Background: The goal of this study was to challenge the hypothesis that local recurrence of breast cancer does not affect survival rates, by determining whether survival rates differ for conservative and radical surgical policies.Methods: This study used prospective long-term follow-up monitoring of two contemporaneous groups of patients, within a single unit, who were treated identically except for the one variable of local treatment policy, i.e., conservative or radical. A total of 451 patients with operable breast cancer were chosen from 567 consecutive patients with breast cancer who were treated between 1970 and 1979 in the University Department of Surgery. The rate of survival 132 months after treatment was used as an outcome measure.Results: Two hundred forty-one patients were treated using a conservative approach and 210 were treated using a radical approach. At 132 months, the survival rate (58% vs. 42%) and median survival time (>132 vs. 100 months) were significantly improved for the radically treated group (P < .01). The treatment groups were comparable in terms of age, menopausal status, tumor size, histologic grading, and Nottingham Prognostic Index values. The advantage of the radical policy persisted when examined in relation to each of these prognostic factors.Conclusions: Use of radical local treatment yielded a highly significant survival benefit (comparable to that obtained with adjuvant therapy), compared with a conservative approach. This was related to a reduced locoregional recurrence rate and provides evidence that local therapy influences long-term outcomes for patients with breast cancer. High-quality locoregional control should be emphasized, as is systemic therapy, in management policies. Assessment of surgical techniques, particularly in relation to locoregional recurrence rates, should be included in all studies in which surgery is a component of therapy.

A case of extensive squamous cell carcinoma arising in widespread perianal and inguinal hidradenitis suppurativa is used to illustrate the pathological features which influence management. The surgical pathology, with wide extension along subcutaneous sinuses, frequently leads to the view that it is incurable. A planned surgical approach, using both immediate frozen section and delayed paraffin histology to assess clearance margins allowed complete surgical excision in two stages. Colostomy is not a necessary part of management and healing by granulation is an acceptable alternative to extensive reconstruction procedures. Radiotherapy and chemotherapy, sometimes used in palliation mode, are not likely to be beneficial.

PURPOSE: Parastomal pyoderma gangrenosum is uncommon and its association with inflammatory bowel disease is unclear. This is a review of five patients with parastomal pyoderma gangrenosum. METHODS: A retrospective review of five patients with ulcerative colitis (two patients) or Crohn's disease (three patients) who have been seen in one surgical unit was conducted. RESULTS: All patients were females and each presented within nine months of abdominal surgery and stoma construction. All had active proctitis (n=3) or perianal Crohn's disease (n=2). Both patients with perianal Crohn's disease had a mild clinical course with healing of parastomal pyoderma gangrenosum when treated with steroids with and without low-dose cyclosporin A. They both had curettage of the perineal wound as well. In the remaining three patients with active proctitis, the parastomal lesions failed to resolve despite high-dose systemic steroids. By contrast, the parastomal pyoderma gangrenosum healed promptly in two of these patients following proctectomy for active proctitis. CONCLUSION: The variable clinical outcome of parastomal pyoderma gangrenosum may be related to the activity of the underlying inflammatory bowel disease or possibly to low-grade perineal sepsis.

Journal of Surgical OncologyVolume 56, Issue 3 p. 185-185 Letter to the Editor Immunohistochemical detection of metallothionein expression and its correlation with ras activation in melanoma Dr. V. K. Shukla MCh, Corresponding Author Dr. V. K. Shukla MCh University Department of Surgery, University of Wales College of Medicine, Heath Park, Cardiff, UKDepartment of Surgery, Institute of Medical Sciences, Banaras Hindu University, Varanasi 221 005, IndiaSearch for more papers by this authorP. Laidler FRCP, P. Laidler FRCP Department of Pathology, University of Wales College of Medicine, Heath Park, Cardiff, UKSearch for more papers by this authorK. Horgan MCh, K. Horgan MCh University Department of Surgery, University of Wales College of Medicine, Heath Park, Cardiff, UKSearch for more papers by this authorL. E. Hughes DS, L. E. Hughes DS University Department of Surgery, University of Wales College of Medicine, Heath Park, Cardiff, UKSearch for more papers by this authorR. A. Padua PhD, R. A. Padua PhD Department of Haematology, University of Wales College of Medicine, Heath Park, Cardiff, UKSearch for more papers by this authorB. Jasani PhD, B. Jasani PhD Department of Pathology, University of Wales College of Medicine, Heath Park, Cardiff, UKSearch for more papers by this author Dr. V. K. Shukla MCh, Corresponding Author Dr. V. K. Shukla MCh University Department of Surgery, University of Wales College of Medicine, Heath Park, Cardiff, UKDepartment of Surgery, Institute of Medical Sciences, Banaras Hindu University, Varanasi 221 005, IndiaSearch for more papers by this authorP. Laidler FRCP, P. Laidler FRCP Department of Pathology, University of Wales College of Medicine, Heath Park, Cardiff, UKSearch for more papers by this authorK. Horgan MCh, K. Horgan MCh University Department of Surgery, University of Wales College of Medicine, Heath Park, Cardiff, UKSearch for more papers by this authorL. E. Hughes DS, L. E. Hughes DS University Department of Surgery, University of Wales College of Medicine, Heath Park, Cardiff, UKSearch for more papers by this authorR. A. Padua PhD, R. A. Padua PhD Department of Haematology, University of Wales College of Medicine, Heath Park, Cardiff, UKSearch for more papers by this authorB. Jasani PhD, B. Jasani PhD Department of Pathology, University of Wales College of Medicine, Heath Park, Cardiff, UKSearch for more papers by this author First published: July 1994 https://doi.org/10.1002/jso.2930560312Citations: 1AboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onEmailFacebookTwitterLinkedInRedditWechat No abstract is available for this article. References 1 Zegler B, Schir M, Hittmair A, et al.: Metallothionein overexpression in melanoma–A factor of prognostic value. Arch Dermatol Res 284: 56, 1992. 2 Schmidt CJ, Hamer DH: Cell specificity and an effect of ras on human metallothionein gene expression. Proc Natl Acad Sci USA 83: 3346–3350, 1986. 3 Shukla VK, Hughes DC, Hughes LE, et al.: ras mutations in human melanocytic lesions. K-ras activation is a frequent and early event in melanoma development. Oncogene Res 5: 121–127, 1989. 4 Jasani B, Elmes ME: Immunohistochemical detection of metallothionein. Methods Enzymol 205: 95–107, 1991. Citing Literature Volume56, Issue3July 1994Pages 185-185 ReferencesRelatedInformation

A prospective case-control study of 81 patients has been carried out over 10 years comparing mastectomy with immediate reconstruction to mastectomy alone. The patients were matched for age (within 5 years), TNM stage, pathologic nodal status and operative procedure. After complete 10-year follow-up we have failed to demonstrate any long term difference in tumour behaviour. We conclude that immediate reconstruction is widely applicable and technically feasible without any long term effect on the development of local recurrence or metastatic disease.

Plastic and reconstructive surgery of the breast, R. B. Noone (ed.). 284 × 220 mm. Pp. 533. Illustrated. 1991. USA: B. C. Decker Plastic and Reconstructive Surgery of the Breast, Noone R B (ed.). 284 × 220 mm. Pp. 533. Illustrated. 1991. USA: B. C. Decker. L E Hughes L E Hughes University of Wales College of Medicine, Cardiff CF4 4XN, UK Search for other works by this author on: Oxford Academic Google Scholar British Journal of Surgery, Volume 80, Issue 2, February 1993, Page 266, https://doi.org/10.1002/bjs.1800800264 Published: 08 December 2005

One-hundred-and-twenty-two rectus abdominis myocutaneous flaps used for reconstruction, post mastectomy (106) and after salvage surgery (16), were reviewed. The minimum period of follow up was 24 months. Simple vertical flaps were raised in 88 patients; in addition seven Drevers, four trans-umbilical, 19 lower transverse and four combined (vertical and transverse flaps) were raised. Early complications (within 2 weeks of surgery) were seen in 30% (37/122) patients. Late complications occurred in 5% of patients (6/122) and 8% had both early and late complications. Flap necrosis was seen in 25% (21/122) of patients. This comprised complete flap loss in two patients. Partial skin and fat necrosis was observed in 14 patients and partial skin loss only in 15. In the group with simple vertical flaps the incidence of partial flap necrosis was 12.5%. Late complications included incisional hernia in 5% of patients. Reoperation for complications were required in 18% of patients. We conclude that while minor morbidity is common with rectus flaps, major complications are few. The more important considerations relate to cigarette smoking and overuse of the peripheral segment of the transverse rectus abdominis flap. While the transverse flaps have now largely replaced other breast flaps, in our practice vertical and higher transverse flaps were useful alternatives. Lessons learned during the development of these flaps have led to greatly improved results in the latter part of the series and it is regarded as a versatile and useful flap in this situation.

An assessment by staff and patients of two cavity wound dressings in the treatment of surgical granulating cavity wounds

The late Emmanuel Lee, a Consultant Surgeon in Oxford, originally proposed the setting up of a Working Party to rationalise nomenclature of benign breast disorders. Groups in Southampton, Oxford and Cardiff established a joint project and invited interested individuals from the UK, Europe, USA and South Africa and an international multi-disciplinary group was formed in 1987. The major aim of the group was to rationalise terminology, particularly eliminating many of the terms used in the past (such as fibroadenosis and fibrocystic disease) which imply histological abnormalities, some of which are now recognised as normal. At the same time, the group wished to emphasise that benign breast disorders include a number of conditions associated with clinical symptoms that may be distressing, and a range of pathological findings whose relevance and significance require clarification.

This study is concerned with acute surgical granulating wounds such as those which follow excision of hidradenitis suppurativa. The Wound Healing Research Unit, Cardiff, frequently assesses the effect of new dressing materials on such wounds. The aim was to establish the normal histological findings during healing in these wounds before examining the effects of active agents on them. No detailed information has been found in the literature on histological findings in non-experimental human wounds.

Mastalgia commonly presents to medical practitioners. The majority of patients can be managed by exclusion of cancer and reassurance. In some the severity of pain affects the quality of life and drug treatment should be considered. Since its inception 324 patients with cyclical mastalgia and 90 with non-cyclical mastalgia have received a therapeutic trial of drug treatment in the Cardiff Mastalgia Clinic. Overall 92% of those with cyclical mastalgia and 64% with non-cyclical mastalgia obtained a clinically useful response to therapy. Danazol was the most effective drug, with bromocriptine and evening primrose oil having equivalent efficacy. Many fewer adverse events were complained of by patients treated with evening primrose oil than danazol or bromocriptine.

Benign breast disorders can be considered from four points of view: clinical presentations, clinical significance, management, and pathogenesis. Understanding the pathogenesis is important for rational management and for assessing clinical significance. Clearly understood nomenclature is also important.Clinicians have tended to concentrate on the condition usually known as fibrocystic disease, a clinical condition (painful nodularity), but a terminology which relates to a histological picture of fibrosis, cyst formation, and epithelial hyperplasia, now known to occur in both asymptomatic and symptomatic breasts.To address these problems the aberrations of normal development and involution (ANDI) concept has been proposed as a framework for benign breast disorders which is comprehensive, accurate in terminology, and based on pathogenesis. For each disorder, there is a spectrum from normal through mild abnormality (aberration) and in some cases (only) to disease.This concept encompasses pathogenesis, clinical and histological significance, and general principles of management. It has proved particularly useful in giving an understanding of benign breast disorders to doctors in training.

The differentiation of subungual haematoma from benign and malignant nevoid lesions is a common clinical problem. To determine the incidence of benign subungual naevi in the general population, the digits of the hands and feet of 1000 white patients were examined. These were consecutive patients presenting to hospital for problems unrelated to the finger or toe-nail. Eight patients were found to have pigmented subungual lesions. All proved to be haematoma, although there was no history of injury. Benign subungual naevi are rare in caucasians, so subungual nevoid lesions should be regarded as malignant until proved otherwise.

Two hundred women with breast cysts proven by aspiration were entered into a randomized double-blind trial of Efamol (evening primrose oil) at a dose of 6 capsules daily or equivalent placebo dose for a year. Cysts were categorized by initial electrolyte composition, and follow-up continued for 1 year posttherapy. Recurrent cyst formation in the first year was slightly (but not significantly) lower in the Efamol group compared with the placebo-treated group. The Efamol treatment was well tolerated as the dropout rate was only 7% and equal in both the active and placebo groups. The initial electrolyte composition did not predict for cyst recurrence.

Two hundred women with breast cysts proven by aspiration were entered into a randomized double-blind trial of evening primrose oil (Efamol) at a dose of 3 g daily by mouth or placebo for a year. Neither the number of patients developing recurrent cysts nor the total numbers of recurrent cysts were significantly reduced in the Efamol treated group compared with the placebo treated group. Efamol treatment was well-tolerated as only six women dropped out because of side effects, three in both the Efamol and placebo treated groups. There was no difference in the numbers of patients in each group who complained of side effects, and no haematological suppression or alteration of renal or hepatic function during the treatment period.Key Words: n-6 essential fatty acidsevening primrose oilbreast cysts

We have used polymerase chain reaction (PCR), an amplification procedure, and oligonucleotide hybridization to detect ras gene point mutations in DNA from melanoma tumor samples. Genomic DNA was examined from 40 specimens of melanotic lesions, including benign nevi, primary melanomas, lymph node metastases, and systemic metastases. Adjacent normal skin or peripheral blood was analyzed as control material in 28 cases. ras mutations were detected overall in 25% of malignant tumors. In addition, mutations of all three ras genes were detected. We observed ras mutations in 2 of 4 benign atypical nevi (2 X K12), 4 of 22 primary melanomas (3 X K12, 1 X H12, 1 X N61), and 4 of 14 secondary (5 X K12, 1 X N61) tumors. One with a primary melanoma had concurrent K12 and H12, and two patients with secondary tumors had concurrent K12/N61 and K12 Asp/K12 Val mutations, respectively, making a total of 10 of 40 (25%) patients with ras mutations. This is the first demonstration of K-ras mutations in human melanoma. The presence of K-ras mutations in nevi, putative melanoma precursors, suggests that ras activation may be an early event in melanoma development. No correlation between tumor thickness and the presence of a ras mutation was observed.