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D J Gillett

Publications and source records attributed to D J Gillett.

At least 19 recordsLinked to original sources
PubMed2001

Screen-detected breast cancer compared to symptomatic presentation: an analysis of surgical treatment and end-points of effective mammographic screening.

BACKGROUND: Mammographic screening has been shown to reduce mortality from breast cancer and to offer more opportunity for breast conservation surgery (BCS). The minimum standards (or surrogate end-points) that need to be achieved by a screening programme if it is to reduce mortality have been derived from the Two County Study. Three surrogate end-points that can be used to gauge the quality of the screening service are that 50% of the identified infiltrating cancers should be < 15 mm; at least 30% of grade 3 cancers should be < 15 mm; and 70% of screen-detected cancers should have a negative axillary dissection. The present study assesses these end-points of effective screening in an urban population referred to The Strathfield Breast Centre (TSBC). The screening end-points and surgical treatment of one group of women referred with a BreastScreen New South Wales (NSW)-detected breast cancer (screen group) were compared to all the other, mostly symptomatic, breast cancer referrals (symptom group). The problems with the current pattern of acceptance of mammographic screening in TSBC's referral area are discussed. METHODS: A prospective non-randomized study was done via analysis of the prospective database at The Strathfield Breast Centre (TSBC). RESULTS: There were 224 women in the screen group and 657 women in the symptom group. The mean tumour size was 18.1 mm in the screen group and 22.1 mm in the symptom group. There were significantly more small invasive cancers (< 15 mm) in the screen group (58%) compared with the symptom group (33%; P < 0.001). In the screen group there were more low-grade tumours but 30% of grade 3 tumours were < 15 mm compared with 16% in the symptom group (P = 0.009). In patients with invasive cancers who underwent axillary dissection, there was a significant difference in axillary node negativity, being 72% in the screen group and 59% in the symptom group (P = 0.003). In the screen group 64% of women had BCS compared with 51% in the symptom group (P = 0.002). CONCLUSIONS: These end-points of effective mammographic screening were met in the BreastScreen NSW group of women who were referred to TSBC despite the biases involved which could lessen the effectiveness of the screening programme. This crudely translated into a significant reduction in breast cancer mortality but selection and lead time bias has to be taken into account in evaluation of these data. There was a significantly greater chance of BCS in the screen group.

Breast Neoplasms↗
PubMed2000

Sentinel node biopsy in breast cancer: results of 103 cases.

BACKGROUND: In early breast cancer the status of the axillary nodes has been shown to be one of the primary prognostic indicators. Biopsy of the sentinel node, or first draining lymph node, of a tumour has been investigated as an alternative to axillary dissection in early breast cancer. A series of sentinel node biopsies in 103 patients is reported here. METHODS: Both pre-operative lymphoscintigraphy and intra-operative blue dye were used to map the sentinel nodes. RESULTS: Mapping was successful in 87 (84.4%) cases and sentinel nodes were retrieved in 94.2% of these patients. Where lymphoscintigraphic mapping was unsuccessful, sentinel nodes were found in 37.5%. When sentinel nodes were retrieved, correlation of the sentinel node status with the axillary nodes was accurate in 97.5%. There were two false negatives, both in large tumours. The sentinel node status was an accurate predictor of axillary status in 95.7% of the node positive patients. CONCLUSIONS: If only the 86 patients with invasive carcinoma and four or more axillary nodes removed at surgery are considered, the sentinel node was accurate in assessing the axillary status in 97.7% of the total patient group (2.3% false negative rate), 97.2% of those in whom sentinel nodes were successfully retrieved (2.8% false negative rate) and 94.9% of the patients with positive axillary nodes (5.1% false negative rate). Sentinel node biopsy is a valid technique providing an accurate reflection of the axillary node status and having a low false negative rate.

Axilla↗
PubMed1998

Carcinoma of the male breast: a review and recommendations for management.

BACKGROUND: Male breast cancer is rare and experience of it in any single institution is limited. The aim of this study was to evaluate the presentation, management and outcome of male patients with breast cancer treated at Concord Repatriation General Hospital hospital over a 38-year period and to determine a best-practice protocol based on the results and a review of the literature. METHODS: A total of 42 patients were retrospectively reviewed, pathology slides were re-examined and reclassified where necessary. Outcome was assessed and compared with results obtained from a literature review. RESULTS: A trend towards less radical surgery has emerged. Overall 5-year survival was 50%, but, due to the late age at presentation, more than half the deaths were non-breast cancer related. One quarter of the patients presented with locally advanced or metastatic disease. CONCLUSIONS: The presentation, diagnosis pathology and outcome of breast cancer are similar in men and women, although the disease occurs at a later age in men. Radical surgery is not required in order to gain local control, but knowledge of axillary node status is important in determining prognosis and the need for adjuvant therapy.

Adult↗
PubMed1998

Breast cancer outcomes at the Strathfield Breast Centre.

BACKGROUND: Breast cancer is the most commonly diagnosed cancer and the most common cause of cancer death in women. This report presents outcomes from a multidisciplinary breast clinic established in 1989 with the specific aim of providing a rapid, integrated assessment service for patients with breast disease. METHODS: A prospective data collection and analysis using a Microsoft Access (Microsoft Corp., North Ryde, NSW, Australia) database was established and has collected information on all patients presenting for diagnosis or ongoing management of breast cancer. Data on survival were obtained by routine follow-up visits or contact with the patient's general practitioner. RESULTS: Patient age, mode of presentation and histopathology were similar to other population-based studies in Australia. Ninety-three per cent of the patients had a diagnosis confirmed on the day of consultation. The average time between diagnosis and surgery was 11.9 days. Breast preserving surgery was attempted in 68% and achieved in 50% of cases, 67% of patients had one stage surgery. Five-year disease-free survival was 74% and is comparable with other reports. CONCLUSIONS: The centralization of services and expertise has enabled us to provide efficient service and achieve internationally comparable outcomes.

Breast Neoplasms↗
PubMed1997

Fine-needle biopsy specimens of benign breast lesions distinguished from invasive cancer ex vivo with proton MR spectroscopy.

PURPOSE: To determine whether invasive breast cancer can be distinguished from benign lesions with proton magnetic resonance (MR) spectroscopy ex vivo on the basis of altered cellular chemistry. MATERIALS AND METHODS: Two hundred eighteen fine-needle biopsy specimens were obtained in 191 patients undergoing surgery and were analyzed with proton MR spectroscopy. MR spectroscopic and histopathologic findings were compared. RESULTS: Invasive carcinoma produced increased signal at 3.25 ppm, attributable to choline-containing metabolites. Discrimination between invasive carcinoma (n = 82), benign lesions (n = 106), or carcinoma in situ (n = 17) was based on the resonance intensity at 3.25 ppm standardized to the resonance at 3.05 ppm (P < .001). The ratio of peak height intensities of resonances at 3.25 to those at 3.05 ppm was less than 1.7 in 102 of the 106 normal or benign lesions. All carcinoma in situ specimens with comedonecrosis or a microinvasive component (n = 6) were categorized at MR spectroscopy with invasive carcinoma, while others with in situ disease alone were categorized with benign lesions (n = 11). The sensitivity and specificity of MR spectroscopy in fine-needle biopsy specimens in distinguishing benign lesions from invasive cancer were 95% and 96%, respectively. CONCLUSION: Proton MR spectroscopy of fine-needle biopsy specimens provides objective diagnostic information that complements findings of conventional preoperative investigations of breast lesions.

Adult↗
PubMed1996

A review of pathology reporting for breast cancer.

BACKGROUND: A detailed pathology report is important in the determination of treatment options and prognosis in breast cancer. Australia's first National Cancer Consensus Conference, held in 1994, recommended guidelines for the standardization of the clinical information to be provided to the pathologist, the specifications relating to the handling of specimens, and the resultant pathology report. METHODS: We examined the current status of pathology reporting in invasive breast cancer in three New South Wales hospitals from 1986 to 1994. RESULTS: Histopathologic type was documented in 99% of reports, grade was documented in 47%, size in 46%, and lymph node status in 98%. Only 27% of pathology reports reviewed documented the status of all the above parameters in the one report. Other features such as lymphatic and vascular invasion were documented in only 21% and 9% of pathology reports, respectively, while sex steroid receptor status was reported in almost 90% of cases. CONCLUSIONS: In view of the wide range in the percentage of features reported, we recommend the use of a standardized checklist for the pathological assessment of surgically resected invasive breast cancer specimens.

Adult↗
PubMed1990

Highly selective vagotomy in the treatment of complicated duodenal ulcer.

Highly selective vagotomy has been utilized urgently in 33 patients with bleeding duodenal ulcer, 16 patients with pyloric stenosis and six patients presenting with perforated ulcer. Five patients died after surgery for bleeding duodenal ulcer, and two patients rebled after surgery. Forty-eight patients were reviewed at a mean of 28 months with an excellent outcome being obtained in 45 patients. Two of the three patients with poor results had proven ulcer recurrence while the third patient required reoperation for recurrent pyloric stenosis. No patient has suffered diarrhoea after vagotomy. Highly selective vagotomy is an effective treatment for urgent management of complicated duodenal ulceration and is without troublesome post-vagotomy symptoms.

Aged↗
PubMed1990

Carcinoma of the stomach: a review with special reference to total gastrectomy.

Five hundred and eleven patients with adenocarcinoma of the stomach were reviewed. Weight loss and abdominal pain were the most common symptoms. One-third of patients were found to have proximal gastric lesions with dysphagia being a major symptom in 23% of all patients. Laparotomy was performed on 88% of patients with 56% of the entire series undergoing gastric resection. The overall 5-year survival rate was 12.3% and for curative resection 43%. The 5-year survival rate of patients undergoing total gastrectomy was 53% and for patients undergoing subtotal or partial gastrectomy the 5-year survival rate was 42%. The operative mortality, similar in both groups, was 8.1% versus 5.6%. Palliation was better achieved by resection than bypass. Total gastrectomy for palliation was undertaken in 48 patients. This group of patients has achieved a good quality of life and a mean survival rate of 12.5 months.

Adenocarcinoma↗
PubMed1990

Early gastric cancer.

Eighteen cases of 'early gastric cancer' have been managed over a 14-year period. This represents only 3.5% of all patients diagnosed as having adenocarcinoma of the stomach. The symptoms of early gastric cancer are similar to those of benign peptic ulcer disease and differ from those of invasive disease. The pathology of the lesions is described and the morphology shown to be similar to that seen in Japan. The overall 5-year survival rate is 82% but no patient has developed recurrence within 5 years of surgery, confirming the biological behaviour of the lesion to be identical to that noted by Japanese researchers.

Adenocarcinoma↗
PubMed1986

Major hepatic resection for neoplasia. The Concord Hospital experience.

In a major hepatic resection one, or more, of the eight major anatomical segments of the liver is removed. Such procedures are a recent development and during 1972-1982, 22 such resections were performed for neoplasia at Concord Hospital, with a mortality rate of 5%. The indications for elective hepatic resection for neoplasia are discussed. Of particular importance is the excellent palliation and survival that is achieved when localized metastases of colorectal origin are resected.

Adult↗
PubMed1985

Fine bore jejunostomy feeding following major abdominal surgery: a controlled randomized clinical trial.

A randomized controlled prospective clinical trial has been undertaken to examine the efficacy of the technique of early postoperative feeding using a fine bore catheter jejunostomy. Fifty patients undergoing surgery for gastrointestinal malignancy were randomly allocated into treatment and control groups. A low residue liquidized diet (Isocal) was administered to the patients in the treatment group. Control patients received routine intravenous therapy. Nutritional parameters (serum albumin, serum transferrin, serum prealbumin, weight, body fat and fat free mass) were measured pre-operatively and on the tenth postoperative day. Postoperative surgical complications were similar in both groups. There were 20 catheter complications and one death directly attributable to the jejunal catheter feeding. Postoperative stay was significantly longer (P less than 0.01) in the treatment group patients. Evaluation of the nutritional parameters showed no advantage for either the treatment group or a selected complication-free, 'successful treatment', subgroup. It is concluded that no significant clinical or nutritional advantage for jejunal catheter feeding has been demonstrated and because of the related complications, its routine use cannot be recommended.

Aged↗
PubMed1981

Treatment of granulating wounds with silastic foam dressings.

We have examined the usefulness of a Silastic foam dressing in the management of open granulating wounds in 55 outpatients. It is an acceptable and comfortable dressing, which allows earlier discharge from hospital. The method of making the dressing, and the daily care of the wound are described. Improved wound care is achieved by providing two dressings, so that when one is in place the other is being thoroughly cleaned. This technique has been shown to reduce bacterial contamination of the wounds and to improve wound healing (p less than 0.02).

Abdomen↗
PubMed1977

Sclerosing peritonitis after practolol administration.

We have recently managed two patients with sclerosing peritonitis who had undergone a course of practolol but had ceased taking it some months prior to presentation. Publication of these cases will help to assess the extent of this complication and will increase awareness amongst surgeons who may be called upon to treat such cases.

Aged↗