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Biomedical subjects

D W Collure

Publications and source records attributed to D W Collure.

9 recordsLinked to original sources
PubMed1999

Unilateral male breast masses: cancer risk and their evaluation and management.

Breast cancer is an uncommon cause of breast enlargement in the adult male. Overall, it accounts for <1 per cent of all male cancers. Although most male breast carcinomas are clinically apparent, distinguishing early breast cancer from gynecomastia, the most common cause of male breast enlargement, is considered a difficult task. To overcome this difficulty, many surgeons proceed directly to surgery as their initial diagnostic test. Although appropriate in some cases, the infrequent occurrence of male breast cancer and the diagnostic accuracy of mammography and fine-needle aspiration cytology suggest a modification of our present management. The aim of this study was to assess the incidence of breast cancer in men with unilateral breast masses and to propose a treatment algorithm for unilateral male breast masses. The medical records of 36 male patients who underwent subcutaneous mastectomy for a unilateral breast mass at the Buffalo Veterans Administration Medical Center between 1989 and 1996 were retrospectively reviewed. Data was collected on a standard data form. The median age was 63-years-old (range, 22-82). Gynecomastia was diagnosed in 30 patients (83%), lipoma in 4 patients (11%), invasive breast cancer in 1 patient (3%), and melanoma in situ in 1 patient (3%). Of the 30 patients with gynecomastia, 60% (18 patients) gave a history of a medical condition or use of medications known to cause gynecomastia, compared with 16 per cent (1 of 6) of the patients without gynecomastia (P = 0.08). Half of the patients with gynecomastia presented with an asymptomatic mass compared with 67 per cent of the patients without gynecomastia (P = not significant). The median duration of symptoms for patients with gynecomastia was 3 months. Men with unilateral breast masses have a low incidence of breast cancer. A male patient with a palpable unilateral breast mass consistent with gynecomastia on the basis of historical, physical and mammographic findings does not require surgical biopsy unless other clinical indications prevail. Lack of symptoms (pain) related to the mass is probably not helpful in deciphering gynecomastia from breast cancer.

Adult↗
PubMed1996

Loss of ganglion cells and marked attenuation of bowel wall in cecal dilatation.

Cecal dilatation may be encountered in volvulus, distal colonic obstruction, and colonic pseudo-obstruction. Our study attempts to determine whether the dilatation is related to loss of ganglion cells and bowel wall attenuation. The records and colonic pathology of 27 patients who had undergone resection of the right colon for obstruction at the Veterans Affairs Medical Center, Buffalo, New York, were reviewed. Patients with severe ischemic changes and bowel wall necrosis were excluded. The remaining 10 cases were all elderly males who had cecal dilatation associated with cecal volvulus (7 cases), distal obstruction (2 cases), and colonic pseudo-obstruction (1 case). The dilated ceca ranged in circumference from 12 to 35 cm with a wall thickness of 0.1 to 0.2 cm. Ganglion cells of the Auerbach's plexus were counted per 10 fields at 200x magnification in hematoxylin and eosin-stained sections. Adjacent nondilated segments were examined for comparison. The number of ganglion cells within the dilated segments was significantly lower (1 to 6 cells; mean of 2.8) than in adjacent nondilated segments (8 to 42; mean of 23). Both the muscularis mucosae and propria were markedly attenuated in the dilated segments. Since the parasympathetic tone is probably impaired given the loss of ganglion cells, it is conceivable that conservative measures alone may not provide long term relief from dilatation.

Aged↗
PubMed1995

Laparoscopic cholecystectomy in patients with ventriculoperitoneal (VP) shunts.

Increased intracranial pressure is often relieved by a ventriculoperitoneal shunt. The shunt has a one-way valve which can withstand pressures of 300 mmHg and prevent reflux of intraabdominal fluid. We have utilized laparoscopy for cholecystectomy in four patients with VP shunts. In all patients the peritoneal cavity was free of adhesions. When CO2 insufflation pressure was as high as 10-15 mmHg cerebrospinal fluid was still noted to flow from the end of the shunts. In three patients the entire procedure was performed laparoscopically. In the fourth patient the procedure was converted to an open cholecystectomy because of extensive inflammation surrounding a gangrenous gallbladder. Postoperatively the shunts remained intact and functional. There were no central nervous system sequelae. None of the shunts became infected. Elective laparoscopic cholecystectomy in patients with VP shunts can be done safely without a need for clamping or other manipulation of the shunt.

Adult↗
PubMed1990

A cheap external fixator device.

A cheap external fixator made from readily available materials is described. This device should prove useful in the management of difficult compound fractures of the leg. Multiple staged procedures such as serial debridement, and bone and skin grafts can be carried out while maintaining the fracture fragments in position by means of this fixator.

Adult↗
PubMed1989

Pyloric obstruction following the ingestion of corrosive acid.

Pyloric obstruction is a well documented end result of ingestion of corrosive acid. Whereas the oesophageal mucosa is resistant to damage, the pyloric spasm and the resultant pooling of acid in the pre-pyloric region, causes injury to this area. The fibrosis of the gastric wall with motility disturbances, and the diminution of acid and pepsin production from damage to the glandular elements, would weigh against the addition of a vagotomy to the drainage procedure. A case of ingestion of concentrated sulphuric acid and the management of its late sequelae, are discussed.

Adult↗