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Southampton, United States

Layfield D.M.,University of Southampton | Agrawal A.,Portsmouth Breast Surgical Unit | Roche H.,Southampton General Hospital | Cutress R.I.,University of Southampton
British Journal of Surgery

Background: Sentinel lymph node biopsy (SLNB) reduces the morbidity of axillary clearance and is the standard of care for patients with clinically node-negative breast cancer. The ability to analyse the sentinel node during surgery enables a decision to be made whether to proceed to full axillary clearance during primary surgery, thus avoiding a second procedure in node-positive patients. Methods: Current evidence for intraoperative sentinel node analysis following SLNB in breast cancer was reviewed and evaluated, based on articles obtained from a MEDLINE search using the terms 'sentinel node', 'intra-operative' and 'breast cancer'. Results and conclusion: Current methods for evaluating the sentinel node during surgery include cytological and histological techniques. Newer quantitative molecular assays have been the subject of much recent clinical research. Pathological techniques of intraoperative SLNB analysis such as touch imprint cytology and frozen section have a high specificity, but a lower and more variably reported sensitivity. Molecular techniques are potentially able to sample a greater proportion of the sentinel node, and could have higher sensitivity. Copyright © 2010 British Journal of Surgery Society Ltd. Source

Roberts I.S.D.,John Radcliffe Hospital | Benamore R.E.,Churchill Hospital | Benbow E.W.,Royal Infirmary | Lee S.H.,Royal Infirmary | And 7 more authors.
The Lancet

Background: Public objection to autopsy has led to a search for minimally invasive alternatives. Imaging has potential, but its accuracy is unknown. We aimed to identify the accuracy of post-mortem CT and MRI compared with full autopsy in a large series of adult deaths. Methods: This study was undertaken at two UK centres in Manchester and Oxford between April, 2006, and November, 2008. We used whole-body CT and MRI followed by full autopsy to investigate a series of adult deaths that were reported to the coroner. CT and MRI scans were reported independently, each by two radiologists who were masked to the autopsy findings. All four radiologists then produced a consensus report based on both techniques, recorded their confidence in cause of death, and identified whether autopsy was needed. Findings: We assessed 182 unselected cases. The major discrepancy rate between cause of death identified by radiology and autopsy was 32 (95 CI 26-40) for CT, 43 (36-50) for MRI, and 30 (24-37) for the consensus radiology report; 10 (3-17) lower for CT than for MRI. Radiologists indicated that autopsy was not needed in 62 (34; 95 CI 28-41) of 182 cases for CT reports, 76 (42; 35-49) of 182 cases for MRI reports, and 88 (48; 41-56) of 182 cases for consensus reports. Of these cases, the major discrepancy rate compared with autopsy was 16 (95 CI 9-27), 21 (13-32), and 16 (10-25), respectively, which is significantly lower (p<0·0001) than for cases with no definite cause of death. The most common imaging errors in identification of cause of death were ischaemic heart disease (n=27), pulmonary embolism (11), pneumonia (13), and intra-abdominal lesions (16). Interpretation: We found that, compared with traditional autopsy, CT was a more accurate imaging technique than MRI for providing a cause of death. The error rate when radiologists provided a confident cause of death was similar to that for clinical death certificates, and could therefore be acceptable for medicolegal purposes. However, common causes of sudden death are frequently missed on CT and MRI, and, unless these weaknesses are addressed, systematic errors in mortality statistics would result if imaging were to replace conventional autopsy. Funding: Policy Research Programme, Department of Health, UK. © 2012 Elsevier Ltd. Source

Heun R.,Royal Derby Hospital | Schoepf D.,University of Bonn | Potluri R.,Imperial College London | Natalwala A.,Southampton General Hospital
European Psychiatry

Background: Subjects with late-onset Alzheimer's disease (AD) have to be sufficiently healthy to live long enough to experience and to be diagnosed with dementia in later life. In contrast, neurodegeneration and cognitive deficits in AD may increase the frequency of co-morbid disorders and their possible influence on mortality. Consequently, we investigated whether the pattern of co-morbidity and its relevance for later death differed between hospitalized AD and age-matched controls subjects. Methods: Co-morbid diseases with a prevalence of more than 1% at hospital admission were compared between 634 hospitalized AD and 72,244 control subjects aged above 70 years admitted to the University of Birmingham NHS Trust between 1 January 2000 to 31 December 2007. Risk factors, i.e. co-morbid diseases that were predictors of mortality within the 7-year follow-up, were identified and compared. Results: Subjects with AD suffer more eating disorders, infections, brain diseases and neck of femur fractures than other hospitalized elderly patients. In contrast, some cardiovascular diseases and diabetes mellitus were less prevalent in AD subjects in comparison with hospitalized controls. Diseases that might have contributed to later mortality in AD were pneumonia, ischemic heart disease and gastroenteritis, but there were no significant differences in their impact on mortality compared to other hospitalized elderly subjects with the same co-morbidities in multivariate logistic regression analyses. Conclusion: Patients with AD have a different pattern of co-morbidity, but die from the same diseases as other hospitalized patients. Infections including pneumonia and diseases that may occur secondary to neurodegeneration and cognitive decline may need special attention in patients with AD who may not be able to identify or report the early symptoms. Preventive measures may be helpful to reduce the high risk and fatal consequences of undetected disease in AD. © 2011. Source

Wright E.,Southampton General Hospital
Nursing children and young people

Buckle fractures of the distal radius are unique to children. Immobilising the limb in a plaster cast is the traditional treatment. An alternative is to use a removable wrist splint and this has been adopted at the author's clinic. In this article, literature on the change of practice is reviewed, the change is described and the outcomes evaluated. It was found that treatment with the wrist splint was cost-effective and was preferred by children, families and carers. Source

Doull I.,Respiratory Cystic Fibrosis Unit | Evans H.,Southampton General Hospital
Archives of Disease in Childhood

Background: Although care for children with cystic fibrosis (CF) is increasingly shared between CF centres and local CF clinics, the optimal model is unclear. Objectives: The authors compared three models of care within a well established CF network: full centre care; local clinic based care with annual review by the CF centre; and hybrid care, where the child is usually reviewed at least three times a year by the specialist CF centre. Results: Of 199 children and young people with CF in South and Mid Wales, 77 were receiving full care, 102 shared care and 20 hybrid care. There were no significant differences in baseline characteristics, nutritional outcomes or use of chronic therapies. There was however a statistically significant difference between full, shared and hybrid care in mean forced expiratory volume in 1 s (FEV 1) per cent predicted (89.2% vs 74.5% vs 88.9%; p=0.001). Conclusions: These differences in pulmonary function are likely to reflect the model of care received, and may affect long term outcomes. Source

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