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Lucey Á, Beecher S, McLaughlin R. Emergency surgery preoperative delays: realities, economic impacts and gains of a second emergency operating theatre. Ann R Coll Surg Engl 2024. [PMID: 38563079 DOI: 10.1308/rcsann.2024.0021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/04/2024] Open
Abstract
INTRODUCTION Time-to-theatre (TTT) is a key performance indicator of theatre efficiency and delayed TTT incurs significant costs and poor clinical outcomes. An increasing Irish population in conjunction with an ageing population puts increasing pressure on emergency surgical services across Ireland. We examined our institution's experience with introducing a second emergency theatre and semi-elective theatre lists for acute surgical patients. METHODS A retrospective review of electronic, prospectively maintained databases was performed between 1 February 2018 and 31 January 2020. A cost analysis was conducted to assess the economic impact of delayed TTT. The cost-saving benefit of introducing a second emergency theatre and semi-elective Kaizen lists was then calculated and compared with 2012-2014 figures from our institution. RESULTS In total, 6,679 procedures were performed. Overall mean TTT was 16h, 10h shorter than before the introduction of a second emergency theatre and Kaizen theatre lists (p < 0.001). Patients aged >65 years, who are historically a significantly disadvantaged group, had a shorter TTT following the introduction of a second emergency theatre. The economic advantage of a second emergency theatre resulted in a cost saving of €3,674,538 over 24 months. CONCLUSION Investment in emergency surgical services resulted in more efficient access to emergency theatres. There was a reduction in out-of-hours operating across all specialties and across the more at-risk groups such as those over the age of 65, who had an overall reduction in TTT. This had significant financial benefits and likely reduced the clinical risk associated with delayed TTT and out-of-hours operating.
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Affiliation(s)
- Á Lucey
- Department of General Surgery, Galway University Hospital, Ireland
| | - S Beecher
- Department of General Surgery, Galway University Hospital, Ireland
| | - R McLaughlin
- Department of General Surgery, Galway University Hospital, Ireland
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2
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van der Merwe R, Nadel J, Copes-Finke D, Pawelko S, Scott J, Ghanem M, Fox M, Morehouse C, McLaughlin R, Maddox C, Albert-Lyons R, Malaki G, Groce V, Turocy A, Aggadi N, Jin X, Howard C. Characterization of striatal dopamine projections across striatal subregions in behavioral flexibility. Eur J Neurosci 2023; 58:4466-4486. [PMID: 36617434 PMCID: PMC10329096 DOI: 10.1111/ejn.15910] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Revised: 12/13/2022] [Accepted: 12/30/2022] [Indexed: 01/10/2023]
Abstract
Behavioural flexibility is key to survival in a dynamic environmentWhile flexible, goal-directed behaviours are initially dependent on dorsomedial striatum, they become dependent on lateral striatum as behaviours become inflexible. Similarly, lesions of dopamine terminals in lateral striatum disrupt the development of inflexible habits. This work suggests that dopamine release in lateral striatum may drive inflexible behaviours, though few studies have investigated a causative role of subpopulations of striatal dopamine terminals in reversal learning, a measure of flexibility. Here, we performed two optogenetic experiments to activate dopamine terminals in dorsomedial (DMS), dorsolateral (DLS) or ventral (nucleus accumbens [NAc]) striatum in DAT-Cre mice that expressed channelrhodopsin-2 via viral injection (Experiment I) or through transgenic breeding with an Ai32 reporter line (Experiment II) to determine how specific dopamine subpopulations impact reversal learning. Mice performed a reversal task in which they self-stimulated DMS, DLS, or NAc dopamine terminals by pressing one of two levers before action-outcome lever contingencies were reversed. Largely consistent with presumed ventromedial/lateral striatal function, we found that mice self-stimulating medial dopamine terminals reversed lever preference following contingency reversal, while mice self-stimulating NAc showed parial flexibility, and DLS self-stimulation resulted in impaired reversal. Impairments in DLS mice were characterized by more regressive errors and reliance on lose-stay strategies following reversal, as well as reduced within-session learning, suggesting reward insensitivity and overreliance on previously learned actions. This study supports a model of striatal function in which DMS and ventral dopamine facilitate goal-directed responding, and DLS dopamine supports more inflexible responding.
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Affiliation(s)
- R.K. van der Merwe
- Neuroscience Department, Oberlin College, 173 Lorain St., Oberlin, OH, USA
| | - J.A. Nadel
- Neuroscience Department, Oberlin College, 173 Lorain St., Oberlin, OH, USA
- Northwestern University Interdepartmental Neuroscience Program (NUIN), Evanston, IL, USA
| | - D. Copes-Finke
- Neuroscience Department, Oberlin College, 173 Lorain St., Oberlin, OH, USA
| | - S. Pawelko
- Neuroscience Department, Oberlin College, 173 Lorain St., Oberlin, OH, USA
| | - J.S. Scott
- Neuroscience Department, Oberlin College, 173 Lorain St., Oberlin, OH, USA
| | - M. Ghanem
- Neuroscience Department, Oberlin College, 173 Lorain St., Oberlin, OH, USA
| | - M. Fox
- Neuroscience Department, Oberlin College, 173 Lorain St., Oberlin, OH, USA
| | - C. Morehouse
- Neuroscience Department, Oberlin College, 173 Lorain St., Oberlin, OH, USA
| | - R. McLaughlin
- Neuroscience Department, Oberlin College, 173 Lorain St., Oberlin, OH, USA
| | - C. Maddox
- Neuroscience Department, Oberlin College, 173 Lorain St., Oberlin, OH, USA
| | - R. Albert-Lyons
- Neuroscience Department, Oberlin College, 173 Lorain St., Oberlin, OH, USA
| | - G. Malaki
- Neuroscience Department, Oberlin College, 173 Lorain St., Oberlin, OH, USA
| | - V. Groce
- Neuroscience Department, Oberlin College, 173 Lorain St., Oberlin, OH, USA
| | - A. Turocy
- Neuroscience Department, Oberlin College, 173 Lorain St., Oberlin, OH, USA
| | - N. Aggadi
- Neuroscience Department, Oberlin College, 173 Lorain St., Oberlin, OH, USA
| | - X. Jin
- Center for Motor Control and Disease, Key Laboratory of Brain Functional Genomics, East China Normal University, Shanghai 200062, China
- NYU–ECNU Institute of Brain and Cognitive Science, New York University Shanghai, Shanghai 200062, China
| | - C.D. Howard
- Neuroscience Department, Oberlin College, 173 Lorain St., Oberlin, OH, USA
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3
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McVeigh TP, Sweeney KJ, Brennan DJ, McVeigh UM, Ward S, Strydom A, Seal S, Astbury K, Donnellan P, Higgins J, Keane M, Kerin MJ, Malone C, McGough P, McLaughlin R, O'Leary M, Rushe M, Barry MK, MacGregor G, Sugrue M, Yousif A, Al-Azawi D, Berkeley E, Boyle TJ, Connolly EM, Nolan C, Richardson E, Giffney C, Doyle SB, Broderick S, Boyd W, McVey R, Walsh T, Farrell M, Gallagher DJ, Rahman N, George AJ. A pilot study investigating feasibility of mainstreaming germline BRCA1 and BRCA2 testing in high-risk patients with breast and/or ovarian cancer in three tertiary Cancer Centres in Ireland. Fam Cancer 2023; 22:135-149. [PMID: 36029389 DOI: 10.1007/s10689-022-00313-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Accepted: 08/13/2022] [Indexed: 11/24/2022]
Abstract
In the Republic of Ireland (ROI), BRCA1/BRCA2 genetic testing has been traditionally undertaken in eligible individuals, after pre-test counselling by a Clinical Geneticist/Genetic Counsellor. Clinical Genetics services in ROI are poorly resourced, with routine waiting times for appointments at the time of this pilot often extending beyond a year. The consequent prolonged waiting times are unacceptable where therapeutic decision-making depends on the patient's BRCA status. "Mainstreaming" BRCA1/BRCA2 testing through routine oncology/surgical clinics has been implemented successfully in other centres in the UK and internationally. We aimed to pilot this pathway in three Irish tertiary centres. A service evaluation project was undertaken over a 6-month period between January and July 2017. Eligible patients, fulfilling pathology and age-based inclusion criteria defined by TGL clinical, were identified, and offered constitutional BRCA1/BRCA2 testing after pre-test counselling by treating clinicians. Tests were undertaken by TGL Clinical. Results were returned to clinicians by secure email. Onward referrals of patients with uncertain/pathogenic results, or suspicious family histories, to Clinical Genetics were made by the treating team. Surveys assessing patient and clinician satisfaction were sent to participating clinicians and a sample of participating patients. Data was collected with respect to diagnostic yield, turnaround time, onward referral rates, and patient and clinician feedback. A total of 101 patients underwent diagnostic germline BRCA1/BRCA2 tests through this pathway. Pathogenic variants were identified in 12 patients (12%). All patients in whom variants were identified were appropriately referred to Clinical Genetics. At least 12 additional patients with uninformative BRCA1/BRCA2 tests were also referred for formal assessment by Clinical Geneticist or Genetic Counsellor. Issues were noted in terms of time pressures and communication of results to patients. Results from a representative sample of participants completing the satisfaction survey indicated that the pathway was acceptable to patients and clinicians. Mainstreaming of constitutional BRCA1/BRCA2 testing guided by age- and pathology-based criteria is potentially feasible for patients with breast cancer as well as patients with ovarian cancer in Ireland.
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Affiliation(s)
- Terri Patricia McVeigh
- Cancer Genetics Unit, Royal Marsden NHS Foundation Trust, London, UK.
- Division of Genetics and Epidemiology, Institute of Cancer Research, London, UK.
| | - Karl J Sweeney
- Saolta Health Care Group, Galway University Hospital, Galway, Ireland
| | - Donal J Brennan
- Mater Misericordiae University Hospital, Dublin, Ireland
- The National Maternity Hospital, Holles St, Dublin, Ireland
| | | | - Simon Ward
- Cancer Genetics Unit, Royal Marsden NHS Foundation Trust, London, UK
| | | | | | - Katherine Astbury
- Saolta Health Care Group, Galway University Hospital, Galway, Ireland
| | - Paul Donnellan
- Saolta Health Care Group, Galway University Hospital, Galway, Ireland
| | - Joanne Higgins
- Saolta Health Care Group, Galway University Hospital, Galway, Ireland
| | - Maccon Keane
- Saolta Health Care Group, Galway University Hospital, Galway, Ireland
| | - Michael J Kerin
- Saolta Health Care Group, Galway University Hospital, Galway, Ireland
- National University of Ireland, Galway, Ireland
| | - Carmel Malone
- Saolta Health Care Group, Galway University Hospital, Galway, Ireland
- National University of Ireland, Galway, Ireland
| | - Pauline McGough
- Saolta Health Care Group, Galway University Hospital, Galway, Ireland
| | - Ray McLaughlin
- Saolta Health Care Group, Galway University Hospital, Galway, Ireland
| | - Michael O'Leary
- Saolta Health Care Group, Galway University Hospital, Galway, Ireland
| | - Margaret Rushe
- Saolta Health Care Group, Galway University Hospital, Galway, Ireland
| | - Michael Kevin Barry
- Saolta Health Care Group, Mayo University Hospital, Co Mayo, Castlebar, Ireland
| | - Geraldine MacGregor
- Saolta University Health Care Group, Letterkenny University Hospital, Co Donegal, Letterkenny, Ireland
| | - Michael Sugrue
- Saolta University Health Care Group, Letterkenny University Hospital, Co Donegal, Letterkenny, Ireland
| | - Ala Yousif
- Saolta University Hospital Group, Sligo University Hospital, Sligo, Ireland
| | | | | | | | | | | | | | | | | | | | - William Boyd
- Mater Misericordiae University Hospital, Dublin, Ireland
| | - Ruaidhri McVey
- Mater Misericordiae University Hospital, Dublin, Ireland
| | - Thomas Walsh
- Mater Misericordiae University Hospital, Dublin, Ireland
| | | | - David J Gallagher
- St James's University Hospital, Dublin, Ireland
- Mater Private Hospital, Dublin, Ireland
| | | | - Angela J George
- Cancer Genetics Unit, Royal Marsden NHS Foundation Trust, London, UK
- Division of Genetics and Epidemiology, Institute of Cancer Research, London, UK
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4
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O'Beirn E, Elliott J, Neary C, McLaughlin R. 32 Congenital Arteriovenous Malformation of The Breast Associated with Giant Hairy Naevus: A Case Report. Br J Surg 2021. [DOI: 10.1093/bjs/znab259.264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Abstract
Introduction
An arteriovenous malformation (AVM) is defined as an abnormal connection between arteries and veins, bypassing the capillary system. AVM of the breast is a rare clinical entity, with limited evidence to guide management. We present the case of a congenital AVM of the breast in an otherwise healthy woman, with an interesting presenting complaint.
Case Description
A 38-year-old female presented with a ‘buzzing’ sensation and mastalgia in her left breast. Examination revealed a visible pulsatile linear abnormality with a bruit on auscultation. Duplex ultrasonography demonstrated mixing of the arterial and venous flow, consistent with an AVM. Operative management entailed ultrasound guided identification, ligation and excision of all aneurysmal segments. Histopathologic evaluation demonstrated an AVM with no malignant features. At one year postoperatively, the patient reported complete symptom resolution. Literature review identified nine case reports, including two cases of congenital breast AVM, both treated surgically. Seven cases of iatrogenic AVM were identified, with diagnosis based on duplex ultrasonography and management by surgical ligation in all except one, which resolved spontaneously.
Conclusions
ongenital AVM of the breast is a rare clinical entity. Diagnosis can be established using duplex ultrasonography, while CT and MRI may be useful for preoperative planning. Endovascular management alone is associated with high recurrence rates and surgical excision is the favoured approach where technically feasible without major aesthetic or functional compromise.
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Affiliation(s)
- E O'Beirn
- Galway University Hospital, Galway, Ireland
| | - J Elliott
- Galway University Hospital, Galway, Ireland
| | - C Neary
- Galway University Hospital, Galway, Ireland
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5
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Nadel JA, Pawelko SS, Scott JR, McLaughlin R, Fox M, Ghanem M, van der Merwe R, Hollon NG, Ramsson ES, Howard CD. Optogenetic stimulation of striatal patches modifies habit formation and inhibits dopamine release. Sci Rep 2021; 11:19847. [PMID: 34615966 PMCID: PMC8494762 DOI: 10.1038/s41598-021-99350-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Accepted: 09/23/2021] [Indexed: 11/12/2022] Open
Abstract
Habits are inflexible behaviors that develop after extensive repetition, and overreliance on habits is a hallmark of many pathological states. The striatum is involved in the transition from flexible to inflexible responding, and interspersed throughout the striatum are patches, or striosomes, which make up ~15% of the volume of the striatum relative to the surrounding matrix compartment. Previous studies have suggested that patches are necessary for normal habit formation, but it remains unknown exactly how patches contribute to habit formation and expression. Here, using optogenetics, we stimulated striatal patches in Sepw1-NP67 mice during variable interval training (VI60), which is used to establish habitual responding. We found that activation of patches at reward retrieval resulted in elevated responding during VI60 training by modifying the pattern of head entry and pressing. Further, this optogenetic manipulation reduced subsequent responding following reinforcer devaluation, suggesting modified habit formation. However, patch stimulation did not generally increase extinction rates during a subsequent extinction probe, but did result in a small 'extinction burst', further suggesting goal-directed behavior. On the other hand, this manipulation had no effect in omission trials, where mice had to withhold responses to obtain rewards. Finally, we utilized fast-scan cyclic voltammetry to investigate how patch activation modifies evoked striatal dopamine release and found that optogenetic activation of patch projections to the substantia nigra pars compacta (SNc) is sufficient to suppress dopamine release in the dorsal striatum. Overall, this work provides novel insight into the role of the patch compartment in habit formation, and provides a potential mechanism for how patches modify habitual behavior by exerting control over dopamine signaling.
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Affiliation(s)
- J A Nadel
- Neuroscience Department, Oberlin College, Oberlin, OH, USA
| | - S S Pawelko
- Neuroscience Department, Oberlin College, Oberlin, OH, USA
| | - J R Scott
- Neuroscience Department, Oberlin College, Oberlin, OH, USA
| | - R McLaughlin
- Neuroscience Department, Oberlin College, Oberlin, OH, USA
| | - M Fox
- Neuroscience Department, Oberlin College, Oberlin, OH, USA
| | - M Ghanem
- Neuroscience Department, Oberlin College, Oberlin, OH, USA
| | | | - N G Hollon
- Molecular Neurobiology Laboratory, The Salk Institute for Biological Studies, La Jolla, CA, USA
| | - E S Ramsson
- Department of Biomedical Science, Grand Valley State University, Allendale, MI, USA
| | - C D Howard
- Neuroscience Department, Oberlin College, Oberlin, OH, USA.
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6
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Collins PM, Elliott JA, Brennan MJ, McNamara M, O'Malley E, Barry K, Sweeney K, Malone C, Lowery A, McLaughlin R, Kerin MJ. O78: SARCOPENIA IN LOCALLY ADVANCED BREAST CANCER: PREVALENCE, AND IMPACT ON CLINICAL AND ONCOLOGIC OUTCOMES. Br J Surg 2021. [DOI: 10.1093/bjs/znab117.078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Abstract
Introduction
Sarcopenia in cancer may confer negative outcomes, but its prevalence and impact in the modern multimodal management of locally advanced breast cancer have not been systematically studied.
Method
Patients undergoing neoadjuvant therapy and surgery for locally advanced breast cancer between 2010 and 2015 were studied. Skeletal muscle index (SMI) and lean body mass (LBM) were determined. Sarcopenia was defined by computed tomography (CT) at L3 as SMI<38.5cm2/m2. Multivariable linear, logistic, and Cox regression analysis was undertaken to determine the independent impact of sarcopenia on clinical and oncologic outcome.
Result
258 patients were studied. Sarcopenia was present in 23.0%, 7.8% and 0.0% of patients with normal weight, overweight and obesity, respectively (P=0.001). Sarcopenia was not associated with baseline cT and cN stage, tumour grade, histologic type or receptor status. Patients with sarcopenia exhibited equivalent indices of neoadjuvant therapy response including ypT and ypN stage, pathologic complete response and Sataloff grade following surgical resection. Postoperatively, sarcopenia was not independently associated with comprehensive complications index (P=0.242), length of stay (P=0.716) or overall morbidity (P=0.365). However, on multivariable analysis, lower LBM independently predicted reduced invasive disease-free (P=0.049,HR0.93[95%CI0.87-1.00]) and overall (P=0.028,HR0.92[0.85-0.99]), but not disease-specific survival (P=0.070).
Conclusion
Consistent with a lack of association with baseline and post-treatment pathologic features, sarcopenia in locally advanced breast cancer is associated with reduced overall, but not disease-specific, survival. These data indicate that the prognostic impact of sarcopenia may be mediated by impaired performance status and increased non-cancer mortality.
Take-home message
Consistent with a lack of association with baseline and post-treatment pathologic features, sarcopenia in locally advanced breast cancer is associated with reduced overall, but not disease-specific, survival. These data indicate that the prognostic impact of sarcopenia may be mediated by impaired performance status and increased non-cancer mortality.
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Affiliation(s)
- PM Collins
- Department of Breast Surgery, University Hospital Galway, Galway, Ireland
| | - JA Elliott
- Department of Breast Surgery, University Hospital Galway, Galway, Ireland
| | - MJ Brennan
- Department of Breast Surgery, University Hospital Galway, Galway, Ireland
| | - M McNamara
- Department of Breast Surgery, University Hospital Galway, Galway, Ireland
| | - E O'Malley
- Department of Breast Surgery, University Hospital Galway, Galway, Ireland
| | | | - K Sweeney
- Department of Breast Surgery, University Hospital Galway, Galway, Ireland
| | - C Malone
- Department of Breast Surgery, University Hospital Galway, Galway, Ireland
| | - A Lowery
- Department of Breast Surgery, University Hospital Galway, Galway, Ireland
- Lambe Institute for Translational Research, National University of Ireland Galway, University Road, Galway, Ireland
| | - R McLaughlin
- Department of Breast Surgery, University Hospital Galway, Galway, Ireland
| | - MJ Kerin
- Department of Breast Surgery, University Hospital Galway, Galway, Ireland
- Lambe Institute for Translational Research, National University of Ireland Galway, University Road, Galway, Ireland
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Lloyd A, Ryan E, Boland M, Medani S, Elwahab A, Malone C, Sweeney K, Barry K, McLaughlin R, Lowery A, Kerin M. O39: THE HISTOPATHOLOGICAL AND MOLECULAR FEATURES OF BREAST CARCINOMA WITH HIGH-GRADE TUMOUR BUDDING. Br J Surg 2021. [DOI: 10.1093/bjs/znab117.039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Abstract
Background
Tumour budding (TB) is an adverse histological feature in many cancers. It is thought to represent epithelial-to-mesenchymal transition, a key step in the metastatic process. The role of TB in breast carcinoma (BC) remains unclear.
Aim
To investigate the relationship between TB and other histological and molecular features of BC.
Method
A systematic search was performed to identify studies that compared features of BC based on the presence or absence of high-grade TB. Dichotomous variables were pooled as odds ratios (OR) using the Cochran–Mantel–Haenszel method. Quality assessment of the included studies was performed using the Newcastle-Ottawa scale (NOS).
Result
Seven studies with a total of 1040 patients (high grade TB n=519, 49.9%; low grade TB n=521, 50.1%) were included. A moderate- to high-risk of bias was noted. The median NOS was 7 (range 6-8). High-grade TB was significantly associated with lymph node involvement (OR 2.28, 95% c.i. 1.74 to 2.98, P<0.001) and lymphovascular invasion (OR 3.08, 95% c.i. 2.13 to 4.47, P<0.001). Regarding molecular subtypes, there was an increased likelihood of high-grade TB in oestrogen- (OR 1.66, 95% c.i. 1.21 to 2.29, P=0.002) and progesterone-receptor positive (OR 1.68, 95% c.i. 1.10 to 2.59, P=0.02) tumours. In contrast triple negative breast cancer had a reduced incidence of high-grade TB (OR 0.46, 95% c.i. 0.30 to 0.72, P=0.0006).
Conclusion
High-grade TB is enriched in hormone-positive BC and is associated with known adverse prognostic variables. TB may offer new insights into the metastatic processes of luminal BC.
Take-home message
High-grade TB is enriched in hormone-positive BC and is associated with known adverse prognostic variables. TB may offer new insights into the metastatic processes of luminal BC.
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Affiliation(s)
- A Lloyd
- Royal College of Surgeons Ireland
| | - E Ryan
- Galway University Hospital
| | - M Boland
- Royal College of Surgeons Ireland
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8
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Davey MG, Ryan ÉJ, Abd Elwahab S, Elliott JA, McAnena PF, Sweeney KJ, Malone CM, McLaughlin R, Barry MK, Keane MM, Lowery AJ, Kerin MJ. Clinicopathological correlates, oncological impact, and validation of Oncotype DX™ in a European Tertiary Referral Centre. Breast J 2021; 27:521-528. [PMID: 33709552 DOI: 10.1111/tbj.14217] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Revised: 02/20/2021] [Accepted: 02/22/2021] [Indexed: 02/06/2023]
Abstract
Oncotype DX™ (ODX) score estimates prognosis and predicts breast cancer recurrence. It also individualizes patient adjuvant chemotherapy prescription in breast cancer. This assay relies on genetic and molecular markers; the clinicopathological phenotype of which are tested routinely. The aim of this study was determine whether clinicopathological and immunohistochemical information predicts ODX recurrence score (RS). Secondly, to assess the impact on adjuvant chemotherapy (AC) and oncological outcome of ODX testing in patients in a European tertiary referral center. Estrogen receptor positive (ER+), human epidermal growth factor receptor-2 negative (HER2-), lymph node negative (LN-), and female breast cancer patients with ODX testing performed between 2007 and 2015 were categorized into low- (<11), intermediate- (11-25), and high-risk (>25) groups. Clinicopathological and immunohistochemical correlates of RS were determined. Predictors of RS were assessed using binary logistic regression. Oncological outcome was assessed using Kaplan-Meier and Cox regression analyses. ODX was performed in 400 consecutive ER+LN- patients. Median follow-up was 74.1 months (3.0-144.4). Low grade (odds ratio [OR]:2.39; 95% confidence interval [CI]:1.04-5.51, p = 0.041) independently predicted low ODX, while high grade (OR:2.04; 95% CI: 1.19-3.49, p = 0.009) and reduced progesterone receptor (PgR) expression (OR: 2.57, 95% CI: 1.42-4.65, p = 0.002) independently predicted high ODX. Omission of AC in intermediate- (p = 0.159) and high-risk (p = 0.702) groups did not negatively impact survival. In conclusion, tumor grade independently predicts low and high RS, while PgR negativity predicts high RS. ODX reduced AC prescription without compromising oncological outcome.
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Affiliation(s)
- Matthew G Davey
- Department of Surgery, Galway University Hospitals, Galway, Ireland.,The Lambe Institute for Translational Research, National University of Ireland, Galway, Ireland
| | - Éanna J Ryan
- Department of Surgery, Galway University Hospitals, Galway, Ireland
| | - Sami Abd Elwahab
- Department of Surgery, Galway University Hospitals, Galway, Ireland
| | - Jessie A Elliott
- Department of Surgery, Galway University Hospitals, Galway, Ireland
| | - Peter F McAnena
- Department of Surgery, Galway University Hospitals, Galway, Ireland
| | - Karl J Sweeney
- Department of Surgery, Galway University Hospitals, Galway, Ireland
| | - Carmel M Malone
- Department of Surgery, Galway University Hospitals, Galway, Ireland
| | - Ray McLaughlin
- Department of Surgery, Galway University Hospitals, Galway, Ireland
| | - Michael K Barry
- Department of Surgery, Galway University Hospitals, Galway, Ireland
| | - Maccon M Keane
- Department of Medical Oncology, Galway University Hospitals, Galway, Ireland
| | - Aoife J Lowery
- Department of Surgery, Galway University Hospitals, Galway, Ireland.,The Lambe Institute for Translational Research, National University of Ireland, Galway, Ireland
| | - Michael J Kerin
- Department of Surgery, Galway University Hospitals, Galway, Ireland.,The Lambe Institute for Translational Research, National University of Ireland, Galway, Ireland
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9
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O'Beirn E, Elliott JA, Neary C, O'Connell A, McLaughlin R. Congenital arteriovenous malformation of the breast associated with giant hairy nevus. Breast J 2020; 27:58-59. [PMID: 33368810 DOI: 10.1111/tbj.14133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Revised: 10/29/2020] [Accepted: 10/29/2020] [Indexed: 11/29/2022]
Affiliation(s)
- Ellen O'Beirn
- Department of Breast Surgery, Galway University Hospital, Galway, Ireland
| | - Jessie A Elliott
- Department of Breast Surgery, Galway University Hospital, Galway, Ireland
| | - Colm Neary
- Department of Breast Surgery, Galway University Hospital, Galway, Ireland
| | | | - Ray McLaughlin
- Department of Breast Surgery, Galway University Hospital, Galway, Ireland.,Lambe Institute for Translational Research, National University of Ireland Galway, Galway, Ireland
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10
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O'Donnell JP, Sugrue R, McLaughlin R, McInerney NM. Multidisciplinary approach to chest wall reconstruction in primary breast angiosarcoma resection. BMJ Case Rep 2020; 13:13/5/e233156. [PMID: 32381526 DOI: 10.1136/bcr-2019-233156] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Angiosarcomas account for less than 1% of primary breast cancers. Typically, they occur in young women with a low-risk personal or family history. Diagnosis, resection and reconstruction require a multidisciplinary team of breast surgeons, oncologists and plastic reconstructive surgeons. Cross-disciplinary awareness among these specialities enables dimensional patient treatment. We report a case of primary angiosarcoma of the breast in a 33-year-old woman, with no previous radiotherapy exposure, treated with a radical mastectomy and chest wall reconstruction with a deep inferior epigastric perforator (DIEP) Flap. There is a general consensus in current literature regarding the difficulty for curative treatment in angiosarcomas. There is a requirement for surgical intervention to be aggressive to ensure oncological clearance. Subsequently, the extensive reconstructive task proves a major procedure for any plastic surgeon. DIEP autologous flap chest wall reconstruction accompanying radical mastectomy can be used in efforts to eradicate risks of deep margin incomplete excision in breast angiosarcomas. This case report and review of the current literature aim to provide guidance for colleagues managing angiosarcomas and also highlight the versatility of the DIEP flap.
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Affiliation(s)
- John Phineas O'Donnell
- Department of Surgery, Galway University Hospitals, Galway, Ireland .,Plastic & Reconstructive Surgery, National University of Ireland Galway, Galway, Ireland
| | - Ryan Sugrue
- Department of Surgery, Galway University Hospitals, Galway, Ireland.,Plastic & Reconstructive Surgery, National University of Ireland Galway, Galway, Ireland
| | - Ray McLaughlin
- Department of Surgery, Galway University Hospitals, Galway, Ireland.,Breast & General Surgery, National University of Ireland Galway, Galway, Ireland
| | - Niall M McInerney
- Department of Surgery, Galway University Hospitals, Galway, Ireland.,Plastic & Reconstructive Surgery, National University of Ireland Galway, Galway, Ireland
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11
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Davey M, Elwahaab SA, Elliott JA, McAnena P, Curran C, Malone C, Sweeney K, Barry K, McLaughlin R, Lowery A, Kerin M. AB076. Oncotype DX™: a necessary expense in the era of personalised medicine? Mesentery Peritoneum 2020; 4:AB076-AB076. [DOI: 10.21037/map.2020.ab076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/02/2023]
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12
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Sutcliffe J, McLaughlin R, Del Rosso J, Weiss J, Baldwin H, Webster G, Leyden J, Zhao X, Read A, Drlica K, Elliott R, Stuart I. LB1117 Assessing bacterial susceptibility of FMX101 4% topical minocycline foam. J Invest Dermatol 2019. [DOI: 10.1016/j.jid.2019.06.084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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13
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Joyce DP, O'Neill C, Heneghan HM, Curran C, Barry K, Sweeney K, Malone C, McLaughlin R, Kerin MJ. The changing cost of breast cancer care: lessons from a centralised modern cancer centre. Ir J Med Sci 2018; 188:409-414. [PMID: 30032478 DOI: 10.1007/s11845-018-1872-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2017] [Accepted: 07/16/2018] [Indexed: 11/26/2022]
Abstract
BACKGROUND The cost of new cancer technologies has been the subject of intense debate in recent years. There have been significant advances in therapeutic techniques for breast cancer over the past 20 years. This has been accompanied by the concentration of services in designated cancer centres. The aim of this study was to examine the changing cost of breast cancer management over an 18-year period and identify factors underlying this. METHODS We use breast cancer services data from Galway University Hospital in 1995-1996, 2005-2006 and 2011-2012 to examine the changing pattern of care costs and survival. RESULTS The number of patients treated for breast cancer rose from 200 in 1995-1996, to 411 in 2005-2006 and 563 in 2011-2012. Two-year survival rose in line with national figures from 84 to 89.78 and 92.07%, in the three-time periods respectively. Adjusting for inflation, the average cost per patient rose from €14,710 (95% C.I., €13,398 to €16,022) in 1995-1996 to €30,405 (95% C.I., €38,620 to €32,189) in 2005-2006, before falling to €14,458 (C.I., €13,343 to €15,572) in 2011-2012. We found significant changes in the pattern of costs, with some rising in relative and absolute terms while others fell as new therapies became available and/or moved off patent. CONCLUSION Within an evolving context where services are centralised, new therapies emerge and subsequently come off patent, our understanding of the value of cancer therapies continues to evolve. This has important implications for the evaluation of new therapies and broader policy initiatives in this area.
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Affiliation(s)
- Doireann P Joyce
- Discipline of Surgery, Clinical Science Institute, National University of Ireland Galway, Galway, Ireland.
| | - Ciaran O'Neill
- J.E. Cairnes School of Business & Economics, National University of Ireland Galway, Galway, Ireland
| | - Helen M Heneghan
- Discipline of Surgery, Clinical Science Institute, National University of Ireland Galway, Galway, Ireland
| | - Catherine Curran
- Discipline of Surgery, Clinical Science Institute, National University of Ireland Galway, Galway, Ireland
| | - Kevin Barry
- Discipline of Surgery, Clinical Science Institute, National University of Ireland Galway, Galway, Ireland
| | - Karl Sweeney
- Discipline of Surgery, Clinical Science Institute, National University of Ireland Galway, Galway, Ireland
| | - Carmel Malone
- Discipline of Surgery, Clinical Science Institute, National University of Ireland Galway, Galway, Ireland
| | - Ray McLaughlin
- Discipline of Surgery, Clinical Science Institute, National University of Ireland Galway, Galway, Ireland
| | - Michael J Kerin
- Discipline of Surgery, Clinical Science Institute, National University of Ireland Galway, Galway, Ireland
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14
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Beecher SM, OʼLeary DP, McLaughlin R, Kerin MJ. The Impact of Surgical Complications on Cancer Recurrence Rates: A Literature Review. Oncol Res Treat 2018; 41:478-482. [PMID: 29895008 DOI: 10.1159/000487510] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2017] [Accepted: 02/08/2018] [Indexed: 11/19/2022]
Abstract
INTRODUCTION The inflammatory response to a post-operative infection can increase the risk of tumour recurrence in cancer through the release of pro-inflammatory mediators. The aim of this study was review the literature to assess the relationship between post-operative complications and cancer recurrence. METHODS We performed a literature review of the mechanism of such an association and looked at evidence in different cancer subtypes. RESULTS A relationship has been identified for many cancer subtypes, and multiple theories have been proposed for the mechanism of this association. Methods to reduce post-operative complications may impact positively on cancer recurrence rates. CONCLUSION This review demonstrates that wound complications after surgery can have significant implications for cancer patients. Strategies are required to minimize the risk of post-operative wound complications in patients undergoing cancer resection.
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15
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Abd Elwahab S, McGough P, Cooley G, McLaughlin R. Patients’ attitude towards travelling for breast services versus waiting longer for local services. Ir Med J 2018; 111:754. [PMID: 30489050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Geographical access is a cornerstone of health care provision. However, prolonged waiting for breast clinic appointments in local services results in delayed diagnosis and excessive anxiety for patients. In this study, we present a patient satisfaction survey results of an initiative to offer out-patient clinic appointments for non-urgent patients referred to the breast unit in Letterkenny General Hospital (LGH), Ireland, and exceeded the recommended waiting period of 12 weeks. These patients were offered appointment in University Hospital Galway (UCHG), which is an average travel time of about 3.5-4.5 hours away from LGH. 163 patients out of 336 (48.5%) patients actively waiting more than 12 weeks for appointments in LGH accepted alternative appointments in UCHG. Despite the long travel distance for these patients, 100% of them reported high satisfaction and 97.3% said they would accept further UCHG appointments if a similar situation of prolonged waiting in LGH arises. None of these patients were diagnosed with cancer, and only one had a benign lumpectomy. This study showed that if offered alternative appointments, just under half of the patients would accept. The initiative provides a feasible solution for long waiters, and the survey shows that patients’ satisfaction remains high despite long travel.
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Affiliation(s)
- S Abd Elwahab
- Symptomatic Breast Unit, University College Hospital Galway
| | - P McGough
- Symptomatic Breast Unit, University College Hospital Galway
| | - G Cooley
- Symptomatic Breast Unit, University College Hospital Galway
| | - R McLaughlin
- Symptomatic Breast Unit, University College Hospital Galway
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16
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McLaughlin R, McGrath J, Grimes H, Given HF. The Prognostic Value of the Tumor Marker CA 15–3 at Initial Diagnosis of Patients with Breast Cancer. Int J Biol Markers 2018; 15:340-2. [PMID: 11192831 DOI: 10.1177/172460080001500412] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
CA 15–3 has been most widely used as a serum tumor marker in follow-up and detection of breast cancer recurrence. In this study we have specifically focused upon the prognostic implications and utility of preoperative CA 15–3 levels. We have identified on our database 414 patients with breast cancer in whom serial levels of the serum tumor marker CA 15–3 had been determined at diagnosis and follow-up. We have analyzed the follow-up and clinical outcomes in these patients and from this data we have assessed the potential of CA 15–3 as a predictor of five-year overall and disease-free survival. Our results show that an initially elevated CA 15–3 level is associated with a very poor prognosis in both early and late stage disease. Elevated pre-biopsy CA 15–3 levels are associated with 14% five-year disease-free survival rates and 17% overall survival rates at five years. In contrast, normal CA 15–3 levels are associated with 47% five-year disease-free survival rates and 54% overall survival rates at five years (p<0.01). Comparison of five-year survival rates between patients with elevated and normal CA 15–3 levels in early breast cancer (stage I and II) also showed significant differences, with survival being 41% and 75%, respectively (p<0.01).
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Affiliation(s)
- R McLaughlin
- National Breast Cancer Research Institute, University College Hospital Galway, Ireland
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17
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McAnena PF, McGuire A, Ramli A, Curran C, Malone C, McLaughlin R, Barry K, Brown JAL, Kerin MJ. Correction to: Breast cancer subtype discordance: impact on post-recurrence survival and potential treatment options. BMC Cancer 2018. [PMID: 29534688 PMCID: PMC5851151 DOI: 10.1186/s12885-018-4174-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Affiliation(s)
- Peter F McAnena
- Discipline of Surgery, Lambe Institute for Translational Research, School of Medicine, National University of Ireland Galway, Galway, Ireland
| | - Andrew McGuire
- Discipline of Surgery, Lambe Institute for Translational Research, School of Medicine, National University of Ireland Galway, Galway, Ireland
| | - A Ramli
- Discipline of Surgery, Lambe Institute for Translational Research, School of Medicine, National University of Ireland Galway, Galway, Ireland
| | - C Curran
- Discipline of Surgery, Lambe Institute for Translational Research, School of Medicine, National University of Ireland Galway, Galway, Ireland
| | - C Malone
- Discipline of Surgery, Galway University Hospital, Galway, Ireland
| | - R McLaughlin
- Discipline of Surgery, Galway University Hospital, Galway, Ireland
| | - K Barry
- Discipline of Surgery, Galway University Hospital, Galway, Ireland
| | - James A L Brown
- Discipline of Surgery, Lambe Institute for Translational Research, School of Medicine, National University of Ireland Galway, Galway, Ireland.
| | - M J Kerin
- Discipline of Surgery, Lambe Institute for Translational Research, School of Medicine, National University of Ireland Galway, Galway, Ireland
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18
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McAnena PF, McGuire A, Ramli A, Curran C, Malone C, McLaughlin R, Barry K, Brown JAL, Kerin MJ. Breast cancer subtype discordance: impact on post-recurrence survival and potential treatment options. BMC Cancer 2018; 18:203. [PMID: 29463223 PMCID: PMC5819681 DOI: 10.1186/s12885-018-4101-7] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2017] [Accepted: 02/05/2018] [Indexed: 12/25/2022] Open
Abstract
Background Recent studies have shown that breast cancer subtype can change from the primary tumour to the recurrence. Discordance between primary and recurrent breast cancer has implications for further treatment and ultimately prognosis. The aim of the study was to determine the rate of change between primary and recurrence of breast cancer and to assess the impact of these changes on survival and potential treatment options. Methods Patient demographics were collected on those who underwent surgery for breast cancer between 2001 and 2014 and had a recurrence with biopsy results and pathology scoring of both the primary and recurrence. Results One hundred thirty two consecutive patients were included. There were 31 (23.5%) changes in subtype. Discordance occurred most frequently in luminal A breast cancer (n = 20), followed by triple negative (n = 4), luminal B (n = 3) and HER2 (n = 3). Patients who changed from luminal A to triple negative (n = 18) had a significantly worse post-recurrence survival (p < 0.05) with overall survival approaching significance (p = 0.064) compared to concordant luminal A cases (n = 46). Overall receptor discordance rates were: estrogen receptor 20.4% (n = 27), progesterone receptor 37.7% (n = 50) and HER2 3% (n = 4). Loss of estrogen receptor and progesterone receptor was more common than gain (21 vs. 6 (p = 0.04) and 44 vs. 6 (p = 0.01) respectively). Nine patients (6.8%) gained receptor status potentially impacting treatment options. Conclusion Discordance in subtype and receptor status occurs between primary and recurrent breast cancer, ultimately affecting survival and potentially impacting treatment options. Electronic supplementary material The online version of this article (10.1186/s12885-018-4101-7) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Peter F McAnena
- Discipline of Surgery, Lambe Institute for Translational Research, School of Medicine, National University of Ireland Galway, Galway, Ireland
| | - Andrew McGuire
- Discipline of Surgery, Lambe Institute for Translational Research, School of Medicine, National University of Ireland Galway, Galway, Ireland
| | - A Ramli
- Discipline of Surgery, Lambe Institute for Translational Research, School of Medicine, National University of Ireland Galway, Galway, Ireland
| | - C Curran
- Discipline of Surgery, Lambe Institute for Translational Research, School of Medicine, National University of Ireland Galway, Galway, Ireland
| | - C Malone
- Discipline of Surgery, Galway University Hospital, Galway, Ireland
| | - R McLaughlin
- Discipline of Surgery, Galway University Hospital, Galway, Ireland
| | - K Barry
- Discipline of Surgery, Galway University Hospital, Galway, Ireland
| | - James A L Brown
- Discipline of Surgery, Lambe Institute for Translational Research, School of Medicine, National University of Ireland Galway, Galway, Ireland.
| | - M J Kerin
- Discipline of Surgery, Lambe Institute for Translational Research, School of Medicine, National University of Ireland Galway, Galway, Ireland
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19
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McLaughlin R, Hoskinson J, Griffon D. Effects of a Bone Inducing Agent Derived from a Cultured Human Osteosarcoma Cell Line after Orthotopic and Heterotopic Implantation in the Dog. Vet Comp Orthop Traumatol 2018. [DOI: 10.1055/s-0038-1632497] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
SummaryBIA, a Bone Inducing Agent extracted from a cultured human osteosarcoma cell line (Saos–2), is highly osteoinductive in the skeletal muscle of athymic mice and promotes early osseous union of stabilized femoral non-unions in rats. To evaluate its effect in dogs, ten milligrams of BIA mixed with an equal amount of pure bovine collagen type I was compared with 20 mg of bovine collagen alone, a gelatin capsule alone, and fresh autogenous cancellous graft, after orthotopic and heterotopic implantation in Beagles.For osteoinductive bioassays, each implant was placed in the latissimus dorsi muscle of five Beagles for six weeks. Bone formation was evaluated by thoracic radiographs every two weeks and by high detail radiographs and histology six weeks after implantation. To evaluate the effects of BIA after orthotopic implantation, four cortical defects were created in each left femur of four Beagles. One defect on each femur was randomly filled with BIA plus collagen, collagen alone, a gelatin capsule alone, or autogenous cancellous graft. Radiographic evaluation of the femurs was performed every two weeks for eight weeks. Healing of the defects was assessed with high detail radiographs, dual energy X-ray absorptiometry, histology and histomorphometry eight weeks after implantation.Ten mg of BIA did not induce bone formation six weeks after heterotopic implantation and did not promote bone healing after orthotopic implantation in the dogs. The discrepancy between these results and those obtained in rodents may be related to immunogenic factors or to the dose of BIA used in this study.BIA, a Bone Inducing Agent extracted from a cultured osteosarcoma cell line is highly osteoinductive in rodents. BIA was evaluated and compared with autogenous cancellous bone graft and bovine collagen after orthotopic and heterotopic implantation in Beagles. Each implant was placed in the latissimus dorsi muscle of five Beagles and in femoral cortical defects of four Beagles. Bone formation was evaluated by radiography, dual energy X-ray absorptiometry, histology and histo-morphometry. BIA did not induce bone formation after heterotopic implantation and did not promote bone healing after orthotopic implantation in dogs.
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20
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Miller CW, McLaughlin R. Evaluation of Hip Joint Congruence and Range of Motion Before and After Triple Pelvic Osteotomy. Vet Comp Orthop Traumatol 2018. [DOI: 10.1055/s-0038-1633256] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
SummaryFifteen dogs undergoing triple pelvic osteotomy (TPO) for bilateral hip dysplasia were evaluated prospectively. Ten dogs were treated bilaterally, five dogs were treated unilaterally. Hip joint palpation, radiography and goniometry were performed before surgery and at 5, 10, 15, and 28 weeks after surgery.Joint congruence was significantly improved palpably and radiographically in treated hips while congruence deteriorated in untreated hips. Improvement in congruence was minimal after the five week evaluation. Goniometric measurements were variable but range of motion was generally not decreased after TPO.
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21
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McGuire A, Kalinina O, Holian E, Curran C, Malone CA, McLaughlin R, Lowery A, Brown JAL, Kerin MJ. Differential impact of hormone receptor status on survival and recurrence for HER2 receptor-positive breast cancers treated with Trastuzumab. Breast Cancer Res Treat 2017; 164:221-229. [PMID: 28378298 PMCID: PMC5487720 DOI: 10.1007/s10549-017-4225-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2017] [Accepted: 03/29/2017] [Indexed: 01/01/2023]
Abstract
INTRODUCTION Hormone receptor status has major implications for treatment and survival of breast cancer. Yet the impact of hormone receptor status on outcome after Trastuzumab has received little attention. The objective here was to explore any differential effects of Trastuzumab treatment (Trast +ve) on Luminal B HER2 or HER2+(ER-) breast cancer subtypes. METHODS A cohort of 469 HER2 receptor-positive breast cancers was categorised by molecular subtype and Trastuzumab treatment. Effects of Trastuzumab treatment on survival, locoregional recurrence and distant metastasis were investigated by subtype, using univariate and multivariate analysis. RESULTS Trast +ve Luminal B HER2 patients had significant improvements in 5-year DFS (p < 0.001) and OS (p < 0.001), while Trast +ve HER2+(ER-) patients had significant improvements in 5-year DFS (p = 0.012) alone. Only Trast +ve Luminal B HER2 cancers displayed a significant reduction in LRR rates (p < 0.001). A significant reduction in distant metastasis rates was seen in Trast +ve Luminal B HER2 (p < 0.001) and HER2+(ER-) (p = 0.009) cancers. Interestingly, bone metastasis rates in Trast +ve Luminal B HER2 cancers demonstrated the greatest reduction (36.2-6.7%). Multivariate analysis of Trast +ve patients found no difference in distant metastasis rates (p = 0.96) between subtypes. Significantly, lower LRR rates were seen in Trast +ve Luminal B HER2 cancers, compared to Trast +ve HER2+(ER-) (p = 0.018). CONCLUSION An enhanced response to Trastuzumab was seen in Luminal B HER2 cancers. We highlight how Trastuzumab treatment changed the natural history of the HER2 receptor-positive breast cancer, demonstrating improved efficacy in changing the outcome of hormone receptor-positive patients.
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Affiliation(s)
- Andrew McGuire
- Discipline of Surgery, Lambe Institute for Translational Research, School of Medicine, National University of Ireland Galway, Galway, Ireland
| | - Olga Kalinina
- School of Mathematics, Statistics and Applied Mathematics, National University of Ireland Galway, Galway, Ireland
| | - Emma Holian
- School of Mathematics, Statistics and Applied Mathematics, National University of Ireland Galway, Galway, Ireland
| | - Catherine Curran
- Discipline of Surgery, Lambe Institute for Translational Research, School of Medicine, National University of Ireland Galway, Galway, Ireland
| | - Carmel A Malone
- Discipline of Surgery, Lambe Institute for Translational Research, School of Medicine, National University of Ireland Galway, Galway, Ireland
| | - Ray McLaughlin
- Discipline of Surgery, Lambe Institute for Translational Research, School of Medicine, National University of Ireland Galway, Galway, Ireland
| | - Aoife Lowery
- Discipline of Surgery, Lambe Institute for Translational Research, School of Medicine, National University of Ireland Galway, Galway, Ireland
| | - James A L Brown
- Discipline of Surgery, Lambe Institute for Translational Research, School of Medicine, National University of Ireland Galway, Galway, Ireland.
| | - Michael J Kerin
- Discipline of Surgery, Lambe Institute for Translational Research, School of Medicine, National University of Ireland Galway, Galway, Ireland.
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22
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Joyce DP, Murphy D, Lowery AJ, Curran C, Barry K, Malone C, McLaughlin R, Kerin MJ. Prospective comparison of outcome after treatment for triple-negative and non-triple-negative breast cancer. Surgeon 2016; 15:272-277. [PMID: 28277293 DOI: 10.1016/j.surge.2016.10.001] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2016] [Revised: 09/27/2016] [Accepted: 10/04/2016] [Indexed: 12/18/2022]
Abstract
INTRODUCTION Triple-negative breast cancers (TNBC) are associated with a poor prognosis owing to an aggressive phenotype. We aimed to carry out a prospective study comparing management strategies and response to therapy in TNBC and non-TNBC patients. METHODS Data were obtained from a prospectively maintained database of patients treated for breast cancer. RESULTS A total of 142 TNBC and 142 age-, stage- and NPI-matched non-TNBC patients were treated. The difference in overall survival between the 2 groups was statistically significant (77% of TNBC patients alive at a mean follow-up of 32 months, versus 92% of non-TNBC patients at a mean follow-up of 38 months, P = 0.0 Log rank test). This survival difference was found to be independent of NPI (P = 0.0 Log rank test). Locoregional recurrence rates were similar between TNBC patients who were treated with wide local excision versus mastectomy (P = 0.449 Log rank test). A significant difference in survival was noted between TNBC patients who responded differentially to neoadjuvant chemotherapy (P = 0.035 Log rank test). CONCLUSION Patients with TNBC have adverse outcomes despite aggressive treatment. The development of effective targeted therapies is essential for this breast cancer subtype.
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Affiliation(s)
- D P Joyce
- Discipline of Surgery, Lambe Institute for Translational Research, National University of Ireland Galway, Ireland.
| | - D Murphy
- Discipline of Surgery, Lambe Institute for Translational Research, National University of Ireland Galway, Ireland
| | - A J Lowery
- Discipline of Surgery, Lambe Institute for Translational Research, National University of Ireland Galway, Ireland
| | - C Curran
- Discipline of Surgery, Lambe Institute for Translational Research, National University of Ireland Galway, Ireland
| | - K Barry
- Discipline of Surgery, Lambe Institute for Translational Research, National University of Ireland Galway, Ireland
| | - C Malone
- Discipline of Surgery, Lambe Institute for Translational Research, National University of Ireland Galway, Ireland
| | - R McLaughlin
- Discipline of Surgery, Lambe Institute for Translational Research, National University of Ireland Galway, Ireland
| | - M J Kerin
- Discipline of Surgery, Lambe Institute for Translational Research, National University of Ireland Galway, Ireland
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23
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McLaughlin R, Lee NG, Abu Kwaik Y, Spinola S, Apicella M. Characterization and sequence analysis of the lsg (LOS synthesis genes) locus from Haemophilus influenzae type b. ACTA ACUST UNITED AC 2016. [DOI: 10.1177/096805199400100305] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Analysis of the lsg (LOS synthesis genes) cluster in Escherichia coli strain K12 and mutations in the lsg locus in Haemophilus influenzae type b indicated the presence of 3 regions responsible for sequential modifications of E. coli lipopolysaccharide (LPS). Sequencing of the lsg region yielded 7,435 bp that encompassed 7 complete and 1 partial open reading frames (ORFs 1-8). The predicted product of ORF1 had homology to the consensus sequence of cytochrome b proteins (21% identity, 51% similarity) and to other transmembrane proteins. The products of ORF5 and ORF6 share overall 23% identity and 49% similarity with each other. The ORF6 protein had high homology with the product of ORF275 of the E. coli rfb gene cluster (40% identity, 58% similarity), whose function is not known. Multiple sequence alignment of the ORF5 and ORF6 proteins with the RfbB, RfbJ and RfbX proteins revealed conserved motifs over the N-terminal half region of all these proteins. The products of ORF7 and ORF8 are homologous with Azotobacter vinelandii MolA protein (30% identity, 51% similarity) and MolB protein (26% identity, 48% similarity), respectively. The promoter regions of ORF1, 7 and 8 were determined by primer extension analysis and found to be similar to bacterial σ70-dependent promoters. ORF7 and ORF8 are transcribed into diverse orientation. At least 5 of the encoded proteins have been identified using coupled E. coli transcription/translation system and labeling with [35S]-methionine. We conclude that the genetic organization of the lsg biosynthesis pathway involves multiple operons that lead to the assembly of an H. influenzae LOS structure.
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Affiliation(s)
- R. McLaughlin
- Department of Microbiology, The University of Oklahoma Health Sciences Center, OK, USA, Department of Microbiology, University of Iowa, Iowa City, IA, USA, Department of Microbiology and Immunology, University of Michigan, Ann Arbor, MI, USA, Department of Medicine, Division of Infectious Diseases, University of Indiana, Indianapolis, IN, USA
| | - N.-G. Lee
- Department of Microbiology, The University of Oklahoma Health Sciences Center, OK, USA, Department of Microbiology, University of Iowa, Iowa City, IA, USA, Department of Microbiology and Immunology, University of Michigan, Ann Arbor, MI, USA, Department of Medicine, Division of Infectious Diseases, University of Indiana, Indianapolis, IN, USA
| | - Y. Abu Kwaik
- Department of Microbiology, The University of Oklahoma Health Sciences Center, OK, USA, Department of Microbiology, University of Iowa, Iowa City, IA, USA, Department of Microbiology and Immunology, University of Michigan, Ann Arbor, MI, USA, Department of Medicine, Division of Infectious Diseases, University of Indiana, Indianapolis, IN, USA
| | - S.M. Spinola
- Department of Microbiology, The University of Oklahoma Health Sciences Center, OK, USA, Department of Microbiology, University of Iowa, Iowa City, IA, USA, Department of Microbiology and Immunology, University of Michigan, Ann Arbor, MI, USA, Department of Medicine, Division of Infectious Diseases, University of Indiana, Indianapolis, IN, USA
| | - M.A. Apicella
- Department of Microbiology, The University of Oklahoma Health Sciences Center, OK, USA, Department of Microbiology, University of Iowa, Iowa City, IA, USA, Department of Microbiology and Immunology, University of Michigan, Ann Arbor, MI, USA, Department of Medicine, Division of Infectious Diseases, University of Indiana, Indianapolis, IN, USA
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Beecher SM, O'Leary DP, McLaughlin R, Sweeney KJ, Kerin MJ. Influence of complications following immediate breast reconstruction on breast cancer recurrence rates. Br J Surg 2016; 103:391-8. [PMID: 26891211 DOI: 10.1002/bjs.10068] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2015] [Revised: 06/13/2015] [Accepted: 10/29/2015] [Indexed: 01/04/2023]
Abstract
BACKGROUND The rate of immediate breast reconstruction is rising. Postoperative infections are more frequent in patients who undergo reconstruction. The inflammatory response to a postoperative infection can increase the risk of tumour recurrence in other forms of cancer through the release of proinflammatory mediators. The aim of this study was to assess the relationship between complications and breast cancer recurrence in patients undergoing immediate reconstruction. METHODS This was a review of a prospectively maintained database of all patients who had immediate breast reconstruction between 2004 and 2009 at Galway University Hospital, a tertiary breast cancer referral centre serving the west of Ireland. All patients had a minimum follow-up of 5 years. Outcomes assessed included the development of wound complications and breast cancer recurrence. The data were evaluated by univariable and multivariable Cox regression analysis. RESULTS A total of 229 patients who underwent immediate reconstruction were identified. The overall 5-year recurrence-free survival rate was 85·6 per cent. Fifty-three patients (23·1 per cent) had wound complications, of whom 44 (19·2 per cent) developed a wound infection. There was a significantly greater risk of developing systemic recurrence among patients who experienced a postoperative wound complication compared with those without a complication (hazard ratio 4·94, 95 per cent c.i. 2·72 to 8·95; P < 0·001). This remained significant after adjusting for Nottingham Prognostic Index group in the multivariable analysis. The 5-year recurrence-free survival rate for patients who had a wound complication was 64 per cent, compared with 89·2 per cent in patients without a complication (P < 0·001). CONCLUSION This study has demonstrated that wound complications after immediate breast reconstructive surgery have significant implications for patients with breast cancer. Strategies are required to minimize the risk of postoperative wound complications in patients with breast cancer undergoing immediate reconstruction.
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Affiliation(s)
- S M Beecher
- Department of Breast Surgery, University Hospital Galway, and The Lambe Institute for Translational Research, National University of Ireland, Galway, Ireland
| | - D P O'Leary
- Department of Breast Surgery, University Hospital Galway, and The Lambe Institute for Translational Research, National University of Ireland, Galway, Ireland
| | - R McLaughlin
- Department of Breast Surgery, University Hospital Galway, and The Lambe Institute for Translational Research, National University of Ireland, Galway, Ireland
| | - K J Sweeney
- Department of Breast Surgery, University Hospital Galway, and The Lambe Institute for Translational Research, National University of Ireland, Galway, Ireland
| | - M J Kerin
- Department of Breast Surgery, University Hospital Galway, and The Lambe Institute for Translational Research, National University of Ireland, Galway, Ireland
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Beecher SM, Hogan J, O''Leary DP, McLaughlin R. An Appraisal of Inflammatory Markers in Distinguishing Acute Uncomplicated and Complicated Appendicitis. Dig Surg 2016; 33:177-81. [PMID: 26859506 DOI: 10.1159/000444101] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2015] [Accepted: 01/17/2016] [Indexed: 12/10/2022]
Abstract
BACKGROUND It remains difficult to distinguish between complicated appendicitis (CAP) and uncomplicated appendicitis (UAP). There is a paucity of studies utilizing inflammatory markers to stratify the severity of acute appendicitis. This study aimed to evaluate and demonstrate the potential clinical utility of inflammatory markers as adjuncts in distinguishing CAP and UAP. METHODS A comparative observational study was performed. Patients diagnosed with acute appendicitis were categorized as (a) complicated (necrosis, perforation, abscess) and (b) uncomplicated (inflamed, edematous). Hematological indices were combined to generate the following ratios: white cell lymphocyte ratio (WLR), white cell neutrophil ratio (WNR) and neutrophil lymphocyte ratio (NLR). Parameter accuracy was assessed using summary receiver operating characteristic (sROC) curves, classification and regression tree analysis and confusion matrix generation. RESULTS On sROC analysis, neutrophils (area under the curve (AUC) 0.79, p < 0.001), WLR (AUC 0.79, p < 0.001) and NLR (AUC 0.79, p < 0.001) were the most accurate parameters in distinguishing CAP and UAP. White cell count (WCC; AUC 0.76, p < 0.001) and C-reactive protein (AUC 0.75, p < 0.001) were less accurate. WCC >12.25 (sensitivity 70%, specificity 68%) and NLR >5.47 (sensitivity 78%, specificity 70%) were the most accurate in identifying CAP. CONCLUSION Inflammatory marker cutoff points can be generated and utilized to differentiate between UAP and CAP. This may be useful when deciding between conservative and operative management.
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Beecher SM, Donlan C, O'Leary DP, Kerin MJ, McLaughlin R. Clinical and economic benefit of general practitioner integration to a symptomatic breast service. Ir J Med Sci 2015; 185:877-880. [PMID: 26597951 DOI: 10.1007/s11845-015-1386-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2015] [Accepted: 11/16/2015] [Indexed: 11/30/2022]
Abstract
BACKGROUND Integration of general practitioners (GPs) into a tertiary care team is a model used internationally to assist with provision of patient care. Symptomatic breast clinics have seen significant increases in attendances and consequential staffing issues. We wished to analyze the integration of GPs into a tertiary breast care team and establish whether their inclusion is a cost-effective approach. METHODS A prospectively maintained database was used to identify 1614 new and 1453 review patients seen in the clinic between September and December 2013. The triple assessment clinical, radiological, and biopsy scores of patients assessed by GPs were compared to those assessed by registrars and to the overall number of patients seen. A cost analysis was performed based on the hourly rates of GPs and registrars. RESULTS 1614 new patients seen over the 4-month period. GPs reviewed a mean of 153.6 new patients and registrars reviewed a mean of 97.8. Registrars reviewed patients who were allocated higher 'S' scores, with 46 % of patients allocated an S4 and 21 % of patients allocated an S5 score. GPs reviewed a mean of 115.6 return patients and registrars reviewed a mean of 110.1 return patients. The weekly cost of employing 3 GPs for 15 h was €835. This compares favorably to the cost of employing a full-time registrar. CONCLUSION This study demonstrates that GPs can play a substantial role in the provision of a symptomatic breast service. In addition, the incorporation of GPs in this setting can prove cost-effective.
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Affiliation(s)
- S M Beecher
- Department of Breast Surgery, Galway University Hospital, Galway, Ireland.
| | - C Donlan
- Department of Breast Surgery, Galway University Hospital, Galway, Ireland
| | - D P O'Leary
- Department of Breast Surgery, Galway University Hospital, Galway, Ireland
| | - M J Kerin
- Department of Breast Surgery, Galway University Hospital, Galway, Ireland
| | - R McLaughlin
- Department of Breast Surgery, Galway University Hospital, Galway, Ireland
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Beecher S, O'Leary D, McLaughlin R. Increased risk environment for emergency general surgery in the context of regionalization and specialization. Int J Surg 2015; 21:112-4. [DOI: 10.1016/j.ijsu.2015.06.070] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2015] [Revised: 05/22/2015] [Accepted: 06/23/2015] [Indexed: 10/23/2022]
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Beecher SM, O'Leary DP, McLaughlin R. Diagnostic dilemmas due to fish bone ingestion: Case report & literature review. Int J Surg Case Rep 2015; 13:112-5. [PMID: 26188981 PMCID: PMC4529669 DOI: 10.1016/j.ijscr.2015.06.034] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2015] [Revised: 05/01/2015] [Accepted: 06/27/2015] [Indexed: 12/12/2022] Open
Abstract
Pre-operative diagnosis of fish bone perforation of the bowel is difficult. It usually mimics common abdominal pathology. A low threshold must be maintained to perform a diagnostic laparoscopy.
Introduction The diagnosis of abdominal complications due to fish bone ingestion is particularly difficult as the presentation may mimic common abdominal pathologies. Presentation of case 65 year-old male presented with a two day history of right iliac fossa pain. He denied any nausea and vomiting. He had no systemic systems including fever, change in bowel habit. He had tenderness and guarding localized to the right iliac fossa. He had raised inflammatory markers. A CT scan of the abdomen was performed which showed fat standing in proximity to the terminal ileum, with the appearance of Crohn’s disease. The clinical picture did not match the imaging and so the patient underwent a diagnostic laparoscopy. Findings included an acutely inflamed terminal ileum. A foreign body was identified piercing through at the small bowel wall at the terminal ileum. The foreign body was removed and revealed a fish bone. Intracorporeal sutures were inserted at the site of the microperforation. The patient was discharged well two days post operatively. Discussion Fish bone perforation is not a common cause of gastrointestinal perforation. Unfortunately the history is often non-specific and these people can be misdiagnosed with acute appendicitis & other pathologies. CT scans can be useful to aid diagnostics. It is not however fully sensitive in detecting complications arising from fishbone ingestion. Conclusion Management therefore, should be based taking into account primarily the clinical picture & may necessitate diagnostic laparoscopy.
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Affiliation(s)
- Suzanne M Beecher
- Department of Surgery, University College Hospital Galway, Galway, Ireland.
| | | | - Ray McLaughlin
- Department of Surgery, University College Hospital Galway, Galway, Ireland
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Stymiest L, Ornstein A, McLaughlin R. 180: Preparing to Interact with the Legal System: It's Child's Play! Paediatr Child Health 2015. [DOI: 10.1093/pch/20.5.e98a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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McGuire A, Brown JAL, Malone C, McLaughlin R, Kerin MJ. Effects of age on the detection and management of breast cancer. Cancers (Basel) 2015; 7:908-29. [PMID: 26010605 PMCID: PMC4491690 DOI: 10.3390/cancers7020815] [Citation(s) in RCA: 203] [Impact Index Per Article: 22.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2015] [Accepted: 05/12/2015] [Indexed: 12/15/2022] Open
Abstract
Currently, breast cancer affects approximately 12% of women worldwide. While the incidence of breast cancer rises with age, a younger age at diagnosis is linked to increased mortality. We discuss age related factors affecting breast cancer diagnosis, management and treatment, exploring key concepts and identifying critical areas requiring further research. We examine age as a factor in breast cancer diagnosis and treatment relating it to factors such as genetic status, breast cancer subtype, hormone factors and nodal status. We examine the effects of age as seen through the adoption of population wide breast cancer screening programs. Assessing the incidence rates of each breast cancer subtype, in the context of age, we examine the observed correlations. We explore how age affects patient's prognosis, exploring the effects of age on stage and subtype incidence. Finally we discuss the future of breast cancer diagnosis and treatment, examining the potential of emerging tests and technologies (such as microRNA) and how novel research findings are being translated into clinically relevant practices.
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Affiliation(s)
- Andrew McGuire
- Discipline of Surgery, School of Medicine, National University of Ireland, Galway, Ireland.
| | - James A L Brown
- Discipline of Surgery, School of Medicine, National University of Ireland, Galway, Ireland.
| | - Carmel Malone
- Discipline of Surgery, School of Medicine, National University of Ireland, Galway, Ireland.
| | - Ray McLaughlin
- Discipline of Surgery, School of Medicine, National University of Ireland, Galway, Ireland.
| | - Michael J Kerin
- Discipline of Surgery, School of Medicine, National University of Ireland, Galway, Ireland.
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Beecher SM, O'leary DP, Malone C, McLaughlin R, Sweeney K, Hussey A, Kerin MJ. Complications following immediate breast reconstruction and influence on breast cancer recurrence rates. J Clin Oncol 2015. [DOI: 10.1200/jco.2015.33.15_suppl.11022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Beecher SM, O'Leary DP, McLaughlin R. Metastatic ovarian carcinoma presenting as an incarcerated femoral hernia. Int J Surg Case Rep 2015; 11:53-55. [PMID: 25931301 PMCID: PMC4446680 DOI: 10.1016/j.ijscr.2015.04.024] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2015] [Revised: 04/20/2015] [Accepted: 04/20/2015] [Indexed: 11/25/2022] Open
Abstract
Occasionally unusual abdominal structures may be found within the hernia sacs. Abdominal malignancies have the potential to seed any part of the peritoneum. Surgeons should be vigilant where there is a known intra-abdominal malignancy & the presence of an incarcerated hernia.
Introduction Incarcerated femoral hernias usually contain a simple loop of bowel. Occasionally other abdominal structures may be found within the hernial sac. Rarely femoral hernias may contain metastatic tumour deposits. Presentation of case We report the case of an 82 year old lady with a background of ovarian carcinoma, who presented with acute small bowel obstruction and an irreducible right groin mass. CT imaging revealed an incarcerated loop of small bowel within a femoral hernia sac. The patient proceeded to theatre for hernia repair. Upon opening the hernial sac an adherent incarcerated small bowel loop was discovered. Interestingly, the sac itself was lined with metastatic deposits, which were later histologically proven to be ovarian in origin. The sac was reduced and the hernia was repaired. The patient’s post-operative course was uneventful. Discussion As abdominal wall hernias communicate with the abdominal cavity there is the potential for malignant cells to seed the peritoneal lining of the hernia sac. If the sac also contains bowel wall, this may become involved in the tumour mass. This may result in small bowel incarceration & obstruction. Conclusion In cases, where there is a known intra-abdominal malignancy & the presence of an incarcerated hernia, there should be a high index of suspicion for the presence of tumour within the hernial contents.
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Affiliation(s)
- Suzanne M Beecher
- Department of Surgery, University College Hospital Galway, Galway, Ireland.
| | | | - Ray McLaughlin
- Department of Surgery, University College Hospital Galway, Galway, Ireland
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Y.L. JT, McGowan K, Cooley G, McLaughlin R, Sugrue M. The role of ultrasound guided core biopsy of axillary nodes in predicting macrometastases and avoiding overtreatment outside ACOSOG Z0011 parameters. Breast 2015; 24:57-61. [DOI: 10.1016/j.breast.2014.11.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2014] [Revised: 09/19/2014] [Accepted: 11/15/2014] [Indexed: 10/24/2022] Open
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Beecher S, O'Leary DP, McLaughlin R. Hospital tests and patient related factors influencing time-to-theatre in 1000 cases of suspected appendicitis: a cohort study. World J Emerg Surg 2015; 10:6. [PMID: 25685177 PMCID: PMC4328835 DOI: 10.1186/1749-7922-10-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2014] [Accepted: 01/18/2015] [Indexed: 01/26/2023] Open
Abstract
Background Acute appendicitis is increasingly being managed in the setting of a dedicated emergency theatre. However understanding of hospital factors that influence time-to-theatre (TTT) is poor. Thus, the aim of this study is to identify factors that influence TTT and to observe the effect of prolonged TTT on patient outcome. Methods A retrospective review of an electronic prospectively maintained database was performed over a 2 year period. Factors thought to influence TTT were highlighted. A delay was defined as TTT >8 hours. Data analysis was performed using SPSS 20. Results 1,000 cases of suspected acute appendicitis were identified. Median age was 19 years. Appendicectomy was performed in 90.7%. 68.1% underwent laparoscopic appendicectomy. Overall mean TTT was 12 hours, 27 minutes. There was a significant association between delayed TTT and female gender (p = 0.017), older age (p = 0.001), pre-operative radiology (<0.001), normal WCC (p < 0.001), normal neutrophils (p < 0.001) and histological non-perforated appendix (p < 0.001). However, on multivariate analysis, younger age, a neutrophilia and presence of a perforation had a shorter TTT. Delayed TTT did not affect outcome variables including post-operative collection (3.59% v 4.38%, p = 0.528), readmission rate (6.54% v 5.72%, p = 0.403) and length of stay (3.1 days v 3.34 days, p = 0.823). Conclusions This study highlights key hospital factors that influence TTT in patients with suspected appendicitis. Identification of these influential factors adds greatly to our understanding of patient prioritisation. Finally, TTT delays greater than 8 hour do not appear to affect short-term patient outcomes.
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Affiliation(s)
- Suzanne Beecher
- Department of Surgery, Galway University Hospital/National University of Ireland (NUI), Galway, Republic of Ireland
| | - Donal Peter O'Leary
- Department of Surgery, Galway University Hospital/National University of Ireland (NUI), Galway, Republic of Ireland
| | - Ray McLaughlin
- Department of Surgery, Galway University Hospital/National University of Ireland (NUI), Galway, Republic of Ireland
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Quinn EM, Kealy R, O'Meara S, Whelan M, Ennis R, Malone C, McLaughlin R, Kerin MJ, Sweeney KJ. Is there a role for locoregional surgery in stage IV breast cancer? Breast 2014; 24:32-7. [PMID: 25466502 DOI: 10.1016/j.breast.2014.10.009] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2014] [Revised: 09/23/2014] [Accepted: 10/25/2014] [Indexed: 11/19/2022] Open
Abstract
Current guidelines do not recommend locoregional surgery for Stage IV breast cancer at presentation despite some studies suggesting a survival benefit. We aimed to assess outcomes in patients with Stage IV breast cancer who underwent surgery. In a cohort study of all Stage IV breast cancers diagnosed at our tertiary-referral specialist centre between 2006 and 2012, we assessed patient survival in the context of demographics, histopathology, metastatic burden, and type of surgery performed. One hundred and nine patients were included; 52 underwent surgery. Patients in the surgery group had longer 5-year-survival (p = 0.003). Survival was also significantly longer in those with just one site of metastatic disease (p < 0.001). Patients with axillary cytology positive for regional metastases were less likely to proceed to surgery. Locoregional surgery does confer a survival advantage in Stage IV breast cancer. Assessment of preoperative axillary cytology may preclude some patients from proceeding to potentially beneficial locoregional surgery.
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Affiliation(s)
- Edel M Quinn
- Breastcheck Western Unit, Newcastle Road, Galway, Ireland.
| | - Rebecca Kealy
- Symptomatic Breast Unit, University Hospital Galway, Newcastle Road, Galway, Ireland
| | - Siobhan O'Meara
- Symptomatic Breast Unit, University Hospital Galway, Newcastle Road, Galway, Ireland
| | - Maria Whelan
- Symptomatic Breast Unit, University Hospital Galway, Newcastle Road, Galway, Ireland
| | - Rachel Ennis
- Department of Radiology, University Hospital Galway, Newcastle Road, Galway, Ireland
| | - Carmel Malone
- Symptomatic Breast Unit, University Hospital Galway, Newcastle Road, Galway, Ireland
| | - Ray McLaughlin
- Symptomatic Breast Unit, University Hospital Galway, Newcastle Road, Galway, Ireland
| | - Michael J Kerin
- Division of Surgery, National University of Ireland Galway, University Road, Galway, Ireland
| | - Karl J Sweeney
- Breastcheck Western Unit, Newcastle Road, Galway, Ireland
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O'Leary DP, Beecher S, McLaughlin R. Emergency surgery pre-operative delays - realities and economic impacts. Int J Surg 2014; 12:1333-6. [PMID: 25462705 DOI: 10.1016/j.ijsu.2014.10.002] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2014] [Revised: 09/18/2014] [Accepted: 10/04/2014] [Indexed: 11/19/2022]
Abstract
BACKGROUND A key principle of acute surgical service provision is the establishment of a distinct patient flow process and an emergency theatre. Time-to-theatre (TTT) is a key performance indicator of theatre efficiency. The combined impacts of an aging population, increasing demands and complexity associated with centralisation of emergency and oncology services has placed pressure on emergency theatre access. We examined our institution's experience with running a designated emergency theatre for acute surgical patients. METHODS A retrospective review of an electronic prospectively maintained database was performed between 1/1/12 and 31/12/13. A cost analysis was conducted to assess the economic impact of delayed TTT, with every 24hr delay incurring the cost of an additional overnight bed. Delays and the economic effects were assessed only after the first 24 h as an in-patient had elapsed. RESULTS In total, 7041 procedures were performed. Overall mean TTT was 26 h, 2 min. There were significant differences between different age groups, with those aged under 16 year and over 65 having mean TTT at 6 h, 34 min (95% C.I. 0.51-2.15, p < 0.001) and 23 h, 41 min (95% C.I. 19.6-23.9, p < 0.001) respectively. 2421 (34%) waited greater than 24 h for emergency procedures. The >65 years age group had a mean TTT of 23 h, 41 min which was significantly longer than the overall mean TTT Vascular and urological emergencies are significantly disadvantaged in competition with other services for a shared emergency theatre. The economic impact of delayed TTT was calculated at €7,116,000, or €9880/day of additional costs generated from delayed TTT over a 24 month period. CONCLUSION One third of patients waited longer than 24 h for emergency surgery, with the elderly disproportionately represented in this group. Aside from the clinical risks of delayed and out of hours surgery, such practices incur significant additional costs. New strategies must be devised to ensure efficient access to emergency theatres, investment in such services is likely to be financially and clinically beneficial.
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Affiliation(s)
- D P O'Leary
- Department of Surgery, Galway University Hospital, National University of Ireland (NUI), Galway, Ireland.
| | - S Beecher
- Department of Surgery, Galway University Hospital, National University of Ireland (NUI), Galway, Ireland
| | - R McLaughlin
- Department of Surgery, Galway University Hospital, National University of Ireland (NUI), Galway, Ireland
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Joyce DP, Alamiri J, Lowery AJ, Downey E, Ahmed A, McLaughlin R, Hill ADK. Breast clinic referrals: can mastalgia be managed in primary care? Ir J Med Sci 2014; 183:639-42. [PMID: 24402166 DOI: 10.1007/s11845-013-1066-z] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2013] [Accepted: 12/30/2013] [Indexed: 11/29/2022]
Abstract
BACKGROUND Centralisation of breast cancer services in Ireland has resulted in a significant increase in the number of patients attending symptomatic breast units (SBU). A considerable proportion of patients referred to SBU present with non-suspicious symptoms and fall into a "low-risk" category for breast cancer. It has been proposed that consideration be given to a primary care-delivered service for these patients. AIM To evaluate SBU attendances and correlate with diagnosis to identify a cohort of patients who may be suitable for management in the primary care setting. METHODS Data were collected from a prospectively maintained database on patients attending SBU at two tertiary referral centres (Beaumont Hospital and University College Hospital Galway) from January 2011 to 2012. Reasons for attendance, outcome of triple-assessment and incidence of malignancy were analysed. RESULTS 14,325 patients underwent triple assessment at the SBU in this time period. 5,841 patients were referred with mastalgia, of whom 3,331 (57 %) reported mastalgia as the only symptom. The incidence of breast cancer in patients presenting with mastalgia alone was 1.2 %. All patients diagnosed with breast cancer in this cohort were over 35 years of age. CONCLUSION The incidence of breast cancer in patients referred to SBU with mastalgia as an isolated symptom is extremely low. Patients under 35 years of age, with mastalgia as an isolated symptom do not require breast imaging and have a sufficiently low risk of breast cancer that they may be suitable for management in the primary care setting.
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Affiliation(s)
- D P Joyce
- Department of Breast and Endocrine Surgery, Beaumont Hospital, Beaumont Road, Dublin 9, Ireland,
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Millar J, Wilson R, O'Connor P, McLaughlin R. Impact of closing an emergency department on a neighbouring teaching hospital: the concentrate effect. Crit Care 2013. [PMCID: PMC3642603 DOI: 10.1186/cc12195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Millar J, Adamson F, O'Connor P, Wilson R, Ferrie E, McLaughlin R. Use of propofol for procedural sedation reduces length of stay in the emergency department. Crit Care 2013. [PMCID: PMC3642759 DOI: 10.1186/cc12328] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
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Hynes SO, McLaughlin R, Kerin M, Rowaiye B, Connolly CE. A unique cause of a rare disorder, unilateral macromastia due to lymphangiomatosis of the breast: a case report. Breast J 2012; 18:367-70. [PMID: 22730958 DOI: 10.1111/j.1524-4741.2012.01256.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Macromastia and in particular unilateral macromastia is a rare clinical entity. It relates to massive enlargement of the breast in non-obese women. This case report describes an initially mild unilateral asymmetry occurring nine months postpartum in a 33-year-old female. However, following her second pregnancy within 12 months, her left breast became severely enlarged. This did not improve on delivery. No discrete lesion was seen on imaging and no significant abnormalities were seen in her blood chemistry. Surgical treatment was a mammoplasty and 580 g of mammary tissue was removed. Grossly, there was spongiform subcutaneous tissue with diffuse extension. On histology, this consisted of a highly complex and diffuse pattern of infiltration and of cavernous empty channels lined by a delicate attenuated endothelium which was CD34 and D2-40 positive. The appearances were consistent with lymphangiomatosis, more commonly encountered in the limbs, heretofore. Lymphangiomatosis has not been previously described in breast tissue and only a single case report exists for such a lesion in axillary tissue. Treatment of such lesions in the periphery by surgical excision is very difficult and excision without being radical can be impossible. Follow up of our patient, shows no evidence of recurrence in this patient. Our case report describes the clinicopathological features, differential diagnosis to be considered and treatment, in addition to reviewing the relevant literature.
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Affiliation(s)
- Sean O Hynes
- Departments of Histopathology Department of Surgery, Galway University Hospitals, Galway, Ireland
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Byrne S, Shatunov A, Bede P, Elamin M, Lynch C, Kenna K, McLaughlin R, Pender N, Bradley D, Al-Chalabi A, Hardiman O. The Population Based Prevalence and Phenotype of 9p21 Hexanucleotide Repeats in ALS/FTD (IN9-1.005). Neurology 2012. [DOI: 10.1212/wnl.78.1_meetingabstracts.in9-1.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Byrne S, Shatunov A, Bede P, Elamin M, Lynch C, Kenna K, McLaughlin R, Pender N, Bradley D, Al-Chalabi A, Hardiman O. The Population Based Prevalence and Phenotype of 9p21 Hexanucleotide Repeats in ALS/FTD (S05.004). Neurology 2012. [DOI: 10.1212/wnl.78.1_meetingabstracts.s05.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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43
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McVeigh T, Al-Azawi D, Sweeney K, Malone C, Keane M, McLaughlin R, Kerin M. Investigating the impact of neoadjuvant chemotherapy and herceptin on the surgical management of patients with invasive breast cancer. Int J Surg 2012. [DOI: 10.1016/j.ijsu.2012.06.078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Wilmes LJ, McLaughlin R, Sinha S, Singer L, Proctor E, Wisner D, Newitt DN, Shankaranarayanan A, Joe BN, Hylton NM. P2-08-06: Improved Spatial Resolution Diffusion-Weighted Imaging for Characterizing Tumors and Treatment Response in Patients with Invasive Breast Cancer. Cancer Res 2011. [DOI: 10.1158/0008-5472.sabcs11-p2-08-06] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: Diffusion weighted magnetic resonance imaging (DWI) is a non-invasive technique that is sensitive to tissue microstructure. Previous studies have shown that DWI adds positive predictive value in diagnostic studies of breast cancer and it has been shown to predict tumor response to neoadjuvant chemotherapy. While DWI shows promise for evaluating breast cancer, the technique suffers from limitations. Specifically, image distortion is common with the echo planar sequence available for DWI on clinical scanners, and spatial resolution is lower than that of other MRI sequences. Our group has optimized a high-resolution reduced field-of-view DWI acquisition, originally developed for the spine by Saritas et al., for breast imaging. The goal of this work was to compare high resolution (hr)-DWI) to standard resolution (std)-DWI for characterizing breast tumors.
Methods: Patients undergoing neoadjuvant chemotherapy were scanned with MRI before, during and after neoadjuvant chemotherapy as part of IRB-approved studies at our institution. Nine women were scanned with both hr-DWI and std-DWI before and after one cycle of chemotherapy. Apparent diffusion coefficient (ADC) maps were calculated from hr-DWI and std-DWI data using previously described methods. One tumor region of interest (ROI) was defined on the hr-DWI slice estimated to contain the largest tumor area. This tumor ROI was then applied to the corresponding slice and location on the std-DWI and hr-DWI ADC maps. Mean tumor ADC as well as 15th, 25th, 50th, 75th, and 90th percentile ADCs were calculated for both DWI acquisitions for all subjects.
Results: The mean tumor ADC values measured prior to treatment were similar for the hr-DWI and std-DWI acquisitions, however there was a significant difference between hr- and std-DWI 15th and 25th percentile ADC values (p= 0.0495, p=0.0717) For the early treatment time point, significant differences between the two DWI acquisitions were found for: mean tumor ADC, 15th, 25th, and 50th percentiles (p=0.0302, 0.0075, 0.0212, and 0.0488, respectively), with the most significant difference found for the lowest (15th) percentile measured. Tumor hr-DWI ADCs were consistently lower than std-DWI ADCs.
Discussion: These data show that although the mean ADC values calculated from the pre-treatment hr-DWI and std-DWI are similar, the lower percentile (15th, and 25th) ADC values are significantly lower for the hr-DWI acquisition. Our results also showed larger difference in lower percentile ADC values between the two sequences after one cycle of chemotherapy. The differences in the lower percentile ADC values calculated from the hr-DWI are consistent with reduced partial voluming between viable tumor tissue, which is characterized low ADC values, and normal fibroglandular tissue. This may be particularly important for post-treatment ADC measurements where tumor size may decrease, potentially making partial volume effects more pronounced. Continuing studies are evaluating the relationship between low percentile ADC values from hr-DWI and tumor stage and response to treatment.
Citation Information: Cancer Res 2011;71(24 Suppl):Abstract nr P2-08-06.
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Affiliation(s)
- LJ Wilmes
- 1University of California San Francisco, San Francisco, CA; GE Healthcare, Menlo Park, CA
| | - R McLaughlin
- 1University of California San Francisco, San Francisco, CA; GE Healthcare, Menlo Park, CA
| | - S Sinha
- 1University of California San Francisco, San Francisco, CA; GE Healthcare, Menlo Park, CA
| | - L Singer
- 1University of California San Francisco, San Francisco, CA; GE Healthcare, Menlo Park, CA
| | - E Proctor
- 1University of California San Francisco, San Francisco, CA; GE Healthcare, Menlo Park, CA
| | - D Wisner
- 1University of California San Francisco, San Francisco, CA; GE Healthcare, Menlo Park, CA
| | - DN Newitt
- 1University of California San Francisco, San Francisco, CA; GE Healthcare, Menlo Park, CA
| | - A Shankaranarayanan
- 1University of California San Francisco, San Francisco, CA; GE Healthcare, Menlo Park, CA
| | - BN Joe
- 1University of California San Francisco, San Francisco, CA; GE Healthcare, Menlo Park, CA
| | - NM Hylton
- 1University of California San Francisco, San Francisco, CA; GE Healthcare, Menlo Park, CA
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Heneghan H, Prichard R, Lyons R, Regan P, Kelly J, Malone C, McLaughlin R, Sweeney K, Kerin M. Quality of life after immediate breast reconstruction and skin-sparing mastectomy – A comparison with patients undergoing breast conserving surgery. European Journal of Surgical Oncology (EJSO) 2011; 37:937-43. [DOI: 10.1016/j.ejso.2011.08.126] [Citation(s) in RCA: 60] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2011] [Revised: 08/06/2011] [Accepted: 08/22/2011] [Indexed: 10/17/2022]
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Perkins R, Furness B, Hager M, McLaughlin R, Goforth J, Davies M. O5-S4.04 Targeted STD screening among high-risk men who have sex with men. Br J Vener Dis 2011. [DOI: 10.1136/sextrans-2011-050109.172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Coll JM, Healy N, Coyne J, Malone C, McLaughlin R, Keane MM, Sweeney KJ, Kerin MJ. Does progesterone receptor status matter in endocrine-responsive breast cancer? J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.15_suppl.e11085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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48
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Millar JE, Fisher B, McLaughlin R. Effect of a trauma proforma on the quality of documentation in the Emergency Department. Crit Care 2011. [PMCID: PMC3068383 DOI: 10.1186/cc9874] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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49
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Heneghan H, Lyons R, Malone C, McLaughlin R, Sweeney K, Kerin M. O-6 Oncological, clinical and quality of life outcomes after immediate breast reconstruction. EJC Suppl 2010. [DOI: 10.1016/j.ejcsup.2010.06.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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50
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Prichard RS, Murphy R, Lowry A, McLaughlin R, Malone C, Kerin MJ. The routine use of post-operative drains in thyroid surgery: an outdated concept. Ir Med J 2010; 103:26-27. [PMID: 20222393] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
The use of surgical drains in patients undergoing thyroid surgery is standard surgical teaching. Life-threatening complications, arising from post-operative haematomas, mandates their utilization. There is increasing evidence to suggest that this is an outdated practice. This paper determines whether thyroid surgery can be safely performed without the routine use of drains. A retrospective review of patients undergoing thyroid surgery, over a three year period was performed and post-operative complications documented. One hundred and four thyroidectomies were performed. 63 (60.6%) patients had a partial thyroidectomy, 27 (25.9%) had a total thyroidectomy and 14 (13.5%) had a sub-total thyroidectomy. Suction drains were not inserted in any patient. A cervical haematoma did not develop in any patient in this series and no patient required re-operation. There is no evidence to suggest the routine use of surgical drains following uncomplicated thyroid surgery reduces the rate of haematoma formation or re-operation rates and indeed is now unwarranted.
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