Prognostic and predictive factors of invasive ductal breast carcinomas

PURPOSE

To investigate the significance of certain immunohistochemical markers, namely estrogen (ER) and progesterone receptors (PgR), c-erbB-2 oncogene, p53 tumor suppressor gene and E-cadherin adhesion molecule, in invasive ductal breast carcinomas.

METHODS

A series of 102 primary breast carcinomas of the ductal type and a standard immunohistochemical technique was used to detect the aforementioned biological markers. The findings were related to various clinical and pathological tumor characteristics, including lymph node metastases.

RESULTS

ER and E-cadherin were expressed more commonly in tumors of low histological grade and small number (< or =3) of metastatic lymph nodes, whereas c-erbB-2 and the p53 gene were usually expressed in breast tumors of high histological grade and increased number (>3) of metastatic lymph nodes. PgR, on the other hand, was detected frequently in patients with early menarche and metastases in <3 lymph nodes, but this tendency was not statistically significant.

CONCLUSION

The use of these biomarkers, preferably in combination, may provide additional prognostic and therapeutic information which may be proved useful in planning breast cancer treatment.

Synergistic action of protease-modulating matrix and autologous growth factors in healing of diabetic foot ulcers. A prospective randomized trial

This study tests the hypothesis that addition of a protease-modulating matrix enhances the efficacy of autologous growth factors in diabetic ulcers. Fifty-one patients with chronic diabetic foot ulcers were managed as outpatients at the Democritus University Hospital of Alexandroupolis and followed up for 8 weeks. All target ulcers were > or = 2.5 cm in any one dimension and had been previously treated only with moist gauze. Patients were randomly allocated in three groups of 17 patients each: Group A was treated only with the oxidized regenerated cellulose/collagen biomaterial (Promogran, Johnson & Johnson, New Brunswick, NJ), Group B was treated only with autologous growth factors delivered by Gravitational Platelet Separation System (GPS, Biomet), and Group C was managed by a combination of both. All ulcers were digitally photographed at initiation of the study and then at change of dressings once weekly. Computerized planimetry (Texas Health Science Center ImageTool, Version 3.0) was used to assess ulcer dimensions that were analyzed for homogeneity and significance using the Statistical Package for Social Sciences, Version 13.0. Post hoc analysis revealed that there was significantly greater reduction of all three dimensions of the ulcers in Group C compared to Groups A and B (all P<.001). Although reduction of ulcer dimensions was greater in Group A than in Group B, these differences did not reach statistical significance. It is concluded that protease-modulating dressings act synergistically with autologous growth factors and enhance their efficacy in diabetic foot ulcers.

Postoperative analgesic effect of locally infiltrated levobupivacaine in fleur-de-Lys abdominoplasty

BACKGROUND

This prospective double-blind study compared the analgesic properties of locally infiltrated levobupivacaine with those of ropivacaine in fleur-de-lys abdominoplasty.

METHODS

A total of 46 patients subjected to fleur-de-lis abdominoplasty under general anesthesia were included. The patients were randomly assigned to receive local infiltration of the peri-incisional and dissected area with the following solutions: group A (placebo group, n = 15) received 100 ml of saline 0.9%, group B (n = 15) received 50 ml of ropivacaine 0.75% in 50 ml of saline 0.9%, and group C (n = 16) received 60 ml of levobupivacaine 0.25% in 40 ml of saline 0.9%. The anesthetic technique was standardized for all the groups. The patients were asked to assess their pain at rest on a visual analog scale (VAS) at 2 h, 4 h, and 24 h postoperatively. Data were analyzed by mixed analysis of variance (ANOVA), simple ANOVA, and repeated measures ANOVA, followed by Tukey's test.

RESULTS

Groups B and C did not differ significantly in their VAS scores at 2 h postoperatively, but group C experienced significantly less pain (p < 0.001) than either the control group or the B group at 4 h and 24 h postoperatively. Group B also registered significantly lower VAS scores (p < 0.001) than the placebo group at 4 h postoperatively.

CONCLUSIONS

It is concluded that for mini abdominoplasty, adequate analgesia is achieved for at least 4 h postoperatively by local tissue infiltration with either ropivacaine or levobupivacaine. However, in terms of intensity and duration of analgesia, levobupivacaine was found to be more effective than ropivacaine in reducing postoperative pain associated with mini abdominoplasty.

Breastfeeding After Reduction Mammaplasty

Breastfeeding following reduction mammaplasty by using 3 different techniques is evaluated in this retrospective study. A questionnaire was sent to 178 patients who had undergone the operation at childbearing age and provided data on quality and duration of preoperative and postoperative breastfeeding, as well as reasons for not attempting or failing. Demographic data and operative details were obtained from patients' records. One hundred six of the patients who replied to the questionnaire and had given birth after reduction mammaplasty were included in this study. Breastfeeding was considered successful if it was performed for at least 3 weeks without supplementation. For women who attempted to breastfeed postoperatively, successful rates were 71% for superior pedicle mammaplasty, 77% for the inferior pedicle technique, and 63% following horizontal bipedicled reduction mammaplasty. However, 22% of women had not made any attempt to breastfeed at all after breast reduction. The postoperative ability to breastfeed was not found to relate to the amount of resected breast tissue or the time elapsing between operation and delivery. It is concluded that after breast reduction with pedicled transposition of the nipple-areola complex and preservation of adequate subareolar breast tissue, the ability to breastfeed highly depends on encouragement and support offered to women rather than the choice of the operative technique.

Levobupivacaine Versus Ropivacaine Infiltration Analgesia for Mastopexy

A prospective double-blind study was conducted to compare the analgesic properties of levobupivacaine and ropivacaine in a bilaterally symmetrical mastopexy model. Both of these 2 long-acting local anesthetic amides are associated with lower cardiac and central nervous system toxicity than racemic bupivacaine, a widely used agent for long-lasting perioperative analgesia in esthetic procedures. In this study, each of the 18 patients undergoing bilateral mastopexy under conscious sedation received preoperative infiltration with levobupivacaine in 1 breast and equal volume of ropivacaine in the other. Patients were requested to assess their pain separately in each side every 2 hours and for 12 hours postoperatively on a visual analog scale. Overall analgesia achieved up to 12 hours postoperatively was found to be statistically different between the 2 local anesthetic factors in favor of levobupivacaine. At 2 hours postoperatively, no difference was found between the 2 local anesthetic agents in terms of analgesic efficacy (P = 0.298). However, postoperative pain scores recorded after infiltration with levobupivacaine were significantly lower than pain scores for the ropivacaine-infiltrated sides (P<0.001) at all other timeframes. Both anesthetics provided satisfactory analgesia for at least 10 hours, but constantly low pain scores were recorded for levobupivacaine for 10 hours postoperatively, whereas for ropivacaine only for 6 hours. At 12 hours, 66% of patients needed oral analgesia for pain in the ropivacaine-infiltrated breast. It is concluded that levobupivacaine is more effective for local infiltrative analgesia in mastopexy than ropivacaine, providing longer-lasting postoperative analgesia.

Comparative efficacy of ropivacaine and bupivacaine infiltrative analgesia in otoplasty

A prospective double-blind study was conducted to compare the anesthetic efficacy of ropivacaine and bupivacaine in a bilaterally symmetrical otoplasty model. Because ropivacaine has a significantly lower toxic potential than bupivacaine, it may be established as the anesthetic agent of choice for low-dose infiltration anesthesia in routine aesthetic facial operations. Each of the 24 adult patients undergoing bilateral otoplasty received infiltration with ropivacaine in 1 auricle and an equal volume of bupivacaine in the other. Patients were requested to assess their pain separately in each side at the times of infiltration, during cartilage scoring, and 2, 6, and 10 hours postoperatively on a visual analog scale. Intraoperative success rates were similar, and overall analgesia achieved at 2 hours, 6 hours, and 10 hours postoperatively was not found to be statistically different between ropivacaine and bupivacaine. The authors conclude that ropivacaine can be used as an effective alternative to bupivacaine in otoplasty.

The development of bone metastases as the first sign of metastatic spread in patients with primary solid tumours

The purpose of this retrospective study was to investigate the incidence of bone metastases as the first sign of metastatic spread in patients with primary solid malignant tumours. Between January 1987 and December 1998, we treated 867 patients suffering from primary solid malignant tumours. Their average age was 67 (range: 30-96) years and all were thoroughly investigated with a complete physical examination and laboratory tests as well as imaging studies and bone scans. No bone metastases were found at the time of the initial diagnosis, and the patients were then re-assessed every 6 months for the first 5 years and then once a year. We found that, regardless of treatment, bone metastases appeared in a certain number of patients and that after excluding patients with prostate cancer a bone metastasis was the first sign of "recurrence" in 1.3% of the patients with a known primary solid malignant tumour.

Peritoneal cancer index: a prognostic indicator of survival in advanced ovarian cancer

AIM

The peritoneal cancer index (PCI) has been used for the detailed evaluation of the peritoneal spread in tumors of gastrointestinal origin and has been found to be a prognostic indicator of survival. The aim of this study was the identification of the significance of the peritoneal cancer index in advanced ovarian cancer.

METHODS

From 1990 to 2001, 60 women, mean age 65+/-10.84 (41-86), were treated for advanced ovarian cancer. The performance status (Karnofsky performance scale), age, prior surgery score (PSS), peritoneal cancer index (PCI), tumor volume, tumor grade, residual tumor, the presence of ascites, treatment with adjuvant chemotherapy, histopathologic subtype and FIGO stage were retrospectively correlated to survival using univariate model of statistical analysis.

RESULTS

Hospital mortality and morbidity were 11.7 and 16.7% respectively. The recurrence rate was 23.3%. Overall 5-year survival rate was 41% and mean survival 63+/-8 months. The peritoneal cancer index was related to survival (P=0.0253). The other favorable clinical prognostic indicators of survival were low grade and small volume tumors, treatment with adjuvant chemotherapy and complete cytoreductive surgery (P<0.05).

CONCLUSIONS

The peritoneal spread in advanced ovarian cancer can be assessed in detail using the peritoneal cancer index. It is a significant prognostic factor of survival and is useful in identifying subgroups.