Biomedical subjects
Publications and source records attributed to T T Alagaratnam.
The term gigantomastia has been used to describe breast enlargement to extreme size, with sloughing, haemorrhage and infection. The condition is rare and a case of pregnancy-related gigantomastia is reported.
Nipple discharge was the presenting complaint in 104 patients (1.5%) from a series of 7000 women who were seen in a breast clinic over a 13-year period. Complete follow-up information was available in 66 Chinese patients. The mean age at presentation was 47 years. Twenty-six patients (39%) were postmenopausal. Unilateral discharge (92%) from a single duct (77%) was the main finding. There were five patients (8%) with proven breast cancer; benign duct papilloma was found in 17 patients. Multivariate analysis showed that cancer was most likely in women over the age of 55 (P < 0.05) and when the discharge was bloody (P < 0.05). Ductography was also found to be useful in the diagnosis of duct papilloma (P < 0.02).
OBJECTIVE: To study the mode of presentation, the tumor, nodes, metastasis (TNM) staging and the efficacy of multimodal treatment of breast cancer among Chinese women treated in Queen Mary Hospital. METHODS: The available records of all breast cancer patients treated between January 1980 and December 1994 were reviewed. The mode of presentation, the TNM staging of the disease, estrogen receptor status and the mode of surgical and adjuvant treatment were studied. Statistical correlation was performed between the factors studied and the survival time. RESULTS: Seven hundred and one cases of breast cancer were identified. The mean age of the patients was 56.6 years (range, 20-98 years). The most common complaint was the presence of a mass which occurred in 635 (90.6%) patients and 454 (71.5%) of these patients were painless. The majority of patients had T2 tumours (51.8%) and stage II disease (59.6%), but only 86 (12.3%) patients underwent breast conservative therapy (BCT). Estrogen receptor was positive in 43% of patients. Two hundred and ninety (41.4%) patients were node positive and the mean number of involved nodes was 3.8 per patient. Adjuvant chemotherapy was given to 125 node positive patients, adjuvant tamoxifen to 188 patients and both to 63 patients. Univariate analyses of factors possibly affecting survival showed that advanced stage disease and nodal involvement were associated with a significantly lower survival time. Among the node positive patients, those with seven or more involved nodes had a shorter survival. The types of surgery and adjuvant treatment (for node positive patients) had no direct correlation with survival. CONCLUSION: Our results showed that the majority of our patients presented with a painless mass and the final outcome was determined by the tumour load at the time of presentation (TNM staging and nodal status).
BACKGROUND: The injection of liquid paraffin wax was a form of breast augmentation practised in Hong Kong 30-40 years ago. Patients may present many years later with complications of this treatment. METHODS: The records of 43 patients diagnosed with paraffinomas of the breast at a teaching hospital in Hong Kong were reviewed. These patients had received paraffin injections 3-41 years (median 17) previously. RESULTS: Patients presented with hard masses in the breast 4-18 cm (median 17) diameter. Ulceration or infection occurred in 10 patients. Mammography revealed a honeycomb appearance in the affected breast. Treatment included biopsy only (7), excision of masses (3) and total mastectomy (30, bilateral in 27). Histology demonstrated hyalinized and densely sclerotic fibrous tissue with cystic spaces of various sizes. CONCLUSIONS: Awareness of this condition facilitates the differentiation from tuberculosis and carcinoma of the breast which often present late in this population of patients. Adequate treatment usually require total mastectomy.
Twenty-six patients were diagnosed to have giant fibroadenomas of the breast over a 19-year period. The majority of these tumours occurred in adolescents and young adults and the bimodal age incidence described in caucasians was not seen. Tumour sizes ranged from 5 cm to 11 cm. None of the patients presented with a clinical picture simulating malignancy of the breast. All tumours were treated by simple enucleation; no recurrences were observed over a minimum follow-up period of three years.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
Simple closure, the conventional operation for perforated acute duodenal ulcers, is associated with symptomatic relapse in a large proportion of patients. In order to assess the role of immediate definitive surgery, 78 fit patients with perforated acute ulcers were prospectively randomized to undergo either closure alone or proximal gastric vagotomy with closure (PGV). Patients taking potentially ulcerogenic drugs or who had severe stress were excluded from the study. Both groups were comparable with respect to age, sex, general medical health, duration of perforation, length of ulcer history, and presence of duodenal scarring. There was no hospital mortality. Minor complications occurred in 7.3% after closure and 10.8% after PGV. At 3 years follow-up, the cumulative recurrence rates were 36.6% and 10.6% after closure and PGV, respectively (p = 0.001). Eighty-five per cent of recurrences after closure were symptomatic, and half of them required reoperation. Duodenal scarring itself did not appear to influence the outcome after closure. PGV was not associated with dumping, diarrhea or other unwanted side effects. Although less than that in chronic ulcers, there is a substantial risk of symptomatic relapse after closure of perforated acute duodenal ulcers. With judicious patient selection, PGV effectively reduces this risk without incurring disabling side effects associated with other ulcer operations.
We undertook a 12-year review of the elective and emergency surgery for duodenal ulcer in Queen Mary Hospital, Hong Kong, to ascertain whether the introduction of cimetidine as treatment for duodenal ulcer had led to a reduction in the number of elective and emergency operations being performed for duodenal ulcer. There was no decrease in the number of elective operations performed for duodenal ulcer. Indeed, in the same period, emergency operations for bleeding and perforated ulcers had increased.
A painless lump in the breast in a 43-year-old Chinese woman was found on surgical excision to be a cysticercus presumed to be that of Taenia solium. Routine investigations failed to reveal infection at any other site.
In order to validate a previously derived set of risk factors, 259 consecutive patients who had simple closure or definitive operation for perforated duodenal ulcers were studied prospectively. Major medical illness, preoperative shock, and longstanding perforation (more than 24 hours) correctly predicted the outcome in 93.8% of patients. Most importantly, 16 patients (6.2%) who died after operation could be identified (no false-negative error). The mortality rate increased progressively with increasing numbers of risk factors: 0%, 10%, 45.5%, and 100% in patients with none, one, two, and all three risk factors, respectively. These findings underscore the importance of patient selection and the feasibility of a risk grading system in guiding surgical management. Definitive surgery can be done safely in good-risk patients. Simple closure is preferable in those patients with uncomplicated perforations if any risk factor is present. Truncal vagotomy and drainage may be required if there is coexisting bleeding or stenosis. Nonoperative treatment deserves re-evaluation in patients with all three risk factors because of their uniformly dismal outcome after operation.
Oestradiol binding activity was studied in normal liver tissues of rats as well as in experimentally induced liver tumours by incubating a cytosol prepared from the tissue with radioactive oestradiol. The free radioactive hormone was absorbed by a dextran-charcoal suspension, and the amount required to saturate the receptors was calculated by a Scatchard plot. Similar activity was observed in normal human liver as well as naturally occurring hepatocellular carcinoma.
Fine needle aspiration cytology (FNA) and Tru-cut needle biopsy (TNB) have been used for the pre-operative diagnosis of cancer in breast masses as alternatives to open breast biopsy. The accuracy of clinical examination, fine needle aspiration biopsy and Tru-cut needle biopsy was assessed in 230 patients with palpable breast masses and the value of using both biopsy methods in the management was prospectively evaluated. Clinical diagnosis had a sensitivity of 89.2% and specificity of 78.4% (32.7% false positive, 6.5% false negative). Aspiration cytology was diagnostic in 78.4% of cancers and 71.6% of benign lesions [excluding non-diagnostic samples (27.4%), sensitivity was 96.6% and specificity was 100%]. Tru-cut needle biopsy identified 82.9% of cancers and 61.7% of benign lesions [excluding non-diagnostic samples (33.3%), sensitivity was 96.7% and specificity was 100%]. There were no false positive errors with either aspiration cytology or needle biopsy. Statistical comparison showed that there was no significant difference between aspiration cytology and needle biopsy. The combined result of both biopsies was superior to clinical examination when non-diagnostic samples were excluded. With the routine use of both biopsy techniques, frozen section was avoided in 73% of all cancers and unnecessary operations were avoided in 33.5% of patients which included breast cysts, benign mammary dysplasia and inflammatory lesions.
Explore the source record for details and available documents.
Sixty-one Chinese men with idiopathic gynecomastia were treated with 40 mg of tamoxifen daily for one of four months (median, two months). Eighty percent had complete regression of their breast swelling. No long-term side effects of tamoxifen were observed over a median follow-up period of 36 months.
A randomized prospective trial was conducted to compare Tamoxifen and combination chemotherapy (5-fluorouracil, doxorubicin and cyclophosphamide) as adjuvant treatment for patients with locally advanced (Stage III) breast cancer. At the end of 5 years, no significant difference could be found in the disease-free period for both groups.
An 82 year old woman with bilateral amyloid tumours of the breast is described. Clinically, the breast masses were hard and were suspicious of carcinoma. Investigation revealed no evidence of systemic amyloidosis or amyloid related illness. Microscopically there was no neoplasia. Instead there was extensive fibrosis with amyloid deposition in perivascular periductal areas and also in the intervening stroma. The presence of amyloid was confirmed by special stains and by electron microscopy.