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Biomedical subjects

A Kothari

Publications and source records attributed to A Kothari.

At least 19 recordsLinked to original sources
PubMed2006

Treatment of mammary duct fistula by fistulectomy and saucerization.

This study was designed to assess the efficacy and long-term outcome of fistulectomy and saucerization for treatment of mammary duct fistulae. Mammary fistula is a chronic condition that represents the final step in what has been termed "mammary duct associated inflammatory disease sequence." The treatment is primarily surgical and may include healing by secondary intention or primary closure with or without antibiotics. Reported series are small and often include variable surgical strategies applied without consistency. A consecutive series of 53 patients who had 59 mammary duct fistulae were treated by fistulectomy with saucerization. The median age was 32 years. Wounds were allowed to heal by secondary intention and antibiotics were not used. We reviewed the case records to establish the incidence of recurrent fistula and the time to complete healing. The long-term cosmetic outcome was determined by a postal survey. After a median follow-up of 6 years there had been no relapse in 92%. There was significant delay in healing in six cases (range: 10 to 30 weeks). Thirty-eight patients (83%) gave a definite history of regularly smoking between 10 and 20 cigarettes a day. Two thirds of the patients were either pleased or satisfied with the final cosmetic result of the surgery, but more than 90% said that it left them with some distortion of the nipple. Fistulectomy and saucerization achieves long-term cure in the majority of patients with mammary duct fistula, but it results in some degree of distortion of the nipple. The strong relationship between smoking and the occurrence of mammary duct fistulae is again demonstrated.

Adolescent↗
PubMed2005

Breast duct micro-endoscopy: a study of technique and a morphological classification of endo-luminal lesions.

Endoscopic visualisation of the human mammary ductal system has been sporadically reported over the last decade. Recent rapid and groundbreaking developments in the field of optics have made the previously unseen labyrinth of mammary ducts more easily accessible to direct visualisation and examination. The emphasis so far has been on visualisation of ectatic ducts with pathological nipple discharge. The purpose of this study was to assess the feasibility of mammary duct epithelium in patients with a range of other pathologies. Based on our findings we have developed a morphological classification of endo-luminal lesions seen on endoscopy. We successfully conducted ex vivo mammary duct micro-endoscopy on 115 ducts in 35 mastectomy specimens. Visualisation of mammary duct epithelium was achieved using a solid rod depth of field imaging micro-minimally invasive (DOFI MMI, Acueity Inc., USA) and more recently the LaDuScope (PolyDiagnost GmbH, Germany) system. Both these systems consist of 0.9 mm maximum outer diameter micro-endoscope, with working channels 0.35 and 0.45 mm, respectively. Saline or air insufflation was used to keep the mammary ducts from collapsing. An average of 3.3 (median 3) mammary ducts could be identified and cannulated in all 35 mastectomy specimens (total of 115 ducts). Visualisation beyond 2 cm of the ductal system was possible in 23/35 (66%) of specimens. Abnormalities were visualised in 40% of the ducts. The maximum depth we could negotiate to was 8.9 cm and in doing so manoeuvred past eight duct divisions. In 34% of ducts cannulated, we were able to navigate the scope beyond at least one bifurcation of the principal duct and in 16% of cases extensive intra-ductal navigation was possible. Peripheral ducts were visualised in 16% of cases. False passages were created in 16% of cases. Previous history of smoking, parity, breastfeeding and radiotherapy offered neither significant advantages nor disadvantages for the technique nor did they increase or decrease the number of normal ducts visualised per specimen. This study showed that mammary duct micro-endoscopy is a practical and technically feasible procedure even in the absence of nipple discharge, in normal non-ectatic milk ducts. A simple morphological classification of endoscopically visualised intra-ductal abnormalities is suggested.

Adult↗
PubMed2005

Breast duct microendoscopy in nipple discharge: microbrush improves cytology.

BACKGROUND: Breast duct microendoscopy is a new technique that allows direct visualization of the mammary ductal epithelia and has the potential to provide greater accuracy in the diagnosis of benign and malignant breast conditions. We have already established the feasibility of BDME on mastectomy specimens and in patients both under general and local anesthesia. It was the aim of this study to investigate the use of BDME in patients with pathological nipple discharge and to explore the feasibility of using an endoluminal microbrush to take cytology samples from specific lesions. MATERIALS AND METHODS: Breast duct microendoscopy was offered to all patients undergoing surgery for nipple discharge. Surgery included microdochectomy (younger women) and total duct excision (especially in postmenopausal women). The microbrush was used to collect samples whenever an endoluminal papilloma was seen on endoscopy. The results of microbrush cytology samples were compared to ductal lavage samples. RESULTS: Fifty consecutive patients undergoing microdochectomy or total duct excision for nipple discharge had breast microendoscopy (28 general, and 22 under local anesthesia). Thirty-one patients had microdochectomy and nineteen had total duct excision. Visualiza- tion of discharging ducts was accomplished in 100% cases. Endoluminal abnormalities were seen in 33 (66%) patients and dilated ducts were seen in 17 patients. Among the 33 patients, 15 had single papilloma, 3 multiple papilloma and 15 inflammation (erythema, fronds, adhesions). Seven out of eight patients with an intraductal papillorna who had microbrush cytology showed papillary cells whereas only 2 out of 11 patients who had ductal lavage were positive for papillary cells. Thus the sensitivity of the brush cytology technique for the diagnosis of papilloma was 87.5% and the sensitivity of ductal lavage 18% (p = 0.0055). CONCLUSION: Breast duct microendoscopy is an effective way of establishing the etiology of nipple discharge. The microbrush increases the sensitivity of cytology significantly.

Breast Diseases↗
PubMed2003

22. Diagnostic delays in breast cancer and impact on survival.

There is always an interval between the first symptoms, time to diagnosis and start of treatment in women with symptomatic breast cancer. Delay may be due to the patient, her general practitioner or a false negative diagnosis in hospital. A systematic overview showed that delays of 3-6 months were clearly associated with increased tumour size, advance in disease stage and poorer long-term prognosis. Nevertheless, controversy persists regarding the impact of delay on survival. The conflicting results may be due to a difference in sample characteristics, differences in the delay interval studied or variations in the definition of delay. A major drawback of many studies was that the potential confounding effect of lead-time bias was not taken into account. One of the largest single institution studies, designed to control for the lead-time bias, confirmed that survival measured from both date of diagnosis and onset of patient's symptoms was worse in women with delays of >12 weeks. Within individual stages, longer delays had no adverse impact on survival. It is important to identify groups of patients at high risk of delay so that strategies can be developed and effectively targeted.

Attitude of Health Personnel↗
PubMed1998

Smoking cessation, physicians, and medical office staff. Clinical tobacco intervention in Prince Edward Island.

OBJECTIVE: To assess attitudes and self-reported behaviours of physicians and medical office staff in Prince Edward Island concerning clinical tobacco intervention (CTI). DESIGN: Mail survey of PEI primary care physicians and their medical office staff. Most surveys were not mailed back but picked up in person by research staff. SETTING: Primary care settings in PEI. PARTICIPANTS: All active primary care physicians in PEI identified in the Canadian Medical Association database and medical office staff. Respondents included 63/88 (71.6%) physicians and 59/88 (67.0%) medical office staff. Fifty-seven physicians and medical office staff surveys overlapped. MAIN OUTCOME MEASURES: Attitudes and self-reported behaviours in CTI. RESULTS: More than 70% of the time, 68.3% of physicians reported asking new patients about their smoking behaviour and 66.7% reported that they listen to and acknowledge patients' feelings and fears about stopping smoking. Close to half (43.3%) of physicians reported thinking about or planning to do more CTI. Physicians and medical office staff reported that staff had limited involvement in methods to cue smoking interventions. Only half (50.8%) of physicians reported that their offices are well set up to identify smokers and to help them quit smoking. Offices were well set up for CTI if physicians perceived that office staff had an active role in CTI and if follow-up visits were frequently arranged. CONCLUSIONS: This study identified apparent opportunities for improving CIT, particularly in the areas of physician training, involvement of medical office staff, and awareness of billing codes. This could improve the quality of preventive care for patients in PEI.

Adult↗
PubMed1997

Right to bill may affect amount of tobacco counselling by MDs.

Unpublished data from Health Canada indicate that only 32% of Canada's family physicians believe they can bill their health plans for providing smoking-cessation counselling to patients with no smoking-related illness. A CMA study of provincial billing codes determined that all provinces and territories except British Columbia and Alberta have billing codes for clinical tobacco interventions, which include counselling. Ontario leads the way with 4 separate codes.

Canada↗
PubMed1997

Combination of melatonin and tamoxifen as a chemoprophylaxis against N-nitroso-N-methylurea-induced rat mammary tumors.

The effect of melatonin (Mel) and or tamoxifen (Tam) was evaluated on a mammary tumor model induced in 50 day old female Sprague-Dawley rats by a single intraperitoneal (i.p.) injection of a direct carcinogen, N-nitroso-N-methylurea (NMU) (50 mg/kg b.wt./rat). These animals were treated with either Mel 200 microg/rat per day, orally in drinking water and/or Tam (s.c.) 60 microg/rat per week or 180 microg/rat per week. The total observation period was 300 days post-NMU administration in all the animals. The mean latency period of tumor appearance and tumor incidence was recorded. The mean latency period was significantly lengthened in all the treated groups as compared to that in the only NMU-administered rats (P < 0.001). Highly significant suppression of tumor incidence was observed in Mel + Tam180 group (P < 0.001). The other two groups i.e. Mel + Tam60, and Tam180 also showed significant suppression of tumor incidence (P < 0.01). Eight weeks after the initiation of treatment regimen, we observed marked reduction in [3H]thymidine incorporation into mammary gland DNA of Mel- and/or Tam-treated groups of animals as compared to the age-matched controls and NMU-administered rats, which correlated positively with the sparse mammary gland development seen in the whole mount preparations. The result of the combined therapy is highly promising and warrants clinical evaluation in the prophylaxis of breast carcinogenesis in humans.

Animals↗
PubMed1995

Chemoprevention by melatonin and combined melatonin-tamoxifen therapy of second generation nitroso-methylurea-induced mammary tumours in rats.

Melatonin, an indole of pineal origin, is known to have an oncostatic effect on carcinogen-induced rat mammary tumours. We have assessed for the first time, the efficacy of melatonin alone and in combination with a sub-optimal dose of tamoxifen, a partial oestrogen antagonist, on N-nitroso-N-methylurea-induced rat mammary tumours. Both these agents were administered to Sprague-Dawley rats following excision of the primary tumours. Melatonin (200 micrograms/day/rat) at the given dose level could significantly suppress the appearance of second generation mammary tumours and the latency period of tumour appearance was also significantly increased (P < 0.001) as compared to vehicle-treated animals. Tamoxifen (60 micrograms/week/rat) does not suppress the development of second generation mammary tumours. Co-administration of melatonin and low dose of tamoxifen had no additive or synergistic effect on the prevention of second generation of mammary tumours. The results warrant the clinical evaluation of melatonin for chemoprevention and adjuvant therapy.

Animals↗
PubMed1994

Spatial planning deficits in limb apraxia.

Geschwind (1975) proposed a disconnection model in which an apraxic subject is unable to carry out movements to command because the left hemisphere that comprehended the verbal command is disconnected from the right premotor and motor areas which controls the left hand. An alternate model, however, proposes that apraxia results from destruction of spatiotemporal representations of learned movement stored in the left hemisphere (Heilman, 1979). The disconnection hypothesis would predict that apraxic subjects should be able to correctly imitate gestures and correctly use actual tools since these tasks do not require language. The movement representation model predicts that imitation and actual tool use would also be impaired. Motion analyses were performed on the trajectories of repetitive 'slicing' gestures made in a series of conditions in which contextual cues were introduced in a graded fashion. Four cue conditions were presented: no cues (verbal command), object present, tool present and both object and tool present. Positions of the hand, wrist, elbow, and shoulder were digitized from neighbouring views, reconstructed in three dimensions and analysed with respect to specific spatiotemporal features of the trajectories. Three subjects with limb apraxia, who had lesions that included left parietal cortex, and four neurologically intact subjects participated. The apraxic subjects showed disturbances in planning the movement of the hand in space across the cue conditions. For example, they showed deficits in the plane of motion, the shape of the trajectory and in the coupling of hand speed and trajectory shape even when given full contextual cues. These data support the hypothesis that apraxia can result from the destruction of spatiotemporal representations of learned movement, rather than from a disconnection between the receptive language areas in the left hemisphere and the contralateral motor cortices.

Aged↗
PubMedDate not supplied

Throwing light on nipple discharge.

Five percent of the patients presenting to a symptomatic breast clinic have nipple discharge. Conventional surgical management for the nipple discharge includes microdochectomy or total duct excision. Breast duct micro-endoscopy (BDME) is a new technique, which helps evaluate the underlying cause of nipple discharge. We describe a case of nipple discharge with a unique etiology: mammary duct foreign body.

Breast Diseases↗
PubMedDate not supplied

A comparative study of two devices used for cervical cell sampling raises some doubts about liquid-based cytology.

The objective of this study was to compare the quality of smears obtained by a newly designed cervical cell sampler (the implement) to those obtained with the cervex brush, using liquid-based cytology (LBC). A prospective randomized controlled trial with the approval of the local ethics committees after informing the Medical Devices Agency in the UK was used in this study. The study was carried out in colposcopy clinics in two district general NHS Trust Hospitals in London. A total of 200 women were recruited (100 from each hospital). The women were randomized into two groups, each of them having two smears at the same time. One hundred (50%) of the women had their first smear with the new implement, and the other 100 (50%) had their first smear with the cervex brush. The main outcome of this study is good-quality smears, assessed by evidence of effective sampling of the transformation zone, including immature metaplastic cells and also endocervical cells. Eighty-five percent of the smears taken by the new implement showed good-quality smears compared to 91% of those taken by the cervex brush, a statistically marginally nonsignificant result, with P value = 0.052 (McNemar exact test). A larger number of good-quality smears, judged by evidence of sampling of transformation zone, were obtained with the cervex brush, though the difference was statistically marginally nonsignificant, using the British society for clinical cytology criteria. Surprisingly, despite the use of LBC, there was a higher rate of inadequate smears obtained with both the devices (8% with each) compared to our previous study using the conventional slide test (1.3% with the new implement and 1.8% with the Jordan's spatula).

Cytodiagnosis↗
PubMedDate not supplied

Cardiovascular dysautonomia in patients with lepromatous leprosy.

Autonomic functions were studied by six standard tests in 65 patients with lepromatous leprosy and 25 healthy controls. Dysautonomia was observed in 22 patients, all having the disease for more than five years. Associated peripheral neuropathy, judged clinically, was present in all, except one patient. Of the 22 dysautonomic patients, 9 each had mild or moderate dysantonomia and 4 had severe dysautonomia as per the scoring schedule devised by us. Syncope, gustatory sweating and impotence were the symptoms suggestive of dysautonomia. But not all affected patients reported these symptoms. Involvement of the sympathetic system was more frequent than that of the parasympathetic system. Statistically significant abnormality was seen with Atropine ratio, standing 30:15 beat ratio, postural hypotension and sustained hand grip test. Sustained hand grip test was the one which consistently gave abnormal results in all the 22 dysautonomic patients.

Adult↗