Seroma, with its secondary complications, represents one of the major unsolved problems in direct to implant breast reconstruction with acellular dermal matrix. The seroma formation not only ...represents a complication, but causes other secondary complications such as major infections, surgical dehiscence, and implant loss. These lead to the failure of the reconstruction. The authors have developed a new ultrasound protocol for early diagnosis and management of seroma, with the aim of detecting and treating early seroma through a series of ultrasound-guided suctions. In this way, we want to avoid the onset of seroma-related complications. After 12.5 months of mean follow-up time, we performed 22 fluid aspirations, and no seroma recurrence was reported, as well as no secondary complications. The authors believe that the introduction of this novel ultrasound protocol allows the plastic surgeon to actively and promptly manage seroma.
Background:
In prepectoral breast reconstruction (PPBR) the acellular dermal matrix (ADM)’s integration capacity into the tissue is known. The aim of this study was to analyze the effect of the ADM ...on development and composition of the peri-implant breast capsule in a dynamic setting of breast tissue expansion during two-stage prepectoral breast reconstruction.
Methods:
This is a prospective single-center study in which 50 patients who underwent mastectomy and breast reconstruction with prepectoral tissue expander and Braxon ADM (group A) and submuscular tissue expander (group B) were enrolled. One-year post implantation hematoxylin & eosin (H&E) staining and immunohistochemistry analyses were done on capsule tissue samples.
Results:
The analysis conducted on H&E-stained samples showed a significant reduction of cellular density and a decrease of the cellular infiltration in capsules of ADM-covered expanders compared with naked expander capsules (
P
< 0.05). The immunohistochemical analyses showed that group A capsules presented significantly less M1 CD68+ macrophages (
P
< 0.05), lower alfa-SMA expression levels, and a lower number of myofibroblasts (
P
< 0.05) compared with group B capsules. Presence of lymphatic vessels was minimally detected in both groups.
Conclusions:
The ADM presence around the prepectoral tissue expander influences the development of the peri-implant capsule, causing a significant reduction of the number of cells and inflammatory infiltrate, especially M1 macrophages and myofibroblasts. The ADM Braxon is therefore effective in creating a noninflamed capsule around the implant and in dynamic tissue conditions, and such an environment is maintained in time.
Abstract Purpose Computer Aided Design/Computer Aided Modelling (CAD/CAM) has become standard in mandibular reconstruction since it offers better outcomes. Occasionally, the reconstructive plans need ...to be changed intra-operatively and the custom-made prefabricated devices may become inadequate. We present an efficient adjunct to the standard CAD/CAM technique which resolves this problem. Methods Customized surgical devices with our “triple-cut” concept were used in five patients for mandibular reconstruction with free fibula flap (four after mandible resection for squamous-cell carcinoma and one after mandible osteoradionecrosis). In all patients the mandibular and fibular cutting guides were provided with 3 different cutting levels per side. Results Three different cutting levels on the mandible permitted an accurate resection based on the intraoperative needs. The corresponding three “cutting levels” on the fibula created perfectly matching segments of vascularized bone. Good contact of bony segments was obtained in all patients. Conclusions The prefabricated “triple-cut” cutting guides make change of the dimensions of bony resection, while still using the prefabricated CAD/CAM reconstructive plate, possible.
In-medium binding energies and Mott points for d, t, 3He and α clusters in low-density nuclear matter have been determined at specific combinations of temperature and density in low-density nuclear ...matter produced in collisions of 47A MeV 40Ar and 64Zn projectiles with 112Sn and 124Sn target nuclei. The experimentally derived values of the in-medium modified binding energies are in good agreement with recent theoretical predictions based upon the implementation of Pauli blocking effects in a quantum statistical approach.
Adult intradural lipoma with tethered spinal cord syndrome Horrion, J; Houbart, M A; Georgiopoulos, A ...
JBR-BTR : organe de la Societe royale belge de radiologie (SRBR) = orgaan van de Koninklijke Belgische Vereniging voor Radiologie (KBVR),
03/2014, Letnik:
97, Številka:
2
Journal Article
HER2DX is a prognostic and predictive assay in early-stage HER2-positive breast cancer based on clinical features and the expression of 4 gene signatures (immune, proliferation, luminal ...differentiation and HER2 amplicon), including ERBB2 mRNA levels. Here, we evaluated the ability of HER2DX to predict efficacy of a de-escalated, chemotherapy-free neoadjuvant regimen in HER2-positive/hormone receptor-positive breast cancer.
HER2DX was evaluated on pre-treatment tumour samples from the PerELISA phase II study focused on postmenopausal patients with operable HER2-positive/hormone receptor-positive breast cancer. Patients received 2-weeks of letrozole, and then underwent a re-biopsy for Ki67 evaluation. Patients with endocrine therapy sensitive disease (ESD) (i.e., >20.0% Ki67 relative reduction at week 2) continued letrozole and 5 cycles of trastuzumab and pertuzumab. Primary aim was to test the ability of HER2DX risk-score, HER2DX pCR score and HER2DX ERBB2 mRNA score (as continuous variables and group categories) to predict pathological complete response (pCR) in patients with ESD. Logistic regression and receiver–operator curve (ROC) analysis assessed associations of HER2DX scores with pCR and ESD.
HER2DX was evaluated in 55 patients (86.0%) enrolled in PerELISA and 40 patients (73.0%) had ESD. The pCR rate in patients with ESD was 22.5% (9/40). In this group, HER2DX pCR score and HER2DX ERBB2 mRNA score were significantly associated with pCR (p = 0.008 and p = 0.003, univariate logistic regression model; area under ROC AUC = 0.803 and 0.896). The pCR rate in low, medium, and high HER2DX pCR score groups was 7.7% (2/26), 46.2% (6/13) and 100.0% (1/1), respectively. The pCR rate in low, medium, and high HER2DX ERBB2 score groups was 0.0% (0/12), 7.7% (1/13) and 53.3% (8/15), respectively. HER2DX pCR score was also significantly associated with Ki-67 response following 2-weeks of letrozole (p = 0.002, univariate logistic regression model; AUC = 0.775). The rate of ESD in low, medium, and high HER2DX pCR score groups was 89.7% (26/29), 65.0% (13/20) and 16.7% (1/6), respectively.
HER2DX predicts response following neoadjuvant letrozole in combination with dual HER2 blockade with trastuzumab and pertuzumab in early-stage HER2-positive/hormone receptor-positive breast cancer.
This study received funding from Reveal Genomics.
IntroductionPallid breath-holding spells are common and dramatic forms of recurrent syncope in infancy. They are very stressful despite their harmless nature and sometimes require treatment.
The ...objective of this study was to evaluate the efficacy of belladonna in severe breath-holding spells.
This is a multicentric, retrospective series involving 84 children with severe pallid breath-holding spells. Inclusion criteria were >1 pallid breath-holding spell with loss of consciousness, paediatric cardiology evaluation, and follow-up >6 months. In total, 45 patients received belladonna and 39 patients did not receive treatment, according to physician preference.
Mean age was 11 months, ranging from 4 to 18 months, with 54% of males. Mean spell duration was 30 seconds (interquartile range 15, 60), and the frequency was four episodes per month (interquartile range 0.5, 6.5). Comparison of baseline characteristics between groups showed similar demographics, with the single difference in the severity of the spells, being more severe in the treated group. When comparing the treated and non-treated groups at 3 months, only two (5%) patients had a complete remission in the first group, whereas 20 (44%) had remission in the belladonna group (p<0.01). When considering the characteristics of the spells before and after the initiation of treatment with belladonna, 75% of the patients presented a positive response, with 44% of the patients presenting with complete resolution of the spells (p<0.01). No major adverse reaction was reported, with only 5% minor adverse events.
Belladonna is highly effective to alleviate severe breath-holding spells in young children, without any major adverse effects.
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