ABSTRACT
AIM: Risk-reducing mastectomy (RRM) is on the increase, now frequently combined with breast reconstruction (BR). However, the resource implications associated with bilateral mastectomy and reconstruction are unknown. This study assessed the overall cost of performing risk-reducing surgery. METHODS: All cases of RRM and BR performed between 1991 and 2011 at this hospital were identified from a prospectively collected database. All patients undergoing bilateral mastectomy were included, when at least one mastectomy was risk-reducing. Overall treatment costs for all surgical procedures, complications, revisional procedures and outpatient attendances were calculated and compared to the National Tariff allowed. Mann-Whitney U and Fischer's exact tests were used to calculate levels of significance. RESULTS: Fifty patients underwent bilateral mastectomy and BR (median follow up 20 [range 1-106] months), 72 were Latissimus Dorsi reconstructions (LDR) and 28 were Subpectoral reconstructions (SPR). LDR took longer than SPR (p = 0.001), with a greater length of stay (p = 0.024). Nine percent of patients returned to theatre for early complications, but the type of BR did not influence the early complication rate (LDR versus SPR, p = 0.345) or the need for additional unplanned procedures (LDR versus SPR, p = 0.671). The overall mean cost for bilateral RRM and BR was £14,797 per patient. The inpatient cost for bilateral RRM and LDR was £10,082 compared with £5,905 SPR. Both procedures exceeded the £5,697 tariff allowed in the UK. CONCLUSION: Bilateral RRM and BR is a safe procedure, but the resource implications are considerable and exceed the tariff allowed, particularly when performing more complex techniques.
Subject(s)
Breast Neoplasms/surgery , Health Resources/economics , Mammaplasty/economics , Mastectomy/economics , National Health Programs/economics , Adult , Aged , Breast Neoplasms/economics , Breast Neoplasms/pathology , Cost-Benefit Analysis , Databases, Factual , Female , Humans , Mammaplasty/methods , Mastectomy/methods , Middle Aged , Retrospective Studies , Risk Reduction Behavior , United KingdomSubject(s)
Mammaplasty/methods , Surgical Flaps , Female , Humans , Intraoperative Care/instrumentationABSTRACT
Schwann cells play a central role in peripheral-nerve regeneration, in which it has been shown that the addition of exogenous Schwann cells enhances the temporal and spatial sequence of events observed in regeneration. In this study, the authors investigated the fate of exogenous cells in this process by using fluorescently tagged autogenous Schwann cells in an established rat model of peripheral-nerve regeneration. Tracking labeled cells over a 4-week period revealed early migration of Schwann cells into the proximal nerve segment, followed by a concentration of migrating Schwann cells, leading the proximal growth cone throughout the regenerative process. The early proximal distribution of labeled cells suggests active migration in response to nerve damage, with spatial localization at the center of the proximal nerve segment and not the epineural surface. These observations demonstrate an interaction of exogenous Schwann cells with intact nerve tissue in vivo and affirm their role in the directional growth of regenerating axons.
Subject(s)
Cell Movement/physiology , Nerve Regeneration/physiology , Schwann Cells/physiology , Animals , Cells, Cultured , Disease Models, Animal , Female , Male , Peripheral Nerves/physiology , Rats , Rats, Sprague-Dawley , Sciatic Nerve/physiology , Sensitivity and SpecificityABSTRACT
BACKGROUND & AIMS: Src activation is reported as an early event found in preneoplastic colonic adenomas and in 70% of colon carcinomas. The aim of this study was to identify the biological consequences of c-src overexpression in rat colon epithelial cells. METHODS: Introduction and overexpression of c-src in an immortalized rat colon epithelial cell line was achieved using lipofection. Transfectants were tested for changes in growth and cell behavior using different in vitro assay systems. RESULTS: Colon epithelial cells overexpressing c-src showed the ability to form microcolonies in soft agar without acquiring tumorigenic potential. In in vitro assays, c-src transfectants displayed a gain of invasive potential through Matrigel without an accompanying change in migrational ability. No discernible qualitative changes were observed in the phosphotyrosyl protein profile between c-src and v-src transfectants. Assessment of the cadherin/catenin status in these cells revealed an intact, functional complex with no detectable tyrosine phosphorylation of different components of the complex. CONCLUSIONS: Overexpression of c-src in an immortalized rat colon epithelial cell line does not elicit full neoplastic transformation but enhances anchorage-independent growth and confers invasion capability. Increased invasion through Matrigel was not linked to inactivation of the cadherin complex in c-src transfectants.
Subject(s)
Colon/metabolism , Intestinal Mucosa/metabolism , Proto-Oncogene Proteins pp60(c-src)/metabolism , Animals , Cadherins/metabolism , Cadherins/physiology , Cell Line, Transformed/physiology , Cell Movement , Colon/cytology , Colon/physiology , Intestinal Mucosa/cytology , Intestinal Mucosa/physiology , Neoplasm Invasiveness/physiopathology , Rats , TransfectionABSTRACT
Immersion in water in spas has been practised for centuries and has many proponents. Despite fierce debate about its efficacy there has been little scientific evaluation of the effect of immersion in mineral waters. Eight normal subjects were immersed in Bath spa water for two hours and the renal, haematological, and cardiovascular responses were compared with those in the control periods before and after immersion. Significant, twofold diuresis and natriuresis, 5% haemodilution, and a 50% increase in cardiac index were observed in subjects immersed, sitting, in Bath spa water at 35 degrees C. These changes may constitute part of the scientific rationale for spa treatment in many states of disease.
