Edinburgh Experience Research Articles

Combination blue dye sentinel lymph node biopsy and axillary node sampling: The Edinburgh experience

The sentinel node biopsy technique which is being increasingly used to stage breast cancers has limitations regarding not being able to find the blue hot node in about 5% of cases and false negative results in 7% of cases. It has been suggested this is probably due to tumour blocking the lymphatic channels. The four node sampling technique is dependent on the surgeon's ability to find abnormal palpable nodes in the axilla without visual or radioactive signal directions. We have combined the two techniques with the expectation to improve the results. The study evaluates the combined technique in 434 patients with early breast cancer in a single centre. A blue sentinel node was identified in 394 of 434 cases (91.7%), the false negative rate was 2.4%. Thirty six patients had no sentinel node identified. Thirteen of these had positive nodes in the node sample. Axillary node sampling adds to the accuracy of the sentinel node biopsy using blue dye. Pathological features suggest that the principal cause of false negative sentinel node biopsy is due to blocking of the lymphatic channels by the cancer.

Cutaneous malignant melanoma. Publicity, screening clinics and survival--the Edinburgh experience 1982-90.

The incidence of cutaneous malignant melanoma has increased considerably in south-east Scotland over recent years. In 1987 the Cancer Research Campaign launched a project to aid the early detection, diagnosis and treatment of malignant melanoma. Edinburgh, chosen as one of seven centres in the U.K. to participate in the study, was provided with funding for a direct access pigmented lesion clinic from 1987 to 1989. The changes in the pattern of cutaneous malignant melanoma before, during and after the publicity campaign have been examined; between 1982 and 1990. The incidence of malignant melanoma doubled from 5.7 to 11.4/100,000 per annum. The percentage of thin tumours (Breslow thickness < or = 1.5 mm) increased steadily and significantly (from 43% in 1982 to 68% in 1990), but the number of thick tumours (Breslow thickness > 3.0 mm) remained constant over the same period (22 +/- 3.8). The influence of publicity was assessed using a questionnaire. Those who were influenced by publicity were significantly younger and had more thin tumours (Breslow < or = 1.5 mm) than those who were uninfluenced by publicity. Five-year survival has significantly increased from 70% in the 1982-84 cohort to 84% in the 1987-89 cohort. The effect of the publicity campaign has been beneficial, but the impact on mortality cannot yet be assessed.

Comparison of cartilage scoring and cartilage sparing otoplasty – A study of 203 cases

The Edinburgh experience of different methods of otoplasty techniques in 203 patients (406 ears) over a five-year period is reviewed. The patients were divided into three groups - Group A (anterior cartilage scoring), Group B (cartilage sparing in the fashion of posterior suturing) and Group C (posterior suturing refined with posterior fascial flap). Demographic details, operation technique, operation time, grade of the surgeon, suture materials, early and late complications, recurrence and revision rates, patients' and physicians' comments at the follow-up clinic were retrieved from the case notes. The pre- and the post-operative photographs were assessed by a blinded lay observer and a physician and scored on a visual analogue scale. Median follow-up was 11 months. The recurrence rate was 11.0%, 8.0% and 4.8% in Groups A, B and C, respectively (p = 0.0214). Complications were more common in Group A (8.8%) and Group B (7.9%) compared to Group C (1.2%) (p = 0.0208). The cosmetic result was judged best in Group C. In our experience, cartilage-sparing otoplasty refined with the post-auricular fascial flap results in significantly reduced complication rate and improved aesthetic outcome.

145 Budd-Chiari syndrome (BCS): The Edinburgh experience

145 Budd-Chiari syndrome (BCS): The Edinburgh experience

Growth factor signalling in clinical breast cancer and its impact on response to conventional therapies: the Edinburgh experience

Neoadjuvant endocrine treatment in which therapy is given while the primary tumour is still in the breast provides a highly useful model system by which to identify mechanisms associated with de novo resistance and signs of early acquired resistance. Most importantly, the model is clinically relevant. It has been confirmed that the absence of tumour oestrogen receptors confers resistance to endocrine therapy. Early changes in tumour cell proliferation following neoadjuvant treatment with the third-generation aromatase inhibitor, letrozole, do not predict accurately for subsequent clinical response. Additionally, changes in proliferation seen at later times can be the consequence of response and may be associated with early resistance. High expression of c-erbB2 does not reduce tumour responses to neoadjuvant treatment with aromatase inhibitors, but is associated with high tumour proliferation before and during treatment. It remains to be determined whether these characteristics confer subsequent resistance to treatment and early relapse in the adjuvant setting.

Testicular Sex Cord–Stromal Tumours: The Edinburgh Experience 1988–2002, and a Review of the Literature

Sex cord-stromal tumours of the testis are uncommon tumours, accounting for around 5% of testicular neoplasms. Treatment is primarily surgical, with no adjuvant therapy of proven benefit. We present a single-centre experience over a period of 15 years. From 1988 to 2002, 18 patients with a diagnosis of sex cord-stromal tumour were referred to our centre. A retrospective analysis of their case notes was made and a pathological review undertaken. Sixteen were Leydig-cell tumours and two were Sertoli cell. For the Leydig-cell tumours, the median age at presentation was 42 years, 50% presented with a testicular mass and 31% with gynaecomastia. Two patients followed a malignant course: one revealing disease dissemination at initial staging, and a second 12 months after potentially curative orchidectomy. Salvage retroperitoneal lymphadenectomy in the latter patient proved unsuccessful. Clinical outcome correlated strongly with the presence of adverse pathological features described previously in the literature. After a median follow-up of 46 months, two patients have developed progressive disease, and two patients have died, one of metastatic Leydig-cell tumour. No patient defined as being of low malignant potential on pathological examination has relapsed outside our review period of 2 years. We confirm the overall excellent prognosis for most of the patients with sex cord-stromal tumours of the testis. Compared with most previous reports, pathological features seem to predict with reasonable accuracy the risk of malignant behaviour, and can adequately inform the subsequent review policy.

Direct access ambulatory BP monitoring???the Edinburgh experience

The use of electronic measurement of blood pressure and, in particular, ambulatory blood pressure monitoring offers the opportunity to determine which patients with apparent hypertension have truly sustained elevation of their blood pressure levels. Given the high prevalence of hypertension and the even larger number of individuals who appear to be hypertensive but may not be so, it is difficult to deliver ambulatory blood pressure monitoring to all individuals who might benefit from it. In Edinburgh, Scotland, we have piloted a system of direct access ambulatory blood pressure monitoring whereby physicians in primary care can request of the hospital service, an ambulatory monitor on their patient without the patients attending a formal hospital clinic. In the 7 years since the service was first instituted, almost 6,000 monitors have been performed with referrals running at approximately 100 per month in recent times. The present study was set up to assess the impact of the ambulatory monitor result on clinical decision making in primary care. The referral form invited primary care physicians to indicate their planned management if an ambulatory monitor had not been available and we thereafter audited patient records to determine what ultimately happened following the advice given on the basis of the ambulatory monitoring record.A random sample of results was obtained on untreated patients and approximately 500 were analysed. It was clear that if the advice to the primary care physician based upon the ABPM was not to treat, that this was largely followed with some 94% of patients not receiving treatment within 3 months of the monitor. If, however, the advice given was to start treatment, this was less reliably followed and in only 76% of patients treatment was started within 3 months. At the time of the audit this figure had increased to 82%. Primary care physicians had indicated that they would have treated 60% of the individuals referred and in reality only treated 40%. The potential saving in drug costs from the reduction by 20% of those treated would have significant impact on health care budgets.

The role of marketing in quality bus corridor promotion

Quality bus corridors (QBCs) are being implemented in towns and cities throughout the British Isles in order to improve the image of the bus and to boost patronage, with a view to meeting local and national transport policy objectives such as reduced reliance on the private car. QBC initiatives commonly consist of bus priority measures, improved vehicles, enhanced waiting environments, better information and, sometimes, enhanced service frequencies. The purpose of this paper is to examine the importance of the marketing of the QBC concept to the achievement of its objectives: are infrastructure and services sufficient, or will careful marketing increase awareness of the QBC and hence its overall effectiveness? To answer this question, the paper considers empirical experience of QBC implementation in one smaller and two larger urban areas in Britain—with its largely deregulated bus system—and the Republic of Ireland. Based on interview data from local authorities and operators, and on other unpublished information, comparisons are drawn between the QBC experience in Perth and Edinburgh in Scotland and Dublin in Ireland. The British examples are of interest because of their creation of an overall image for bus travel—through Greenways in Edinburgh, and Kick Start in Perth. Their Irish comparator has invested in vehicles and infrastructure, with less attention paid to the overall image of the QBCs. The paper will assess whether or not this is important.

41 The decision for percutaneous nephrolithotomy with a multiple puncture technique. Does therapeutic outcome justify potential risks? The Edinburgh experience

41 The decision for percutaneous nephrolithotomy with a multiple puncture technique. Does therapeutic outcome justify potential risks? The Edinburgh experience

Current practice: The development of an alcohol liaison service within a general hospital setting: the Edinburgh experience

In 1992, a Scottish Office grant was awarded to develop a nurse‐led alcohol liaison service for patients within a busy general hospital (Leslie &amp; Learmonth, 1994).This project was based on previous research conducted in the same hospital that concluded that early detection of alcohol problems and minimal intervention could considerably reduce long‐term alcohol‐related damage (Chick et al., 1985). A first article describing the service was published in 1994 (Leslie &amp; Learmonth). This follow‐up article aims to describe how the service has developed and expanded since then. This includes the many issues we have encountered on our path to a greater understanding and delivery of specialist alcohol service.

Clinical use of Infliximab in Crohn's disease: the Edinburgh experience

Clinical use of Infliximab in Crohn's disease: the Edinburgh experience

Clinical use of Infliximab in Crohn’s disease: the Edinburgh experience

Infliximab is an established treatment for steroid-resistant and fistulating Crohn's disease. Although efficacy has been shown in clinical trials, financial implications often limit its use and limited data exist regarding clinical practice. To audit the clinical effectiveness of Infliximab. We prospectively audited 50 consecutive patients [28 females; median age, 34 years (17-70 years)]. Disease activity and response rates were assessed by the Harvey-Bradshaw index. Clinical and disease data were collected and blood was taken for inflammatory markers, complement and double-stranded DNA antibodies. Patients received Infliximab at 5 mg/kg and were followed for 12 weeks. Indications for Infliximab were refractory Crohn's disease in 39 patients, fistulating Crohn's disease in six, pyoderma gangrenosum in one, pouchitis in two and coeliac disease in two. Thirty-one (79%) of the refractory Crohn's disease patients and four (66%) of the fistulating patients responded at 4 weeks. Twenty-one (54%) of the refractory Crohn's disease patients had a continued response at 12 weeks. Perianal disease was more prevalent in non-responders (7/8 vs. 12/31, P < 0.02). Response rates to Infliximab in our group are comparable to those of clinical trials. Despite the expense, it remains a useful adjunct to treatment in this otherwise difficult group of patients. Patients with perianal disease responded less well in our cohort.

How best to express oestrogen receptor activity

Oestrogen receptor (ER) activity, detected and expressed in a variety of ways, is important in breast cancer. Experience in Edinburgh (1973–1996) showed that [1] no single mode of expression was entirely satisfactory, [2] the probability of a good ‘outcome’ (prognosis or response to endocrine therapy) increased with increasing activity (either fmol ER sites/mg protein or per cent cells staining for ER). Thus the use of a single ‘cut-off’ should be avoided and activity quantified, or stratified into categories.

TRANSPORT PLANNING IN DUBLIN AND EDINBURGH.

Keywords TRINITY COLLEGE DUBLIN TRANSPORT, PLANNING, CITIES, URBAN, POLICIES, LRT, LIGHT RAIL, TRANSIT, BUSWAYS, UNDERGROUND, RAILWAYS, OPERATION, CITY CENTRES, PUBLIC, CONSULTATION, STRATEGIES, STUDIES, CONGESTION, AIR, POLLUTION, USE, LAND, LAND USE, POLITICS, ROADS, PRICING DUBLIN, EDINBURGH, SCOTLAND UK, IRELAND, EIRE... Show All

35. Antenatal screening for cystic fibrosis: The Edinburgh experience

35. Antenatal screening for cystic fibrosis: The Edinburgh experience

Long-term follow-up after breast conservation: the Edinburgh experience

Abstract The value of long-term follow-up of patients treated by breast-conserving therapy is uncertain. An audit was carried out of 341 such patients treated between 1986 and 1990. The follow-up schedule was 3- to 4-monthly for 3 years then 6-monthly thereafter with annual mammography. Relapse occured in 75 patients. The site of first relapse was local in 24, regional in 12, contralateral breast in 4 and distant in 35. The detection rate at routine visits was 0.6% whereas it was 21.5% at interval visits. The detection rate of recurrent cancers on mammography in asymptomatic patients was 0.6%. Ninety-four per cent of patients with distant disease presented with symptoms. The low detection rate for relapse at routine visits and the higher yield among symptomatic patients at interval visits suggests that annual mammography with prompt assessment of symptomatic patients would make better use of clinic resources.

Rollerblading in children: the Edinburgh experience.

To determine the incidence and severity of injuries sustained by children who present to an accident and emergency (A&E) department following rollerblading accidents. A prospective case-control study. The A&E department of a city centre paediatric teaching hospital. Data were collected on a specially designed proforma on each child presenting with an injury sustained while rollerblading. The injury severity score was calculated for each patient and details were taken of the length of admission or outpatient follow up where appropriate. Seventy four children (37 male; 37 female) presented with injuries over a three month period. The age range was 6-13 years in both groups. Half the injuries occurred at weekends. Fractures (n = 37) and soft tissue injuries (n = 28) were the most prevalent; 89% of injuries involved the limbs. Sixty eight children (92%) required treatment in A&E. Four (3%) were admitted to hospital and required operative procedures under general anaesthetic. The injury severity score ranged from 1 to 9 with a mean of 2.8. The length of hospital stay for admissions was 1-3 days; 47 children required follow up in the outpatient department (1-3 visits). Average length of outpatient contact was 18 days. This study shows a greater incidence of rollerblading injuries than has been reported elsewhere. No figures are at present available for the United Kingdom as a whole.

Burn injuries caused by chip-pan fires: the Edinburgh experience

Thirty-two patients were admitted to the South-East Scotland Burn Unit over a 4-year period (1990–1994), with burns sustained as a consequence of chip-pan fires. This represented 7 per cent of all admissions to the unit. Fourteen patients came from the Edinburgh city area, and 18 from surrounding countries. There were 14 males and 18 females, and an average age of 51.6 years. The average burn surface area was 4.7 per cent. Eighteen patients had burns to their hands, this being the most common area involved. Fourteen patients were managed conservatively, and 18 needed operative intervention. The patients spent an average of 19.4 days in hospital, and they required 46.3 days for complete healing to take place. Prevention by increased community awareness and widespread education is necessary to minimize the incidence, morbidity and cost of this relatively common and preventable type of burn.

Treatment of hepatitis C infection in haemophiliacs: the Edinburgh experience.

Treatment of hepatitis C infection in haemophiliacs: the Edinburgh experience.

Uterine sarcomas: a review of the Edinburgh experience from 1974 to 1992

A retrospective review of patients treated for a uterine sarcoma in Edinburgh from 1974 to 1992 has been performed. Clinical details at presentation, tumour pathology, treatment and the outcome of treatment were all recorded. 82 patients' case notes were reviewed. 54 patients had died and 28 were alive (mean follow-up period 80.3 months). 39 patients had a malignant mixed mesodermal tumour, 12 patients had an endometrial stromal sarcoma, and 27 had a leiomyosarcoma. Using a modified FIGO staging retrospectively, 41 patients had Stage 1 disease, two patients had Stage 2, 16 patients had Stage 3, and 13 patients had Stage 4 disease. Definitive treatment of total abdominal hysterectomy and bilateral salpingo-oophorectomy was used in 69 patients, with 35 of these patients also receiving post-operative radiotherapy to the pelvis. 13 patients did not undergo surgery. Five of these patients received radical radiotherapy, three patients received palliative radiotherapy, and five patients were not treated. The overall median survival is 15 months and the 5-year actuarial survival is 31%. 25 of the 26 surviving patients had Stage 1 disease at presentation. Post-operative pelvic radiotherapy did not influence either survival or local tumour control. 51 of the 54 patients who relapsed had evidence of distant metastases. We conclude that total abdominal hysterectomy and bilateral salpingo-oophorectomy remains the treatment of choice for uterine sarcomas.