bluuebunny/crossref_metadata_2025 huggingface dataset:
Taxonomic features of the red alga Meristotheca coacta (Solieriaceae, Gigartinales)
Authors: Faye Etienne Jean , Kogame Kazuhiro , Shimada Satoshi , Kawaguchi Shigeo , Masuda Michio
Published: April 2007

Vegetative and reproductive structures of the little‐known red alga, Meristotheca coacta Okamura (Solieriaceae, Gigartinales) were described on the basis of specimens collected from three localities in southern Japan, including an island close to the lectotype locality. Meristotheca coacta was shown to be a strongly supported monophyletic clade in our rbcL analyses. The taxonomic features of this species were reassessed. This species is characterized as follows: (i) the thalli consist of relatively thick (300–1400 μm from the uppermost to basal regions), elastic and rose‐red blades; (ii) the blades are irregularly lobed and branched into variously shaped segments with undulate and crispate margins; (iii) tetrasporangial initials are laterally attached to their parental cells and the lateral pit‐connections remain in mature tetrasporangia; (iv) gametophytes are dioecious; (v) carpogonial branches are three‐celled (occasionally two‐ or four‐celled); (vi) a darkly staining auxiliary cell complex is present and recognizable prior to diploidization; and (vii) cystocarps are produced along (or near) the margins of the blades and on the marginal proliferations and lack spinous outgrowths.
BS01 LOCALLY ADVANCED BREAST CANCER: NEED FOR A CO‐ORDINATED, MULTIDISCIPLINARY APPROACH
Authors: Chan A.
Published: April 2007

Historically, patients presenting with large, inoperable cancers were treated with radiation therapy alone or radiation therapy followed by surgical resection. The use of systemic therapy in patients with locally advanced breast cancer (LABC) has led to improved disease outcome when compared with surgery or radiotherapy alone. In comparison with operable breast cancer, there is a relative paucity of randomised trials evaluating systemic therapy for LABC. Of the randomised trials published, a statistically significant survival benefit is only demonstrated in a few. The difficulties in performing large randomised trials in LABC relate to several issues. The classification of LABC which includes T3, T4, and N2 disease incorporates a heterogeneous group of patients. There is a variable approach taken by clinicians in terms of the type of pre‐operative chemotherapy used, sequencing of locoregional therapy and whether post‐operative adjuvant systemic therapy is also given. To date, the efficacy of systemic therapy in LABC has largely been established from results of non‐randomised Phase II studies. These studies compare favourably to historical data with higher 5‐ and 10‐year disease‐free and overall survival. A common finding in several trials of pre‐operative systemic treatment is that the rates of breast conserving surgery is increased and those patient achieving a complete pathological response have superior disease outcomes than those who do not.

An overview of trials supporting the current management of LABC will be presented. The objectives and preliminary findings of a multicentre study initiated in Perth for women with LABC will also be discussed.
BS11 THE ROLE OF PRE‐OPERATIVE MRI IN PATIENTS WITH INVASIVE LOBULAR CARCINOMA OF BREAST
Authors: Edirimanne S. , Mckenzie K. , Wells S. , Dijkstra B.
Published: April 2007

Background  Conventional breast imaging with mammography and ultrasonography have a tendency to underestimate the extent of invasive lobular carcinoma (ILC) of the breast. The aim of the study is to determine the role of routine pre‐operative breast MRI in treatment of patients with ILC of breast.

Methods  33 patients with ILC and 6 patients with pleomorphic lobular cancer (PLC) of the breast had pre‐operative contrast enhanced MRI of the breasts. Suspicious additional foci were evaluated with focussed ultrasound and biopsy, selectively in ipsilateral breast and routinely in contralateral breast. The histological results of additional foci were correlated with MRI findings to determine the accuracy.

Results  In 1 patient (3%) index tumour was detected only by MRI. In ipsilateral breast, additional foci were found in 16 patients (41%) that led to more extensive surgery in 13 patients (33%) with a false positive rate of 15%. In the contralateral breast MRI detected suspicious foci in 7 patients (18%) and malignancy was confirmed by biopsy in 1 patient (false positive rate 86%).

Conclusions  In patients with ILC or PLC routine pre‐operative MRI alters management of ipsilateral breast significantly with a high accuracy. Due to high false positive rate contralateral breast surgery should not be undertaken based on MRI finding only without biopsy confirmation.
BS12 PREDICTIVE MARKERS FOR BREAST CANCER NEOADJUVANT CHEMOTHERAPY
Authors: Syed S. , Rogers P. A. W. , Ganju V. , Hart S. , Susil B. , Cann L.
Published: April 2007

Purpose  Although neoadjuvant chemotherapy (NACT) is routinely used in the management of breast cancer, there is no definitive way of predicting which patients are more likely to respond to a particular therapy. The aim of this study was to identify markers that can be used to predict tumor response to chemotherapy in breast cancer.

Methodology  We used immunohistochemistry to evaluate blood microvessel density (MVD) (CD31), tumor cell proliferation (Ki‐67), anti‐apoptotic marker (Bcl‐2), ER and PR expression, and HER‐2/neu expression in core biopsy samples (taken before chemotherapy) from patients with locally advanced breast cancer (n = 20), receiving neo‐adjuvant chemotherapy {anthracycline‐based regimen (FEC100) (n = 10) vs single agent taxane regimen (docetaxel) (n = 10), and correlated these factors with tumor response (as assessed clinically and by tumor imaging) after 4 cycles of treatment.

Results  Tumors expressing low levels of Bcl‐2 showed significantly greater reduction in size to both taxane (P < 0.05) and anthracycline‐based (P < 0.01) regimens, compared to tumors expressing high levels of Bcl‐2. Further, HER‐2/neu positive tumors showed significantly greater reduction in size to taxane regimen (P < 0.05), while estrogen receptor (ER) negative tumors showed a trend of greater reduction in size to anthracycline‐based regimen (P = 0.06).

Conclusions  Bcl‐2 and HER‐2/neu expression may be useful markers to predict response to neoadjuvant chemotherapy in breast cancer. While subject numbers are still too low to draw firm conclusions, the current data indicates that HER‐2/neu may specifically predict a positive tumor response to taxane regimen, and high Bcl‐2 is a marker of chemoresistance.
BS13 THE EFFECT OF ANTIBIOTIC TREATMENT OF INFLAMMATORY BREAST DISEASE ASSOCIATED WITH THE ISOLATION OF LIPOPHILIC CORYNEBACTERIA
Authors: Skinner A. M. , Holland D. J. , Taylor G. B. , Ellis‐Pegler R. , Jones W. O. , Paviour S. D.
Published: April 2007

Granulomatous mastitis is a rare benign condition effecting women of reproductive age and is most commonly treated surgically. It is an inflammatory disease of the breast associated with the isolation of intracellular lipophilic corynebacteria and has a course of chronicity with recurrences.

Purpose   Our aim was to observe the clinical response and subsequent course of women diagnosed with granulomatous mastitis and treated by a long course of lipophilic antibiotics. We also recorded the concurrent requirement for surgical intervention.

Methodology   The clinical course of seventeen women with inflammatory breast disease and microbiologic and histologic evidence of infection with Corynebacterium kroppenstedtii were prospectively followed. 11 received treatment with doxycycline (or clindamycin if breast feeding), 5 women received alternative antibiotics, and one patient received no antibiotics.

Results   Among the 11 who received doxycycline, full resolution without surgery of disease was achieved in 9 women while another woman showed improvement at follow up, further surgical management was required by 2. All the five women who received alternative antibiotics also had surgery. They each had full resolution of disease at follow up. Further admissions were required by one woman.

Conclusion   Optimal treatment for granulomatous mastitis is yet to be determined. We found promising results with a small group of young women who were treated with the lipophilic antibiotic doxycycline alone. These had resolution of disease without requiring surgical intervention.
BS15P FACILITATING NATIONAL CONSISTENCY IN BREAST CANCER DATA COLLECTION
Authors: Roder D. , Kollias J. , Gillett D. , Pyke C. , Care O. , Zorbas H.
Published: April 2007

In Australia there is currently no consistent approach to collecting breast cancer specific data. The National Health Data Dictionary (NHDD) recommends a core set of generic data items for clinical cancer registration. However this list does not include the more detailed items required by specific tumour streams. The NBCC has developed a supplementary set of Breast Specific Data Items and definitions to serve as a guide for specialist breast cancer data collection in Australia.

A multidisciplinary Working Group comprising clinical and consumer representation, including three breast surgeons, identified 16 breast specific data items for collection. The items are designed to align with items collected through the RACS National Breast Cancer Audit and leading cancer centres. A range of items from patient data (menopausal status), diagnostic data (HER2 status, sentinel lymph node), treatment (surgical margin clearance and involvement), and breast reconstruction are included.

The data items are recommended as best practice for breast cancer specific data collection and aim to facilitate national consistency in defining, recording, and monitoring information about patients with breast cancer. This national approach will contribute to improved patient outcomes by informing planning, quality improvement and evaluation strategies for cancer services. The items are currently being piloted in two sites in NSW and will be available nationally in late 2007.
BS17P UTILISATION OF CYTOLOGICAL AND HISTOLOGICAL DIAGNOSIS IN THE MANAGEMENT OF BREAST CANCER BY NEW ZEALAND SURGEONS
Authors: Scarlett A. , Dijkstra B. , Mercer P.
Published: April 2007

The purpose of the study was to determine the practice of breast surgeons working in New Zealand with regard to utilisation of fine needle aspiration and core biopsy in the diagnosis of breast cancer. Surveys were distributed to surgeons in New Zealand involved in breast cancer surgery. Two cases examples were given and their subsequent management questioned. There were 68 respondents (87% response rate).

For a palpable breast abnormality which is clinically, radiologically and cytologically (C5) consistent with breast cancer but without pre‐operative histology: 81.5% of respondents would be comfortable to proceed with wide excision 46.2% mastectomy 44.6% with axillary clearance.

For a non‐palpable breast abnormality which is radiologically and cytologically (C5) consistent with breast cancer but without pre‐operative histology: 66.2% of respondents would be comfortable to proceed with wide excision 27.7% mastectomy 26.1% with axillary clearance.

This survey shows a wide variation in New Zealand in the management of breast cancer with respect to the use of cytology and/or histology to establish diagnosis. There was no statistically significant difference between those who were members of Aotearoa Breast Screening New Zealand, number of years as a surgeon or number of years working in New Zealand.

The concern is that patients with non‐invasive disease will undergo an axillary clearance or procedure unnecessarily. Axillary clearance/procedure is not recommended for non‐invasive malignancy. FNA cannot distinguish between non‐invasive and invasive malignancy as can a core biopsy.
BS18 DCIS AND TREATMENT
Authors: Bundred N. J.
Published: April 2007

Ductal carcinoma in situ now represents 30% of all screen detected breast cancers. Breast conserving surgery for ductal carcinoma in situ is now established although the extent of margin clearance necessary to prevent recurrence after breast conserving surgery remains controversial. None of the previous trials which compared radiotherapy with breast conserving surgery alone have achieved clear margin status in all patients and analysis of their data suggests that the recurrence rate when clear margins around the ductal carcinoma in situ are achieved is low (approximately 10% at six years). Data from randomised trials indicates that a margin of greater than 1 mm clearance is sufficient to minimise recurrence in the breast. Several centres have published that clear margins are essential in the management of ductal carcinoma in situ whether radiotherapy is used or not.

Tamoxifen has been studied after wide local excision and radiotherapy in the NSABP24 trial and in the UK DCIS trial. In the former trial a 40% reduction in recurrence in the breast using tamoxifen was seen but the majority of this effect was in women under 50 years of age and only a marginal effect was seen in older patients. In the UK DCIS trial a 20% non‐significant reduction in recurrence was seen in women who were not given radiotherapy. Studies show that younger women (less than 50 years of age) have a significantly higher risk of recurrence after ductal carcinoma in situ treatment and tamoxifen is therefore recommended in women under 50 years of age who are undergoing wide local excision for ductal carcinoma in situ. Oestrogen receptor status was retrospectively assessed in the NSABP B24 trial and ER positive DCIS had a 60% reduction in recurrence whilst ER negative DCIS had no benefit. The BASO DCIS II trial assesses the benefit of adding radiotherapy in ER positive DCIS treated with 5 years Tamoxifen on local recurrence. Aromatase inhibitors are more effective in the presence of CerbB2 oncogene, which is frequently expressed in ductal carcinoma in situ and studies comparing aromatase inhibition with Tamoxifen in ductal carcinoma in situ are already underway (IBIS II). These studies should take account of oestrogen receptor status in the ductal carcinoma in situ to allow us to more adequately define the role of oestrogen receptor status in predicting response to therapy in patients with ductal carcinoma in situ.
BS19 BRCA 1 & BRCA2 GENE TESTING FOR BREAST AND OVARIAN CANCER IN AUSTRALIA AND NEW ZEALAND – THE GTG EXPERIENCE
Authors: Firgaira F.
Published: April 2007

Over the past three years, Genetic Technologies Ltd (GTG) has been providing a fee for service (commercial) BRCA 1 & 2 genetic pathology testing service. Full gene screening isperformed within 8 weeks and fast tracking of testing for clinical management purposes cab be performed in 2–4 weeks.

We present a schema for testing that utilizes robotics, LIMS, automated DNA sequencing, computer aided analysis and ISO15189 / NATA / RCPA accredited test protocols.

Despite the active testing that has been carried out of the BRCA1 & 2 genes worldwide over the past decade, it is interesting to note that significant numbers of new (not previously reported) BRCA mutational events and gene variants have been identified in our testing service – the GTG experience.
BS21 SCREENING FOR BREAST CANCER – THE UK APPROACH
Authors: Bundred N. J.
Published: April 2007

In the United Kingdom the Forest Report in 1985 recommended the setting up of breast screening with women aged 50–64 years screened every 3 years by single view mammography. Since 2000 the screening process has been increased to women aged 50–70 years and the screening every 3 years is now with two view mammography, producing a 40% expansion in workload.

Screening for breast cancer was funded centrally with allocation to each region and regional and national quality assurance centres were set up for both surgery, pathology and radiology. The programme is dependant on a high compliance rate with a low recall rate and a high cancer detection rate. It is carried out by a combination of mobile vans and static site for screening. Around 5% of women are recalled to the assessment clinics and 16% of these will have cancer (CF symptomatic practice where 6% have cancer).

Survival rates in screening programmes of those patients who attend is 90.2% at 10 years whereas for non‐attendees it is 52% survival from diagnosed breast cancer. The cancer detection rate per 1,000 women has gone up regularly from inception such that last year it was 8 cancers detected per 1,000 women screened, with a total of 14,040 cancers detected in the screening programme in the UK.

The development of breast screening centres led to the development of breast specialisation in pathology surgery and radiology across the UK and has had a major impact in the multidisciplinary management of breast cancer and the improvement in overall survival.
BS24 APOPTOSIS: WHY SURGEONS NEED TO UNDERSTAND IT
Authors: Bundred N. J.
Published: April 2007

Apoptosis (programmed cell death) is a mechanism which enables regulation of cell number in tissues and elimination of unneeded, ageing or damaged cells. Imbalances between epithelial proliferation and apoptosis contributes tumour genesis and tumour progression. Apoptosis is morphologically characterised by nuclear condensation and cytoplasmic shrinkage. The process of proliferation and apoptosis within tumours is closely linked with higher proliferative accounts being associated with higher apoptotic rates. Initial therapeutic advances involved agents that block proliferation but evidence is mounting that it is blocks to apoptosis which need to be overcome to enhance treatments for breast cancer. A newer group of novel biological agents such as the HER2 inhibitors trigger apoptosis to achieve responses.

Apoptosis occurs via two predominant pathways, which act via a Caspase effector mechanism. An extrinsic pathway activated by ligands to the TRAIL, FAS/TNF family of cell membrane bound death receptors which recruits intracellular adaptor proteins including pro‐Caspases to induce apoptosis in the cells. Recent studies suggest Caspase 8 alterations influence breast cancer development via the extrinsic pathway.

The intrinsic pathway starts from the mitochondria and can be activated by a large number of signals including irradiation, DNA damage and alteration of the ratio of BCL2, BAX family members. This leads to release of Cytochrome C and activation of Caspase 9 leading to apoptosis. Apoptosis and activation of Caspase 9 can be prevented by the Inhibitor of Apoptosis Protein (IAP) family. Breast cancers often express mutated p53 which makes them resistant to apoptosis induced by alkylating agent chemotherapy. Pro‐apoptotic agents will potentially improve the effectiveness of chemotherapy. Breast cancer expresses the BCL2 family proteins which are induced by oestrogen and thus anti‐oestrogens such as Tamoxifen and Fulvestrant can induce apoptosis by increasing BAX expression and decreasing BCL2 activity.

Newer agents such as Herceptin, Lapatinib (dual molecular HER1/HER2 inhibitor) and the RAS farnesylation transferase inhibitors induce apoptosis by activating the pro‐apoptotic protein BAD another member of the BCL2 family. Combinations of drugs which induce apoptosis can potentially be used to cause tumour regression. For instance, a one per cent increase in apoptosis is likely to have the same effect as a 50% reduction in cell proliferation on tumour growth. Current targets for drug discovery includes targets against endogenous antagonists of Caspase activation and IAP antagonists. Therapies for inducing apoptosis will be discussed.
BS25 BREAST RECONSTRUCTION WITH TRANSVERSE RECTUS ABDOMINUS MYOCUTANEOUS FLAP
Authors: Codner M. A. , Weinfeld A. B.
Published: April 2007

Introduction  In the absence of contraindications, autologous tissue reconstruction is an attractive method of breast reconstruction. The TRAM flap has become the cornerstone of autologous tissue only breast reconstruction. In most women, there is sufficient abdominal adipose tissue and skin for bilateral breast reconstruction without the need for prosthetic devices. This flap can be employed for both immediate and delayed reconstruction. It provides soft pliable tissue for post‐mastectomy reconstruction and in general has fewer radiation therapy associated complications than implant based methods of breast reconstruction.

Methods  Pedicled TRAM flaps are employed for breast reconstruction. Each hemi‐TRAM is based on a single pedicle. In cases of immediate breast reconstruction the flap is raised at the same time the mastectomy is being performed. In cases of DM, tobacco history, or moderate obesity, a vascular delay is performed by ligating the DIEP vessels 2 weeks prior to elevating the flap and a bipedicle flap is used to maximize blood supply. The rectus sheath fascia is repaired primarily, and the abdominal wall is reinforced with onlay marlex mesh. The TRAM flap is inset and shaped to form a youthful but mildly ptotic breast. Drains are used in both the donor site and recipient site. Long term catheter delivery of local anesthetic is employed at the donor site.

Results  Over the past years 10 years, 78 TRAM breast reconstructions have been performed with satisfactory to excellent results. 90% were performed for immediate reconstruction and 10% for delayed reconstructions 10% underwent surgical vascular delay of the flap for the indications discussed above and in order to avoid a free flap. There were 2 cases of total flap loss. The percentage of fat necrosis was 15%. Other complications included mastectomy skin loss (8%), hematoma/seroma (5%), and infection (5%). Revision surgery to improve the aesthetic outcome was performed in (20%). NAC reconstruction using the purse‐string method was performed in 95% of the patients.

Conclusions  TRAM flap breast reconstruction is a very favorable method for assisting in the overall care of a patient with breast cancer. Satisfaction is very high and major complications are acceptable. The disadvantages include longer operative time and prolonged recovery compared to tissue expander reconstruction. I feel the advantages of autologous tissue reconstruction outweigh these riskes in addition to the risks of complications associated with tissue expander, implant reconstruction. A staged approach to TRAM flap reconstruction should be considered for patients who may require postoperative radiation for local control in order to avoid the deleterious effects of radiation on the TRAM flap.
BS03 PATTERNS AND PROGNOSIS OF BREAST CANCER RECURRENCE
Authors: Gillett D. J. , Elder E. , Gluch L. , Carmalt H. C.
Published: April 2007

The data base of The Strathfield Breast Centre (TSBC) was reviewed to determine the patterns of recurrence and their prognosis after the treatment of breast cancer.

The TSBC has a prospective data base from 1989 forward with information on 2509 patients up to 2002. The follow‐up on these patients is 81%. This data was interrogated.

Breast conservation was performed in 1390 (55.4%) and of these 84.7% had adjuvant radiotherapy and 62.7% had adjuvant systemic treatment. Rates of recurrence were related to grade and stage of the tumour.

Local regional or distant relapse occurred in 456 (18%). The site of first cancer recurrence was local 27.2%, bone 27.4%, lung 16% liver 12.5% and supraclavicular fossa 5.5%.

At the end of the study 527 patients had died, 323 were cancer related deaths, the majority of the recurrences occurred in the first three years (58%) and 79% occurred within 5 years.

Local recurrence in the breast occurred in 4.6% of patients and in the chest wall in 5.2%. The 5 yr disease free survival of these patients was 49.4% and 33.1% respectively.

Distant metastases occurred to bone, lung and liver in the majority of cases in which it happened. The 5 yr survival for these patients was16%, 12% and 0%.

The recurrence data from the TSBC is comparable to that reported elsewhere. The majority of recurrences occurr in the first 5 yrs, The prognosis after relapse varies with site.Local in the b reast being better than in the chest wall and bone being better than visceral.
BS06 PATIENT‐RATED OUTCOME MEASURES WERE MORE SENSITIVE THAN CLINICIAN‐RATED MEASURES AT DISTINGUISHING THE EFFECTS OF SENTINEL NODE BIOPSY AND AXILLARY CLEARANCE IN THE SNAC TRIAL
Authors: Smith M. J. , Gill P. G. , Wetzig N. , Sourjina T. , Simes R. J. , Stockler M. R.
Published: April 2007

Purpose  We sought to determine which outcome measures were most sensitive at detecting the benefits of Sentinel node based management (SNBM) over routine axillary clearance (RAC) in the SNAC trial.

Patients and Methods  1088 women with early breast cancer were randomised to either SNBM or RAC. The primary endpoint was the percent increase in arm volume based on clinicians’ measurements of arm circumference at 10cm intervals. Secondary endpoints included patients self‐ratings of arm swelling and other aspects of quality of life, assessed using the SNAC Study Specific Scales (SSSS: 15 questions asking about symptoms, dysfunction and disabilities). We report a comparison of the relative sensitivity of these endpoints in detecting differences between the treatment groups.

Results  Patients’ ratings on the SSSS were 3.2 times as sensitive as clinicians’ ratings of arm swelling, requiring 68% fewer patients to detect a given treatment effect. The 7 questions asking patients about symptoms were most sensitive. Questions asking about dysfunctions and disabilities were less sensitive.

Conclusion  Patient‐rated measures were more sensitive in this trial than clinician‐rated measures at distinguishing the effects of SNBM and RAC. Similar trials would require only a third as many patients if the primary endpoint was rated by patients rather than clinicians.
BS07 PATENT BLUE AND SENTINEL NODE BIOPSY – THE NEW ZEALAND EXPERIENCE
Authors: Pochin R. S. B. , Harman R. , Ashrafi A. N.
Published: April 2007

Purpose  Since adopting sentinel node biopsy at North Shore Hospital, we have become increasingly aware of cases of major reactions to patent blue dye within our unit. This study aims to assess the use of sentinel node biopsy in breast cancer patients in NZ and document the complications related to the use of patent blue.

Methodology  Questionnaires were sent to all NZ surgeons registered with the Breast Section of the RACS. Hospitals with no breast section member were individually contacted and questionnaires sent to those surgeons performing breast surgery. Follow‐up phone calls were used to improve completion rate.

Results  Completion rate was 83%. Eighty four percent of surgeons report using sentinel node biopsy.

Indications varied widely including all grades and sizes of DCIS and invasive cancer.

Most surgeons utilized colloid plus lymphoscintigraphy and patent blue dye.

Surgeons’ perceptions of the expected reaction rate to patent blue dye varied from 1 in 200 to 1 in 100 000.

In our study there were 12 minor reactions including rash, urticaria and blistering. There were 11 major reactions including hypotension and anaphylaxis. There was one myocardial infarct and one patient requiring CPR. There were no deaths.

All major reactions reported were in high volume Auckland centres.

Conclusions  There is no consistency amongst NZ surgeons on the indications and technique for sentinel node biopsy.

A notable number of major reactions have occurred with the use of patent blue dye. These findings show the need for comparative studies on technique for sentinel node biopsy. There is also a need for a comprehensive system of adverse reaction reporting and consideration of skin testing.
BS08 SENTINEL NODE BIOPSY IN LARGER OR MULTIFOCAL BREAST CANCERS: TO DO OR NOT TO DO
Authors: Behm E. C. , Buckingham J. M.
Published: April 2007

Background  The use of sentinel node biopsy in breast cancer patients with large and/or multifocal tumours is controversial.

Methods  A review of clinical records was undertaken for 213 consecutive patients undergoing sentinel node biopsy for invasive breast cancer from September 2000 to February 2006. The results of sentinel node biopsy and axillary dissection were compared for patients with unifocal or multifocal tumours less than 3 cm or greater than 3 cm. Patient outcomes were also assessed.

Results  The mean number of sentinel nodes removed per patient increased from 2.33 in 2000 to 4.17 in 2006. For patients with unifocal tumours less than 3 cm, 47/147 (32.0%) were sentinel node positive compared to 15/30 (50%) for multifocal tumours less than 3 cm (p = 0.04), 19/28 (67.9%) for unifocal tumours greater than 3 cm (p < 0.001) and 7/8 (87.5%) for multifocal tumours greater than 3 cm (p = 0.003). Following axillary dissection, 20/48 (41.7%) patients with sentinel node macrometastases were found to have positive non‐sentinel nodes, compared to 4/20 (20.0%) and 1/8 (12.5%) for patients with sentinel node micrometastases and isolated tumour cells. The mean total number of positive nodes was 1.74 compared to 4.21 for unifocal tumours less than or greater than 3 cm respectively (p = 0.005). No axillary recurrences were detected during the follow‐up period.

Conclusions  Although patients with large and/or multifocal tumours were more likely to have a positive sentinel node, the findings suggest that sentinel node biopsy is safe, accurate and reliable for staging the axilla in these patients.
BS09 WHY WOMEN IN TARANAKI CHOOSE MASTECTOMY OVER BREAST CONSERVATION
Authors: Gollop S. J. , Mosquera D. A. , Fancourt M. W. , Gilkison W. T. C. , Kyle S. M.
Published: April 2007

Purpose  Breast conservation treatment (BCT) rate is recognized as a marker of surgical practice. An historically low BCT rate in Taranaki, may reflect the requirement for Taranaki women, to travel for adjuvant radiotherapy. The aim of this study was to determine the reasons Taranaki women with breast cancer choose mastectomy or BCT.

Methodology  Prospective information, on all women presenting with breast cancer between May 2004–Dec 2006, was collected on a standardised questionnaire. After factual advice from their surgeon, patients suitable for both BCT and mastectomy completed a questionnaire on reasons for their treatment preference. Surgeons completed a questionnaire for all patients with breast cancer on BCT/mastectomy suitability.

Results  BCT was offered to 67% (139 of 209), but chosen by only 45% (n = 62) of suitable patients.

If radiotherapy had been available locally 23% (17 of 73) of patients who chose mastectomy, would have instead opted for BCT. Travel distance, time away from family, wait for treatment, exposure to radiation and fear of side effects were other important considerations to this group.

A quarter of each group of women thought they knew their surgeon’s treatment preference and most chose this option.

Fear of local recurrence and need for further surgery were important factors.

Conclusion  The rate of BCT in Taranaki is low, despite being offered by surgeons to the majority of patients. Local availability of radiotherapy and neutral patient guidance may increase the BCT rate to a level more consistent with larger centres in New Zealand.
CT10 MANAGING DEEP STERNAL WOUND INFECTIONS WITH VACUUM ASSISTED CLOSURE
Authors: Chen Y. , Almeida A. A. , Mitnovetski S. , Goldstein J. , Lowe C. , Smith J. A.
Published: April 2007

Purpose  Deep sternal wound infection is a rare but serious complication of cardiac surgery. Currently there is no consensus on the optimal management. Vacuum Assisted Closure (V.A.C.) has been increasingly used to facilitate wound healing. We aim to review the management of deep sternal wound infections using V.A.C. dressing at our hospital.

Methodology  31 consecutive deep sternal wound infections over a five year period were reviewed. V.A.C. dressing was used either as a stand alone therapy or as an intermediate therapy to late sternal reconstruction.

Results  Deep sternal wound infections were diagnosed on average 13 days from initial surgery. 26 (84%) patients were treated with V.A.C. dressing. Of these, 17 (65%) had stand alone V.A.C. therapy and 9 were followed by sternal reconstruction. The average duration of V.A.C dressing in the two groups were 21 and 13 days respectively. 7 patients died, 6 in the stand alone V.A.C. group and 1 in the intermediate V.A.C. group. The length of hospital stay was similar in both groups (41 vs. 45 days). Median follow up was 17 months. No late relapse was found in the stand alone group. In the intermediate therapy group, 2 patients had chronic wound sinuses and one patient had a wound collection.

Conclusion  V.A.C. dressing may be used both as a stand alone and as an intermediate therapy for deep sternal wound infection. Reconstructive surgery may be avoided in a significant proportion of patients. No late relapse has been associated with V.A.C. use.
CT12 SURGICAL MANAGEMENT OF DESCENDING NECROTIZING MEDIASTINITIS
Authors: Kejriwal N. K. , Lin Z. , Parkinson G. , Ullal R. , Singhal P.
Published: April 2007

Descending necrotizing mediastinitis is a form of mediastinitis caused by odontogenic infection or deep cervical infections, which spreads to the mediastinum via the cervical facial planes. Criteria adopted for the diagnosis of Descending Necrotizing mediastinitis are clinical manifestations of severe infection, demonstration of characteristic roentgenographic features, documentation of the necrotizing mediastinal infection and establishment of oropharyngeal or cervical infection with the development of the necrotizing mediastinal process. Most of the published reports in literature are single case report. The largest series published is of 17 patients over 15 years. Despite the increased use of CT scan as a diagnostic aid and the improvement in antibiotics, mortality in patients with descending necrotizing mediastinitis remains high, reported between 25–40% in the literature.

We have treated two patients with descending necrotizing mediastinitis at our institution. The primary oropharyngeal infection was Ludwig’s angina in one and odontogenic abscess in other. Both patients underwent mediastinal drainage, one through midsternotomy and other through right thoracotomy in addition of cervical infection drainage. The outcome was favorable in both the patients.

Delay of diagnosis and inappropriate drainage of the mediastinum are the main cause of mortality in this life threatening condition. The various surgical approaches have been reported for mediastinal drainage to treat Descending necrotizing mediastinitis.

We report our experience of patients with Descending necrotizing mediastinitis and discuss the surgical management of this highly fatal condition.
CT13 PREVENTION OF ATRIAL FIBRILLATION AFTER CABG WITH OMEGA‐3 POLYUNSATURATED FATTY ACIDS
Authors: Cole C. M. W. , Kostner K. M. , Mundy J. , Marwick T. , Peters P.
Published: April 2007

Purpose  Atrial fibrillation (AF) is a common complication of cardiothoracic surgery, occurring in more than 30% of patients undergoing CABG. Postoperative AF results in thromboembolic events, haemodynamic compromise and an increase in length and cost of hospitalisation. Any intervention that reduces the incidence of postoperative AF should result in fewer complications in addition to being of important economic benefit. Increased consumption of oily fish or Omega‐3 Polyunsaturated Fatty Acid (PUFA) supplements substantially lowers the risk of sudden cardiac death and myocardial infarction both in primary and secondary prevention trials, through a reduction in fatal arrhythmias. Omega‐3 PUFAs may also play a role in the treatment of AF as shown by cell culture research, animal models and a recent prospective observation study in 5000 elderly adults. With respect to postoperative AF, a recent Italian randomized controlled study in 160 patients showed that Omega‐3 PUFA administration during hospitalisation in patients undergoing CABG reduced the incidence of postoperative AF by 54% and led to a shorter hospital stay.

Methodology  We have undertaken a randomized, placebo controlled, prospective trial of Omega‐3 PUFAs in patients undergoing CABG to examine its effect on the incidence of AF within 30 days and variations in length of hospital stay. We have also developed a clinically relevant measurement of the concentrations of the PUFA arachidonic acid and the omega‐3 fatty acids eicosapentaenoic acid and docosahexaenoic acid in patients with and without atrial fibrillation.

Results  We are presenting interim results of the first 80 patients enrolled in the trial.
CT16 HYBRID OPEN AND ENDOVASCULAR PROCEDURES FOR COMPLEX AORTIC PATHOLOGY IN THE HIGH‐RISK SURGICAL PATIENT
Authors: Neale M. L. , Hemli J. M. , Jain M. , Brady P. W.
Published: April 2007

Purpose  The management algorithm for the complex aorta in the high‐risk patient continues to evolve, especially given increasing applicability of endovascular solutions to these cases. We present three examples of aortic pathology managed in a staged fashion utilising hybrid open/endovascular techniques, as alternatives to classic aortic procedures.

Methodology  Hybrid open/endovascular procedures were employed in three select cases. All patients underwent an open aortic “debranching” procedure, in which some of the cervical/thoracic/abdominal aortic branches were relocated, to permit subsequent insertion of an endoluminal prosthesis while preserving end‐organ perfusion. The stent‐graft was inserted as a separate procedure.

Results  All patients were males aged over seventy‐five years. Two patients presented with saccular aneurysms of the mid‐distal aortic arch, whereas the third patient had a Crawford type I thoracoabdominal aortic aneurysm associated with chronic dissection. The left common carotid/subclavian arteries were relocated in all three patients, as were the major abdominal visceral vessels in the patient with thoracoabdominal disease. Endoluminal stent‐grafts were placed into the relevant portion of the aorta in all patients. Stent‐graft placement was successful in all cases, with radiologically confirmed exclusion of the relevant aortic pathology. There was no mortality and no significant morbidity.

Conclusion  Patients considered to be at high risk for thoracic/thoracoabdominal open aortic surgery may be suitable for an endovascular management strategy, although an accompanying surgical debranching procedure may be required to facilitate the subsequent appropriate placement of a stent‐graft.
CT18P RADIOFREQUENCY ABLATION OF LUNG TUMOURS: A SYSTEMATIC REVIEW
Authors: Zhu J. C. , Yan T. D. , Black D. , Morris D. L.
Published: April 2007

Purpose  This systematic review aims to assess the safety and efficacy of radiofrequency ablation(RFA) for pulmonary malignancies.

Methodology  Searches for relevant literature on RFA for lung tumours prior to Nov 2006 were performed in six electronic databases. Application of predetermined inclusion and exclusion criteria, quality assessment and data extraction were independently performed for all retrieved studies. Results were synthesized through tabulation and combined with a narrative review.

Results  Sixteen relevant studies on lung RFA with more than 10 patients that reported rates of morbidity, mortality, complete tumour ablation, local recurrence or survival were identified for this review. All included studies were level 4 evidence case series with median follow‐up periods ranging from 9–24 months. The overall post‐procedural morbidity rates ranged from 15–76% and mortality rates ranged from 0–5%. The most common complications were pneumothoraces occurring at 9–61 % of procedures. The rates of complete tumour necrosis achieved by RFA ranged from 38–98% while the rates of local recurrence from previously ablated lesions ranged from 2–38%. The overall median progression free interval ranged from 13 to 26 months. The overall median survival from the time of lung RFA, ranged from 8.6–33 months, with 1, 2 and 3 year survival of 71–85%, 55–65% and 38–46%, respectively.

Conclusion  The available evidence for radiofrequency ablation of primary and metastatic lung tumours is very limited. Surgical resection should remain the standard of care when feasible. Radiofrequency ablation, however, is safe and appears to have a promising role in the treatment of unresectable lung tumours.
CT02 A STUDY TO EVALUATE VARIOUS TECHNIQUES OF CORONARY ARTERY BYPASS GRAFTING
Authors: Singhal P. , Mahon B. D. , Sharma A. , Riordan J. P.
Published: April 2007

Introduction  In Wellington Hospital, CABG is being performed by various techniques like OPCAB, On‐pump cardioplegic arrest, fibrillatory arrest and On‐pump beating heart.

Aim  This study was undertaken to compare morbidity and mortality between On‐ pump CABG and OPCAB on basis of Euroscore.

Material and Method  From January 2003 till December 2004, data were collected according to Australasian society of Cardiothoracic surgery data set. Euroscores were calculated and patients were divided into 3 groups. Results of OPCAB and On‐pump CABG were compared on basis of Euroscore group. In this period we performed 350 On‐pump CABG and 254 OPCAB.

Results  OPCAB group had less number of grafts per patients. Even for triple vessel disease numbers of grafts were lower in OPCAB group. OPCAB group had more patients with total arterial revascularization. There were 10 deaths in On‐pump group and 1 in OPCAB group. In the low and moderate risk group there was no significant difference in hospital stay, ventilation hours and ICU stay. However inotropic requirement and requirements of blood products were less in OPCAB group. There was no statistically significant difference between Incidence of new renal failure or arrhythmia in two groups. 2 patients in each group had blocked graft in immediate postop period and required revascularization. There were only 5 patients in the high‐risk group in OPCAB making intergroup comparisons difficult.

Conclusion  OPCAB does not offer any significant advantage in terms of mortality and morbidity over On‐pump CABG. To evaluate the effects of number of grafts and total arterial revascularization, it needs a long‐term follow‐up.
CT20P ENDOBRONCHIAL PALLIATION USING ND:YAG LASER IS ASSOCIATED WITH IMPROVED SURVIVAL WHEN COMBINED WITH MULTIMODAL ADJUVANT TREATMENTS
Authors: Han C. , Wright G. , Praseyatpo D.
Published: April 2007

Purpose  This study aims to confirm the safety and effectiveness of Nd:YAG laser therapy in the contemporary setting and investigate the effectiveness of multi‐modal therapy compared to laser alone.

Methology  153 Nd:YAG laser treatments on 110 patients between 1999 and 2004 were reviewed retrospectively. Symptom scores for dyspnoea, haemoptysis and cough before and after the procedure were compared. Survival and time to reintervention were analysed using the Kaplan‐Meier method. Multimodality treatment was compared to Nd:YAG laser therapy alone to determine differences in survival and time to reintervention. P values less than 0.05 were considered significant.

Results  There were no operative mortality directly caused by laser intervention, however 30 day mortality was 6.5%. Deaths were due to progression of advanced neoplastic processes rather than laser intervention, 6.5% of patients had some post‐operative morbidity. After Nd:YAG laser intervention, 76% of patients reported improvement to dyspnoea, 94% for haemoptysis and 75% for cough. Median survival after Nd:YAG laser treatment was 6.64 months, 21% requiring repeated laser. Compared to Nd:YAG laser treatment alone, multimodality treatments significantly prolonged median time to reintervention by 1.7 months (p = 0.002) and prolonged median survival by 4.9 months (p < 0.001) in patients with NSCLC.

Conclusion  Nd:YAG laser intervention is safe and effective for palliation of endobronchial malignancies. In most cases it is only required to be performed once. Multimodal treatment prolonged survival compared to Nd:YAG laser therapy alone.
CT26 MANAGING THE HUMAN FACTOR
Authors: Henderson R.
Published: April 2007

Flying a commercial aircraft is sometimes referred to as being 95% sheer boredom and 5% sheer terror. The safety record of modern airliners is dramatic. In 2006 there was one fatal accident for every 2.6 million departures. To put this in perspective: there were 65 departures every 60 seconds during that year; and one fatal accident every 28 days. While progress continues to be made on both the technical and human issues involved with aircraft design and operation, recent accidents, such as Swissair 111, have shown how rapidly a situation can progress from uncertainly to alarm to critical.

In the last 10 years the number of airlines in the world flying western‐built jets has increased by 46% (674 to 990), the number of flights has increased by 49%, the number of fatal accidents (hull losses) has decreased by 36% and the number of ‘near‐misses’ has increased by 85%. These statistics suggest that major gains have been made in the area of human factors training given that the aircraft designs achieved a very high level of reliability some time ago.

Human factors training in aviation is now focused on the management of ‘threats’ and ‘errors’. This presentation will review this training philosophy and consider parallels for the medical environment.
CT28 CREATING THE “ERROR ENVIRONMENT”
Authors: Merry A. F.
Published: April 2007

The Second Global Patient Challenge, ‘Safe Surgery Saves Lives’ initiative of the World Health Organisation (WHO) will promote standardised, evidence‐based approaches to improving patient safety, in part through measures to reduce certain common errors.

From harmless slips (using salt instead of sugar) to disastrous and costly failures (a wrong drug leading to the death of a patient, wrong co‐ordinates in a navigational computer leading to the Erebus airline disaster, or the simultaneous use of empirical and metric systems of measurement in an international collaboration leading to the loss of a Mars probe), error shadows every human endeavour, in part because error is closely linked to creativity and success.

Our team has developed realistic scenarios using a high‐fidelity human‐patient simulator, in which participants must cope with multiple demands at times of high stress and distraction. In this ‘error environment’ anaesthetists are likely to fail in various ways, which may be predicted from the fundamental theories of the genesis of human error, thus allowing us to better study these otherwise rare events. In the next phase of our research we plan to include surgeons as active subjects, and to focus on the functioning of the team rather than the individual. This will further elucidate the factors which contribute to positive and negative aspects of human performance and will inform intiatives (such as that of the WHO) to improve patient safety in the operating room.
CT29 MECHANICAL VALVE HISTORY –“MEDTRONIC” TELECONFERENCE PRESENTATION
Authors: Campbell A.
Published: April 2007

Charles Hufnagel began the era of artificial heart valve implantation in 1952, before the existence of technology that allowed the heart to be arrested. Hufnagel implanted a Lucite tube and ball in the descending aorta with clamps that facilitated rapid insertion without arresting the heart. Although valves in the descending aorta were somewhat successful in the management of aortic insufficiency, only a device placed in the appropriate anatomical or orthotopic position could help patients with valvular stenosis. This presentation will review the development of mechanical heart, emphasizing changes in valve design resulting from our greater understanding of blood hemodynamics, the mechanical forces imposed on valve components, and the interaction of artificial materials with components of circulating blood. The evolution from polymer to metal and finally the dominance of pyrolitic carbon as the material of choice will be explored. Similarities and differences between the four bileaflet valves that have received FDA approval and the two valves with CE mark approval that have not yet received FDA approval will be discussed.