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L S Chagla

Publications and source records attributed to L S Chagla.

5 recordsLinked to original sources
PubMed2005

Tumour localisation with a metal coil before the administration of neo-adjuvant chemotherapy.

Complete clinical response (CR) with tumour disappearance is not uncommon after neo-adjuvant chemotherapy (NAC) for locally advanced breast cancer, avoiding 25% mastectomies by facilitating breast-conserving procedures. We reviewed our series to understand the feasibility and utility of marking the cancer site before administering NAC. In total, 23 women (median age 47 years) with T2-4, N0-1, M0 tumours were considered unsuitable for breast conserving surgery between January 2002 and November 2003, thus received NAC following a coil placement at the core of tumour. All patients had the coil successfully inserted and no migration or infection was recorded. Eight patients (35%) had a radiological CR (rCR) including 3 (13%) with pathological CR (pCR). In total, 87% patients were managed conservatively. The insertion of a metal coil is a simple mean to provide a landmark for localisation and excision when the breast lump becomes impalpable and radiologically undetectable after the administration of NAC.

Adult↗
PubMed2005

Occult breast lesions: A comparison between radioguided occult lesion localisation (ROLL) vs. wire-guided lumpectomy (WGL).

Mammographic screening increases the number of impalpable breast cancers requiring surgical excision. It is important to optimise the localisation technique to remove the smallest amount of tissue, still adequately excising the lesion. The last 65 wire-guided lumpectomies (WGLs) were compared vs. the first 65 radioguided occult lesion localisations (ROLLs) performed for impalpable breast cancers. Data collection included patient's age, radiological abnormality, pre-operative core biopsy, type of primary surgery, length of localisation and excision, hospital stay, cancer size, weight and volume of the excised specimen, clearance margins. All patients were successfully localised with ROLL and WGL. Localisation time was reduced with ROLL (P<0.001). Clear margins were achieved in 83% ROLLs and 57% WGLs (P=0.001). Pathological cancer size and specimen weight were similar in both groups, although the specimen volume was slightly smaller for ROLL. A total of 74% ROLLs had excellent cosmetic outcomes and 26% good, vs. 55% excellent and 45% good in WGLs. A larger amount of normal breast tissue was excised with WGL, without achieving any better cancer clearance. ROLL provides a feasible alternative to WGL. This quick and simple technique achieves an improved rate of clear margins.

Adult↗
PubMed2005

Radio-guided localization of clinically occult breast lesions (ROLL): a DGH experience.

AIM: Wire-guided localization (WGL) of clinically occult breast lesions is a well established technique. The aim of this study was to evaluate radio-guided localization (ROLL) within the breast screening service of a district general hospital. METHOD: The study group comprised 70 women who underwent ROLL under US and stereotaxis. This required an injection of Technetium-labelled colloidal albumen into the impalpable breast lesion. The women then proceeded to theatre, where localization was achieved with the use of a gamma probe. The lesion was identified by the presence of a high signal, caused by the injected isotope. The results of 70 consecutive cases in which a breast lesion was localized using ROLL were compared with the results of the latest 70 WGLs. RESULTS: All 140 lesions were successfully localized. However, the change in technique from WGL to ROLL offered significant benefits to patients. CONCLUSION: Our study demonstrated that ROLL is a practical and reliable localization technique. It can be implemented in hospital units without using valuable gamma camera time. The cost compares well with WGL. There is an improved cosmetic outcome for patients, and the very small quantity of radioactivity used is safe for both patients and staff.

Adult↗
PubMed2003

Management of gallstone disease in the elderly.

AIM: To determine the outcome of management of symptomatic gallstone disease (GSD) in patients aged 80 years or more. PATIENTS AND METHODS: A retrospective review of the outcome of 79 patients admitted to 2 district general hospitals with symptomatic GSD over a 1-year period was undertaken. Patients were grouped according to method of management: non-operative, ERCP, and cholecystectomy. POSSUM scores for the ERCP and cholecystectomy groups were calculated and observed, and predicted outcome compared. RESULTS: Obstructive jaundice and biliary colic were the most common presenting symptoms. Each patient had been admitted at least once before the study period (median, 2; range, 1-3). Outcomes are detailed in Table 1. Non-operative management failed in 18 of 23 patients, with 17.4% mortality. ERCP was successful in 40 of 47 patients with 3 complications (0.24 of predicted) and no mortality. In all, 11 laparoscopic and 12 open cholecystectomies were performed with 6 complications and 1 mortality (0.95 and 0.83 of predicted, respectively): 4 complications and the only death occurring after emergency cholecystectomy. Table 1 Outcomes Management Number Mortality Morbidity Outcome Non-operative 23 4 9 5 OK, 13 re-admitted, 4 still symptomatic ERCP 47 0 3 1 PTC, 6 operated Operative 23 1 6 CONCLUSIONS: This study suggests that recurrent GSD in elderly patients managed non-operatively may have fatal outcome. Elective cholecystectomy has acceptable morbidity and mortality in this age group and there is often ample opportunity to avoid emergency surgery, but a prospective randomised study is required to improve clinical algorithms.

Aged↗