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Difficult Area (difficult + area)
Selected AbstractsInterpectoral approach to dissection of the Axillary Apex: An elegant and effective approachJOURNAL OF SURGICAL ONCOLOGY, Issue 3 2006Ajit Pai MS Abstract Background Axillary dissection is the goldstandard for treatment of the axilla. It provides important prognostic information, accurately stages the axilla, and has the lowest recurrence rate among all modalities. In today's age of conservation surgery, the axilla is often addressed through a cosmetically acceptable small incision with limited access, thereby making clearance of the level III nodes difficult. Methods We describe a method of apical lymph node dissection through the interpectoral plane, which effectively clears the apex despite the constraints of limited exposure. Results This method has been used in nearly 5,000 axillary dissections performed at our institute, with excellent results. It preserves the innervation of the pectoral muscles and affords access to the interpectoral nodes. Conclusions Our method has a short learning curve, provides good exposure of a difficult area and consistently provides a good yield of nodes. J. Surg. Oncol. 2006;94:252,254. © 2006 Wiley-Liss, Inc. [source] Revisiting pure economic loss: lessons to be learnt from the Supreme Court of Canada?LEGAL STUDIES, Issue 1 2005Dr Paula Giliker This article examines the treatment of pure economic loss claims in England and Canada. The two jurisdictions have much in common. Starting from the same case sources, the common law of each system has struggled to deal with claims for negligently-incurred pure economic loss. Yet, the systems diverged in the 1990s when the Canadian Supreme Court refused to follow the lead of Murphy v Brentwood DC and reiterated its adherence to the Anns two-stage test. It is submitted that, in view of recent developments which suggest the gradual convergence of the two systems, English law should carefully examine the categorisation approach adopted by the Canadian courts. The current English position is far from clear, and the Canadian model is capable of bringing transparency and greater clarity to this difficult area of law. [source] Bereavement in paediatric intensive carePEDIATRIC ANESTHESIA, Issue 8 2003Charles G. Stack MBBS Summary The death of a child is a very sad event in anyone's life. It also affects all staff in paediatric intensive care units in different ways at different times. The publication of standards of bereavement care in paediatric intensive care hopes to be able to assist medical and nursing staff to understand and feel more confident in this emotionally difficult area of medicine. The aim of this article is to summarize some of the major points made in the document. [source] Hand-assisted laparoscopic lymphadenectomy: a novel approach to a difficult areaANZ JOURNAL OF SURGERY, Issue 9 2003Andrew Sutherland Background: Hand-assisted laparoscopic surgery (HALS) is an emerging technique that is gaining acceptance for a wide range of abdominal procedures. We drew upon our growing experience with hand-assisted laparoscopic and thoracoscopic surgery to manage a case that was felt to require a major thoracoabdominal incision if it were to be completed by conventional open surgery. Methods: A technique is described that combines the advantages of both laparoscopic and open surgery in the form of hand-assisted laparoscopic surgery to permit safe dissection of a retrocrural mass extending into the chest. Results: We used this technique successfully to completely resect a nodal deposit of metastatic embryonal carcinoma previously thought to be inaccessible to surgical resection. Conclusion: The use of hand-assisted laparoscopic surgery improves tactile and visual feedback for the operator. This allows complex procedures involving delicate dissection to be completed safely and with less morbidity than open surgery. [source] Australian Child Support Reforms: A Case Study of the Use of Microsimulation Modelling in the Policy Development ProcessAUSTRALIAN JOURNAL OF PUBLIC ADMINISTRATION, Issue 4 2007Ann Harding Child support is always a difficult area of public policy, balancing the sometimes competing needs of children, resident and non-resident parents and the state. This article provides a relatively rare insight into some of the processes involved in developing the new Australian Child Support Scheme (CSS), which will commence full operation in July 2008. In particular, this article shows how microsimulation modelling was used by the Ministerial Taskforce on Child Support and the government in the policy reform process. The availability of such sophisticated distributional analysis and modelling allowed the development of a comprehensive picture of how the reforms would affect CSS clients, thereby facilitating the adoption of major policy change. This article also provides a blueprint for policy-makers of how modelling can facilitate their policy development processes. [source] Behavioral Medicine Strategies for Heart Disease Prevention: The Example of Smoking CessationPREVENTIVE CARDIOLOGY, Issue 1 2000Barrie J Guise PhD Health related behavior change is one of the most important challenges in the prevention of cardiovascular disease. Lifestyle patterns, such as high fat diet, lack of exercise, persistent smoking, and poor compliance with prescribed medications present the core of this challenge. Conventional wisdom and considerable scientific evidence establish that the barriers to health related behavior change are many and varied. However, much is also known about methods of improving behavioral outcomes. Behavioral medicine strategies incorporate fundamental principles of behavior change together with biomedical and interpersonal approaches to facilitate successful cardiac risk factor modification. Physicians have the most potent opportunity to assist patients with health behavior change. Unfortunately, physicians are least familiar with behavior change technology and the contemporary physician-patient relationship lacks the partnership needed to succeed in these difficult areas. The good news is that medical education has begun to incorporate training in behavior change and interpersonal effectiveness. A description of the behavioral medicine approach to smoking cessation provides an excellent model for a thoughtful and practical approach to heart disease prevention in every day practice. [source] The successful management of two pregnancies with wild type metastatic gastrointestinal stromal tumorsASIA-PACIFIC JOURNAL OF CLINICAL ONCOLOGY, Issue 3 2009Thean Hsiang TAN Abstract Aim: To discuss the management of the uncommon situation of metastatic gastrointestinal tumour coexisting with pregnancy. Method: We describe two cases of women with metastatic gastrointestinal stromal tumor (GIST) who successfully achieved a full-term pregnancy without complications and with the delivery of healthy infants. In both cases, treatment with imatinib mesylate was withheld during pregnancy because of its unknown effects and questionable safety for the developing fetus. The available data in the medical literature regarding the use and safety of imatinib and pregnancy are reviewed. We also examine whether the knowledge of the exon mutational status would have influenced treatment decisions. Results: Both women had wild type GIST, but with different tumor growth characteristics, treatment responses and outcomes. The first patient deferred imatinib therapy to fall pregnant and her disease progressed rapidly off treatment. The second patient had a more indolent GIST where active surgical management allowed her to experience a long durable clinical response. She potentially belongs to a pediatric subgroup which carries a better prognosis despite being off imatinib. Conclusion: While we have successfully managed two pregnant women with metastatic GIST, the issue of initiating imatinib therapy in treatment-naive women, and treatment interruption in women already on therapy, remain difficult areas. Patients and their partners need to make an informed choice regarding the associated risks and the potential long-term sequelae if pregnancies are contemplated. Further research into the natural history of wild type GIST and how to tailor subsequent treatment are needed. 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