Experiences with axillary reverse mapping Beek, Martinus A; Gobardhan, Paul D; Klompenhouwer, Elisabeth G ...
Nederlands tijdschrift voor geneeskunde,
02/2020, Letnik:
164
Journal Article
Axillary reverse mapping (ARM) is a technique by which the lymphatic drainage system of the upper extremities is mapped, so that the lymph channels and glands can be preserved during axillary lymph ...node dissection (ALND). This can lead to less postoperative morbidity, such as lymphoedema. A randomised multicentre study showed that there are statistically significantly fewer post-operative symptoms if the lymph channels and glands of the upper extremities are spared with this technique. Despite the declining indication for an ALND, ARM can have added value for the patients who do have to undergo ALND.
The aim of this study was to investigate and compare the prognosis after treatment for loco-regional recurrences (LR) after (modified) radical mastectomy (MRM) or breast conserving therapy (BCT), in ...terms of overall survival and time to subsequent LR, in patients originally treated in two European randomised trials. In EORTC trial 10801 and DBCG trial 82-TM, 1,807 patients with stage I and II breast cancer were randomised to receive MRM or BCT from 1980 to 1989. All patients with a LR in these trials were analysed for survival and time to subsequent LR after salvage treatment. Of these, 133 patients had their LR as a first event, the majority within 5 years after initial treatment. The prognostic significance for survival and time to subsequent LR after salvage treatment was analysed in uni-, and multivariate analyses for a number of original tumour- and recurrence-related variables. After salvage treatment of LR after MRM or BCT, actuarial survival curves and the actuarial locoregional control curves were similar. The 5-year survival rates were 58% and 59% and the 5-year subsequent loco-regional control rates 62% and 63%, respectively. In a multivariate analysis, pN category (P = 0.03), pT category (P = 0.01) and vascular invasion (P = 0.02) of the primary tumour were the only independent prognostic factors for survival, whereas extensive LR (P < 0.001), interval < or = 2 years (P < 0.002) and pN+ at primary treatment (P = 0.004) were significant predictive factors for time to subsequent LR. The type of original treatment (MRM or BCT) did not have any prognostic impact. It is concluded that the survival and time to subsequent LR after treatment for an early loco-regional recurrence after MRM or BCT was similar in these two European randomised trials. This suggests that both after MRM and BCT an early LR is an indicator of a biologically aggressive tumour; early loco-regional relapse carries a poor prognosis and salvage treatment only cures a limited number of patients, whether treated by MRM or BCT originally.
Investigations on diet, body weight, and lipoproteins were carried out in 28 patients with stable angina pectoris. They consumed a linoleic acid-enriched diet (P/S ratio = 2) for a period of 2 years. ...The total fat content remained constant before and during intervention, contributing 34% to energy intake. During intervention serum total cholesterol and the total/HDL cholesterol ratio decreased significantly, but HDL cholesterol did not change. Changes in body weight were significantly inversely related to changes in HDL cholesterol and positively to the total/HDL cholesterol ratio. Changes in alcohol intake were significantly positively related to both total and HDL cholesterol but unrelated to the total/HDL cholesterol ratio. From the results of this long-term study it can be concluded that a moderate fat diet with a P/S ratio of 2 can lower total cholesterol effectively without affecting HDL cholesterol.
There is a dearth of knowledge and understanding concerning hoarding by children and adolescents. Psychiatrists need to know more about the phenomenon of hoarding since it can be a marker of ...psychopathology and it sometimes is symptomatic of a psychiatric disorder.
To review hoarding from an epidemiological and psychopathological perspective and to discuss it in relation to the developmental aspect of the first object acquisition: the transitional object.
We conducted a literature search in PubMed, Medline, PsycINFO and the Cochranedatabase using primarily the search term ‘hoarding', but also in combination with the terms: primates, child, adolescent, psych*, klepto*, transitional object, obsessive-compulsive disorder, collecting and attachment.
Both animals and humans engage frequently in collecting and hoarding. Up to 60% of normally functioning children and adolescents are involved in collecting. A strong emotional attachment to possessions may be a response to an attachment problem. Hoarding combined with psychopathology is seen in persons of all ages but the prevalence rates for children and adults are unknown.
Hoarding is a worrisome type of behaviour which must be regarded as an indication of serious comorbid psychopathology. It can occur either as a symptom of an existing disorder or as a separate disorder. Finally we recommend that hoarding be included in the diagnostic criteria of the dsm and icd.
Buying young people’s health? Voogd, C
British journal of school nursing,
10/2009, Letnik:
4, Številka:
8
Journal Article
It seems that since last spring the practice of using financial incentives and rewards to encourage healthier lifestyles in children and young people is on the increase. For example, schemes are ...offering cash vouchers or entries in draws to reward obese children to lose weight or young people to stop smoking (BBC News, 2009). Not all schemes are there to reward a change in unhealthy behaviours, some are there to encourage Chlamydia screening. For instance, Hammersmith and Fulham NHS (2009) offers £10 HMV vouchers to 16–24-year-olds for sending back their sample.
To analyse the incidence and treatment of ductal carcinoma in situ (DCIS) of the breast in the population.
Retrospective, descriptive.
The incidence of DCIS in the period 1975-1997 in 8 hospitals in ...southeastern North Brabant and northern Limburg, the Netherlands, was analysed, using data from the Eindhoven Cancer Registry. Changes in the treatment of DCIS in the period 1984-1997 were studied, using information from the Breast Cancer Documentation Project.
Between 1975 and 1997, 448 cases of DCIS were detected in 442 women. After adjustment for age according to the European Standard Population, the incidence rate of DCIS increased from 0.3 per 100,000 in 1975 to 13.4 in 1997. Of the 87 patients with DCIS between 50 and 69 years of age in 1996 and 1997, 68% was detected by the screening programme. The proportion of patients with DCIS undergoing ablation of the breast was 53% during the period 1984-1989, and varied around 45% thereafter. The other patients underwent local excision. The proportion of patients receiving radiotherapy after local excision decreased from 78% in the period 1984-1989 to 24% in the period 1994-1995 and rose to 41% during the last few years. Substantial differences in the treatment of DCIS were observed between the 8 hospitals.
The 21st Century Schools White Paper (Department for Children, Schools and Families (DCSF), 2009) was published late last month. According to the DCSF, the aims behind the paper are to ensure that ...every child achieves his/her potential and that the system is increasingly driven by parental demand and choice.
Methyl bromide is commonly used as a soil fumigant in greenhouses. In the framework of a toxicological evaluation, it was tested for possible genotoxic properties in two bacterial test systems (the ...fluctuation test using Klebsiella pneumoniae and the plate test using Salmonella typhimurium TA100 and TA98), two systems using mammalian cells in vitro (forward mutations at the TK and HPRT loci in L5178Y mouse lymphoma cells and unscheduled DNA synthesis in primary rat-liver cells) and in the sex-linked recessive lethal test using Drosophila melanogaster. Methyl bromide was active in all tests except the DNA-repair assay. The results indicate a relatively low mutagenic efficiency of the compound, as expected from its alkylating properties.
The independent review on the proposal to make personal, social, health and economic (PSHE) education statutory (Macdonald, 2009) was published at the end of last month. As a result of this review Ed ...Balls reaffirmed his intentions to make PSHE a statutory subject. The aim is to make PSHE including sex and relationship education (SRE) a compulsory part of the curriculum in primary and secondary schools from September 2011.
