Clinical, histological and immunological studies in human breast cancer

Part 1 (Volume 1) A clinico-pathological investigation into the significance of metastases and reactive changes in regional lymph nodes draining breast cancer. In the introduction, an extensive review of the literature is presented. The original work, which involved review of clinical records, histological techniques, radio-isotope scanning and data processing, is then described. The principal findings were: 1. Lower axillary sampling was only useful for indicating prognosis in primary breast cancer if more than one node was found. However, a trial of sampling versus clearance demonstrated that, if done correctly, sampling was equally capable of detecting metastases. 2. Nodal metastases were shown to correlate significantly with tumour size, tumour border, histological grade, oestrogen receptor status and duration of symptoms. 3. A grading system incorporating all the major histological reactive changes was shown to be an effective prognostic index, but favourable reactive changes were found to be associated with favourable tumour factors, suggesting that these nodal reactions may merely reflect the nature of the tumour rather than represent an effective host response. Furthermore, sinus histiocytosis, a reactive change which is widely recognised to be a favourable prognostic factor, was shown to be induced by breast biopsy. 4. The prognostic significance of lymphocytic infiltration of breast cancer was found to be dependent on reactive changes in the regional nodes. 5« The inaccuracy of clinical examination in detecting axillary metastases or assessing reactive changes was confirmed. Axillary lymphoscintigraphy was found to be no more effective than clinical examination in detecting nodal metastases, but a computer-based combination analysis of several parameters related to metastases was a significant improvement. Part 2 (Volume 2) An investigation into some of the properties of monocytes and macrophages in breast cancer patients and normal subjects. In the introduction, a review of the literature is presented. The original work, which involved the identification and characterisation of monocytes and macrophages using rosetting techniques and immunoperoxidase staining, is then described. The principal findings were: 1. Peripheral blood monocytes from breast cancer patients were activated in terms of lysozyme content and Fc (IgG) receptor expression. 2. Tumour-infiltrating macrophages showed depressed lysozyme and alpha-1-antitrypsin contents and defective phagocytosis of IgG-coated red blood cells. 3« A higher macrophage content was found in tumours with a poor prognosis when compared to tumours with a good prognosis. These findings suggest that tumour-infiltrating macrophages are selectively depressed, accounting for their lack of anti-tumour activity in vivo. 4. Studies on normal monocytes revealed that the third component of complement can stimulate lysozyme synthesis, and that phagocytosis may induce the release of alpha- 1-antitrypsin. Both of these findings may represent important regulatory mechanisms in monocyte/macrophage physiology

Practical management of acute gastrointestinal bleeding

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Testing of frost hardiness models for Pinus sylvestris in natural conditions and in elevated temperature

<p>OBJECTIVE: Aspirin is associated with a reduced risk of developing colorectal cancer. This study examined whether patients with colorectal cancer prescribed aspirin had improved survival.</p> <p>DESIGN: An observational population cohort study was undertaken using data linkage of cancer registry, dispensed prescriptions and death certificate records in Tayside, Scotland. All community prescribed aspirin pre- and post-diagnosis was extracted and periods of aspirin use post-diagnosis for each individual were analysed using Cox proportional hazard models. Main outcome measures were all-cause and colorectal mortality from death certificates.</p> <p>RESULTS: Two thousand nine hundred ninety patients were identified with colorectal cancer between 1st January 1997 and 30th December 2006 and followed up until 28th February 2010. Median age at diagnosis was 73 (interquartile range [IQR] 65-80) with 52% male. One thousand nine hundred ninety-eight (67%) deaths were recorded with 1021 (34%) attributed to colorectal cancer. One thousand three hundred forty (45%) patients used aspirin at some stage of the study period. Aspirin use post-diagnosis was associated with lower risk of all cause mortality (hazard ratio [HR]=0.67, 95% confidence interval [CI]=0.57-0.79, p<0.001) and colorectal cancer specific mortality after allowing for age, Dukes' stage, gender, socio-economic status and aspirin use pre-diagnosis. Increasing age and stage at diagnosis were associated with increased risk, with more affluent patients at reduced risk.</p> <p>CONCLUSIONS: Our study suggests that aspirin use post-diagnosis of colorectal cancer may reduce both all cause and colorectal cancer specific mortality. However further work is required to ensure this is a causal relationship and to identify whether it is best used in specific groups of patients.</p&gt

Training specialist registrars in general surgery: A qualitative study in Tayside

BACKGROUND:Owing to decreased hours of work and duration of training, there is a need to refashion the training of surgical specialist registrars (SpRs) in the United Kingdom. This requires more guidance for trainers, but consensus regarding good trainer attributes does not exist. This study describes the training practices of Tayside general surgical trainers working with SpRs and highlights good training practice involving technical and patient management skills.METHODS: 1) Semi-structured interviews carried out with eighteen consultant trainers and twelve SpRs, 2) Action inquiry (i.e. observations and dialogue with participants) during ward, theatre, outpatient clinic and other hospital-based settings with eleven consultant and SpRs pairs.RESULTS AND CONCLUSION: Participants reflected on multiple training episodes and evaluated their impact. Relatively positive or negative impacts on their skill learning, self-esteem and relationship with the trainee or trainer were described. These are presented and discussed in terms of their implications for equipping trainers with techniques for training registrars and those factors which have hindered the adoption of successful strategie

Attributes of trainers for postgraduate training in general surgery - A national consensus

Background: The aim of this study was to obtain consensus amongst consultant surgeons on the attributes of a good surgical trainer that can be used to inform continuing professional development programmes for trainers. Methods: good trainer attributes were generated from an intensive qualitative study using a participative inquiry process with consultant general surgeons and specialist registrars in the Tayside region. These good trainer attributes were then used as the basis of a modified Delphi study; the early rounds of the Delphi simultaneously sought participants' views concerning stated attributes and sought to generate new attributes. A final Delphi questionnaire was sent to all 180 consultant general surgeons in Scotland to identify consensus. Results: The first two rounds of the Delphi process produced 45 attributes covering seven themes: interest in training, trainer as a team member, communication, receptiveness to trainee needs, trainer as a role model, reflection on practice and clinical and operative competence. The final survey identified significant consensus among surgeons. Clinical and operative competence achieved the highest consensus with 89.2% of surgeons believing it to be an essential attribute. Conclusions: The results indicate that there is consensus on the seven themes identified as essential for a trainer in general surgery. The recognition of the importance by trainers of non-surgical trainer attributes in the changed training structure is encouraging. Surgeons' level of awareness of their roles as a trainer will help inform the level and direction of trainer training and support required as part of a flexible and continuing developmental proces

Training specialist registrars in general surgery: A qualitative study in Tayside

BACKGROUND:Owing to decreased hours of work and duration of training, there is a need to refashion the training of surgical specialist registrars (SpRs) in the United Kingdom. This requires more guidance for trainers, but consensus regarding good trainer attributes does not exist. This study describes the training practices of Tayside general surgical trainers working with SpRs and highlights good training practice involving technical and patient management skills.METHODS: 1) Semi-structured interviews carried out with eighteen consultant trainers and twelve SpRs, 2) Action inquiry (i.e. observations and dialogue with participants) during ward, theatre, outpatient clinic and other hospital-based settings with eleven consultant and SpRs pairs.RESULTS AND CONCLUSION: Participants reflected on multiple training episodes and evaluated their impact. Relatively positive or negative impacts on their skill learning, self-esteem and relationship with the trainee or trainer were described. These are presented and discussed in terms of their implications for equipping trainers with techniques for training registrars and those factors which have hindered the adoption of successful strategie