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Meguro T, Clower BR, Carpenter R, Parent AD, Zhang JH. Improved rat model for cerebral vasospasm studies. Neurol Res 2001; 23:761-6. [PMID: 11680518 DOI: 10.1179/016164101101199144] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
While the rat has been used extensively in subarachnoid hemorrhage (SAH)-cerebral vasospasm studies, concerns exist whether this animal represents a usable model because its time course and pattern of cerebral vasospasm following SAH is not comparable to that observed in man. At present, our knowledge of the rat model is based almost exclusively on studies using a 'single hemorrhage' method. Since there is a positive correlation between severity of cerebral vasospasm, and volume of subarachnoid blood, an obvious question is whether the rat will show modifications in vascular responses when insulted by a second SAH. Here, an SAH was produced in rats using a 'double hemorrhage' method. Following SAH, cerebral arteries showed pathological alterations, significant decreases in luminal perimeter, and increases in arterial wall thickness, over a 7-day post-SAH period. The above vascular features are considered to be indicative of cerebral vasospasm and their presence over a 7-day post-SAH period represents a significant time extension when compared to a single hemorrhage. These modified vascular responses made the double hemorrhaged rat a much-improved animal model.
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MESH Headings
- Animals
- Basilar Artery/pathology
- Basilar Artery/physiopathology
- Basilar Artery/ultrastructure
- Brain/blood supply
- Brain/pathology
- Cerebral Arteries/pathology
- Cerebral Arteries/physiopathology
- Cerebral Arteries/ultrastructure
- Circle of Willis/pathology
- Circle of Willis/physiopathology
- Circle of Willis/ultrastructure
- Disease Models, Animal
- Endothelium, Vascular/pathology
- Endothelium, Vascular/physiopathology
- Endothelium, Vascular/ultrastructure
- Image Processing, Computer-Assisted
- Male
- Microscopy, Electron
- Neurosurgical Procedures
- Rats
- Rats, Sprague-Dawley
- Subarachnoid Hemorrhage/complications
- Subarachnoid Hemorrhage/pathology
- Subarachnoid Hemorrhage/physiopathology
- Vasospasm, Intracranial/etiology
- Vasospasm, Intracranial/pathology
- Vasospasm, Intracranial/physiopathology
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Mostafa A, Carpenter R. Anaphylaxis to patent blue dye during sentinel lymph node biopsy for breast cancer. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2001; 27:610. [PMID: 11520102 DOI: 10.1053/ejso.2001.1174] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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53
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Carpenter R. Golden jubilee. W INDIAN MED J 2001; 50 Suppl 4:4-5. [PMID: 11824015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/23/2023]
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54
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Carpenter R. Sentinel node biopsy should be introduced into routine practice before results of randomized trials are available. Breast 2001; 10:281-4. [PMID: 14965594 DOI: 10.1054/brst.2001.0314] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
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55
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Chan SY, Berry MG, Engledow AH, Perry NM, Wells CA, Carpenter R. Audit of a one-stop breast clinic--revisited. Breast Cancer 2001; 7:191-4. [PMID: 11029797 DOI: 10.1007/bf02967459] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
BACKGROUND A one-stop diagnostic service has been available for women with symptomatic breast disease at St Bartholomew's Hospital for 5 years and was originally audited in May 1993. In re-auditing the one-stop service our aim was to see if our practice had improved following the original audit and to look at the impact which these changes in practice had made to the service offered to the patient. METHODS A prospective audit of 4 consecutive clinics was undertaken in November 1997. A total of 300 patients (59 new and 241 follow up) were seen in clinic in this time. The primary outcome measure concerned the completeness of triple assessment in the 40 patients who required one stop investigations, including mammography, ultrasonography and fine-needle aspiration cytology. In addition, mean time to initial consultation and level of awareness of the one-stop facility and its attendant time delay were measured. RESULTS Of the 300 clinic attendees 40 (38 new, 2 follow-up) had one-stop investigations. As a result of the one-stop service being in practice, 36 patients (90%) had a definitive management decision made at their first outpatient visit. Of these 2 were symptomatic cancers, forming 5% of the workload. A total of 86% of the workload was benign. Four patients (10%) had equivocal results. The mean waiting time from designated appointment until surgical consultation was 36.7 minutes and was disappointingly unchanged from that of the previous audit. However this does not take into account the significant reduction in staffing levels which has occurred between the two periods of assessment. CONCLUSIONS The initial audit identified a significant problem with time constraints, necessitating that a large number of patients with carcinomas return at a later date for further investigations. Booking only new patients at the beginning of clinic has provided a solution. Disappointingly, our figures do not show a significant improvement in mean waiting time compared with the previous audit, despite allowing GPs greater access of referral. Encouragingly, we have been able to maintain a similar standard of provision of care despite lower staffing levels and to implement the changes suggested by the original audit (thereby closing the audit loop).
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Mostafa A, Elkak AE, Hu JCC, Kirkpatrick K, Wells C, Carpenter R, Mokbel K. The role of subareolar methylene blue in identifying the sentinel node in patients with invasive breast cancer. Breast Cancer Res 2001. [PMCID: PMC3300553 DOI: 10.1186/bcr370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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57
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Burns SM, Carpenter R, Truwit JD. Report on the development of a procedure to prevent placement of feeding tubes into the lungs using end-tidal CO2 measurements. Crit Care Med 2001; 29:936-9. [PMID: 11378600 DOI: 10.1097/00003246-200105000-00004] [Citation(s) in RCA: 67] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To determine the accuracy of a technique using capnography to prevent inadvertent placement of small-bore feeding tubes and Salem sump tubes into the lungs. SETTING Twelve-bed medical intensive care unit (MICU) in a 557-bed teaching hospital. PATIENTS A total of 25 ventilated adult MICU patients were studied-5 in phase 1 and 20 in phase 2. DESIGN Phase 1 tested the ability of the end-tidal CO2 (ETCO2) monitor to detect flow (and thus accurately detect CO2) through small-bore feeding tubes. A small-bore feeding tube, with stylet in place, was placed 5 cm through the top of the tracheostomy tube ventilator adapter in five consecutive patients. The distal end of the feeding tube was attached to the ETCO2 monitor. The ETCO2 level and waveform were assessed and recorded. Because CO2 waveforms were successfully detected, a convenience sample of 20 adult MICU patients who were having feeding tubes placed (13 Salem sump tubes, 7 small-bore feeding tubes) was then studied. The technique consisted of attaching the ETCO2 monitor to the tubes and observing the ETCO2 waveform throughout placement. RESULTS The study hypothesis was supported. Of the seven small-bore feeding tubes tested, all were successfully placed on initial insertion. Placement was confirmed by absence of an ETCO2 waveform and by radiograph. Of the 13 Salem sump tubes, 9 were placed successfully on first attempt and confirmed by absence of CO2 and by air bolus and aspiration of stomach contents. ETCO2 waveforms were detected with insertion of four of the Salem sump tubes; the tubes were immediately withdrawn, and placement was reattempted until successful. CONCLUSIONS The technique described is a simple, cost-effective method of assuring accurate gastric tube placement in critically ill patients.
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Al Yasi AR, Carroll MJ, Azad M, Mokbel K, Granowska M, Jan H, Wells C, Carpenter R, Britton KE. 16. Humanized 99Tcm-hHMFG1 monoclonal antibody in determining involvement of impalpable axillary nodes in breast cancer patients before surgery. Nucl Med Commun 2001. [DOI: 10.1097/00006231-200104000-00028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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59
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Schultz E, Carpenter R, Doyle S, Coen E. The gene fimbriata interacts non-cell autonomously with floral regulatory genes. THE PLANT JOURNAL : FOR CELL AND MOLECULAR BIOLOGY 2001; 25:499-507. [PMID: 11309140 DOI: 10.1046/j.1365-313x.2001.00977.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
In Antirrhinum majus, one proposed role of the gene fimbriata (fim) is as a mediator between the floral meristem identify gene floricaula (flo) and floral organ identity genes such as deficiens (def) and plena (ple). The mechanism of fim activity is probably unique as, while the other genes in the hierarchy are thought to be transcription factors, fim is thought to target proteins to a ubiquitin-mediated destruction pathway. Both flo and def have been shown to act non-cell autonomously. We tested the hypotheses that (i) fim acts in a non-cell autonomous manner; and (ii) non-cell autonomy of flo might be through activation and subsequent non-cell autonomous activity of fim. Plants bearing an unstable fim allele were monitored for revertant shoots. Analysis of fim RNA expression in plants derived from revertant shoots, and segregation of revertant phenotype in progeny from revertant plants, indicated that all were periclinal chimeras with wild-type fim expression only in subepidermal layers. Despite the absence of fim in the epidermal layer, expression of downstream genes was normal, suggesting non-cell autonomous activity of fim. Subsequently, we tested the hypothesis that fim is the mediator of flo non-cell autonomy by examining fim expression in flo periclinal chimeras. In these chimeras, fim is activated in cells where flo is not expressed, indicating that fim cannot be the sole mediator of flo non-cell autonomy.
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Mokbel K, Choy C, Leris C, Akbar M, Vinnicombe S, Kessar P, Perry N, Wells C, Carpenter R. Predictors of positive margins after local excision of ductal carcinoma in situ. Am J Surg 2001; 181:91-5. [PMID: 11425066 DOI: 10.1016/s0002-9610(00)00572-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND This study aimed to examine the association between clinicopathologic parameters and positive margins in women with ductal carcinoma in situ (DCIS) treated by breast-conserving surgery (BCS). METHODS We retrospectively reviewed the clinical, radiologic, and pathologic data of 100 women who had undergone BCS for DCIS in our center. RESULTS Sixty-seven percent of patients presented via breast screening and 55% of all cases were diagnosed preoperatively on fine needle aspiration cytology ([FNAC] ie, C5). Overall, 45% of patients had clear margins after initial local excision. Positive margins showed a nonsignificant trend of association with distribution of microcalcifications (MCC), nonconsultant operating surgeon, inconclusive preoperative FNAC, presence of necrosis, and low specimen weight. There was a highly significant association between low grade DCIS (P = 0.003) and incomplete excision. There was no significant association with age, associated invasive focus, morphology of MCC, or with mode of presentation. CONCLUSION Positive margins after local excision of DCIS are significantly associated with low nuclear grade, and preoperative determination of nuclear grade by core biopsy may have surgical implications.
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Jenkinson AD, Al-Mufti RA, Mohsen Y, Berry MJ, Wells C, Carpenter R. Does intraductal breast cancer spread in a segmental distribution? An analysis of residual tumour burden following segmental mastectomy using tumour bed biopsies. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2001; 27:21-5. [PMID: 11237487 DOI: 10.1053/ejso.2000.1051] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
INTRODUCTION Breast-conserving surgery for early breast cancer is now routinely used as an alternative to mastectomy. Despite post-operative radiotherapy, early local recurrence of tumour remains a concern. It has been reported that invasive and in-situ ductal carcinoma spread locally through the ductal tree in a segmental distribution, however, there is no consensus as to the best surgical method to maximize tumour clearance whilst leaving a good cosmetic result. AIM We aimed to measure the effectiveness of segmental mastectomy (excision of tumour plus associated segmental ductal tissue) in the clearance of different tumour types. Bed biopsy of the excision cavity was employed to assess the rate of incomplete excision or the multifocality of certain breast cancers. METHODS One hundred and one patients with breast cancers underwent segmental mastectomy and cavity bed biopsies. Specimens were assessed for tumour type and completeness of excision. An excision of the cancer was considered incomplete if the margins were involved or if any of the bed biopsies showed residual or multifocal tumour. RESULTS A total of 24 patients had incomplete tumour excision. Invasive ductal carcinoma was more likely to be completely excised by segmental mastectomy than invasive lobular carcinoma (P<0.05). Incomplete excision was associated with multifocality and the presence of extensive DCIS. The report of clear pathological margins was significantly more likely to be accurate, as measured by negative bed biopsies, in invasive ductal carcinoma when compared to invasive lobular carcinoma (P<0.05). CONCLUSION These results support the concept that ductal carcinomas spread locally in a segmental fashion. Patients with invasive ductal carcinomas are more likely to benefit from breast conserving surgery that is tailored to include the associated ductal tissue, in a segmental fashioned excision.
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MESH Headings
- Adult
- Aged
- Aged, 80 and over
- Biopsy
- Breast Neoplasms/pathology
- Breast Neoplasms/surgery
- Carcinoma, Ductal, Breast/pathology
- Carcinoma, Ductal, Breast/surgery
- Carcinoma, Intraductal, Noninfiltrating/pathology
- Carcinoma, Intraductal, Noninfiltrating/surgery
- Female
- Humans
- Mastectomy, Segmental
- Middle Aged
- Neoplasm Invasiveness
- Neoplasm Recurrence, Local
- Neoplasm, Residual
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Williams NJ, Leris AC, Kouriefs C, Mokbel KM, Hungerford J, Carpenter R. Choroidal metastasis-the initial presentation of breast carcinoma. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2000; 26:817-8. [PMID: 11087653 DOI: 10.1053/ejso.2000.1012] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
We report a rare case of a breast carcinoma metastasis in the choroid presenting as the initial symptom of the primary disease.
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63
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McMillan D, Brady P, Menzie S, Brouwer M, Potger K, Southwell J, Carpenter R. Clinical experience with deep hypothermic circulatory arrest using ‘low dose heparin’. Heart Lung Circ 2000. [DOI: 10.1046/j.1443-9506.2000.09417.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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64
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Clark CL, Conaghan PJ, Carpenter R. Education provision for surgical senior house officers. Ann R Coll Surg Engl 2000; 82:326-8. [PMID: 11116757] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/18/2023] Open
Abstract
The provision of formal education in surgical SHO training is a requirement for posts to be accredited by postgraduate deans. We carried out a questionnaire survey of surgical SHOs attending a Royal College of Surgeons of England study day to quantify the amount of time given to formal education and supervised operating. We found that 79% of SHOs at district general hospitals and 87.5% at teaching hospitals were provided with a formal education programme. Of these SHOs, 77% were able to attend the teaching on a regular basis. In an average week, 8% of SHOs received no supervised operating experience and 37% had no operations supervised by a consultant. These results suggest that many hospitals fall short of the accepted guidelines on basic surgical training. This issue must be addressed by the Royal Colleges.
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65
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Brown PG, Hildebrand AR, Zolensky ME, Grady M, Clayton RN, Mayeda TK, Tagliaferri E, Spalding R, MacRae ND, Hoffman EL, Mittlefehldt DW, Wacker JF, Bird JA, Campbell MD, Carpenter R, Gingerich H, Glatiotis M, Greiner E, Mazur MJ, McCausland PJ, Plotkin H, Rubak Mazur T. The fall, recovery, orbit, and composition of the Tagish Lake meteorite: a new type of carbonaceous chondrite. Science 2000; 290:320-5. [PMID: 11030647 DOI: 10.1126/science.290.5490.320] [Citation(s) in RCA: 241] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
The preatmospheric mass of the Tagish Lake meteoroid was about 200,000 kilograms. Its calculated orbit indicates affinity to the Apollo asteroids with a semimajor axis in the middle of the asteroid belt, consistent with a linkage to low-albedo C, D, and P type asteroids. The mineralogy, oxygen isotope, and bulk chemical composition of recovered samples of the Tagish Lake meteorite are intermediate between CM and CI meteorites. These data suggest that the Tagish Lake meteorite may be one of the most primitive solar system materials yet studied.
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66
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Mokbel K, Choy C, Carpenter R. Adjuvant radiotherapy for DCIS. Lancet 2000; 355:2071-2; author reply 2072-3. [PMID: 10885374 DOI: 10.1016/s0140-6736(05)73522-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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67
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Gupta R, Sinnett D, Carpenter R, Preece PE, Royle GT. Antibiotic prophylaxis for post-operative wound infection in clean elective breast surgery. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2000; 26:363-6. [PMID: 10873356 DOI: 10.1053/ejso.1999.0899] [Citation(s) in RCA: 70] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Antibiotic prophylaxis has been used to good effect in the prevention of post-operative wound infections in patients undergoing gastrointestinal operations. We have assessed the use of a single dose of intravenous antibiotic (Augmentin 1.2 g), given with induction of anaesthesia as prophylaxis, against post-operative wound infection in women undergoing clean, elective breast surgery. Three hundred and thirty-four patients were recruited. Of the 164 receiving antibiotic prophylaxis 29 (17.7%) had wound infections compared with 32 (18.8%) in the placebo group (P=0.79). There were no significant differences in any other post-operative infective complications. Antibiotic prophylaxis is probably not required in clean, elective breast surgery.
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68
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Kouriefs C, Leris AC, Mokbel K, Carpenter R. The role of urine cytology in the assessment of lower urinary tract symptoms. BJU Int 2000; 85:1155. [PMID: 10939871] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2023]
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69
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Mostafa A, Mokbel K, Engledow A, Leris AC, Choy C, Wells C, Carpenter R. Is dissection of the internerve tissue during axillary lymphadenectomy for breast cancer necessary? EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2000; 26:153-4. [PMID: 10744934 DOI: 10.1053/ejso.1999.0760] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
AIMS The study evaluates the necessity of dissecting the tissue between the long thoracic and thoracodorsal nerves (internerve tissue) during axillary dissection in breast cancer surgery. By reviewing the lymph node yield and the metastatic rate in the internerve tissue, we examine whether the internerve tissue could be left in situ to minimize the risk of nerve injury. METHODS A prospective study was conducted on 30 consecutive women undergoing axillary lymphadenectomy for breast cancer. The internerve tissue remaining was excised separately after a routine axillary dissection and was examined by the same pathologist. RESULTS Twenty (67%) of 30 internerve specimens contained lymph nodes; the internerve nodes were positive for carcinoma in three cases (10%). In one case the lymph node in the internerve tissue was the only metastatic node in the axilla. CONCLUSIONS There is a significant incidence of lymph nodes (67%) and axillary node metastases (10%) in the tissue lying between the long thoracic and thoracodorsal nerves. Therefore excision of this internerve tissue is strongly recommended in order to optimize decision making regarding adjuvant treatment and oucome in women with operable breast cancer.
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70
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Berry MG, Goode AW, Puddefoot JR, Vinson GP, Carpenter R. Integrin beta1 upregulation in MCF-7 breast cancer cells by angiotensin II. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2000; 26:25-9. [PMID: 10718175 DOI: 10.1053/ejso.1999.0735] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
AIMS Integrins are a major family of cell adhesion molecules whose function is perturbed in tumour invasion and metastasis. Angiotensin II (A II) is well-known in the systemic control of water and electrolyte homeostasis and haemodynamics, but recent evidence points to an additional local renin-angiotensin system (RAS) with possible long-term trophic effects including carcinogenesis. METHODS The effect of angiotensin II on MCF-7 human breast cancer cell line integrin expression was evaluated with immunocytochemistry (ICC) and immunoprecipitation (IP). RESULTS The experiments demonstrated a 1.40 +/- 0.14-fold increase in beta, integrin expression on MCF-7 cells following treatment with A II. CONCLUSIONS These findings report the first evidence of an association between integrins and the RAS in human breast cancer cells and suggest a novel research avenue for future anti-metastatic strategies, through the manipulation of cell adhesion mechanics, in the management of invasive human breast cancer.
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Mokbel K, Athow A, Kouriefs C, Leris C, Williams N, Carpenter R. Sector resection for stage I breast cancer. J Clin Oncol 2000; 18:942-3. [PMID: 10673537 DOI: 10.1200/jco.2000.18.4.942] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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72
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Branday JM, Crandon I, Carpenter R, Rhoden A, Meeks-Aitken N. The challenge of designing a database for auditing surgical in-patients. W INDIAN MED J 1999; 48:195-7. [PMID: 10639837] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/15/2023]
Abstract
Surgical audit is imperative in modern practice, particularly in the developing world where resources are limited and efficient allocation important. The structure, process and outcome of surgical care can be determined for quality assurance or for research. Improved efficiency and reduction of morbidity and mortality are additional goals which may be accomplished. However, computerization, medical staff cooperation and the availability of dedicated staff are among the hurdles which may be encountered. We report the challenge of designing and establishing a database for auditing surgical inpatients in a developing country and the difficulties which were encountered.
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73
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Bailey R, Duong T, Carpenter R, Whittle H, Mabey D. The duration of human ocular Chlamydia trachomatis infection is age dependent. Epidemiol Infect 1999; 123:479-86. [PMID: 10694161 PMCID: PMC2810784 DOI: 10.1017/s0950268899003076] [Citation(s) in RCA: 89] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
We studied the relationship between age and prevalence, duration and incidence of clinical and laboratory evidence of ocular Chlamydia trachomatis infection in a cohort of Gambian subjects examined bi-weekly for 6 months. The duration of disease and infection, estimated by stratified survival analysis, proportional hazards regression and Weibull modelling, was markedly age-dependent. The estimated median duration of disease was 13.2 weeks in 0-4-year-old subjects and 1.7 weeks in those age 15 and over. Adjustment for multiple infections, and for missing observations did not alter this trend. The cumulative incidence rate of disease was reduced threefold with age. More rapid disease resolution is the main source of reduction in prevalence of active trachoma and ocular C. trachomatis infection with age; disease incidence was reduced to a lesser extent. This age-dependent resolution may be effected by adaptive cellular immune mechanisms. Mechanisms responsible for natural immunity should receive appropriate emphasis in vaccine design.
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74
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Cass G, Reynolds W, Lorenzen T, Leach D, Matson D, Carpenter R. Randomized double-blind study of the clinical duration and efficacy of Nesacaine-MPF 2% and 3% in peribulbar anesthesia. J Cataract Refract Surg 1999; 25:1656-61. [PMID: 10609213 DOI: 10.1016/s0886-3350(99)00265-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
PURPOSE To compare 2 commercially available concentrations of Nesacaine-MPF (2-chloroprocaine) to determine the time to onset of adequate motor blockade, the quality of surgical anesthesia, and the duration of motor blockade in the extraocular muscles after peribulbar anesthesia for cataract surgery. SETTING Tampa Eye and Specialty Surgery Center, Tampa, Florida, USA. METHODS This double-blind, randomized, single-center study comprised 40 patients scheduled to receive peribulbar anesthesia before cataract surgery. Patients were given 5 mL of Nesacaine-MPF 2% or 3% before surgery. Beginning at the end of the injection, assessments of ocular and eyelid movement were made every 2 minutes until adequate motor blockade was achieved or 25 minutes elapsed. Ocular assessments were made immediately after completion of surgery, 60 minutes after the end of the initial injection, and at 15 minute intervals thereafter until full recovery. Assessments of the quality of anesthesia achieved by the patient during surgery were made by the surgeon. RESULTS The 3% solution provided significantly faster onset of surgical anesthesia than the 2% solution (mean 3.9 minutes +/- 2.2 [SD] versus 6.0 +/- 3.6 minutes) (P = .02) but also required more time for recovery from anesthesia (98.9 +/- 18.7 minutes versus 84.8 +/- 20.6 minutes) (P = .02). All patients had adequate surgical anesthesia. Duration of ocular motor function was brief enough so that all patients could be sent home without an eye patch. Both concentrations were safe for use in this procedure. CONCLUSION Both Nesacaine-MPF 2% and 3% produced safe and effective peribulbar anesthesia in all patients; however, the 3% solution provided better duration of clinical anesthesia.
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75
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Kouriefs C, Mokbel K, Leris AC, Williams NJ, Carpenter R. Surgical implications of underestimation of adrenal tumour size by computed tomography. Br J Surg 1999; 86:1589. [PMID: 10636706 DOI: 10.1046/j.1365-2168.1999.01309-4.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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