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Introduction Patients undergoing selective minor emergency and elective procedures are followed up by a nurse-led structured telephone review six weeks post-operatively in our hospital. Our study objectives were to review patients' satisfaction, assess cost-effectiveness and compare our practice with other surgical units in Northern Ireland (NI). Patients and Methods Completed telephone follow-up forms were reviewed retrospectively for a three-year period and cost savings calculated. Fifty patients were contacted prospectively by telephone using a questionnaire to assess satisfaction of this follow-up. A postal questionnaire was sent to 68 general and vascular surgeons in NI, assessing individual preferences for patient follow-up. Results A total of 1378 patients received a telephone review from September 2005 to September 2008. One thousand one hundred and seventy-seven (85.4%) were successfully contacted, while 201 (14.6%) did not respond despite multiple attempts. One hundred and thirty-seven respondents (10.7%) required further outpatient follow-up, thereby saving 1231 outpatient reviews, equivalent to £41,509 per annum Thirty-nine (78%) patients expected post-operative follow-up, with 29 (58%) expecting this in the outpatient department. However, all patients were satisfied with the nurse-led telephone review. Fifty-three (78%) consultants responded. Those who always, or occasionally, review patients post-operatively varies according to the operation perforated, ranging from 2.2% appendicectomy patients to 40.0% for varicose vein surgery. Conclusion Current practice in NI varies, but a significant proportion of patients are not routinely reviewed. This study confirmed that patients expect post-operative follow-up. A nurse-led telephone review service is acceptable to patients, cost-effective and reduces the number of unnecessary outpatient reviews. [ABSTRACT FROM AUTHOR]

Introduction Pancreatic cancer has a poor prognosis with <5% alive at 5 years, despite active surgical treatment. The study aim was to review patients undergoing pancreatic resection and assess the effect of clinical and pathological parameters on survival. Patients and methods All patients who had undergone radical pancreatic surgery, January 1996 to December 2008, were identified from the unit database. Additional information was retrieved from the patient records. The demographic, clinical, and pathological records were recorded using Microsoft Excel. Survival was assessed using Kaplan-Meier and predictors of survival determined by multinominal logistic regression and log rank test. Results 126 patients were identified from the database. The majority (106) had a Whipple's procedure, 14 had a distal pancreatectomy and 6 had local periampullary excision. The average age of the Whipple's group of patients was 61.7 years (± 11.7) with most procedures performed for malignancy (n=100). Survival was worse with adenocarcinoma compared to all other pathologies (p=0.013), while periampullary tumours had a better prognosis compared to other locations (p=0.019). Survival decreased with poorer differentiation (p=0.001), increasing pT (p<0.001) and pN stage (p<0.001). Survival was worse with perineural (p=0.04) or lymphovascular invasion (p=0.05). A microscopic postive resection margin (RI) was associated with a worse survival (p=0.007). Turnout differentiation (p=0.001) and positive nodal status (p<0.001) were found to be independent predictors of mortality. Conclusion Tumour differentiation and nodal status are important predictors of outcome. A positive resection margin is associated with a poorer survival. [ABSTRACT FROM AUTHOR]

Objectives: Cilostazol improves walking distance. The study aimed to assess vascular and biochemical effects of cilostazol in peripheral arterial disease (PAD) patients. Methods: Patients were randomised in a double-blinded, placebo-controlled trial. Baseline clinical data were recorded following medical optimisation. Clinical assessment included ankle-brachial index (ABI), arterial compliance, peripheral trancutaneous oxygenation (TCO2) and treadmill walking distance. Glucose homeostasis was assessed by fasting serum glucose and glycosylated haemoglobin levels along with lipid profiles. Quality of life (QoL) indices were recorded using the VascuQoL questionnaire. All tests were at baseline, 6- and 24-weeks. Results: 106 PAD patients (M=73) were recruited from December 2004 to January 2006 (median age:66.5, range 37-86). Patients in both treatment limbs had similar baseline demographics, medical co-morbidities and walking performance. Patients who received cilostazol demonstrated a mean percentage improvement, in absolute claudication distance (77.2%vs.26.6% at 6-weeks and 161.7%vs.79.0% at 24-weeks, p<0.05). Arterial compliance improved at 6-weeks (-28.8%vs.-11.0%,p=0.005) and 24-weeks (-21.0%vs.-11.5%,p=0.012). There was no difference in ABI, TCO2 or glucose homeostasis. Cilostazol reduced triglycerides at 6-and 24-weeks (p<0.002). Activity, symptom, pain, emotion and total VascuQoL indices improved in the cilostazol group at 24-weeks (p<0.03). Conclusions: Maximal walking distance was improved by cilostazol in PAD patients with further beneficial effects in arterial compliance, lipid homeostasis and QoL. [ABSTRACT FROM AUTHOR]

Objectives: The phosphodiesterase-3 inhibitor Cilostazol improves walking distance in peripheral arterial disease (PAD) patients through an increase in cyclic AMP levels. The study objective was to assess the effects of cilostazol on the inflammatory response post-exercise in such patients. Methods: PAD patients were prospectively recruited to a randomised double-blinded, placebo-controlled trial. Baseline clinical data were recorded following medical optimisation. Initial and absolute walking distances were measured on a validated treadmill protocol. Inflammatory response was assessed before and 30-minutes post-exercise by serum lipid hydroperoxide, interleukins 6 and 10, intracellular and vascular cell-adhesion-molecules (I-CAM & V-CAM), highly-selective C-reactive protein (hsCRP) measurement and plasma ascorbate analysis. All tests were at baseline, 6-weeks and 6-months. Results: 106 PAD patients (72 males) were recruited from August 2004 to August 2006 (overall median age: 66.5, range 37-86). 26 patients were diabetic. Treatment limbs were demographically and medically matched. Patients who received cilostazol, compared to placebo, demonstrated a mean percentage improvement from baseline in absolute claudication distance (77.2% vs. 26.6% at 6 weeks and 161.7% vs. 79.0% at 6 months, p<0.05, t-test). There was a reduction from baseline lipid hydroperoxide levels in the cilostazol group compared to an increase in the placebo group before and after exercise (6-weeks: pre-exercise: -11.8% vs. +5.8% and post-exercise: -12.3% vs. +13.9%) (6-months: pre-exercise -15.5% vs. +12.0% and post-exercise: -9.2% vs. +1.9%) (p<0.01, MWU-test). Cilostazol significantly reduced I-CAM and V-CAM levels at 24-weeks compared to baseline (p<0.05, WSR-test). However, there was no difference between groups for interleukins 6 and 10, ascorbate or hsCRP levels. Conclusions: Cilostazol is a highly efficacious treatment for improving walking distance in patients with PAD with additional beneficial effects on lower limb ischaemiareperfusion both before and after walking. [ABSTRACT FROM AUTHOR]

Introduction: Breast cancer is a common malignancy. Department of Health guidelines state that all patients with suspected breast cancer should be referred urgently and seen by a specialist within two weeks of referral. The aim of this study was to assess referral patterns and clinical findings in patients referred to a specialist breast clinic within this context. Methods: A prospective database was maintained for consecutive patients referred to a specialist breast clinic. Clinical findings in primary care and at the breast clinic were recorded and correlated with final diagnoses. Results: Data were collected on 1098 patients. 588 (54%) were referred urgently, 285 (26%) routinely and 225 (20%) were unspecified. In many cases, referrals did not adhere to the "two-week-rule" guidelines. 86 patients (8%) were diagnosed with breast cancer. 72 (84%) of these were referred urgently, 6 (7%) routinely and 8 (9%) unspecified. Examination findings in primary and secondary care correlated in 487 (46%) patients. Conclusions: A large number of sub-optimal referrals were made. Sensitivity and specificity of clinical examination in primary care was low. Nonetheless, with excellent examination and diagnostic skills, sensitivity of the two-week-rule could only reach 86%, suggesting that either the concept of urgent referral criteria or the criteria themselves are flawed. [ABSTRACT FROM AUTHOR]

Introduction: Current NHS guidelines require patients with suspected breast cancer to be seen urgently at a specialist breast clinic. The aim of this study was to assess referral patterns and clinical findings of patients referred to a specialist breast clinic., Materials and Methods: A prospective database was maintained for consecutive patients referred. Symptoms and clinical findings in primary and secondary care were recorded. Correlation with final diagnoses was made. Tertiary referral patients were excluded., Results: 1098 patients attended a specialist breast clinic over six months. 588 (54%) were referred as urgent, 285 (26%) routinely and 225 (20%) were unspecified. 492 (45%) patients were referred with the incorrect referral priority. 42 patients were unexamined in primary care. Examination findings in primary and secondary care correlated in only 487 (46%) patients. Examination in primary care when compared with secondary care was highly sensitive for detecting breast lumps, but specificity was low. 86 patients (8%) were diagnosed with breast cancer, 72 (84%) were referred urgently, 6 (7%) routinely and 8 (9%) as unspecified priority. Regardless of the clinical expertise of the referrer, sensitivity and specificity of the two-week guidelines for cancer are low., Conclusions: Examination findings in primary and secondary care correlate in only 46% of referrals. Additionally, 55% of referrals were of the correct priority. The two-week rule guidelines have poor sensitivity and specificity for cancer. The safest and fairest policy would be to abandon the concept of urgent referral criteria and see all patients in a timely fashion. Alternatively, simplifying the referral criteria would improve sensitivity and specificity for cancer without leading to increased waiting times.