Prospective analysis of psychosocial outcomes after breast reconstruction: cross-cultural comparisons of 1-year postoperative results.

Breast reconstruction has been shown to improve quality of life in women following mastectomy for breast cancer. To date, there have been no published prospective reports looking at the effect nationality has on patient quality of life following breast reconstruction. Women from the USA, Sweden and Canada were recruited prior to reconstruction and followed prospectively for 1 year postoperatively. Thirteen centres with 24 plastic surgeons were involved. Preoperatively and 1 year postoperatively, women completed the Short Form-36 questionnaire. Data were analysed using t-tests and analysis of variance. A total of 313 women were followed up. American women who had immediate expander/implant surgery were compared with Swedish patients, whilst Americans who had undergone transverse rectus abdominis myocutaneous (TRAM) flap reconstructions were compared with Canadians. Women benefited from having breast reconstruction, but this improvement was not dependent upon country of origin. Swedish women reported less improvement in one subscale, that of general health, compared with American women (P=0.01). There were no cultural differences detected between Americans and Canadians.

Endocrine tumours of the pancreas: review and recent advances.

Pancreatic endocrine tumours (PET) are rare but nonetheless important to recognize and treat in a timely fashion. Significant morbidity occurs due to excess secretion of hormones, with all of the PET having some degree of malignant potential. Surgeons must plan directed operative strategies to deal with these tumours and be prepared to undertake aggressive palliative debulking resections if indicated. Somatostatin receptor scintigraphy and endoscopic ultrasound have been particularly helpful in both localizing and staging patients with PET. Other important advances in management include the use of long-acting somatostatin analogues to inhibit hormonal secretion and tumour growth. The possibility of multiple endocrine neoplasia type 1 (MEN-1) should be considered in any patient with a PET. The present article will review the various classes of PET, describe MEN-1 in relation to PET and examine advances in imaging and localization. The role of surgery for PET is also discussed in the present review.

Oral contraceptives and oral antibiotics: interactions and advice in an accident and emergency setting.

OBJECTIVE: (1) To determine what advice, if any, would be given by accident and emergency (A&E) doctors to women who were taking the combined oral contraceptive pill (OCP) if they had been issued with broad spectrum antibiotics and (2) after an audit programme had been instigated, whether appropriate advice was given to such women. METHODS: A questionnaire was circulated to 12 doctors working in the Exeter A&E department to assess their level of knowledge in prescribing antibiotics to women taking the OCP. Notes of women aged 15-50 who had been prescribed broad spectrum antibiotics were examined to see if a contraceptive history had been taken. If the patient was found to be taking the combined OCP it was noted whether documented advice had been given about using an additional form of contraception. Six months later after two education sessions had been held, prescriptions and notes were examined. A patient education leaflet was produced to be given to these women, indicating what additional precautions should be taken after having been prescribed antibiotics. SETTING: The A&E department of a busy district general hospital. SUBJECTS: Women aged 15-50 who had been issued with broad spectrum antibiotics. RESULTS: The level of knowledge in regard to contraceptive advice given to women taking the OCP among doctors working in an A&E department was poor. However, after educational sessions and the production of a patient information leaflet, there was an improvement in women receiving correct advice. CONCLUSIONS: The clinical significance of drug interactions between oral contraceptives and antibiotics indicates the importance of asking a full contraceptive drug history of any woman of childbearing age and documenting this in the notes. Regular audit of this topic is needed to keep it at the front of doctors' minds.

Role of surgical biopsies in the management of bone marrow transplant patients.

BACKGROUND: Bone marrow transplantation (BMT) patients frequently develop life-threatening problems that have similar clinical presentations but differing aetiologies. Despite intensive investigation by haematological, biochemical, and microbiological means, accurate diagnosis is not always possible. Histological and microbiological examination of biopsies from the affected organ may be indicated to enable an accurate diagnosis to be made in these patients. Here we assess the indications, findings, and outcomes in patients who have required surgical biopsy after BMT. PROCEDURE: We retrospectively reviewed all BMT patients who had surgical biopsies between February 1994 and January 1997. Twenty-six patients (1-46 years, median age 10 years) underwent 40 biopsies from the upper and lower GI tract, lung, or liver. Indications for BMT were: relapsed leukaemia = 18; other types of leukaemia = 3; aplastic anaemia=3; other diseases = 2. Type of BMT: matched related donor = 3, unrelated T-cell depleted donor = 23. RESULTS: Eleven (42%) cases had a change in management; 4 (16%) patients avoided further aggressive therapy because of poor prognosis. Unexpected diagnoses were found in 7 biopsies: 1 acute colitis, 1 duodenal ulcer, 1 liver aspergilloma, 2 transfusion siderosis, 1 radiation fibrosis of the lung, and 1 cytomegalovirus infection of the lung. Three patients were noted to have complications after their procedure. CONCLUSIONS: Surgical biopsies for undiagnosed problems can be of benefit in the management of very sick patients who have received bone marrow transplantations. Despite the fact that these patients are so unwell, there is a low rate of complications related to surgery and anaesthesia.