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Biomedical subjects

A P Corder

Publications and source records attributed to A P Corder.

At least 19 recordsLinked to original sources
PubMed2003

Core biopsy vs fine needle aspiration cytology in a symptomatic breast clinic.

AIM: The adequacy of physical examination, mammography and fine needle aspiration cytology (FNAC) (conventional triple assessment) in the diagnosis of breast cancer has been questioned. We have performed a prospective study directly comparing FNAC and core biopsy in our symptomatic breast clinic. METHOD: Between 15/5/00 and 17/1/01, 330 consecutive patients with breast lumps were assessed by physical examination, ultrasound, and mammography if over 35 years, and FNAC and core biopsy with or without ultrasound guidance. RESULTS: Three hundred and forty four specimens yielded the following FNAC and core biopsy results: C1-109, C2-144, C3-6, C4-17, C5-68; B1-97, B2-150, B3-7, B4-3, B5-87. The FNAC results corresponding to the 87 B5 samples were as follows: C1-5, C2-2, C3-0, C4-12, C5-68. All C5 samples were associated with a corresponding B5 result. All except one cancer in this series was diagnosed at a single clinic visit. CONCLUSION: In this series, core biopsy diagnosed symptomatic breast cancer more accurately than FNAC.

Adult↗
PubMed2002

An unusual case of metastatic post-irradiation breast sarcoma.

A 71-year-old lady developed a left breast angiosarcoma 10 years after a wide local excision and external beam radiotherapy for invasive breast cancer. Three years after a left simple mastectomy for the angiosarcoma, she presented with metastatic angiosarcoma in the contralateral axilla. There were no local or distant metastases. This is the first reported case of isolated contralateral axillary metastases from post-irradiation angiosarcoma of the breast. A previous study has reported ipsilateral axillary metastases in relation to secondary breast angiosarcoma. Contralateral axillary metastases have always been associated with extensive distant metastases. We present a review of the available literature on radiation-associated breast angiosarcomas.

Journal Article↗
PubMed1996

Administrative aspects of a general surgical firm: an audit of accuracy of operation lists and timeliness of discharge summaries.

A one-year audit of operation lists and discharge summaries of one surgical firm showed only 1.4 percent of operation lists contained errors or omissions and only 5 percent contained abbreviations. 74.2 percent of discharge summaries were dictated within one week of discharge. A high proportion of day cases allowed 44.7 percent of the discharge summaries to be dictated on the day of operation. Close consultant and secretarial involvement in the preparation of operating lists can ensure a high degree of accuracy. Day case operation notes should be combined with a discharge letter to optimise communication with general practitioners.

Appointments and Schedules↗
PubMed1994

Leakage from stapled low anastomosis after total mesorectal excision for carcinoma of the rectum.

Over 14 years 276 patients with rectal cancer underwent surgery; 219 who underwent low anterior resection of the rectum with total mesorectal excision were studied. There were 24 (11.0 per cent) major anastomotic leaks associated with peritonitis or a pelvic collection and 14 (6.4 per cent) minor leaks that were asymptomatic and detected by contrast enema. All major leaks occurred at an anastomotic height of less than 6 cm (P = 0.08). The abdominoperineal excision rate was 9.1 per cent. Major leaks were associated with failure to defunction in 11 of 62 patients and with a defunctioning colostomy in 13 of 157 (P = 0.03). Of the 24 patients with major leaks seven developed peritonitis, one with a defunctioned anastomosis (P = 0.002), and three died (P = 0.02). Use of the sigmoid colon led to major leakage in seven of 32 patients compared with 17 of 187 when the splenic flexure was employed (P = 0.05). There was no increase in the local recurrence rate but only nine patients with major leakage and a temporary stoma have had these closed. Key technical factors include: a clean dry pelvic cavity, pulsatile colonic blood supply, suction drainage started during closure and mobilization of ample tissue to fill the pelvic space.

Adult↗
PubMed1994

The timing of breast cancer surgery within the menstrual cycle.

The effects of the timing of surgery, fine needle aspiration cytology (FNAC) and mammography within the menstrual cycle were investigated retrospectively in 211 premenopausal breast cancer patients. The day of surgery within the menstrual cycle was known for 157 women whose menstrual cycles were regular. Recurrence and survival were closely similar whether surgery was performed during days 3-12 or at other times (days 0-2 or 13-32) in the cycle. Outcome was also unrelated to the timing of mammography which was known in 101 cases. There were no significant differences in recurrence or survival associated with the timing of FNAC when all patients were considered. In the subset of lymph node negative patients (n = 32), however, FNAC outside days 3-12 was associated with a significantly decreased rate of relapse (RR = 0.25, 95% CI = 0.07-0.9) and death (RR = 0.10, 95% CI = 0.02-0.9). These patients, however, also had significantly smaller tumours (median = 2 cm, interquartile range = 2-3 cm) than patients having FNAC on days 3-12 of the cycle (median = 3, interquartile range = 2-4) (Mann-Whitney: z = 2.11, P = 0.04). We have not confirmed that surgery or FNAC during days 3-12 of the cycle is associated with a poorer outcome than interventions during other parts of the cycle.

Adult↗
PubMed1992

Flush aortic tie versus selective preservation of the ascending left colic artery in low anterior resection for rectal carcinoma.

The effects of two methods of colonic vascular ligation were studied in 143 consecutive patients who underwent low anterior resection with total mesorectal excision and full mobilization of the splenic flexure. Either the ascending left colic artery (ALCA) was selectively preserved (n = 52) or a flush aortic ligation was performed (n = 91). In those with a protective colostomy, the radiological leak rate was 12 per cent when the ALCA was preserved (n = 41) and 10 per cent when a flush aortic tie was performed (n = 60) (P greater than 0.95; 95 per cent confidence interval (c.i.) for difference -10 to +15 per cent). In those without a colostomy, the clinical leak rates of 9 per cent when the ALCA was preserved (n = 11) and 19 per cent when a flush aortic tie was performed (n = 31) were not significantly different (P greater than 0.10; 95 per cent c.i. for difference -12 to +32 per cent). Proportional hazards analysis showed no association between the method of vascular ligation and the risk of tumour recurrence and death. Anastomotic leak rates, tumour recurrence and survival were not related to the method of vascular ligation.

Anastomosis, Surgical↗
PubMed1992

The diagnosis of femoral hernia.

The accuracy of diagnosis of femoral hernia in referrals to a district general hospital over a period of 5 years has been studied and related to clinical outcome. A correct diagnosis was made in only 36 of 98 cases (60 urgent, 38 routine) before admission to hospital. A correct pre-operative diagnosis was ultimately made in 85 cases. Four patients, all urgent admissions with incarcerated bowel, died within 30 days of operation. In none of these cases was a correct diagnosis made before admission to hospital. The median length of post-operative stay of urgent admissions was 7 days (range 4-50) when a correct initial diagnosis was made and 10 days (range 4-50) when the initial diagnosis was incorrect (P = 0.07, Mann-Whitney test). When strangulated small bowel was found at operation, 70% of those with an incorrect initial diagnosis (n = 23) required resection, as compared with 20% of those with a correct initial diagnosis (n = 10, P = 0.014, chi 2 with Yates' correction). Femoral hernias are frequently incorrectly diagnosed before hospital admission and this is associated with worsened outcome in urgent cases.

Adult↗
PubMed1992

What are the benefits of routine breast cancer follow-up?

The value of follow-up after potentially curative treatment of breast cancer remains controversial. Recurrence-free women (n = 402) attending a breast clinic over a 3 month period were studied. The women attended 423 appointments, 412 of which were routine. Eleven were requested by the patient or general practitioner (interval appointments). All 11 interval and 19 of the routine appointments resulted in investigations for possible recurrence. Three (27%) interval appointments and four (1%) routine appointments resulted in the diagnosis of a recurrence (P < 10(-5). The attitudes of 285 patients to follow-up were investigated by questionnaire. Two hundred and twenty-three (78%) questionnaires were completed. Regular follow-up in the breast clinic was preferred to attendance only when symptomatic by 190 (85%) women and 169 (76%) preferred regular breast clinic visits to general practitioner follow-up. Most women (n = 174) (81%) said they felt reassured and less anxious having attended the breast clinic. Routine follow-up after potentially curative treatment of breast cancer is inefficient in the detection of recurrence. It is, however, highly rated for providing reassurance and reducing anxiety. Reassurance rather than detection of recurrence may be the most important function of the breast cancer follow-up clinic.

Adult↗