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Biomedical subjects

N Beechey-Newman

Publications and source records attributed to N Beechey-Newman.

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↗
PubMed2005

Gigantomastia: A problem of local recurrence.

Gigantomastia by definition means bilateral benign progressive breast enlargement to a degree that requires breast reduction surgery to remove more than 1800 g of tissue on each side. It is seen at puberty or during pregnancy. The etiology for this condition is still not clear, but surgery remains the mainstay of treatment. We present a unique case of Gigantomastia, which was neither related to puberty nor pregnancy and has undergone three operations so far for recurrence.

Adult↗
PubMed2002

Gigantomastia unrelated to pregnancy or puberty: a case report.

Idiopathic gigantomastia occurs during puberty and pregnancy but a spontaneous case has not been reported in the literature. An unusual case is described, which required urgent bilateral mastectomy to control systemic sepsis and extreme discomfort.

Journal Article↗
PubMed2002

10. Sentinel node biopsy in primary breast cancer.

Sentinel node biopsy is a minimally invasive but accurate way of staging the axilla such that as many as 50% of women with primary breast cancer could avoid axillary clearance and the morbidity this carries with it. The methodology has yet to be perfected but identification of the sentinel node(s) with either dye or isotope, or with a combination of these, is a robust technique that is quick to learn and correctly predicts the status of the rest of the axilla in significantly more than 90% of patients. Improvements in the methodology and in patient selection will inevitably make sentinel node biopsy even more accurate. Studies to demonstrate the survival impact of replacing axillary clearance with sentinel node biopsy and selective axillary node treatment are required and are in their early stages.

Breast Neoplasms↗
PubMed1996

Activation of human granulocyte type 1-prophospholipase A2.

Using an assay for measurement of released type 1-prophospholipase A2 (type 1-proPLA2) propeptides (PROP assay), we have shown that human granulocytes, but not lymphocytes or macrophages, abundantly express this 'pancreatic' type 1-proPLA2 zymogen. Stimulation with tumour necrosis factor-alpha (TNF-alpha) and other cytokines results in the immediate release from granulocytes of a mixture of free propeptides and type 1-proPLA2 precursor. We also found that granulocytes contain an approximately 29 kDa trypsin-like endogenous type 1-proPLA2 activator. PROP assay and TAP (trypsinogen activation peptide) assay of plasma samples accurately predicts the segregation of acute pancreatitis into three clearly defined categories of severity--mild, intermediate and severe--at the time of first hospital admission and over the next few hours of observation. Mild and intermediate pancreatitis are associated with a degree of granulocyte stimulation limited to the release of the unactivated type 1-proPLA2 precursor. Progression to severe disease is accompanied by the activation of granulocyte type 1-proPLA2, apparently carried to completion. This identifies the approximately 29 kDa endogenous activator of type 1-proPLA2 in granulocytes as a critical mediator at a threshold stage in acute pancreatitis, which marks the transition from uncomplicated pancreatitis to the potentially lethal disease. Specific inhibitors of this key regulatory enzyme modelled on the P3-P1 domain of the type 1-proPLA2 activation peptide would seem to be promising candidates for a new class of chemotherapeutic agents.

Enzyme Activation↗
PubMed1995

Cholecystokinin-8 induces edematous pancreatitis in dogs associated with short burst of trypsinogen activation.

To study the early pathogenesis of acute edematous pancreatitis in dogs, we examined the relationship of pancreatic hyperstimulation with cholecystokinin-8 (10 micrograms/kg/hr intravenously for 6 hr) to alterations in circulating pancreatic enzymes and pancreatic morphology with special reference to trypsinogen activation. Cholecystokinin-8 infusion was associated with increases in plasma amylase, lipase, trypsin-like immunoreactivity, and plasma and urine trypsinogen activation peptide. Pancreatic parenchymal swelling and interlobular and subcapsular fluid accumulations were detected ultrasonographically within 2 hr of cholecystokinin-8. Circulating trypsin-like immunoreactivity and trypsinogen activation peptide in urine reached a peak at 2 and 4 hr, respectively, then declined despite progressive increases in circulating amylase and lipase and intrapancreatic fluid. No significant changes were observed in dogs receiving a saline infusion. This study illustrates that cholecystokinin-8 induces edematous pancreatitis in dogs that is associated with a short-lived burst of trypsinogen activation.

Acute Disease↗
PubMed1995

Type 1-prophospholipase A2 propeptide immunoreactivity is released from activated granulocytes.

OBJECTIVE: To establish a ELISA assay to measure release of type 1-phospholipase A2 propeptide from activated granulocytes. Human type 1-prophospholipase A2 (1-proPLA2) is biosynthesized and stored as inactive zymogen. Activation involves tryptic-like cleavage at the N-terminus, with equimolar release of the heptapeptide DSGISPR. METHODS: Using antibodies directed to the carboxyterminus of synthetic DSGISPR we developed a sensitive solid-phase ELISA specific for the released propeptide that accurately reports the activation of 1-proPLA2. The presence of the 1-proPLA2 precursor itself can be determined by trypsinization of the sample and subsequent assay for free DSGISPR. RESULTS: Using this ELISA, we demonstrated the presence of immunoreactive DSGISPR and its 14 kDa 1-proPLA2-like precursor in human granulocytes, but their absence in human macrophages and lymphocytes. Stimulation of cultured granulocytes with 1 pM of TNF alpha or GM-CSF caused rapid release of DSGISPR and precursor into the surrounding medium. The immunoreactive signal coeluted with standard synthetic DSGISPR on G50 Sephadex chromatography. CONCLUSION: Release of DSGISPR immunoreactivity appears to be a specific consequence of granulocyte activation of potential relevance to the clinical pathophysiology of conditions like acute lung injury.

Amino Acid Sequence↗
PubMed1994

Type 1 prophospholipase A2 propeptide in acute lung injury.

Neutrophil sequestration and activation in the pulmonary vasculature and interstitium are important in acute lung injury. Phospholipase A2 plays an important part in the production of potent inflammatory mediators in this syndrome. We used our ELISA for type 1 prophospholipase A2 activation peptides, which have the aminoacid sequence Asp-Ser-Gly-Ile-Ser-Pro-Arg (DSGISPR), to show that DSGISPR concentrations in plasma and urine are a sensitive and specific marker of acute lung injury in patients admitted to intensive care. The detection of DSGISPR in the plasma of 11 of 50 unselected patients had a sensitivity of 100% and a specificity of 93% for the presence or future development of acute lung injury.

Amino Acid Sequence↗
PubMed1993

Controlled trial of high-dose octreotide in treatment of acute pancreatitis. Evidence of improvement in disease severity.

Nineteen consecutive patients with acute pancreatitis were sequentially allocated to treatment with high-dose octreotide (N = 9) or to act as controls (N = 10). All other aspects of treatment were similar and were according to a strict treatment protocol. There was no significant difference between the two groups on admission with regard to recognized criteria of poor prognosis. The octreotide-treated group required significantly less analgesia and after 48 hr developed significantly fewer poor prognostic indicators, including falls in hematocrit of > 10%, in serum albumin to < 32 g/liter, and in serum calcium to < 2.00 mmol/liter. Falls in arterial PO2 to < 10 kPa, in serum albumin of > 20%, and in hemoglobin of > 2 g/dl were also significantly less frequent. There was a trend towards improvement in the octreotide-treated group in every other physiological and radiological indicator of disease severity. High-dose octreotide may reduce the severity of acute pancreatitis.

Acute Disease↗
PubMed1991

A case of candidal umbilical granuloma.

A case is reported of a 14-year-old boy with a mass arising from the umbilicus, which was a large, well-organized candidal granuloma. Cell markers showed normal numbers and distribution of peripheral T and B lymphocytes but there was no reaction to intradermal injection of Candida, suggesting a specific T-cell defect such as occurs in chronic mucocutaneous candidiasis.

Adolescent↗
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↗