James C. Donald

Treatment of invasive breast carcinoma with ultrasound-guided radiofrequency ablation

BACKGROUND Radiofrequency ablation (RFA) is a minimally invasive thermal ablation technique. This study reports the safety and efficacy of RFA as a minimally invasive strategy for breast cancers <3 cm diameter in postmenopausal women. METHODS Twenty-two postmenopausal women (aged 60 years or older) with clinical T-1N0 core biopsy proven breast cancers were studied. Thermocoagulation was undertaken using a sonographically guided RF probe under local anesthesia and sedation. The ablated tumor was resected between 1 and 2 weeks later. Endpoints were technical success, completeness of tumor kill, marginal clearance, skin damage, and patient reports of pain and procedural acceptability. RESULTS The procedure was well tolerated and cosmesis was excellent. Pathology revealed a central ablation zone surrounded by hyperemia. Coagulative necrosis was complete in 19 of 22 patients. Disease at the ablation zone margin was found in 3 patients and 5 patients had disease distant to the ablation zone consisting of multifocal tumors (2), in-transit metastasis (1), and extensive ductal carcinoma in situ with microinvasive carcinoma (2). Ninety-five percent of patients would be willing to have RFA again. CONCLUSIONS Radiofrequency ablation can be safely applied in an outpatient setting with acceptable patient tolerance. By itself, RFA cannot be considered effective local therapy. Trials to evaluate RFA complemented with breast irradiation are justified.

Outcomes of sentinel node biopsy for breast cancer in British Columbia, 1996 to 2001

BACKGROUND This study evaluated the outcomes of the first 5 years of sentinel node biopsy (SNB) in British Columbia (BC), Canada, 1996 to 2001. METHODS There were 547 SNB procedures for breast cancer performed by 29 surgeons at 12 hospitals in BC between October 1996 and July 2001. Identification, accuracy, and false-negative rates were determined and correlated to patient, tumor, and surgical factors with the chi-square test. RESULTS SNB mapping was performed using blue dye alone (15%), radiopharmaceutical alone (6%), or both (79%). A completion axillary dissection was performed in 93%. A median of 2 (range 1 to 16) sentinel nodes was biopsied. The overall identification rate was 88%, accuracy was 92%, and false-negative rate was 22%. All rates were improved in younger (age <50 years) compared with older women. A positive lymphoscintiscan and the mapping agent used were associated with higher identification rates but not accuracy or false negative rates. Increasing surgeon experience was not significantly associated with improvements in identification or false-negative rates. CONCLUSIONS The potential of SNB was not fully translated into surgical practice in BC by 2001.

St. John and first aid for the weak leg.

0 ne of the duties the President of the Association is charged with is delivering the Annual Presidential Address. In preparation for this, as others have done in this position, I have reviewed what Past Presidents have said and written. The common thread that runs through many of the presentations is the role of someone or something the speaker feels has played a part in “influencing” his career. The subject I have chosen to speak on is the influence of a voluntary organization which, in the United Kingdom and Canada, has a history of over a century of service to mankind and in fact has its roots going back for almost ten centuries to the Crusades, Its influence, as you will see, on the management of trauma, particularly that of the prehospital segment, is far reaching and, even today, still has a role of great importance. This is the organization known as St. John. The hospital management of trauma over the last 30 years has advanced with the work of McLean in Montreal, Canda; Cowley in the United States; and Thomas in England. In our own society, Trunkey and others have contributed to the high level of care in our major trauma centers, so that if a seriously traumatized patient arrives in one of our modern trauma centers, chances of survival are extremely good. At about the same time as these advances were made in the hospital management of trauma, considerable improvement in the transportation services resulted in further improvement in survival rate, but the problem still remains of adequate care at the site by those initially at the scene of the accident. Last year, when I was thinking about how I might address the subject of prehospital trauma care and yet acquaint you with the work of St. John Ambulance in Canada and its role both past and present in the management of prehospital trauma care, an incident occurred one night when I was on trauma call which helped to crystallize my thoughts. A young man and his girlfriend were driving home that night. The car hit a slick in the road and slid into a telephone pole. The driver sustained a cardiac contusion with an arrest and his girlfriend, who was not injured, remembered reading that one should immediately call for help. A bystander, who happened to have some first-aid training initiated first-aid treatment with cardiac massage with cardiopulmonary resuscitation until the paramedics arrived and confirmed the fact that the patient had a cardiac arrest and continued resuscitation. He was brought to the hospital where it was estimated that he had arrested for some 10 to 12 minutes.