Towards the intra-operative use of Raman spectroscopy in breast cancer-overcoming the effects of theatre lighting.

The ability to use Raman spectroscopy to assess tissue in the operative theatre setting could be advantageous for both patients and clinicians. In this study, a method of overcoming the deleterious effects of theatre lighting on the Raman spectra is demonstrated. The effectiveness of this technique is highlighted both within the theatre setting and using human lymph node tissue. The portable MiniRam II Raman spectroscopy device that incorporated a 785-nm laser was used in all experiments. This is an important step towards the use of Raman spectroscopy as a means of analysing sentinel lymph nodes in patients who have been newly diagnosed with breast cancer.

Recording inpatient weight: implications for medicines administration.

AIM: To identify the proportions of hospital inpatients with recorded weights: among all patients, and among those receiving weight-dosed drug therapy. METHOD: Survey of clinical notes of hospital inpatients across a convenience sample of 11 secondary and tertiary referral hospitals in England and Wales in November 2011. RESULTS: 1068 patients were included, and 1061 patient clinical notes were available (99.3%). Nearly all paediatric patients had recorded weights (77/78; 98.7%). Half of adult inpatients had recorded weights (503/983, 51.2%). The proportion of adult inpatients with recorded weights varied by hospital, ranging from 13.5% to 92.5% (p<0.0001). In those receiving gentamicin or therapeutic-dose low molecular weight heparin (t-LMWH), only 64.5% (71/110) had a recorded weight. CONCLUSIONS: Half of adult inpatients, and two-thirds of those receiving gentamicin or t-LMWH, had recorded weights. There was significant variation in rates of weighing adult inpatients across hospitals. This may put patients at increased risk of side effects and problems resulting from malnutrition.

Raman spectroscopy--a potential new method for the intra-operative assessment of axillary lymph nodes.

Sentinel Lymph Node Biopsy has become the standard surgical procedure for the sampling of axillary lymph nodes in breast cancer. Intra-operative node assessment of these nodes would allow definitive axillary surgery to take place immediately with associated benefits for patient management. Our experimental study aims to demonstrate that a Raman spectroscopy probe system could overcome many of the disadvantages of current intra-operative methods. 59 axillary lymph nodes, 43 negative and 16 positive from 58 patients undergoing breast surgery at our district general hospital were mapped using Raman micro-spectroscopy. These maps were then used to model the effect of using a Raman spectroscopic probe by selecting 5 and 10 probe points across the mapped images and evaluating the impact on disease detection. Results demonstrated sensitivities of up to 81% and specificities of up to 97% when differentiating between positive and negative lymph nodes, dependent on the number of probe points included. The results would have concurred with histopathology assessment in 89% and 91% of cases in the 5 and 10 point models respectively. Using Raman spectroscopy in this way could allow lymph node assessment within a time-frame suitable for intra-operative use.

A vesicocutaneous fistula secondary to bladder calculi in a patient with spina bifida.

We present a rare case of a vesicocutaneous fistula secondary to two large bladder calculi in a patient with spina bifida. A 62 year old lady presented with swelling of her right thigh and a calcified mass protruding through the subcutaneous tissues of her right groin. Urine was seen to be draining from around the area and plain radiographs and a computed topography (CT) scan confirmed the presence of two bladder calculi with a vesicocutaneous fistula. Vesicolithotomy was performed and the fistula tract left to close spontaneously. Worldwide this is only the fourth case of a bladder calculus causing a vesicocutaneous fistula.