bluuebunny/crossref_metadata_2025_split huggingface dataset:
IS PARATHYROID HORMONE‐RELATED PROTEIN A SENSITIVE SERUM MARKER IN ADVANCED BREAST CANCER?
Authors: Pyke C. M. , Menezes G. , Purdie D. M. , Johnson S. , Cowley D. 
Published: January 2008

Background: To compare already used serum markers in advanced breast cancer, namely erythrocyte sedimentation rate (ESR), carcino‐embryonic antigen (CEA), and polymorphic epithelial mucins (e.g. CA15‐3) with a newer potential marker: parathyroid hormone related protein (PTHrP). Methods: A study group of 33 patients of proven advanced breast cancer was compared with 11 patients with benign breast lumps who were undergoing surgery, and eight patients with humoral hypercalcaemia of malignancy of non‐breast origin. ESR, CA15‐3, CEA, PTHrP, parathormone (PTH), liver and renal function were measured using commercially available kits. Using given reference ranges, results were classified into normal versus abnormal, and univariate statistical comparisons were made using Fisher's exact test. For multivariate analysis, absolute serum levels were used, and multivariate logistic regression models were employed. Results: By univariate analysis, only CA15‐3 (P= 0.007), and CEA (P= 0.004), were significant markers of metastatic disease. By multivariate analysis the only independently significant serum marker was CA15‐3 (P= 0.043). PTHrP was neither a sensitive (22%) nor specific (90.1%) serum marker when compared to CEA or CA15‐3. ESR was the most sensitive single serum marker (93%). An incidental finding of elevations of serum parathormone was found in as many patients as in the study group as there were elevations of PTHrP. Conclusions: PTHrP would not have revealed any patients with metastatic disease that would not have been predicted by any existing tumour markers including CA15‐3, CEA and ESR. The finding of elevated PTH in as many patients as PTHrP indicates the possible need for a study inclusive of other polypeptide hormones as markers in advanced breast cancer.
ABO BLOOD GROUP INCOMPATIBILITY IN LIVER TRANSPLANTATION: A SINGLE‐CENTRE EXPERIENCE
Authors: Chui A. K. K. , Ling J. , McCaughan G. W. , Painter D. , Shun A. , Dorney S. F. A. , Mears D. C. , Sheil A. G. R. 
Published: January 2008

Background: For most organ transplantation (Tx), ABO blood group incompatibility (ABOI) is an absolute contraindication because of the high incidence of hyperacute rejection (HAR). While HAR occurs in ABOI liver Tx (LTx), it is known that some liver grafts can be accepted. Methods: ABO‐incompatible (ABOI) liver allografts were used in seven of 355 orthotopic LTx operations performed at our institution over a 10‐year period. All seven recipients were in fulminant hepatic failure (FHF) prior to Tx. Results: Following Tx, all grafts functioned immediately. One patient died without recovering consciousness. Six patients recovered consciousness following Tx but three patients subsequently required re‐transplantation (with ABO‐compatible grafts (ABOC)) because of severe acute rejection (2) and chronic rejection (1). Hyper‐acute rejection did not occur. All six patients are now well, with a mean survival of 61.5 months. When compared to 36 other FHF patients who received ABOC grafts, graft survivals were 3/7 (43%) for ABOI versus 23/36 (64%) for ABOC (P= not significant (NS)). Patient survivals were 6/7 (85.7%) for ABOI patients and 23/36 (64%) for ABOC (P= NS). The re‐transplantation rate was significantly higher in the ABOI group (P= 0.001). Conclusions: The results confirm that ABOI liver grafts should be used in urgent circumstances when compatible grafts are not available. Some grafts function indefinitely, while those that fail may function for sufficient time to allow successful re‐transplantation with ABOC grafts.
TRANSPLANTATION OF ADULT AND PAEDIATRIC HORSESHOE KIDNEYS
Authors: Thomson B. N. J. , Francis D. M. , Millar R. J. 
Published: January 2008

Background: The incidence of horseshoe kidneys is between 1 in 300 and 1 in 1600. Horseshoe kidneys may be either transplanted into two recipients after division of the kidney, or used foren bloctransplantation into one recipient.Methods: We report two cases of adult‐to‐child and child‐to‐adult transplantation of horseshoe kidneys. Embryology and associated abnormalities are outlined, and previous case reports reviewed.Results: One transplant was successful and one transplant failed due to an unrecognized C peptide deficiency.Conclusions: Horseshoe kidneys are acceptable as donor organs in renal transplantation.
BREAST CONSERVATION: LONG‐TERM RESULTS FROM WESTMEAD HOSPITAL
Authors: Zissiadis Yvonne , Langlands Allan O. , Barraclough Bruce , Boyages John 
Published: January 2008

Background: Breast conservation has been shown to be a safe and effective alternative to mastectomy in early‐stage breast cancer. The present study reviews the long‐term outcome and toxicity after treatment of early breast cancer by conservative surgery and radiation. Methods: Between November 1979 and December 1989, 438 patients with Union Internationale Contre le Cancer (UICC) stage I or II breast cancer were treated with conservative surgery and radiation therapy (CS + RT) at Westmead Hospital. Surgery to the breast varied from a local excision to a quadrantectomy, depending on the preference of the referring surgeon. The axilla was surgically dissected in 299 patients (68%). All patients received postoperative breast irradiation. The whole breast was irradiated to 46–54 Gy (median dose, 50 Gy) using 6 Mev photons for 5–6.5 weeks. Boosts were given at the primary tumour site in 336 patients (78%), by electron therapy (88 patients), iridium‐192 (247 patients) or photons (one patient). A total of 44 patients (10%) received adjuvant chemotherapy. Results: The median follow‐up period for surviving patients was 84 months (range: 56–172 months). The 5‐year actuarial rate of local recurrence was 6% (312 patients at risk), and the 10‐year rate was 10% (52 patients at risk). Very young patients (aged 34 years at diagnosis) had a 5‐year actuarial rate of local recurrence of 13% compared to 5% for older patients (P= 0.04). Neither the total dose to the primary site nor the boost technique influenced local recurrence. The 5‐year freedom from distant relapse was 83%. The side effects included rib fractures (2%), symptomatic pneumonitis (3%), fatty necrosis or fibrosis requiring surgery (4%), and moderate‐severe oedema of the arm (7%). Conclusions: The long‐term data show that CS + RT for UICC stage I or II breast cancer results in low rates of local recurrence which are influenced by age at diagnosis, but not by radiation dose or boost technique. These results confirm those of other international series that CS + RT is a safe alternative to mastectomy for most women with operable breast cancer.
CORE BIOPSY FOR MICROCALCIFICATIONS IN THE BREAST
Authors: Hirst Cherrell , Davis Neville 
Published: January 2008

Background: The conventional method of dealing with clustered mammographic microcalcification in the breast when it is of uncertain aetiology is to undertake either a short‐term mammographic review or to surgically excise the abnormal area and submit it for histological examination. Stereotactic wide‐bore needle biopsy (core biopsy) of microcalcifications is a suitable alternative to surgical biopsy and experience with this technique forms the basis of the present study. Methods: Percutaneous core biopsy has been used at the Wesley Breast Clinic as a means of assessing clustered calcification in 297 cases from November 1992 to October 1995. The procedure is done under local anaesthesia as an outpatient procedure using a Stereotactic attachment to a standard mammography unit. Results: A diagnosis of frank malignancy was made on core samples in 22 cases (7.4%), and in all of these malignancy was confirmed at open surgical biopsy. In a further six women in whom the core biopsy was reported as ‘suspicious of malignancy’, open surgical biopsy confirmed malignancy in three women, lobular in situ carcinoma was found in two women, and atypical ductal hyperplasia in one woman. In two instances the core sample was reported as showing atypical ductal hyperplasia and in those cases, this was confirmed at open surgical biopsy. In 265 cases (89%) the histology of the core revealed appearances of benign breast tissue. Open surgical biopsy has been undertaken in only six of these cases, but in all instances the histology has confirmed a benign process. In the two remaining cases, the procedure was considered to be technically unsatisfactory, and open surgical biopsy was recommended because of doubt about the appearance of the microcalcification. In both instances, malignancy was demonstrated. Conclusions: Core biopsy of clustered mammographic microcalcification of uncertain aetiology is recommended as a satisfactory and reliable alternative to open surgical biopsy. It is less expensive, can be done quickly, produces few complications, and does not produce subsequent mammographic distortion.
THE COST BENEFIT OF CHANGING PROTOCOLS IN THE MANAGEMENT OF INTUSSUSCEPTION
Authors: Stein James E. , Beasley Spencer W. , Phela Ethna 
Published: January 2008

Background: At a time when pressure is being applied to healthcare systems to reduce costs and improve efficiency, both the medical and financial implications of changing practices need to be documented. Methods: A review was undertaken of 703 patients with intussusception, treated during a 10‐year period from 1983. Results: This review showed that changes to the protocol for the management of intussusception have not only benefited the patient by reducing the morbidity and the operative rate, but also have led to a reduction in the length of hospital stay, providing significant cost savings to the health system. The reduction in the operative rate accounts for an estimated annual saving at the Royal Children's Hospital of $139 000. Conclusions: Improvements in the management of intussusception have resulted in significant reductions in the costs of treatments. The recent diagnosis‐related group casemix funding arrangements mean, however, that the Royal Children's Hospital benefits more financially from inappropriate operative management of intussusception, than from non‐operative management. Funding arrangements should not discourage optimal treatment.
THE INITIAL AUSTRALIAN EXPERIENCE OF TECHNETIUM‐99M SESTAMIBI SCINTIMAMMOGRAPHY: A COMPLEMENTARY TEST IN THE MANAGEMENT OF BREAST CANCER
Authors: Sillar Robert , Howarth Douglas , Clark David 
Published: January 2008

Background: The adjunctive role of Tc‐99 m sestamibi scintimammography in the diagnosis and management of patients with a high probability of breast cancer was assessed. Methods: A descriptive study of 16 patients with palpable masses who had a high probability of breast cancer as determined by investigations such as cytology and conventional imaging techniques were carried out. All patients were followed‐up to surgery. Results: Scintimammography true positive results were found in 14 of 18 lesions detected in 16 patients. There were two falsepositives, which included one lobar carcinoma in situ lesion and one complex sclerosing lesion, and one false‐negative patient, Scintimammography detected abnormal radiotracer uptake in four of six patients with axillary metastases. Three patients had clinically and mammographically undetected multicentric disease detected on scintimammography which allowed appropriate modification of surgical excision. Breast cancer was detected in a patient with breast prostheses. Conclusions: Scintimammography would appear to have a useful adjunctive role to mammography in the diagnosis of breast cancer. The diagnosis of breast cancer may be enhanced in difficult cases and the detection of multicentricity on scintimammography may have an impact on subsequent surgical management.
FINE‐NEEDLE ASPIRATION BIOPSY OF PAROTID LESIONS: COMPARISON WITH FROZEN SECTION
Authors: Tew S. , Poole A. G. , Philips J. 
Published: January 2008

Background: Opinions vary as to the necessity for fine‐needle aspiration biopsy (FNAB) in parotid tumours. The present study reflects the experience gained over a 12‐year period and shows the accuracy of a diagnostic FNAB, and improved results with experience. Methods: Between 1983 and 1995, 201 parotid lesions were excised by one surgeon (AGP) and a prospective database was established. Fine‐needle aspiration biopsy was performed prior to surgery in 195 lesions and frozen section was performed in 159 lesions. Results: The FNAB was diagnostic in 129 (66%) specimens and its sensitivity for malignancy was 90% and specificity was 100% (excluding non‐diagnostic FNAB, where there was insufficient cellular material for reliable diagnosis or where specific tissue diagnosis could not be given). The positive predictive value was 100% and the negative predictive value was 98%. Of interest, the positive predictive value of diagnostic FNAB for pleomorphic adenomas was 99%. A specific tumour diagnosis could not be made on the FNAB sample in 37 specimens; 11 of these lesions were histologically confirmed as malignant after excision. Frozen section was diagnostic in 144 specimens (91%). Its sensitivity for malignancy was 96% and specificity was 99%. The positive predictive value was 96% and negative predictive value 99%. A specific tumour diagnosis could not be made on frozen section in 15 specimens, including six cases in which malignancy was finally reported. The positive predictive value of diagnostic frozen section for pleomorphic adenomas was 99%. Conclusions: A diagnostic FNAB is an accurate and useful tool in the management of parotid lesions. An FNAB diagnosis of pleomorphic adenoma obviates the need for frozen section. The performance of FNAB in parotid tumours does not in any way preclude the necessity of surgical removal of such lesions except in exceptional circumstances.
A PROSPECTIVE RANDOMIZED CONTROLLED TRIAL COMPARING SUPRAPUBIC WITH URETHRAL CATHETERIZATION IN RECTAL SURGERY
Authors: Perrin Lewis C. , Penfold Campbell , McLeish Andrew 
Published: January 2008

Background: Bladder drainage is necessary for several days following rectal surgery. Urethral catheterization has long been known to be associated with significant morbidity. Therefore a prospective randomized trial was performed to determine if this morbidity could be decreased by suprapubic catheterization. Methods: One hundred and thirty‐seven patients undergoing rectal surgery were prospectively randomized to either suprapubic or urethral catheterization. Results: After exclusions, 108 patients were analysed. Of the 49 patients with suprapubic catheters there was 14% morbidity, and of the 59 patients with urethral catheters there was 32% morbidity. Significant bacteriuria was halved with suprapubic catheterization. Patient acceptability of suprapubic catheterization was high, and there was no increased morbidity in any of the areas studied. Conclusions: This study suggests that suprapubic catheterization has advantages over urethral catheterization with decreased bacteriuria, and greater patient acceptability. However, the significance of decreased bacteriuria is not clear and therefore we can only say suprapubic catheter drainage is comparable to urethral catheter drainage.
POSTANAL REPAIR FOR FAECAL INCONTINENCE: LONG‐TERM FOLLOW‐UP
Authors: Rieger N. A. , Sarre R. G. , Saccone G. T. P. , Hunter A. , Toouli J. 
Published: January 2008

Background: To determine the long‐term outcome of postanal repair, and to assess whether the preoperative and physiological tests had any bearing on this outcome. Review included an opportunity for assessment with anal manometry and anal ultrasound. Method: Review of all patients (n= 22) over a 10 year period from 1986 to 1996. Comparison was of pre‐operative symptoms to symptoms at review. Correlation of outcome with pre‐operative manometry and the results of manometry and ultrasound at review (n= 6) was determined. Results: Assessment was possible in 19 of the 22 patients. Follow‐up ranged from 2 to 10 years (median, 8 years). Two had stomas created at 6 and 9 months and are considered failures. Seven patients considered the operation a success, in four it improved their symptoms and in six it was considered a failure. Comparison of pre‐and postoperative symptoms scores found a statistically significant improvement (P= 0.0093; two‐tailed Wilcoxon signed rank sum test). The outcome was not influenced by the results of pre‐operative anal manometry. Anal ultrasound found five sphincter defects in six patients. Such defects did not preclude improvement from postanal repair. Conclusions: Although the results showed improvement or success in only 11 (58%) of the patients this was felt to be important given that these patients may have few alternatives other than complicated procedures or a stoma. Postanal repair has a place in the management of faecal incontinence.
A SIMPLE INDEX TO PREDICT PROGNOSIS INDEPENDENT OF AXILLARY NODE INFORMATION IN BREAST CANCER
Authors: Seshadri Ram , Horsfall David J. , McCaul Kieran , Leon Anthony S‐Y. 
Published: January 2008

Background: Since the course of breast cancer is often unpredictable, we wished to develop a model using characteristics of the primary tumour alone to predict prognosis.Methods: Several tumour features were determined, and after a median follow‐up duration of 65 months, multivariate analysis identified tumour size and grade, oestrogen receptor concentration, axillary lymph node metastasis and tumour cell proliferation fraction (MIB‐1 count) as being independently associated with increases in risk for both relapse and death from breast cancer.A prognostic model was constructed using tumour size and grade, oestrogen receptor concentration and MIB‐1 count only. A score of 1 for each was given to tumour size> 20 mm, tumour grade 2 or 3, oestrogen receptor concentration < 10 fmol/mg cytosol protein and MIB‐1 count < 9%. Five groups established by assigning a combined score of 0, 1, 2, 3 or 4 for each patient were analysed for their associations with disease‐free and overall survivals.Results: This preliminary model predicted 5‐year survival rates of 97, 91, 85, 68 and 50% for the five groups. The model was further simplified by excluding tumour grade from the analysis. The revised model identified four risk groups with predicted 5‐year survival rates of 91, 86, 66 and 52%. This model, the Adelaide prognostic index, was also able to identify four risk groups in both node‐negative and node‐positive patients.Conclusions: The Adelaide prognostic index can be used to predict prognosis even in the absence of axillary lymph node information.
COSMETIC OUTCOME OF BREAST‐CONSERVING THERAPY IN CHINESE PATIENTS WITH EARLY BREAST CANCER
Authors: Yeo W. , Kwan W. H. , Teo P. M. L. , Leung W. T. , King W. , Johnson P. J. 
Published: January 2008

Background: Breast‐conserving surgery combined with radiotherapy has emerged as an alternative to mastectomy for women with early breast cancer, and cosmetic outcome has correlated closely with the psychosocial and physical well‐being of the patient. Cosmetic outcome assessment after breast‐conserving therapy in Chinese patients has so far not been conducted among the clinicians, the patients or their spouses. Methods: The cosmetic results from breast‐conserving therapy were evaluated in a group of 33 patients who had been selected as suitable for undergoing local excision, axillary dissection and postoperative radiation therapy for early stage breast cancer.The success of the procedures was assessed by the patients, the clinicians and the patient'spouse, and their ratings were compared with each other. Results: Eighty per cent of the patients and their spouse were satisfied with the cosmetic outcome. Using McNemar'test, when the groups were evaluated on a case‐by‐case basis, there was a good level of concordance between the patients and their spouses, and that of the patients and the clinicians. Conclusions: Evaluation of the cosmetic and psychosocial sequelae of breast cancer patients is essential when new approaches to treatment are introduced; our data suggest that cosmetically successful breast conservation is feasible in a selected group of Chinese women with early breast cancer.
DIAGNOSTIC LAPAROSCOPY FOR CHRONIC RIGHT ILIAC FOSSA PAIN: A PILOT STUDY
Authors: Chao Ken , Farrell Stephen , Kerdemelidis Paul , Tulloh Bruce 
Published: January 2008

Background: The aim of this study was to determine the value of diagnostic laparoscopy in patients with chronic right iliac fossa pain. Methods: A retrospective study at Echuca Hospital involving case‐note review and telephone questionnaire of patients who had undergone diagnostic laparoscopy for chronic right iliac fossa pain at least 12 months earlier (September 1992 to August 1995)was carried out. Results: Forty‐one cases were identified and followed up 12‐40 months postoperatively (median 21 months). Eleven cases had positive findings at laparoscopy, of whom eight obtained lasting relief after treatment. Of the remaining 30 patients 17 had a normal‐looking appendix removed and 12 were cured; these were younger patients with episodic symptoms and localized signs. Of eight patients who had adhesions divided, four with adhesions beneath old scars obtained relief. Altogether 32 of the 41 patients considered the laparoscopy worthwhile even though in some cases it did not relieve their chronic pain. Conclusions: Diagnostic laparoscopy is worthwhile for patients with chronic right iliac fossa pain. Concurrent appendicectomy should be considered in young patients with episodic, well‐localized symptoms associated with systemic malaise while adhesiolysis may be beneficial for viscero‐parietal adhesions beneath abdominal wall scars.
PRE‐OPERATIVE RADIOTHERAPY AND CHEMOTHERAPY FOR NON‐RESECTABLE RECTAL CANCER
Authors: Leong Trevor , Guiney Michael , Ngan Samuel , Mackay John 
Published: January 2008

Background: The treatment results of combined pre‐operative radiotherapy and chemotherapy followed by surgery for patients with initially non‐resectable primary rectal cancer were reviewed. Methods: Thirteen patients with locally advanced non‐resectable rectal cancer were treated with pre‐operative irradiation consisting of 50.4–54 Gy plus concomitant 5‐fluorouracil (5‐Fu) delivered during the 1st and 5th weeks of radiotherapy. Results: Following pre‐operative therapy, the resectability rate was 91%, with all but one patient undergoing complete resection. The pathologic complete response rate was 10%. The overall peri‐operative and postoperative complication rate was 0.8 complications per patient. There was no postoperative mortality. Conclusions: This early experience indicates that high resectability rates are achievable with pre‐operative radiotherapy and chemotherapy for non‐resectable rectal cancer while maintaining acceptable postoperative morbidity.