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Background: Mammary ductoscopy allows direct visualization of ductal epithelium using a fibreoptic microendoscope. As the first centre in Canada to apply ductoscopy to surgical practice, we report our experience with this technology. Methods: Between 2004 and 2008, 65 women with pathologic nipple discharge underwent ductoscopy before surgical duct excision under general anesthetic. Prospective data collection included cannulation and complication rates, procedure length and lesion visualization rate compared with preoperative ductography, if performed. In addition, we classified the endoscopic appearance according to Makita and colleagues and correlated it with surgical pathology. Results: It took longer than 6 months to overcome technical problems before the routine use of ductoscopy in the operating room. The ductoscope was easy to use: we achieved cannulation in 63 of 66 breast ducts (95%) and we visualized a lesion in 52 of 63 breast ducts (83%). The mean procedure length was 5.1 minutes, with no complications. Lesions seen on ductography were seen endoscopically 30 of 33 (91%) times. All 3 malignancies were seen: invasive carcinoma in 1 of 62 (1.6%) and in situ disease in 2 of 62 (3.2%) patients. Surgeons found ductoscopy helpful in defining the extent of duct excision. Except for the 'polypoid solitary' class, which accurately predicted a papilloma (23/23), we found poor correlation between Makita and colleague's endoscopic classification and final pathology. Conclusion: Ductoscopy is feasible, safe and practical. Our surgeons routinely use it to identify the location and extent of duct excision without ordering preoperative ductography. Identifying pathology based on the endoscopic appearance is unreliable unless the lesion is solitary and polypoid. Contexte : La ductoscopie mammaire permet une visualisation directe de l'epithelium des canaux a l'aide d'un microendoscope a fibres optiques. En tant que premier centre au Canada a appliquer la ductoscopie a la pratique chirurgicale, nous faisons etat de l'experience que nous avons acquise avec cette technologie. Methodes : Entre 2004 et 2008, 65 femmes presentant un ecoulement pathologique au niveau du mamelon ont subi une ductoscopie avant une excision canalaire chirurgicale sous anesthesie generale. La collecte prospective des donnees a inclus les taux de canulation et de complications, la duree de l'intervention et le taux de visualisation des lesions, comparativement a la ductographie preoperatoire, le cas echeant. De plus, nous avons classifie l'aspect a l'endoscopie selon les criteres de Makita et coll. et nous avons etabli sa correlation avec la pathologie chirurgicale. Resultats : Il a fallu plus de six mois pour surmonter certains problemes techniques avant de pouvoir utiliser de routine la ductoscopie au bloc operatoire. Facile d'emploi, le ductoscope nous a permis d'effectuer avec succes la canulation de 63 canaux mammaires sur 66 (95%) et de visualiser une lesion dans 52 canaux mammaires sur 63 (83%). La duree moyenne de l'intervention a ete de 5,1 minutes, sans complications. Les lesions perceptibles a la ductographie s'observaient a l'endoscopie 30 fois sur 33 (91%). Les 3 neoplasies ont ete apercues : un carcinome envahissant dans 1 cas sur 62 (1,6%) et une maladie in situ dans 2 cas sur 62 (3,2%). Les chirurgiens ont trouve la ductoscopie utile pour determiner l'etendue de l'excision canalaire. A l'exception de la classe << solitaire et polypoide >> qui permettait de prevoir avec precision un papillome (23/23), nous avons observe une faible correlation entre la classification endoscopique de Makita et coll. et la pathologie finale. Conclusion : La ductoscopie est une intervention faisable, securitaire et pratique. Nos chirurgiens l'utilisent de routine pour localiser l'excision canalaire et en determiner l'ampleur, sans demander de ductographie preoperatoire. La reconnaissance de la pathologie a partir de l'aspect endoscopique est peu fiable, a moins que la lesion ne soit solitaire et polypoide., Pathologic nipple discharge is unilateral, persistent and spontaneous, and arises from a single duct. (1) Discharge of this type is responsible for up to 5% of consultations at breast clinics. [...]

Background: Breast cancer is the most common female cancer worldwide. The lifetime risk of a woman being diagnosed with breast cancer is approximately 12.5%. For women who carry the deleterious mutation in either of the BRCA genes, BRCA1 or BRCA2, the risk of developing breast or ovarian cancer is significantly increased. In recent years there has been increased penetrance of BRCA1 and BRCA2 associated breast cancer, prompting investigation into the role of modifiable risk factors in this group. Previous investigations into this topic have relied on participants recalling lifetime weight changes and subjective methods of recording physical activity. The influence of obesity-related biomarkers, which may explain the link between obesity, physical activity and breast cancer risk, has not been investigated prospectively in this group. This paper describes the design of a prospective cohort study investigating the role of predictive and modifiable risk factors for breast cancer in unaffected BRCA1 and BRCA2 gene mutation carriers. Methods/design: Participants will be recruited from breast cancer family risk clinics and genetics clinics. Lifestyle risk factors that will be investigated will include body composition, metabolic syndrome and its components, physical activity and dietary intake. PBMC telomere length will be measured as a potential predictor of breast cancer occurrence. Measurements will be completed on entry to the study and repeated at two years and five years. Participants will also be followed annually by questionnaire to track changes in risk factor status and to record cancer occurrence. Data will be analysed using multiple regression models. The study has an accrual target of 352 participants. Discussion: The results from this study will provide valuable information regarding the role of modifiable lifestyle risk factors for breast cancer in women with a deleterious mutation in the BRCA gene. Additionally, the study will attempt to identify potential blood biomarkers which may be predictive of breast cancer occurrence. [ABSTRACT FROM AUTHOR]

Background: Substantial observational evidence exists which supports a role for physical activity in improving breast cancer prognosis. Biological pathways linking physical activity to prognosis include alterations in obesity-related biomarkers involving chronic low-grade inflammation, adipokines, and markers of insulin resistance. Exercise interventions, with these biomarkers as end-points, may be beneficial for improving breast cancer outcomes. Objective: To conduct a systematic literature review, investigating the effect of exercise interventions on anthropometric variables and related biomarkers of cancer risk in breast cancer survivors. Methods: The preferred reporting for systematic review and meta-analysis (PRISMA) guidelines were followed. A comprehensive literatures search was conducted using the databases PubMed, Embase, SciVerse, the Cochrane Library, AMED, and PEDro, for articles published in English up to June 2012. Exercise interventions, both randomized and non-randomized, examining a range of biomarkers of cancer risk were included. Results: Thirteen articles, representing nine exercise interventions were included - seven randomized controlled trials (RCT) and two non-randomized trials. A number of trials reported improvements in anthropometrics (percentage body fat, body mass index, and waist / hip circumference). Three trials reported changes in insulin-like growth factor (IGF)-I and IGF-II, and insulin-like growth factor binding protein (IGFBP)-3. There were no reported changes in insulin, glucose, insulin resistance, adipokines or inflammatory markers. Conclusions: More robust RCTs are required to fully elucidate the effect of exercise training on biomarkers of breast cancer risk and determine the role of physical activity as an adjunct to breast cancer treatment as a means of reducing breast cancer recurrence and improving mortality. [ABSTRACT FROM AUTHOR]

Objective: To present our experience with conversion from bladder to enteric drainage after simultaneous pancreatic and renal transplants, so that new transplant centres know that it is both safe and effective. Design: Retrospective study. Settings: Teaching hospital, Republic of Ireland. Subjects: Six patients who had simultaneous pancreatic and renal transplants for insulin-dependent diabetes and who subsequently developed complications of bladder drainage including recurrent episodes of dehydration and metabolic acidosis (n = 3), haematuria (n = 2), and urinary tract infections (n = 1). Intervention: Conversion to enteric drainage. Main outcome measure: Resolution of symptoms. Results: All symptoms resolved, but one patient each developed pulmonary oedema, haematuria, and prolonged ileus. All three complications resolved on conservative treatment. All patients are well with surviving grafts a mean of 40 months later (range 19-50). Conclusion: Conversion to enteric drainage is safe and effective in patients with refractory metabolic or urological complications of bladder drainage after simultaneous pancreatic and renal transplantation. [ABSTRACT FROM AUTHOR]

Objectives: Women who inherit a pathogenic BRCA1 or BRCA2 mutation are at substantially higher risk of developing breast and ovarian cancer than average. Several cancer risk management strategies exist to address this increased risk. Decisions about which strategies to choose are complex, personal and multifactorial for these women. Decision aids (DAs) are tools that assist patients in making health-related decisions. The aim of this scoping review was to map evidence relating to the development and testing of patient DAs for cancer unaffected BRCA mutation carriers., Design: Scoping review conducted according to the Joanna Briggs Institute's (JBI's) scoping review methodological framework., Data Sources: MEDLINE, EMBASE, CINAHL, Web of Science. No restrictions applied for language or publication date. A manual search was also performed., Eligibility Criteria for Selecting Studies: Studies on DAs for cancer risk management designed for or applicable to women with a pathogenic BRCA1 or BRCA2 mutation who are unaffected by breast or ovarian cancer., Data Extraction and Synthesis: Data were extracted using a form based on the JBI instrument for extracting details of studies' characteristics and results. Data extraction was performed independently by two reviewers. Extracted data were tabulated., Results: 32 evidence sources relating to development or testing of 21 DAs were included. Four DAs were developed exclusively for cancer unaffected BRCA mutation carriers. Of these, two covered all guideline recommended risk management strategies for this population though only one of these was readily available publicly in its full version. All studies investigating DA effectiveness reported a positive effect of the DA under investigation on at least one of the outcomes evaluated, however only six DAs were tested in randomised controlled trials., Conclusion: This scoping review has mapped the landscape of the literature relating to developing and testing, DAs applicable to cancer unaffected BRCA mutation carriers., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Objectives: To evaluate a system of prehospital thrombolysis, delivered by paramedics, in meeting the national service framework's targets for the management of acute myocardial infarction., Design: Prospective observational cohort study comparing patients with suspected acute myocardial infarction considered for thrombolysis in the prehospital environment with patients treated in hospital., Setting: The catchment area of a large teaching hospital, including urban and rural areas., Participants: 201 patients presenting concurrently over a 12 month period who had changes to the electrocardiogram that were diagnostic of acute myocardial infarction or who received thrombolysis for suspected acute myocardial infarction., Main Outcome Measures: Time from first medical contact to initiation of thrombolysis (call to needle time), number of patients given thrombolysis appropriately, and all cause mortality in hospital., Results: The median call to needle time for patients treated before arriving in hospital (n=28) was 52 (95% confidence interval 41 to 62) minutes. Patients from similar rural areas who were treated in hospital (n=43) had a median time of 125 (104 to 140) minutes. This represents a median time saved of 73 minutes (P < 0.001). Sixty minutes after medical contact 64% of patients (18/28) treated before arrival in hospital had received thrombolysis; this compares with 4% of patients (2/43) in a cohort from similar areas. Median call to needle time for patients from urban areas (n=107) was 80 (78 to 93) minutes. Myocardial infarction was confirmed in 89% of patients (25/28) who had received prehospital thrombolysis; this compares with 92% (138/150) in the two groups of patients receiving thrombolysis in hospital., Conclusions: Thrombolysis delivered by paramedics with support from the base hospital can meet the national targets for early thrombolysis. The system has been shown to work well and can be introduced without delay.