ABSTRACT
AIM: To determine the current practice in the UK National Health Service Breast Screening Programme for invasive diagnostic procedures and surgery in patients taking anticoagulant and antiplatelet medication. MATERIALS AND METHODS: Lead radiologists and surgeons at each breast screening service were surveyed to determine current practice. One hundred and five respondents provided information regarding their services, protocols, and willingness to proceed with combinations of procedures and anti-haemostatic medications. RESULTS: Between units there was wide variation in practice. Within 21 services providing more than one response, 10 (48%) disagreed on whether protocols existed. Decisions to perform biopsies were unrelated to professional group. The taking of a drug history was variable. Surgeons reported more adverse effects than radiologists [21 (48%) versus 12 (26%)], but no difference in self-assessment of knowledge. CONCLUSION: Both radiologists and surgeons have expressed uncertainty about their understanding of anticoagulant and antiplatelet treatment. This is reflected in a wide range of practice. Guidance regarding the management of these patients is suggested.
Subject(s)
Anticoagulants/therapeutic use , Breast Neoplasms , Breast , Platelet Aggregation Inhibitors/therapeutic use , Attitude of Health Personnel , Biopsy , Breast/pathology , Breast/surgery , Breast Neoplasms/pathology , Breast Neoplasms/surgery , Female , Health Care Surveys , Humans , Radiology, Interventional , Risk Assessment , State Medicine , Surgical Procedures, Operative/adverse effects , United KingdomABSTRACT
A theoretical study is reported of the Cl+CH3OH-->CH2OH+HCl reaction based on the diffusion Monte Carlo (DMC) variant of the quantum Monte Carlo method. Using a DMC trial function constructed as a product of Hartree-Fock and correlation functions, we have computed the barrier height, heat of reaction, atomization energies, and heats of formation of reagents and products. The DMC heat of reaction, atomization energies, and heats of formation are found to agree with experiment to within the error bounds of computation and experiment. Møller-Plesset second order perturbation theory (MP2) and density functional theory, the latter in the B3LYP generalized gradient approximation, are found to overestimate the experimental heat of reaction. Intrinsic reaction coordinate calculations at the MP2 level of theory demonstrate that the reaction is predominantly direct, i.e., proceeds without formation of intermediates, which is consistent with a recent molecular beam experiment. The reaction barrier as determined from MP2 calculations is found to be 2.24 kcal/mol and by DMC it is computed to be 2.39(49) kcal/mol.
ABSTRACT
We report two cases of acute myeloid leukaemia FAB classification M4Eo with high white cell counts at presentation, who developed acute respiratory failure with pulmonary infiltrates on chest radiograph soon after commencing conventional cytotoxic chemotherapy plus all-trans retinoic acid (ATRA). We suggest that in patients with M4Eo ATRA should be used with caution, perhaps delaying its commencement until the white cell count is < 10 x 109/l.
