Abstract Background Following unilateral breast cancer surgery, mastopexy and reduction of the unaffected breast are often performed to obtain symmetrical breasts. The use of implants in breast ...reconstruction results in a non-ptotic breast. To achieve symmetry, following the procedure, the unaffected side should be non-ptotic too. However, no study has yet reported any indices for the design of mastopexy and reduction in this direction. We present a new method of preoperative design that uses vertical breast measurements to form non-ptotic breasts according to individual breast shapes. Methods We performed vertical breast measurements of the unaffected breasts of 193 patients scheduled to undergo surgery for unilateral breast cancer. The vertical base dimension (VBD) and vertical surface dimension (VSD) of the ptotic and non-ptotic breasts and the height of the nipple in the non-ptotic breast were measured in centimeters. Results The borderline between ptotic and non-ptotic breasts was expressed by using the formula VSD = 1.13 × VBD + 1.86. The height of the nipple in non-ptotic breasts was 0.8 times the distance between the sternal notch and the lowest point of the inframammary fold on the midline. Using these findings, we formulated a new method for forming a non-ptotic breast from a ptotic breast using an inverted T design. Conclusion These results could be used for the design of mastopexy and reduction when forming a non-ptotic breast on the unaffected side. These procedures can be performed without significantly lifting the nipple-areolar complex if required during unilateral prosthetic breast reconstruction.
A 90-year-old man had chest pain. Portal venous gas and ileal edema were noted on abdominal CT, and severe ischemic enteritis was diagnosed. Conservative treatment was performed because of ...circulatory failure. Later, ileus slowly developed, and ileal stenosis was noted on contrast imaging through an ileus tube. Laparoscopy-assisted small bowel resection was performed and achieved remission. Emergency surgery is performed for portal venous gas in acute celiopathy because it may result in intestinal necrosis, but it is also necessary to consider conservative treatment for maintaining mesenteric blood flow in cases difficult to treat by surgery.
In order to achieve a good cosmetic result without increasing the risk of ipsilateral breast cancer recurrence after breast conserving surgery, it is very important to minimize the resection volume ...of the breast without compromising the negativity of the surgical margin. For this purpose, it is necessary to obtain precise information on tumor extension. We therefore developed a three-dimensional (3-D) ultrasound navigation system for breast cancer surgery, which can be performed in the operating room just before surgery.
We obtained 3-D breast tumor images by the 3-D ultrasound navigation system in 40 patients with primary breast cancer (stage 0-II) who underwent mastectomy or breast conserving surgery. The tumor size was measured in a coronal view of the 3-D tumor image and compared with the tumor size obtained from a pathological map of the tumor extension.
We obtained 3-D tumor images in 38 patients (success rate=95%). The tumor size in the images showed a very strong correlation with the pathological tumor size (r=0.898). The difference in tumor size between the 3-D images and pathology was less than 1 cm in 29 tumors (76.3%) and less than 2 cm in 36 (94.7%). On the other hand, the difference in tumor size between palpation and pathology was less than 1 cm in 19 out of 38 tumors (50.0%) and less than 2 cm in 29 tumors (76.3%). The absolute difference between the 3-D images and pathology was significantly less than that between palpation and pathology (p=0.0197).
Our 3-D ultrasound navigation system is useful in visualizing breast tumor extension and is more accurate than palpation. The system is expected to be helpful in deciding on the appropriate surgical margin in breast cancer surgery, resulting in a better cosmetic outcome without increasing the risk of surgical margin positivity.
The purpose of this study was to identify helical CT and MR imaging features of pancreatic masses (focal enlargement) due to chronic pancreatitis and their correlation with pathologic findings.
When ...histologic fibrosis is uniformly present through the pancreas in patients with chronic pancreatitis, there is no demarcation of masses due to chronic pancreatitis. When there is a greater degree of histologic fibrosis in the masslike part of the pancreas, the mass is often demarcated from the remaining pancreas, and the enhancement pattern on two-phase helical CT and dynamic gadolinium-enhanced MR imaging mimics that of pancreatic adenocarcinoma.
: The purpose of this study was to evaluate the usefulness of three‐dimensional magnetic resonance imaging (3D MRI) for the preoperative assessment of residual tumor extent in breast cancer patients ...treated with neoadjuvant chemotherapy (NAC). Thirty‐eight breast cancer patients treated with NAC containing taxane and/or anthracycline for 3–6 months were enrolled in this study. Tumor size was measured by means of calipers, ultrasonography, and dynamic MRI before and after NAC. Three‐dimensional maximum intensity projection MRIs to measure the tumor size were created for every case. The tumor size determined by calipers, ultrasonography, and 3D MRI after NAC was compared with that determined by pathologic examination. The tumor size determined by 3D MRI showed a strong correlation with that determined by pathologic examination (r = 0.896). Moderate, but significant correlations were found between measurements obtained with calipers and pathology (r = 0.554), and between ultrasonography and pathology (r = 0.484). The response rates to NAC were estimated at 84.2% with calipers, 58.0% with ultrasonography, and 44.7% with 3D MRI. Calipers and ultrasonography thus tended to overestimate the response to NAC compared to 3D MRI (p < 0.001 and 0.240, respectively). Three‐dimensional MRI can visualize residual tumor extent after NAC more accurately than calipers and ultrasonography, and seems to be more reliable than other modalities for estimating response to NAC. It should also help surgeons with decision making for breast‐conserving surgery after NAC
Predictors of pathologic complete response (pCR) to neoadjuvant chemotherapy for breast cancers have been studied extensively. Here, we focused on reduction rate after paclitaxel administration for ...prediction of pCR to paclitaxel followed by 5-fluorouracil, epirubicin, and cyclophosphamide (FEC).
This study included 115 patients with tumors > or =3.0 cm or with node-positive disease who were treated preoperatively with paclitaxel (80 mg/m(2), once a week, 12 cycles) followed by FEC (500/75/500 mg/m(2), every three weeks, 4 cycles). Reduction rate was measured with magnetic resonance imaging.
Tumor size (< or =5.0 cm) (p = 0.014), estrogen receptor (ER) negativity (p = 0.013), and human epidermal growth factor receptor 2 positivity (p = 0.020), but not histologic type, histologic grade, or progesterone receptor, were significantly associated with pCR, while association of reduction rate > or =80% was highly significant (p = 0.0003). Multivariate analysis identified negative ER (p = 0.022) and reduction rate (p = 0.003) as independent predictors of pCR. Finally, patients with reduction rate > or =80% showed a significantly higher favorable outcome (p = 0.014) than others.
Good response (reduction rate > or =80%) to paclitaxel seems to be a clinically useful predictor of pCR as well as a favorable prognosticator for patients treated preoperatively with paclitaxel followed by FEC.
The latissimus dorsi musculocutaneous flap is a workhorse flap used after nipple-sparing mastectomy or skin-sparing mastectomy in small-breasted patients. However, the elevation of an inadequate flap ...may require a secondary procedure to compensate for tissue deficiency. Accurate preoperative gauging of the amount of breast tissue to be removed and the amount of flap tissue to be harvested is important for obtaining a good outcome. In this respect, we developed the following reliable formulae: Breast resection volume (ml) = 0.229 × resection area (cm2) × breast projection (cm) + 51.351 ; and Flap weight (g) = 13.50 × body mass index (kg/m2) + 1.67 × skin paddle area (cm2) - 163.26. A flap weight / breast resection volume of 1.8 to 2.0 was considered adequate for obtaining optimal results. These objective determinations of breast resection volume and flap weight could provide useful preoperative assistance in planning breast reconstructive surgery.
PDF
