Abdelaziz, M.

Ahlijha, B.

Awan, M.

Bazerbashi, S.

Marchbank, A.

Rahamim, J.

Unswoth-White, M.

Elsevier - Publisher Connector 

Abstracts / International Journal of Surgery 8 (2010) 501–578560Conclusions: Whilst FISH is useful in determining HER2 receptor status
particularly when IHC is inconclusive, results not being available multidis-
ciplinarymeetings potentially delays appropriate treatment. Acknowledging
Herceptin is not used to treat all HER2 positive cancers highlights the need to
evaluate its beneﬁts in patients who do not receive chemotherapy.
HOW ACCURATE ARE OUR NEEDLE CORE BIOPSIES IN DETECTING
PHYLLODES TUMOURS?
N. Kain, C.R. Tait, A.M. Wason, P. Carder, R.A. Linforth. Bradford Royal
Inﬁrmary, Bradford
Aims: We aimed to assess how accurate our needle core biopsies are in
detecting phyllodes tumours.
Methods: We retrospectively analysed all needle core biopsies (NCB) and
ﬁnal histology results for breast pathology between 2004 and 2008 at our
hospital which suggested a diagnosis of Phyllodes tumour. These included
both symptomatic and screen-detected patients.
Results: Twenty patients had a diagnosis of possible Phyllodes tumour
from a total of 3250 (0.006 or 6 per thousand cores) - 12 who presented
with a symptomatic breast lump and 8 from breast screening. The median
age for symptomatic group was 40yrs (25 – 75yrs) and 61yrs in screen
detected (53 – 65yrs). Of 9 NCB predicting phyllodes tumour, 8 were
phyllodes. This gave a positive predictive value of 89%. Of the 5 NCBs
predicting ﬁbroadenoma (FA) / benign breast pathology, 2 were conﬁrmed
on ﬁnal excision as phyllodes giving a negative predictive value of 40%.
There were 6 cases of indeterminate NCB (34% of all cases). Final pathology
conﬁrmed 2 of these to be FA/benign breast disease and 4 as phyllodes.
Conclusion: Our results show that NCB suggesting phyllodes are likely to
be accurate. From the indeterminate group, most ﬁnal histologies were
reported as phyllodes therefore favouring excision in this group.
MRI FOR INVASIVE LOBULAR CARCINOMA; IS IT LIKELY TO BE USEFUL?
T. Hanna, R. Watkins, S. Andrews. Derriford Hospital, Plymouth
Aims: Invasive lobular cancer (ILC) is often multifocal with implications
for surgical treatment. MRI more accurately detects multifocality than
standard imaging and NICE guidelines recommend this investigation for
patients considering breast conserving therapy (BCT). Our aim was to
determine the potential beneﬁt of MRI.
Methods: Women diagnosed with ILC between 1996 and 2009 who did
not have MRI were identiﬁed. The preoperative diagnosis and surgical
treatment were reviewed.
Results: 366 women underwent surgery. 159 (43%) initially received BCT
and 207 (57%) mastectomy. Of 159 having initial BCT, only 94 (59%) had
a preoperative diagnosis of ILC and would now warrant MRI. Of these 64
(68%) had no further surgery. 18 (19%) required completion mastectomies
and 9 (10%) had repeat BCT. Three women (4%) needed repeat BCT and
completion mastectomy. The maximum theoretical advantage from pre-
operativeMRIwould be avoidance of 33 repeat operations in 94womenbut
at a cost of approx £500 for each patient with proven ILC eligible for BCT.THE USE OF PLEURX DRAINS IN THE MANAGEMENT OF PERSISTENT
PLEURAL EFFUSION SECONDARY TO MALIGNANT MESOTHELIOMA: A
5 YEAR EXPERIENCE
S. Bazerbashi, M. Abdelaziz, B. Ahlijha, A. Marchbank, M. Awan, J.
Rahamim, M. Unswoth-White. Southwest Cardiothroacic Centre,
Plymouth Hospital NHS TrustObjectives: To report the morbidity and evaluate the outcome and
beneﬁts associated with plurex drain in the management of persistent
malignant pleural effusion in mesothelioma.
Method: This is a 5 year retrospective study; data was collected from
clinical case notes of symptomatic patients who underwent primary or
secondary pleurex drain insertion for malignant plural effusion. 61
patients withmesotheliomawere comparedwith another 61 patients with
other malignancies.
Results: There were 58 (95%) Males and 3 (5%) Females with mean age 
SD of 69.7  8 years. 10 (16%) and 2 (3%) of patients had failed talc plur-
edesis and pleuro peritoneal shunt prior to drain insertion. 65.6% of the
drains were right sided and 35.4% were left sided. 80% of patients reported
immediate improvement post drain insertion and Drainage related pleu-
rodesis was achieved in 38% of patients. 34.4% of patients developed
complications related to plurex drain insertion. The median hospital stay
was 3 days and survival post drain insertion was 146 days.
Conclusion: The use of pleurex drain in pleural effusion associated with
malignant mesothelioma is effective in symptomatic and usually termi-
nally ill patients. It is associated with immediate improvement and few
complications.
PAIN MANAGEMENT IN PAEDIATRIC TRAUMA PATIENTS WITH LONG
BONE FRACTURES IN AN EMERGENCY DEPARTMENT: DO WE COMPLY
WITH THE COLLEGE OF EMERGENCY MEDICINE (CEM) GUIDELINES?
R. Kaba, Y. Sheena, T. Redfern, S. Shubber. Eastbourne District General
Hospital
It has been well documented that, a delay in initiating appropriate anal-
gesia to children with long bone fracture has a direct impact on their
quality of life, clinical state and prolongs hospital stay. Furthermore, it is
also known that time from triage to analgesia amongst the paediatric
population is a key performance indicator, for emergency departments.
We conducted a one year prospective audit, in our emergency department
of children between the ages of 5-15 years, who sustained upper limb long
bone fractures. We compared the time from triage to analgesic ingestion,
and the documentation of pain scores and compared these against the
national CEM targets. An audit of 150 children showed that the percentage
of children receiving analgesia within 20 minutes increase from 25% to
76%, following the introduction local protocols and suggestions. The
documentation of pain scores also rose signiﬁcantly from 40%, to 78% over
a one year period. In this audit we provide suggestions and a protocol that
will aid current CEM guidelines for the management of pain in children
with long bone fractures.
CAROTID ENDARTERECTOMY IN THE ELDERLY: RISK FACTORS, INTRA-
OPERATIVE HAEMODYNAMICS AND SHORT-TERM COMPLICATIONS; A
UK TERTIARY CENTRE EXPERIENCE
Hazim Sadideen 1,2, M. Navidi 1,2, Soundrie Padayachee 2, Peter Taylor 1.
1 Departments of Vascular Surgery; 2Ultrasonic Angiology, Guy’s & St
Thomas? Hospital NHS Trust
Introduction: Literature has reported the safety of carotid endarterec-
tomy (CE) in the elderly. This study reports a UK-experience with partic-
ular attention to intra-operative haemodynamics.
Methods: 496 consecutive patients with >70% stenosis who underwent
CE were prospectively assessed and divided into those <75yrs (n ¼ 408;
mean 64yrs) and those >75yrs (n ¼ 88; mean 78yrs). Risk factors, hae-
modynamic parameters, surgical techniques and 30-day peri-operative
complications were compared.


The Use of Pleurx Drains in the Management of Persistent Pleural Effusion Secondary to Malignant Mesothelioma: A 5 Year Experience 

file:///data/core-remote/dit/data/elsevier/pdf/1ff/aHR0cDovL2FwaS5lbHNldmllci5jb20vY29udGVudC9hcnRpY2xlL3BpaS9zMTc0MzkxOTExMDAwMzE5NQ==.pdf

The Use of Pleurx Drains in the Management of Persistent Pleural Effusion Secondary to Malignant Mesothelioma: A 5 Year Experience

Abstract

Similar works

Full text

Available Versions

Elsevier - Publisher Connector