Nipple-sparing mastectomy (NSM) has become widely available for breast cancer prophylaxis. There are limited data on its long-term oncologic safety. The objective of this study was to determine the ...incidence of breast cancer in patients who underwent prophylactic NSM.
All patients undergoing prophylactic NSM at a single institution from 2006 through 2019 were retrospectively reviewed. Patient demographic factors, genetic predispositions, mastectomy specimen pathology, and oncologic occurrences at follow-up were recorded. Descriptive statistics were performed where necessary to classify demographic factors and oncologic characteristics.
A total of 871 prophylactic NSMs were performed on 641 patients, with median follow-up of 82.0 months (standard error 1.24). A total of 94.4% of patients ( n = 605) underwent bilateral NSMs, although only the prophylactic mastectomy was considered. The majority of mastectomy specimens (69.6%) had no identifiable pathology. A total of 38 specimens (4.4%) had cancer identified in mastectomy specimens, with ductal carcinoma in situ being the most common (92.1%; n = 35). Multifocal or multicentric disease was observed in seven cases (18.4%) and lymphovascular invasion was identified in two (5.3%). One patient (0.16%), who was a BRCA2 variant carrier, was found to have breast cancer 6.5 years after prophylactic mastectomy.
Overall primary oncologic occurrence rates are very low in high-risk patients undergoing prophylactic NSM. In addition to reducing the risk of oncologic occurrence, prophylactic surgery itself may be therapeutic in a small proportion of patients. Continued surveillance for these patients remains important to assess at longer follow-up intervals.
Risk, IV.
Domestic violence and the trauma surgeon Guth, Amber A; Pachter, H.Leon
The American Journal of Surgery,
02/2000, Letnik:
179, Številka:
2
Book Review, Journal Article
Recenzirano
Background: Domestic violence has become increasingly recognized as a public health problem, and was declared a national epidemic by C. Everett Koop in 1992. In the United States, 1 to 2 million ...women yearly suffer injuries due to domestic violence, and 30% to 50% of female homicides are committed by a present or former partner. The majority of these murder victims had either been seen in emergency rooms for prior domestic violence-related injuries, or had reported these injuries to the police. It is estimated that 50% of all acute injuries and 21% of all injuries in women requiring urgent surgery are the result of partner abuse.
Data source: Medline and current literature review.
Conclusions: Health care professionals in the emergency room are an important contact with the victims of domestic violence, and timely identification and intervention can save lives. Overall, upwards of 35% of all emergency room visits by women are the result of domestic violence, whether due to acute injury, problems during pregnancy, or stress-related complaints. Unfortunately, domestic abuse is infrequently disclosed voluntarily by the patient, and often overlooked by the treating physician. Thus, the purpose of this review is to familiarize surgeons with the presentation and management of victims of this hidden epidemic.
Abstract Lymphedema following breast cancer surgery is considered to be mainly due to the mechanical injury from surgery. Recent research identified that inflammation-infection and obesity may be the ...important predictors for lymphedema. The purpose of this exploratory research was to prospectively examine phenotype of arm lymphedema defined by limb volume and lymphedema symptoms in relation to inflammatory genes in women treated for breast cancer. A prospective, descriptive and repeated-measure design using candidate gene association method was used to enroll 140 women at pre-surgery and followed at 4–8 weeks and 12 months post-surgery. Arm lymphedema was determined by a perometer measurement of ≥5% limb volume increase from baseline of pre-surgery. Lymphedema symptom phenotype was evaluated using a reliable and valid instrument. Saliva samples were collected for DNA extraction. Genes known for inflammation were evaluated, including lymphatic specific growth factors (VEGF-C & VEGF-D), cytokines (IL1- a , IL-4, IL6, IL8, IL10, & IL13), and tumor necrosis factor- a (TNF- a ). No significant associations were found between arm lymphedema phenotype and any inflammatory genetic variations. IL1- a rs17561 was marginally associated with symptom count phenotype of ≥8 symptoms. IL-4 rs2070874 was significantly associated with phenotype of impaired limb mobility and fluid accumulation. Phenotype of fluid accumulation was significantly associated with IL6 rs1800795, IL4 rs2243250 and IL4 rs2070874. Phenotype of discomfort was significantly associated with VEGF-C rs3775203 and IL13 rs1800925. Precision assessment of heterogeneity of lymphedema phenotype and understanding the biological mechanism of each phenotype through the exploration of inherited genetic susceptibility is essential for finding a cure. Further exploration of investigative intervention in the context of genotype and gene expressions would advance our understanding of heterogeneity of lymphedema phenotype.
Volatilisation of crop protection chemicals from soil and crop surfaces is one of a number of processes that may contribute to their dissipation in the environment. Therefore, information on the ...potential of a chemical to volatilise from these surfaces is required by international and national registration authorities. This paper reports the results of more than 190 experiments, which were carried out with 80 different crop protection chemicals under controlled conditions (laboratory and/or greenhouse) according to the BBA guideline. Percent loss values observed during 24
h after application are reported for 123 soil and 71 crop volatility studies. Generally, volatile losses from crop surfaces were found to be greater than from soil surfaces under comparable experimental conditions. It has been previously proposed that volatile losses from soil surfaces, from crops, and from aqueous systems can be estimated from physico-chemical parameters. The data are therefore analysed to determine whether a correlation exists between volatilisation and physico-chemical parameters, such as vapour pressure, Henry’s law constant, water/air and soil/air distribution coefficients. It was found that these parameters can be used to make reasonable predictions of volatile losses from crop and soil surfaces, which can be expected for crop protection chemicals under controlled conditions. Vapour pressure was the best predictor of losses from soil and crops. The use of the soil/air distribution coefficient is an alternative for predicting/estimating the volatility potential of a chemical from soil. Based on direct measurements, no noticeable volatility can be expected from compounds with a vapour pressure below 10
−3
Pa from soil and 10
−4
Pa from crops, this is fully confirmed by indirect measurements. A tiered volatility testing scheme including appropriate trigger values is proposed.
Abstract Introduction Reconstruction of the oral cavity and oropharynx after tumour resection often involves the use of free flaps, but donor site morbidity must be taken into account. The radial ...forearm flap, the flap most commonly used in this setting, leaves a readily visible scar on an exposed region of the body. The thoracodorsal artery perforator flap (TDAP), which possesses the same plastic qualities as the radial forearm flap, leaves a scar that is hidden in the axilla. The purpose of this study was to evaluate the cosmetic results of radial forearm and thoracodorsal artery perforator free flap donor sites. Material and methods The medical charts of all patients undergoing reconstruction by a radial forearm or thoracodorsal artery perforator free flap between January 2011 and December 2011 were retrospectively reviewed. The Patient and Observer Scar Assessment Scales and the Vancouver Scar Scale were used to evaluate the quality of the scars. Results Reconstruction was performed by radial forearm flap in 4 cases and TDAP flap in 7 cases. The PSAS score was significantly lower in the TDAP group than in the radial forearm group ( P = 0.03), and the OSAS score was higher in the radial forearm group (21.5 versus 14). The Vancouver Scar Scale was significantly higher for radial forearm flap scars than for TDAP scars (8 versus 2.7, P = 0.005). Conclusion This is the first study to compare radial forearm and thoracodorsal artery perforator free flap donor site scars. It demonstrates the minimal TDAP donor site morbidity and the high level of patient satisfaction.
Current breast cancer care involves a multidisciplinary clinical approach for diagnosis and treatment including input from radiology, surgery, pathology, radiation, and medical oncology. Radiation is ...an integral part of the treatment for locoregionally confined breast cancer, and has well-recognized long-term risks of secondary malignancies, such as angiosarcomas. Basal cell carcinoma (BCC), a common skin malignancy, is not typically considered a radiation-induced carcinoma following breast cancer treatment. Our recent experience with 4 patients with vastly different presentations of BCC in previous radiation fields prompts the current report in order to alert clinicians to this entity.
Background
Advances in cancer treatments continue to reduce the incidence of lymphedema. Yet, many breast cancer survivors still face long-term postoperative challenges as a result of developing ...lymphedema. The purpose of this study was to preliminarily evaluate The Optimal Lymph Flow program, a patient-centered education and behavioral program focusing on self-care strategies to enhance lymphedema risk reduction by promoting lymph flow and optimize body mass index (BMI).
Methods
A prospective, longitudinal, quasi-experimental design with repeated-measures was used. The study outcomes included lymph volume changes by infrared perometer, and BMI by a bioimpedance device at pre-surgery baseline, 2–4 weeks after surgery, 6-month and 12-month follow-up. A total of 140 patients were recruited and participated in The Optimal Lymph Flow program; 134 patients completed the study with 4 % attrition rate.
Results
Fifty-eight percent of patients had axillary node dissection and 42 % had sentinel lymph node biopsy (SLNB). The majority (97 %) of patients maintained and improved their preoperative limb volume (LV) and BMI at the study endpoint of 12 months following cancer surgery. Cumulatively, two patients with SLNB and two patients with axillary lymph node dissection had measurable lymphedema (>10 % LV change). At the 12-month follow-up, among the four patients with measurable lymphedema, two patients’ LV returned to preoperative level without compression therapy but by maintaining The Optimal Lymph Flow exercises to promote daily lymph flow.
Conclusions
This educational and behavioral program is effective in enhancing lymphedema risk reduction. The study provided initial evidence for emerging change in lymphedema care from treatment-focus to proactive risk reduction.
This pilot, double-blind, randomized, placebo-controlled study is aimed at evaluating the effectiveness of low-level laser therapy (LLLT) as a complementary treatment to complete decongestive therapy ...(CDT) treating lymphedema among breast cancer patients for 12 months post-intervention. Study population was breast cancer patients who were diagnosed and referred to lymphedema clinic for CDT. Participants (
n
= 22) were randomized and assigned into either an active laser intervention group or an inactive laser placebo-control group. Active LLLT was administered to participants twice a week at the beginning of each CDT session. Outcome measures included lymphedema symptoms, symptom distress, and limb volume by an infrared perometer. Participants in the active and placebo laser groups were comparable in demographic and clinical predictors of lymphedema. In comparison with the placebo group (83.3%), significantly fewer participants in the active laser group (55.6%) reported more than one lymphedema symptom (
p
= 0.012) at 12 months post-intervention. Significantly, more patients in the active laser group (44.4%) reported less than two impaired limb mobility symptoms in comparison with the placebo group (33.3%) at 12 months post-intervention (
p
= 0.017). The active laser group had statistically significant improvements in symptom distress of sadness (
p
= 0.005) from 73 to 11% and self-perception (
p
= 0.030) from 36 to 0% over time from baseline to 12-months post-intervention. There was no significant reduction in limb volume. Findings of the trial demonstrated significant benefits of complementary LLLT for relieving symptoms and improvement of emotional distress in breast cancer patients with lymphedema.
Introduction Le diabète de la mucoviscidose est un facteur majeur de morbimortalité en transplantation pulmonaire. Nous rapportons le suivi de cinq patients atteints de mucoviscidose avec une ...insuffisance respiratoire terminale et un diabète sévère traités par greffe combinée poumon – îlots pancréatiques. Patients et méthodes Le greffon pulmonaire et le pancréas étaient prélevés du même donneur. Les îlots étaient isolés du pancréas pendant la greffe pulmonaire puis mis en culture. Sept à 10 jours après la greffe pulmonaire, les îlots étaient injectés dans le foie par cathétérisme portal sous anesthésie locale et contrôle échographique. L’immunosuppression comprenait des corticoïdes et du basiliximab en induction et était poursuivie par tacrolimus, mycophénolate mofétil et corticoïdes. Résultats D’octobre 2011 à octobre 2014, 5 patients atteints de mucoviscidose (2 F/3 M, âge : 31 ± 5 années, IMC : 18,8 ± 2 kg.m-2 ) présentant une insuffisance respiratoire (VEMS : 25,6 ± 4 %) et un diabète non contrôlé (durée : 10 ± 3 années, C peptide < 0,5 mcg/l ou non stimulable, HbA1c = 8,6 ± 1 %) ont bénéficié d’une greffe combinée bipulmonaire et îlots pancréatiques (2 940 ± 850 IEQ/kg). La fonction pulmonaire était améliorée chez tous les patients avec un VEMS à 62 ± 16 % et 67 ± 15 % associée à une augmentation du C peptide sanguin à 2,34 ± 1,01 mcg/l et 0,86 ± 0,10 mcg/l, 3 et 12 mois postgreffe. L’HbA1c était à 5,7 ± 0,8 % et 6,4 ± 0,6 % 3 et 12 mois postgreffe en l’absence d’hypoglycémie. Les besoins en insuline étaient réduits de 30 ± 14 %. Aucune complication liée à la procédure d’injection des îlots n’était rapportée. Conclusion Chez le patient atteint de mucoviscidose, la greffe combinée poumon – îlots pancréatiques restaure une fonction pulmonaire et un contrôle métabolique satisfaisant. La greffe d’îlots n’augmente pas la morbidité chirurgicale de la greffe pulmonaire. Des études prolongées sont nécessaires pour évaluer la balance bénéfice risque et l’intérêt à long terme de cette greffe. Déclaration d’intérêt Les auteurs déclarent ne pas avoir d’intérêt direct ou indirect (financier ou en nature) avec un organisme privé, industriel ou commercial en relation avec le sujet présenté.
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