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Biomedical subjects

P R Kitchen

Publications and source records attributed to P R Kitchen.

15 recordsLinked to original sources
PubMed1994

Changes in the investigation and management of primary operable breast cancer in Victoria.

OBJECTIVES: To investigate the surgical practice and adjuvant therapies used in the treatment of primary operable breast cancer in Victoria in 1990 and compare them with results of a similar study in 1986. DESIGN: All 856 cases of primary operable breast cancer registered by the Victorian Cancer Registry between 1 April and 30 September 1990 were identified. Each patient's surgeon was sent a standard questionnaire covering diagnosis, investigations, operative procedures, adjuvant therapies and reasons for certain management choices. Data were collected on 89% of the patients from 176 participating surgeons. RESULTS: Most patients (82%) were referred to surgeons by general practitioners. Mammographic screening detected 14% of the cancers. The proportion of women receiving breast-conserving operations rose from 22% in 1986 to 42% in 1990. Surgeons operating on more than 20 breast cancers per annum were most likely to perform breast-conserving operations. The most common reasons given for non-conservative operations were the size of the tumour (37%), its central location (25%) and/or patient concern about the risk of recurrence if the breast was to be conserved (22%). Among these patients, reconstruction was done at the time of primary treatment in 13%, subsequently in 2%, and was planned by another 5%. Of all patients, 33% were referred to a radiation oncologist and 24% actually received radiotherapy (similar to 1986). Medical oncologists saw 33% of the patients and 20% of all patients received chemotherapy (similar to 1986), which was given by a medical oncologist in 83% of the cases. Use of endocrine therapy increased from 20% in 1986 to 40% in 1990. CONCLUSIONS: There has been a strong trend towards more conservative breast surgery in Victoria, with surgeons who are most active in breast cancer surgery most likely to perform breast-conserving operations. Apart from a significant increase in the use of endocrine therapy, use of adjuvant therapies was unchanged from 1986.

Adult↗
PubMed1991

Management of sub-areolar abscess and mammary fistula.

Sub-areolar abscess is a form of chronic non-lactational mastitis often presenting in young women at the areolar margin as a recurring discharge or painful infection. Incision and drainage is inadequate and will be followed by recurrence unless the major duct leading from the abscess to the nipple is identified and laid open. Three cases are presented to illustrate this problem and its management.

Abscess↗
PubMed1991

Oestrogen receptor assay of breast cancer by immunocytochemistry of fine needle aspirates.

Sixty-five patients with operable breast cancer were studied to assess the reliability of immunocytochemical analysis of oestrogen receptor (ER-ICA) in specimens obtained by percutaneous fine needle aspiration. Results obtained with the commercially available ER-ICA kit were compared with those obtained by the routine biochemical radioligand assay of oestrogen receptor (ER) on excised tumour specimens. Fifty-two of 65 percutaneous aspirates were evaluable. Of these, thirty-five (67%) were ER positive by the radioligand method. ER-ICA was found to be a reliable method for oestrogen receptor assay, with a high concordance (90.4%) between it and the radioligand essay. The ER-ICA assay had a sensitivity of 89%, specificity of 94%, positive predictive value of 97% and negative predictive value of 80%. ER-ICA assay performed on material obtained by fine-needle aspiration is a reliable method of ER assay. It can replace formal biopsy for patients with inoperable primary tumours or accessible metastases.

Adenocarcinoma, Mucinous↗
PubMed1987

Breast cancer and pregnancy.

Although breast cancer is a rare event in pregnancy, the consequences of a delay in its detection and of late-stage disease are tragic for the young woman who presents in her childbearing years. Therefore, all pregnant women with breast problems should undergo a careful assessment. Pregnancy is not a contraindication to orthodox investigations for breast cancer, provided that special care is taken to reduce the risk to the developing fetus. Management is also orthodox, and breast cancer in pregnant or lactating women is thought to behave no differently from breast cancer in non-pregnant women, when age, stage and histological type are similar. For women who have developed early breast cancer during pregnancy, termination of the pregnancy does not appear to have a beneficial influence on the disease. There is no convincing evidence that a subsequent pregnancy has any effect on the outcome of a breast cancer that has been managed successfully previously. The prevention of subsequent pregnancy is not an indication for a prophylactic oophorectomy. A decision for further pregnancies must be made by the patient and the family after sound advice is given as to the prognosis and consideration of the social, economic and spiritual factors. There is no evidence that the termination of a subsequent pregnancy will affect beneficially or adversely the prognosis of a patient with breast cancer.

Axilla↗
PubMed1984

Effect on immunologic and other indices of adjuvant cytotoxic chemotherapy including melphalan in breast cancer.

Thirty patients with histologically proven node-positive early breast cancer (Stage II) were treated by total mastectomy and axillary clearance and adjuvant chemotherapy regimens including melphalan for 1 year. These patients were studied sequentially, at 3-month intervals, for up to 2 years to assess effects of cytotoxic drugs on immune function, and to determine whether any changes in immune function were related to recurrence. All indices were in the normal range before chemotherapy. The most marked and long-lasting effects of chemotherapy were on numbers of circulating T-cells and B-cells. Mean counts +/- one standard error (X 10(6)/ml) for T-cells before and 12 months after stopping chemotherapy were 1.537 +/- 0.118 and 0.874 +/- 0.120 (P less than 0.01), and for B-cells 0.345 +/- 0.060 and 0.207 +/- 0.030 (P less than 0.01). Functional indices of T-cell and B-cell competence were less compromised than values for cell counts and, in contrast, recovery occurred either during or within 3 months of stopping chemotherapy. This held for both T-cell function measured by delayed-type hypersensitivity (DTH) responsiveness to five recall antigens and mitogenic responsiveness to phytohemagglutinin, and for B-cell function measured by titration of blood group isohemagglutinins. After 4 years the 30 subjects were divided into groups according to whether there was recurrence of cancer (14) or no recurrence (16); the only index predictive of recurrence was depression of DTH to recall antigens. Thus it was found that cytotoxic chemotherapy with melphalan appears to cause long-lasting depression of cell counts but only short-lasting depression of functional indices of immunocompetence, and that levels of immunologic indices during chemotherapy are mostly nonpredictive of recurrence of cancer. The results prompt some caution in the use of adjuvant chemotherapy, at least with melphalan.

Adult↗
PubMed1982

Pilonidal sinus: excision and primary closure with a lateralised wound - the Karydakis operation.

In a personal series, forty-five patients with postanal pilonidal sinus have been treated by the Karydakis operation. The sinus is excised using an eccentric elliptical incision, the medial edge of which is undermined and advanced across the midline to produce a lateral vertical scar and shallower natal cleft. Forty patients were followed up for an average of thirty-three months. There were two wound haematomata, four wound infections and two recurrences, one of which was not in the scar. A low recurrence rate can be achieved by flattening the natal cleft and closing the skin away from the midline.

Follow-Up Studies↗
PubMed1981

Pilonidal surgery.

Explore the source record for details and available documents.

Follow-Up Studies↗
PubMed1980

Node-positive breast cancer: a comparison of clinical and pathological findings and assessment of axillary clearance.

The Breast Adjuvant Chemotherapy Study of the Anti-Cancer Council of Victoria was set up to encourage the cooperation of clinicians from many centres who are involved in the management of early node-positive breast cancer in Victoria. Data sheets were completed by participants, and an analysis was made of the first 100 registered patients to determine the reliability of clinical assessment related to pathological findings and to study the extent of axillary node clearance. Although all subjects were histologically node positive, 47 had no palpable axillary lymph nodes, and in only 38 were nodes considered to be clinically involved. Correlation between clinical and pathological measurements of breast tumour size was significantly better (86%) with tumours over 5 cm in extent than with tumours of 5 cm or less (70%). Total mastectomy with total axillary clearance was the most common operative procedure performed. The pectoralis major was preserved in 97 and the pectoralis minor was divided or removed in 71 cases as part of the axillary clearance. In a subgroup (33) the location of involved nodes in the axilla was studied, and of these seven (21%) were found to have involved upper axillary nodes in the absence of lower axillary nodal involvement, emphasizing the inadequacy of axillary sampling in determining nodal status.

Axilla↗
PubMed1977

Radionuclide pancreatic scanning: a retrospective analysis.

Records of 346 patients were studied to determine the reliability and diagnostic value of pancreatic scanning. In 157 the pancreatic diagnosis was established subsequent to scanning. The scan was abnormal in 28 of 34 patients (82%) with pancreatic neoplasm, and in 21 of 26 patients (81%) with chronic pancreatitis. Of 71 with normal scans, 56 (79%) had a normal pancreas, and 15 had pancreatic disease (a false negative rate of 21%). Of the 86 with abnormal scans, the pancreas was diseased in 56 (65%), and of the others, 14 had extrapancreatic conditions known to be associated with a high incidence of scan abnormalities. In obstructive jaundice all 21 patients with pancreatic carcinoma had abnormal scans (and the scan accurately diagnosed all four cases of bile duct carcinoma). A normal scan reliably indicated that the cause of jaundice was outside the pancreas. In chronic abdominal pain an abnormal scan was unreliable, but a normal scan excluded pancreatic disease with reasonable accuracy.

Cholestasis↗