1,721,396 research outputs found
What The Surgeons Should Know About The Bilateral Prophylactic Mastectomy in BRCA Mutation Carriers
No full textDecision-Making Skills and Performance of Standardized Tasks Can Optimize Total Operating Time in Breast Cancer Patients Undergoing Mastectomy
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Decision-making and technical skills to prevent local recurrence after mastectomy for pure ductal carcinoma in situ
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Targeted Therapies for Pediatric AML: Gaps and Perspective
Full text linkAcute myeloid leukemia (AML) is a hematopoietic disorder characterized by numerous cytogenetic and molecular aberrations that accounts for ~25% of childhood leukemia diagnoses. The outcome of children with AML has increased remarkably over the past 30 years, with current survival rates up to 70%, mainly due to intensification of standard chemotherapy and improvements in risk classification, supportive care, and minimal residual disease monitoring. However, childhood AML prognosis remains unfavorable and relapse rates are still around 30%. Therefore, novel therapeutic approaches are needed to increase the cure rate. In AML, the presence of gene mutations and rearrangements prompted the identification of effective targeted molecular strategies, including kinase inhibitors, cell pathway inhibitors, and epigenetic modulators. This review will discuss several new drugs that recently received US Food and Drug Administration approval for AML treatment and promising strategies to treat childhood AML, including FLT3 inhibitors, epigenetic modulators, and Hedgehog pathway inhibitors
Oncoplastic breast surgery with oxidized regenerated cellulose: appraisals based on five-year experience.
No full textWe have read with great interest the article by
Tanaka et al. reporting improved cosmetic outcomes
after breast conserving surgery with the use of oxidized
regenerated cellulose (ORC) (1) in 94 breast
cancer patients treated at the Osaka Medical College
Hospital (Osaka, Japan). Evaluation of cosmetic outcomes,
performed by three staff surgeons at least
2 months after surgery using the scoring system (0–12
points) of the Japanese Breast Cancer Society, documented
very positive results, with a mean score of 9.5
(3–12 points) and 71 patients (75.5%) categorized as
“Excellent” (≥11 points) or “Good” (8–10 points),
and only one patient (1.1%) as “Poor” (≤4 points).
We have previously reported our 5-year experience
with the use of ORC at the Catholic Breast Unit of
Rome and agree with the Authors that the use of this
biomaterial can improve the cosmetic results (Fig. 1)
in patients undergoing an oncoplastic procedures for
breast cancer (2).
However, as ORC is being increasingly utilized in
breast conserving surgery (1–3), we think that it is
important to properly inform the patients not only
about the potential cosmetic advantages but also
about possible postoperative complications of this
technique. Tanaka et al. report a 18% rate of allergic
reaction with the use of ORC, mainly presenting as
acute dermatitis and eczema, and one case of exudation
followed by wound dehiscence.
In our series, we noted a 10% rate of allergic skin
reactions with irritation, redness, itching, swelling,
rash, and hives in the mammary region, successfully
managed with steroids and antihistamine medications.
In addition, we experienced a significant seroma in the
site of ORC placement in 45% of our patients. This
seroma that appears in the early postoperative period
as consequence of redundant ORC digestion, normally
resolved within few weeks with repeated percutaneous
aspirations, but in two cases it was followed by the
formation of an abscess in the residual cavity that
required surgical drainage.
Moreover, we think it is important to call the
attention of radiologists on the peculiar findings that
ORC determines on postoperative ultrasound (US)
examination, that often lead to undue alarmism.
In our series, peculiar fluid anechoic accumulation
containing small hyperechoic, round components were
documented on breast US examination (performed
6 months after surgery) in all cases. This typical round
image (that we named “ile-flottante”; Fig. 2), is consequence
of the fibrogenetic action induced by ORC and
of the partial reabsorption of this biomaterial. It
appears non-mobile, avascular, and adherent to the
parenchymal tissue planes and is often misinterpreted
in an alarming way by the radiologists. The diagnostic
interpretations in our patients varied from possible
residual disease to hematoma sequele, local abscess, or
area of fat necrosis.
In conclusion, when using ORC as a filler to optimize
esthetic outcomes, it is important to discuss with
the patient also about possible postoperative complications
and to acquire an exhaustive informed consent.
It is also important that surgeons specify clearly
the use of this biomaterial in the report of the surgical
procedure, so that radiologists can properly interpret
the sonographic findings due to this biomaterial and
avoid misdiagnosis, and undue alarmism during the
follow-up of these patients
The use of oxidized regenerated cellulose in oncoplastic breast surgery: “warning” for postoperative follow-up!
No full textWe have read with interest the article by Rassu et al on the use of oxidized regenerated cellulose (ORC) in oncoplastic breast surgery (1). The Authors present their early experience on breast cancer patients treated with breast-conserving surgery and reshaping procedures aided by the use of ORC. With a limited follow-up of 6 to 8 months, the Authors report improved cosmetic results while no data are presented on postoperative complication rate or on the impact of ORC in the postoperative imaging and follow-up in this new subset of patients.
These two parameters should be monitored strictly when proposing the use of a new biomaterial during a surgical procedure, in order to confirm its safety. In our surgical Breast Unit, we have conducted an early experience with the use of ORC (Tabotamp fibrillar®, Johnson & Johnson; Ethicon, New Brunswick, NJ, USA) as a possible aid to reduce the risk of postoperative haematoma and infections and to improve the aesthetic outcomes in patients undergoing an oncoplastic procedures for breast cancer (2).
As concerns postoperative complications, a significant seroma was frequently observed in the early postoperative period, as consequence of redundant ORC digestion, and resolved within few weeks with repeated percutaneous aspirations. More demanding inflammatory reactions with redness, itching, swelling, rash and hives in the mammary region were observed only occasionally and were successfully managed with the use of steroids and antihistamine medications.
As concerns postoperative imaging, peculiar signs were always observed on breast ultrasound examination (US), performed six months after surgery. As consequence of the fibrogenetic action induced by ORC and of the partial reabsorption of this biomaterial, fluid anaechoic accumulation containing small hyperechoic, round components were documented. These typical round images, due to the presence of fibrillar material, appeared non-mobile, avascular, and adherent to the parenchymal tissue planes (figures 1,2,3) and were often interpreted in an alarming way by the radiologists. The diagnostic interpretations varied from possible residual disease to haematoma sequaele, local abscess or area of fat necrosis.
As the use of ORC could become more frequent in oncoplastic breast surgery, it is important that radiologists become acquainted with these sonographic findings to avoid misdiagnosis and undue alarmism during the follow-up of these patients. It is also important that surgeons specify clearly the use of this biomaterial in the report of the surgical procedure
Contralateral prophylactic mastectomy: What should not be forgotten to improve communication between clinicians and patients!
Full text linkThe rationale for CPM in a patient who has had breast cancer is to reduce the risk of contralateral breast cancer (CBC) and possibly improve survival and quality of life. Other reasons for undergoing a CPM include relative ease of follow-up, reduction of anxiety for occurrence of a second breast cancer, and desire for symmetry that can be achieved with bilateral mastectomies and reconstruction
Contralateral prophylactic mastectomy: Warnings for a difficult decision to make with caution!
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