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Biomedical subjects

H P Leis

Publications and source records attributed to H P Leis.

At least 19 recordsLinked to original sources
PubMed1988

Nipple discharge: surgical significance.

Nipple discharge is an important clinical entity ranking second only to a lump as the most common complaint among 7,588 patients having breast surgery (560/7,588, or 7.4%). In the office and clinic it is even more common, since many patients can be treated medically and do not require an operation. To be significant, a discharge should be true, spontaneous, persistent, and nonlactational. Nipple discharge can be milky, multicolored and sticky, purulent, clear (watery), yellow (serous), pink (serosanguineous), or bloody (sanguineous). Watery, serous, serosanguineous, and sanguineous discharges are surgically significant; while they are most often caused by intraductal papillomas or fibrocystic disease, they can be due to cancer or a precancerous mastopathy. Among 503 patients operated on for one of these types of discharge, 67 (13.3%) had cancer, and 36 (7.2%) had a precancerous mastopathy. Among the 67 patients with cancer, eight (11.9%) had no palpable mass, 11 (16.4%) had negative cytologic findings, and seven (10.4%) had a negative mammogram. The incidence of associated cancers increases when the discharge is, in order of increasing frequency, serous, serosanguineous, sanguineous, or watery, when it is accompanied by a lump, when it is unilateral and from a single duct, when there are positive cytologic or mammographic findings, and when the patient is more than 50 years of age. Milky discharge caused by galactorrhea is treated medically except when caused by a pituitary adenoma. Multicolored sticky discharge due to duct ectasia is also treated medically except in advanced cases. Purulent discharge caused by an abscess requires drainage and a biopsy of the abscess wall. Except in women less than 30 years of age of in those anxious to have children, we advise a complete central duct excision for patients with surgically significant types of discharge. If done carefully, this procedure can yield good cosmetic results.

Adult↗
PubMed1983

Family history, oral contraceptive usage, and breast cancer.

When breast cancer patients were grouped according to their family history of breast cancer striking differences were found in age distribution. Thus, the proportion of cases less than 45 years of age was grandmother greater than aunt greater than mother greater than FH-negative greater than sister. A similar FH-related sequence was observed in regard to current OC usage among breast cancer patients less than 45 years of age. It also appeared that current oral contraceptive (OC) usage increased the risk of invasive breast cancer among grandmother- or aunt-positive women while decreasing the risk among FH-negative women. There are important practical and conceptual reasons for further studies of the influence of interactions between age, OC usage and family history on the stepwise development of breast cancer.

Adult↗
PubMed1980

Family history and oral contraceptives: unique relationships in breast cancer patients.

The relative frequency of a history of breast cancer among specific blood relatives was determined for breast cancer patients according to their prior use of oral contraceptives (OC). These data were compared with those derived from patients having various types of noninvasive breast lesions and from control women. It was found that a history of breast cancer among grandmothers or aunts was significantly more frequent among breast cancer patients who had used OC for one or more years continuously than among OC-negative breast cancer patients, and among patients with noninvasive breast lesions and control women, regardless of OC usage. Breast cancer patients whose grandmothers or aunts had breast cancer used OC significantly more frequently than did family history (FH)-negative breast cancer patients and breast cancer patients having a history of breast cancer limited to relatives other than grandmothers and aunts (mothers, sisters, cousins). It appears that the family history is a significant covariable in the relationship between OC usage and breast cancer. There is a need for specific studies to test the possibilities that OC usage increases the risk of breast cancer among women whose grandmothers or aunts had breast cancer, and reduces the risk of breast cancer in FH-negative women.

Adult↗
PubMed1980

Managing the remaining breast.

Bilateral breast cancer is discussed as to 1) the criteria for determining whether a cancer in the other breast is primary or metastatic; 2) the incidence of simultaneous and subsequent primary cancers in the second breast and the factors that could account for the reported frequency variance by different authors; 3) the influence that a second primary cancer in the contralateral breast makes on the survival of the patient; 4) the psychologic and physical importance of the remaining breast to the patient; and 5) the management of the other breast using preoperative x-rays and random biopsies as added modalities for detection and reserving prophylactic mastectomy of the remaining breast for those patients at high risk for developing cancer in it with a definition of these risk factors. Forty-two simultaneous primary cancers were found in the other breast in a series of 500 (8.4%) patients undergoing primary therapy for cancer in their first breast of which 19 (45.2%) were invasive, and 23 (54.8%) were non-invasive. Two (0.4%) were detected clinically, 16 (3.2%) by x-rays, and 24 (7.5%) by random biopsies in 321 patients. In a series of 846 patients with potentially curable breast cancer, the absolute ten-year survival rate was 63%. They were operated on before the routine use of preoperative x-rays and random biopsies. Eleven (1.3%) had either clinical or x-ray detected simultaneous cancers in the other breast. Of the remaining 835, 48 had prophylactic mastectomies in which 8 (16.6%) unsuspected cancers were found. In the remaining 787, 70 (8.9%) developed subsequent cancers making a total subsequent rate of 78 of 835 (9.3%).

Biopsy↗
PubMed1979

Selective and reconstructive surgical procedures for carcinoma of the breast.

Eighteen hundred and fifty-nine patients with primary carcinoma of the breast from New York Medical College-Flower and Fifth Avenue Hospitals were treated by a moderate selective surgical approach between 1950 and 1975. Seven hundred and eleven patients with potentially curable carcinoma of the breast were observed for ten or more years. Based upon strict criteria of evaluation, the series did not have an increased number of prognostically favorable cancers compared with that of other series. The results obtained were most rewarding regarding absolute gross ten year survival rates, local recurrence rates, percentage of skin grafts, management of the other breast, arm and shoulder function and cosmetic appearance, especially in relation to reconstruction of the breast in properly selected patients.

Adenocarcinoma, Scirrhous↗
PubMed1979

Fibrocystic disease of the breast.

Fibrocystic disease is the most common type of lesion in the female breast. It is a common dumping ground for a variety of distinct clinical and histologic entities which require different modalities of therapy and which have different malignant transformation potentials. In general, fibrocystic disease is managed medically unless a dominant lump or other adverse symptom develops, in which case a biopsy is performed. The exception to this rule is a cyst which can be safely aspirated under controlled conditions. If, on biopsy, one of the histologic types of fibrocystic disease called "precancerous mastopathy" is found, which has a high potential for malignant transformation, then serious consideration must be given to definitive surgical procedures, especially if the patient has other risk factors that would increase her risk of developing breast cancer even further.

Biopsy↗
PubMed1979

Diagnosis of breast cancer: clinical and preclinical.

While a tentative diagnosis of lesion type can be made fairly accurately on the basis of a patient's history, combined with a thorough examination, and the use of diagnostic aids, biopsy and histologic examination remain the only absolute means of determining whether a lesion is benign, premalignant, or malignant.

Adenofibroma↗
PubMed1978

Bilateral breast cancer.

The true incidence of bilateral breast cancer, both simultaneous and subsequent, is higher than older statistics indicate, and the frequency can be expected to increase as more efficient methods of detection and treatment become commonplace. Furthermore, there is a subgroup of patients who have an especially high risk for having a second primary cancer in the other breast; if such a cancer develops it deleteriously influences the survival of the patient. A rational approach to the management of the other breast is presented using contralateral biopsy as an added modality for detection and reserving prophylatic matectomy of the other breast for those patients who ar at high risk for developing cancer in it.

Biopsy↗