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Biomedical subjects

R E Mansel

Publications and source records attributed to R E Mansel.

At least 127 records · Page 7Linked to original sources
PubMed1991

The axilla: not a no-go zone.

Many surgeons, particularly in the UK, give inadequate primary treatment to patients with operable breast cancer. For spurious reasons they regard axillary clearance as unnecessarily extensive surgery and rely instead upon total mastectomy or tumour excision and node sampling, with or without postoperative radiotherapy. But it is now clear that relapse-free and overall survival can be improved by appropriate adjuvant therapy. Thus inadequate exploration of the axilla is doubly unjustified. Not only is there the obvious risk of failure to remove nodes that contain metastases--so that some patients are deprived of cure by primary treatment--but the extent of tumour spread will be inadequately assessed in many more patients, with the risk that they may not receive appropriate adjuvant treatment.

Axilla↗
PubMed1991

Oestrogen-regulated 24-kDa protein--a marker for breast carcinoma in benign breast tissue.

A monoclonal antibody (mAb) raised to an oestrogen-induced protein (24-kDa protein) has been suggested as a marker of women at risk of developing breast cancer. Patients with benign breast biopsies who have not developed breast cancer (benign control groups) were compared to women who had malignant breast biopsies. The benign tissue components from each group were studied. Subsequently, women with benign breast biopsies who have not developed malignancy were compared to women with benign breast biopsies who later went on to develop breast cancer. The study was carried out on formalin-fixed paraffin-embedded tissue sections. Comparison between tissue from the benign control groups and from women with breast cancer demonstrated the cytoplasmic staining in apocrine metaplasia of benign controls to be more pronounced. No staining differences were apparent between benign biopsies of patients who have not developed breast cancer and benign biopsies of those who have. We conclude that diminished expression in apocrine metaplasia of mAb to 24-kDa protein may indicate the presence of breast cancer but we have been unable to establish the role of 24-kDa protein as a marker for cancer risk.

Adult↗
PubMed1991

Traumatic rupture of the diaphragm: a difficult diagnosis.

Rupture of the diaphragm occurs in approximately 5 per cent of cases of severe blunt trauma to the trunk, and the mortality may be as high as 50 per cent. The diagnosis is important because of the high incidence of associated organ damage and complications of a missed injury. Successful diagnosis requires a high index of suspicion but can be made from the chest radiograph in 90 per cent of cases if visceral herniation has occurred. We present three cases of rupture of the diaphragm which highlight the frequent occurrence of a delayed or missed diagnosis.

Accidents, Traffic↗
PubMed1991

Zinc alpha-2 glycoprotein levels in serum and breast fluids: a potential marker of apocrine activity.

Zinc alpha-2 glycoprotein (ZnGP) was measured in human breast microcysts, breast secretions, breast cyst fluid and serum. Detectable amounts of ZnGP were found in all fluids but the highest levels were found in microcysts. Apocrine macrocysts had a higher ZnGP level than flattened macrocysts. In both cysts and secretions levels of ZnGP correlated with those of dehydroepiandrosterone sulphate. Levels were significantly higher in cyst fluids from women who developed further cysts during follow-up compared with those in fluid from women who did not. Concentrations of ZnGP in serum from breast cancer patients were significantly higher than controls but not women with breast cysts. Women with node positive breast cancer had higher serum levels compared with those in node negative patients. Women with more advanced breast cancer had higher serum ZnGP levels than those with earlier disease. ZnGP is a serum and breast marker of apocrine activity and may prove to be a useful prognostic marker in breast cancer.

Apocrine Glands↗
PubMed1991

Is there an increased risk of breast cancer in women who have had a breast cyst aspirated?

A consecutive series of 644 women who presented with breast nodularity between 1976 and 1982 have been followed up to determine their rate of subsequent breast cancer. Fifteen women have developed breast cancer, 14 of these were among 352 women with an aspirated cyst (relative risk 4.4). Women with multiple cysts had the highest risk and women with breast nodularity had no excess risk. Review of histology specimens from those women who had undergone biopsy showed an excess of florid epithelial hyperplasia in women who subsequently developed breast cancer and women with multiple aspirated cysts were more likely to have florid epithelial hyperplasia. Multiple cysts are clinical markers of histological breast proliferation and women who have had multiple breast cysts aspirated have an increased risk of breast cancer and should be advised to practice regular self examination.

Adult↗
PubMed1991

Management of the painful and nodular breast.

Mild breast pain and nodularity are common and may be considered normal. Only when symptoms are severe enough to affect the patient's lifestyle should drug treatment be considered. Using danazol, bromocriptine or evening primrose oil a clinically useful improvement in pain can be anticipated in 77% of patients with cyclical mastalgia and 44% with non-cyclical mastalgia. Benign nodularity should not be biopsied surgically as it is unnecessary and makes subsequent assessment of the breast difficult.

Adult↗
PubMed1991

Basal prolactin and total lactogenic hormone levels by microbioassay and immunoassay in normal human sera.

The availability of an improved microbioassay for prolactin measurement has enabled comparison of lactogenic hormone bioactivity and immunoreactivity in normal human serum. Serum was studied from 61 normal females and 15 normal males. The correlation of both assays was very close for all subjects with a mean ratio of bioassay to immunoassay of 1.5 (range 0.8-2.0) for prolactin and 1.4 (range 0.5-1.9) for total lactogenic hormone. There was no significant variation in prolactin or total lactogenic hormone values by microbioassay or immunoassay with sexual or menstrual status. Postmenopausal prolactin levels were lower by both assays compared with premenopausal values with a relative and absolute decrease in prolactin bioactivity with age. These findings indicate that there is a good correlation between prolactin bioactivity and immunoactivity in human serum.

Adult↗
PubMed1991

Management of mammillary fistulae.

Mammillary fistulae develop between the lactiferous ducts of the breast and areolar skin. Over a 14-year period 41 fistulae were treated in 36 patients (34 women, 2 men). In 24 women at least one subareolar abscess (mean 2.5) had been incised and drained previously. Fourteen fistulae developed after discharge of an inflammatory mass and three after surgical biopsy. Twelve women underwent 13 fistulectomies, two of which required reoperation. The remaining 24 patients with complicated fistulae (n = 28) had previously undergone multiple surgical procedures; 12 patients had 13 fistulae treated by total duct excision and primary closure without antibiotic cover and six fistulae required reoperation. Fifteen fistulae in 12 women were treated by duct excision with either primary closure under antibiotic cover (n = 7) or packing with healing by granulation (n = 8) and only one recurred (P less than 0.05). Operations for mammillary fistulae should be treated as contaminated procedures. In simple cases where no previous surgery has taken place, fistulectomy is appropriate. In complicated cases, treatment should be duct excision with the wound either closed primarily under antibiotic cover or left open to heal by secondary intention.

Adolescent↗
PubMed1990

Evaluation of immunohistochemical staining of breast tissue by an oestrogen-regulated protein, 24K according to epidemiological and radiological breast cancer risk criteria.

The staining characteristics of monoclonal antibodies (MAb) are often determined on small numbers of biopsies. The true staining profile can only properly be determined when large numbers of biopsies are stained. We have examined the staining profile of 24K MAb on 146 benign breast biopsies. The staining characteristics were then grouped according to whether the patients were at high or low risk of breast cancer by current epidemiological or radiological risk criteria. This was done to detect whether 24K MAb could be used as a marker of cancer risk. Only Wolfe coded risk criteria showed staining differences between the two risk categories. Cytoplasmic staining was more common in the low risk Wolfe coded groups (P = 0.03, Fisher's exact test). We recommend that further studies be undertaken to evaluate the role of 24K MAb as a marker of cancer risk.

Adolescent↗
PubMed1990

European multicentre trial of bromocriptine in cyclical mastalgia.

In a randomised parallel-block trial in thirteen European centres bromocriptine 2.5 mg twice a day was compared with placebo therapy for cyclical mastalgia. 272 patients were enrolled into the study. Linear analogue charts and diary pain cards were used for assessment of response. Reduction in breast pain, heaviness, tenderness, and serum prolactin after 3 and 6 months' therapy were significantly greater with bromocriptine than with placebo. Improvement in symptoms with bromocriptine was maintained for at least 6 months after therapy. Overall 29% of patients dropped out while on therapy, more from the bromocriptine than from the placebo group. Adverse effects, especially nausea and dizziness, were commoner among the bromocriptine-treated patients, but blood pressure was unaffected.

Adult↗
PubMed1990

Mastalgia refractory to drug treatment.

Management of the patient with mastalgia who fails to respond to first line therapy is a difficult problem and there is a group of patients who do not respond to any therapy. A group of 126 patients with mastalgia who failed to respond to first line therapy and completed further treatment options was studied. The response rate of those with cyclical mastalgia fell to 57 and 25 per cent for second and third line therapy respectively. Equivalent figures for non-cyclical mastalgia were 24 and 21 per cent. Danazol maintains a high response rate after the failure of other drugs, whereas the second line response to bromocriptine and evening primrose oil is poor. Unresponsive patients were matched to a group of patients who responded to first line therapy, and reproductive and historical factors were compared using the chi 2 test, but failed to identify which patients would respond to therapy.

Anti-Inflammatory Agents, Non-Steroidal↗
PubMed1990

A randomized trial of dietary intervention with essential fatty acids in patients with categorized cysts.

Two hundred women with breast cysts proven by aspiration were entered into a randomized double-blind trial of Efamol (evening primrose oil) at a dose of 6 capsules daily or equivalent placebo dose for a year. Cysts were categorized by initial electrolyte composition, and follow-up continued for 1 year posttherapy. Recurrent cyst formation in the first year was slightly (but not significantly) lower in the Efamol group compared with the placebo-treated group. The Efamol treatment was well tolerated as the dropout rate was only 7% and equal in both the active and placebo groups. The initial electrolyte composition did not predict for cyst recurrence.

Adult↗
PubMed1990

Monoclonal antibodies 323/A3 and Ca1 identify a paracrine function of breast carcinoma on adjacent benign histological components.

The 323/A23 monoclonal antibody (MAb) is expressed with increasing breast atypia, whilst Ca1 has been suggested as a marker of cancer risk in benign breast disease. To establish whether they would be useful as markers of malignancy the staining characteristics in benign tissue components associated with malignant biopsies have been compared with the staining patterns of benign biopsies from patients with no known malignancy. Staining with 323/A3 and Ca1 MAb was carried out on formalin-fixed paraffin-embedded tissue sections using ABC Vectastain Reagents (Vector Laboratories) and diaminobenzidine as the chromogen. All biopsies contained ductolobular tissues. Apocrine metaplasia was present in 35 of 79 malignant biopsies, in 42 of 77 selected and 20 of 50 prospective unselected benign biopsies. The 323/A3 MAb stained strongly the cytoplasm of apocrine metaplasia in breast carcinoma biopsies in 18 of 35 cases, in the selected benign group this was two out of 42 (P less than 0.001) and in the prospective benign group one of 19 (P less than 0.01). No differences in staining were noted for ductolobular tissue. The Ca1 MAb showed strong apical staining in ductolobular tissue in 66 of 79 invasive carcinoma biopsies, in 20 of 50 prospective benign biopsies and 53 of 77 selected biopsies. The prospective and selected benign group staining was significantly different from that of the invasive carcinomas (P less than 0.005 and less than 0.05 respectively). These data suggest that 323/A3 staining of apocrine metaplasia and Ca1 staining of ductolobular tissue is affected by a paracrine function of breast cancer.

Antibodies, Monoclonal↗
PubMed1990

A randomised controlled trial of medroxyprogesterone acetate in mastalgia.

A double-blind crossover study giving 20 mg/day of medroxyprogesterone acetate during the luteal phase was carried out in 26 women with cyclical mastalgia. Symptomatic response to this progestogen supplementation or placebo was assessed objectively by clinical examination and subjectively by linear analogue scales and breast pain charts. No significant relief of pain or tenderness was found on placebo or active treatment, irrespective of treatment order, and breast nodularity was similarly unaltered. No evidence of progesterone deficiency or prolactin abnormality was found. Side-effects were incurred in 11 patients (five on placebo, five on active treatment and one while on both) and were mostly vague premenstrual symptoms. We conclude that the therapeutic response of medroxyprogesterone acetate in cyclical mastalgia is no better than placebo and that progestogen supplementation can no longer be recommended for routine use in the management of breast pain.

Adult↗
PubMed1990

Management of cyclical breast pain.

Cyclical breast pain or mastalgia occurs in up to 70% of the female population. After exclusion of breast cancer and proper reassurance, only 15% of patients initially presenting will require drug treatment. Using bromocriptine, danazol and evening primrose oil some 77% of patients treated can obtain useful relief of their symptoms.

Anti-Inflammatory Agents, Non-Steroidal↗
PubMed1989

Non-cyclical mastalgia: an improved classification and treatment.

A prospective study of 72 patients with non-cyclical breast pain was carried out. Non-cyclical breast pain was subdivided into true non-cyclical mastalgia (35 patients) and musculoskeletal pain (37 patients), the latter including Tietze's syndrome and other causes of chest wall pain. Mean age at presentation was significantly greater in the musculoskeletal group (39.3 versus 33.9 years) with a shorter mean duration of pain (14.7 versus 35.4 months) compared with the non-cyclical mastalgia group. True non-cyclical mastalgia was commonly bilateral and located within the upper outer quadrant of the breast, whereas musculoskeletal pain was almost always along the lateral chest wall or costochondral junctions and unilateral in 92 per cent of cases. Breast nodularity was present in 54 per cent of patients with non-cyclical mastalgia, but in only four cases (11 per cent) in the musculoskeletal group. Nine of 14 patients (64 per cent) with non-cyclical mastalgia obtained a good clinical response to drug therapy (over half responding to danazol alone); 19 underwent spontaneous remission, but there was a prolonged mean time to pain resolution of 27 months. In the musculoskeletal group 33 of 34 patients (97 per cent) had a good response to steroid and local anaesthetic injection; three resolved spontaneously without treatment, with a mean time to pain resolution of 17 months. This study indicates that differentiation of musculoskeletal pain from non-cyclical mastalgia may lead to more effective treatment with some prediction of the overall prognosis.

Adult↗
PubMed1989

Lipids in breast carcinogenesis.

Excess dietary fat has been identified as a risk factor in the development of human breast carcinoma. However, the quality of fat may be more important than the overall quantity. We have studied the growth of human MCF7 breast carcinoma xenografts in athymic mice treated with dietary supplements of N-6 and N-3 series essential fatty acids given as natural preparations of evening primrose oil and fish oil. Olive oil and normal laboratory diet lacking the essential fatty acids served as controls. Animals treated with essential fatty acids developed tumours which were significantly smaller than both control groups (Mann-Whitney U test, P less than 0.001). Median tumour weights according to diet were: evening primrose oil, 133 mg; fish oil, 70 mg; olive oil, 212 mg; and control, 270 mg. Nutritional intervention to increase the proportion of essential fatty acids in the diet may have a role in the management of breast carcinoma.

Animals↗