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Biomedical subjects

M Morrow

Publications and source records attributed to M Morrow.

At least 55 records · Page 3Linked to original sources
PubMed1999

Breastfeeding practices among employed Thai women in Chiang Mai.

In many developing countries, labor force participation by women in the childbearing years has increased rapidly. Social and economic changes present new challenges for women attempting to combine their roles as workers and mothers. Little is known about how these challenges affect infant feeding choices. This multidisciplinary study investigated work and infant feeding decisions among 313 employed women in Chiang Mai, Thailand. Resumption of employment generally had negative affects on breastfeeding rates and duration. At 6 months postpartum, women who worked inside the home breastfed more than those working in the formal sector at jobs with inflexible hours (home, 80%; public sector, 37%; private sector, 39%). Women who were working outside the home for a long period or had shift jobs encountered many obstacles to maintaining breastfeeding, and most gave it up within 1 month after resuming employment. There is a need for multisectoral policies that address obstacles to breastfeeding among women in the paid labor force in Thailand.

Adult↗
PubMed1999

Management of complex breast cysts.

OBJECTIVE: This study was undertaken to evaluate the various strategies currently in use to manage complex cysts and specifically address the need for intervention. MATERIALS AND METHODS: A review of 4562 breast sonograms obtained during an 18-month period revealed 308 complex cysts in 252 women. Data collected from review of patient records included the patient's age and risk factors for breast cancer, aspiration or biopsy results (or both), follow-up imaging studies, and management recommendations. RESULTS: Management recommendations for complex cysts were 1-year follow-up in 13 patients, 6-month follow-up in 148, sonographically guided aspiration in 82, aspiration with possible core biopsy in 62, and excisional biopsy in three. No malignancies were diagnosed in the group treated with follow-up imaging, sonographically guided aspiration, or excisional biopsy. One malignancy, a papilloma with a 3-mm focus of ductal carcinoma in situ, was diagnosed in one of the patients who underwent core biopsy. CONCLUSION: Of the lesions classified as complex cysts, the malignancy rate was 0.3% (1/308). This malignancy rate is lower than that for lesions classified as probably benign using mammographic criteria (i.e., for lesions classified as category 3 lesions using the Breast Imaging Reporting and Data System). Because the accepted standard practice for management of probably benign lesions is follow-up studies, the low yield of malignancy in this series suggests that complex cysts can be managed with follow-up imaging studies instead of intervention.

Adult↗
PubMed1999

Menstrual and reproductive factors for salivary gland cancer risk in women.

Several observations suggest that salivary gland cancer may be, in part, a hormonally dependent disease. We examined associations between hormonally mediated life events and salivary gland cancer risk in a population-based case-control study. Of 76 women diagnosed between 1989 and 1993, 63 (83%) were interviewed. Of 111 population controls, 83 (75%) were interviewed. Early menarche (OR = 4.1, 95% CI = 1.4-12.1) and nulliparity (OR = 2.6, 95% CI = 1.0-6.7) were associated with increased risk whereas late age at first full-term pregnancy (OR = 0.19, 95% CI = 0.3-1.2) and longer duration of oral contraceptive use (OR = 0.31, 95% CI = 0.10-1.0) were associated with diminished risk. These findings are consistent with a hormonal component in salivary gland cancer risk.

Adult↗
PubMed1999

Lobular carcinoma in situ: current concepts and controversies.

Clinical and clinicopathologic studies performed over the last 50 years have elucidated many of the important features of lobular carcinoma in situ. However, certain aspects of the natural history, treatment, and diagnosis of these lesions remain controversial. The purpose of this article is to review the current understanding of lobular carcinoma in situ and to highlight some of the controversies surrounding this entity.

Breast Neoplasms↗
PubMed1999

Urinary tract infection as nidus for systemic spread and septic arthritis.

A 12-year-old bearded collie was diagnosed with septic arthritis. The same beta-hemolytic streptococcus was cultured from the joint, blood, and urine. With arthritis, it is important to search for an inciting cause (this case, urinary tract infection) and to differentiate infectious from immune-mediated disorders, as treatment may be very different.

Animals↗
PubMed1999

Learning sentinel node biopsy: results of a prospective randomized trial of two techniques.

BACKGROUND: Evidence indicates that sentinel node (SN) biopsy can accurately predict axillary nodal status. Debate exists as to the optimal method of SN identification. METHODS: Patients with clinical T1 or T2 tumors and negative axillae were randomized to SN localization with blue dye (B) alone (n = 50) or blue dye plus radioactivity (B+R) (n = 42). Patients undergoing needle localization (n = 47) were assigned to blue dye. RESULTS: The SN was identified in 110 patients (79%) and contained metastases in 28. The SN predicted the axillary nodal status in 96% of cases. The SN identification rate did not differ between B (88%) or B+R (86%) but was significantly lower in patients requiring localization (64%). The time to SN identification also did not differ between B and B+R. The number of cases done by an individual surgeon was a significant predictor of SN identification. A stepwise logistic regression analysis of factors influencing the success of SN identification identified tumor location, needle localization, number of operations, and body mass index as significant predictors. CONCLUSIONS: Our study does not identify any advantage for the use of the more expensive and complex method of SN identification using B+R compared with B alone, even for surgeons learning the techniques.

Axilla↗
PubMed1998

The National Cancer Data Base 10-year survey of breast carcinoma treatment at hospitals in the United States.

BACKGROUND: The National Cancer Data Base (NCDB), a joint project of the American College of Surgeons Commission on Cancer and the American Cancer Society, is a cancer management and outcome data base for health care organizations. It provides a comparative summary of patient care that is used by participating hospitals and communities for self-assessment. The most current (1995) data are described herein. METHODS: Since 1989, seven calls for data have been issued, yielding reports on a total of 240,031 breast carcinoma patients for the years included in this analysis. A total of 1849 hospital cancer registries responded to at least 1 of the calls for data. RESULTS: A continuous improvement in care was reported. By 1995, 45.8% (nearly one-half) of breast carcinoma patients were diagnosed early as Stage 0 or I, and early stage patients (Stage 0 or I) were most often treated with partial mastectomy (in 58% of cases). Favorable 10-year relative survival rates for Stage 0 (95%) and Stage I (88%) breast carcinoma patients were reported. Patients who were presumed to be Stage I and were not selected for axillary dissection had poorer survival. Survival differences were reported for different treatment groups within individual stage strata. Over the 10-year observation period, fewer patients from lower-income neighborhoods were diagnosed with early stage breast carcinoma. In general, the annual relative survival rate remained constant over the 10-year observation period (with no plateau after 5 years) within each stage and for all stages combined. CONCLUSIONS: Improvements in diagnosis and treatment during the period 1985-1995 were demonstrated by these data. The NCDB breast carcinoma data are appropriate norms for formal quality assurance purposes, such as those specified by the Standards of the Commission on Cancer published by the American College of Surgeons Commission on Cancer. Cancer committees and other clinicians working within the hospital setting should assess and compare stage distribution, stage specific treatment patterns, and the correlations between the outcomes of patients and both disease stage and treatment.

Age Distribution↗
PubMed1998

Accuracy of AJCC staging for breast cancer patients undergoing re-excision for positive margins. American Joint Committee on Cancer.

BACKGROUND: The current AJCC protocol for breast cancer staging does not include additional tumor found at the time of re-excision in the calculation of tumor size. We hypothesize that the AJCC protocol may result in understaging and undertreatment of breast cancer patients who have additional tumor found at re-excision. METHODS: In a retrospective chart review of breast cancer patients, patients with tumor present at re-excision for positive margins were placed in group 1 (n=72); patients with no tumor present at re-excision, or who underwent a single, negative margin procedure were placed in group 2 (n=147). RESULTS: Patients in group 1 had a higher risk of nodal metastases when compared to patients in group 2. Mean tumor size did not differ significantly between the subgroups. Positive re-excision was strongly associated with lymph node metastases on multivariate analysis after correction for age, grade, stage, and lymphatic invasion (odds ratio=3.13, 95% CI=1.58 6.18, P=.0011). CONCLUSIONS: Current AJCC guidelines may result in undertreatment of breast cancer patients with positive re-excisions. The presence of additional tumor at the time of re-excision should be considered when determining the need for systemic therapy, and may be relevant in determining T stage.

Breast Neoplasms↗
PubMed1998

Breast disease.

This article reviews the presentation and management of common breast disorders. It focuses on the diagnosis of treatment and management of patients with breast cancer in a multidisciplinary approach.

Algorithms↗
PubMed1998

Medical contraindications are not a major factor in the underutilization of breast conserving therapy.

BACKGROUND: Multiple randomized trials have demonstrated that survival after breast conserving therapy (BCT) is equal to survival after mastectomy, but large population-based studies indicate that > 50% of patients with early stage breast cancer continue to undergo mastectomy. This study was undertaken to determine whether medical contraindications to BCT or patient choice are responsible for high mastectomy rates. STUDY DESIGN: Four hundred thirty-two patients with stage 0, I, or II breast carcinoma were prospectively evaluated by a multidisciplinary team for eligibility for BCT. Standard criteria developed by a joint committee of the American College of Surgeons, American College of Radiologists, College of American Pathologists, and Society of Surgical Oncology were used. Eligible patients were offered a choice among BCT, mastectomy, or mastectomy and immediate reconstruction. RESULTS: Only 97 of the 432 patients had contraindications to BCT. The incidence of contraindications varied by stage: 10% for stage I, 28% for stage II, and 33% for stage 0 (p < 0.01). The type of contraindications also varied with stage. Age, histologic tumor type, and axillary node status (when controlled for tumor size) did not influence rates of BCT. Of eligible patients, 81% chose BCT, independent of age or race. CONCLUSIONS: Medical contraindications to BCT are not major factors resulting in high mastectomy rates. Strategies like neoadjuvant chemotherapy, which addresses medical contraindications, are unlikely to have a major impact on national rates of BCT.

Adult↗
PubMed1998

Ductography for nipple discharge: no replacement for ductal excision.

BACKGROUND: Current management of nipple discharge depends on clinical history to distinguish pathologic from physiologic discharge. We investigated whether ductography supplied additional information in the decision for surgery and/or the localization of pathologic lesion. METHODS: A retrospective review of patients with a presenting complaint of nipple discharge seen at the Lynn Sage Breast Center was conducted from January 1995 to June 1996. Medical records, pathology, and ductograms were reviewed. RESULTS: Of 91 patients with nipple discharge, 49 met the criteria for physiologic discharge and 42 had pathologic discharge. Eleven with physiologic discharge had ductograms; none were abnormal. Four of 20 preoperative ductograms were normal but showed intraductal papillomas at the time of surgery; 6 of 20 (30%) had multiple lesions. Four lesions on ductograms did not demonstrate corresponding lesions in the surgical specimen. It is uncertain whether this is due to a missed lesion or a false-positive ductogram. CONCLUSIONS: Modern ductography does not reliably exclude intraductal pathology and is not a substitute for surgery in patients with pathologic discharge. Its utility is in identifying multiple lesions or those with lesions in the periphery of the breast.

Adult↗
PubMed1998

The evaluation of breast masses in women younger than forty years of age.

BACKGROUND: Breast masses in young women are common, but carcinoma is rare. This study was undertaken to determine how often a complaint of mass was found to represent a dominant mass and to define the role of breast imaging and fine-needle aspiration cytology (FNA) in the evaluation of clinically nonworrisome masses. METHODS: A retrospective review was made of 605 patients younger than 40 years of age with a breast mass between February 1994 and February 1996. RESULTS: Dominant masses were confirmed by surgeon examination in 36% of 484 self-detected masses compared with 29% of physician-detected masses (difference not significant). With pathologic confirmation, 29% of self-detected masses had a dominant mass compared with 19% of physician-detected masses (P = .02). Carcinoma was present in 5% of both groups and not predicted by family history. Imaging studies were not useful in patients with normal examinations but were more likely to identify dominant masses in patients with an examination described as benign (P < .001). FNA did not identify any cancers in normal or benign examinations. CONCLUSIONS: Self-examination is as reliable as a general physician examination in detecting breast masses. When an examination by an experienced surgeon is normal, imaging studies and FNA are low yield. When the examination is equivocal, directed ultrasonography is a useful adjunct.

Adolescent↗
PubMed1998

Breast conservation for mammographically occult carcinoma.

OBJECTIVE: Preoperative mammography is an essential part of the evaluation of patient eligibility for breast conserving therapy. SUMMARY BACKGROUND DATA: It is uncertain whether factors that contribute to the nonvisualization of carcinoma on mammograms are indications for mastectomy. The purpose of this study was to determine if the failure to identify clinically evident carcinoma on a mammogram is a contraindication to breast conserving therapy. METHODS: An analysis of 268 women with 269 clinically evident carcinomas who were treated from June 1988 to September 1993 was performed. Contraindications to breast preservation included multicentric tumors, diffuse indeterminate microcalcifications, pregnancy, prior irradiation to the breast region, the inability to achieve negative margins after two surgical procedures, and a large tumor to breast ratio. RESULTS: Mammographically occult tumors (MO) were present in 52 patients (19%). The mean age of patients with MO tumors was 52 versus 57 for mammographically evident (ME) tumors (p = 0.009), but the incidence by decade did not vary. Special histologic tumor types were more frequent among MO than ME tumors (13.5% vs. 1.8%, p < 0.001). Tumor size, the incidence of axillary node metastases, and stage did not vary. An equal proportion of patients with MO and ME tumors were candidates for breast preservation (67% vs. 70%), and a large tumor to breast ratio was the most common contraindication in both groups. CONCLUSIONS: Even with modem mammographic technology, MO tumors remain a significant problem. This study did not demonstrate an association between MO tumors and factors such as size, unfavorable histology, or multicentricity which would preclude the use of breast conserving therapy. These results support the treatment of MO tumors with breast conserving surgery after a detailed clinical evaluation.

Breast Neoplasms↗