1
|
Deutschmann C, Singer CF, Gschwantler-Kaulich D, Pfeiler G, Leser C, Baltzer PAT, Helbich TH, Kraus C, Korbatits R, Marzogi A, Clauser P. Residual fibroglandular breast tissue after mastectomy is associated with an increased risk of a local recurrence or a new primary breast cancer". BMC Cancer 2023; 23:281. [PMID: 36978031 PMCID: PMC10044359 DOI: 10.1186/s12885-023-10764-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Accepted: 03/22/2023] [Indexed: 03/30/2023] Open
Abstract
BACKGROUND Residual fibroglandular breast tissue (RFGT) following a mastectomy has been claimed to be associated with the occurrence of an in-breast local recurrence (IBLR) or new primary tumor (NP). Yet, scientific evidence proving this assumption is lacking. The primary aim of the study was to verify whether RFGT following a mastectomy is a risk factor for an IBLR or NP. METHODS This retrospective analysis included all patients that underwent a mastectomy and were followed up at the Department of Obstetrics and Gynecology of the Medical University of Vienna between 01.01.2015 and 26.02.2020. RFGT volume (assessed on magnetic resonance imaging) was correlated with the prevalence of an IBLR and a NP. RESULTS A total of 105 patients (126 breasts) following a therapeutic mastectomy were included. After a mean follow-up of 46.0 months an IBLR had occurred in 17 breasts and a NP in 1 breast. A significant difference in RFGT volume was observed between the disease-free cohort and the subgroup with an IBLR or NP (p = .017). A RFGT volume of ≥ 1153 mm3 increased the risk by the factor 3.57 [95%CI 1.27; 10.03]. CONCLUSIONS RFGT volume is associated with an increased risk for an IBLR or NP.
Collapse
Affiliation(s)
- Christine Deutschmann
- Department of Obstetrics and Gynecology, Division of General Gynecology and Gynecologic Oncology, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria.
| | - Christian F Singer
- Department of Obstetrics and Gynecology, Division of General Gynecology and Gynecologic Oncology, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Daphne Gschwantler-Kaulich
- Department of Obstetrics and Gynecology, Division of General Gynecology and Gynecologic Oncology, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Georg Pfeiler
- Department of Obstetrics and Gynecology, Division of General Gynecology and Gynecologic Oncology, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Carmen Leser
- Department of Obstetrics and Gynecology, Division of General Gynecology and Gynecologic Oncology, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Pascal A T Baltzer
- Department of Biomedical Imaging and Image-Guided Therapy, Division of General and Pediatric Radiology, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Thomas H Helbich
- Department of Biomedical Imaging and Image-Guided Therapy, Division of General and Pediatric Radiology, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Christine Kraus
- Department of Obstetrics and Gynecology, Division of General Gynecology and Gynecologic Oncology, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Ricarda Korbatits
- Department of Obstetrics and Gynecology, Division of General Gynecology and Gynecologic Oncology, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Alaa Marzogi
- Department of Biomedical Imaging and Image-Guided Therapy, Division of General and Pediatric Radiology, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Paola Clauser
- Department of Biomedical Imaging and Image-Guided Therapy, Division of General and Pediatric Radiology, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| |
Collapse
|
2
|
Leser C, Dorffner G, Marhold M, Rutter A, Döger M, Singer C, König-Castillo DM, Deutschmann C, Holzer I, König-Castillo D, Gschwantler-Kaulich D. Liver function indicators in patients with breast cancer before and after detection of hepatic metastases-a retrospective study. PLoS One 2023; 18:e0278454. [PMID: 36867604 PMCID: PMC9983906 DOI: 10.1371/journal.pone.0278454] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Accepted: 11/16/2022] [Indexed: 03/04/2023] Open
Abstract
BACKGROUND Liver metastases are common in patients with breast cancer, and determining the factors associated with such metastases may improve both their early detection and treatment. Given that liver function protein level changes in these patients have not been determined, the aim of our study was to investigate liver function protein level changes over time, spanning 6 months before the detection of liver metastasis to 12 months after. METHODS We retrospectively studied 104 patients with hepatic metastasis from breast cancer who were treated at the Departments of Internal Medicine I and the Department of Obstetrics and Gynecology at the Medical University of Vienna between 1980 and 2019. Data were extracted from patient records. RESULTS Aspartate aminotransferase, alanine aminotransferase, gamma-glutamyltransferase, lactate dehydrogenase and alkaline phosphatase were significantly elevated when compared to normal range 6 months before the detection of liver metastases (p<0.001) Albumin was decreased (p<0.001). The values of aspartate aminotransferase, gamma-glutamyltransferase, and lactate dehydrogenase were significantly increased at the time of diagnosis compared to 6 months prior (p<0.001). Patient- and tumor-specific parameters had no influence on these liver function indicators. Elevated aspartate aminotransferase (p = 0.002) and reduced albumin (p = 0.002) levels at the time of diagnosis were associated with shorter overall survival. CONCLUSION Liver function protein levels should be considered as potential indicators when screening for liver metastasis in patients with breast cancer. With the new treatment options available, it could lead to prolonged life.
Collapse
Affiliation(s)
- Carmen Leser
- Department of Obstetrics and Gynecology, Cancer Comprehensive Center, Medical University of Vienna, Vienna, Austria
- * E-mail:
| | - Georg Dorffner
- Section for Artificial Intelligence and Decision Support, Medical University of Vienna, Vienna, Austria
| | - Maximilian Marhold
- Medical University of Vienna Department of Medicine I, Clinical Division of Oncology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
| | - Anemone Rutter
- Department of Obstetrics and Gynecology, Cancer Comprehensive Center, Medical University of Vienna, Vienna, Austria
| | - Mert Döger
- Department of Obstetrics and Gynecology, Cancer Comprehensive Center, Medical University of Vienna, Vienna, Austria
| | - Christian Singer
- Department of Obstetrics and Gynecology, Cancer Comprehensive Center, Medical University of Vienna, Vienna, Austria
| | | | - Christine Deutschmann
- Department of Obstetrics and Gynecology, Cancer Comprehensive Center, Medical University of Vienna, Vienna, Austria
| | - Iris Holzer
- Department of Obstetrics and Gynecology, Cancer Comprehensive Center, Medical University of Vienna, Vienna, Austria
| | - Daniel König-Castillo
- Clinical Division of Social Psychiatry, Department of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna, Austria
| | - Daphne Gschwantler-Kaulich
- Department of Obstetrics and Gynecology, Cancer Comprehensive Center, Medical University of Vienna, Vienna, Austria
| |
Collapse
|
3
|
Deutschmann C, Bartsch R, Singer CF, Gschwantler-Kaulich D, Seifert M, Leser C, Marhold M, Bago-Horvath Z, Pfeiler G. Atezolizumab plus nab-paclitaxel for unresectable, locally advanced or metastatic breast cancer: real-world results from a single academic center in Austria. BMC Cancer 2022; 22:1099. [PMID: 36289467 PMCID: PMC9609239 DOI: 10.1186/s12885-022-10168-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Accepted: 06/15/2022] [Indexed: 11/10/2022] Open
Abstract
Purpose IMpassion130 led to the approval of atezolizumab plus nab-paclitaxel as first-line treatment for patients with unresectable locally advanced or metastatic triple-negative, PD-L1 immune-cell positive breast cancer (BC) by the European Medicines Agency (EMA). The objective of the present study was to investigate the implementation, safety and efficacy of this combination in the initial phase after approval. Methods A retrospective data analysis including all BC patients who received atezolizumab and nab-paclitaxel between 1.1.2019 and 31.10.2020 at the Department of Obstetrics and Gynecology and the Department of Medicine 1, respectively, at the Medical University of Vienna, Austria, was performed. Progression-free survival (PFS) and overall survival (OS) were estimated with the Kaplan-Maier product-limit method. Owing to the retrospective nature of this study, all statistics must be considered exploratory. Results In total 20 patients were included in the study. Median follow-up was 7.1 months (IQR 5.2–9.1). Median PFS was 3.0 months (SE = .24; 95% CI [2.5; 3.5]). Median OS was 8.94 months (SE = 2.34, 95%CI [4.35; 13.53]). No new safety signals were observed. Conclusion The present study showed a considerably shorter PFS (3.0 vs. 7.5 months) and OS (8.94 vs. 25.0 months) than IMpassion130 putatively owing to the use of atezolizumab in later treatment lines, more aggressive tumors and a study population with higher morbidity compared to the pivotal trial.
Collapse
Affiliation(s)
- Christine Deutschmann
- grid.22937.3d0000 0000 9259 8492Department of Obstetrics and Gynecology, Division of General Gynecology and Gynecologic Oncology, Medical University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria
| | - Rupert Bartsch
- grid.22937.3d0000 0000 9259 8492Department of Medicine 1, Clinical Division of Oncology, Medical University of Vienna, Vienna, Austria
| | - Christian F Singer
- grid.22937.3d0000 0000 9259 8492Department of Obstetrics and Gynecology, Division of General Gynecology and Gynecologic Oncology, Medical University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria
| | - Daphne Gschwantler-Kaulich
- grid.22937.3d0000 0000 9259 8492Department of Obstetrics and Gynecology, Division of General Gynecology and Gynecologic Oncology, Medical University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria
| | - Michael Seifert
- grid.22937.3d0000 0000 9259 8492Department of Obstetrics and Gynecology, Division of General Gynecology and Gynecologic Oncology, Medical University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria
| | - Carmen Leser
- grid.22937.3d0000 0000 9259 8492Department of Obstetrics and Gynecology, Division of General Gynecology and Gynecologic Oncology, Medical University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria
| | - Maximilian Marhold
- grid.22937.3d0000 0000 9259 8492Department of Medicine 1, Clinical Division of Oncology, Medical University of Vienna, Vienna, Austria
| | - Zsuzsanna Bago-Horvath
- grid.22937.3d0000 0000 9259 8492Department of Pathology, Medical University of Vienna, Vienna, Austria
| | - Georg Pfeiler
- grid.22937.3d0000 0000 9259 8492Department of Obstetrics and Gynecology, Division of General Gynecology and Gynecologic Oncology, Medical University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria
| |
Collapse
|
4
|
Holzer I, Farr A, Tan Y, Deutschmann C, Leser C, Singer CF. Receptor Discordance of Metastatic Breast Cancer Depending on the Molecular Subtype. Breast Care (Basel) 2021; 15:648-654. [PMID: 33447240 DOI: 10.1159/000506464] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2019] [Accepted: 02/12/2020] [Indexed: 11/19/2022] Open
Abstract
Introduction Almost 30% of all women with early-stage breast cancer develop metastases. Treatment of metastatic disease is often based on the immunohistochemical information of the primary tumor, despite possible discordance of the hormone and Her2 receptor status. Objectives The aim of this study was to compare the receptor status of the primary tumor with the metastasis, and to evaluate for receptor discordance with regard to the molecular subtype, receptor status, and the localization of the metastases. Methods We retrospectively analyzed the data of all consecutive women with metastatic breast cancer, who underwent treatment at the Medical University Vienna between 2009 and 2016. Associations were calculated using the χ2or Fisher's exact test; years from primary diagnosis to metastatic disease were calculated using the Kaplan-Meier method. Results We identified 213 metastatic breast cancer patients, of whom 67 (31.5%) showed a discordant receptor status. Out of 32 patients with luminal A subtype, 14 (43.8%) had a switch of at least one receptor; 27 of 53 patients (50.9%) with luminal B subtype and 21 of 32 patients (65.6%) with Her2+ subtype showed receptor discordance; for triple-negative disease, 5 of 19 patients (36.3%) had a switch of at least one receptor. In 63 samples of bone metastases, 13 (20.6%) had discordant estrogen receptor status (p = 0.04). In 55 samples of bone metastases, 35 (63.3%) had discordant Her2 status (p = 0.002). Conclusions Our data show high rates of receptor discordance in metastatic breast cancer. Apart from the primary tumor, the immunohistochemical receptor status of the metastasis needs to be verified. This can lead to a change in treatment and prognosis.
Collapse
Affiliation(s)
- Iris Holzer
- Breast Health Center, Division of Gynecology and Gynecologic Oncology, Department of Obstetrics and Gynecology, Medical University of Vienna, Vienna, Austria
| | - Alex Farr
- Breast Health Center, Division of Gynecology and Gynecologic Oncology, Department of Obstetrics and Gynecology, Medical University of Vienna, Vienna, Austria
| | - Yen Tan
- Breast Health Center, Division of Gynecology and Gynecologic Oncology, Department of Obstetrics and Gynecology, Medical University of Vienna, Vienna, Austria
| | - Christine Deutschmann
- Breast Health Center, Division of Gynecology and Gynecologic Oncology, Department of Obstetrics and Gynecology, Medical University of Vienna, Vienna, Austria
| | - Carmen Leser
- Breast Health Center, Division of Gynecology and Gynecologic Oncology, Department of Obstetrics and Gynecology, Medical University of Vienna, Vienna, Austria
| | - Christian F Singer
- Breast Health Center, Division of Gynecology and Gynecologic Oncology, Department of Obstetrics and Gynecology, Medical University of Vienna, Vienna, Austria
| |
Collapse
|
5
|
Gruber M, König D, Holzhäuser J, Castillo DM, Blüml V, Jahn R, Leser C, Werneck-Rohrer S, Werneck H. Parental feeding practices and the relationship with parents in female adolescents and young adults with eating disorders: A case control study. PLoS One 2020; 15:e0242518. [PMID: 33212471 PMCID: PMC7676917 DOI: 10.1371/journal.pone.0242518] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Accepted: 11/04/2020] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE Perceived parental influence on diet in early adolescence in the context of the parental relationship had previously not been studied in a clinical sample. The aim of this study was to investigate a possible association between eating disorders and characteristics of the relationship with parents and the parental feeding practices in early adolescence. METHODS 21 female adolescents and young adults with an eating disorder (ED)-bulimia nervosa or anorexia nervosa-and 22 females without eating disorder (healthy control; HC), aged between 16 and 26, were assessed via self-report questionnaires for problematic eating behaviour, relationship with parents, perceptions of parent's feeding practices at the age of 10-13 years and personality. Statistical evaluation was performed by means of group comparisons, effect sizes, regression analyses and mediator analyses. RESULTS Adolescent and young adult females with ED reported more fears/overprotection and rejection/neglect by their mothers and less self-responsibility in terms of eating behaviour during adolescence than did the HC. The relationship with the fathers did not differ significantly. Females who perceived more cohesion, rejection/neglect and fears/overprotection by the mother were more likely to suffer from an ED. Rejection/neglect by both parents were associated with less self-acceptance of the young females with even stronger effect sizes for the fathers than the mothers. Harm prevention in the young females was a partial mediator between fears/overprotection and the drive for thinness. CONCLUSIONS The parental relationship is partly reflected in the self-acceptance and self-responsibility in eating of the adolescent and young females, both of them are particularly affected in EDs. Stressors in the parent-child relationship should be targeted in treatment of eating disorders. Nutritional counselling for parents might be useful in early adolescence.
Collapse
Affiliation(s)
- Maria Gruber
- Division of Social Psychiatry, Department of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna, Austria
| | - Daniel König
- Division of Social Psychiatry, Department of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna, Austria
| | - Julika Holzhäuser
- Department of Developmental and Educational Psychology, Faculty of Psychology, University of Vienna, Vienna, Austria
| | | | - Victor Blüml
- Department of Psychoanalysis and Psychotherapy, Medical University of Vienna, Vienna, Austria
| | - Rebecca Jahn
- Division of Social Psychiatry, Department of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna, Austria
| | - Carmen Leser
- Department of Obstetrics and Gynaecology, Medical University of Vienna, Vienna, Austria
| | - Sonja Werneck-Rohrer
- Department of Child and Adolescent Psychiatry, Medical University of Vienna, Vienna, Austria
| | - Harald Werneck
- Department of Developmental and Educational Psychology, Faculty of Psychology, University of Vienna, Vienna, Austria
- * E-mail:
| |
Collapse
|
6
|
Leser C, Tan YY, Singer C, Zeillinger R, Fitzal F, Lehrner J, König D, Deutschmann C, Gschwantler-Kaulich D. Patient satisfaction after breast cancer surgery : A prospective clinical trial. Wien Klin Wochenschr 2020; 133:6-13. [PMID: 32880714 PMCID: PMC7840629 DOI: 10.1007/s00508-020-01730-w] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2020] [Accepted: 08/03/2020] [Indexed: 11/25/2022]
Abstract
BACKGROUND This study investigated the impact of curative breast cancer surgery on patient satisfaction concerning cosmetic results and quality of life (QoL). METHODS In this study 61 participants completed questionnaires to evaluate their QoL and patient satisfaction with cosmetic results following breast cancer surgery. Cosmetic outcomes were evaluated by the breast surgeon and an independent breast specialist using the Harris scale and the breast analyzing tool (BAT). RESULTS Of the participants 71% completed all 4 follow-up visits, 38 (62%) patients received breast-conserving therapy (BCT) and 23 (38%) received a mastectomy. Surgery-associated complications arose in 2.6% of the patients who received BCT and 17.4% of patients who received a mastectomy. No significant differences in QoL between BCT patients and mastectomy patients were observed immediately after surgery, or after 6 and 12 months. Breast asymmetry, measured using the BAT score, and QoL scores were worst immediately after surgery. The surgeon rated the cosmetic results as better compared to the independent breast expert (p = 0.001). Furthermore, patients aged over 60 years old were less satisfied with the cosmetic outcome compared to younger patients at the time of discharge (p = 0.024). Patients who received a mastectomy were less satisfied when the resected volume was higher. CONCLUSION Patient satisfaction was lowest immediately after surgery but improved during the following months, despite continued breast asymmetry. For mastectomy patients, a lower resected volume led to a higher satisfaction with cosmetic results. Satisfaction is subjective and cannot be determined from the esthetic satisfaction of the surgeon or using an objective tool measuring breast asymmetry.
Collapse
Affiliation(s)
- Carmen Leser
- Department of Obstetrics and Gynaecology, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria.
- Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria.
| | - Yen Y Tan
- Department of Obstetrics and Gynaecology, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
- Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
| | - Christian Singer
- Department of Obstetrics and Gynaecology, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
- Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
| | - Robert Zeillinger
- Department of Obstetrics and Gynaecology, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
- Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
| | - Florian Fitzal
- Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
- Department of Surgery, Medical University of Vienna, Vienna, Austria
| | - Johann Lehrner
- Department of Neurology, Medical University of Vienna, Vienna, Austria
| | - Daniel König
- Clinical Division of Social Psychiatry, Department of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna, Austria
| | - Christine Deutschmann
- Department of Obstetrics and Gynaecology, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
- Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
| | - Daphne Gschwantler-Kaulich
- Department of Obstetrics and Gynaecology, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
- Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
| |
Collapse
|
7
|
Deutschmann C, Knoth J, Gschwantler-Kaulich D, Singer CF, Leser C, Kauer-Dorner D. The impact of prepectoral implant positioning in breast reconstruction on the technical delivery of postmastectomy radiotherapy. Geburtshilfe Frauenheilkd 2020. [DOI: 10.1055/s-0040-1714532] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/22/2023] Open
Affiliation(s)
| | - J Knoth
- Medizinische Universität Wien
| | | | | | - C Leser
- Medizinische Universität Wien
| | | |
Collapse
|
8
|
Leser C, Deutschmann C, Dorffner G, Gschwantler-Kaulich D, Castillo DM, Abayev S, Stübler M, Reitsamer R, Singer C. Complication rates among women undergoing preventive mastectomy: An Austrian registry. Breast J 2020; 26:1639-1644. [PMID: 32452097 DOI: 10.1111/tbj.13877] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2019] [Revised: 03/24/2020] [Accepted: 04/23/2020] [Indexed: 11/27/2022]
Abstract
Germline variations in the BRCA-1 and BRCA-2 genes are associated with an increased risk of breast cancer. These variants are found in 5% of all breast cancer cases. Prophylactic mastectomy is the most effective risk-reducing method and shows high rates of patient satisfaction and acceptance. We established a registry of Austrian BRCA-1 and BRCA-2 mutation carriers who had undergone mastectomy for oncologic or prophylactic reasons. Data were collected on the type of operation, complications, and type of reconstructive surgery for patients between 2014 and 2017. The complication rate in patients with nipple-sparing mastectomy was significantly lower (23.1%) than in those with other types of mastectomies (60.7%; P = .005). In patients with implant-based breast reconstruction, subpectoral placement was associated with a significantly higher rate of complications than prepectoral placement (P = .025). Median implant volume was 350 cc (range: 155-650 cc), and a 100-cc increase was associated with doubling of the odds of a complication (regression coefficient = 0.007); based on this finding, some surgeons may decide on using smaller implants. In summary, we identified significant associations between the risk of complications and surgical characteristics, and found host factors like diabetes, BMI, and smoking among Austrian patients with BRCA-1 and BRCA-2 variants.
Collapse
Affiliation(s)
- Carmen Leser
- Department of Obstetrics and Gynaecology, Medical University of Vienna, Vienna, Austria.,Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
| | - Christine Deutschmann
- Department of Obstetrics and Gynaecology, Medical University of Vienna, Vienna, Austria.,Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
| | - Georg Dorffner
- Institute for Artificial Intelligence and Decision Support, Medical University of Vienna, Vienna, Austria
| | - Daphne Gschwantler-Kaulich
- Department of Obstetrics and Gynaecology, Medical University of Vienna, Vienna, Austria.,Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
| | | | - Sara Abayev
- Department of Plastic and Reconstructive Surgery, Wilhelminen Hospital, Vienna, Austria
| | - Madeleine Stübler
- Department of Surgery, Kepler University Hospital Linz, Linz, Austria
| | - Roland Reitsamer
- Department of Obstetrics and Gynaecology, University Hospital Salzburg, Salzburg, Austria
| | - Christian Singer
- Department of Obstetrics and Gynaecology, Medical University of Vienna, Vienna, Austria.,Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
| |
Collapse
|
9
|
Deutschmann C, Clauser P, Tan Y, Singer CF, Leser C, Gschwantler-Kaulich D. Präpektorale versus Retropektorale Implantatrekonstruktion – Überlegungen zur Implantattasche. Geburtshilfe Frauenheilkd 2020. [DOI: 10.1055/s-0039-3403409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
Affiliation(s)
- C Deutschmann
- Medizinische Universität Wien, Universitätsklinik für Frauenheilkunde
| | - P Clauser
- Medizinische Universität Wien, Universitätsklinik für Radiologie
| | - Y Tan
- Medizinische Universität Wien, Universitätsklinik für Frauenheilkunde
| | - C F Singer
- Medizinische Universität Wien, Universitätsklinik für Frauenheilkunde
| | - C Leser
- Medizinische Universität Wien, Universitätsklinik für Frauenheilkunde
| | | |
Collapse
|
10
|
Leser C, Reiner A, Dorffner G, Kastner MT, Igaz M, Singer C, Deutschmann C, Holzer I, Castillo DM, Gschwantler-Kaulich D. Expression von Biomarkern des Cyclin D-Cyclin dependent Kinase 4/6-Retinoblastompathways in tissue arrays von primären Brusttumoren und gematchten Lymphknotenmetastasen. Geburtshilfe Frauenheilkd 2020. [DOI: 10.1055/s-0039-3403393] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
Affiliation(s)
- C Leser
- Abteilung für Gynäkologie und geburtshilfe, Medizinische Universität Wien
| | - A Reiner
- Abteilung für Pathologie, Sozialmedizinisches Zentrum Ost, Wien
| | - G Dorffner
- Sektion für artifizielle Intelligenz, Medizinische Universität Wien
| | - M-T Kastner
- Abteilung für Gynäkologie und geburtshilfe, Medizinische Universität Wien
| | | | - C Singer
- Abteilung für Gynäkologie und geburtshilfe, Medizinische Universität Wien
| | - C Deutschmann
- Abteilung für Gynäkologie und geburtshilfe, Medizinische Universität Wien
| | - I Holzer
- Abteilung für Gynäkologie und geburtshilfe, Medizinische Universität Wien
| | - D M Castillo
- Abteilung für Gynäkologie und geburtshilfe, Medizinische Universität Wien
| | | |
Collapse
|
11
|
Deutschmann C, Dorffner G, Singer CF, Leser C, Gschwantler-Kaulich D. Präpektorale versus retropektorale Implantatrekonstruktion – ein Vergleich der Methoden-assoziierten Komplikationsraten. Geburtshilfe Frauenheilkd 2019. [DOI: 10.1055/s-0039-1681989] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
Affiliation(s)
- C Deutschmann
- Medizinische Universität Wien, Universitätsklinik für Frauenheilkunde, Klinische Abteilung für Allgemeine Gynäkologie und gynäkologische Onkologie
| | - G Dorffner
- Medizinische Universität Wien, Zentrum für Medizinische Statistik, Informatik und Intelligente Systeme, Institut für Artificial Intelligence and Decision Support
| | - CF Singer
- Medizinische Universität Wien, Universitätsklinik für Frauenheilkunde, Klinische Abteilung für Allgemeine Gynäkologie und gynäkologische Onkologie
| | - C Leser
- Medizinische Universität Wien, Universitätsklinik für Frauenheilkunde, Klinische Abteilung für Allgemeine Gynäkologie und gynäkologische Onkologie
| | - D Gschwantler-Kaulich
- Medizinische Universität Wien, Universitätsklinik für Frauenheilkunde, Klinische Abteilung für Allgemeine Gynäkologie und gynäkologische Onkologie
| |
Collapse
|
12
|
Deutschmann C, Gschwantler-Kaulich D, Dorffner G, Singer CF, Leser C, Kauer-Dorner D. Präpektorale versus retropektorale implantat-basierte Brustrekonstruktion – Die strahlentherapeutische Perspektive. Geburtshilfe Frauenheilkd 2019. [DOI: 10.1055/s-0039-1681988] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
Affiliation(s)
- C Deutschmann
- Medizinische Universität Wien, Universitätsklinik für Frauenheilkunde, Klinische Abteilung für Allgemeine Gynäkologie und gynäkologische Onkologie
| | - D Gschwantler-Kaulich
- Medizinische Universität Wien, Universitätsklinik für Frauenheilkunde, Klinische Abteilung für Allgemeine Gynäkologie und gynäkologische Onkologie
| | - G Dorffner
- Medizinische Universität Wien, Zentrum für Medizinische Statistik, Informatik und Intelligente Systeme, Institut für Artificial Intelligence and Decision Support
| | - CF Singer
- Medizinische Universität Wien, Universitätsklinik für Frauenheilkunde, Klinische Abteilung für Allgemeine Gynäkologie und gynäkologische Onkologie
| | - C Leser
- Medizinische Universität Wien, Universitätsklinik für Frauenheilkunde, Klinische Abteilung für Allgemeine Gynäkologie und gynäkologische Onkologie
| | - D Kauer-Dorner
- Medizinische Universität Wien, Universitätsklinik für Strahlentherapie
| |
Collapse
|
13
|
Deutschmann C, Singer C, Leser C, Gschwantler-Kaulich D. Prepectoral versus retropectoral implant-based breast reconstruction – considerations regarding the implant pocket. Breast 2019. [DOI: 10.1016/s0960-9776(19)30404-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
|
14
|
Deutschmann C, Gschwantler-Kaulich D, Dorffner G, Singer C, Leser C, Kauer-Dorner D. Abstract P5-16-06: Prepectoral versus retropectoral implant-based breast reconstruction - The surgical and radiotherapeutical perspective. Cancer Res 2019. [DOI: 10.1158/1538-7445.sabcs18-p5-16-06] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: Subpectoral implant positioning has been the standard of care in breast reconstruction despite involving disadvantages owing to the detachment of the pectoralis major muscle such as disruption of the muscle function, animation deformities and prolonged postoperative pain. Refined ablative techniques as well as dermal matrices and synthetic mesh products have led to the reintroduction of subcutaneous implant-based breast reconstruction possibly avoiding the negative sequelae of pectoralis disinsertion.
Objective: The primary objective of this study was to compare procedure-related complication rates following prepectoral versus retropectoral implant-based breast reconstruction. Furthermore the effect of the implant position on the quality of post-mastectomy radiation therapy (PMRT) was analysed.
Methods: All patients who underwent an implant-based breast reconstruction after mastectomy at the Department of Obstetrics and Gynecology of the University Clinic of Vienna within the years 1.1.2013 to 31.12.2017 were included in the study. A retrospective chart review of the patients was conducted assessing parameters regarding the mastectomy, the reconstruction, complications following the reconstructive procedure, patient-associated risk factors and radiation treatment plans. Complication rates were analysed one week, one month and one year after the implant-based reconstructive operation.
Results: In total 57 patients (94 breasts) were reconstructed following a prepectoral implant-placement approach, 95 patients (149 breasts) were reconstructed with implants in a retropectoral position. The two patient cohorts did not differ significantly in the occurrence of complications including the following dehiscence, infection, seroma, secondary bleeding, necrosis, fistula, capsular contracture and rippling. No significant differences regarding reinterventions and reoperations including seroma drainage, secondary suture and reoperation following secondary hemorrhage and necrosis could be detected between the two study populations. The two surgical procedures were not associated with a different rate of implant loss.
12 (2 in the cohort of patients with prepectorally placed implants and 10 in the subgroup of patients with subpectorally positioned implants) out of 152 patients needed PMRT for oncological safety. Prepectoral versus retropectoral implant positioning did not affect breast Dmean or D90, heart Dmax or V5 or lung V20 across treatment plans.
Conclusion: The study demonstrated no inferior outcome regarding the occurrence of complications, reinterventions, reoperations and implant loss of prepectoral implant-based breast reconstruction compared to retropectoral implant positioning. Therefore, subcutaneous implant placement permits reconstruction of the breast with comparable procedure-related complication rates while avoiding disadvantages associated with the detachment of the pectoral muscle.
Regarding the radiation perspective both prepectoral and retropectoral implant positioning allow for optimal coverage of the chest wall with acceptable doses to the heart and lung.
Citation Format: Deutschmann C, Gschwantler-Kaulich D, Dorffner G, Singer C, Leser C, Kauer-Dorner D. Prepectoral versus retropectoral implant-based breast reconstruction - The surgical and radiotherapeutical perspective [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P5-16-06.
Collapse
Affiliation(s)
- C Deutschmann
- Medical University of Vienna, Vienna, Austria; Medical University of Vienna, Center for Medical Statistics, Informatics and Intelligent Systems, Section for Artificial Intelligence and Decision Support, Vienna, Austria
| | - D Gschwantler-Kaulich
- Medical University of Vienna, Vienna, Austria; Medical University of Vienna, Center for Medical Statistics, Informatics and Intelligent Systems, Section for Artificial Intelligence and Decision Support, Vienna, Austria
| | - G Dorffner
- Medical University of Vienna, Vienna, Austria; Medical University of Vienna, Center for Medical Statistics, Informatics and Intelligent Systems, Section for Artificial Intelligence and Decision Support, Vienna, Austria
| | - C Singer
- Medical University of Vienna, Vienna, Austria; Medical University of Vienna, Center for Medical Statistics, Informatics and Intelligent Systems, Section for Artificial Intelligence and Decision Support, Vienna, Austria
| | - C Leser
- Medical University of Vienna, Vienna, Austria; Medical University of Vienna, Center for Medical Statistics, Informatics and Intelligent Systems, Section for Artificial Intelligence and Decision Support, Vienna, Austria
| | - D Kauer-Dorner
- Medical University of Vienna, Vienna, Austria; Medical University of Vienna, Center for Medical Statistics, Informatics and Intelligent Systems, Section for Artificial Intelligence and Decision Support, Vienna, Austria
| |
Collapse
|
15
|
Gschwantler-Kaulich D, Leser C, Salama M, Singer CF. Direct-to-implant breast reconstruction: Higher complication rate vs cosmetic benefits. Breast J 2018; 24:957-964. [DOI: 10.1111/tbj.13113] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2017] [Revised: 11/21/2017] [Accepted: 11/21/2017] [Indexed: 11/27/2022]
Affiliation(s)
- Daphne Gschwantler-Kaulich
- Breast Cancer Center, Department of Obstetrics and Gynaecology; Medical University of Vienna; Vienna Austria
| | - Carmen Leser
- Breast Cancer Center, Department of Obstetrics and Gynaecology; Medical University of Vienna; Vienna Austria
| | - Mohamed Salama
- Department of Surgery; Otto Wagner Hospital; Vienna Austria
| | - Christian Fridolin Singer
- Breast Cancer Center, Department of Obstetrics and Gynaecology; Medical University of Vienna; Vienna Austria
| |
Collapse
|
16
|
Gschwantler-Kaulich D, Schrenk P, Bjelic-Radisic V, Unterrieder K, Leser C, Fink-Retter A, Salama M, Singer C. Corrigendum to "Mesh versus acellular dermal matrix in immediate implant-based breast reconstruction - A prospective randomized trial" [Eur J Surg Oncol 42 (5) (2016) 665-671]. Eur J Surg Oncol 2017; 43:1380-1381. [PMID: 28526188 DOI: 10.1016/j.ejso.2017.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Affiliation(s)
- D Gschwantler-Kaulich
- Medical University of Vienna, Breast Cancer Center, Department of Gynaecological Oncology, Waehringer Guertel 18-20, 1090 Vienna, Austria.
| | - P Schrenk
- AKH Linz Breast Cancer Center, Krankenhausstrasse 9, 4021 Linz, Austria
| | - V Bjelic-Radisic
- Medical University of Graz, Department of Gynaecology, Auenbruggerplatz 1, 8036 Graz, Austria
| | - K Unterrieder
- Private Hospital Villach, Breast Cancer Center, Department of Gynaecology, Dr.-Walter-Hochsteiner-Straße 4, 9504 Villach, Austria
| | - C Leser
- Medical University of Vienna, Breast Cancer Center, Department of Gynaecological Oncology, Waehringer Guertel 18-20, 1090 Vienna, Austria
| | - A Fink-Retter
- Medical University of Vienna, Breast Cancer Center, Department of Gynaecological Oncology, Waehringer Guertel 18-20, 1090 Vienna, Austria
| | - M Salama
- Otto Wagner Hospital, Department of Surgery, Baumgartner Hoehe 1, 1140 Vienna, Austria
| | - C Singer
- Medical University of Vienna, Breast Cancer Center, Department of Gynaecological Oncology, Waehringer Guertel 18-20, 1090 Vienna, Austria
| |
Collapse
|
17
|
Gschwantler-Kaulich D, Tan YY, Fuchs EM, Hudelist G, Köstler WJ, Reiner A, Leser C, Salama M, Attems J, Deutschmann C, Zielinski CC, Singer CF. PTEN expression as a predictor for the response to trastuzumab-based therapy in Her-2 overexpressing metastatic breast cancer. PLoS One 2017; 12:e0172911. [PMID: 28253285 PMCID: PMC5333838 DOI: 10.1371/journal.pone.0172911] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2016] [Accepted: 02/10/2017] [Indexed: 02/07/2023] Open
Abstract
Background Even though trastuzumab is an effective therapy in early stage Her-2+ breast cancer, 40–50% of advanced Her-2+ breast cancer patients develop trastuzumab resistance. A potential resistance mechanism is aberrant downstream signal transmission due to loss of phosphatase and tensin homologue (PTEN). This study investigated the relationship between the expression of PTEN and trastuzumab response in Her-2 overexpressing metastatic breast cancer patients. Methods Between 2000 and 2007, 164 patients with Her-2+ metastatic breast cancer received trastuzumab-based therapy in our institution. We analyzed PTEN status by immunohistochemistry of 115 available tumor tissues and analyzed associations with other histopathological parameters, response rate, progression free survival (PFS) and overall survival (OS) with a median follow-up of 60 months. Results Eighty patients were PTEN positive (69.6%) and 35 patients PTEN negative (30.4%). We found a significant association of the expression of PTEN and p53 (p = 0.041), while there was no association with grading, hormone receptor status, IGFR or MIB. We found significantly more cases with progressive disease under trastuzumab-based therapy in patients with PTEN positive breast cancers (p = 0.018), while there was no significant correlation with PFS or OS. Conclusion In Her-2-positive metastatic breast cancers, PTEN positivity was significantly associated with progressive disease, but not with PFS or OS.
Collapse
Affiliation(s)
- Daphne Gschwantler-Kaulich
- Department of Obstetrics and Gynecology, Cancer Comprehensive Center, Medical University of Vienna, Vienna, Austria
- * E-mail:
| | - Yen Y. Tan
- Department of Obstetrics and Gynecology, Cancer Comprehensive Center, Medical University of Vienna, Vienna, Austria
- QIMR Berghofer Medical Research Institute, Herston, Queensland, Australia
| | - Eva-Maria Fuchs
- Clinical Division of Oncology, Department of Medicine I and Center for Excellence in Clinical and Experimental Oncology, Medical University of Vienna, Vienna, Austria
| | - Gernot Hudelist
- Department of Obstetrics and Gynecology, Cancer Comprehensive Center, Medical University of Vienna, Vienna, Austria
- Department of Obstetrics and Gynaecology, Wilhelminenspital, Vienna, Austria
| | - Wolfgang J. Köstler
- Clinical Division of Oncology, Department of Medicine I and Center for Excellence in Clinical and Experimental Oncology, Medical University of Vienna, Vienna, Austria
| | - Angelika Reiner
- Department of Pathology, Sozialmedizinisches Zentrum Ost, Vienna, Austria
| | - Carmen Leser
- Department of Obstetrics and Gynecology, Cancer Comprehensive Center, Medical University of Vienna, Vienna, Austria
| | - Mohamed Salama
- Department of Thoracic Surgery, Otto Wagner Hospital, Vienna, Austria
| | - Johannes Attems
- Department of Pathology, Otto Wagner Hospital, Vienna, Austria
| | - Christine Deutschmann
- Department of Obstetrics and Gynecology, Cancer Comprehensive Center, Medical University of Vienna, Vienna, Austria
| | - Christoph C. Zielinski
- Clinical Division of Oncology, Department of Medicine I and Center for Excellence in Clinical and Experimental Oncology, Medical University of Vienna, Vienna, Austria
| | - Christian F. Singer
- Department of Obstetrics and Gynecology, Cancer Comprehensive Center, Medical University of Vienna, Vienna, Austria
| |
Collapse
|
18
|
Gschwantler-Kaulich E, Schrenk P, Bjelic-Radisic V, Unterrieder K, Leser C, Fink-Retter A, Salama M, Singer C. Mesh versus acellular dermal matrix in immediate implant based breast reconstruction – a prospective randomized trial. Eur J Cancer 2017. [DOI: 10.1016/s0959-8049(17)30176-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
|
19
|
Leser C, Tisch A, Tophoven S. [Shift Work among Men and Women on the Threshold to Higher Working Age - Working Conditions and Health Status]. Gesundheitswesen 2016; 78:765-771. [PMID: 27903012 DOI: 10.1055/s-0034-1396850] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Background: The number of older employees in shift and night work has increased significantly in recent years. Furthermore, the proportion of women in shift and night work has increased markedly. This is due to the aging workforce and the expansion of shift work in the tertiary sector. Previous research shows that shift work is often associated with health risks. Against this background, the aim of the present study is to examine the situation of working men and women on the threshold to higher working age with regard to the relationship between shift work and physical health. Methods: We employed data from the study "lidA - leben in der Arbeit" German Cohort Study on Work, Age and Health, a survey of the German baby boom cohorts born in 1959 and 1965 (n=5 637). Linear regression models are used to study the effect of shift work - with and without night work - and of further work exposures on the baby boomers' physical health status. The models control for sleep and health-related behaviour and are stratified by gender. Among women, also the scope of work was taken into account. Results: The results show that male shift workers are burdened by their on average lower occupational status and by physical exposure; female shift workers additionally suffer from high personal effort and low rewards and female part-time shift workers also from overcommitment. Conclusion: Working conditions of shift workers are strongly characterised by work stress. In order to preserve aging shift workers' work ability, some organisational measures seem necessary. In this context, occupational safety and health management as well as opportunities for recovery and encouraging leadership should be considered.
Collapse
Affiliation(s)
- C Leser
- Otto-Friedrich-Universität, Bamberg
| | - A Tisch
- Institut für Arbeitmarkt- und Berufsforschung, Nürnberg
| | - S Tophoven
- Institut für Arbeitmarkt- und Berufsforschung, Nürnberg
| |
Collapse
|
20
|
Gschwantler-Kaulich D, Schrenk P, Bjelic-Radisic V, Unterrieder K, Leser C, Fink-Retter A, Salama M, Singer C. Mesh versus acellular dermal matrix in immediate implant-based breast reconstruction - A prospective randomized trial. Eur J Surg Oncol 2016; 42:665-71. [PMID: 26947961 DOI: 10.1016/j.ejso.2016.02.007] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2015] [Revised: 01/21/2016] [Accepted: 02/02/2016] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Comparative studies on the use of meshes and acellular dermal matrices (ADM) in implant-based breast reconstruction (IBBR) have not yet been performed. METHODS This prospective, randomized, controlled, multicenter pilot study was performed at four Austrian breast cancer centers. Fifty patients with oncologic or prophylactic indication for mastectomy and IBBR were randomized to immediate IBBR with either an ADM (Protexa(®)) or a titanized mesh (TiLOOP(®) Bra). Complications, failed reconstruction, cosmetic outcome, patients' quality of life and the thickness of the overlying tissue were recorded immediately postoperatively and 3 and 6 months after surgery. RESULTS 48 patients participated in the study (Protexa(®) group: 23; TiLOOP(®) Bra group: 25 patients). The overall complication rate was 31.25% with similar rates in both groups (Protexa(®) group: 9 versus TiLOOP(®) Bra group: 6; p = 0.188). There was a higher incidence of severe complications leading to failed reconstructions with implant loss in the Protexa(®) group than in the TiLOOP(®) Bra group (7 versus 2; p < 0.0001). An inverted T-incision technique led to significantly more complications and reconstructive failure with Protexa(®) (p = 0.037, p = 0.012, respectively). There were no significant differences in patients' satisfaction with cosmetic results (p = 0.632), but surgeons and external specialists graded significantly better outcomes with TiLOOP(®) Bra (p = 0.034, p = 0.032). CONCLUSION This pilot study showed use of TiLOOP(®) Bra or Protexa(®) in IBBR is feasible leading to good cosmetic outcomes and high patient satisfaction. To validate the higher failure rates in the Protexa(®) group, data from a larger trial are required. NCT02562170.
Collapse
Affiliation(s)
- D Gschwantler-Kaulich
- Medical University of Vienna, Breast Cancer Center, Department of Gynaecological Oncology, Waehringer Guertel 18-20, 1090 Vienna, Austria.
| | - P Schrenk
- AKH Linz Breast Cancer Center, Krankenhausstrasse 9, 4021 Linz, Austria
| | - V Bjelic-Radisic
- Medical University of Graz, Department of Gynaecology, Auenbruggerplatz 1, 8036 Graz, Austria
| | - K Unterrieder
- Private Hospital Villach, Breast Cancer Center, Department of Gynaecology, Dr.-Walter-Hochsteiner-Straße 4, 9504 Villach, Austria
| | - C Leser
- Medical University of Vienna, Breast Cancer Center, Department of Gynaecological Oncology, Waehringer Guertel 18-20, 1090 Vienna, Austria
| | - A Fink-Retter
- Medical University of Vienna, Breast Cancer Center, Department of Gynaecological Oncology, Waehringer Guertel 18-20, 1090 Vienna, Austria
| | - M Salama
- Otto Wagner Hospital, Department of Surgery, Baumgartner Hoehe 1, 1140 Vienna, Austria
| | - C Singer
- Medical University of Vienna, Breast Cancer Center, Department of Gynaecological Oncology, Waehringer Guertel 18-20, 1090 Vienna, Austria
| |
Collapse
|
21
|
Leser C, Hartmann AL, Praml G, Wüthrich B. The "egg-egg" syndrome: occupational respiratory allergy to airborne egg proteins with consecutive ingestive egg allergy in the bakery and confectionery industry. J Investig Allergol Clin Immunol 2002; 11:89-93. [PMID: 11642578] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/22/2023] Open
Abstract
Allergies to various inhalative allergens are a serious problem in the bakery and confectionery industry. Sensitization to wheat flour and enzymes such as alpha-amylase are a frequent cause of occupational asthma. Airborne egg allergens have been reported as another cause of respiratory allergy. We examined bakery and confectionery workers with respiratory symptoms due to egg aerosols. Skin tests (SPT), scratch tests (ST), nasal provocation tests (NPT) and serological examinations (IgE) were performed. Lung function was assessed by spirometry, and continuous registration of aerosols and particulates as well as gravimetric sampling was done at the workplace. Four bakery and two confectionery workers intensively exposed to airborne egg proteins suffered from conjunctivitis and rhinitis, four also from asthma. Subsequently, three of these four workers reported symptoms after ingestion of food that contained egg. SPT with commercial egg white and egg yolk extracts were negative in four cases. Only two employees had clearly positive SPT to commercial egg allergens and reacted also to wheat flour extracts. Scratch tests with native egg proteins were positive in four employees. Specific IgE to egg white and egg yolk were positive (CAP > or = 2) in three and in four cases, respectively, whereas they were negative in two cases. Elevated levels of specific IgE to lysozyme were detected in four employees. Two workers were sensitized to lysozyme but not to other egg proteins. The clinical relevance of egg sensitization was confirmed by continuous air sampling and by correlating the onset of the respiratory symptoms which were reflected by a significant decline (> or = 30%) of the forced one second capacity (FEV1) in two workers. Sieving of egg white powder and an inadequate spray station for liquid eggs were identified as sources of excessive allergen exposure. Bakery and confectionery workers exposed to airborne egg proteins are at risk of developing occupational asthma and subsequent nutritive egg allergy. To our knowledge, these are the first cases of inhalative egg allergy and subsequent nutritive egg allergy reported in the literature, which we refer to as the "egg-egg syndrome" in analogy to the already known "bird-egg" and "egg-bird" syndromes.
Collapse
Affiliation(s)
- C Leser
- Department of Dermatology, University Hospital, Zurich, Switzerland
| | | | | | | |
Collapse
|
22
|
Affiliation(s)
- G Senti
- Department of Dermatology, University Hospital, Zurich, Switzerland
| | | | | | | |
Collapse
|
23
|
Leser C, Rothe TB, Karrer WL. [Rehabilitation of cystic fibrosis in adulthood]. Praxis (Bern 1994) 1997; 86:1984-1990. [PMID: 9465725] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
Abstract
By the example of 2 adult patients with cystic fibrosis (CF) problems of pulmonary manifestation of CF and its complications are discussed. In both patients disease manifested late. Life expectancy of CF-patients has markedly increased over the last decades. In the adult distinct complications appear more often such as exacerbation of bronchitis due to pseudomonas aeruginosa, colonisation of air ways by Burkholderia cepacia or by atypical mycobacteria, development of allergic bronchopulmonary aspergillosis, bronchiectases and spontaneous pneumothorax. Today, even in adults with chronic bronchitis of unknown origin the possibility of CF has to be considered. Optimized treatment under clinical conditions, in combination with a physical training program and a diet rich in calories will ameliorate subjective physical performance as well as objective pulmonary function and work capacity. Regular rehabilitation programs contribute to better compliance. In patients with CF direct transition from pediatric to pneumologic/internistic treatment for adults is mandatory in order to optimize expectancy and quality of life.
Collapse
Affiliation(s)
- C Leser
- Luzerner Höhenklinik, Montana
| | | | | |
Collapse
|
24
|
Leser C, Bolliger CT, Winnewisser J, Burkart F, Perruchoud AP. Pulmonary oedema and hypotension induced by hydrochlorothiazide. Monaldi Arch Chest Dis 1994; 49:308-10. [PMID: 8000416] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
We present the case of a patient with acute onset of dyspnoea after a long-distance flight. Pulmonary embolism was suspected, but could be excluded by perfusion scintigraphy. The electrocardiogram and chest X-ray were compatible with acute myocardial infarction and pulmonary oedema, but the slightness of the elevation of pulmonary capillary wedge pressure allowed cardiogenic pulmonary oedema to be excluded. The clinical picture was then interpreted as pneumonia with sepsis and hypotension. The rapid and full clinical recovery within 48 h, together with the close temporal relationship of ingestion of hydrochlorothiazide and the onset of symptoms, allowed the diagnosis of drug-induced pulmonary oedema and anaphylactoid hypotension.
Collapse
Affiliation(s)
- C Leser
- Division of Pneumology, University Hospital of Basel, Switzerland
| | | | | | | | | |
Collapse
|
25
|
Abstract
Immunoblotting, radioallergosorbent test (RAST), and enzyme-linked immunosorbent assay (ELISA) were performed to determine specific IgE and IgG responses to Aspergillus fumigatus (Af) allergens (IgE-Af; IgG-Af). Serology results were compared in patients with allergic bronchopulmonary aspergillosis (ABPA) (n = 43), patients with Aspergillus fumigatus-associated asthma (Af-asthma) (n = 26), and healthy individuals (n = 3). In patients with different clinical phases of ABPA, three specific immunopatterns were found by immunoblotting. It is proposed to classify ABPA into the active, intermediate, and remission phase with respect to the specific immunoresponse to Af-allergens and asthma symptoms. First, the active phase of ABPA is characterized by a fully developed specific immunoresponse to Af-allergens and severe asthma. Second, the intermediate phase includes patients with elevated specific immunologic findings without asthma symptoms. Third, the remission phase is characterized by a weak specific immunoresponse to Af-allergens after a long-term asymptomatic period. No correlation occurred between specific immunopatterns and irreversible brochopulmonary lesions. The IgE-Af RAST and IgG-Af ELISA titers of patients with ABPA in the active and intermediate phase were significantly higher compared with patients with ABPA in remission phase and with patients with Af-asthma. In particular, the demonstration of positive IgG-Af ELISA titer generally allows the serologic discrimination of patients with asthma and ABPA from patients with Af-asthma in clinical practice. The present study revealed that immunoblots of most patients with Af-asthma were negative. Immunoblotting demonstrated an IgG reactivity exclusively to low molecular weight (MW) Af-allergens in 8 out of 26 patients with Af-asthma and in the three healthy individuals, and this IgG response may reflect naturally occurring antibodies.
Collapse
Affiliation(s)
- C Leser
- Hochgebirgsklinik Davos-Wolfgang, Asthma- and Allergy Clinic, Switzerland
| | | | | | | |
Collapse
|
26
|
Jones TK, Burston WA, Eikenberg S, Leser C, Miller RH, Mock ES. Use of a portable X-ray device during Operation Desert Storm. Gen Dent 1992; 40:210-1. [PMID: 1499973] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
|
27
|
Razemon P, Dascotte JC, Leser C. [Our experience with the tonometric effect of timolol]. Bull Soc Ophtalmol Fr 1979; 79:749-52. [PMID: 555367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
|
28
|
Razemon P, Leser C, François P. [Clinical evaluation of a 0.5% epinephrine-pilocarpine combination]. Bull Soc Ophtalmol Fr 1976; 76:717-20. [PMID: 1029563] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
|
29
|
Corbel MM, Leser C, François P. [Notes on 0.03% phospholine iodide, with more than 4 years' experience]. Bull Soc Ophtalmol Fr 1976; 76:249-50. [PMID: 1024748] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
|
30
|
Dhoine G, Leser C, Asseman R, Razemon P. [Unilateral capsular pseudo-exfoliation]. Bull Soc Ophtalmol Fr 1974; 74:475-6. [PMID: 4468148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
|
31
|
Asseman R, Leser C. [Trabeculotomy during a very advanced glaucoma in the adult]. Bull Soc Ophtalmol Fr 1973; 73:1191-3. [PMID: 4803753] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
|
32
|
Corbel M, Leser C, François P, Razemon P. [Long term results of 0,03 per cent phospholin iodide in serveral ocular hypertonia]. Bull Soc Ophtalmol Fr 1973; 73:455-60. [PMID: 4792544] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
|
33
|
Asseman R, Razemon P, Corbel M, Leser C. [Trabeculotomy in adult glaucoma. Various results]. Bull Soc Ophtalmol Fr 1973; 73:461-4. [PMID: 4792545] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
|
34
|
Razemon P, Dufour D, Leser C. [Eales' disease and multiple sclerosis. Report of new cases]. Bull Soc Ophtalmol Fr 1972; 72:1143-6. [PMID: 4667839] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
|
35
|
Corbel M, Leser C, Lemaire E. [Absence of cataractogenic effect of 0.03 percent phospholine iodide]. Bull Soc Ophtalmol Fr 1971; 71:885-9. [PMID: 5151034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
|
36
|
Corbel M, François P, Leser C, Lemaire E. [Tonometric stabilization with 0.03 per cent phospholine in primary hypertonia]. Bull Soc Ophtalmol Fr 1971; 71:184-90. [PMID: 5120576] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
|
37
|
Dufour D, Guilbert F, Leser C. [Segmentary periarteritis of the retina]. Bull Soc Ophtalmol Fr 1970; 70:602-6. [PMID: 5474603] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
|
38
|
Beal F, Dufour D, Leser C. [Vogt method of radiography while disengaging the eyeball]. Bull Soc Ophtalmol Fr 1968; 68:122-124. [PMID: 5698075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
|
39
|
Corbel M, Leser C, Gibault R. [Tonometric stabilization in combined cataract-glaucoma surgical interventions]. Bull Soc Ophtalmol Fr 1968; 68:85-9. [PMID: 5698096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
|