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Biomedical subjects

Rajendra A Badwe

Publications and source records attributed to Rajendra A Badwe.

11 recordsLinked to original sources
PubMed2006

Recurrent gossypiboma in the thigh.

Gossypiboma, an iatrogenic mass lesion caused by a retained surgical sponge is an extremely rare event following musculoskeletal procedures. This entity is therefore a very unusual experience and can create considerable confusion. Unsuspecting surgeons may thus be caught out by this unlikely presentation. We present our experience with a recurrent gossypiboma in the thigh occurring several years after surgical evacuation of a similar gossypiboma from the same anatomic location with interval resolution of symptoms. The purpose of this case report is to highlight the possibility of a "recurrent" soft tissue mass occurring for reasons other than a neoplasm. In the absence of a definitive biopsy diagnosis of tumor in patients who have undergone prior surgical procedures in that area, it may be more prudent to adopt a conservative surgical resection rather than a conventional radical resection as warranted by the dramatic clinical presentation mimicking a soft tissue sarcoma.

Biopsy↗
PubMed2006

Breast conservation surgery without pre-operative mammography--a definite feasibility.

Mammography is mandatory before breast conservation. Its limited availability in developing countries has discouraged surgeons in rural areas from practicing breast conservation. We analyzed the database of breast surgeries at our institute to investigate whether breast conservation could be safely performed if clinically feasible without the use of mammography. If mammography had not been performed in the 735 patients undergoing surgery, breast conservation could have been erroneously performed in 38 (5.17%) patients; 13 had impalpable mammographic multicentricity and 25 had extensive microcalcifications. A detailed analysis showed that this error in decision would have been detected and rectified in each of the above patients before commencement of radiotherapy. We conclude that although mammography cannot be totally excluded from the treatment algorithm for palpable breast cancer, conservative surgery can be offered in clinically suitable cases even if pre-operative mammography is not available due to limited resources in the developing world.

Breast Neoplasms↗
PubMed2006

Medial pectoral pedicle: a critical landmark in axillary dissection.

Surgery for breast cancer has evolved over the last century and has gone from limited to radical, extended radical and back to conservative surgery. Along this journey, one constant feature has been the necessity for a complete axillary dissection. In recent times, this concept has also been successfully challenged and now we are in an era of conservative or limited surgery in the axilla as well. These surgical procedures such as four-node axillary sampling or the technology-driven sentinel node biopsy are conservative axillary procedures and are often performed through very small incisions. With limited access to the surgical field, there is always an increased chance of inadvertent and unnecessary injury to surrounding vital anatomical structures such as nerves or blood vessels. A well-designed road map can definitely prevent such mishaps. This paper describes a simple technique of axillary surgery, which is step-wise and makes use of a relatively constant landmark, namely the medial pectoral pedicle, present within the axilla. Such a regimented systematic approach not only allows us to minimize the risks of complications during axillary surgery, but also enables us to train beginners easily and efficiently.

Axilla↗
PubMed2004

Functional maps of metastases from breast cancers: proof of the principle that multidimensional scaling can summarize disease progression.

The mathematic technique of multidimensional scaling can create "functional maps" of metastases from breast cancer such that positions of organs in these maps are proportional to the probability of metastases. Areas that are likely to share disease are close together in a functional map, even though they may be physically distant, and vice versa. Two functional maps of breast cancers-one of local metastases to axillary levels I to III and another of distant metastases-are statistically significant and clinically meaningful. The maps accurately reflect the clinical data ( r > 0.97, p < 0.01), and so the progression of disease is revealed in simple visual summaries. As an analogy, the metastatic sites are like buoys on a fluid surface, and cancer spreads from a primary tumor like waves emanating from a point of impact on that surface. Metastases are predicted when the waves swamp the buoys. Because breast cancers do not always spread to the next nearest site, these functional maps do not resemble anatomic maps. The maps are a view of the body as "seen" by the tumor. Several well known clinical features are seen in these maps: most local metastases are to axillary level I; upper-inner primaries spread equally to levels II and III; in-transit metastases in the lymph and blood vessels do not follow the pattern of other distant metastases. Future functional maps can expand these summary diagrams to include biologic parameters (gene-expression profiles or endocrine response) and give valuable insights into patterns of recurrence in different populations.

Adult↗
PubMedDate not supplied

Breast cancer in limited-resource countries: diagnosis and pathology.

In 2002 the Breast Health Global Initiative (BHGI) convened a panel of breast cancer experts and patient advocates to develop consensus recommendations for diagnosing breast cancer in countries with limited resources. The panel agreed on the need for a pathologic diagnosis, based on microscopic evaluation of tissue specimens, before initiating breast cancer treatment. The panel discussed options for pathologic diagnosis (fine-needle aspiration biopsy, core needle biopsy, and surgical biopsy) and concluded that the choice among these methods should be based on available tools and expertise. Correlation of pathology, clinical, and imaging findings was emphasized. A 2005 BHGI panel reaffirmed these recommendations and additionally stratified diagnostic and pathology methods into four levels--basic, limited, enhanced, and maximal--from lowest to highest resources. The minimal requirements (basic level) include a history, clinical breast examination, tissue diagnosis, and medical record keeping. Fine-needle aspiration biopsy was recognized as the least expensive reliable method of tissue sampling, and the need for comparing its clinical usefulness with that of core needle biopsy in the limited-resource setting was emphasized. Increasing resources (limited level) may enable diagnostic breast imaging (ultrasound +/- mammography), use of tests to evaluate for metastases, limited image-guided sampling, and hormone receptor testing. With more resources (enhanced level), diagnostic mammography, bone scanning, and an onsite cytologist may be possible. Mass screening mammography is introduced at the maximal-resource level. At all levels, increasing breast cancer awareness, diagnosing breast cancer at an early stage, training individuals to perform and interpret breast biopsies, and collecting statistics about breast cancer, resources, and competing priorities may improve breast cancer outcomes in countries with limited resources. Expertise in pathology was reaffirmed to be a key requirement for ensuring reliable diagnostic findings. Several approaches were again proposed for improving breast pathology, including training pathologists, establishing pathology services in centralized facilities, and organizing international pathology services.

Biopsy, Needle↗