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Biomedical subjects

C L Chua

Publications and source records attributed to C L Chua.

26 records · Page 2Linked to original sources
PubMed1989

Cystosarcoma phyllodes: a review of surgical options.

The unpredictable behavior of histologic types and the disputable results of particular surgical procedures have contributed to the controversies surrounding phyllode tumors. The therapeutic issue is further compounded by an imprecise preoperative diagnosis. This is illustrated in our series of 106 patients, in whom 71.7% were mistakenly operated on for fibroadenoma. Since only 15.8% of this group developed local recurrence, it may be acceptable to adopt a watchful policy, unless detailed microscopic assessment of tumor margins provides evidence of inadvertent transection. Reoperation would then be logical advice, as with one of our patients. In patients clinically suspected of having phyllode tumors, tissue diagnosis is preferable to investigative procedures, which are seldom definitive. Our experience has been with frozen-section diagnosis, although trucut core biopsy is certainly an attractive procedure. In 18 patients only 50% were positively identified as having phyllode tumors. The logistic and therapeutic issues related to use of frozen-section diagnosis are discussed. Wide excision has been recommended by many investigators as an appropriate measure, as long as it is technically possible to remove the lesion with an adequate rim of normal breast tissue. This applies especially to young female patients (less than 20 years), in whom conservation of the breast is particularly desirable and whose tumors behave in a more benign manner. On the other hand, mastectomy is necessary if the phyllode tumor is large compared with breast morphologic size,when histologic transformation has taken place, or when clinical behavior takes a more aggressive course. In this retrospective study, conservative surgery is generally practiced for both primary and recurrent tumors.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1988

Cystosarcoma phyllodes tumors.

Of 106 females treated surgically for cystosarcoma phyllodes, 20 had one or more local recurrences, while seven other patients had "pseudorecurrences" in that the histologic findings showed benign disease of the breast. Histologic transformation into a histologically more aggressive lesion was noted in three patients. There was a higher incidence of recurrence among the younger patients (those less than 20 years of age) and in those with the larger tumors (greater than 5 centimeters diameter). The reasons for these findings are discussed. The phenomenon of recurrence was reviewed with regard to age of the patient, size of the lesion, histologic features of the tumor and extent of the operation.

Adult↗
PubMed1988

Cystosarcoma phyllodes--Asian variations.

Cystosarcoma phyllodes afflicting 106 female patients in a multiracial Asian society is reviewed and some interesting variations are noted when compared with Western patients. The incidence of phyllodes tumour is 3.83% of surgically removed breast tumours compared with 0.5-2.5% in Western series. This lends weight to the belief that non-Caucasians are more prone to this enigmatic breast disease than the Caucasian population. The profile of the Asian phyllodes patient is that of a young female, aged 25-30 years, whereas her Western counterpart is in her 40s. As a result, she is liable to be mistaken clinically as having fibro-adenoma. The disease is notably rare among the females below 20 years of age but in the Asian context, as much as one-quarter-one-third may be in the adolescent group. There were only three malignant and six borderline phyllodes tumours out of 106 cases, and this incidence is far below that of many other studies in which the malignant cases are believed to constitute 23-27%. However, this may not be a racial variation but explicable by the fact that the present study is an unselected cohort from a general surgical unit. The presence of associated benign breast disease in 25.5% cases helps to reinforce the widely held belief that fibro-adenoma and phyllodes tumour are related to some degree.

Adult↗
PubMed1988

Empyema of the gallbladder.

There is fairly widespread belief that suppuration superimposed upon acute cholecystitis is a rather uncommon condition. Scanty information on this subject is found in the published literature. No doubt, the scarcity of data further reinforces this clinical impression. Yet, from the few studies available, a surprisingly high incidence (7-11%) is documented. We reviewed 518 patients who underwent emergency cholecystectomy and found 139 cases to have frank pus present within the gallbladder. The clinical presentation is often difficult to distinguish from that of acute cholecystitis but diagnosis is crucial to identify this potentially fatal surgical emergency. There are encouraging reports of specific ultrasonic features which can demonstrate the increased viscosity produced by the purulent and fibrinous content within the gallbladder.

Adult↗
PubMed1986

The value of cervical lymph node biopsy--a surgical audit.

Cervical lymph node biopsy is a fairly common surgical procedure. The diagnostic yield, however, varies in different centres and in different series depending on the vigour of the screening procedure, the surgical policy adopted and the surgical techniques employed. A surgical audit of the diagnostic yield of 203 lymph node biopsies was made and the results are discussed especially in relation to asymptomatic lymphadenopathy, infective lymphadenitis and metastatic nodes. Comments are also made as to how a better diagnostic yield could be obtained through more meticulous handling of the tissue.

Adolescent↗
PubMed1985

Axonal degeneration distal to the site of accumulation of vesicular profiles in the myelinated fiber axon in experimental isoniazid neuropathy.

Morphometric sequential studies of pathologic changes were carried out on myelinated fibers in the lumbar ventral root of Sprague-Dawley rats administered with isoniazid, 1,500 mg/kg body weight, in a single dose. Accumulation of axoplasmic organelles with secondary paranodal retraction of myelin sheath occurred in the middle part of the ventral root as early as day 2 after the administration. On day 3, axonal degeneration started to occur, distal to the middle part, where the accumulation of axoplasmic organelles is prominent. Such accumulation with the possible blockade of the fast axoplasmic transport in the proximal axon may be directly responsible for the distal axonal degeneration. Alternatively such accumulation may be secondary to the distal axonal degeneration. The morphological sequential findings described clearly reflects the pathological events in isoniazid neuropathy.

Animals↗
PubMed1983

Morphometric evaluation of degenerative and regenerative changes in isoniazid-induced neuropathy.

Morphometric studies of the pathologic changes were carried out on the peripheral nerves, spinal roots, and different levels of the Goll's tract in rats given isoniazid and killed 1, 2, 3, 4, 5, 6, 7, 14, and 30 days after intoxication. In teased fiber preparations, axonal degeneration was the main change present, and this was seen as early as day 2 in the peroneal and distal sural nerves. The frequency of myelinated fibers showing axonal degeneration was higher in the distal than the proximal sural nerve, and in the ventral than the dorsal root. In the group of rats killed on 5, 6, 7, and 14 days, a significant decrease of the myelinated fiber density was observed in the distal and proximal sural nerves, ventral root, and at the third cervical level of the Goll's tract. The degree of fiber degeneration was more severe in the distal than in the proximal sural nerve and in the third cervical than the fifth thoracic level of the Goll's tract. Preferential decrease of large myelinated fibers was noted in all the affected nerves. No definite abnormalities, however, were seen in nerve cells of the 6th lumbar spinal ganglia and anterior horn cells of the lumbar spinal cord on light microscopy. On 30 days, regeneration at varying degrees was discerned in all the affected nerves with significant increase of small myelinated fibers, particularly in the ventral root. The findings indicate that both centrally and peripherally directed myelinated axons are more affected in the distal than in the proximal segments while the neuronal cell bodies are spared. The spatio-temporal evolution of this pattern of change is compatible with the concept of the "dying back" process or central-peripheral distal axonopathy.

Animals↗