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Biomedical subjects

U Chetty

Publications and source records attributed to U Chetty.

At least 91 records · Page 5Linked to original sources
PubMed1990

Goblet cell carcinoid of the appendix.

We have reviewed all cases of goblet cell carcinoid in the Department of Pathology, Edinburgh University. Of the 10 cases identified, two had died as a result of the tumour. This would suggest a poorer prognosis than is generally recognized. Those patients who subsequently had progression of their disease were not predicted by histological criteria. Because of the unpredictable behaviour of these tumours we recommend that such patients should correctly be treated by a right hemicolectomy.

Adult↗
PubMed1990

Appraisal of breast reconstruction with the tissue expansion technique.

Our experience with 29 patients treated using the tissue expander technique at the Breast Unit, Longmore Hospital, Edinburgh, UK was evaluated. A morbidity rate of 19%, of minor complications only, was seen with expander insertion, tissue expansion and insertion of the permanent prosthesis. Twenty-two women completed questionnaires, two of whom had undergone bilateral reconstruction. In the opinion of the patients, the improved freedom of dress and improved naked appearance after reconstruction, compared with after mastectomy, more than compensated for the abnormal sensation over or around the reconstructed breast; 19 patients rated their clothed appearance as good as that before mastectomy. Twenty of these women were assessed by a four-person panel. A range of end results was noted; symmetry, cosmesis and size were generally better when wearing a brassiere. Lack of ptosis, surgical scars and firmness on the reconstructed side were the main reservations. Tissue expansion breast reconstruction is highly acceptable to patients and has satisfactory surgical results.

Adult↗
PubMed1989

Fibroadenoma of the breast: a follow-up of conservative management.

This report details the outcome after clinical diagnosis of mammary fibroadenoma in 110 women aged under 35 years. After fine needle aspiration cytology, and subsequent exclusions and failures of follow-up, 92 lesions were observed for a mean of 47 weeks (range 13-90 weeks), with regular measurements until removal of persisting lesions at 12 months. Fifteen lesions disappeared and 56 had the classical histology of fibroadenoma, mean size 2.5 cm; 30 of the latter continued to grow throughout the study. Cytology is essential to exclude malignancy if conservative treatment is considered, and is helpful in identifying a benign lesion. A period longer than 12 months may be required for resolution of a fibroadenoma and removal under local anaesthesia as a day case offers a simple alternative.

Adenofibroma↗
PubMed1989

Arm morbidity within a trial of mastectomy and either nodal sample with selective radiotherapy or axillary clearance.

The aim of this study was to assess upper limb morbidity following treatment for operable breast cancer. Patients were randomized to either mastectomy and axillary clearance (40 women: 12 with axillary nodal metastasis and 28 without axillary metastasis) or mastectomy and axillary sampling (54 women). Adjuvant radiotherapy was delivered to those in whom the sample revealed axillary nodal metastasis (28 women) but not to those with no axillary nodal metastasis (26 women). A subjective assessment of the state of the arm was made using a standard questionnaire. Objective assessment included upper and forearm circumference, should joint mobility and assessment of power in the pectoralis muscle. The mean age was 56.8 years (range 33-77 years) and the mean elapsed time from treatment was 5.72 years (range 4.0-7.5 years). Subjective limb oedema was greatest in those who had axillary lymph node metastasis but there was no objective difference. Subjective joint mobility was reduced in the women who received radiotherapy and this was confirmed by objective assessment (P less than 0.05). The objective reduction in arm mobility was related to the treatment rather than the axillary lymph node status. There was no difference in power. In this study women receiving adjuvant radiotherapy had significantly reduced shoulder mobility. This may have implications for current conservation studies using adjuvant radiotherapy.

Adult↗
PubMed1989

Stereotaxic localisation and aspiration cytology of impalpable breast lesions.

As part of a programme of assessment of the 'Sterotix' localisation device, aspiration cytology was carried out on 50 patients with 52 impalpable, mammographically detected breast lesions using the stereotaxic guidance device. This was followed by an open localisation biopsy of the area for confirmation. In 12 patients (23%) the aspirations failed to yield sufficient material for diagnosis. This was frequently due to the poorly cellular nature or very small size of the lesions. Of the remaining 40 patients, 15 were regarded as having both mammographically and cytologically benign changes which were confirmed histologically; they could thus have been spared diagnostic surgery. Ten patients had a diagnosis of malignancy with both investigations, and could have had planned investigation and subsequent definitive surgery. Of the remainder, 14 lesions had a report of malignancy or suspicion of it with either technique and these patients would have come to conventional localisation biopsy. Only one patient was found to have a malignancy, who had cytologically benign and mammographically 'probably benign' disease: this was an invasive lobular carcinoma with a dominant in-situ component and may well have been an incidental finding on biopsy.

Adult↗
PubMed1989

Response to endocrine manipulation and oestrogen receptor concentration in large operable primary breast cancer.

Forty-three patients with large (greater than or equal to 4 cm) but operable carcinoma of the breast have been treated by endocrine manipulation before definitive local surgery. This has allowed the study of the relationship between response to therapy and pretreatment oestrogen receptor (ER) concentration, as measured by a dextran-coated charcoal adsorption method. Premenopausal patients (17) were treated by surgical (4) or medical (13) oophorectomy. Post-menopausal patients (26) received either tamoxifen (10) or an aromatase inhibitor (16). Response was assessed from statistical analysis of the changes in tumour size. On completion of 12 weeks of endocrine therapy, there was significant regression of tumour size in 18 of the 43 patients. All 18 patients had tumours with ER concentrations of greater than or equal to 20 fmol mg-1 cytosol protein. Conversely all patients except one progressing on treatment had tumours with ER concentrations of less than 20 fmol mg-1 cytosol protein. This relationship applied for both premenopausal and post-menopausal patients. The overall response rate of patients with tumours of ER concentration greater than or equal to 20 fmol mg-1 cytosol protein was 60%.

Aminoglutethimide↗
PubMed1989

Subcuticular skin closure following minor breast biopsy: Prolene is superior to polydioxanone (PDS)

The aim of this study was to determine whether a subcuticular absorbable suture (polydioxanone acid, PDS, Ethicon, UK) was superior to a subcuticular non-absorbable suture (Prolene, Ethicon, UK) for day-case breast biopsy performed under local anaesthesia. After breast biopsy, the type of subcuticular suture to be used was randomized in 100 patients. In all other respects the surgery and written postoperative instructions were similar for the group. Patients were reviewed over two visits by one independent observer who was unaware of the suture utilized (median 10 days and 52 days after surgery). Three patients had incomplete documentation and four patients failed to attend for either visit: thus 47 and 46 patients in the Prolene and PDS groups, respectively, were assessed. There was no difference between the Prolene and PDS groups, respectively, in the median interval to either the first shower or removal of the original plaster. There were three wound infections (one with Prolene, two with PDS). At the first visit three patients in the Prolene group had their incision uncovered, compared to 20 patients in the PDS group. In the PDS group a buried knot eroded through the incision in eight patients (17%). In this study the expected advantages of an absorbable suture were not confirmed.

Adult↗
PubMed1988

The cytochemical detection of oestrogen receptors in fine needle aspirates of breast cancer; correlation with biochemical assay and prediction of response to endocrine therapy.

A total of 98 breast aspirates from patients with breast cancer have been fixed and stained for oestrogen receptors using the Abbott ERICA kit. In a preliminary series of 41 aspirates, cytochemical staining index (% cells staining x mean intensity) related to the receptor concentration determined biochemically on a subsequent biopsy with a correlation coefficient of +0.65. In a second series of 56 aspirates examined after lysis and cytocentrifugation, the correlation coefficient was +0.73. For 14 patients, the response of the primary tumour to endocrine therapy was assessed objectively by serial clinical and mammographic measurements (Forrest et al., 1986) and was found to relate strongly to the cytochemical staining of the initial aspirate. The potential and limitations of this technique are discussed.

Adult↗
PubMed1988

Partial deletion of chromosome 11p in breast cancer correlates with size of primary tumour and oestrogen receptor level.

In a study of DNAs from 100 breast cancer patients and 100 controls, there were no differences in the frequencies of common or rare alleles at the Harvey ras (c-Ha-ras) locus on chromosome 11. However, one Ha-ras allele was deleted from the tumour DNA in 14 of 65 informative patients. Loss of a Ha-ras allele correlates with paucity of oestrogen receptor protein and with increased tumour size at presentation, but is not associated with microscopic evidence of lymph node invasion. The findings on Ha-ras and other informative loci are consistent with the possibility that a tumour suppressor gene involved in the early stages of breast cancer is located on the short arm of chromosome 11.

Alleles↗
PubMed1987

Mammillary fistula.

Forty women presenting with mammillary fistulas over a 6 year period have been reviewed. The events preceding the fistula were incision of a periareolar breast abscess (n = 24), breast biopsy (n = 13) and spontaneous discharge of an inflammatory mass (n = 3). Only two of the women with abscesses were lactating. Two patients had granulomatous mastitis. The remaining 36 patients were all considered to have periductal mastitis/mammary duct ectasia as the cause of their fistulas. The two mammillary fistulas associated with lactation healed spontaneously. Nine patients had the fistula excised and the wound packed; this resulted in satisfactory healing in all but one patient. Twenty-one patients had excision of the fistula and primary closure, without antibiotic cover, but only ten healed without complications and six patients required further surgical procedures for a recurrent fistula. Six patients had primary excision and closure under antibiotic cover with a penicillin and metronidazole; all healed. Mammillary fistulas are complications of the periductal mastitis/duct ectasia syndrome. They should be treated by excision and primary closure under appropriate antibiotic cover or alternatively excised and left open to granulate.

Adult↗
PubMed1987

Granulomatous lobular mastitis.

The clinical and pathological features of nine cases of granulomatous mastitis were compared with those of 10 cases of duct ectasia/periductal mastitis (DE/PM), all of which were associated with active granulomatous inflammation. Granulomatous mastitis affects a younger age group, and although there is some overlap with DE/PM, it has distinctive pathological features, particularly a lobule centred distribution, for which the term "granulomatous lobular mastitis" is recommended. There is a strong tendency for persistence or recurrence. Our cases of granulomatous mastitis all occurred in parous women, five of them within three years of pregnancy. Awareness of this condition is important, because surgery does not offer the best treatment of recurrent disease, and trials of adequate drug treatment, including corticosteroids, are required.

Adolescent↗
PubMed1987

Somatic DNA variability in human breast carcinoma.

Bkm-related probe 2[8], consisting mainly of GATA repeats, detects a hypervariable pattern of restriction fragment length polymorphisms in human DNA which is normally developmentally stable. However, specific somatic DNA variability was found in 53% (7/13) of human breast carcinomas, but not in eight cases of bladder carcinoma, when compared with leukocyte DNAs from the same patient under the same conditions. Certain of the restriction fragments detected carry both GATA-related sequences and sequences related to the M13 vector. Comparison of BstN1 digests of tumour and cognate leukocyte DNA revealed a further variable ethidium-stained restriction fragment class, not recognised by the probe, in 93% of breast and in 63% of bladder carcinomas.

Breast Neoplasms↗
PubMed1986

A human tumour model.

An approach to the management of patients with large (greater than 4 cm) operable breast cancers is described. The conventional sequence of mastectomy followed by systemic therapy is reversed, allowing accurate measurements of response to individual forms of endocrine therapy or chemotherapy. Such a method not only permits individual selection of appropriate systemic therapy, but also allows clinical response to be related to histological and biochemical tumour parameters. A response was observed in eleven of twenty-three patients to endocrine treatment and in twelve of thirteen to combination chemotherapy. In five of the latter the response was histologically complete.

Antineoplastic Combined Chemotherapy Protocols↗