8651
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Buller M, Heiman A, Davis J, Lee T, Ajkay N, Wilhelmi B. Immediate Breast Reconstruction of a Nipple Areolar Lumpectomy Defect With the L-Flap Skin Paddle Breast Reduction Design and Contralateral Reduction Mammoplasty Symmetry Procedure: Optimizing the Oncoplastic Surgery Multispecialty Approach. EPLASTY 2017; 17:e14. [PMID: 28416989 PMCID: PMC5379251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Objective: We describe a modification of the inferior pedicle reduction mammoplasty for oncoplastic reconstruction of a central tumor defect. Our technique involved a deepithelialized L-shaped medial inferior based flap with removal of lateral breast tissue after central lumpectomy with a contralateral Wise-pattern mastopexy with inferior pedicle for symmetry. This technique is ideal for patients with large, ptotic breasts that desire breast conservation with immediate reconstruction. Methods: A 47-year-old woman with size 38 DD breasts presented with a palpable 2-cm subareolar mass of the left breast. Surgical oncology performed a left lumpectomy with nipple-areola complex excision and a sentinel lymph node biopsy. Immediate left breast reconstruction was performed with an inferior pedicle island flap. An additional 30 g of breast tissue was excised laterally for contour, and the neo-nipple-areola complex was rotated into the defect to facilitate inverted-T closure. A standard Wise-pattern mastopexy with inferior pedicle was then performed on the right breast and an additional 205 g of tissue was removed for symmetry. Results: The patient showed excellent symmetry at the conclusion of the procedure. Final pathology demonstrated complete excision of the tumor with negative margins. The entire neo-nipple-areola complex skin island was viable postoperatively. Conclusions: Immediate reconstruction of a nipple-areola complex lumpectomy defect with a L-shaped medial inferior based skin paddle flap and contralateral reduction mammoplasty provides an excellent cosmetic outcome in patients with large, ptotic breasts and central defects following oncologic tumor resection.
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Affiliation(s)
| | - Adee Heiman
- aSchool of Medicine, University of Louisville
| | - Jared Davis
- bDivision of Plastic and Reconstructive Surgery
| | | | - Nicolás Ajkay
- cDivision of Surgical Oncology, Department of Surgery, University of Louisville, Louisville, Ky
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Carrasco-López C, Julian Ibañez JF, Vilà J, Luna Tomás MA, Navinés López J, Pascual Miguel I, Fernandez-Llamazares-Rodriguez J, Higueras-Suñe C. Anterior intercostal artery perforator flap in immediate breast reconstruction: Anatomical study and clinical application. Microsurgery 2017; 37:603-610. [DOI: 10.1002/micr.30171] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2016] [Revised: 02/06/2017] [Accepted: 02/28/2017] [Indexed: 11/11/2022]
Affiliation(s)
- Cristian Carrasco-López
- Plastic Department; Hospital Germans Trias i Pujol, Universitat Autonoma de Barcelona; Barcelona Spain
| | | | - Jordi Vilà
- Plastic Surgeon; Plastic Department, Hospital Germans Trias i Pujol; Barcelona Spain
| | | | | | | | | | - Carmen Higueras-Suñe
- Chief of Department in Plastic Surgery; Hospital Germans Trias i Pujol; Barcelona Spain
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8653
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Empis de Vendin O, Schmartz D, Brunaud L, Fuchs-Buder T. Recurrent Laryngeal Nerve Monitoring and Rocuronium: A Selective Sugammadex Reversal Protocol. World J Surg 2017; 41:2298-2303. [DOI: 10.1007/s00268-017-4004-9] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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8654
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Pusic AL, Matros E, Fine N, Buchel E, Gordillo GM, Hamill JB, Kim HM, Qi J, Albornoz C, Klassen AF, Wilkins EG. Patient-Reported Outcomes 1 Year After Immediate Breast Reconstruction: Results of the Mastectomy Reconstruction Outcomes Consortium Study. J Clin Oncol 2017; 35:2499-2506. [PMID: 28346808 DOI: 10.1200/jco.2016.69.9561] [Citation(s) in RCA: 213] [Impact Index Per Article: 30.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Purpose The goals of immediate postmastectomy breast reconstruction are to minimize deformity and optimize quality of life as perceived by patients. We prospectively evaluated patient-reported outcomes (PROs) in women undergoing immediate implant-based or autologous reconstruction. Methods Women undergoing immediate postmastectomy reconstruction for invasive cancer and/or carcinoma in situ were enrolled at 11 sites. Women underwent implant-based or autologous tissue reconstruction. Patients completed the BREAST-Q, a condition-specific PRO measure for breast surgery patients, and Patient-Reported Outcomes Measurement Information System-29, a generic PRO measure, before and 1 year after surgery. Mean changes in PRO scores were summarized. Mixed-effects regression models were used to compare PRO scores across procedure types. Results In total, 1,632 patients (n = 1,139 implant, n = 493 autologous) were included; 1,183 (72.5%) responded to 1-year questionnaires. After analysis was controlled for baseline values, patients who underwent autologous reconstruction had greater satisfaction with their breasts than those who underwent implant-based reconstruction (difference, 6.3; P < .001), greater sexual well-being (difference, 4.5; P = .003), and greater psychosocial well-being (difference, 3.7; P = .02) at 1 year. Patients in the autologous reconstruction group had improved satisfaction with breasts (difference, 8.0; P = .002) and psychosocial well-being (difference, 4.6; P = .047) compared with preoperative baseline. Physical well-being of the chest was not fully restored in either the implant group (difference, -3.8; P = .001) or autologous group (-2.2; P = .04), nor was physical well-being of the abdomen in patients who underwent autologous reconstruction (-13.4; P < .001). Anxiety and depression were mitigated at 1 year in both groups. Compared with their baseline reports, patients who underwent implant reconstruction had decreased fatigue (difference, -1.4; P = .035), whereas patients who underwent autologous reconstruction had increased pain interference (difference, 2.0; P = .006). Conclusion At 1 year after mastectomy, patients who underwent autologous reconstruction were more satisfied with their breasts and had greater psychosocial and sexual well-being than those who underwent implant reconstruction. Although satisfaction with breasts was equal to or greater than baseline levels, physical well-being was not fully restored. This information can help patients better understand expected outcomes and may guide innovations to improve outcomes.
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Affiliation(s)
- Andrea L Pusic
- Andrea L. Pusic, Evan Matros, and Claudia Albornoz, Memorial Sloan Kettering Cancer Center, New York, NY; Neil Fine, Northwestern Specialists in Plastic Surgery, Chicago, IL; Edward Buchel, University of Manitoba, Winnipeg, Manitoba; Anne F. Klassen, McMaster University, Hamilton, Ontario, Canada; Gayle M. Gordillo, The Ohio State University Wexner Medical Center, Columbus, OH; and Jennifer B. Hamill, Hyungjin M. Kim, Ji Qi, and Edwin G. Wilkins, University of Michigan, Ann Arbor, MI
| | - Evan Matros
- Andrea L. Pusic, Evan Matros, and Claudia Albornoz, Memorial Sloan Kettering Cancer Center, New York, NY; Neil Fine, Northwestern Specialists in Plastic Surgery, Chicago, IL; Edward Buchel, University of Manitoba, Winnipeg, Manitoba; Anne F. Klassen, McMaster University, Hamilton, Ontario, Canada; Gayle M. Gordillo, The Ohio State University Wexner Medical Center, Columbus, OH; and Jennifer B. Hamill, Hyungjin M. Kim, Ji Qi, and Edwin G. Wilkins, University of Michigan, Ann Arbor, MI
| | - Neil Fine
- Andrea L. Pusic, Evan Matros, and Claudia Albornoz, Memorial Sloan Kettering Cancer Center, New York, NY; Neil Fine, Northwestern Specialists in Plastic Surgery, Chicago, IL; Edward Buchel, University of Manitoba, Winnipeg, Manitoba; Anne F. Klassen, McMaster University, Hamilton, Ontario, Canada; Gayle M. Gordillo, The Ohio State University Wexner Medical Center, Columbus, OH; and Jennifer B. Hamill, Hyungjin M. Kim, Ji Qi, and Edwin G. Wilkins, University of Michigan, Ann Arbor, MI
| | - Edward Buchel
- Andrea L. Pusic, Evan Matros, and Claudia Albornoz, Memorial Sloan Kettering Cancer Center, New York, NY; Neil Fine, Northwestern Specialists in Plastic Surgery, Chicago, IL; Edward Buchel, University of Manitoba, Winnipeg, Manitoba; Anne F. Klassen, McMaster University, Hamilton, Ontario, Canada; Gayle M. Gordillo, The Ohio State University Wexner Medical Center, Columbus, OH; and Jennifer B. Hamill, Hyungjin M. Kim, Ji Qi, and Edwin G. Wilkins, University of Michigan, Ann Arbor, MI
| | - Gayle M Gordillo
- Andrea L. Pusic, Evan Matros, and Claudia Albornoz, Memorial Sloan Kettering Cancer Center, New York, NY; Neil Fine, Northwestern Specialists in Plastic Surgery, Chicago, IL; Edward Buchel, University of Manitoba, Winnipeg, Manitoba; Anne F. Klassen, McMaster University, Hamilton, Ontario, Canada; Gayle M. Gordillo, The Ohio State University Wexner Medical Center, Columbus, OH; and Jennifer B. Hamill, Hyungjin M. Kim, Ji Qi, and Edwin G. Wilkins, University of Michigan, Ann Arbor, MI
| | - Jennifer B Hamill
- Andrea L. Pusic, Evan Matros, and Claudia Albornoz, Memorial Sloan Kettering Cancer Center, New York, NY; Neil Fine, Northwestern Specialists in Plastic Surgery, Chicago, IL; Edward Buchel, University of Manitoba, Winnipeg, Manitoba; Anne F. Klassen, McMaster University, Hamilton, Ontario, Canada; Gayle M. Gordillo, The Ohio State University Wexner Medical Center, Columbus, OH; and Jennifer B. Hamill, Hyungjin M. Kim, Ji Qi, and Edwin G. Wilkins, University of Michigan, Ann Arbor, MI
| | - Hyungjin M Kim
- Andrea L. Pusic, Evan Matros, and Claudia Albornoz, Memorial Sloan Kettering Cancer Center, New York, NY; Neil Fine, Northwestern Specialists in Plastic Surgery, Chicago, IL; Edward Buchel, University of Manitoba, Winnipeg, Manitoba; Anne F. Klassen, McMaster University, Hamilton, Ontario, Canada; Gayle M. Gordillo, The Ohio State University Wexner Medical Center, Columbus, OH; and Jennifer B. Hamill, Hyungjin M. Kim, Ji Qi, and Edwin G. Wilkins, University of Michigan, Ann Arbor, MI
| | - Ji Qi
- Andrea L. Pusic, Evan Matros, and Claudia Albornoz, Memorial Sloan Kettering Cancer Center, New York, NY; Neil Fine, Northwestern Specialists in Plastic Surgery, Chicago, IL; Edward Buchel, University of Manitoba, Winnipeg, Manitoba; Anne F. Klassen, McMaster University, Hamilton, Ontario, Canada; Gayle M. Gordillo, The Ohio State University Wexner Medical Center, Columbus, OH; and Jennifer B. Hamill, Hyungjin M. Kim, Ji Qi, and Edwin G. Wilkins, University of Michigan, Ann Arbor, MI
| | - Claudia Albornoz
- Andrea L. Pusic, Evan Matros, and Claudia Albornoz, Memorial Sloan Kettering Cancer Center, New York, NY; Neil Fine, Northwestern Specialists in Plastic Surgery, Chicago, IL; Edward Buchel, University of Manitoba, Winnipeg, Manitoba; Anne F. Klassen, McMaster University, Hamilton, Ontario, Canada; Gayle M. Gordillo, The Ohio State University Wexner Medical Center, Columbus, OH; and Jennifer B. Hamill, Hyungjin M. Kim, Ji Qi, and Edwin G. Wilkins, University of Michigan, Ann Arbor, MI
| | - Anne F Klassen
- Andrea L. Pusic, Evan Matros, and Claudia Albornoz, Memorial Sloan Kettering Cancer Center, New York, NY; Neil Fine, Northwestern Specialists in Plastic Surgery, Chicago, IL; Edward Buchel, University of Manitoba, Winnipeg, Manitoba; Anne F. Klassen, McMaster University, Hamilton, Ontario, Canada; Gayle M. Gordillo, The Ohio State University Wexner Medical Center, Columbus, OH; and Jennifer B. Hamill, Hyungjin M. Kim, Ji Qi, and Edwin G. Wilkins, University of Michigan, Ann Arbor, MI
| | - Edwin G Wilkins
- Andrea L. Pusic, Evan Matros, and Claudia Albornoz, Memorial Sloan Kettering Cancer Center, New York, NY; Neil Fine, Northwestern Specialists in Plastic Surgery, Chicago, IL; Edward Buchel, University of Manitoba, Winnipeg, Manitoba; Anne F. Klassen, McMaster University, Hamilton, Ontario, Canada; Gayle M. Gordillo, The Ohio State University Wexner Medical Center, Columbus, OH; and Jennifer B. Hamill, Hyungjin M. Kim, Ji Qi, and Edwin G. Wilkins, University of Michigan, Ann Arbor, MI
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8655
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Wang L, Hu T, Zhu X. The Mechanism of Metabolic Surgery: Gastric Center Hypothesis: Letter to the Editor. Obes Surg 2017; 27:1622-1623. [PMID: 28326489 DOI: 10.1007/s11695-017-2647-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Lijuan Wang
- Institute of Pathogen Biology and Immunology, North University of Hebei, No 11, Zuanshi South Road, 075000, Zhangjiakou, Hebei Province, People's Republic of China
| | - Tingting Hu
- The First Affiliated Hospital, North University of Hebei, 075000, Zhangjiakou, People's Republic of China
| | - Xiaobo Zhu
- Institute of Pathogen Biology and Immunology, North University of Hebei, No 11, Zuanshi South Road, 075000, Zhangjiakou, Hebei Province, People's Republic of China.
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Pan JH, Zhou H, Zhao XX, Ding H, Wei L, Qin L, Pan YL. Robotic thyroidectomy versus conventional open thyroidectomy for thyroid cancer: a systematic review and meta-analysis. Surg Endosc 2017; 31:3985-4001. [PMID: 28337546 DOI: 10.1007/s00464-017-5433-0] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2016] [Accepted: 01/20/2017] [Indexed: 01/22/2023]
Abstract
BACKGROUND Despite the new technical alternative offered by the robotic surgery for minimally invasive thyroid surgery, the role of the robotic thyroidectomy (RT) in thyroid cancer has been highly disputed. This paper gives a systematic review and meta-analysis aiming to compare RT and open thyroidectomy (OT) based on the surgical outcomes and oncologic results. METHODS Relevant literature was searched from various databases up to July 2016, including PubMed, MEDLINE, EMBASE, Cochrane Library, Web of science and Clinical Trials. gov. Outcomes of interest included patient characteristics, surgical outcomes, adverse events and complications, recurrence rate, and surgical completeness. RESULTS The systematic review and meta-analysis were based on the 5200 cases selected from the twenty-three publications. RT was associated with an equivalent adverse event and complication rate including transient hypocalcemia, permanent hypocalcemia, transient hoarseness, permanent recurrent laryngeal nerve (RLN) palsy, transient hypoparathyroidism, permanent hypoparathyroidism, hematoma, postoperative bleeding, seroma, chyle leakage, the Voice Handicap Index-10 (VHI-10) score, as well as equivalent surgical completeness including postoperative radioactive iodine (RAI) ablation rate, number of RAI ablation sessions, mean total RAI ablation dose, mean stimulated Tg of postoperation RAI, and proportion of stimulated Tg < 1.0 ng/ml on first ablation. Moreover, RT had lesser blood loss (WMD - 1.47, p = 0.04), smaller number of retrieved lymph nodes (WMD - 1.21, p = 0.0002), a low level of swallowing impairment (WMD - 4.17, p < 0.00001), and better cosmetic satisfaction (OR 4.05, p < 0.00001). However, OT was associated with shorter operation time (WMD 69.80, p < 0.00001), less total drain amount (WMD 66.53, p < 0.0001), and lower postoperative serum Tg level (WMD 0.21, p < 0.00001). CONCLUSIONS RT is as safe as OT for the treatment of thyroid cancer. Based on the long-time follow-up and surgical completeness, the adverse events and complications, and recurrence rate of RT were comparable with OT. RT was associated with a significantly lesser blood loss, smaller number of retrieved lymph nodes, a lower level of swallowing impairment, and better cosmetic satisfaction. In contrast, OT was associated with shorter operation time, smaller total drain amount, and lower postoperative serum Tg level. Overall, randomized clinical trials and larger patient cohort with long-term follow-up are still essential to further demonstrate the value of the robotic approach.
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Affiliation(s)
- Jing-Hua Pan
- Department of General Surgery, the First Affiliated Hospital of Jinan University, Guangzhou, 510632, China
| | - Hong Zhou
- Department of Gynecology, the First Affiliated Hospital of Jinan University, Guangzhou, 510632, China
| | - Xiao-Xu Zhao
- Department of General Surgery, the First Affiliated Hospital of Jinan University, Guangzhou, 510632, China
| | - Hui Ding
- Department of General Surgery, the First Affiliated Hospital of Jinan University, Guangzhou, 510632, China
| | - Li Wei
- Department of General Surgery, the First Affiliated Hospital of Jinan University, Guangzhou, 510632, China
| | - Li Qin
- Department of Histology and Embryology, Medical School of Jinan University, Guangzhou, 510632, China
| | - Yun-Long Pan
- Department of General Surgery, the First Affiliated Hospital of Jinan University, Guangzhou, 510632, China.
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8657
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Li Z, Gao B, Hao S, Tian W, Chen Y, Wang L, Zhang X, Luo D. Knockdown of lncRNA-PANDAR suppresses the proliferation, cell cycle and promotes apoptosis in thyroid cancer cells. EXCLI JOURNAL 2017; 16:354-362. [PMID: 28507479 PMCID: PMC5427478 DOI: 10.17179/excli2017-113] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/02/2017] [Accepted: 03/14/2017] [Indexed: 01/01/2023]
Abstract
Long non-coding RNAs (lncRNAs) have been found to show important regulatory roles in various human cancers. Lnc-RNA PANDAR is a novel identified lncRNA that was previously reported to show abnormal expression pattern in various cancers. However, little is known of its expression and biological function in thyroid cancer. Here, we used the quantitative real-time PCR (qRT-PCR) to determine the expression of PANDAR in 64 thyroid cancer tissues. We found that expression of PANDAR was up-regulated in thyroid cancer tissues compared with adjacent non-tumor tissues. Functional assays in vitro demonstrated that knockdown of PANDAR could inhibit proliferation, cell cycle progression, induces the apoptosis, inhibit invasion of thyroid cancer cells. Thus, our study provides evidence that PANDAR may function as a potential target for treatment for patients with thyroid cancer.
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Affiliation(s)
- Zhirong Li
- Department of Breast and Thyroid Surgery, Research Institute of Surgery, Daping Hospital, Third Military Medical University, Chongqing 400042, China
| | - Bo Gao
- Department of Breast and Thyroid Surgery, Research Institute of Surgery, Daping Hospital, Third Military Medical University, Chongqing 400042, China
| | - Shuai Hao
- Department of Breast and Thyroid Surgery, Research Institute of Surgery, Daping Hospital, Third Military Medical University, Chongqing 400042, China
| | - Wuguo Tian
- Department of Breast and Thyroid Surgery, Research Institute of Surgery, Daping Hospital, Third Military Medical University, Chongqing 400042, China
| | - Yi Chen
- Department of Breast and Thyroid Surgery, Research Institute of Surgery, Daping Hospital, Third Military Medical University, Chongqing 400042, China
| | - Lingli Wang
- Department of Breast and Thyroid Surgery, Research Institute of Surgery, Daping Hospital, Third Military Medical University, Chongqing 400042, China
| | - Xiaohua Zhang
- Department of Breast and Thyroid Surgery, Research Institute of Surgery, Daping Hospital, Third Military Medical University, Chongqing 400042, China
| | - Donglin Luo
- Department of Breast and Thyroid Surgery, Research Institute of Surgery, Daping Hospital, Third Military Medical University, Chongqing 400042, China
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8658
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Wahid B, Ali A, Rafique S, Idrees M. New Insights into the Epigenetics of Hepatocellular Carcinoma. BIOMED RESEARCH INTERNATIONAL 2017; 2017:1609575. [PMID: 28401148 PMCID: PMC5376429 DOI: 10.1155/2017/1609575] [Citation(s) in RCA: 63] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/26/2016] [Accepted: 01/17/2017] [Indexed: 02/07/2023]
Abstract
Hepatocellular Carcinoma (HCC) is one of the most predominant malignancies with high fatality rate. This deadly cancer is rising at an alarming rate because it is quite resistant to radio- and chemotherapy. Different epigenetic mechanisms such as histone modifications, DNA methylation, chromatin remodeling, and expression of noncoding RNAs drive the cell proliferation, invasion, metastasis, initiation, progression, and development of HCC. These epigenetic alterations because of potential reversibility open way towards the development of biomarkers and therapeutics. The contribution of these epigenetic changes to HCC development has not been thoroughly explored yet. Further research on HCC epigenetics is necessary to better understand novel molecular-targeted HCC treatment and prevention. This review highlights latest research progress and current updates regarding epigenetics of HCC, biomarker discovery, and future preventive and therapeutic strategies to combat the increasing risk of HCC.
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Affiliation(s)
- Braira Wahid
- Centre for Applied Molecular Biology, 87 West Canal Bank Road Thokar Niaz Baig, University of the Punjab, Lahore, Pakistan
| | - Amjad Ali
- Centre for Applied Molecular Biology, 87 West Canal Bank Road Thokar Niaz Baig, University of the Punjab, Lahore, Pakistan
| | - Shazia Rafique
- Centre for Applied Molecular Biology, 87 West Canal Bank Road Thokar Niaz Baig, University of the Punjab, Lahore, Pakistan
| | - Muhammad Idrees
- Centre for Applied Molecular Biology, 87 West Canal Bank Road Thokar Niaz Baig, University of the Punjab, Lahore, Pakistan
- Hazara University, Mansehra, Pakistan
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8659
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Papathemelis T, Heim S, Lux MP, Erhardt I, Scharl A, Scharl S. Minimally Invasive Breast Fibroadenoma Excision Using an Ultrasound-Guided Vacuum-Assisted Biopsy Device. Geburtshilfe Frauenheilkd 2017; 77:176-181. [PMID: 28331240 DOI: 10.1055/s-0043-100387] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Introduction We studied the extent to which an ultrasound-guided vacuum-assisted biopsy device ("hand-held Mammotome") could be used not only as a valuable tool for investigation of suspicious breast lesions, but also therapeutically for the complete removal of breast fibroadenomas. Materials and Methods 132 aspiration biopsies showing fibroadenoma on histology were collected retrospectively. We ascertained whether there were residual findings on breast ultrasound at a median follow-up of approx. 9 months following biopsy. A questionnaire was used to determine the complication rate, patient satisfaction and acceptance of the procedure. Results In this study complete fibroadenomectomy was achieved at aspiration biopsy in 76 % of cases (n = 132). Compared to fibroadenomas larger than 2.51 cm3 (59 %), those smaller than 2.5 cm3 were completely removed more often (87.6 %; p < 0.05). The procedure is associated with very little pain during and after biopsy and minimal haematoma development, both factors supporting a high rate of acceptance among patients. Conclusion Ultrasound-guided vacuum-assisted biopsy is safe and associated with very few complications. Its additional therapeutic potential is dependant on the size of the benign lesion as measured at initial ultrasound.
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Affiliation(s)
| | | | - Michael P Lux
- Universitätsfrauenklinik Erlangen, Erlangen, Germany
| | | | | | - Sophia Scharl
- Klinik für Strahlentherapie, Universität Regensburg, Regensburg, Germany
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8660
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Franceschi S, Lessi F, Panebianco F, Tantillo E, La Ferla M, Menicagli M, Aretini P, Apollo A, Naccarato AG, Marchetti I, Mazzanti CM. Loss of c-KIT expression in thyroid cancer cells. PLoS One 2017; 12:e0173913. [PMID: 28301608 PMCID: PMC5354407 DOI: 10.1371/journal.pone.0173913] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2016] [Accepted: 02/28/2017] [Indexed: 02/07/2023] Open
Abstract
Papillary thyroid carcinoma is the most frequent histologic type of thyroid tumor. Few studies investigated the role of c-KIT expression in thyroid tumors, suggesting a role for this receptor and its ligand in differentiation and growth control of thyroid epithelium and a receptor loss following malignant transformation. We investigated and correlated c-KIT expression levels and two known markers of thyrocytes differentiation, PAX8 and TTF-1, in malignant and benign cytological thyroid samples. Moreover, we performed functional studies on human papillary thyroid carcinoma cell line to associated c-KIT expression to thyrocytes differentiation and tumor proliferation. c-KIT and PAX8 expression resulted higher in benign samples compared to the malignant ones, and the expression levels of these two genes were significantly correlated to each other. We also observed that c-KIT overexpression led to an increase of PAX8 expression level together with a decrease of proliferation. Furthermore, c-KIT overexpressing cells showed a regression of typical morphological features of malignancy. Taken together these results suggest that c-KIT could be involved in the differentiation of thyroid cells and in tumor progression.
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Affiliation(s)
| | | | - Federica Panebianco
- Department of Translational Research and New Technologies in Medicine and Surgery, University Hospital of Pisa, Pisa, Italy.,Department of Pathology, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States of America
| | | | | | | | | | - Alessandro Apollo
- Department of Translational Research and New Technologies in Medicine and Surgery, University Hospital of Pisa, Pisa, Italy.,Core Research Laboratory, Istituto Toscano Tumori, Firenze, Italy
| | - Antonio Giuseppe Naccarato
- Department of Translational Research and New Technologies in Medicine and Surgery, University Hospital of Pisa, Pisa, Italy
| | - Ivo Marchetti
- Department of Translational Research and New Technologies in Medicine and Surgery, University Hospital of Pisa, Pisa, Italy
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Fang H, Xie J, Zhang M, Zhao Z, Wan Y, Yao Y. miRNA-21 promotes proliferation and invasion of triple-negative breast cancer cells through targeting PTEN. Am J Transl Res 2017; 9:953-961. [PMID: 28386324 PMCID: PMC5375989] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2016] [Accepted: 02/01/2017] [Indexed: 06/07/2023]
Abstract
MicroRNAs (miRNAs) are small single-stranded RNAs that bind to the 3'UTR of the mRNAs of target genes. They can target multiple genes and regulate translation or degradation of the mRNA. miRNAs target genes in a tissue-specific manner, and the role of a particular miRNA varies according to tumor origin or even subtype within the same cancer. This study evaluated the effect of miR-21 expression in triple-negative breast cancer (TNBC) tissues and MDA-MB-468, a cell line derived from TNBC tissues. miR-21 was consistently upregulated in TNBC and MDA-MB-468 cells compared to normal tissues. Inhibition of miR-21 by miR-21 antisense oligonucleotides decreased the proliferation, viability, and invasiveness of MDA-MB-468 cells and enhanced apoptosis. Furthermore, we confirmed that PTEN was downregulated by miR-21 in MDA-MB-468 cells. The results indicated that PTEN may mediate the oncogenic properties of miR-21 in TNBC. In summary, miR-21 was upregulated in TNBC tissues and cells, and promoted the proliferation and invasion of MDA-MB-468 cells, but negatively regulated the expression of PTEN protein. Inhibition of miR-21 or overexpression of PTEN protein could be promising strategies for the treatment of patients with TNBC.
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Affiliation(s)
- Hong Fang
- Breast and Thyroid Surgery Ward III, The Affiliated Zhongshan Hospital of Dalian University Dalian 116001, Liaoning Province, China
| | - Jiping Xie
- Breast and Thyroid Surgery Ward III, The Affiliated Zhongshan Hospital of Dalian University Dalian 116001, Liaoning Province, China
| | - Min Zhang
- Breast and Thyroid Surgery Ward III, The Affiliated Zhongshan Hospital of Dalian University Dalian 116001, Liaoning Province, China
| | - Ziwei Zhao
- Breast and Thyroid Surgery Ward III, The Affiliated Zhongshan Hospital of Dalian University Dalian 116001, Liaoning Province, China
| | - Yi Wan
- Breast and Thyroid Surgery Ward III, The Affiliated Zhongshan Hospital of Dalian University Dalian 116001, Liaoning Province, China
| | - Yongqiang Yao
- Breast and Thyroid Surgery Ward III, The Affiliated Zhongshan Hospital of Dalian University Dalian 116001, Liaoning Province, China
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8662
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Robertson SA, Jeevaratnam JA, Agrawal A, Cutress RI. Mastectomy skin flap necrosis: challenges and solutions. BREAST CANCER-TARGETS AND THERAPY 2017; 9:141-152. [PMID: 28331365 PMCID: PMC5357072 DOI: 10.2147/bctt.s81712] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Introduction Mastectomy skin flap necrosis (MSFN) has a reported incidence of 5%–30% in the literature. It is often a significant and underappreciated problem. The aim of this article was to review the associated challenges and possible solutions. Methods A MEDLINE search was performed using the search term “mastectomy skin flap necrosis”. Titles and abstracts from peer-reviewed publications were screened for relevance. Results MSFN is a common complication and may present as partial- or full-thickness necrosis. Predictive patient risk factors include smoking, diabetes, obesity, radiotherapy, previous scars and severe medical comorbidity. MSFN leads to a number of challenges, including wound management problems, delays to adjuvant therapy, esthetic compromise, implant extrusion, patient distress and financial loss. Careful preoperative planning and meticulous surgical technique may reduce the incidence of MSFN. A number of intraoperative techniques are available to try and predict skin flaps at risk of MSFN. MSFN may be managed operatively or nonoperatively. Early intervention may reduce the morbidity of MSFN in selected cases. Topical nitroglycerin ointment may be beneficial in reducing MSFN following immediate reconstruction, but the evidence base is still limited. Conclusion MSFN can result in considerable challenges for the patient and the health care service. This review discusses the management options for this problem.
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Affiliation(s)
- Stuart A Robertson
- Department of Surgery, University Hospital Coventry and Warwickshire NHS Trust, Coventry
| | - Johann A Jeevaratnam
- Department of Breast Surgery, Portsmouth Hospitals NHS Trust, Cosham, Portsmouth
| | - Avi Agrawal
- Department of Breast Surgery, Portsmouth Hospitals NHS Trust, Cosham, Portsmouth
| | - Ramsey I Cutress
- Department of Breast Surgery, University Hospital Southampton NHS Foundation Trust, Princess Anne Hospital; Somers Cancer Research UK Centre, Southampton General Hospital Southampton, UK
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8663
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Vetshev PS, Yankin PL, Zhivotov VA, Poddubnyi EI, Drozzin AY, Bondarev NS, Korol VV, Maady AS, Vasilev IV, Alekseev KI, Osipov AS, Apostolidi KG, Savchuk OV, Shirokova NV, Krastyn EA, Balan BA. Ultrasonography of the larynx for diagnosis of the vocal folds mobility impairment. ENDOCRINE SURGERY 2017. [DOI: 10.14341/serg201635-14] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Purpose. To study a possibility of performance and diagnostic accuracy of ultrasonography (US) of a larynx in identification of motility disorders of VF (vocal folds) in comparison with the laryngoscope which is traditionally applied for this purpose.Materials and methods. According to the objectives of the study, two patient groups were formed. In first group of patients (n = 466) we studied acceptability of ultrasonografy to discriminate various laryngeal structures. In second group of patient (n = 432) we evaluated the diagnostic accuracy of ultrasonography in point of detection of vocal muscles paresis.Results. Laryngeal structures were available to examination by ultrasound (without taking in account age and sex) in 92.7% of patients. Two patterns have been identified in the course of this part of the study: deterioration of visibility of the vocal folds with increasing patient age and better visibility of the vocal folds in women than in men. According to the comparative analysis, ultrasonography accuracy rate (in those patients who had had clearly visible vocal folds during ultrasonography) did not differ from that during videolaryngoscopy.Conclusion. During the conducted research it was found that the US of the larynx is an effective and perspective method for detection of a paresis of VF with sensitivity and specificity 93,55% and 100% respectively. Among those patients who' VF are available to ultrasound evaluation the accuracy of method is comparable with a videolaryngoscopy and can be used with success in daily work of units of endocrine surgery.
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8664
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Improved Outcomes with Pedicled Nipple-sparing Mastectomies Using a New Surgical Delay: Mastectomy through Wise Incisions. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2017; 5:e1259. [PMID: 28458973 PMCID: PMC5404444 DOI: 10.1097/gox.0000000000001259] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2016] [Accepted: 01/13/2017] [Indexed: 11/26/2022]
Abstract
Nipple-sparing mastectomy (NSM) is challenging in patients with significant ptosis and skin excess. We previously described the first use of a surgical delay (a supraareolar incision with undermining off the breast mound) to facilitate a second-stage pedicled NSM and reconstruction. Here, we present an improvement in our surgical delay technique—a total skin and NSM through Wise incisions. This technique obviates concerns regarding delays in cancer care and more aggressively delays the nipple, allowing for more reliable and extreme NAC transpositions. This strategy also delays the Wise pattern flaps resulting in better wound healing, which is critical in implant-based reconstructions.
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8665
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Anatomical basis of the extended TDAP flap: study of its territories of vascularization and its volume. Surg Radiol Anat 2017; 39:821-826. [PMID: 28260217 DOI: 10.1007/s00276-016-1811-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2016] [Accepted: 12/30/2016] [Indexed: 10/20/2022]
Abstract
INTRODUCTION The concept of extended thoracodorsal artery perforator (TDAP) flap was described in 2015 for breast reconstruction. Our anatomical study aims to identify the territories vascularised by the thoracodorsal artery perforator via the deep muscular fascial network. The second goal was to define the volume of the extended TDAP flap. MATERIALS AND METHOD Ten extended TDAP flaps were dissected on 5 fresh human cadavers. Around the classical skin paddle of a TDAP flap, the dissections were performed in a subfascial level, including the muscular fascia and the adipose tissue compartments to increase the volume of the flap. After injection of methylene blue in the thoracodorsal artery, we measured the length and width, the surface and the volume of the coloured flap. RESULTS The mean sizes of the extended TDAP flap were 24.9 cm × 20.1 cm. The mean surface of the total vascularization zone was 441 cm2. The mean volume of the vascularized flap was 193 ml. CONCLUSION The thoracodorsal artery perforator via the deep muscular fascial network allows us to harvest a flap of 25 cm × 20 cm with a mean surface of 441 cm² and a mean volume of 193 ml. The extended TDAP flap is a credible option in breast reconstruction.
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8666
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Yao X, Gan Y, Chang E, Hibshoosh H, Feldman S, Hendon C. Visualization and tissue classification of human breast cancer images using ultrahigh-resolution OCT. Lasers Surg Med 2017; 49:258-269. [PMID: 28264146 DOI: 10.1002/lsm.22654] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/08/2017] [Indexed: 12/31/2022]
Abstract
BACKGROUND AND OBJECTIVE Breast cancer is one of the most common cancers, and recognized as the third leading cause of mortality in women. Optical coherence tomography (OCT) enables three dimensional visualization of biological tissue with micrometer level resolution at high speed, and can play an important role in early diagnosis and treatment guidance of breast cancer. In particular, ultra-high resolution (UHR) OCT provides images with better histological correlation. This paper compared UHR OCT performance with standard OCT in breast cancer imaging qualitatively and quantitatively. Automatic tissue classification algorithms were used to automatically detect invasive ductal carcinoma in ex vivo human breast tissue. STUDY DESIGN/MATERIALS AND METHODS Human breast tissues, including non-neoplastic/normal tissues from breast reduction and tumor samples from mastectomy specimens, were excised from patients at Columbia University Medical Center. The tissue specimens were imaged by two spectral domain OCT systems at different wavelengths: a home-built ultra-high resolution (UHR) OCT system at 800 nm (measured as 2.72 μm axial and 5.52 μm lateral) and a commercial OCT system at 1,300 nm with standard resolution (measured as 6.5 μm axial and 15 μm lateral), and their imaging performances were analyzed qualitatively. Using regional features derived from OCT images produced by the two systems, we developed an automated classification algorithm based on relevance vector machine (RVM) to differentiate hollow-structured adipose tissue against solid tissue. We further developed B-scan based features for RVM to classify invasive ductal carcinoma (IDC) against normal fibrous stroma tissue among OCT datasets produced by the two systems. For adipose classification, 32 UHR OCT B-scans from 9 normal specimens, and 28 standard OCT B-scans from 6 normal and 4 IDC specimens were employed. For IDC classification, 152 UHR OCT B-scans from 6 normal and 13 IDC specimens, and 104 standard OCT B-scans from 5 normal and 8 IDC specimens were employed. RESULTS We have demonstrated that UHR OCT images can produce images with better feature delineation compared with images produced by 1,300 nm OCT system. UHR OCT images of a variety of tissue types found in human breast tissue were presented. With a limited number of datasets, we showed that both OCT systems can achieve a good accuracy in identifying adipose tissue. Classification in UHR OCT images achieved higher sensitivity (94%) and specificity (93%) of adipose tissue than the sensitivity (91%) and specificity (76%) in 1,300 nm OCT images. In IDC classification, similarly, we achieved better results with UHR OCT images, featured an overall accuracy of 84%, sensitivity of 89% and specificity of 71% in this preliminary study. CONCLUSION In this study, we provided UHR OCT images of different normal and malignant breast tissue types, and qualitatively and quantitatively studied the texture and optical features from OCT images of human breast tissue at different resolutions. We developed an automated approach to differentiate adipose tissue, fibrous stroma, and IDC within human breast tissues. Our work may open the door toward automatic intraoperative OCT evaluation of early-stage breast cancer. Lasers Surg. Med. 49:258-269, 2017. © 2017 Wiley Periodicals, Inc.
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Affiliation(s)
- Xinwen Yao
- Departmentof Electrical Engineering, Columbia University, New York, New York, 10027
| | - Yu Gan
- Departmentof Electrical Engineering, Columbia University, New York, New York, 10027
| | - Ernest Chang
- Columbia University College of Physicians and Surgeons, New York, New York, 10027
| | - Hanina Hibshoosh
- Columbia University College of Physicians and Surgeons, New York, New York, 10027
| | - Sheldon Feldman
- Columbia University College of Physicians and Surgeons, New York, New York, 10027
| | - Christine Hendon
- Departmentof Electrical Engineering, Columbia University, New York, New York, 10027
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8667
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Szabo J, Garcia D, Ciomek N, Margolies L. Spuriously aggressive features of a lactating adenoma prompting repeated biopsies. Radiol Case Rep 2017; 12:215-218. [PMID: 28491154 PMCID: PMC5417739 DOI: 10.1016/j.radcr.2017.01.019] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2016] [Accepted: 01/28/2017] [Indexed: 11/26/2022] Open
Abstract
We present an atypical presentation of a common pregnancy-related breast mass, a lactating adenoma with imaging and pathologic correlation. The patient presented with a rapidly enlarging left breast mass associated with skin changes and severe pain in the perinatal period. Core biopsies were considered discordant, and the patient went on to surgical excision for the definitive diagnosis of an infarcted lactating adenoma. The symptoms of infarction may obscure the diagnosis of common entities and result in additional evaluation.
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Affiliation(s)
- Janet Szabo
- Department of Radiology, Icahn School of Medicine at Mount Sinai, 1 Gustave Levy Place, New York, NY 10029
| | - Dairon Garcia
- Department of Radiology, Icahn School of Medicine at Mount Sinai, 1 Gustave Levy Place, New York, NY 10029
| | - Natalie Ciomek
- Department of Pathology, Icahn School of Medicine at Mount Sinai, New York, NY 10029
| | - Laurie Margolies
- Department of Radiology, Icahn School of Medicine at Mount Sinai, 1 Gustave Levy Place, New York, NY 10029
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8668
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Razdan SN, Cordeiro PG, Albornoz CR, Disa JJ, Panchal HJ, Ho AY, Momoh AO, Matros E. National Breast Reconstruction Utilization in the Setting of Postmastectomy Radiotherapy. J Reconstr Microsurg 2017; 33:312-317. [PMID: 28235218 DOI: 10.1055/s-0037-1598201] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Background Immediate breast reconstruction (IBR) is often deferred, when postmastectomy radiotherapy (PMRT) is anticipated, due to high complication rates. Nonetheless, because of robust data supporting improved health-related quality of life associated with reconstruction, physicians and patients may be more accepting of tradeoffs. The current study explores national trends of IBR utilization rates and methods in the setting of PMRT, using the National Cancer Database (NCDB). The study hypothesis is that prosthetic techniques have become the most common method of IBR in the setting of PMRT. Methods NCDB was queried from 2004 to 2013 for women, who underwent mastectomy with or without IBR. Patients were grouped according to PMRT status. Multivariate logistic regression was used to calculate odds of IBR in the setting of PMRT. Trend analyses were done for rates and methods of IBR using Poisson regression to determine incidence rate ratios (IRRs). Results In multivariate analysis, radiated patients were 30% less likely to receive IBR (p < 0.05). The rate increase in IBR was greater in radiated compared with nonradiated patients (IRR: 1.12 vs. 1.09). Rates of reconstruction increased more so in radiated compared with nonradiated patients for both implants (IRR 1.15 vs. 1.11) and autologous techniques (IRR 1.08 vs. 1.06). Autologous reconstructions were more common in those receiving PMRT until 2005 (p < 0.05), with no predominant technique thereafter. Conclusion Although IBR remains a relative contraindication, rates of IBR are increasing to a greater extent in patients receiving PMRT. Implants have surpassed autologous techniques as the most commonly used method of breast reconstruction in this setting.
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Affiliation(s)
- Shantanu N Razdan
- Division of Plastic and Reconstructive Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Peter G Cordeiro
- Division of Plastic and Reconstructive Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Claudia R Albornoz
- Division of Plastic and Reconstructive Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Joseph J Disa
- Division of Plastic and Reconstructive Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Hina J Panchal
- Division of Plastic and Reconstructive Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Alice Y Ho
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Adeyiza O Momoh
- Division of Plastic and Reconstructive Surgery, University of Michigan Health System, Ann Arbor, Michigan
| | - Evan Matros
- Division of Plastic and Reconstructive Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
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8669
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Autoimmune Pancreatitis Masquerading as Pancreatic Cancer: when in Doubt, Cut It Out. J Gastrointest Cancer 2017; 49:365-372. [PMID: 28197777 DOI: 10.1007/s12029-017-9924-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
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8670
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Phrenic nerve stimulation during neck dissection for advanced thyroid cancer involving level IV: is it worth doing it? Updates Surg 2017; 69:83-87. [PMID: 28194664 DOI: 10.1007/s13304-016-0411-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2016] [Accepted: 11/27/2016] [Indexed: 10/20/2022]
Abstract
During thyroidectomy and neck dissection surgery for advanced or recurrent metastatic thyroid cancer under intraoperative monitoring, we used the available technology to assess the feasibility of such an intervention to monitor those patients with phrenic nerves at risk. A retrospective review of patients operated on from January 2009 to December 2015 by a single surgeon (CSD) was conducted. Patients who had neck and mediastinal dissection, with or without total thyroidectomy, due to advanced or recurrent metastatic disease to the neck were selected. The procedures were done under intraoperative nerve monitoring using nerve monitoring systems (NIM 2.0 or 3.0; Medtronic, Jacksonville, FL, USA). A total of 19 patients were included in the study, with a mean age of 57.6 years ± 16.3 and a male/female ratio of 10:9. Overall, all patients had an intact phrenic nerve at the conclusion of the surgery. One patient had an aggressive tumor that precluded sacrifice of the left recurrent laryngeal nerve and ipsilateral thoracic duct. The procedure was complicated by a temporary impairment of the diaphragm contraction with intraoperative nerve monitoring as well as a chyle fistula. This was due to the manipulation of the tissue surrounding the phrenic nerve. Intraoperative nerve monitoring of the phrenic nerve offers the surgeon a "potential" method of ensuring phrenic nerve integrity in cases of advanced thyroid cancers with gross level IV metastatic disease. Further prospective studies are needed to assess the risks of this intervention and evaluate the method of recording diaphragm contraction movement.
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8671
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Vanderpuye V, Grover S, Hammad N, PoojaPrabhakar, Simonds H, Olopade F, Stefan DC. An update on the management of breast cancer in Africa. Infect Agent Cancer 2017; 12:13. [PMID: 28228841 PMCID: PMC5307840 DOI: 10.1186/s13027-017-0124-y] [Citation(s) in RCA: 98] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2016] [Accepted: 02/03/2017] [Indexed: 01/04/2023] Open
Abstract
Background There is limited information about the challenges of cancer management and attempts at improving outcomes in Africa. Even though South and North Africa are better resourceds to tackle the burden of breast cancer, similar poor prognostic factors are common to all countries. The five-year overall Survival rate for breast cancer patients does not exceed 60% for any low and middle-income country (LMIC) in Africa. In spite of the gains achieved over the past decade, certain characteristics remain the same such as limited availability of breast conservation therapies, inadequate access to drugs, few oncology specialists and adherence to harmful socio-cultural practices. This review on managing breast cancer in Africa is authored by African oncologists who practice or collaborate in Africa and with hands-on experience with the realities. Methods A search was performed via electronic databases from 1999 to 2016. (PubMed/Medline, African Journals Online) for all literature in English or translated into English, covering the terms “breast cancer in Africa and developing countries”. One hundred ninety were deemed appropriate. Results Breast tumors are diagnosed at earlier ages and later stages than in highincome countries. There is a higher prevalence of triple-negative cancers. The limitations of poor nursing care and surgery, inadequate access to radiotherapy, poor availability of basic and modern systemic therapies translate into lower survival rate. Positive strides in breast cancer management in Africa include increased adaptation of treatment guidelines, improved pathology services including immuno-histochemistry, expansion and upgrading of radiotherapy equipment across the continent in addition to more research opportunities. Conclusion This review is an update of the management of breast cancer in Africa, taking a look at the epidemiology, pathology, management resources, outcomes, research and limitations in Africa from the perspective of oncologists with local experience.
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Affiliation(s)
- V Vanderpuye
- National center for Radiotherapy and Nuclear Medicine, Korle-Bu Teaching Hospital, Accra, Ghana
| | - S Grover
- Hospital of University of Pennsylvania, Department of Radiation Oncology, (Botswana-UPENN program), 3400 Civic Center Blvd., Philadelphia, PA 19104 USA
| | - N Hammad
- Cancer Centre of Southeastern Ontario, Burr 2, Kingston General Hospital, 25 King Street W, Kingston, ON K7L 5P9 Canada
| | - PoojaPrabhakar
- University of Texas Southwestern Medical Center, Dallas, TX USA
| | - H Simonds
- Division of Radiation Oncology, Tygerberg Hospital/University of Stellenbosch, Tygerberg, South Africa
| | - F Olopade
- The University of Chicago, 5841 S Maryland Avenue, MC 2115, Chicago, IL 60637 USA
| | - D C Stefan
- Walter Sisulu University Nelson Mandela Dr, Nelson Mandela Drive, Mthatha, 5100 Eastern Cape South Africa
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8672
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Luo G, Liu C, Cheng H, Jin K, Guo M, Lu Y, Long J, Xu J, Ni Q, Chen J, Yu X. Neutrophil-lymphocyte ratio predicts survival in pancreatic neuroendocrine tumors. Oncol Lett 2017; 13:2454-2458. [PMID: 28454419 DOI: 10.3892/ol.2017.5716] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2016] [Accepted: 01/31/2017] [Indexed: 12/15/2022] Open
Abstract
Although the prognostic role of neutrophil-lymphocyte ratio (NLR) has been confirmed in a variety of tumors, the prognostic role of NLR in pancreatic neuroendocrine tumors (PNETs) has not been examined. The present study was performed to assess the role of NLR as a prognostic factor in patients with PNETs. Clinical data were retrospectively retrieved from a single institution. The best cut-off value for baseline NLR levels was determined by the receiver operating characteristic (ROC) curve and area under the ROC curve. The primary event was overall survival and event times were assessed by the Kaplan-Meier method. Potential factors associated with the elevation of NLR in PNETs were examined. A total of 165 consecutive patients with pathologically confirmed PNETs were included in this study. The cutoff value of NLR was 2.4 by ROC curve (area under ROC curve, 0.70). NLR >2.4 was found to be a poor prognostic factor in the univariate and multivariate analyses. Patients with a NLR value >2.4 had a higher proportion of tumor size at >3 cm (P=0.001), TNM stage III or IV (P=0.019), and G2/G3 (P=0.003). We concluded that NLR is an independent predictor of overall survival for patients with PNETs. Aberrant elevation of NLR identifies high-risk patients with aggressive characteristics.
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Affiliation(s)
- Guopei Luo
- Department of Pancreatic Surgery, Fudan University Shanghai Cancer Center, Shanghai 200032, P.R. China.,Department of Oncology, Shanghai Medical College of Fudan University, Shanghai 200032, P.R. China.,Pancreatic Cancer Institute, Fudan University, Shanghai 200032, P.R. China
| | - Chen Liu
- Department of Pancreatic Surgery, Fudan University Shanghai Cancer Center, Shanghai 200032, P.R. China.,Department of Oncology, Shanghai Medical College of Fudan University, Shanghai 200032, P.R. China.,Pancreatic Cancer Institute, Fudan University, Shanghai 200032, P.R. China
| | - He Cheng
- Department of Pancreatic Surgery, Fudan University Shanghai Cancer Center, Shanghai 200032, P.R. China.,Department of Oncology, Shanghai Medical College of Fudan University, Shanghai 200032, P.R. China.,Pancreatic Cancer Institute, Fudan University, Shanghai 200032, P.R. China
| | - Kaizhou Jin
- Department of Pancreatic Surgery, Fudan University Shanghai Cancer Center, Shanghai 200032, P.R. China.,Department of Oncology, Shanghai Medical College of Fudan University, Shanghai 200032, P.R. China.,Pancreatic Cancer Institute, Fudan University, Shanghai 200032, P.R. China
| | - Meng Guo
- Department of Pancreatic Surgery, Fudan University Shanghai Cancer Center, Shanghai 200032, P.R. China.,Department of Oncology, Shanghai Medical College of Fudan University, Shanghai 200032, P.R. China.,Pancreatic Cancer Institute, Fudan University, Shanghai 200032, P.R. China
| | - Yu Lu
- Department of Pancreatic Surgery, Fudan University Shanghai Cancer Center, Shanghai 200032, P.R. China.,Department of Oncology, Shanghai Medical College of Fudan University, Shanghai 200032, P.R. China.,Pancreatic Cancer Institute, Fudan University, Shanghai 200032, P.R. China
| | - Jiang Long
- Department of Pancreatic Surgery, Fudan University Shanghai Cancer Center, Shanghai 200032, P.R. China.,Department of Oncology, Shanghai Medical College of Fudan University, Shanghai 200032, P.R. China.,Pancreatic Cancer Institute, Fudan University, Shanghai 200032, P.R. China
| | - Jin Xu
- Department of Pancreatic Surgery, Fudan University Shanghai Cancer Center, Shanghai 200032, P.R. China.,Department of Oncology, Shanghai Medical College of Fudan University, Shanghai 200032, P.R. China.,Pancreatic Cancer Institute, Fudan University, Shanghai 200032, P.R. China
| | - Quanxing Ni
- Department of Pancreatic Surgery, Fudan University Shanghai Cancer Center, Shanghai 200032, P.R. China.,Department of Oncology, Shanghai Medical College of Fudan University, Shanghai 200032, P.R. China.,Pancreatic Cancer Institute, Fudan University, Shanghai 200032, P.R. China
| | - Jie Chen
- Department of Gastroenterology, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, Guangdong 510080, P.R. China
| | - Xianjun Yu
- Department of Pancreatic Surgery, Fudan University Shanghai Cancer Center, Shanghai 200032, P.R. China.,Department of Oncology, Shanghai Medical College of Fudan University, Shanghai 200032, P.R. China.,Pancreatic Cancer Institute, Fudan University, Shanghai 200032, P.R. China
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8673
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The Association of Discolored Parathyroid Glands and Hypoparathyroidism Following Total Thyroidectomy. World J Surg 2017; 40:1611-7. [PMID: 26908241 DOI: 10.1007/s00268-016-3462-9] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
BACKGROUND It remains uncertain whether a parathyroid gland (PG) that appears darkened or severely bruised but still has an attached vascular pedicle should be left in situ or taken out and auto-transplanted following total thyroidectomy. Our study aimed to examine the impact of discolored PGs (DPGs) on short- and long-term hypoparathyroidism. METHODS One hundred and three patients who underwent total thyroidectomy with 4 clearly identified PGs were analyzed. Location (superior/inferior) and color of each PG were recorded. Patients without DPG were grouped into I while those with 1-2 DPGs and ≥3 DPGs were grouped into II and III, respectively. Transient hypoparathyroidism meant adjusted Ca <2.00 mol/L 24 h after surgery and/or need for supplements. Protracted hypoparathyroidism meant a subnormal PTH at 4-6 weeks and/or supplements >6 weeks. Permanent hypoparathyroidism meant supplements ≥1 year. RESULTS Relative to I, group III had greater adjusted Ca drop at postoperative 1-h (p = 0.012), 24-h (p < 0.001) and lower day-1 PTH (p = 0.015). Having ≥3 DPGs (OR 14.00, 95 % CI 1.575-124.474, p = 0.018) was an independent factor of transient hypoparathyroidism. However, permanent hypoparathyroidism rate was higher than in group I than II (p = 0.019). Eight patients (25.8 %) in group I had undetectable day-1 PTH, while none in group III had undetectable day-1 PTH. Graves' disease/toxic goiter (OR 15.166, 95 % CI 2.594-88.661, p = 0.003) and excised gland weight (OR 1.028, 95 % CI 1.010-1.046, p = 0.003) were independent factors of ≥3 DPGs. CONCLUSIONS PG discoloration is associated with transient hypoparathyroidism while normal colored PG with seemingly adequate blood supply does not always imply functionally normal gland. These findings highlights the need for a real-time intraoperative method to assess PG viability.
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8674
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Berná-Serna JDD, Guzmán-Aroca F, Berná-Mestre JDD, Hernández-Gómez D. A new method for the prevention of skin laceration during vacuum-assisted breast biopsy. Br J Radiol 2017; 90:20160866. [PMID: 28181826 DOI: 10.1259/bjr.20160866] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE To describe a new technique to prevent skin laceration during ultrasound-guided vacuum-assisted breast biopsy with the insertion of a spinal needle between the mass and the skin. METHODS The study includes 118 patients with 118 breast imaging-reporting and data system Category 3 masses located very close to the skin or areola, which were excised using the mammotome system with a spinal needle inserted just above the site of insertion of the probe. RESULTS The mean distance between the most superficial portion of the mass to the under surface of the overlying skin was 1.3 ± 0.4 mm. The average procedure time was 13.5 ± 4.2 min. A complete excision was achieved in 100% of the cases, and the procedure was well tolerated by all the patients. No patient experienced serious adverse events such as a skin laceration. CONCLUSION This is the first study to prevent skin laceration during vacuum assisted breast biopsy. Advances in knowledge: The method described in this study is simple, safe and well tolerated by patients.
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Affiliation(s)
- Juan de D Berná-Serna
- Department of Radiology, Virgen de la Arrixaca Clinical University Hospital, El Palmar (Murcia), Spain
| | - Florentina Guzmán-Aroca
- Department of Radiology, Virgen de la Arrixaca Clinical University Hospital, El Palmar (Murcia), Spain
| | - Juan de D Berná-Mestre
- Department of Radiology, Virgen de la Arrixaca Clinical University Hospital, El Palmar (Murcia), Spain
| | - Dolores Hernández-Gómez
- Department of Radiology, Virgen de la Arrixaca Clinical University Hospital, El Palmar (Murcia), Spain
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8675
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Du Y, Wu J, Zhang H, Li S, Sun H. Reduced expression of SIRT2 in serous ovarian carcinoma promotes cell proliferation through disinhibition of CDK4 expression. Mol Med Rep 2017; 15:1638-1646. [PMID: 28259910 PMCID: PMC5365020 DOI: 10.3892/mmr.2017.6183] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2015] [Accepted: 12/01/2016] [Indexed: 12/02/2022] Open
Abstract
The silent information regulator 2 related enzyme 2 (SIRT2) has been reported to have an important role in tumorigenesis. Although two distinct effects of SIRT2 have recently been revealed, which explain opposing expression patterns in different types of cancer, the specific function of SIRT2 in ovarian cancer remains unknown. The present study investigated the expression of SIRT2 in serous ovarian carcinoma (SOC) and its pathogenic mechanism. It was observed that SIRT2 expression in SOC was significantly downregulated when compared with ovarian surface epithelium via western blot and immunohistochemistry. Statistical analysis revealed that attenuated expression of SIRT2 was associated with the International Federation of Gynecology and Obstetrics classification of ovarian cancer. Reduced SIRT2 expression during tumorigenesis failed to repress cyclin-dependent kinase 4 expression, which eventually led to accelerated cell proliferation. Furthermore, the wound healing assay and Transwell assay determined that reduced expression of SIRT2 promoted SOC cell migration and invasion. In conclusion, the results of the current study suggest that SIRT2 has a tumor-suppressor function in ovarian cells and it might be a viable target for further SOC treatment.
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Affiliation(s)
- Yanhua Du
- Department of Gynecology, Obstetrics and Gynecology Hospital of Fudan University, P.R. China
| | - Jun Wu
- Pathology Center, Shanghai General Hospital/Faculty of Basic Medicine, Shanghai Jiaotong University School of Medicine, Shanghai 200025, P.R. China
| | - Haiyan Zhang
- Department of Gynecology, Obstetrics and Gynecology Hospital of Fudan University, P.R. China
| | - Shaobo Li
- Pathology Center, Shanghai General Hospital/Faculty of Basic Medicine, Shanghai Jiaotong University School of Medicine, Shanghai 200025, P.R. China
| | - Hong Sun
- Department of Gynecology, Obstetrics and Gynecology Hospital of Fudan University, P.R. China
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8676
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Trupe LA, Rositch A, Dickerson L, Lucas S, Harvey SC. Knowledge and Attitudes About Breast Cancer in Limpopo, South Africa. J Glob Oncol 2017; 3:509-514. [PMID: 29094090 PMCID: PMC5646900 DOI: 10.1200/jgo.2016.008102] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Purpose Breast cancer survival is unacceptably low in many low-resource settings, including rural South Africa, where access to screening and treatment services is limited. To describe the context for implementing an early detection program, we assessed knowledge and attitudes toward breast cancer risk, early detection, and treatment. Methods We conducted a cross-sectional survey among 243 women presenting to Hlokomela Clinic in Hoedspruit, South Africa, during April and May 2016. We used quantitative and qualitative analyses to determine levels of knowledge of risk factors, symptoms, and treatment of breast cancer, as well as experience with and attitudes toward detection and treatment methods. Results Thirty-one percent of women correctly identified at least six of 12 risk factors for breast cancer, and 53.1% identified breast lumps as an important symptom. Although > 97% of women stated that self–breast examination and early detection were highly important and that they would seek care for changes in their breasts, only 33.3% of women reported performing self–breast examination, and only 24.3% reported receiving a clinical breast examination. Age and education were not associated with knowledge, and level of knowledge did not predict care-seeking behaviors or attitudes. Conclusion Although women demonstrated moderate levels of knowledge of breast cancer symptoms and risk factors and the importance of early detection, few women reported seeking services. These data demonstrate sufficient levels of knowledge and positive attitudes toward care seeking and suggest both a need and readiness for increased access to cost-effective services to facilitate early diagnosis and improved outcomes.
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Affiliation(s)
- Lydia A Trupe
- , University of Cape Town School of Public Health and Family Medicine, Cape Town; , University of Witwatersrand School of Medicine and Chris Hani Baragwanath Academic Hospital, Johannesburg, South Africa; , Johns Hopkins Bloomberg School of Public Health; and , Johns Hopkins University School of Medicine; and , Johns Hopkins Hospital, Baltimore, MD
| | - Anne Rositch
- , University of Cape Town School of Public Health and Family Medicine, Cape Town; , University of Witwatersrand School of Medicine and Chris Hani Baragwanath Academic Hospital, Johannesburg, South Africa; , Johns Hopkins Bloomberg School of Public Health; and , Johns Hopkins University School of Medicine; and , Johns Hopkins Hospital, Baltimore, MD
| | - Lindsay Dickerson
- , University of Cape Town School of Public Health and Family Medicine, Cape Town; , University of Witwatersrand School of Medicine and Chris Hani Baragwanath Academic Hospital, Johannesburg, South Africa; , Johns Hopkins Bloomberg School of Public Health; and , Johns Hopkins University School of Medicine; and , Johns Hopkins Hospital, Baltimore, MD
| | - Su Lucas
- , University of Cape Town School of Public Health and Family Medicine, Cape Town; , University of Witwatersrand School of Medicine and Chris Hani Baragwanath Academic Hospital, Johannesburg, South Africa; , Johns Hopkins Bloomberg School of Public Health; and , Johns Hopkins University School of Medicine; and , Johns Hopkins Hospital, Baltimore, MD
| | - Susan C Harvey
- , University of Cape Town School of Public Health and Family Medicine, Cape Town; , University of Witwatersrand School of Medicine and Chris Hani Baragwanath Academic Hospital, Johannesburg, South Africa; , Johns Hopkins Bloomberg School of Public Health; and , Johns Hopkins University School of Medicine; and , Johns Hopkins Hospital, Baltimore, MD
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8677
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Yan CM. Professor Paolo Miccoli: robotic surgery will become more and more popular. Gland Surg 2017; 5:652-653. [PMID: 28149816 DOI: 10.21037/gs.2016.12.09] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Abstract
Solid tumors are much more common than hematologic malignancies. Although severe and prolonged neutropenia is uncommon, several factors increase the risk of infection in patients with solid tumors, and the presence of multiple risk factors in the same patient is not uncommon. These include obstruction (most often caused by progression of the tumor), disruption of natural anatomic barriers such as the skin and mucosal surfaces, and treatment-related factors such as chemotherapy, radiation, diagnostic and/or therapeutic surgical procedures, and the increasing use of medical devices such as various catheters, stents, and prostheses. Common sites of infection include the skin and skin structures (including surgical site infections), the bloodstream (including infections associated with central venous catheters), the lungs, the hepato-biliary and intestinal tracts, and the urinary tract, and include distinct clinical syndromes such as post-obstructive pneumonia, obstructive uropathy, and neutropenic enterocolitis. The epidemiology of most of these infections is changing with resistant organisms [MRSA, Pseudomonas aeruginosa, extended spectrum beta-lactamase (ESBL)-producing organisms] being isolated more often than in the past. Polymicrobial infections now predominate when deep tissue sites are involved. Conservative management of most of these infections (antibiotics, fluid and electrolyte replacement, bowel rest when needed) is generally effective, with surgical intervention being reserved for the drainage of deep abscesses, or to deal with complications such as intestinal obstruction or hemorrhage. Infected prostheses often need to be removed. Reactivation of certain viral infections (HBV, HCV, and occasionally CMV) has become an important issue, and screening, prevention and treatment strategies are being developed. Infection prevention, infection control, and antimicrobial stewardship are important strategies in the overall management of infections in patients with solid tumors. Occasionally, infections mimic solid tumors and cause diagnostic and therapeutic challenges.
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8679
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Russell JO, Noureldine SI, Al Khadem MG, Chaudhary HA, Day AT, Kim HY, Tufano RP, Richmon JD. Transoral robotic thyroidectomy: a preclinical feasibility study using the da Vinci Xi platform. J Robot Surg 2017; 11:341-346. [PMID: 28155047 DOI: 10.1007/s11701-016-0661-1] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2016] [Accepted: 12/04/2016] [Indexed: 10/20/2022]
Abstract
Transoral thyroid surgery allows the surgeon to conceal incisions within the oral cavity without significantly increasing the amount of required dissection. TORT provides an ideal scarless, midline access to the thyroid gland and bilateral central neck compartments. This approach, however, presents multiple technical challenges. Herein, we present our experience using the latest generation robotic surgical system to accomplish transoral robotic thyroidectomy (TORT). In two human cadavers, the da Vinci Xi surgical system (Intuitive Surgical, Sunnyvale, CA, USA) was used to complete TORT. Total thyroidectomy and bilateral central neck dissection was successfully completed in both cadavers. The da Vinci Xi platform offered several technologic advantages over previous robotic generations including overhead docking, narrower arms, and improved range of motion allowing for improved execution of previously described TORT techniques.
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Affiliation(s)
- Jonathon O Russell
- Department of Otolaryngology-Head and Neck Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Salem I Noureldine
- Department of Otolaryngology-Head and Neck Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Mai G Al Khadem
- Department of Otolaryngology-Head and Neck Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Hamad A Chaudhary
- Department of Otolaryngology-Head and Neck Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Andrew T Day
- Department of Otolaryngology-Head and Neck Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Hoon Yub Kim
- Department of Surgery, Korea University College of Medicine, Seoul, Korea
| | - Ralph P Tufano
- Department of Otolaryngology-Head and Neck Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Jeremy D Richmon
- Department of Otolaryngology-Head and Neck Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD, USA. .,Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Boston, MA, USA.
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8680
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Rodriguez MJ, Brown J, Giordano J, Lin SJ, Omenetto FG, Kaplan DL. Silk based bioinks for soft tissue reconstruction using 3-dimensional (3D) printing with in vitro and in vivo assessments. Biomaterials 2017; 117:105-115. [PMID: 27940389 PMCID: PMC5180454 DOI: 10.1016/j.biomaterials.2016.11.046] [Citation(s) in RCA: 125] [Impact Index Per Article: 17.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2016] [Revised: 11/15/2016] [Accepted: 11/24/2016] [Indexed: 02/07/2023]
Abstract
In the field of soft tissue reconstruction, custom implants could address the need for materials that can fill complex geometries. Our aim was to develop a material system with optimal rheology for material extrusion, that can be processed in physiological and non-toxic conditions and provide structural support for soft tissue reconstruction. To meet this need we developed silk based bioinks using gelatin as a bulking agent and glycerol as a non-toxic additive to induce physical crosslinking. We developed these inks optimizing printing efficacy and resolution for patient-specific geometries that can be used for soft tissue reconstruction. We demonstrated in vitro that the material was stable under physiological conditions and could be tuned to match soft tissue mechanical properties. We demonstrated in vivo that the material was biocompatible and could be tuned to maintain shape and volume up to three months while promoting cellular infiltration and tissue integration.
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Affiliation(s)
- María J Rodriguez
- Department of Biomedical Engineering, Tufts University, Medford, MA, USA
| | - Joseph Brown
- Department of Biomedical Engineering, Tufts University, Medford, MA, USA
| | - Jodie Giordano
- Department of Biomedical Engineering, Tufts University, Medford, MA, USA
| | - Samuel J Lin
- Division of Plastic and Reconstructive Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, 02215, USA
| | | | - David L Kaplan
- Department of Biomedical Engineering, Tufts University, Medford, MA, USA.
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8681
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Stegehuis PL, Boogerd LSF, Inderson A, Veenendaal RA, van Gerven P, Bonsing BA, Sven Mieog J, Amelink A, Veselic M, Morreau H, van de Velde CJH, Lelieveldt BPF, Dijkstra J, Robinson DJ, Vahrmeijer AL. Toward optical guidance during endoscopic ultrasound-guided fine needle aspirations of pancreatic masses using single fiber reflectance spectroscopy: a feasibility study. JOURNAL OF BIOMEDICAL OPTICS 2017; 22:24001. [PMID: 28170030 DOI: 10.1117/1.jbo.22.2.024001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/16/2016] [Accepted: 01/12/2017] [Indexed: 05/04/2023]
Abstract
Endoscopic ultrasound-guided fine needle aspirations (EUS-FNA) of pancreatic masses suffer from sample errors and low-negative predictive values. Fiber-optic spectroscopy in the visible to near-infrared wavelength spectrum can noninvasively extract physiological parameters from tissue and has the potential to guide the sampling process and reduce sample errors. We assessed the feasibility of single fiber (SF) reflectance spectroscopy measurements during EUS-FNA of pancreatic masses and its ability to distinguish benign from malignant pancreatic tissue. A single optical fiber was placed inside a 19-gauge biopsy needle during EUS-FNA and at least three reflectance measurements were taken prior to FNA. Spectroscopy measurements did not cause any related adverse events and prolonged procedure time with ? 5 ?? min . An accurate correlation between spectroscopy measurements and cytology could be made in nine patients (three benign and six malignant). The oxygen saturation and bilirubin concentration were significantly higher in benign tissue compared with malignant tissue (55% versus 21%, p = 0.038 ; 166 ?? ? mol / L versus 17 ?? ? mol / L , p = 0.039 , respectively). To conclude, incorporation of SF spectroscopy during EUS-FNA was feasible, safe, and relatively quick to perform. The optical properties of benign and malignant pancreatic tissue are different, implying that SF spectroscopy can potentially guide the FNA sampling.
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Affiliation(s)
- Paulien L Stegehuis
- Leiden University Medical Center, Department of Surgery, Leiden, The NetherlandsbLeiden University Medical Center, Department of Radiology, Leiden, The Netherlands
| | - Leonora S F Boogerd
- Leiden University Medical Center, Department of Surgery, Leiden, The Netherlands
| | - Akin Inderson
- Leiden University Medical Center, Department of Gastroenterology and Hepatology, Leiden, The Netherlands
| | - Roeland A Veenendaal
- Leiden University Medical Center, Department of Gastroenterology and Hepatology, Leiden, The Netherlands
| | - P van Gerven
- Leiden University Medical Center, Department of Surgery, Leiden, The Netherlands
| | - Bert A Bonsing
- Leiden University Medical Center, Department of Surgery, Leiden, The Netherlands
| | - J Sven Mieog
- Leiden University Medical Center, Department of Surgery, Leiden, The Netherlands
| | - Arjen Amelink
- Netherlands Organisation for Applied Scientific Research TNO, Department of Optics, Delft, The Netherlands
| | - Maud Veselic
- Leiden University Medical Center, Department of Pathology, Leiden, The Netherlands
| | - Hans Morreau
- Leiden University Medical Center, Department of Pathology, Leiden, The Netherlands
| | | | | | - Jouke Dijkstra
- Leiden University Medical Center, Department of Radiology, Leiden, The Netherlands
| | - Dominic J Robinson
- Center for Optical Diagnostics and Therapy, Department of Otolaryngology and Head and Neck Surgery, Erasmus MC, Rotterdam, The Netherlands
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8682
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Weinberger P, Ponny SR, Xu H, Bai S, Smallridge R, Copland J, Sharma A. Cell Cycle M-Phase Genes Are Highly Upregulated in Anaplastic Thyroid Carcinoma. Thyroid 2017; 27:236-252. [PMID: 27796151 PMCID: PMC5314727 DOI: 10.1089/thy.2016.0285] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND Anaplastic thyroid carcinoma (ATC) accounts for only 3% of thyroid cancers, yet strikingly, it accounts for almost 40% of thyroid cancer deaths. Currently, no effective therapies exist. In an effort to identify ATC-specific therapeutic targets, we analyzed global gene expression data from multiple studies to identify ATC-specific dysregulated genes. METHODS The National Center for Biotechnology Information Gene Expression Omnibus database was searched for high-throughput gene expression microarray studies from human ATC tissue along with normal thyroid and/or papillary thyroid cancer (PTC) tissue. Gene expression levels in ATC were compared with normal thyroid or PTC using seven separate comparisons, and an ATC-specific gene set common in all seven comparisons was identified. We investigated these genes for their biological functions and pathways. RESULTS There were three studies meeting inclusion criteria, (including 32 ATC patients, 69 PTC, and 75 normal). There were 259 upregulated genes and 286 downregulated genes in ATC with at least two-fold change in all seven comparisons. Using a five-fold filter, 36 genes were upregulated in ATC, while 40 genes were downregulated. Of the 10 top globally upregulated genes in ATC, 4/10 (MMP1, ANLN, CEP55, and TFPI2) are known to play a role in ATC progression; however, 6/10 genes (TMEM158, CXCL5, E2F7, DLGAP5, MME, and ASPM) had not been specifically implicated in ATC. Similarly, 3/10 (SFTA3, LMO3, and C2orf40) of the most globally downregulated genes were novel in this context, while 7/10 genes (SLC26A7, TG, TSHR, DUOX2, CDH1, PDE8B, and FOXE1) have been previously identified in ATC. We experimentally validated a significant correlation for seven transcription factors (KLF16, SP3, ETV6, FOXC1, SP1, EGFR1, and MAFK) with the ATC-specific genes using microarray analysis of ATC cell lines. Ontology clustering of globally altered genes revealed that "mitotic cell cycle" is highly enriched in the globally upregulated gene set (44% of top upregulated genes, p-value <10-30). CONCLUSIONS By focusing on globally altered genes, we have identified a set of consistently altered biological processes and pathways in ATC. Our data are consistent with an important role for M-phase cell cycle genes in ATC, and may provide direction for future studies to identify novel therapeutic targets for this disease.
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Affiliation(s)
- Paul Weinberger
- Center for Biotechnology and Genomic Medicine, Medical College of Georgia at Augusta University, Augusta, Georgia
- Department of Otolaryngology, Medical College of Georgia at Augusta University, Augusta, Georgia
- Augusta University Cancer Center, Medical College of Georgia at Augusta University, Augusta, Georgia
| | - Sithara Raju Ponny
- Center for Biotechnology and Genomic Medicine, Medical College of Georgia at Augusta University, Augusta, Georgia
| | - Hongyan Xu
- Department of Biostatistics and Epidemiology, Medical College of Georgia at Augusta University, Augusta, Georgia
| | - Shan Bai
- Center for Biotechnology and Genomic Medicine, Medical College of Georgia at Augusta University, Augusta, Georgia
| | | | - John Copland
- Department of Cancer Biology, Mayo Clinic, Jacksonville, Florida
| | - Ashok Sharma
- Center for Biotechnology and Genomic Medicine, Medical College of Georgia at Augusta University, Augusta, Georgia
- Department of Biostatistics and Epidemiology, Medical College of Georgia at Augusta University, Augusta, Georgia
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8683
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Han Q, Deng M, Lv Y, Dai G. Survival of patients with advanced pancreatic cancer after iodine125 seeds implantation brachytherapy: A meta-analysis. Medicine (Baltimore) 2017; 96:e5719. [PMID: 28151849 PMCID: PMC5293412 DOI: 10.1097/md.0000000000005719] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Brachytherapy with iodine-labeled seeds (I-seeds) implantation is increasingly being used to treat tumors because of its positional precision, minimal invasion, least damage to noncancerous tissue due to slow and continuous release of radioactivity and facilitation with modern medical imaging technologies. This study evaluates the survival and pain relief outcomes of the I-seeds implantation brachytherapy in advanced pancreatic cancer patients. METHODS Literature search was carried out in multiple electronic databases (Google Scholar, Embase, Medline/PubMed, and Ovid SP) and studies reporting I seeds implantation brachytherapy in pancreatic cancer patients with unresectable tumor were selected by following predetermined eligibility criteria. Random effects meta-analysis was performed to achieve inverse variance weighted effect size of the overall survival rate after the intervention. Sensitivity and subgroups analyses were also carried out. RESULTS Twenty-three studies (824 patients' data) were included in the meta-analysis. I-seeds implantation brachytherapy alone was associated with 8.98 [95% confidence interval (CI): 6.94, 11.03] months (P < 0.00001) overall survival with 1-year survival of 25.7 ± 9.3% (mean ± standard deviation; SD) and 2-year survival was 17.9 ± 8.6% (mean ± SD). In stage IV pancreatic cancer patients, overall survival was 7.13 [95% CI: 4.75, 9.51] months (P < 0.00001). In patients treated with I-seeds implantation along with 1 or more therapies, overall survival was 11.75 [95% CI: 9.84, 13.65] months (P < 0.00001) with 1-year survival of 47.4 ± 22.75% (mean ± SD) and 2-year survival was 16.97 ± 3.1% (mean ± SD). I-seeds brachytherapy was associated with relief of pain in 79.7 ± 9.9% (mean ± SD) of the patients. CONCLUSIONS Survival of pancreatic cancer patients after I-seeds implantation brachytherapy is found to be 9 months, whereas a combined treatment with I-seeds brachytherapy and other therapies was associated with approximately 12 months' survival. The majority of patients who underwent I-seeds brachytherapy had their pain relieved.
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8684
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Shapey IM, Jabbar S, Khan Z, Nicholson JE, Watson RJ. Scan-directed mini-incision focused parathyroidectomy: how accurate is accurate enough? Ann R Coll Surg Engl 2017; 99:123-128. [PMID: 28145779 PMCID: PMC5392823 DOI: 10.1308/rcsann.2016.0271] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/31/2016] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION Mini-incision focused parathyroidectomy (MI-FP) is advocated as an alternative to bilateral neck exploration (BNE), owing to its reduced morbidity. The site and side of the affected gland is identified preoperatively using a combination of ultrasound and sestamibi scans. However, the acceptable degree of inter-scan concordance required to prompt MI-FP without compromising accuracy is undetermined. METHODS Accuracy of preoperative imaging was determined both individually and in combination for all parathyroidectomies (2007-2014). A grading system (excellent, good, poor) was devised to describe the interscan concordance, which was validated by the operative and histological findings. RESULTS Eighty-nine patients (17 male, 68 female) underwent parathyroidectomy (MI-FP 44, BNE 45). The accuracy of scans interpreted individually was 53% for ultrasound and 60% for sestamibi, with no difference according to surgical technique (P = 0.43, P = 1, respectively). The proportion of interscan concordance was: excellent - 35%, good - 40%, poor 25%. Combined accuracy was 100% for both excellent and good grades but only 13% for those graded poor. Similar rates of normocalcaemia were observed for MI-FP and BNE, while postoperative hypocalcaemia was five times higher in those undergoing BNE. CONCLUSIONS Reduction in the inter-scan concordance from excellent to good does not compromise accuracy. MI-FP could be successfully performed in up to 75% of patients - 25% higher than recommended in national guidelines. Focused parathyroidectomy does not compromise surgical and endocrinological outcomes but boasts a far superior complication rate.
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Affiliation(s)
- I M Shapey
- Department of General Surgery, East Lancashire Hospitals NHS Trust, Royal Blackburn Hospital , Blackburn , UK
| | - S Jabbar
- Department of General Surgery, East Lancashire Hospitals NHS Trust, Royal Blackburn Hospital , Blackburn , UK
| | - Z Khan
- Department of General Surgery, East Lancashire Hospitals NHS Trust, Royal Blackburn Hospital , Blackburn , UK
| | - J E Nicholson
- Department of General Surgery, East Lancashire Hospitals NHS Trust, Royal Blackburn Hospital , Blackburn , UK
| | - R J Watson
- Department of General Surgery, East Lancashire Hospitals NHS Trust, Royal Blackburn Hospital , Blackburn , UK
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8685
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Abstract
Insulinomas are rare neuroendocrine tumors which occur predominantly in the pancreas. Although majority of the insulinomas are benign, over-secretion of insulin by the tumor leads to debilitating hypoglycemic symptoms. The diagnosis is based on clinical and biochemical findings. After the diagnosis is made, the principal challenge lies in locating the tumor because most tumors are solitary and small in size. Locating the tumor is of paramount importance as complete surgical excision is the only curative treatment, and incomplete resection leads to persistence of symptoms. Different preoperative and intraoperative imaging techniques have been used with varying success rates for the insulinoma imaging. Besides localizing the tumor, imaging also helps to guide biopsy, detect metastatic lesions, and perform image-guided therapeutic procedures. This review will discuss the role of different Cross sectional and nuclear medicine imaging modalities in insulinomas.
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8686
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Gabriel A, Maxwell GP, Griffin L, Champaneria MC, Parekh M, Macarios D. A Comparison of Two Fat Grafting Methods on Operating Room Efficiency and Costs. Aesthet Surg J 2017; 37:161-168. [PMID: 27733351 PMCID: PMC5241715 DOI: 10.1093/asj/sjw169] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/12/2016] [Indexed: 11/18/2022] Open
Abstract
Background Centrifugation (Cf) is a common method of fat processing but may be time consuming, especially when processing large volumes. Objectives To determine the effects on fat grafting time, volume efficiency, reoperations, and complication rates of Cf vs an autologous fat processing system (Rv) that incorporates fat harvesting and processing in a single unit. Methods We performed a retrospective cohort study of consecutive patients who underwent autologous fat grafting during reconstructive breast surgery with Rv or Cf. Endpoints measured were volume of fat harvested (lipoaspirate) and volume injected after processing, time to complete processing, reoperations, and complications. A budget impact model was used to estimate cost of Rv vs Cf. Results Ninety-eight patients underwent fat grafting with Rv, and 96 patients received Cf. Mean volumes of lipoaspirate (506.0 vs 126.1 mL) and fat injected (177.3 vs 79.2 mL) were significantly higher (P < .0001) in the Rv vs Cf group, respectively. Mean time to complete fat grafting was significantly shorter in the Rv vs Cf group (34.6 vs 90.1 minutes, respectively; P < .0001). Proportions of patients with nodule and cyst formation and/or who received reoperations were significantly less in the Rv vs Cf group. Based on these outcomes and an assumed per minute operating room cost, an average per patient cost savings of $2,870.08 was estimated with Rv vs Cf. Conclusions Compared to Cf, the Rv fat processing system allowed for a larger volume of fat to be processed for injection and decreased operative time in these patients, potentially translating to cost savings. Level of Evidence: 3
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Affiliation(s)
- Allen Gabriel
- Drs Gabriel and Champaneria are plastic surgeons in private practice in Vancouver, WA. Ms Griffin is a Senior Manager of Biostatistics and Outcomes Research, Acelity, San Antonio, TX. Dr Maxwell is a plastic surgeon in private practice in Nashville, TN. Ms Parekh is a Global Health Economics Manager and Mr Macarios is a Vice President of Health Economics and Outcomes Research, Acelity, Bridgewater, NJ
| | - G Patrick Maxwell
- Drs Gabriel and Champaneria are plastic surgeons in private practice in Vancouver, WA. Ms Griffin is a Senior Manager of Biostatistics and Outcomes Research, Acelity, San Antonio, TX. Dr Maxwell is a plastic surgeon in private practice in Nashville, TN. Ms Parekh is a Global Health Economics Manager and Mr Macarios is a Vice President of Health Economics and Outcomes Research, Acelity, Bridgewater, NJ
| | - Leah Griffin
- Drs Gabriel and Champaneria are plastic surgeons in private practice in Vancouver, WA. Ms Griffin is a Senior Manager of Biostatistics and Outcomes Research, Acelity, San Antonio, TX. Dr Maxwell is a plastic surgeon in private practice in Nashville, TN. Ms Parekh is a Global Health Economics Manager and Mr Macarios is a Vice President of Health Economics and Outcomes Research, Acelity, Bridgewater, NJ
| | - Manish C Champaneria
- Drs Gabriel and Champaneria are plastic surgeons in private practice in Vancouver, WA. Ms Griffin is a Senior Manager of Biostatistics and Outcomes Research, Acelity, San Antonio, TX. Dr Maxwell is a plastic surgeon in private practice in Nashville, TN. Ms Parekh is a Global Health Economics Manager and Mr Macarios is a Vice President of Health Economics and Outcomes Research, Acelity, Bridgewater, NJ
| | - Mousam Parekh
- Drs Gabriel and Champaneria are plastic surgeons in private practice in Vancouver, WA. Ms Griffin is a Senior Manager of Biostatistics and Outcomes Research, Acelity, San Antonio, TX. Dr Maxwell is a plastic surgeon in private practice in Nashville, TN. Ms Parekh is a Global Health Economics Manager and Mr Macarios is a Vice President of Health Economics and Outcomes Research, Acelity, Bridgewater, NJ
| | - David Macarios
- Drs Gabriel and Champaneria are plastic surgeons in private practice in Vancouver, WA. Ms Griffin is a Senior Manager of Biostatistics and Outcomes Research, Acelity, San Antonio, TX. Dr Maxwell is a plastic surgeon in private practice in Nashville, TN. Ms Parekh is a Global Health Economics Manager and Mr Macarios is a Vice President of Health Economics and Outcomes Research, Acelity, Bridgewater, NJ
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8687
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Park KC, Kim SM, Jeon JY, Kim BW, Kim HK, Chang HJ, Lee YS, Kim SY, Choi SH, Park CS, Chang HS. Synergistic Activity of N-hydroxy-7-(2-naphthylthio) Heptanomide and Sorafenib Against Cancer Stem Cells, Anaplastic Thyroid Cancer. Neoplasia 2017; 19:145-153. [PMID: 28142087 PMCID: PMC5279904 DOI: 10.1016/j.neo.2016.12.005] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2016] [Revised: 12/03/2016] [Accepted: 12/06/2016] [Indexed: 01/19/2023] Open
Abstract
Anaplastic thyroid carcinoma (ATC) although rare is the most deadly form of thyroid cancer. The fatality rate for ATC is high-pitched, the survival rate at 1 year after diagnosis is <20%. Control of ATC is severely hard and widespread with unpredictability. We Previous proved that histone gene reviser and epigenetic changes role significant parts in papillary and anaplastic thyroid cancer tumorigenesis. Herein, the goal of this study was to investigate the anti-tumor activities of a HDAC inhibitor, HNHA alone and in combination with sorafenib in ATC cells in vitro and in vivo and to explore its effects on apoptotic cell death pathways. Three ATC cell lines were exposed to sorafenib in the presence or absence of HNHA, and cell viability was determined by MTT assay. Effects of combined treatment on cell cycle and intracellular signaling pathways were assessed by flow cytometry and western blot analysis. The ATC cell lines xenograft model was used to examine the anti-tumor activity in vivo. Our data showed that HNHA and sorafenib synergistically decreased cell viability in ATC cells, and also significantly increased apoptotic cell death in these cells, as proved by the cleavage of caspase-3 and DNA fragmentation. HNHA and sorafenib combination was reduced anti-apoptotic factor in ATC. Thus, combination therapy with HNHA and sorafenib significantly decreased vessel density, and most significantly reduced tumor volume and increased survival in ATC xenografts. These results propose that HNHA in combination with sorafenib has significant anti-cancer activity in preclinical models, potentially suggesting a new clinical approach for patients of advanced thyroid cancer type.
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Affiliation(s)
- Ki Cheong Park
- Thyroid Cancer Center, Gangnam Severance Hospital, Department of Surgery, Yonsei University College of Medicine, Seoul 120-752, Republic of Korea; Gangnam Severance Hospital, Department of Surgery, Yonsei University College of Medicine, Seoul 120-752, Republic of Korea
| | - Seok-Mo Kim
- Thyroid Cancer Center, Gangnam Severance Hospital, Department of Surgery, Yonsei University College of Medicine, Seoul 120-752, Republic of Korea; Gangnam Severance Hospital, Department of Surgery, Yonsei University College of Medicine, Seoul 120-752, Republic of Korea
| | - Jeong Yong Jeon
- Department of Nuclear Medicine, Yonsei College of Medicine, Seoul 120-752, Republic of Korea
| | - Bup-Woo Kim
- Thyroid Cancer Center, Gangnam Severance Hospital, Department of Surgery, Yonsei University College of Medicine, Seoul 120-752, Republic of Korea; Gangnam Severance Hospital, Department of Surgery, Yonsei University College of Medicine, Seoul 120-752, Republic of Korea
| | - Hyeung Kyoo Kim
- Thyroid Cancer Center, Gangnam Severance Hospital, Department of Surgery, Yonsei University College of Medicine, Seoul 120-752, Republic of Korea; Gangnam Severance Hospital, Department of Surgery, Yonsei University College of Medicine, Seoul 120-752, Republic of Korea
| | - Ho Jin Chang
- Thyroid Cancer Center, Gangnam Severance Hospital, Department of Surgery, Yonsei University College of Medicine, Seoul 120-752, Republic of Korea; Gangnam Severance Hospital, Department of Surgery, Yonsei University College of Medicine, Seoul 120-752, Republic of Korea
| | - Yong Sang Lee
- Thyroid Cancer Center, Gangnam Severance Hospital, Department of Surgery, Yonsei University College of Medicine, Seoul 120-752, Republic of Korea; Gangnam Severance Hospital, Department of Surgery, Yonsei University College of Medicine, Seoul 120-752, Republic of Korea
| | - Soo Young Kim
- Thyroid Cancer Center, Gangnam Severance Hospital, Department of Surgery, Yonsei University College of Medicine, Seoul 120-752, Republic of Korea; Gangnam Severance Hospital, Department of Surgery, Yonsei University College of Medicine, Seoul 120-752, Republic of Korea
| | - Seung Hoon Choi
- Thyroid Cancer Center, Gangnam Severance Hospital, Department of Surgery, Yonsei University College of Medicine, Seoul 120-752, Republic of Korea; Gangnam Severance Hospital, Department of Surgery, Yonsei University College of Medicine, Seoul 120-752, Republic of Korea
| | - Cheong Soo Park
- Thyroid Cancer Center, Gangnam Severance Hospital, Department of Surgery, Yonsei University College of Medicine, Seoul 120-752, Republic of Korea; Gangnam Severance Hospital, Department of Surgery, Yonsei University College of Medicine, Seoul 120-752, Republic of Korea
| | - Hang-Seok Chang
- Thyroid Cancer Center, Gangnam Severance Hospital, Department of Surgery, Yonsei University College of Medicine, Seoul 120-752, Republic of Korea; Gangnam Severance Hospital, Department of Surgery, Yonsei University College of Medicine, Seoul 120-752, Republic of Korea.
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8688
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Pashos NC, Scarritt ME, Eagle ZR, Gimble JM, Chaffin AE, Bunnell BA. Characterization of an Acellular Scaffold for a Tissue Engineering Approach to the Nipple-Areolar Complex Reconstruction. Cells Tissues Organs 2017; 203:183-193. [PMID: 28125805 DOI: 10.1159/000455070] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/12/2016] [Indexed: 11/19/2022] Open
Abstract
A significant number of patients undergo mastectomies and breast reconstructions every year using many surgical-based techniques to reconstruct the nipple-areolar complex (NAC). Described herein is a tissue engineering approach that may permit a human NAC onlay graft during breast reconstruction procedures. By applying decellularization, which is the removal of cellular components from tissue, to an intact whole donor NAC, the extracellular matrix (ECM) structure of the NAC is preserved. This creates a biologically derived scaffold for cells to repopulate and regenerate the NAC. A detergent-based decellularization method was used to derive whole NAC scaffolds from nonhuman primate rhesus macaque NAC tissue. Using both histological and quantitative analyses for the native and decellularized tissues, the derived ECM graft was assessed. The bioactivity of the scaffold was evaluated following cell culture with bone marrow-derived mesenchymal stem cells (BMSCs). The data presented here demonstrate that scaffolds are devoid of cells and retain ECM integrity and a high degree of bioactivity. The content of collagen and glycosaminoglycans were not significantly altered by the decellularization process, whereas the elastin content was significantly decreased. The proliferation and apoptosis of seeded BMSCs were found to be approximately 65 and <1.5%, respectively. This study characterizes the successful decellularization of NAC tissue as compared to native NACs based on structural protein composition, lubricating protein retention, the maintenance of adhesion molecules, and bioactivity when reseeded with cells. These histological and quantitative analyses provide the foundation for a novel approach to NAC reconstruction.
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Affiliation(s)
- Nicholas C Pashos
- Center for Stem Cell Research and Regenerative Medicine, Tulane University School of Medicine, New Orleans, LA, USA
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8689
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Cienfuegos JA, Salguero J, Núñez-Córdoba JM, Ruiz-Canela M, Benito A, Ocaña S, Zozaya G, Martí-Cruchaga P, Pardo F, Hernández-Lizoáin JL, Rotellar F. Short- and long-term outcomes of laparoscopic organ-sparing resection in pancreatic neuroendocrine tumors: a single-center experience. Surg Endosc 2017; 31:3847-3857. [DOI: 10.1007/s00464-016-5411-y] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2016] [Accepted: 12/30/2016] [Indexed: 02/06/2023]
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8690
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Abstract
BACKGROUND This study evaluated the feasibility of non-magnified resection of various benign lesions of the upper neck using the facelift incision without endoscopic equipment to establish indications for the procedure. METHODS This retrospective analysis examined 86 patients who underwent surgery for upper neck masses using the facelift incision or conventional transcervical incision at our institute between January 2012 and December 2015. RESULTS We performed 41 operations using facelift incisions (facelift group) and 45 using conventional horizontal incisions (conventional group). All 86 operations were successful. In the facelift group, no patient needed conversion to conventional open resection and no patient required the use of an endoscopic device due to a limited surgical view for safe resection. There were no major surgical complications in either group. Transient sensory changes in the auricle occurred in 26% of the patients in the facelift group, but all patients recovered within 2 months. In all patients in the facelift group, the scars were invisible as they were covered by the auricle and hair, while the surgical scars were noticeable in 91% (41/45) of the patients in the conventional group when they were wearing standard shirts (p < 0.001) at 3-4 weeks after surgery. CONCLUSIONS The facelift approach provides a short direct route to upper neck masses, and it enables an adequate workspace not only for endoscopic or robotic surgery, but also for open surgery with the naked eye. The surgical indications for the facelift incision include the removal of most benign tumors occurring in the upper neck at levels II and III.
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8691
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Partial Breast Reconstruction with Goldilocks Technique After Excision of Giant Fibroadenoma: A Case Report. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2017; 5:e1200. [PMID: 28203501 PMCID: PMC5293299 DOI: 10.1097/gox.0000000000001200] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2016] [Accepted: 11/16/2016] [Indexed: 11/26/2022]
Abstract
Giant juvenile fibroadenomas are relatively rare, accounting for less than 1% fibroadenomas. Large breast tumors create significant asymmetry and provide unique reconstructive challenges after removal. In this case, we describe a 21-year-old female with delayed presentation of a giant fibroadenoma of the right breast. This represents an unusual presentation of benign breast disease requiring reduction of the skin envelope, extensive glandular resection, lower pole reconstruction, and free nipple grafting to achieve symmetry with the opposite breast. A novel modification of the Goldilocks mastectomy technique is described for partial breast reconstruction. Adaptation of the Goldilocks mastectomy technique provides adequate soft tissue for partial breast reconstruction. Using the lower pole deepithelialization breast skin flap provides autologous vascularized tissue to supplement volume loss after tumor and glandular excision. Benign breast disease can create significant breast deformities. Application and combination of the Goldilocks mastectomy technique allow for partial breast reconstruction without the need for an additional donor site or prosthetic devices.
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8692
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Abstract
Surgical breast reconstruction after mastectomy requires precise perforator coordinates/dimensions, perforator course, and fat volume in a radiology report. Automatic perforator reporting software was implemented as an OsiriX Digital Imaging and Communications in Medicine (DICOM) viewer plugin. For perforator analysis, the user identifies a reference point (e.g., umbilicus) and marks each perforating artery/vein bundle with multiple region of interest (ROI) points along its course beginning at the muscle-fat interface. Computations using these points and analysis of image data produce content for the report. Post-processing times were compared against conventional/manual methods using de-identified images of 26 patients with surgically confirmed accuracy of perforator locations and caliber. The time from loading source images to completion of report was measured. Significance of differences in mean processing times for this automated approach versus the conventional/manual approach was assessed using a paired t test. The mean conventional reporting time for our radiologists was 76 ± 27 min (median 65 min) compared with 25 ± 6 min (median 25 min) using our OsiriX plugin (p < 0.01). The conventional approach had three reports with transcription errors compared to none with the OsiriX plugin. Otherwise, the reports were similar. In conclusion, automated reporting of perforator magnetic resonance angiography (MRA) studies is faster compared with the standard, manual approach, and transcription errors which are eliminated.
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8693
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O'Donnell TF, Rasmussen JC, Sevick-Muraca EM. New diagnostic modalities in the evaluation of lymphedema. J Vasc Surg Venous Lymphat Disord 2017; 5:261-273. [PMID: 28214496 DOI: 10.1016/j.jvsv.2016.10.083] [Citation(s) in RCA: 86] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2016] [Accepted: 10/23/2016] [Indexed: 01/30/2023]
Abstract
OBJECTIVE Currently, lymphedema (LED) is typically diagnosed clinically on the basis of a patient's history and characteristic physical findings. Whereas the diagnosis of LED is sometimes confirmed by lymphoscintigraphy (LSG), the technique is limited in both its ability to identify disease and to guide therapy. Recent advancements provide opportunities for new imaging techniques not only to assist in the diagnosis of LED, based on anatomic changes, but also to assess contractile function and to guide therapeutic intervention. The purpose of this contribution was to review these imaging techniques. METHODS Literature for each technique is reviewed and discussed, and the evidence for each of these new diagnostic techniques was assessed on several criteria to determine if each could (1) establish whether disease is present, (2) determine the severity of the disease process, (3) define the pathophysiologic mechanism of the disease process, (4) demonstrate whether intervention is possible as well as what type, and (5) objectively grade the response to therapy. RESULTS LSG is currently the standard test to confirm LED. Duplex ultrasound (DUS) is a simple, readily available noninvasive test that can identify LED by specific tissue characteristics as well as the response to therapy. Magnetic resonance imaging and computed tomography scans similarly demonstrate the alterations in epidermal and subcutaneous tissue, but the latter can also detect obstructing neoplasms as a cause of secondary LED. Moreover, magnetic resonance lymphangiography details lymphatic vessels and nodes and their function. Newer fluorescence imaging techniques provide opportunities to image lymphatic anatomy and function. Visible microlymphangiography by fluorescein sodium is limited by tissue light absorption to imaging depths of 200 μm. Near-infrared fluorescence lymphatic imaging, a newer test using intradermal injection of indocyanine green, can penetrate several centimeters of tissue and can visualize the initial and conducting lymphatics, the lymph node basins, and the active function of lymphangions (the key module) in exquisite detail. CONCLUSIONS The availability and the noninvasive nature of DUS should make this modality the first choice for establishing the diagnosis of LED based on tissue changes. Further studies comparing DUS with LSG, however, are needed. The costs of magnetic resonance imaging and computed tomography limit their adoption as a means to regularly assess the lymphatics. Whereas lymphatic truncal anatomy and transit times can be delineated by the older technique of LSG, near-infrared fluorescence lymphatic imaging is rapid, highly sensitive, and repeatable and provides exquisite detail for lymphatic vessel anatomy and function of the lymphangions as well as the response to therapy.
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Affiliation(s)
- Thomas F O'Donnell
- Cardiovascular Center at Tufts Medical Center, Tufts University School of Medicine, Boston, Mass.
| | - John C Rasmussen
- The Center for Molecular Imaging, The Brown Foundation Institute of Molecular Medicine for the Prevention of Human Diseases at the University of Texas Health Science Center at Houston, Houston, Tex
| | - Eva M Sevick-Muraca
- The Center for Molecular Imaging, The Brown Foundation Institute of Molecular Medicine for the Prevention of Human Diseases at the University of Texas Health Science Center at Houston, Houston, Tex
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8694
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Abstract
INTRODUCTION Lymphedema is characterized by a defect in the lymphatic system that causes limb swelling. Impaired uptake and transport of lymphatic fluid through lymphatic vessels causes accumulation of protein-rich fluid in the interstitial spaces, which leads to swelling of the limb. Primary lymphedema often presents at birth. The rare cases that arise after age 35 years are described as lymphedema tarda. The great majority of patients with lymphedema have swelling of the lower limbs-upper limb lymphedema is a rare disorder. CASE PRESENTATION An 84-year-old woman presented with a 3-year history of unilateral swelling of the right upper limb. There were no constitutional symptoms and no evidence of lymphadenopathy or systemic disease. Blood tests, carcinoembryonic antigen test, computed tomography scans, and venous Doppler ultrasound were all normal. The diagnosis was primary upper limb lymphedema. DISCUSSION The swelling that occurs in upper limb lymphedema is permanent and usually extends to the hand. About one-third of patients with this condition also present with lower limb lymphedema. Thorough investigations are warranted in cases of unilateral upper limb lymphedema to rule out occult malignancy and systemic disease.
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Affiliation(s)
- Michael Ec Mcfarlane
- Consultant General Surgeon and Lecturer in Surgery in the Department of Surgery, Radiology, Anaesthetics and Intensive Care at the University of the West Indies in Mona, Jamaica.
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8695
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Dai L, Wang Y, Chen L, Zheng J, Li J, Wu X. MiR-221, a potential prognostic biomarker for recurrence in papillary thyroid cancer. World J Surg Oncol 2017; 15:11. [PMID: 28061868 PMCID: PMC5219708 DOI: 10.1186/s12957-016-1086-z] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2016] [Accepted: 12/22/2016] [Indexed: 12/18/2022] Open
Abstract
Background Many studies have reported several transcriptionally deregulated microRNAs (miRNAs) in papillary thyroid cancer (PTC) tissue in comparison with benign thyroid nodules and normal thyroid tissues. However, the correlation between miRNA expressions and PTC recurrence still remains unclear. Methods The PTC patients who scheduled to undergo total thyroidectomy by the same surgical team in Ningbo NO.2 Hospital from March 1998 to March 2008 were enrolled in this study. The clinical and pathological characteristics of each patient were recorded in detail. The selected miRNA expressions were detected using quantitative reverse transcriptase-polymerase chain reaction (qRT-PCR). Potential predictive factors for cancer recurrence were evaluated by univariate and multivariate Cox proportional hazard analysis. Results A total of 78 patients were enrolled with 49 females at a mean age of 45.8 years. Enrolled patients were divided into two groups: nonrecurrent group (n = 54) and recurrent group (n = 24). The results from the univariate Cox proportional hazard analysis revealed that primary tumor size, TNM stage, extrathyroid extension, miR-221, and miR-222 expressions were significantly associated with PTC recurrence (P < 0.05). The tissue expression of miR-221 was the only independent risk factor for PTC recurrence (HR 1.41; 95%CI 1.14–1.95, P = 0.007) by multiple Cox proportional hazard analysis. Conclusions This study identified the potential role of miR-221 as a prognostic biomarker for the recurrence in PTC.
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Affiliation(s)
- Lei Dai
- Department of Thyroid Surgery, Ningbo NO.2 Hospital, NO.41 Xibei Street, Ningbo City, 315000, Zhejiang Province, China
| | - Yaozong Wang
- Department of Thyroid Surgery, Ningbo NO.2 Hospital, NO.41 Xibei Street, Ningbo City, 315000, Zhejiang Province, China
| | - Liangliang Chen
- Department of Thyroid Surgery, Ningbo NO.2 Hospital, NO.41 Xibei Street, Ningbo City, 315000, Zhejiang Province, China
| | - Jueru Zheng
- Department of Thyroid Surgery, Ningbo NO.2 Hospital, NO.41 Xibei Street, Ningbo City, 315000, Zhejiang Province, China
| | - Jianjun Li
- Department of Thyroid Surgery, Ningbo NO.2 Hospital, NO.41 Xibei Street, Ningbo City, 315000, Zhejiang Province, China
| | - Xianjiang Wu
- Department of Thyroid Surgery, Ningbo NO.2 Hospital, NO.41 Xibei Street, Ningbo City, 315000, Zhejiang Province, China.
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8696
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Lorente-Poch L, Sancho J, Muñoz JL, Gallego-Otaegui L, Martínez-Ruiz C, Sitges-Serra A. Failure of fragmented parathyroid gland autotransplantation to prevent permanent hypoparathyroidism after total thyroidectomy. Langenbecks Arch Surg 2017; 402:281-287. [PMID: 28064342 DOI: 10.1007/s00423-016-1548-3] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2016] [Accepted: 12/26/2016] [Indexed: 11/29/2022]
Abstract
PURPOSE Parathyroid autotransplantation during total thyroidectomy leads to higher rates of postoperative hypocalcaemia. It has been argued, however, that it prevents permanent hypoparathyroidism. The impact of autografted normal parathyroid gland fragments on long-term parathyroid status has not been assessed properly. To clarify this, the short- and long-term parathyroid function was assessed in patients with three glands remaining in situ after total thyroidectomy, in whom the fourth gland was either autotransplanted (Tx) or accidentally resected (AR). METHODS Consecutive patients (n = 669) undergoing first-time total thyroidectomy were prospectively studied recording the number of parathyroid glands remaining in situ: PGRIS =4-(glands autografted + glands in the specimen). The study was focused on the subgroup of 186 patients with three parathyroid glands remaining in situ as a result of either accidental resection (AR, n = 76) or autotransplantation into the sternocleidomastoid muscle (Tx, n = 110). Prevalence of postoperative hypocalcaemia, protracted, and permanent hypoparathyroidism were compared between the two groups. Demographic, disease-related, laboratory, and surgical variables were recorded. All patients were followed for at least 1 year. RESULTS Both groups were comparable in terms of disease and extent of surgery. Mean postoperative serum calcium was the same (AR: 1.97 ± 0.2 vs Tx: 1.97 ± 0.22 mmol/L). Rates of protracted (AR: 24% vs Tx: 25.5%) and permanent hypoparathyroidism (AR: 5.3% vs Tx: 7.3%) were similar in both groups. CONCLUSIONS The prevalence of parathyroid failure syndromes after total thyroidectomy was similar whether a parathyroid gland was inadvertently excised or autotransplanted. Autotransplantation did not influence the permanent hypoparathyroidism rate.
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Affiliation(s)
- Leyre Lorente-Poch
- Endocrine Surgery Unit, Hospital del Mar, Passeig Marítim 25-29, 08003, Barcelona, Spain
| | - Juan Sancho
- Endocrine Surgery Unit, Hospital del Mar, Passeig Marítim 25-29, 08003, Barcelona, Spain
| | - Jose Luis Muñoz
- Endocrine Surgery Unit, Hospital del Mar, Passeig Marítim 25-29, 08003, Barcelona, Spain
| | - Lander Gallego-Otaegui
- Endocrine Surgery Unit, Hospital del Mar, Passeig Marítim 25-29, 08003, Barcelona, Spain
| | - Carlos Martínez-Ruiz
- Endocrine Surgery Unit, Hospital del Mar, Passeig Marítim 25-29, 08003, Barcelona, Spain
| | - Antonio Sitges-Serra
- Endocrine Surgery Unit, Hospital del Mar, Passeig Marítim 25-29, 08003, Barcelona, Spain.
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8697
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Sandor M, Leamy P, Assan P, Hoonjan A, Huang LT, Edwards M, Zuo W, Li H, Xu H. Relevant In Vitro Predictors of Human Acellular Dermal Matrix-Associated Inflammation and Capsule Formation in a Nonhuman Primate Subcutaneous Tissue Expander Model. EPLASTY 2017; 17:e1. [PMID: 28119764 PMCID: PMC5223281] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective: Benchtop methods were evaluated for preclinical inflammation/capsule formation correlation following implantation of human acellular dermal matrices. Methods: Dermal matrices were compared with native dermis for structure (histology, scanning electron microscopy), collagen solubility (hydroxyproline), enzymatic susceptibility (collagenase), and thermal stability (differential scanning calorimetry). Results were compared with implantation outcomes in a primate tissue expander model. Results: Native dermis, electron beam-sterilized, and freeze-dried human acellular dermal matrices had equivalent morphology, acid-soluble collagen (60.5% ± 6.3%, 65.3% ± 3.2%, and 63.3% ± 2.4%, respectively), and collagenase resistance. Implant results showed minimal inflammation/matrix degradation, lack of capsule formation, insignificant elastic modulus change (57.65 ± 20.24 MPa out-of-package/44.84 ± 23.87 MPa in vivo), and low antibody induction (2- to 8-fold increase) for electron beam-sterilized matrix. Similar results for freeze-dried dermal matrix were previously observed. γ-Irradiated, γ-irradiated/freeze-dried, and ethanol-stored dermal matrices were statistically different from native dermis for acid-soluble collagen (82.4% ± 5.8%, 72.2% ± 6.2%, and 76.8% ± 5.0%, respectively) and collagenase digestion rate, indicating matrix damage. γ-Irradiated matrix-implanted animals demonstrated elevated inflammatory response, foreign body giant cells, capsule formation at the tissue expander junction, and robust matrix metalloproteinase-1 staining with significant elastic modulus decrease (37.43 ± 7.52 MPa out-of-package/19.58 ± 1.16 MPa in vivo). Antibody increase (32- to 128-fold) was observed 6 to 10 weeks following γ-irradiated matrix implantation. Ethanol-stored dermal matrix elicited an acute antibody response (4- to 128-fold increase, 2-4 weeks) and macrophage-concentrated synovial-like hyperplasia at the tissue expander junction, moderate matrix metalloproteinase-1 staining, and significant elastic modulus decrease (61.15 ± 9.12 MPa out-of-package/17.92 ± 4.02 MPa in vivo) by 10 weeks implantation. Conclusion: Demonstrated loss of collagen integrity in vitro may be predictive of inflammation/capsule formation in primate tissue expander models. These results may be further predictive of clinical observations.
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Affiliation(s)
- Maryellen Sandor
- LifeCell Corporation, an ACELITY Company, Bridgewater, NJ,Correspondence:
| | - Patrick Leamy
- LifeCell Corporation, an ACELITY Company, Bridgewater, NJ
| | - Pearl Assan
- LifeCell Corporation, an ACELITY Company, Bridgewater, NJ
| | | | - Li-Ting Huang
- LifeCell Corporation, an ACELITY Company, Bridgewater, NJ
| | | | - Wenqi Zuo
- LifeCell Corporation, an ACELITY Company, Bridgewater, NJ
| | - Hui Li
- LifeCell Corporation, an ACELITY Company, Bridgewater, NJ
| | - Hui Xu
- LifeCell Corporation, an ACELITY Company, Bridgewater, NJ
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8698
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Riggio E, Ardoino I, Richardson CE, Biganzoli E. Predictability of anthropomorphic measurements in implant selection for breast reconstruction: a retrospective cohort study. EUROPEAN JOURNAL OF PLASTIC SURGERY 2017; 40:203-212. [PMID: 28603385 PMCID: PMC5440532 DOI: 10.1007/s00238-016-1261-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2016] [Accepted: 11/20/2016] [Indexed: 11/26/2022]
Abstract
Background Preoperative implant planning for breast reconstruction is often at risk of being changed perioperatively. This study examined which factors are associated with a change of implant selection. Methods Women who had unilateral two-stage breast reconstruction between 2002 and 2007 were studied. Inclusion criteria were photographic evidence of preoperative skin markings indicating breast dimensions and a selected implant model. Multivariable logistic regression was used to identify variables associated with a changed selection. Results Among the 496 women studied, 308 preoperative implant choices (62.1%) were changed during surgery. A change in plan was significantly associated with symmetrization surgery involving contralateral reduction mammaplasty (OR = 1.92; 95% CI, 1.12 to 3.29) and contralateral mastopexy (OR = 2.26; 95% CI, 1.29 to 3.96), but not with BMI. The required implant width changed more than 0.5 cm in 70 cases (14.1%) while height changed more than 0.5 cm in 215 cases (43.2%). The likelihood of a change was high for large preoperative widths (OR = 9.66 for 15.5 cm) and small preoperative heights (OR = 2.97 for 10.5 cm). At a mean follow-up of 16.6 months, patient satisfaction was good or average in 92.1% of cases and 5.9% of implants had been replaced with another model, indicating that the perioperative implant selection was usually appropriate. Conclusions This study documents the frequency with which implant choices, despite accurate preoperative planning, are changed perioperatively as a result of relatively small differences in anthropomorphic measurements. Perioperative recalculation of breast dimensions may have an advantage in terms of patient reoperation rates. Changes in width were less frequent than changes in height and projection. Contralateral surgery, large width, and small height were the most influential factors. Level of Evidence: Level IV, risk / prognostic study.
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Affiliation(s)
- Egidio Riggio
- Unit of Plastic and Reconstructive Surgery, Fondazione IRCCS Istituto Nazionale dei Tumori, Via Venezian 1, 20133 Milan, Italy
| | - Ilaria Ardoino
- G.A. Maccacaro Unit of Medical Statistics, Biometry and Bioinformatics, Department of Clinical Science and Community Health, University of Milan, Milan, Italy
| | - Caroline E. Richardson
- Unit of Plastic and Reconstructive Surgery, Fondazione IRCCS Istituto Nazionale dei Tumori, Via Venezian 1, 20133 Milan, Italy
| | - Elia Biganzoli
- G.A. Maccacaro Unit of Medical Statistics, Biometry and Bioinformatics, Department of Clinical Science and Community Health, University of Milan, Milan, Italy
- Unit of Medical Statistics, Biometry and Bioinformatics, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
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8699
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Trignani M, DI Carlo C, Cefalogli C, Nuzzo M, Ursini LA, Caravatta L, Perrotti F, DI Nicola M, Pamio A, Genovesi D. Outcomes in Patients with pT1-T2, pN0-N1 Breast Cancer After Conservative Surgery and Whole-breast Radiotherapy. ACTA ACUST UNITED AC 2017; 31:151-158. [PMID: 28064235 DOI: 10.21873/invivo.11039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2016] [Revised: 12/09/2016] [Accepted: 12/21/2016] [Indexed: 11/10/2022]
Abstract
AIM To evaluate locoregional recurrence, overall survival, disease-free survival and prognostic influence of the number of positive lymph nodes and other variables in breast cancer treatment. PATIENTS AND METHODS A total of 377 patients with pT1-T2, pN0-N1 invasive breast carcinoma treated from 2005 to 2013 were retrospectively evaluated. Patients underwent conservative surgery followed by whole-breast radiotherapy. Clavicular region irradiation was not performed. RESULTS With a median follow-up of 4 years, locoregional recurrence rate was 3.4% (nodal recurrence=1.06%). Expression of progesterone receptors was significantly associated with better disease-free survival, tumor size (T>2 cm) with poorer disease-free survival, locoregional recurrence and poorer overall survival; the presence of three nodal metastases was related to significantly poorer overall survival (p=0.024). CONCLUSION Whole-breast adjuvant radiotherapy without nodal irradiation after breast-conserving surgery led to low rate of locoregional recurrence and high rates of overall survival and disease-free survival in patients with pT1-T2 pN0-N1 breast cancer.
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Affiliation(s)
- Marianna Trignani
- Department of Radiation Oncology, SS. Annunziata Hospital, G. D'Annunzio University of Chieti, Chieti, Italy
| | - Clelia DI Carlo
- Department of Radiation Oncology, SS. Annunziata Hospital, G. D'Annunzio University of Chieti, Chieti, Italy
| | - Carmen Cefalogli
- Department of Radiation Oncology, SS. Annunziata Hospital, G. D'Annunzio University of Chieti, Chieti, Italy
| | - Marianna Nuzzo
- Department of Radiation Oncology, SS. Annunziata Hospital, G. D'Annunzio University of Chieti, Chieti, Italy
| | - Lucia Anna Ursini
- Department of Radiation Oncology, SS. Annunziata Hospital, G. D'Annunzio University of Chieti, Chieti, Italy
| | - Luciana Caravatta
- Department of Radiation Oncology, SS. Annunziata Hospital, G. D'Annunzio University of Chieti, Chieti, Italy
| | - Francesca Perrotti
- Department of Radiation Oncology, SS. Annunziata Hospital, G. D'Annunzio University of Chieti, Chieti, Italy
| | - Marta DI Nicola
- Laboratory of Biostatistics, Department of Medical, Oral and Biotechnological Sciences, G. D'Annunzio University of Chieti, Chieti, Italy
| | - Ambra Pamio
- Division of Hygene, Epidemiology and Public Health, Department of Medicine and Science of Aging, G. D'Annunzio University of Chieti, Chieti, Italy
| | - Domenico Genovesi
- Department of Radiation Oncology, SS. Annunziata Hospital, G. D'Annunzio University of Chieti, Chieti, Italy
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Kurganov IA, Emelyanov SI, Bogdanov DY, Agafonov OA, Mamistvalov MS, Matveev NL, Fedorov AV, Kusin AN. [Pectoral-retroauricular approach for endoscopic parathyroidectomy (experimental study)]. Khirurgiia (Mosk) 2017:32-36. [PMID: 29186094 DOI: 10.17116/hirurgia20171132-36] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
AIM To develop and investigate in the experiment the method of endoscopic parathyroidectomy in order to prevent intraoperative 'conflict of the instruments' and to reduce surgical trauma via extracervical approach. MATERIAL AND METHODS The results of 10 experimental endoscopic parathyroidectomies with original pectoral-retroauricular approach were analyzed. RESULTS Mean time of surgery was 77.8±10.2 minutes (65-97), mean time of surgical exposure - 50.3±6.7 minutes (41-59). Visualization and identification of parathyroid glands were achieved in 100% of cases. Recurrent laryngeal nerve was preserved in 100% of cases. CONCLUSION Original endoscopic pectoral-retroauricular approach for parathyroidectomy is methodologically and technically justified and can be recommended for clinical application.
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Affiliation(s)
- I A Kurganov
- Chair of Endoscopic Surgery, Evdokimov Moscow State University of Medicine and Dentistry, Ministry of Healthcare of Russia, Moscow, Russia
| | - S I Emelyanov
- Chair of Endoscopic Surgery, Evdokimov Moscow State University of Medicine and Dentistry, Ministry of Healthcare of Russia, Moscow, Russia
| | - D Yu Bogdanov
- Chair of Endoscopic Surgery, Evdokimov Moscow State University of Medicine and Dentistry, Ministry of Healthcare of Russia, Moscow, Russia
| | - O A Agafonov
- Tsentrosoyuz Hospital of the Russian Federation, Moscow, Russia ,Chair of Operative Surgery and Topographic Anatomy, Evdokimov Moscow State University of Medicine and Dentistry, Ministry of Healthcare of Russia, Moscow, Russia
| | - M Sh Mamistvalov
- Chair of Endoscopic Surgery, Evdokimov Moscow State University of Medicine and Dentistry, Ministry of Healthcare of Russia, Moscow, Russia
| | - N L Matveev
- Chair of Endoscopic Surgery, Evdokimov Moscow State University of Medicine and Dentistry, Ministry of Healthcare of Russia, Moscow, Russia
| | - A V Fedorov
- Chair of Endoscopic Surgery, Evdokimov Moscow State University of Medicine and Dentistry, Ministry of Healthcare of Russia, Moscow, Russia
| | - A N Kusin
- Chair of Operative Surgery and Topographic Anatomy, Evdokimov Moscow State University of Medicine and Dentistry, Ministry of Healthcare of Russia, Moscow, Russia
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