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Article: Sentinel node biopsy in breast cancer revisited.

Omair, Mohammad / Al-Azawi, Dhafir / Mann, Gregory Bruce

The surgeon : journal of the Royal Colleges of Surgeons of Edinburgh and Ireland

2014 Volume 12, Issue 3, Page(s) 158–165

Abstract: The axilla has long been a focus of clinicians' attention in the management of breast cancer. The approach to the axilla has undergone dramatic changes over the last century, from radical and extended radical excisions, through the introduction of ... ...

Abstract	The axilla has long been a focus of clinicians' attention in the management of breast cancer. The approach to the axilla has undergone dramatic changes over the last century, from radical and extended radical excisions, through the introduction of sentinel node biopsy for node negative patients to the current situation where selective management of those with nodal involvement is being introduced. The introduction of lymphatic mapping and sentinel node biopsy in the 1990's has been key to the major changes that have occurred. In less than 20 years it has moved from a hypothesis to a situation where it is the default approach to almost all clinically node negative patients and is being considered in other situations where axillary clearance was previously considered standard. This article reviews the development and introduction of sentinel node biopsy, its current uncertainties and limitations, and possible future developments.
MeSH term(s)	Breast Neoplasms/diagnosis ; Breast Neoplasms/secondary ; Female ; Humans ; Lymph Nodes/pathology ; Lymphatic Metastasis ; Sentinel Lymph Node Biopsy/methods
Language	English
Publishing date	2014-06
Publishing country	Scotland
Document type	Journal Article ; Review
ZDB-ID	2102927-1
ISSN	1479-666X
ISSN	1479-666X
DOI	10.1016/j.surge.2013.12.007
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Zs.A 5756: Show issues

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Article ; Online: Use of incentive spirometry in portable chest radiography.

McEntee, Mark F / Houssein, Nariman / Al-azawi, Dhafir

Radiologic technology

2014 Volume 85, Issue 3, Page(s) 261–269

Abstract: Purpose: The degree of lung inflation seen on a chest radiograph is dependent on the point during the patient's respiratory cycle at which the radiographer exposes the image receptor. Exposing the image receptor at the exact peak of inflation can be ... ...

Abstract	Purpose: The degree of lung inflation seen on a chest radiograph is dependent on the point during the patient's respiratory cycle at which the radiographer exposes the image receptor. Exposing the image receptor at the exact peak of inflation can be difficult because of the limited time available in which to capture the inspiratory pause. An incentive spirometer can indicate the moment of peak inhalation. This study tested whether images taken with and without an incentive spirometer display different levels of image quality. Methods: This is a paired, prospective, single-blinded study of 30 patients undergoing portable chest radiography. The radiographs were acquired with and without the use of an incentive spirometer. Visual grading analysis was performed using the 1996 European Guidelines on Quality Criteria for Diagnostic Radiographic Images. Results: The mean patient age was 53 years. Sixty images were acquired, 30 with the use of incentive spirometry and 30 without. The most common indication for portable chest radiography was "postlung lobectomy." Discussion: Scoring on the radiologist's ability to see the sixth rib, spine, trachea, and cardiac border was not affected significantly by the use of incentive spirometry. Use of an incentive spirometer was associated with significant improvement in ability to see the 10th rib (P ≤ .004), vascular pattern (P ≤ .001), retrocardiac lung (P ≤ .013), and the costophrenic angles (P ≤ .005). Conclusion: This study introduces a technique to improve the quality of portable chest radiographs. The use of incentive spirometry improved inspiratory depth and image quality for portable chest radiographs.
MeSH term(s)	Adolescent ; Adult ; Aged ; Female ; Humans ; Lung/diagnostic imaging ; Male ; Middle Aged ; Motivation ; Point-of-Care Systems ; Radiographic Image Enhancement/methods ; Radiography, Thoracic/methods ; Single-Blind Method ; Spirometry/methods ; Young Adult
Language	English
Publishing date	2014-01
Publishing country	United States
Document type	Journal Article
ZDB-ID	414079-5
ISSN	1943-5657 ; 0033-8397
ISSN (online)	1943-5657
ISSN	0033-8397
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Article ; Online: Breast reconstruction post mastectomy- Let's Google it. Accessibility, readability and quality of online information.

Lynch, Noel P / Lang, Bronagh / Angelov, Sophia / McGarrigle, Sarah A / Boyle, Terence J / Al-Azawi, Dhafir / Connolly, Elizabeth M

Breast (Edinburgh, Scotland)

2017 Volume 32, Page(s) 126–129

Abstract: Introduction: This study evaluated the readability, accessibility and quality of information pertaining to breast reconstruction post mastectomy on the Internet in the English language.: Methods: Using the Google: Results: The Web sites were ... ...

Abstract	Introduction: This study evaluated the readability, accessibility and quality of information pertaining to breast reconstruction post mastectomy on the Internet in the English language. Methods: Using the Google Results: The Web sites were difficult to read and comprehend. The mean Flesch Reading Ease scores were 55.5. The mean Gunning Fog Index scores was 8.6. The mean Michigan score was 34.8 indicating weak quality of websites. Websites with HoN certification ranked higher in the search results (p = 0.007). Website quality was influenced by organisation type (p < 0.0001) with academic/healthcare, not for profit and government sites having higher Michigan scores. 20% of sites met the minimum accessibility criteria. Conclusions: Internet information on breast reconstruction post mastectomy and procedures is poorly written and we suggest that Webpages providing information must be made more readable and accessible. We suggest that health professionals should recommend Web sites that are easy to read and contain high-quality surgical information. Medical information on the Internet should be readable, accessible, reliable and of a consistent quality.
MeSH term(s)	Adult ; Breast Neoplasms ; Comprehension ; Consumer Health Information/standards ; Female ; Health Literacy ; Humans ; Internet/standards ; Mammaplasty ; Mastectomy ; Middle Aged ; Search Engine/standards
Language	English
Publishing date	2017-04
Publishing country	Netherlands
Document type	Evaluation Studies ; Journal Article
ZDB-ID	1143210-x
ISSN	1532-3080 ; 0960-9776
ISSN (online)	1532-3080
ISSN	0960-9776
DOI	10.1016/j.breast.2017.01.019
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Zs.A 3620: Show issues			Location: Je nach Verfügbarkeit (siehe Angabe bei Bestand) bis Jg. 1994: Bestellungen von Artikeln über das Online-Bestellformular Jg. 1995 - 2021: Lesesall (2.OG) ab Jg. 2022: Lesesaal (EG)
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Article ; Online: Assessing the impact of an ageing population on complication rates and in-patient length of stay.

McVeigh, Terri P / Al-Azawi, Dhafir / O'Donoghue, Gerrard T / Kerin, Michael J

International journal of surgery (London, England)

2013 Volume 11, Issue 9, Page(s) 872–875

Abstract: Background: Ireland has an ageing population; with the proportion of people aged over 80 years estimated to increase over the next 20 years from 1.1% to 2.1%.: Aims: The aim of this study was to examine the demographics of the population served by ... ...

Abstract	Background: Ireland has an ageing population; with the proportion of people aged over 80 years estimated to increase over the next 20 years from 1.1% to 2.1%. Aims: The aim of this study was to examine the demographics of the population served by the surgical department in a tertiary referral centre in the west of Ireland and to examine whether increasing age had an influence on morbidity, mortality and length of stay. Methods: Data pertaining to all surgical admissions over a 6-month period between was collected prospectively using an ACS-NSQIP based proforma. Data collected included patient age, gender, operative intervention, in-patient length of stay, mode of admission and complications related to their admission. Results: A total of 2209 patients were admitted under the care of the general, vascular and breast services in our centre over a 6-month period between August and January. Two thousand and nineteen patients had complete data collected. The average age was 50.37 years (± 23.62), with 24.12% (n = 533) older than 70 years. Only 12.31% of patients aged younger than 70 years experienced morbidity, compared to 25.10% of older patients. It was shown that there was a stepwise increase with complication rates and hospital in-patient stay across each decade of increasing age. Multivariate analysis showed those factors most predictive of a complication to include emergency admission, major or complex major surgical intervention, female gender and age. Length of stay was also found to have a positive correlation with increasing age (Spearman's Rho, p < 0.001). Conclusion: Increasing age is associated with increased complication rates and increased hospital length of stay.
MeSH term(s)	Adult ; Age Factors ; Aged ; Female ; Humans ; Ireland/epidemiology ; Length of Stay/statistics & numerical data ; Male ; Middle Aged ; Morbidity ; Multivariate Analysis ; Postoperative Complications/epidemiology ; Prospective Studies ; Treatment Outcome
Language	English
Publishing date	2013
Publishing country	England
Document type	Journal Article
ZDB-ID	2212038-5
ISSN	1743-9159 ; 1743-9191
ISSN (online)	1743-9159
ISSN	1743-9191
DOI	10.1016/j.ijsu.2013.07.016
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Zs.A 6502: Show issues

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Article ; Online: Ultrasound-guided core biopsy: an effective method of detecting axillary nodal metastases.

Solon, Jacqueline G / Power, Colm / Al-Azawi, Dhafir / Duke, Deirdre / Hill, Arnold D K

Journal of the American College of Surgeons

2012 Volume 214, Issue 1, Page(s) 12–17

Abstract: Background: Axillary nodal status is an important prognostic predictor in patients with breast cancer. This study evaluated the sensitivity and specificity of ultrasound-guided core biopsy (Ax US-CB) at detecting axillary nodal metastases in patients ... ...

Abstract	Background: Axillary nodal status is an important prognostic predictor in patients with breast cancer. This study evaluated the sensitivity and specificity of ultrasound-guided core biopsy (Ax US-CB) at detecting axillary nodal metastases in patients with primary breast cancer, thereby determining how often sentinel lymph node biopsy could be avoided in node positive patients. Study design: Records of patients presenting to a breast unit between January 2007 and June 2010 were reviewed retrospectively. Patients who underwent axillary ultrasonography with or without preoperative core biopsy were identified. Sensitivity, specificity, positive predictive value, and negative predictive value for ultrasonography and percutaneous biopsy were evaluated. Results: Records of 718 patients were reviewed, with 445 fulfilling inclusion criteria. Forty-seven percent (n = 210/445) had nodal metastases, with 110 detected by Ax US-CB (sensitivity 52.4%, specificity 100%, positive predictive value 100%, negative predictive value 70.1%). Axillary ultrasonography without biopsy had sensitivity and specificity of 54.3% and 97%, respectively. Lymphovascular invasion was an independent predictor of nodal metastases (sensitivity 60.8%, specificity 80%). Ultrasound-guided core biopsy detected more than half of all nodal metastases, sparing more than one-quarter of all breast cancer patients an unnecessary sentinel lymph node biopsy. Conclusions: Axillary ultrasonography, when combined with core biopsy, is a valuable component of the management of patients with primary breast cancer. Its ability to definitively identify nodal metastases before surgical intervention can greatly facilitate a patient's preoperative integrated treatment plan. In this regard, we believe our study adds considerably to the increasing data, which indicate the benefit of Ax US-CB in the preoperative detection of nodal metastases.
MeSH term(s)	Axilla ; Biopsy, Needle/methods ; Breast Neoplasms/diagnostic imaging ; Breast Neoplasms/pathology ; Female ; Humans ; Lymphatic Metastasis/pathology ; Retrospective Studies ; Ultrasonography, Interventional ; Ultrasonography, Mammary
Language	English
Publishing date	2012-01
Publishing country	United States
Document type	Journal Article
ZDB-ID	1181115-8
ISSN	1879-1190 ; 1072-7515
ISSN (online)	1879-1190
ISSN	1072-7515
DOI	10.1016/j.jamcollsurg.2011.09.024
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Article ; Online: Endocrine surgeon-performed US guided thyroid FNAC is accurate and efficient.

Al-azawi, Dhafir / Mann, G Bruce / Judson, Rodney T / Miller, Julie A

World journal of surgery

2012 Volume 36, Issue 8, Page(s) 1947–1952

Abstract: Background: Ultrasound guided fine needle aspiration cytology (US-FNAC) is a key diagnostic technique used to assess thyroid nodules. This procedure has been the domain of radiologists, but it is increasingly performed by endocrine surgeons. In the ... ...

Abstract	Background: Ultrasound guided fine needle aspiration cytology (US-FNAC) is a key diagnostic technique used to assess thyroid nodules. This procedure has been the domain of radiologists, but it is increasingly performed by endocrine surgeons. In the present study we aimed to assess the accuracy and clinical efficiency of US-FNAC performed by endocrine surgeons. Patients and methods: This study was a retrospective review of consecutive patients in a 3-year period who underwent US-FNAC performed by endocrine surgeons and radiologists. Medical records, cytology results, and surgical pathology results were collected and analyzed. Results: A total of 576 US-FNAC were performed on 402 patients during the study period. The endocrine surgeons and radiologists performed 299 and 277 US-FNAC, respectively. The FNAC inadequacy rate was 5.3 % for the endocrine surgeons and 9.3 % for the radiologists (p = 0.05). For thyroid cancer, the sensitivity, specificity, and false negatives of the US-FNAC for the endocrine surgeons was 87 %, 98 %, and 3 %, respectively while that for the radiologists was 88 %, 95 %, and 3.5 %, respectively. Patients with thyroid cancer had a shorter time to surgery in the endocrine surgeons' group (mean 15.3 days) compared to the radiologists' group (mean: 53.3 days; p = 0.01). Conclusions: US-FNAC performed by an experienced endocrine surgeon is accurate and allows efficient surgical management for patients with thyroid cancer.
MeSH term(s)	Adult ; Aged ; Aged, 80 and over ; Biopsy, Fine-Needle/methods ; Clinical Competence ; Endocrinology ; Female ; Humans ; Male ; Middle Aged ; Retrospective Studies ; Sensitivity and Specificity ; Statistics, Nonparametric ; Survival Rate ; Thyroid Nodule/diagnostic imaging ; Thyroid Nodule/pathology ; Ultrasonography, Interventional ; Workforce
Language	English
Publishing date	2012-04-20
Publishing country	United States
Document type	Journal Article
ZDB-ID	224043-9
ISSN	1432-2323 ; 0364-2313
ISSN (online)	1432-2323
ISSN	0364-2313
DOI	10.1007/s00268-012-1592-2
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Article: Esophagogastroduodenoscopy prior to laparoscopic cholecystectomy.

Al-Azawi, Dhafir / Rayis, Abubakir / Hehir, Dermot J

Journal of laparoendoscopic & advanced surgical techniques. Part A

2006 Volume 16, Issue 6, Page(s) 593–597

Abstract: Background: Peptic ulcer disease and gallstones are common causes of upper abdominal pain. The benefits of routine gastrostroscopy before laparoscopic cholecystectomy have been controversial. Some cases of persistent abdominal pain after laparoscopic ... ...

Abstract	Background: Peptic ulcer disease and gallstones are common causes of upper abdominal pain. The benefits of routine gastrostroscopy before laparoscopic cholecystectomy have been controversial. Some cases of persistent abdominal pain after laparoscopic cholecystectomy have been attributed to peptic ulcer disease. Materials and methods: We reviewed the significance of preoperative esophagogastroduodenoscopy in patients scheduled for laparoscopic cholecystectomy. We compared a group of patients who underwent esophagogastroduodenoscopy before laparoscopic cholecystectomy and a group of patients who underwent laparoscopic cholecystectomy with no preoperative esophagogastroduodenoscopy. Postoperative residual abdominal pain, esophagogastroduodenoscopy findings, hospital stay, and other variables were examined. Results: There were 400 patients in this study: 218 (54.5%) patients underwent esophagogastroduodenoscopy while 182 (45.5%) did not. The mean age was 49.8 years, 311 were female and 89 were male patients. One hundred and twenty seven (31.7%) patients were diagnosed with acute cholecystitis and 273 (68.2%) were nonacute. In the esophagogastroduodenoscopy group, there were normal findings in 98 (45%) patients. Disorders such as hiatus hernia (21%), acute duodenal ulcers (3.6%), esophagitis (3.6%), gastric ulcer (0.4%), and Barrett's esophagus (0.4%) were among the findings. Laparoscopic cholecystectomy was avoided in six patients with chronic cholecystitis. Preoperative esophagogastroduodenoscopy did not reduce the incidence of postoperative residual abdominal pain; in fact, patients who underwent esophagogastroduodenoscopy had longer hospital stays (P = 0.02). Unlike chronic cholecystitis, esophagogastroduodenoscopy did not change the course of the planned surgery in acute cholecystitis. Conclusion: Esophagogastroduodenoscopy prior to laparoscopic cholecystectomy does not have an impact on postoperative residual abdominal pain; however, it can disclose other gastroesophageal disorders with similar symptoms to gallstones and may change the course of the planned surgery in chronic cholecystitis.
MeSH term(s)	Adolescent ; Adult ; Aged ; Cholecystectomy, Laparoscopic ; Cholecystitis/complications ; Cholecystitis/pathology ; Cholecystitis/surgery ; Endoscopy, Digestive System ; Female ; Follow-Up Studies ; Humans ; Incidence ; Male ; Middle Aged ; Pain, Postoperative/epidemiology ; Preoperative Care ; Retrospective Studies ; Treatment Outcome
Language	English
Publishing date	2006-12
Publishing country	United States
Document type	Journal Article
ZDB-ID	1381909-4
ISSN	1092-6429
ISSN	1092-6429
DOI	10.1089/lap.2006.16.593
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Zs.A 3246: Show issues

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Article ; Online: HER-2 positive and p53 negative breast cancers are associated with poor prognosis.

Al-azawi, Dhafir / Leong, Sum / Wong, Limy / Kay, Elaine / Hill, Arnold D K / Young, Leonie

Cancer investigation

2011 Volume 29, Issue 5, Page(s) 365–369

Abstract: p53 and HER-2 coexpression in breast cancer has been controversial. These markers were tested using immunohistochemistry and HercepTest. HER-2 expression is related to reduced breast cancer survival (p = .02) . p53 expression relates to HER-2 expression ( ...

Abstract	p53 and HER-2 coexpression in breast cancer has been controversial. These markers were tested using immunohistochemistry and HercepTest. HER-2 expression is related to reduced breast cancer survival (p = .02) . p53 expression relates to HER-2 expression (p = .029). Coexpression between p53 and HER-2 has no relation to prognosis. On univariate and multivariate analysis, combination of HER-2 positive and p53 negative expression was associated with a poor prognosis (p = .018 and p = .027, respectively), while the combination of HER-2 negative and p53 positive expression was associated with a favorable prognosis (p = .022 and p = .010, respectively). Therefore the expression of these markers should be considered collectively.
MeSH term(s)	Adult ; Aged ; Aged, 80 and over ; Antineoplastic Combined Chemotherapy Protocols/therapeutic use ; Biomarkers, Tumor/analysis ; Breast Neoplasms/chemistry ; Breast Neoplasms/mortality ; Breast Neoplasms/pathology ; Breast Neoplasms/therapy ; Chemotherapy, Adjuvant ; Female ; Humans ; Immunohistochemistry ; Ireland ; Kaplan-Meier Estimate ; Mastectomy ; Middle Aged ; Neoplasm Staging ; Proportional Hazards Models ; Receptor, ErbB-2/analysis ; Recurrence ; Retrospective Studies ; Risk Factors ; Survival Rate ; Time Factors ; Treatment Outcome ; Tumor Suppressor Protein p53/analysis
Chemical Substances	Biomarkers, Tumor ; TP53 protein, human ; Tumor Suppressor Protein p53 ; ERBB2 protein, human (EC 2.7.10.1) ; Receptor, ErbB-2 (EC 2.7.10.1)
Language	English
Publishing date	2011-06
Publishing country	England
Document type	Journal Article
ZDB-ID	604942-4
ISSN	1532-4192 ; 0735-7907
ISSN (online)	1532-4192
ISSN	0735-7907
DOI	10.3109/07357907.2011.584586
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Article: The diagnosis of acute cholecystitis in patients undergoing early laparoscopic cholecystectomy in a community hospital.

Al-Azawi, Dhafir / Mc Mahon, Donal / Rajpal, Pawan K

Surgical laparoscopy, endoscopy & percutaneous techniques

2007 Volume 17, Issue 1, Page(s) 19–21

Abstract: Background: Early laparoscopic cholesyctectomy is the procedure of choice for acute cholecystitis; however, the diagnosis of acute cholecystitis in a community hospital setting is not always a simple matter.: Methods: A retrospective review of 70 ... ...

Abstract	Background: Early laparoscopic cholesyctectomy is the procedure of choice for acute cholecystitis; however, the diagnosis of acute cholecystitis in a community hospital setting is not always a simple matter. Methods: A retrospective review of 70 patients who have been admitted through the A&E department with the symptomatic gall bladder stones between July 2002 and May 2003. Results: To diagnose acute cholecystitis, as a single test, the sensitivity and the predictive value of the clinical-based diagnosis were 72.72% and 57.1%, respectively, higher than ultrasonography-based diagnosis 27.2% and 42.8%, respectively. The diagnosis of acute cholecystitis was 100% correct in 5 patients when the clinical diagnosis, ultrasound, and abnormal liver function test suggested the diagnosis of acute cholecystitis. The same was true for the diagnosis of chronic cholecystitis in 15 patients when the clinical picture and the ultrasound together with a normal liver function test supported the diagnosis. Conclusions: A detailed history and clinical examination are superior to ultrasonography for the diagnosis of acute cholecystitis. In a community hospital setting, a combination of clinical, radiologic, and laboratory tests are needed to accurately diagnose or exclude acute cholecystitis.
MeSH term(s)	Cholecystectomy, Laparoscopic ; Cholecystitis/diagnosis ; Female ; Hospitals, Community ; Humans ; Liver Function Tests ; Male ; Middle Aged ; Retrospective Studies ; Time Factors
Language	English
Publishing date	2007-02
Publishing country	United States
Document type	Journal Article
ZDB-ID	1475108-2
ISSN	1534-4908 ; 1530-4515 ; 1051-7200
ISSN (online)	1534-4908
ISSN	1530-4515 ; 1051-7200
DOI	10.1097/01.sle.0000213767.93794.03
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Article ; Online: Three-port versus four-port laparoscopic cholecystectomy in acute and chronic cholecystitis

Rayis Abu / Houssein Nariman / Al-Azawi Dhafir / McMahon Donal / Hehir Dermot J

BMC Surgery, Vol 7, Iss 1, p

2007 Volume 8

Abstract: Abstract Background Several modifications have been introduced to laparoscopic cholecystectomy (LC). The three-port technique has been practiced on a limited scale. Our aim was to compare the three-port and four-port LC in acute (AC) and chronic ... ...

Abstract	Abstract Background Several modifications have been introduced to laparoscopic cholecystectomy (LC). The three-port technique has been practiced on a limited scale. Our aim was to compare the three-port and four-port LC in acute (AC) and chronic cholecystitis (CC). Methods The medical records of 495 patients who underwent LC between September 1999 and September 2003 were reviewed. Variables such as complications, operating time, conversion to open procedure, hospital stay, and analgesia requirements were compared. Results Two hundred and eighty-three patients underwent three-port LC and 212 patients underwent four-port LC. In total, 163 (32.9%) patients were diagnosed with AC and 332 (67.1%) with CC by histology. There was no statistical difference between the three and four-port groups in terms of complications, conversion to open procedure (p = 0.6), and operating time (p = 0.4). Patients who underwent three-port LC required less opiate analgesia (pethidine) than those who underwent four-port LC (p = 0.0001). The hospital stay was found to be related to the amount of opiates consumed (p = 0.0001) and was significantly shorter in the three-port LC group (p = 0.005). Conclusion Three-port LC is a safe procedure for AC and CC in expert hands. The procedure offers considerable advantages over the traditional four-port technique in the reduction of analgesia requirements and length of hospital stay.
Keywords	Surgery ; RD1-811 ; Medicine ; R ; DOAJ:Surgery ; DOAJ:Medicine (General) ; DOAJ:Health Sciences
Language	English
Publishing date	2007-06-01T00:00:00Z
Publisher	BioMed Central
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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