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J J Vyas

Publications and source records attributed to J J Vyas.

At least 19 recordsLinked to original sources
PubMed1998

Prediction of nipple and areola involvement in breast cancer.

AIMS: To find a pre-operative test for nipple and areola involvement in breast cancer. METHODS: Areola-tumour distance was measured in 140 consecutive patients (median age 45, range: 23-83) undergoing a mastectomy. We analysed whether nipple and areola correlated with areola-tumour distance, tumour size, nodal status, perinodal involvement and lymphatic embolization. RESULTS: The nipple was involved in 22 (16%) cases and this correlated with tumour size, number of lymph nodes, perinodal extension and presence of lymphatic emboli. In all these 22 cases, the tumour was within 2.5 cm of the areola. Tumour size, however, could not predict nipple involvement in tumours within 2.5 cm of the areolar edge. CONCLUSIONS: In the one-fifth of cases where the tumour is over 2.5 cm from the areola, preserving the nipple and areola for reconstruction may be worthwhile. In remaining cases, some other predictive test for nipple involvement would be necessary.

Adult↗
PubMed1996

Role of ultrasonography to detect axillary node involvement in operable breast cancer.

Prompted by the concern about unnecessary axillary dissections, we prospectively studied the accuracy of clinical examination (CE) and conventional ultrasonography (USG, 7.5 MHz), to diagnose pre-operatively metastatic axillary lymph nodes in 200 operable breast cancer patients. USG had higher specificity (90% vs 77%, P = 0.025) and higher positive predictive value (ppv = 90% vs 76%, P = 0.02) than CE. Together, CE + USG had higher sensitivity (82% vs 58%, P = 0.00005) and higher negative predictive value (npv = 76% vs 58%, P = 0.008) than CE alone. In women < 45 years, CE + USG had higher sensitivity (91% vs 76%, P = 0.037) and npv (89% vs 67%, P = 0.018) than in older women. The sensitivity and npv of CE + USG to detect > 1 positive node were 97% (for both) in women < 45 years compared to 81% and 79% in older women. The high sensitivity of CE + USG (82% for the whole group) is probably due to the higher proportion of young women (median age = 45) in our population. It suggests that using CE + USG to avoid axillary dissection in some patients is feasible.

Adult↗
PubMed1996

Multicentricity of breast cancer: whole-organ analysis and clinical implications.

We studied the spatial relationship within the breast between multicentric foci (MCF) and the primary tumour in 30 modified radical mastectomy specimens using Egan's correlated pathological-radiological method using 5 mm slices of the whole breast. The relative positions within the breast of the primary tumour and MCF were used to calculate the relative distribution of primary tumour and MCF in the four quadrants of the breast and the per cent breast volume that would be required to be excised to include all MCF. Nineteen (63%) breast harboured MCF. The relative distribution of primary tumour and MCF in the four breast quadrants was significantly different (P = 0.034). MCF were present beyond the index quadrant (25% of breast volume including the tumour) in as many as 79% (15/19) of breasts that harboured MCF; and in half the cases (15/30) when all breast were considered. This is in variance with the suggestion put forward previously that MCF are contained within the index quadrant in 90% of cases. Although the number of patients in the present series is small, the probability of our finding being due to play of chance is 1 in 1500. In a large series of breast conservation studies > 90% of early breast recurrences have been found to occur in the index quadrant. Our finding, that in half the patients (15/30) MCF are present in quadrants other than the index quadrant, suggests that MCF do not give rise to early breast recurrence.

Adult↗
PubMed1996

Ukrain treatment in carcinoma of the oesophagus (case report).

A poorly differentiated squamous cell oesophageal carcinoma was diagnosed in a patient after an 11 month history of difficulty in swallowing. The condition was inoperable according to clinical and X-ray contrast examinations. Radiation therapy with three courses of chemotherapy was carried out, but no amelioration was obtained. Ukrain therapy (course of 46 ampoules) was undertaken; this changed the situation entirely: all the subjective problems disappeared and no residual cancer was seen on the X-rays. Complete remission is seen nearly four years after Ukrain therapy.

Adult↗
PubMed1994

Reconstruction of chest wall defects following extirpative surgery.

Reconstructive procedures following chest wall resection pose a special surgical challenge. With modern surgical technique, a wide range of reconstructive options are at the surgeon's disposal and, hence it is imperative that the appropriate procedure be selected in a given patient. A total of 64 patients underwent resection of malignant chest wall tumors at the Tata Memorial Hospital. The technique of preference at our institution for reconstruction of full-thickness chest wall defects uses a combination of autogenous fascia lata and Marlex mesh. We present our experience with chest wall reconstruction following extirpative surgery in these patients.

Fascia Lata↗
PubMed1993

Oestrogen and progesterone receptor estimation by enzyme-immunoassay on tissues removed before and after a modified radical mastectomy.

To investigate the possibility of receptor degradation due to devascularization of the tumour during mastectomy, oestrogen and progesterone receptors (ER and PgR) were measured by an enzyme-immunoassay (EIA) in 59 cases of primary breast cancer on samples taken before and after performing a modified radical mastectomy. Pre- and post-mastectomy samples from the same patient were analysed simultaneously in the same assay run. There was 86.4% and 93.2% agreement respectively in ER and PgR status between samples removed before and after surgery. When actual values were analysed, the post-mastectomy values were higher or lower than pre-mastectomy values with similar frequency. These random variations could be attributed to heterogeneous distribution of receptors within a tumour. The overall correlation between pre- and post-mastectomy values was excellent (ER: r = 0.810, P < 0.001; PgR: r = 0.706, P < 0.001). Devascularization of the tumour during surgery does not seem to affect the integrity of the epitopes recognized by monoclonal antibodies against ER and PgR to any significant extent.

Breast Neoplasms↗
PubMed1992

Postoperative adjuvant chemotherapy for operable esophageal cancer: a pilot clinical study.

Thirty-eight patients with node positive squamous cell carcinoma of the esophagus were entered into a pilot clinical study using postoperative adjuvant chemotherapy (cisplatinum 100 mg/m2 and methotrexate 150 mg/m2 x 4 cycles) with an intent of improving cure rates and overall survival. Patient compliance was excellent and toxicity minimal. At 24 months of follow-up 22 patients (58%) were disease free, while 14 patients (37%) have relapsed and 2 were lost to follow-up. A highly significant correlation was noted between the number of nodes involved, the grade of the tumour, and the response to chemotherapy. Patients with poorly differentiated tumours and those with more than 4 nodes involved were more likely to develop recurrent disease (P less than 0.01 and P less than 0.005). We conclude that postoperative chemotherapy following resection for carcinoma of the esophagus is well tolerated with minimal side effects. It may also have an impact on improving disease free and overall survival.

Adult↗
PubMed1992

Functional results following esophagogastrectomy for carcinoma of the esophagus.

Fifty patients underwent esophagogastrectomy for histologically proven carcinoma of the esophagus from January to December 1989. The Ivor Lewis procedure was performed in 29 patients and 21 resections were performed by a left thoracoabdominal approach. There was one anastomotic leak which could not be salvaged and was responsible for the sole mortality within 30 days of surgery. The hospital stay averaged 12 days, ranging from 8-26 days. Swallowing was resumed by the 6th postoperative day for liquids and 8th day for soft solids. Following surgery, 5 patients developed dysphagia, 4 of whom responded to dilatation. The anastomosis was hand sutured in all cases except one. The suture material used had no relation to the incidence of leak or stricture formation. Eight patients complained of reflux that settled with medical management. Most patients were eating without dysphagia at the last follow-up or death. Esophagogastrectomy can be performed with a low morbidity and mortality and provides adequate palliation of the patient's most distressing symptom, dysphagia.

Adolescent↗
PubMed1992

De novo biosynthesis and localization of immunoreactive inhibin (10.7 kDa) in normal human stomach.

We have previously reported the occurrence of inhibin-like peptide in gastric juice of normal men. In the present investigation, normal gastric mucosa was shown to synthesize inhibin, in vitro, as measured by 3H-leucine incorporation (Maximum at 18 h). Furthermore, the immunohistochemical localization studies demonstrated its presence in the acid secreting parietal cells and basal region of foveolar epithelium of gastric mucosa. Surprisingly, the protein secreting zymogen cells remained unstained.

Culture Techniques↗
PubMed1992

Intrahepatic cholangiocarcinoma: report of a surgically resected case.

We report a middle aged female with intrahepatic cholangiocarcinoma which was resected successfully. Because of an unusual histology, a microscopic diagnosis could not be established pre-operatively. The tumor recurred locally 21 months after surgery. The case is reported mainly for the diagnostic problems it created.

Adenoma, Bile Duct↗
PubMed1991

Medication induced esophageal injury.

Five patients of medication-induced esophageal injury are reported. A history of ingestion of medications preceding the onset of dysphagia was obtained in all patients. Endoscopy revealed localised mucosal ulceration with surrounding edematous mucosa at the level of the aortic arch in four, and in the retro-cardiac esophagus in one patient. The medications involved were sustained release potassium chloride, doxycycline, ibuprofen, and an unidentified antibiotic and antihypertensive (one each). Healing of the esophageal ulcers was confirmed in all the patients by endoscopy.

Adolescent↗
PubMed1989

Observations on Indian node-negative breast cancer patients: a multivariate analysis.

The modern treatment of breast cancer has evolved over the past 100 years based on clinical observations. Therapeutic principles, from the choice of surgical procedure to the management of disseminated disease, have also changed. The axillary tumour burden, that is, the number of histologically positive nodes (N+) plays an important role as a prognostic factor. However, in histologically Negative nodes (N-), it is necessary to discriminate individuals at high risk despite negative nodes. This presentation analyses retrospectively the prognostic factors for long-term failures in N- patients. These prognostic factors need to be studied in detail, and controlled clinical trials should be carried out to detect high risk N- patients and consider them for adjuvant chemotherapy.

Antineoplastic Agents↗
PubMed1989

Current status of surgical treatment of cancer of the esophagus.

Treatment modalities for cancer of the esophagus continue to encourage a healthy debate amongst surgeons, radiotherapists, and chemotherapists. This is because overall results by current treatment methods are generally unsatisfactory, though an all-round steady gain is now being reported by many authors. With increasing sophistication in radiotherapy techniques (external and intracavitary) and more effective combination chemotherapy, it is likely that surgical treatment of this cancer may be reexamined. There is little doubt, however, that despite the advent of radiotherapy and chemotherapy, surgery is still the most important treatment method in providing lasting relief of dysphagia and maximum survival. While increasingly low surgical mortality and a high cure rate are now being reported, the type and extent of surgery are still contentious issues. Alternatives ranging from a very radical excision (monobloc total esophagectomy with mediastinal dissection) to a blunt transhiatal esophagectomy are now being advocated. Radiotherapists and chemotherapists are now investigating the feasibility of a nonsurgical treatment for cancer of the esophagus.

Combined Modality Therapy↗