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Biomedical subjects

L F Smith

Publications and source records attributed to L F Smith.

At least 19 recordsLinked to original sources
PubMed2001

Racial differences in breast cancer survival: the effect of residual disease.

BACKGROUND: A survival difference has been seen in numerous studies between African-American (AA) and Caucasian (C) women with breast cancer. The purpose of this study was to elucidate the differences in patient characteristics and outcomes between AA and C women with breast cancer in our population. METHODS: We performed a retrospective analysis of 1345 women with newly diagnosed breast cancer who were entered into our tumor registry from October 1980 to December 1998. RESULTS: The association between race and stage at presentation was significant, as was the difference in the overall median survival between C and AA women. The data revealed no significant differences in survival between C and AA women presenting with Stage I or II disease. However, the differences between the median survival times for AA and C women presenting with Stage III and IV disease were both highly significant. A significantly lower percentage of AA women became "disease free" after initial therapy as compared with C women (P < 0.001). Interestingly, when data were stratified by stage, only in Stage III and IV were there significant differences between the races for becoming disease free. CONCLUSIONS: AA women tend to present at a later stage and have poorer survival from later-stage disease as compared with C women. The poorer survival appears to be related to the decreased ability to achieve disease-free status in AA women with advanced disease. The underlying causes of this difference in treatment outcome need further evaluation.

Adult↗
PubMed2001

Magnetic resonance imaging-guided core needle biopsy and needle localized excision of occult breast lesions.

BACKGROUND: Breast magnetic resonance imaging (MRI) has been reported to be twice as sensitive and three times more specific in detecting breast cancer. We report a series of MRI-guided stereotactic breast biopsies (SCNBB) and needle localized breast biopsies (NLBB) to evaluate MRI as a localization tool. METHODS: Forty-one breast lesions were identified in 39 patients who subsequently had SCNBB or NLBB. Suspicious areas of enhancement were stereotactically biopsied with 16-G core biopsy needles or localized with 22-G wires for excision under laser guidance. RESULTS: Forty-one breast lesions were identified from 1,292 breast MRIs. SCNBB identified three malignancies and two areas of atypia. Two additional cancers were found after NLBB. In patients having NLBB alone, five cancers and two areas of atypia were identified. CONCLUSIONS: In this initial series, breast MRI-guided SCNBB and NLBB were valuable tools in the management of patients with suspicious abnormalities seen only on MRI.

Adult↗
PubMed2001

Intraoperative localization after stereotactic breast biopsy without a needle.

BACKGROUND: Needle localization breast biopsy (NLBB) is the standard for the removal of breast lesions after vacuum-assisted breast biopsy (VABB). Disadvantages include a miss rate of 0% to 22%, risk of vasovagal reactions, and scheduling difficulties. We hypothesized that the hematoma resulting from VABB could be used to localize the VABB site with intraoperative ultrasonography (US) for excision. METHODS: Twenty patients had VABB followed by intraoperative US-guided excision. RESULTS: The previous VABB site in 19 patients was successfully visualized with intraoperative US and excised at surgery. One patient had successful removal of the targeted area under US guidance, but failed to show removal of the clip on initial specimen mammogram. CONCLUSION: This study demonstrates the effectiveness of US in identifying hematomas after VABB for excision. This technique, which can be performed weeks after VABB, improves patient comfort and allows easier scheduling.

Adult↗
PubMed2001

Errors leading to unexpected pseudophakic ametropia.

PURPOSE: Determination of the reasons for clinically significant unplanned ametropia following cataract surgery and the results of management of the ametropia. METHODS: Retrospective review of 11 consecutive cases of tertiary referral for management of pseudophakic ametropia to the authors. Corrective surgery involved either lens implant exchange or LASIK refractive surgery. Final outcome was assessed by uncorrected and best spectacle corrected visual acuity and manifest refractive outcome. RESULTS: Five cases (45%) were due to significant error in axial length determination at pre-surgery biometry. Six cases (55%) were due to surgeon or surgical team error, where the surgeon implanted a lens of power at variance with that specified pre-operatively. Nine patients elected to undergo refractive surgery to correct the ametropia and 2 elected to wear a spectacle lens. Seven underwent lens implant exchange and 2 patients underwent LASIK keratorefractive surgery. Eight of nine patients were within 1 dioptre of intended spherical equivalent after refractive surgery and 1 patients was -1.5 dioptre myopic. CONCLUSIONS: Most cases of serious unintended ametropia after cataract surgery are avoidable. Care should be taken with the biometry and procedural checks to minimise error. When lens implant exchange or LASIK was performed the final refractive results were satisfactory.

Aphakia, Postcataract↗
PubMed2001

The influence of presentation format and viewer training in the visual arts on the perception of pictorial and aesthetic qualities of paintings.

The comparability of viewers' responses to slide-projected and computer-generated images of nine paintings by renowned artists to those obtained from individuals experiencing the originals in the galleries of the New York Metropolitan Museum of Art was investigated. The influence of training in the visual arts upon evaluative judgments made under the three presentation formats was also assessed. Specifically, art-trained and untrained participants in each format condition rated each artwork on sixteen measures of physical and structural characteristics, novelty of content, and aesthetic qualities. Analyses revealed significant differences in the judged hedonic value of the originals as contrasted with the two types of reproduction, whereas trained and untrained participants' evaluations of the pictorial qualities of the artworks were comparable across presentation formats. Findings are discussed in terms of a facsimile-accommodation hypothesis proposed by the authors.

Adult↗
PubMed2001

Hematoma-directed ultrasound-guided breast biopsy.

OBJECTIVE AND SUMMARY BACKGROUND DATA: The standard technique for removal of nonpalpable breast lesions is needle localization breast biopsy. Because traumatic hematomas can often be seen with ultrasound, the authors hypothesized that iatrogenically induced hematomas could be used to guide the excision of nonpalpable lesions using ultrasound. METHODS: Twenty patients with nonpalpable breast lesions detected by magnetic resonance imaging only were enrolled in this single-institution trial, approved by the institutional review board. A hematoma consisting of 2 to 5 mL of the patient's own blood was injected into the breast to target the nonpalpable lesion. Intraoperative ultrasound of the hematoma was used to direct the excisional biopsy. RESULTS: The average age of women was 53.8 +/- 10 years. Ninety-five percent of lesions detected by magnetic resonance imaging were localized by hematoma injection. All the hematomas used to recognize targeted lesions were identified at surgery by ultrasound and removed without complication. Eight (40%) of the lesions were malignant, with an average tumor size of 12 +/- 6 mm (range 4-25). The remaining 12 lesions (60%) comprised papillomas, sclerosing adenosis, radial scar, fibroadenoma, and areas of atypical ductal hyperplasia. CONCLUSION: The results of this pilot study show the effectiveness of hematoma-directed ultrasound-guided breast biopsy for nonpalpable lesions seen by magnetic resonance imaging. This new procedure is potentially more comfortable for the patient because no wire or needle is left in the breast. It is technically faster and easier because ultrasound is used to visualize directly the location of the hematoma at surgery and to confirm lesion removal in the operating room by specimen ultrasound. The hematoma can be placed several days before biopsy, easing scheduling, and without fear of the migration that may occur with needle localization. This method may have ready application to mammographically detected lesions.

Adult↗
PubMed2001

Development of a multidimensional labour satisfaction questionnaire: dimensions, validity, and internal reliability.

BACKGROUND: No published quantitative instrument exists to measure maternal satisfaction with the quality of different models of labour care in the UK. METHODS: A quantitative psychometric multidimensional maternal satisfaction questionnaire, the Women's Views of Birth Labour Satisfaction Questionnaire (WOMBLSQ), was developed using principal components analysis with varimax rotation of successive versions. Internal reliability and content and construct validity were assessed. RESULTS: Of 300 women sent the first version (WOMBLSQ1), 120 (40%) replied; of 300 sent WOMBLSQ2, 188 (62.7%) replied; of 500 women sent WOMBLSQ3, 319 (63.8%) replied; and of 2400 women sent WOMBLSQ4, 1683 (70.1%) replied. The latter two versions consisted of 10 dimensions in addition to general satisfaction. These were (Cronbach's alpha): professional support in labour (0.91), expectations of labour (0.90), home assessment in early labour (0.90), holding the baby (0.87), support from husband/partner (0.83), pain relief in labour (0.83), pain relief immediately after labour (0.65), knowing labour carers (0.82), labour environment (0.80), and control in labour (0.62). There were moderate correlations (range 0.16-0.73) between individual dimensions and the general satisfaction scale (0.75). Scores on individual dimensions were significantly related to a range of clinical and demographic variables. CONCLUSION: This multidimensional labour satisfaction instrument has good validity and internal reliability. It could be used to assess care in labour across different models of maternity care, or as a prelude to in depth exploration of specific areas of concern. Its external reliability and transferability to care outside the South West region needs further evaluation, particularly in terms of ethnicity and social class.

Female↗
PubMed2000

Intraoperative ultrasound-guided breast biopsy.

BACKGROUND: Biopsy of nonpalpable lesions has increased during the last decade. Commonly these lesions are excised using preoperative wire localization. We describe a technique of intraoperative ultrasound-guided breast biopsy that allows easier excision and aids in obtaining surgical margins in breast cancer. METHODS: Intraoperative ultrasound was performed on 81 lesions. Ultrasound was used in an attempt to approximate a 1 cm margin on malignant lesions. RESULTS: All attempts to localize lesions with ultrasound in surgery were successful (81 of 81). Ultrasound-guided surgery was accurate in predicting margins in 24 of 25 malignant lesions. No complications resulted. CONCLUSION: Ultrasound proved to be an effective technique for localizing and excising breast lesions. Benefits may include improving patient comfort, avoiding complications of needle localization breast biopsy, and simplifying the scheduling of surgical procedures. Additionally, this procedure may be used to obtain adequate surgical margins and thus reduce the recurrence rate of breast cancer.

Adult↗
PubMed2000

Subareolar injection is a better technique for sentinel lymph node biopsy.

BACKGROUND: Numerous techniques and materials show accuracy in localizing the sentinel lymph node (SLN). We hypothesized that subareolar injection of material would localize the SLN as effectively as peritumoral injection. METHODS: Thirty-eight patients were injected with technetium-99 sulfur colloid either peritumorally or subareolarly in addition to the injection of blue dye around the tumor. Radioactive SLNs were localized using a hand-held gamma probe. RESULTS: Nineteen patients were included in each of the two groups, peritumoral and subareolar. SLNs were found in all patients injected subareolarly and in 18 of 19 injected peritumorally. The false-negative rate was 20% for peritumoral injection and 0% for subareolar injection. CONCLUSION: The results suggest that subareolar injection was as accurate, if not more accurate, than peritumoral injection for localizing the SLN. This technique is simpler than peritumoral injection and does not require injection under image guidance for nonpalpable lesions.

Adult↗
PubMed2000

Autonomic dysfunction in non-specific disorders of oesophageal motility.

OBJECTIVE: Non-specific disorders of oesophageal motility are common manometric findings in patients presenting with non-cardiac chest pain, dysphagia, odynophagia, regurgitation and symptoms of gastro-oesophageal reflux disease. Impairment of vagal function has been reported in gastro-oesophageal reflux disease and achalasia. The role of autonomic dysfunction in patients with non-specific oesophageal disorders is unknown. The aim of this study was to assess autonomic function in patients with non-specific disorders of oesophageal motility. METHOD: An automated computerized system (AUTOCAFT) was used to evaluate autonomic function in 62 patients presenting with non-cardiac chest pain and associated oesophageal symptoms. Cardiovascular reflex responses to deep breathing, Valsalva manoeuvre, posture and sustained handgrip were measured and results compared with 14 sex- and age-matched control subjects. RESULTS: Forty percent of patients with non-specific disorders of oesophageal motility proved to have significant abnormalities of vagal function. There was also a high incidence of gastro-oesophageal reflux (50%). CONCLUSIONS: There appears to be autonomic dysfunction in patients with non-specific oesophageal motility disorders. Autonomic function tests may prove to be a useful tool in the assessment of oesophageal function.

Autonomic Nervous System Diseases↗
PubMed2000

Higher professional education for general practitioners: postal questionnaire survey.

BACKGROUND: There is no consensus about whether higher professional education (HPE) is necessary for general practitioners (GPs) to complete their vocational training. AIM: To investigate beliefs about the need for HPE, its funding, duration, curriculum, and whether new principals (NPs) are eligible to undertake it. METHOD: A confidential postal questionnaire was sent to senior partners, GP registrars, NPs, GP trainers, and GP tutors, principally in the old South West region of England, and nationally to other 'academic' GPs. RESULTS: Of 1199 GPs, 750 (62.6%) replied; 561 (79.2%) responders agreed with the principle of HPE for NPs, especially members of the Royal College of General Practitioners and academic GPs; senior partners (SPs) were less likely to agree (all P < 0.001). Of 700 GPs, 331 (50.3%) believed that HPE should last one or two years, 66.4% agreed that NPs should have a major input into the HPE curriculum, and 54.6% agreed that health authorities should be major sources of funding, together with the postgraduate deans (29.9%). GP tutors and trainers should have the main responsibility for teaching HPE. The principal barriers to setting up a HPE course are the financial cost, the time cost, difficulty in changing the status quo, and various practical problems. The facilitatory influences are: the enthusiasm of the NPs and of their clinical colleagues, an appropriate educational environment, a high quality clinical base, and recognition that NPs have specific needs. Of 668 GPs, 89.7% would release NPs if an HPE course were free and locums were paid, although SPs were less likely to agree (P < 0.001); if the HPE course cost the practice money, then only 30.6% would release NPs. CONCLUSION: If adequately externally funded, then there is widespread support for HPE with most GPs willing to release NPs. NPs and existing GP teachers should decide the curriculum. Its aim should be to provide educational support for NPs during the transition from GP registrar to fully-trained GP principal.

Adult↗
PubMed2000

Higher professional education for general medical practitioners: key informant interviews and focus group findings.

BACKGROUND: If higher professional education (HPE) for general practitioners (GPs) is to be implemented, then key stakeholders will need to be supportive. AIM: To investigate stakeholders' beliefs about the concept of HPE, its funding, and relationships to education and care. METHOD: Interviews were conducted using a topic guide with a health authority (HA) representative, the Local Medical Committee Chair, the Medical Audit Advisory Group Chair, a GP tutor from each of the six health authorities in the old South West region, and a senior member of the three academic GP departments and the two Royal College of General Practitioners faculties in the region. Focus groups were held with GP registrars on both vocational training schemes (VTSs) and on the one HPE course in the region. These were recorded, transcribed verbatim, and analysed for emergent themes that were triangulated with the ideas expressed in the focus groups; the same topic guide was used for both. RESULTS: Of 29 key informants, 24 were interviewed. Six focus groups were held (the one HPE group and five out of the nine VTSs), after which no new ideas emerged. There is a transition period, after becoming a new principal (NP) and before becoming a fully competent independent GP, during which NPs need support. Benefits would include receiving peer support to reduce stress during the transition, enhanced non-clinical competencies, becoming a better skilled GP, avoiding the negative personal impact of a career as a GP, and helping recruitment. To improve patient care there must be a link between education and service provision. Funding is the major consideration in setting HPE; mixed funding is best coming from top-sliced General Medical Services (GMS), the HA, and regional educational funds. Barriers might include NPs' practice workload, their enthusiasm, and their partners' attitudes. The other key is a local enthusiast to initiate a course and coordinate the 'players'. The curriculum would be principally non-clinical and should be agreed by learners and the course tutor together, taking advice from various interested parties. CONCLUSION: There is a need for HPE for new NPs. It will require funding external to individual practices or NPs and a local enthusiast. Top-slicing of GMS funds is one source of funding, with additional funds from regional education and HAs. HPE must be related to service provision, to NP needs, and to vocational training.

Career Choice↗
PubMed2000

The duration of fixed orthodontic treatment: a comparison of two groups of patients treated using Edgewise brackets with 0.018" and 0.022" slots.

The duration of fixed appliance Edgewise orthodontic treatment times using brackets with 0.018" and 0.022" slots was measured to determine whether there were any clinically or statistically significant differences between the two appliances. Sixty-four consecutively treated, fully banded patients were selected from two different practice locations. All 64 patients were treated by one clinician. Thirty-two patients (Group 1) were treated using the 0.018" slot bracket and 32 (Group 2) were treated using the 0.022" slot bracket. The patients in each group were treated to the same standard of care using the same technique. The mean duration of treatment for Group 1 was 20.2 months and for Group 2, 21.7 months. Although the mean difference (1.5 months) was not clinically significant, it was statistically significant at p < 0.05.

Adolescent↗
PubMed1999

Studies of autonomic function in patients with achalasia and nutcracker oesophagus.

BACKGROUND: Post-mortem studies in patients with achalasia reveal degenerative changes in the vagus and its dorsal motor nuclei suggesting the possibility of widespread autonomic dysfunction. AIMS: To study a broad range of autonomic function in patients with achalasia and nutcracker oesophagus and in asymptomatic volunteers. SUBJECTS: Patients with a manometric diagnosis of achalasia and nutcracker oesophagus and age- and sex-matched asymptomatic volunteers. METHODS: Subjects underwent measurement of: (1) pupil cycle time estimation; (2) heart rate response to the Valsalva manoeuvre, standing and deep breathing; (3) systolic blood pressure response to standing; (4) diastolic response to sustained handgrip; (5) spectral analysis of heart rate variability; and (6) heart rate and blood pressure during the Valsalva manoeuvre. RESULTS: No significant differences were found between patients with achalasia and asymptomatic volunteers. Patients with nutcracker oesophagus, however, had longer pupil cycle times (1.2 (0.9-1.4) s versus 0.9 (0.8-1.2) s, P= 0.02) and had attenuation of both the rise in the low frequency peak of heart rate variability and the fall in the high frequency peak on standing (rise in low frequency peak - patients 26.6 (10.4-52.3)% to 42.2 (15.5-54.0)%, P = 0.46, volunteers 16.9 (8.4-37.2)% to 47.4 (21.1-66.3)%, P = 0.03; fall in high frequency peak - patients 18.1 (0.9-43.3)% to 10.1 (0.5-26.6)%, P= 0.46, volunteers 24.8 (8.5-44.4)% to 9.3 (2.6-35.6)%, P= 0.03). The rise in blood pressure during the Valsalva manoeuvre was also attenuated in patients with nutcracker oesophagus compared with asymptomatic volunteers (6.9 (1.0-9.3) mmHg versus 12.9 (11 -23.0) mmHg, P < 0.01). CONCLUSIONS: Whereas tests of cardiovascular and pupillary autonomic function are normal in patients with achalasia, patients with nutcracker oesophagus show defects in both parasympathetic and sympathetic function.

Adult↗
PubMed1999

Squamous cell carcinoma of the breast following silicone injection of the breasts.

During the 1960s, injecting liquid silicone into the breasts for augmentation purposes was a common practice. Many women suffered complications, usually developing silicone mastopathy, but there have been reports of carcinoma as well. A case of squamous cell carcinoma of the breast is reported in a patient who had previously undergone injection of silicone into the breasts. Upon review of the literature, this is only the second reported case of squamous cell carcinoma of the breast following silicone injection. Squamous cell carcinoma of the breast is a very rare tumor comprising 0.04 to 0.075 percent of all breast malignancies. The tumor appears to develop from metaplasia of benign epithelial cells within the breast. Many theories are presented for the development of this metaplastic process. The clinical presentation, evaluation, and treatment of squamous cell carcinoma of the breast is quite similar to that of infiltrating ductal carcinoma of the breast of comparable stage and size.

Aged↗
PubMed1999

A pilot study of community-based training of hospital obstetric senior house officers.

Most senior house officer (SHOs) posts have little relevance to general practice. This problem was addressed in a pilot community teaching placement, of up to one session per week over four to six months that was set up to learn community-based obstetrics from primary health care teams. The nine participating SHOs were interviewed; qualitative analysis revealed seven themes that were important to the SHOs that should help guide further community-based teaching. Such sessional release for improving the practice-based component of vocational training merits evaluation in a larger study.

Community Medicine↗