Biomedical subjects

A Mannell

Publications and source records attributed to A Mannell.

At least 19 recordsLinked to original sources

PubMed1994

Tumour kinetics in breast cancer.

In vivo bromodeoxyuridine was used to measure the 'bromo' labelling index (LI,%), the duration of the S-phase (Ts, hours) and the potential tumour doubling time (Tpot, days) in women with stages I-IV breast cancer. These were studied in relation to lymph node status, tumour size, histological grade, oestrogen receptor status (ER), ploidy and S-phase fraction (SPF). In our patients, a LI of 10%, a Tpot of 2 days or an SPF of 9-10.5% predicted aggressive breast cancer. The LI was significantly higher (5%) in ER-negative than in ER-positive (2%) tumours (P = 0.03). There was a trend towards increased DNA synthesis in cancers with an SPF over 10% (P = 0.08). ER-negative breast cancers over 2 cm in diameter had shorter median Tpots of 5.3 days (P = 0.02) and 8 days (P = 0.05) compared with smaller, ER-positive tumours. A trend towards faster growth rates was seen in lymph node-positive, high-SPF (> 10%) breast cancers. Tumour kinetics may have additional prognostic value in the selection of node-negative patients for adjuvant therapy.

Breast Neoplasms↗

PubMed1991

Phaeochromocytoma. A report of 10 patients.

A spectrum of presentation of phaeochromocytoma in black South Africans is described. Ten patients were reviewed over a 9-year period. Sweating, headache, and palpitations were prominent symptoms in 9 patients; postural dizziness occurred in 5; gastro-intestinal symptoms in 7; diabetes in 3; and hypertension in all. One patient developed a phaeochromocytoma crisis, characterised by hypotension and pulmonary oedema, before operation. One woman presented in pregnancy. Urinary vanillylmandelic acid was elevated in 9 out of 10 subjects tested; plasma catecholamines were elevated in 6 out of 6 tested. Computed tomography detected 7 adrenal tumours and 3 paragangliomas. All patients were stabilised pre-operatively with alpha- and/or beta-receptor blockers. Intraoperative pressor crises were controlled with sodium nitroprusside, phentolamine, or magnesium sulphate infusions. At operation all tumours appeared benign, each was successfully removed, and the diagnosis confirmed on histological examination. There was no operative mortality. Two patients had residual hypertension. This study highlights the various challenges presented by this catecholamine-producing tumour.

Adolescent↗

PubMed1991

Evaluation of the results of oesophagectomy for oesophageal cancer.

The long-term results of standard techniques of oesophagectomy were examined in 127 patients with squamous cell carcinoma of the oesophagus. A near-total oesophagectomy with a cervical anastomosis was performed in 93 patients and an oesophagogastrectomy with an intrathoracic anastomosis was carried out in 34 patients. One hundred and eight patients had a curative oesophagectomy and 19 patients had a palliative resection. Eight patients received radiotherapy to the tumour bed. There were 15 deaths in hospital and the overall 5-year survival rate including perioperative deaths was 13.2 per cent. Survival was adversely affected by incomplete excision of macroscopic tumour (P less than 0.001), positive regional lymph nodes (P less than 0.05) and distant lymphatic metastases (P less than 0.02). The 5-year survival rate of patients with tumour invasion beyond the oesophageal wall (T3) and negative nodes was 20 per cent. Postoperative irradiation had no effect on the survival of patients with gross residual tumour. Complete clearance of microscopic tumour was achieved in 50 per cent of patients with T3 tumours and this group did not benefit from adjuvant radiotherapy. Survival in patients undergoing curative oesophagectomy with residual microscopic tumour, however, was significantly improved by irradiation of the tumour bed (P less than 0.01). These results suggest that the survival of patients can be increased significantly by the excision of all gross tumour and by identification of those who will benefit from local radiotherapy.

Adult↗

PubMed1991

Superior mesenteric artery aneurysms: a case report.

Aneurysms of the superior mesenteric artery (SMA) are rare, accounting for 8% of visceral artery aneurysms. Aneurysms at the site are very liable to rupture, irrespective of size, and may be difficult to manage even in the elective situation. The fact that 50-60% of SMA aneurysms are mycotic has important implications in the selection of the appropriate surgical procedure. In this paper we report a case of an SMA aneurysm diagnosed at the time of impending rupture and treated successfully. The aetiology, mode of presentation, diagnosis and management of SMA aneurysms are discussed.

Adult↗

PubMed1991

Pancreatic leiomyosarcoma. A case report.

The pancreas is an unusual site for leiomyosarcoma. Only 12 such cases have previously been reported. A case of pancreatic leiomyosarcoma in a 68-year-old man is presented and the diagnostic dilemma and management of such a tumour are discussed.

Aged↗

PubMed1991

Risk factors for complications after thyroid surgery.

Data on 60 patients who underwent thyroid surgery were retrospectively reviewed. The clinicopathological data were compared with the occurrence of the complications of recurrent laryngeal nerve palsy, hypocalcaemia and laryngeal oedema. Age, pressure symptoms and types of pathology were not associated with complications. Large glands and radiological evidence of a compressed trachea were statistically significant risk factors for postoperative complications.

Adult↗

PubMed1991

Primary malignant melanoma of the oesophagus. Report of a case with flow cytometric DNA analysis.

Primary malignant melanoma is a very rare tumour of the oesophagus, and although this is the first case reported in a black patient in South Africa, the clinical, radiographic and histopathological features were characteristic of this malignancy. Primary oesophageal melanoma is a highly lethal tumour--fewer than 2% of patients are surviving 5 years after diagnosis. Flow cytometric DNA analysis of the resected specimen in this case revealed two populations of malignant cells, one of which had grossly abnormal DNA. Existence of two clones of malignant melanoma cells supports the observations that this tumour is biologically aggressive, radioresistant and almost always incurable.

DNA, Neoplasm↗

PubMed1990

Role of pyloroplasty in the retrosternal stomach: results of a prospective, randomized, controlled trial.

A prospective, randomized, controlled trial comparing clinical outcome and emptying of a solid meal from the retrosternal stomach, with and without pyloroplasty is described. Forty consecutive patients with oesophageal cancer undergoing retrosternal gastric reconstruction of the oesophagus were studied. In 20 patients the pylorus was left intact (group 1) and 20 patients underwent an Aust pyloroplasty (group 2). Nine patients in group 1 suffered postoperative symptoms of gastric stasis compared with only one patient in group 2 (P = 0.0106). Three patients in group 1 died from aspiration pneumonia before discharge from hospital. A gastric emptying test was performed on 24 patients between 1 and 3 months after surgery. By this time, most survivors had recovered from symptoms attributed to gastric stasis and no significant difference in gastric emptying could be demonstrated between the two groups. Selection of patients, a wide range of emptying times and improvement in gastric emptying on follow-up may explain the lack of correlation between postoperative symptomatology and the gastric half-emptying times. A pyloroplasty is advised to prevent the potentially lethal effects of gastric stasis in the early postoperative period following retrosternal reconstruction of the oesophagus.

Adult↗

PubMed1990

Insulinoma in a black South African. A case report.

A 69-year-old black woman with an insulinoma presented with recurrent episodes of sweating and confusion culminating in two episodes of hypoglycaemic coma. The diagnosis was confirmed by finding an inappropriately elevated serum insulin level in the presence of hypoglycaemia after a fast of 14 hours. Computed tomography revealed a large tumour in the head of the pancreas. Removal of the tumour necessitated partial resection of the head and body of the pancreas, which in turn necessitated certain repair and drainage procedures. Postoperative complications, while not insignificant, were acceptable. At 1-year follow-up the patient is well.

Adenoma, Islet Cell↗

PubMed1990

Parotid haemangioma. A case report.

The presentation of a rare cavernous haemangioma of the parotid in a 17-year-old male is the twenty-first case in the English literature, and the first report in a black adult patient. The aetiology of this lesion is unknown and differs from that of the infantile capillary type. The pathognomonic signs of fluctuating size, discoloration and bruit are rare; the diagnostic hallmark in this case was spontaneous tumour regression. Doppler studies and arteriography may be valuable in diagnosis and management, in which surgical excision is the treatment of choice.

Adolescent↗

PubMed1990

Pancreatic candidiasis. A case report.

A rare case of pancreatic candidiasis is described. The patient presented with weight loss, obstructive jaundice and a mass in the head of the pancreas. Intra-operative fine-needle aspiration cytology was consistent with a well-differentiated adenocarcinoma of the pancreas and a radical pancreaticoduodenectomy was performed. However, histological examination of the resected specimen revealed acute-on-chronic pancreatitis complicated by candidiasis with no evidence of malignant disease. The association between this variety of pancreatic candidiasis and pancreatic abscesses due to Candida albicans in acute pancreatitis is discussed.

Adenocarcinoma↗

PubMed1990

DNA ploidy in oesophageal cancer. A preliminary report.

Prognosis in oesophageal cancer is directly related to depth of invasion and lymph node metastases. However, without surgical exploration, assessment of the spread of oesophageal cancer is notoriously inaccurate and there is a need for another objective measurement of prognosis. In this study, the relationship of DNA-ploidy status to tumour length, histological appearance, extra-oesophageal spread and survival was examined in 42 patients with squamous oesophageal cancer. No correlation was found between DNA-ploidy status and tumour length or histological appearance. But the DNA-aneuploidy rate in cancers with extra-oesophageal spread was significantly greater than the rate in tumours localised to the oesophagus (P = 0.038). Short-term survival was poorer in patients with DNA-aneuploid cancers than in those with a DNA-diploid pattern. DNA analysis may prove to be a more accurate guide to prognosis in oesophageal cancer than either clinical or operative staging.

Carcinoma, Squamous Cell↗

PubMed1989

Oesophageal cancer in South Africa. A review of 1926 cases.

From November 1985 to August 1988, the National Study Group for Oesophageal Cancer collected and centralized data on 1926 new cases of oesophageal cancer in South Africa. A standard data sheet was used to record the age, sex, and condition of the patients, the site, length, and circumferential extent of the tumor, the presence of extraoesophageal and distant spread, associated pulmonary disease, and the therapeutic technique selected for each case. A computerized audit of cases was reviewed to examine the performance status, stage of disease, and methods of treatment. There were 1438 men and 488 women (male to female ratio, 3 to 1) and their ages ranged from 20 to 100 years (mean age, 56 years). Twenty-four percent were admitted to the hospital with total dysphagia. The performance status was excellent or good in 49% of the patients and fair in 29%. Those in poor or desperate condition included 13% of the patients with oesophago-airway fistulae. The most common site of cancer was the mid-thoracic oesophagus (53% of the cases), but 8.3% had tumors longer than 10 cm involving two or more oesophageal segments. Using the American Joint Committee (AJC) system of staging, 2.8% of the patients were assessed as Stage I, 19.8% as Stage II, and 77.4% as Stage III. Thirty-seven percent of the patients were treated by oesophageal intubation, 35% by radiation therapy, and 22% by chemotherapy. Surgery was selected for 17% of the patients. Although the number of young patients appears to have increased, the typical South African patient with oesophageal cancer is a man 56 years of age, in excellent or good condition, with a mid-thoracic tumor 6 cm in length and Stage III disease. This patient is frequently treated by palliative intubation of the oesophagus but may be a candidate for more intensive anti-cancer therapy.

Black or African American↗

PubMed1989

Carboplatin in the treatment of oesophageal cancer.

Cisplatin has modest activity in squamous cancer of the oesophagus but substantial toxicity limits its usefulness. Carboplatin (Paraplatin; BM Group), a second-generation platinum analogue, was developed to maintain the antitumour activity of cisplatin and reduce toxicity. Eleven patients with advanced oesophageal cancer were treated with carboplatin. A partial response was seen in 1 patient (9%) and minor responses in 2 cases. The median survival was 12 months in responding patients and 3 months in non-responders. One patient suffered reversible myelosuppression but nephrotoxicity and vomiting were not observed. Carboplatin is well tolerated and may have a role as a less toxic substitute for cisplatin in combination chemotherapy regimens for oesophageal cancer.

Aged↗

PubMed1989

The role of carbohydrate antigen 19-9 as a tumour marker of oesophageal cancer.

Carcinoma of the oesophagus is endemic in certain well demarcated areas throughout the world, and a method of screening population groups at high risk for oesophageal cancer is urgently needed. In this study the sensitivity and specificity of the carbohydrate antigen CA19-9 as a marker of carcinoma of the oesophagus in African patients was examined. The normal range was established by assay of serum samples from healthy black blood donors, using a solid phase radioimmunoassay with mouse monoclonal antibody to CA19-9 labelled with 125I. Serum concentrations of CA19-9 were then measured in 100 African patients with oesophageal cancer and 28 patients with benign oesophageal disease. The upper limit of CA19-9 in the normal controls was 40 U ml-1. Thirty-four patients with oesophageal cancer and five with benign oesophageal disease had elevated levels. Therefore, in this series, the sensitivity of CA19-9 as a marker of oesophageal cancer was 34% and the specificity was 82%. While CA19-9 is not sufficiently sensitive to be used as a screening test of oesophageal cancer, it compares favourably with other known tumour markers of this disease, and may have a role in monitoring disease recurrence and response to treatment.

Adult↗

PubMed1989

The prolonged course of gastrointestinal tuberculosis.

Review of biopsy specimens showed that a patient incorrectly diagnosed 7 years ago as having Crohn's disease actually had histologically proven gastrointestinal tuberculosis of 7 years' duration. It is significant that gastrointestinal tuberculosis and Crohn's disease can mimic each other not only in their clinical, radiologic, and histologic manifestations but also temporally. We discuss the interrelationship between AIDS, tuberculosis, and inflammatory bowel disease.

Acquired Immunodeficiency Syndrome↗

PubMed1989

Giant submandibular calculus. A case report.

A case of giant mandibular calculus, 6.5 X 5.5 cm, is presented. The management of this condition is reviewed and an explanation offered for the occurrence of these calculi.

Adult↗

PubMed1989

Parotid tumours in black patients. The Baragwanath Hospital experience, 1981-1986.

Parotid tumours are rare, but their diagnosis and management continue to be a surgical challenge. In a retrospective review of 60 patients over a 6-year period, the value of clinical features in distinguishing malignant from benign parotid tumours was examined. The sex of patients, the consistency, size and site of tumour, smoking, length of history and rate of growth were not helpful in differentiation. However, the association of pain, facial nerve paralysis, skin infiltration and enlarged ipsilateral cervical nodes with a final diagnosis of cancer was significant (P less than 0.005). Fixity of tumour and old age were also significant indicators of malignancy (P less than 0.05). When these symptoms and signs suggestive of malignant disease are associated with a parotid tumour, the patient should be prepared for the possibility of a radical operation. The surgeon should make extra efforts to obtain a histological diagnosis before proceeding to definitive surgery.

Adolescent↗