Biomedical subjects

Mandar S Nadkarni

Publications and source records attributed to Mandar S Nadkarni.

5 recordsLinked to original sources

PubMed2006

Interpectoral approach to dissection of the axillary apex: an elegant and effective approach.

BACKGROUND: Axillary dissection is the gold standard for treatment of the axilla. It provides important prognostic information, accurately stages the axilla, and has the lowest recurrence rate among all modalities. In today's age of conservation surgery, the axilla is often addressed through a cosmetically acceptable small incision with limited access, thereby making clearance of the level III nodes difficult. METHODS: We describe a method of apical lymph node dissection through the interpectoral plane, which effectively clears the apex despite the constraints of limited exposure. RESULTS: This method has been used in nearly 5,000 axillary dissections performed at our institute, with excellent results. It preserves the innervation of the pectoral muscles and affords access to the interpectoral nodes. CONCLUSIONS: Our method has a short learning curve, provides good exposure of a difficult area and consistently provides a good yield of nodes.

Axilla↗

PubMed2006

Breast conservation surgery without pre-operative mammography--a definite feasibility.

Mammography is mandatory before breast conservation. Its limited availability in developing countries has discouraged surgeons in rural areas from practicing breast conservation. We analyzed the database of breast surgeries at our institute to investigate whether breast conservation could be safely performed if clinically feasible without the use of mammography. If mammography had not been performed in the 735 patients undergoing surgery, breast conservation could have been erroneously performed in 38 (5.17%) patients; 13 had impalpable mammographic multicentricity and 25 had extensive microcalcifications. A detailed analysis showed that this error in decision would have been detected and rectified in each of the above patients before commencement of radiotherapy. We conclude that although mammography cannot be totally excluded from the treatment algorithm for palpable breast cancer, conservative surgery can be offered in clinically suitable cases even if pre-operative mammography is not available due to limited resources in the developing world.

Breast Neoplasms↗

PubMed2006

Medial pectoral pedicle: a critical landmark in axillary dissection.

Surgery for breast cancer has evolved over the last century and has gone from limited to radical, extended radical and back to conservative surgery. Along this journey, one constant feature has been the necessity for a complete axillary dissection. In recent times, this concept has also been successfully challenged and now we are in an era of conservative or limited surgery in the axilla as well. These surgical procedures such as four-node axillary sampling or the technology-driven sentinel node biopsy are conservative axillary procedures and are often performed through very small incisions. With limited access to the surgical field, there is always an increased chance of inadvertent and unnecessary injury to surrounding vital anatomical structures such as nerves or blood vessels. A well-designed road map can definitely prevent such mishaps. This paper describes a simple technique of axillary surgery, which is step-wise and makes use of a relatively constant landmark, namely the medial pectoral pedicle, present within the axilla. Such a regimented systematic approach not only allows us to minimize the risks of complications during axillary surgery, but also enables us to train beginners easily and efficiently.

Axilla↗

PubMed2005

Pediatric thyroid cancer.

BACKGROUND AND OBJECTIVE: The treatment of pediatric thyroid cancer evokes considerable controversy. The extent of surgery and role of postoperative radioactive iodine are not clearly defined. We analyzed the behavior of pediatric thyroid cancers and its management. METHODS: Eighty-three patients, from 1964-2000, were identified by a search of our database. The clinical course of 26 patients was not evaluated because of inadequate follow-up and the remaining 57 patients were included in the final survival analysis. These 26 patients were included for analyses of epidemiological data. RESULTS: There were 27 males and 56 females. Cervical lymphadenopathy was a common presentation (57.8%). The predominant histology was papillary carcinoma (57%). Sixteen patients (19.2%) had pulmonary metastases at presentation. Patients with cervical nodes had a significantly higher incidence of pulmonary metastasis compared to those who presented with thyroid nodule (P = 0.037). Five patients (31.2%) with pulmonary metastases had a negative chest X-ray and were detected only on the radioiodine scan. At median follow-up of 64 months, all 57 patients were alive, 10 with disease and 47 disease free. CONCLUSION: Despite its advanced stage at presentation, pediatric thyroid cancer is associated with an excellent prognosis. We advocate total thyroidectomy and radioactive iodine as the best management option as the incidence of pulmonary metastases is high.

Adolescent↗

PubMedDate not supplied

Hepatic resection for metastasis from adenoid cystic carcinoma of parotid gland.

Adenoid cystic carcinoma is the commonest malignant tumor of the submandibular and minor salivary glands; the parotid gland constitutes a small share of this neoplasm. We present a 30-year-old woman with solitary liver metastasis from an adenoid cystic carcinoma of the parotid gland, which had been surgically treated 10 years ago. The patient underwent successful resection of this metastasis.

Adult↗