicators such as mortality rates, levels of morbidity and cure measured the success of treatments for esophageal cancer. However, it is now recognised that quality of life (QOL) is an important measure of outcome. This is especially so for esophageal cancer, where the therapeutic options include curative treatments or palliative care.

Symptom-based outcome measures for asthma: the use of discrete choice methods to assess patient preferences.

This paper reports on an application of discrete choice modelling to the measurement of patient preferences over asthma symptoms. A sample of patients with moderate to severe asthma was asked to choose between a series of pairs of scenarios characterised by different combinations of asthma symptoms. Their responses were analysed using a random effects ordered probit model.

Using conjoint analysis to elicit the views of health service users: an application to the patient health card.

OBJECTIVE: To demonstrate the application of conjoint analysis (CA) for eliciting the views of health service users. METHODS: A CA study was conducted alongside a randomized controlled trial evaluating the introduction of a patient health card (PHC). The PHC was evaluated with respect to three other aspects of general practice: number of days between making a non-urgent appointment and seeing a doctor; waiting time in reception between the time of the appointment and seeing a doctor; and whether the patient is usually seen by the doctor of their choice.

The efficient organization of blood donation: what determines the number of donors and donations?

This study investigates the influence of socio-economic characteristics on the number of donors in geographical areas in the North of Scotland as well as the influence of panel-specific characteristics on the number of donations obtained from each panel in the North of Scotland. Econometric models are applied to establish the relationship between these variables. The main findings were that there was no scope for identifying new areas in which to locate new panels or extend the activities of existing panels because the number of donors in an area was closely correlated with population.

The persistence and clonal spread of a single strain of Acinetobacter 13TU in a large Scottish teaching hospital.

This study describes the persistence and spread of a single strain of Acinetobacter 13TU in a large Scottish teaching hospital. Acinetobacter spp. are reported with increasing frequency as a cause of nosocomial infection.

The management of cancer in the elderly.

The treatment of elderly patients with cancer requires a multidisciplinary approach if optimal locoregional control of disease and survival are to be achieved. Wherever possible, the surgical, radiotherapeutic and chemotherapeutic regimens given to elderly patients with cancer should be comparable with those currently used for the treatment of younger patients with cancer. However, the morbidity (physical and psychological) of therapy must be evaluated against the likely benefits to ensure that elderly patients with cancer receive both optimal management and quality of life.

The management of cancer of the breast in the elderly.

Breast cancer in older women continues to be a clinical problem and therapeutic challenge. The clinical presentation, biological characteristics and survival rates are comparable between older and younger women with breast cancer. Treatment of breast cancer in older women should aim to ensure satisfactory control of locoregional disease and prolongation of survival, for as long a period as possible.

NM23 gene product expression does not predict lymph node metastases or survival in young patients with colorectal cancer.

NM23 gene product is a putative metastases suppressor gene which has structural homology to a nucleoside diphosphate kinase. Previous studies examining the relationship between NM23 gene product expression and survival in patients with colorectal cancer have revealed conflicting results. However, no study has focused on young patients with colorectal cancer.

Proliferation in the normal cervix and in preinvasive cervical lesions.

Aims: To characterise further the proliferative compartment of the normal cervix and to document its alteration, if any, in the various grades of cervical intraepithelial neoplasia (CIN), particularly changes to the basal epithelial layer; to hypothesise as to the diagnostic and biological significance of any observed differences.

Method: Proliferative compartments from 86 cervical biopsy specimens (10 normal, 11 with koilocytic change only, 12 CIN I, nine CIN II, and 44 CIN III) were determined using microwave antigen retrieval and a standard three-step Streptavidin biotin peroxidase immunocytochemical technique incorporating the MIB-1 monoclonal antibody (directed against the Ki-67 antigen). Immunoreactivity was assessed as occupying either the lower one third, lower two thirds or all three thirds of the squamous epithelium.

The 1990 GP contract--meeting needs?

This paper reviews the empirical evidence about the effects of the 1990 general practitioner (GP) contract on the provision of medical services in the United Kingdom. A brief outline of the major changes instigated by the 1990 GP contract is given. Studies of the implementation of the changes tend to focus on either trend analysis, cost-effectiveness or medical practice variation.

Evaluating the benefits of antenatal screening: an alternative approach.

This paper presents an alternative method of valuing the benefits of antenatal screening programmes based on individual preferences. The methods of benefit measurement used to date, namely averted costs, QALYs, and willingness to pay, are critically reviewed. The alternative method assumes that screening can be regarded as an investment in improved information, and that the benefits of screening can be measured by the value placed upon this information.

Antigenic heterogeneity of strains of Saccharomyces cerevisiae and Candida albicans recognised by serum antibodies from patients with Crohn's disease.

The antigenic heterogeneity of twelve strains of Saccharomyces cerevisiae and serovar A and B strains of Candida albicans was investigated by cross-absorption of serum antibodies from a patient with Crohn's disease. On the basis of common antibody absorption patterns, eleven of the yeast strains were divided into Group 1 (five S. cerevisiae), Group 2 (two C.

Heat-induced disturbances of intracellular movement and the consistency of the aqueous cytoplasm in HeLa S-3 cells: a laser-Doppler and proton NMR study.

Intracellular particle movements, of both saltatory and streaming types, in HeLa S-3 cells were simultaneously interrupted after 1 h exposure of cells to 43 degrees C, within 10 min at 44 degrees C and within 5 min at 45 degrees C. Intracellular movement inhibited after 15 min at 44 degrees C and 10 min at 45 degrees C was not reversible in cells rescued at 37 degrees C. Brownian motion was not observed in heat-treated cells while they were maintained at elevated temperatures, but became pronounced in blebbing which occurred shortly after they were returned to 37 degrees C.

Dissemination of research findings: who wants what?

There is growing concern to ensure that the results of health services research reach, and are understood by, those who plan and provide health services. Because of the complexity and variability of services, it is often difficult to translate findings from one setting to another. This paper discusses an attempt to disseminate the findings of one study, Patterns and Pathways of Care of Old People, by visiting local health services on request.

Induction agents for day-case anaesthesia. A double-blind comparison of propofol and midazolam antagonised by flumazenil.

Early postoperative recovery was studied using sedation scoring, measurement of flicker fusion frequency and completion of Trieger test figures in 60 male patients who presented for vasectomy under general anaesthesia as day patients. Anaesthesia was induced in groups 1 and 2 (20 patients each) with mean (SD) doses of 0.16 (0.