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Biomedical subjects

R E Mansel

Publications and source records attributed to R E Mansel.

At least 109 records · Page 6Linked to original sources
PubMed1994

Anorectal physiological testing in defecatory disorders: a prospective study.

A prospective study of anorectal physiological testing in 26 patients with obstructed defecation and 20 patients with faecal incontinence was performed. There were overlaps in individual test parameters between the two groups of patients. However, patients with severely blunted rectal sensation (maximum tolerated volume > 300 mL) and anismus were more likely to have obstructed defecation. Patients with very low anal canal pressures, a short (< 2.0 cm) anal canal, bilaterally prolonged (> 2.1 ms) pudendal nerve terminal motor latency and a grossly distorted and canal (vector symmetry index < or = to 0.75) were more likely to have faecal incontinence. Thus, patterns of anorectal physiological test results together with clinical evaluation, rather than individual test measurements, are more valuable in defining the underlying defecatory disorders and providing guidance on therapy.

Adult↗
PubMed1993

Treatment of the axilla in patients with screen-detected breast cancer.

Management of the axillary lymph nodes in patients with screen-detected breast cancer is controversial. Optimal treatment should combine accurate determination of node status and avoidance of unnecessary morbidity. This study attempted to determine whether axillary node status could be accurately predicted using selected criteria in women with screen-detected breast cancer. Of 223 breast cancers excised in the Greater Manchester breast screening programme, 180 were invasive and 40 of these had associated lymph node metastases. The presence of involved nodes was associated with large tumour size, high tumour grade and the absence of mammographic microcalcification. Multiple logistic regression analysis revealed that each of these three factors was independently significant. Women with a screen-detected breast cancer < 1 cm in diameter or those with grade I tumours < 3 cm (35 per cent of the total) could be spared axillary surgery with an expected reduction in morbidity and operating time.

Axilla↗
PubMed1993

Can monoclonal antibody staining by 323/A3 and Ca1 of benign breast biopsies predict the development of breast cancer?

Monoclonal antibodies (mAb) raised to Ca1 and 323/A3 proteins have been suggested as markers of the premalignant breast. To establish the validity of this hypothesis the immunohistochemical staining patterns of these mAb have been studied in two different groups of patients with benign breast disease. One group comprised patients with benign biopsies who later went on to develop breast cancer. The second group were patients with benign breast disease who have not developed breast cancer. The immunohistochemical staining patterns of the two groups were compared. The staining patterns between the groups, when ducto-lobular, apocrine metaplasia and fibroadenomatous tissue were analysed, was similar. This occurred both for Ca1 and 323/A3 mAb. We conclude that the antigens identified by these mAb will not enable prediction of cancer development.

Adult↗
PubMed1993

Non-invasive ultrasound localization of impalpable breast lesions.

Thirty patients presenting through the Breast Screening Programme with impalpable breast abnormalities clearly visible on ultrasound, underwent non-invasive ultrasound localization. The patient was scanned so that the ultrasound abnormality lay below the probe and the skin at this site marked with a skin marker. In all cases the abnormality was easily identified and removed at surgery. All the surgical biopsies contained either a carcinoma (17 cases) or fibroadenoma (13 cases). This non-invasive technique is a simple and accurate method for localizing small ultrasonically visible breast abnormalities.

Adenoma↗
PubMed1993

Is immediate postmastectomy reconstruction safe in the long-term?

A prospective case-control study of 81 patients has been carried out over 10 years comparing mastectomy with immediate reconstruction to mastectomy alone. The patients were matched for age (within 5 years), TNM stage, pathologic nodal status and operative procedure. After complete 10-year follow-up we have failed to demonstrate any long term difference in tumour behaviour. We conclude that immediate reconstruction is widely applicable and technically feasible without any long term effect on the development of local recurrence or metastatic disease.

Adult↗
PubMed1993

Complications of rectus abdominis myocutaneous flaps in breast surgery.

One-hundred-and-twenty-two rectus abdominis myocutaneous flaps used for reconstruction, post mastectomy (106) and after salvage surgery (16), were reviewed. The minimum period of follow up was 24 months. Simple vertical flaps were raised in 88 patients; in addition seven Drevers, four trans-umbilical, 19 lower transverse and four combined (vertical and transverse flaps) were raised. Early complications (within 2 weeks of surgery) were seen in 30% (37/122) patients. Late complications occurred in 5% of patients (6/122) and 8% had both early and late complications. Flap necrosis was seen in 25% (21/122) of patients. This comprised complete flap loss in two patients. Partial skin and fat necrosis was observed in 14 patients and partial skin loss only in 15. In the group with simple vertical flaps the incidence of partial flap necrosis was 12.5%. Late complications included incisional hernia in 5% of patients. Reoperation for complications were required in 18% of patients. We conclude that while minor morbidity is common with rectus flaps, major complications are few. The more important considerations relate to cigarette smoking and overuse of the peripheral segment of the transverse rectus abdominis flap. While the transverse flaps have now largely replaced other breast flaps, in our practice vertical and higher transverse flaps were useful alternatives. Lessons learned during the development of these flaps have led to greatly improved results in the latter part of the series and it is regarded as a versatile and useful flap in this situation.

Abdominal Muscles↗
PubMed1992

Plasma fatty acid profiles in benign breast disorders.

Breast pain (mastalgia) and macroscopic breast cysts present commonly. Mastalgia may be improved by dietary manipulation to reduce saturated fat or supplement essential fatty acid intake. Fatty acid profiles were measured in women with mastalgia and breast cysts, before and during treatment with evening primrose oil, a rich source of essential fatty acids. The fatty acid profiles of both groups of patients were abnormal, with increased proportions of saturated fatty acids and reduced proportions of essential fatty acids. Treatment with evening primrose oil improved the fatty acid profiles towards normal, but this was not necessarily associated with a clinical response.

Breast Diseases↗
PubMed1992

A case control study of factors associated with macroscopic breast cysts.

Women who have a breast cyst aspirated are at increased risk of developing breast cancer. We present an age-matched case control study comparing the reproductive characteristics of 352 women who had a breast cyst aspirated with a control group of 352 contemporaneous clinically normal women. Women with breast cysts were more likely to be nulliparous [odds ratio (OR) = 2.28, 95% confidence interval (CI) = 1.34-3.88] or have a late age at first live birth (chi 2 trend = 5.6, P less than 0.025), and a late menopause (chi 2 trend = 4.3, P less than 0.05). They were less likely to have ever used the oral contraceptive pill (OR = 0.38, 95% CI = 0.26-0.55) or to have used the pill for a short duration (chi 2 trend = 16.8, P less than 0.001), and were less likely to have had a hysterectomy (OR = 0.58, 95% CI = 0.36-0.93). They were more likely to wear a small bra (chi 2 trend = 18.6, P less than 0.001) and bra cup (chi 2 trend = 5.6, P less than 0.025). Nulliparity, late age at first live birth and late menopause are factors common to breast cancer risk.

Adult↗
PubMed1992

Prolactin and total lactogenic hormone measured by microbioassay and immunoassay in breast cancer.

Basal prolactin (PRL) and total lactogenic hormone (TLH) levels were measured using a new microbioassay (BA) and conventional immunoradiometric assay (IRMA) in patients with breast cancer and compared to an age-matched control group. No significant differences were found using the IRMA, but BA lactogenic levels were significantly elevated in breast cancer patients compared controls, leading to a markedly elevated BA/IRMA ratio for both PRL (2.7 vs 1.4, P less than 0.0001) and TLH (2.8 vs 1.4, P less than 0.0001) which was greatest for postmenopausal women. Using the mean +2 standard deviations as the upper limit of normal, there was no significant difference between breast cancer patients and controls for IRMA, but BA and BA/IRMA PRL levels were elevated in 42% and 61% of the patients, respectively. There was a weak negative correlation of BA and IRMA PRL with age for normals (r = -0.53 for both) but no correlation was evident for breast cancer patients (r = 0.06 and -0.13, respectively) implying a sustained absolute and relative bioactive hyperprolactinaemia at all ages. These results show increased lactogenic bioactivity in breast cancer and suggest that different forms of bioactive prolactin undetected by IRMA (or enhancing serum factors) are present in the sera of these patients.

Adult↗
PubMed1992

Bioactive and immunoactive prolactin levels after TRH-stimulation in the sera of normal women.

The availability of an improved microbioassay for lactogenic hormone measurement has enabled comparison of basal and dynamic prolactin bioactivity (BA) and immunoactivity (IRMA) in normal human serum. Serum from 16 normal females aged 22-74 years was assayed and revealed a mean BA/IRMA prolactin ratio of 1.6 for basal and 1.8 for peak TRH-stimulated levels. Basal prolactin levels in postmenopausal women measured by bioassay were lower than in premenopausal women showing a relative and absolute decrease in prolactin bioactivity with age, but there was no significant difference in dynamic levels. There was also no significant difference in BA or IRMA levels following the stress of venepuncture. These findings indicate that, as previously described for basal levels, there is a good correlation between dynamic prolactin bioactivity and immunoactivity in human serum.

Adult↗
PubMed1992

Drug treatments for mastalgia: 17 years experience in the Cardiff Mastalgia Clinic.

Mastalgia commonly presents to medical practitioners. The majority of patients can be managed by exclusion of cancer and reassurance. In some the severity of pain affects the quality of life and drug treatment should be considered. Since its inception 324 patients with cyclical mastalgia and 90 with non-cyclical mastalgia have received a therapeutic trial of drug treatment in the Cardiff Mastalgia Clinic. Overall 92% of those with cyclical mastalgia and 64% with non-cyclical mastalgia obtained a clinically useful response to therapy. Danazol was the most effective drug, with bromocriptine and evening primrose oil having equivalent efficacy. Many fewer adverse events were complained of by patients treated with evening primrose oil than danazol or bromocriptine.

Anti-Inflammatory Agents, Non-Steroidal↗
PubMed1992

Reproductive factors associated with mastalgia.

Mastalgia has been classified as an aberration of the normal, rather than a disease. We present an age-matched, case-control study which compares the reproductive factors of patients with severe cyclical and noncyclical mastalgia with control groups of women who presented to a breast clinic but in whom no clinical abnormality was found and who did not later develop breast disease. There were few statistically significant differences in reproductive factors between the cases and controls, which lends some support to the concept that mastalgia can be considered to be an aberration of the normal.

Breast↗
PubMed1991

Monoclonal antibody 323/A3: a marker for the presence of breast carcinoma.

The monoclonal antibody 323/A3 has been suggested as a marker of cancer risk in benign breast disease. Patients who have had both a benign biopsy and a later biopsy for breast carcinoma were studied. The staining patterns in the biopsies were analysed using a semi-quantitative recording system adapted from Mariani-Costantini et al. Immunohistochemical (IHC) staining was carried out on formalin fixed paraffin embedded tissue sections. In apocrine metaplasia the cytoplasm of benign tissue did not stain with 323/A3 whereas in the biopsies with associated breast cancer 5 of 7 biopsies stained, a statistically significant difference. A positive predictive value of 100% was noted for strong cytoplasmic staining to indicate the presence of carcinoma and this phenomenon may be useful as a means of demonstrating patients who have malignant breast disease in which a biopsy has inadequately sampled the breast tissue.

Adult↗