Chadha, Radhika

Jones, Nick

Wood, Kathryn

Elsevier - Publisher Connector 

Abstracts / International Journal of Surgery 11 (2013) 589e685 603
ABSTRACTS1438: CD4+ MEMORY T CELLS (TM) DO NOT PROVIDE "HELP" TO CD4+
NAIVE T CELLS (TN) TO OVERCOME THE EFFECTS OF
IMMUNOSUPPRESSION
Radhika Chadha, Kathryn Wood, Nick Jones. University of Oxford, Oxford, UK.
Aim: To determine in vitro and in vivo whether CD4+ Tm aid naïve CD4+ T
cell responses to alloantigen in the presence of immunosuppressive
therapies.
Methods: Alloreactive TCR-transgenic T cells (TEa) were isolated from
naive TEamice and TEa Tm from TEamice that had previously been primed
with alloantigen. Tn and Tm TEa Tcells were cultured in vitro, separately or
together, in the presence of irradiated allogeneic splenocytes or were
transferred into immunodeﬁcient recipients that received an allogeneic
skin graft. Both cultures and mice also received immunosuppression in the
form of CTLA4-Ig, anti-CD154 or Rapamycin. Tn were ﬂow sorted from
cultures for functional analysis by ELISA and the rate of skin allograft
rejection observed for different groups of mice.
Results: IFN-g production by Tn was increased in vitro following culture
with Tm and Rapamycin compared to cultures of Tn and Rapamycin alone
(1500 231pg/ml vs. 400 53pg/ml). The proliferative capability of Tn
remained unaffected. Furthermore, no speciﬁc impact on Tn was observed
when adoptively transferred with Tm into mice in the presence or absence
of immunosuppression. All Tm-treated mice rejected their allografts more
rapidly.
Conclusion: Tm do not provide “help” to Tn to overcome the effects of
immunosuppression.Interval/years Area A Area B
0 31% (137) 18% (31)
1 32% (139) 38% (68)
2 37% (164) 44% (78)BREAST SURGERY
0128: HANDS UP AFTER BREAST SURGERY! A STUDY INTO POSTOPERA-
TIVE UPPER LIMB SYMPTOMS IN WOMEN UNDERGOING SURGERY FOR
BREAST CANCER
Luke Kelly, Jennifer McIlhenny, Alison Lannigan. Wishaw General Hospital,
Lanarkshire, UK.
Aim: Altered sensation and reduced range of movement in the upper limb
is well documented following breast cancer surgery. We aim to evaluate
the symptom burden in a Lanarkshire population.
Methods: Patients who underwent surgery during a six month period
were invited to complete a postal questionnaire between 2 weeks and 4
months after surgery. Response rate was 73% (63/86).
Results: The majority of patients (96.8% , n¼61) reported having received
post-operative physiotherapy advice.
Numbness in the ipsilateral arm was reported by 60.3% (n¼38): more
commonly after axillary clearance (ANC: 68.8%, n ¼ 11/16) than sentinel
node biopsy (SLNB: 56%, n ¼14/25). Of those who had axillary sampling,
(n¼16), numbness was reported by 61% (n¼11). 42.9% (27) reported
reduction of function of the ipsilateral arm, and of these, 92.6% reported
that this affected daily activities, though to a variable extent.
Performance across a range of arm and shoulder actions wasworse for ANC
compared with SLNB and ANS; and for mastectomy compared with breast
conserving surgery.
Conclusion: In concordance with published cohorts, there remains a
burden of upper limb symptoms after breast cancer surgery. This exists
despite wide dissemination of physiotherapy advice, and is more common
after more extensive procedures.0129: MASTALGIA AS A PREDICTOR OF BREAST CANCER e TRUE OR
FALSE? A STUDY OF THE DIAGNOSTIC IMPORTANCE OF MASTALGIA IN
PATIENTS UNDERGOING MAMMOGRAPHY AT A ONE-STOP BREAST
CLINIC IN LANARKSHIRE
Luke Kelly, Jennifer McIlhenny, Alison Lannigan. Wishaw General Hospital,
Lanarkshire, UK.
Aim: We aim to evaluate the incidence of breast pain in symptomatic
women undergoing mammography, and its signiﬁcance in predicting a
diagnosis of breast cancer.
Methods: This retrospective study uses patient questionnaires completed
at mammography, analysing the incidence of breast pain and laterality.
Data was recorded in a database with the mammographic grading (M1-5)
and subsequent histology if a biopsy was taken.Results: Of 149 patients, 83 reported mastalgia (55.7%). Breast cancer was
diagnosed in 16 patients (10.7%). Of those who reported mastalgia, 9.6%
were subsequently diagnosed with breast cancer (n¼8), of these, pain was
unilateral in 87.5% (n¼7).
Unilateral mastalgia in breast cancer was signiﬁcantly more likely to be on
the ipsilateral side (n¼6 vs 1, P¼0.05, binomial test).
Conclusions: Of those patients with mastalgia who were diagnosed
with breast cancer, pain was signiﬁcantly more likely to affect the
ipsilateral side. Patients with mastalgia were signiﬁcantly less likely to
undergo core biopsy after mammography than those without pain. This
may reﬂect a less suspicious symptom proﬁle overall. The presence of
mastalgia was not shown to have any positive or negative predictive
value for breast cancer.0182: THE EFFECT OF BREAST SCREENING PROTOCOL ON SYMPTOM-
ATIC BREAST CANCER PRESENTATION
Andrew Mishreki, Antionette Moffa, Keith Callanan. University Hospital of
North Durham, Durham, UK.
Introduction: NHS Breast Screening Programme suggests interval cancer
rate increases with time since last screening round. Our symptomatic unit
is divided between two screening centres: ‘A' screens by date of birth
across its catchment area; ‘B' screens individual communities' three-
yearly. We suggest the rate of symptomatic breast cancers from: ‘A' would
vary randomly each year; ‘B' would exhibit a three-yearly cycle.
Methods: Patients diagnosed with symptomatic breast cancer from 1995 -
2011 were identiﬁed. For those in: ‘B' (screening rounds three-yearly from
1994), time since most recent screening was calculated (0-2 years); ‘A', a
time since last screening was allocated for comparison, based on year of
diagnosis, (1994 ¼ 0, 1995 ¼ 1, 1996 ¼ 2, 1997 ¼ 0.).
Exclusions: screen detected, previous breast cancers (< 5 years), males.
Results: 617 women included.The increase in symptomatic cancers presenting from ‘B' over years 0-2 is
much more marked than that in ‘A'.
Conclusions: Screening by area rather than age group leads to a meas-
ureable variation in annual symptomatic breast cancer diagnoses.
Overall 100% (440) 100% (177)0191: THE IMPORTANCE OF MONITORING BONE HEALTH IN BREAST
CANCER PATIENTS
Ozerah Choudhry 1, Louise Olson 2, Sumohan Chatterjee 2, Zahida Saad 2.
1University of Manchester, Manchester, UK; 2 Salford Royal NHS Foundation
Trust, Manchester, UK.
Aim: Aromatase Inhibitors are associated with premature bone mineral
density loss due to reduced oestrogen, which leaves patients susceptible to
fragility fractures. Aims are to assess whether patients are managed ac-
cording to guidelines regarding bone health; whether this is cost e
effective and whether mammographic breast tissue density has a use in
predicting osteoporosis development.
Method: Retrospective analyses of breast cancer and bone health man-
agement, DEXA scans and BIRADS scores were performed using 248 pa-
tient records between 2008 and 2011.
Results: 84% of patientswere appropriatelymanaged regarding bone health
prior toDEXA. FollowingDEXA,59%ofpatientswere identiﬁedasosteopenic
and 13% osteoporotic. 5% of osteopenic patients and 19% of osteoporotic
patients were inappropriately managed. A fragility fracture rate of 2.5% was
observed, with 50% occurring amongst osteopenic patients and 33% osteo-
porotic patients. Following fracture, 33% of patients were managed inade-
quately. The correlation between mammographic breast tissue density and
osteoporosis development proved to be statistically insigniﬁcant (p¼0.879).
Conclusion: Majority of patients have been managed appropriately.
Implication of these guidelines is beneﬁcial to patients, and application is
cost e effective. The correlation between mammographic breast tissue
density and development of osteoporosis is insigniﬁcant, therefore should
not be clinically employed.


CD4+ memory t cells (Tm) do not provide "help" to CD4+ naive t cells (Tn) to overcome the effects of immunosuppression 

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CD4+ memory t cells (Tm) do not provide "help" to CD4+ naive t cells (Tn) to overcome the effects of immunosuppression

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