Stereotaxic localisation and aspiration cytology of impalpable breast lesions.

As part of a programme of assessment of the 'Sterotix' localisation device, aspiration cytology was carried out on 50 patients with 52 impalpable, mammographically detected breast lesions using the stereotaxic guidance device. This was followed by an open localisation biopsy of the area for confirmation. In 12 patients (23%) the aspirations failed to yield sufficient material for diagnosis.

Effects of long-term testosterone exposure on ovarian function and morphology in the rhesus monkey.

This study was aimed at developing a model in the rhesus monkey for the human gynecologic disorder termed the polycystic ovary syndrome (PCOS). The effects of chronic constant androgen exposure upon quantitative ovarian morphology and ovulatory function were examined. Twenty-five normally cycling females, aged 4-12 yr and weighing 3.

Gastric carcinoma in young adults.

Of 720 patients with gastric carcinoma treated over a 6-year period, 37 (5%) were 35 years of age or younger. They differed from older patients in that the usual sex ratio was altered (18 men: 19 women), and in certain histologic features. Poorly differentiated or undifferentiated lesions predominated (34 patients), and the distribution of histologic types was unusual; two thirds each were of the diffuse type (Lauren classification) or signet ring type (World Health Organization classification), and over three quarters were infiltrative (Ming classification).

Lack of an association between carcinoma of the stomach and the major histocompatibility complex (HLA) in Cape Coloureds.

A possible genetic contribution to the high incidence of gastric carcinoma in the Cape Coloured population of the Western Cape region of South Africa was investigated. The HLA-A, B, C, DR and DQ antigens were determined with a microcytotoxicity assay, and their frequencies compared in 124 individuals with gastric carcinoma and 4,560 controls. No significant difference was found, thus supporting the view that a genetic component has a minor, if any, role in gastric carcinogenesis.

Randomized comparison of R1 and R2 gastrectomy for gastric carcinoma.

The contention that the R2 radical gastrectomy for localized and potentially curable gastric carcinoma may be superior to gastrectomy without lymphadenectomy (R1) was assessed by randomized trial. Five years after commencement 403 patients have been evaluated at surgery and only 43 (11 per cent) found eligible (S0-2, P0, H0, N0-1), 22 of whom underwent R1 and 21 R2 gastrectomy. Seven patients had final histological stages in excess of the protocol.

Immunoproliferative small-intestinal disease: clinical features and outcome in 30 cases.

Experience with 30 patients with immunoproliferative small intestinal disease followed prospectively between 1971 and 1986 is described. All presented with malabsorption or growth retardation and had similar clinical, biochemical, and radiological features, irrespective of the presence of lymphoma or immunological abnormality. Alpha-chain disease protein was detected in 4 of the 11 patients who had a non-lymphomatous, predominantly plasmacytic infiltration of the small bowel; and in 5 of the 19 cases with diffuse intestinal lymphoma.

Fine-needle aspiration biopsy cytology of the breast. A review of the Groote Schuur Hospital experience.

The results of the first 1,500 cytological diagnoses of fine-needle breast aspirates performed at Groote Schuur Hospital Breast Clinic are compared with the histological diagnoses of Tru-cut and excision biopsies of the same lesions. A cytological diagnosis of malignant disease was made in 358 cases, 349 of which were confirmed histologically. The 10 false-positive and 1 false-negative diagnoses are discussed.

Case for conservative management of selected fibro-adenomas of the breast.

To assess the safety of a conservative approach to fibro-adenoma of the breast we prospectively studied 321 women with this clinical diagnosis, and performed aspiration cytology and excision biopsy. There was histological confirmation of fibro-adenoma in 217 (68 per cent), the remainder having various benign conditions and 4 (1.3 per cent) had carcinoma.

The incidence and causes of hypercalcaemia.

A prospective screen for hypercalcaemia in 58,053 hospital in-patients was conducted over 12 months. The incidence of hypercalcaemia was 0.6%, being transient in 19.

Gastric cancer. Some aspects of epidemiology, risk factors, treatment and survival.

Gastric cancer mortality has fallen sharply in many Western populations, yet world-wide it probably remains the single commonest cancer. A diet rich in salted or smoked food and low in vitamin C contributes to its pathogenesis, while the environmental type of atrophic gastritis and intestinal metaplasia are consistently associated and may represent precursors of malignant change. Better food preservation may have a protective effect.

Sensitivity of endoscopic detection of malignancy in resectable gastric carcinoma.

In 50 consecutive cases of resected gastric carcinoma the absolute sensitivity in making an unequivocal pre-operative diagnosis was 54% for endoscopic inspection, 76% for biopsy and 48% for cytology. Inspection and biopsy in combination yielded 90% and adding cytology achieved 92% absolute sensitivity. The relative sensitivity (which included equivocal reports) was far higher for each individual test, and 100% for the combination of all three, but did not reflect the clinical value of these investigations as clinicians did not react appropriately to equivocal reports.

Surgical staging of gastric carcinoma: sources and consequences of error.

Macroscopic 'TNM' staging was performed during 78 consecutive operations for gastric carcinoma and compared with subsequent pathological staging. Surgical assessment was correct for tumour (T) in 60 per cent when depth of invasion was assessed, for nodes (N) in 61 per cent, for liver metastases (M) in 92 per cent but for all aspects in only 21 per cent. Curability (conservatively defined as T1-3, N0-1, M0) was correct in 8 of 18 patients thus assessed at surgery and incurability was pathologically correct in 58 of 60 patients.

Gastric carcinoma--a current clinical profile.

During 1983, 128 patients with gastric carcinoma presented to Groote Schuur Hospital, 71% of them were from the coloured racial group. The commonest symptoms were dyspepsia or pain (88%), and the average delay in presentation was 3 months. Barium meal, endoscopy, biopsy, and cytology were not completely sensitive in making the diagnosis.

Choledochopancreatoduodenal fistula caused by duodenal ulceration. A case report.

A penetrating duodenal ulcer may occasionally erode into the common bile duct and form a choledochoduodenal fistula. Such a fistula occurring simultaneously with a pancreatic duodenal fistula is reported. The presenting features of these fistulas are those of the ulcer and confirmation of the fistula may be difficult, although use of endoscopic retrograde cholangiopancreatography has greatly facilitated their diagnosis.

Factors influencing prognosis in carcinoma of the stomach.

Prognostic factors were prospectively sought in a consecutive group of 223 patients with carcinoma of the stomach observed for a minimum of seven years. Age, race and mode of presentation did not influence survival time. Statistically improved seven year survival rates were observed in females (p less than 0.

Results of treatment in immune thrombocytopenia.

One hundred and forty-eight adults with immune thrombocytopenia attending a single institution between 1971 and 1981 were analysed retrospectively and observed for a minimum of three years. Prednisone was administered to 134 patients (90 per cent) in whom a peak platelet count occurred at a median of eight days, at which time four distinct patterns of response became evident: 20 patients (15 per cent) achieved complete remission with platelet counts greater than 200 X 10(9)/I, and of these 13 relapsed; 46 (34 per cent) had incomplete remission with platelet counts between 100 and 200 X 10(9)/I, and of these 38 relapsed; 22 (17 per cent) had a partial remission with platelet counts between 50 and 100 X 10(9)/I, and 14 have relapsed; the remaining 46 (34 per cent) failed to respond to prednisone. The addition of cytotoxic drugs for patients who relapsed or failed to respond to this agent was uniformly ineffective with the spleen in situ.

For how long can the liver tolerate ischaemia?

In this study the ability of the normal liver to tolerate normothermic ischaemia was assessed. The survival rate in pigs after 3, 6 and 12 h of normothermic hepatic ischaemia was 71, 46 and 0%, respectively. A patient who survived after inadvertently being subjected to 90 min of normothermic hepatic ischaemia is also presented.