Dimitri J Hadjiminas

Imperial College Healthcare NHS Trust, Londinium, England, United Kingdom

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Publications (18)29.38 Total impact

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    ABSTRACT: BACKGROUND: Acquisition of additional breast tissue has become integral to breast oncology research. This questionnaire study examines patient willingness to undergo research-dedicated breast biopsies either at time of diagnostic biopsy (T1) or after carcinoma diagnosis has been confirmed and eligibility for a specific study established (T2), and influencing factors thereof. METHODS: Prior to consultation, patients attending breast clinics were recruited to complete a questionnaire examining willingness to undergo an extra fine needle aspirate (FNA) and/or core needle biopsy (CNB) for research either at T1 or T2. Descriptions of FNA and CNB procedures were supplied to those with no prior experience. Patient perspectives towards donating surplus tissue remaining from a diagnostic procedure and/or surgery for future research were also explored. FINDINGS: A total of 100 patients were recruited, 42% with prior history of breast carcinoma (BC), 22% with family history of BC (FHBC) and 65%/42% with previous experience of CNB/FNA respectively. Overall, 57% were willing to undergo additional biopsy at one or both time points. Willingness to undergo additional biopsy was greater for T1 than T2, but equivalent for CNB and FNA (willingness CNB T1, 50% vs T2, 26%, willingness FNA T1 50% vs T2 29%). A statistically significant increase in willingness to undergo CNB and/or FNA at T1 and/or T2 was seen in association with prior diagnosis of BC, FHBC, previous visit to breast clinic and prior experience of breast biopsy. 83% of patients expressed a willingness to allow surplus tissue to be stored in a biobank for future research. INTERPRETATION: Where possible patients should be approached to undergo baseline research biopsies at time of diagnostic process rather than subsequently. Patients do not find FNA more acceptable than core biopsy. Prior exposure to the biopsy procedure increases willingness to undergo research-dedicated biopsies.
    Breast (Edinburgh, Scotland) 05/2013; · 2.09 Impact Factor
  • The Breast Journal 03/2013; 19(2):215-6. · 1.83 Impact Factor
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    ABSTRACT: The introduction of the National Health Service (NHS) Breast Screening Programme has led to a considerable increase in the detection of impalpable breast cancer. Patients with impalpable breast cancer typically undergo oncological resection facilitated either by the insertion of guide wires placed stereo-tactically or through ultra-sound guided skin markings to delineate the extent of a lesion. The need for radiological interventions on the day of surgery adds complexity and introduces the risk that a patient may accidentally transferred to the operating room directly without the image guidance procedure. A case is described of a patient who required a pre-operative ultrasound scan in order to localise an impalpable breast cancer but who was accidentally taken directly to the operating theatre (OR) and anaesthetised without pre-operative intervention. The radiologist was called to the OR and an on-table ultrasound was performed without further consequence. It is evident that breast cancer patients undergoing image-guided resection are exposed to an additional layer of clinical risks. These risks are not offset by the World Health Organisation surgical safety checklist in its present guise. Here, we review a number of simple and inexpensive changes to the system that may improve the safety of the breast cancer patient undergoing surgery.
    Patient Safety in Surgery 07/2012; 6(1):15.
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    ABSTRACT: The finding of micrometastases (M(i)) and isolated tumour cells (ITC) within the axillary lymph nodes of patients with breast cancer has raised the question whether either/both have some prognostic significance. Several studies have shown that compared to node-negative patients, prognosis is significantly poorer in patients with M(i) and ITC. The fact that patients with M(i)/ITC in their sentinel lymph nodes have a systemic relapse risk that is higher than that of node-negative patients may be considered as an indication for systemic treatment. Most studies in the literature suggest that in patients with M(i) or ITC in their sentinel nodes who receive systemic therapy and whole breast radiotherapy, the risk of axillary relapse without axillary lymphadenectomy is under 2%. Given the fact that axillary lymphadenectomy is associated with a 5-25% risk of lymphoedema, we propose that a policy of close follow up should be adopted in these patients rather than axillary lymphadenectomy.
    Breast (Edinburgh, Scotland) 06/2012; · 2.09 Impact Factor
  • Ejso. 01/2011; 37(11):1014-1015.
  • Plastic and reconstructive surgery 10/2010; 126(4):195e-197e. · 2.74 Impact Factor
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    ABSTRACT: We highlight the pitfalls in delaying the diagnosis of primary hyperparathyroidism (pHPT) in patients with acute pancreatitis as the sole clinical presentation. Primary hyperparathyroidism is a recognised, but rare, cause of acute pancreatitis. Hypercalcaemia caused by undiagnosed pHPT may be the only causative factor of recurrent acute pancreatitis. Three patients with multiple admissions for acute pancreatitis were diagnosed having pHPT during the work-up to identify possible causative factors. None of the patients had any other common predisposing factor for acute pancreatitis as revealed by clinical examination, blood tests and imaging. In retrospect, all had abnormally elevated calcium during previous admissions which was not further assessed. After diagnosis of pPTH, patients underwent bilateral neck exploration and parathyroidectomy. Histology confirmed parathyroid adenomas. The blood calcium level returned to normal and the patients remain well and asymptomatic after operation. The role of pHPT as a causative factor is underestimated when managing patients with acute pancreatitis, and frequently the underlying disease remains undiagnosed for a long time. Proper early diagnosis and management prevent unnecessary morbidity.
    Annals of The Royal College of Surgeons of England 03/2010; 92(2):W29-31. · 1.33 Impact Factor
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    ABSTRACT: To evaluate differences in outcomes of breast cancer patients undergoing either conventional mastectomy without reconstruction (NSSM) or skin-sparing mastectomy (SSM) with immediate reconstruction. All comparative studies published between 1997 and 2009 were used to evaluate local recurrence and distant relapse in the 2 study groups. Meta-analytical models were used to evaluate the study outcomes. Sensitivity analysis, was carried out to evaluate the robustness of the pooled estimates and assess the between-study heterogeneity. Nine studies, comprising of 3739 patients (1104 SSM and 2635 NSSM) were included in the analysis. There were no significant differences in the disease stage or the proportion of invasive cancers between groups (73.9% vs. 83.8%, P = 0.65). There was no significant difference in local recurrence between the SSM versus NSSM groups (7 studies, 3436 patients, 6.2% vs. 4.0%, odds ratio = 1.25, 95% CI: 0.81-1.94) and there was no significant heterogeneity between the studies. The SSM group had a lower proportion of distant relapses compared with the NSSM group (5 studies, 2122 patients, 10.0% vs. 12.7%, odds ratio = 0.67, 95% CI: 0.48-0.94) but this should be interpreted with caution since the grade of the tumors was not adequately reported in the studies considered. Our results suggest that in breast cancer patients, SSM was not significantly different from NSSM, in terms of rates of local recurrence. As no randomized control trial has addressed this question to date, the present meta-analysis reports the best evidence on the subject.
    Annals of surgery 03/2010; 251(4):632-9. · 7.90 Impact Factor
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    ABSTRACT: Atypical axillary metastasis may arise from an occult ipsilateral or contralateral breast cancer or from primary non-breast tumour. The treatment of this entity is challenging and presents various options. We present our experience with a brief review of the literature. A study of atypical axillary metastasis done at St Mary's hospital, from 1998 to 2008, identified six cases. Radiological investigations and immunohistochemistry excluded non-breast primary tumour. Three patients had occult breast cancer on presentation, two patients had previously treated contralateral breast cancer and one patient developed a primary metachronous contralateral breast cancer, which had a completely different histological profile from the involved lymph nodes on the same side. Axillary nodal clearance was done for all patients except for the patient with lymphoedema. Four patients were alive with no evidence of disease and two patients died of the disease at a median follow-up of 23 months. Atypical axillary metastasis from ipsilateral occult or contralateral breast cancer should be treated with axillary node clearance and further endocrine or chemotherapy. Radiation treatment or a watchful policy to the ipsilateral breast should be validated by further studies.
    Breast (Edinburgh, Scotland) 09/2009; 18(4):225-7. · 2.09 Impact Factor
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    ABSTRACT: Adnexal masses are not uncommon in patients with breast cancer. Breast cancer and ovarian malignancies are known to be associated. In patients with breast cancer and co-existing pleural effusions, ascites and adnexal masses, the probability of disseminated disease is high. Nevertheless, benign ovarian masses can mimic this clinical picture when they are associated with Meigs' syndrome making the work-up and management of these patients challenging. To our knowledge, there are no similar reports in the literature and therefore we present this case to highlight this entity. A 56-year old woman presented with a 4 cm, grade 2, invasive ductal carcinoma of her left breast. Pre-treatment staging investigations showed a 13.5 cm mass in her left ovary, a small amount of ascites and a large right pleural effusion. Serum tumour markers showed a raised CA125 supporting the malignant nature of the ovarian mass. The cytology from the pleural effusion was indeterminate but thoracoscopic biopsy failed to show malignancy. The patient was strongly against mastectomy and she was commenced on neo-adjuvant Letrozole 2.5 mg daily with a view to perform breast conserving surgery. After a good response to the hormone manipulation, the patient had breast conserving surgery, axillary sampling and laparoscopic excision of the ovarian mass which was eventually found to be a benign ovarian fibroma. Despite the high probability of disseminated malignancy when an ovarian mass associated with ascites if found in a patient with a breast cancer and pleural effusion, clinicians should be aware about rare benign syndromes, like Meigs', which may mimic a similar picture and mislead the diagnosis and management plan.
    World Journal of Surgical Oncology 02/2009; 7:10. · 1.09 Impact Factor
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    ABSTRACT: Male breast cancer (MBC) is rare with an incidence of 1% of all breast cancers. The evidence about the treatment is derived from the data on the management of the female breast cancer because conduction of randomized, controlled trials is impossible due to the rarity of the disease. In this study, we review the special features, overall management, diagnosis, and treatment of patients with MBC managed under our care with a brief review of the current literature. During the period 1998 to 2006, we managed 1103 new patients with breast cancer in St Mary's Hospital. Among these, 14 patients were men. We retrospectively reviewed the case notes, histology, and follow-up notes of all the newly diagnosed patients with MBC. In this series, 28.6% had only in situ disease. Moreover, in 78.6% there was an in situ component present. One patient was found to have a cancer on the microdochectomy specimen after an operation for single duct nipple discharge, and in a second patient the cancer was found in the gynecomastia operation specimen. All ten invasive tumors were estrogen receptor positive (ER +ve), whereas eight were progesterone receptor positive (PgR +ve). With a median follow-up of 35 months, there was one locoregional recurrence and one disease-associated death. In situ cancer may not be as rare as previously reported among patients with MBC. Increased patient awareness and early assessment by a specialist is a key to early diagnosis and improved outcomes.
    World Journal of Surgery 10/2008; 32(11):2471-6. · 2.23 Impact Factor
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    ABSTRACT: The study aims to assess the morbidity and outcomes associated with gynaecomastia surgery. Between 1998 and 2007, 748 males with a mean age 44.67 years (10-90) were referred to us with breast-related symptoms. From these only 65 patients (102 breasts), with a median age of 26 years (11-82) had an operation for gynaecomastia. We considered for the purpose of the study each operated breast as an individual case. Overall, 42 cases of grade I gynaecomastia, 40 with grade II and 20 with grade III were treated mainly with subcutaneous mastectomies, 22 with skin reduction. Acute major complications requiring intervention occurred in 12 cases. Twenty-three cases required a late corrective operation for unsatisfactory results. The surgical approach appears to be the most important determinant of good cosmesis with the circumareolar approach to give the better results. The majority of the patients can be managed conservatively. Surgical candidates should be made aware of the significant morbidity.
    Breast (Edinburgh, Scotland) 09/2008; 17(6):596-603. · 2.09 Impact Factor
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    ABSTRACT: This study evaluates microdochectomy as a means for diagnosis and treatment of patients with pathological nipple discharge (PND) but with benign or normal imaging and cytology. From 1999 until 2006, in St. Mary's Hospital, 76 patients with the aforementioned condition underwent microdochectomy because of the presence of epithelial cells on nipple smear or for symptomatic relief. Most of the patients had intraductal papillomas (48.7%), duct ectasia (15.8%) or a combination of the two (13.2%). Other benign causes occurred in 11.8% of the patients. Eight patients, including one who was operated for symptomatic relief, had cancer. Of those patients with benign condition, 98% had symptomatic relief while PND recurred twice in one patient. Pre-operative workup and imaging may not be suspicious in patients with single-duct PND and underlying malignancy, therefore, microdochectomy should be considered in such cases.
    The Breast 07/2008; 17(3):309-13. · 2.49 Impact Factor
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    ABSTRACT: We present an unusual case of severe anaphylaxis to Patent Blue dye with atypical clinical features during sentinel lymph node biopsy (SLNB). The medical personnel involved with sentinel node biopsies should be alert, and familiar with this unusual entity. We also present current data from the literature. During a wide local excision for primary breast cancer and SLNB, and early during the operation, the patient became severely tachycardic and hypotensive without any signs of urticaria, rash, oedema, or bronchospasm. Resuscitation required the addition of noradrenaline infusion followed by an overnight admission to the intensive care unit. Raised serum tryptase levels supported the diagnosis of anaphylactic shock while skin tests showed a severe reaction to Patent Blue dye. Severe, life-threatening anaphylaxis to Patent Blue dye may present without obvious previous exposure to the dye and without the cardinal signs of oedema, urticaria and bronchospasm making the diagnosis and management of such cases challenging. Correct diagnosis and identification of the causative factor is important and requires a specific set of laboratory tests that are not commonly requested in every-day medical practice. It is not clear from the literature whether the condition is common enough to justify pre-operative prophylactic or diagnostic measures.
    Annals of The Royal College of Surgeons of England 06/2008; 90(4):338-9. · 1.33 Impact Factor
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    ABSTRACT: Breast cancer in men is rare. The evidence about treatment has been derived from data on the management of the disease in women. The usual treatment is for male patients to undergo modified radical mastectomy. There is insufficient experience of breast conserving surgery with preservation of the nipple. The management of patients who demand such an approach for personal reasons remains a challenge for both the surgeon and oncologist. A 50-year-old man with a breast cancer was successfully managed with breast conserving surgery with nipple preservation combined with axillary clearance and postoperative radiotherapy, chemotherapy and hormone treatment. Since there are no similar cases in the literature, we discuss the feasibility, safety and possible indications of such an approach. Despite the limited indications and evidence about the safety and efficacy of breast conserving surgery with nipple preservation in men with breast cancer, it is a feasible approach if other options are declined by the patient. More studies are necessary to reach firm conclusions about the safety of such an approach.
    Journal of Medical Case Reports 02/2008; 2:126.
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    ABSTRACT: Aim-BackgroundA small but significant percentage of patients that present with breast problems are men. The usual complaint is breast enlargement, lumps or pain, while inflammation and nipple discharge are very rare presentations. This retrospective audit aims to discuss the management of the small but significant percentage of newly presented male breast patients. MethodsBetween October 1998 and October 2007, 748 new male patients with a mean age of 44.67 years were referred to the breast clinic. These patients represent 4.25% of the total number of patients referred to us during the study period. We retrospectively reviewed the clinical notes of those patients treated surgically. ResultsDuring this time, there were 14 newly diagnosed patients with breast cancer (1% of the newly diagnosed breast cancer patients) with a mean age of 68.29 years (47–87), 5 patients with subareolar abscess with a mean age of 25 years (0–57 years) who were managed accordingly and 66 patients with a mean age of 26 year (11 years–82 years) who finally, underwent surgery for gynaecomastia. The vast majority of the remaining patients (99.1%) had a degree of gynaecomastia but either refused surgery or were managed medically. ConclusionEarly referral, thorough triple assessment of the patients (clinical examination, imaging and histology) and appropriate intervention procedures under the right indications is the key to early diagnosis of breast cancer and subsequent favorable outcomes. Reassurance and conservative management is adequate for the vast majority of non-cancer patients while good selection criteria are necessary for optimal results in gynaecomastia surgery. Breast inflammation, though rare among men, should be managed aggressively, with the exception of infants. KeywordsMail breast cancer-Gynaecomastia-Periductal mastitis-Breast abscess-Nipple discharge
    Hellēnikē cheirourgikē. Acta chirurgica Hellenica 82(3):176-183.
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    ABSTRACT: Primary hyperparathyroidism is a disease commonly seen in patients above 60 years of age. It is the most common cause of asymptomatic or symptomatic hypercalcemia, usually found incidentally on routine check-ups. Surgical treatment is the only definitive treatment of choice in the symptomatic patient; however, it can also be employed in asymptomatic patients. First described in 1925, bilateral neck exploration is the gold standard of treatment for primary hyperparathyroidism. The recent interest in minimally invasive surgeries has led to better and improved techniques of neck exploration with improved cosmetic results and lesser chances of transient or permanent hypoparathyroidism due to inadvertent removal of normally functioning parathyroid tissue. These include unilateral neck explorations, minimally invasive parathyroidectomies and minimally invasive radio-guided parathyroidectomy. The intact parathyroid hormone assays have greatly added to the detection of normal and abnormal functioning glands, hence better surgical outcomes.
    Indian Journal of Surgery · 0.09 Impact Factor
  • S. Lanitis, D. Hadjiminas
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    ABSTRACT: The role of surgery has been continuously evolving for the last 100 years, as have the various techniques for the management of breast cancer. Thanks to the results of well-designed randomized control trials, the mutilating radical mastectomies of the past came to be gradually replaced by modified techniques and, eventually, by local excisions combined with radiotherapy without compromising prognosis and survival. The purpose of this approach was to minimize morbidity and avoid unnecessary harm and burden to the patients. Conserving the breast was a start, but up to a decade ago the techniques used were limited to just cancer excision and closure of the wound, leaving behind a mutilated breast in many women. The introduction and evolution of oncoplastic surgery completely changed the modern surgical approach to breast cancer, taking the development to the next level. The concept of oncoplastic breast surgery combines oncologic tumour resection, in the form of either breast conservation or mastectomy, with traditional or modified plastic surgical techniques aiming to achieve an optimal cosmetic result with long-term local tumour control Eventually, what used to be a simple yet frequently mutilating removal of the cancerous breast lesion became a sophisticated, though often technically demanding, quality-of-life-oriented part of the multidisciplinary process in the treatment of cancer that nowadays affects almost 1 out of 9 women. In this review article, we present the basic principles, elements and techniques of oncoplastic breast surgery. We further discuss the indications, contraindications, advantages and disadvantages of these techniques.
    Hellēnikē cheirourgikē. Acta chirurgica Hellenica 84(2).