Assessing wound morbidity after breast surgery using telephone interviews and postal questionnaires.
ANZ journal of surgery Jun 2008, vol. 78, no. 6,
p. 519
Willsher-Peter-C, Hall-Jane-L, Hall-John-C.
Publication type
Letter.
Friday, 27 June 2008
Microsurgery 2008, vol. 28, no. 4
A simple innovation to improve recipient vessel exposure in the axilla during microvascular breast reconstruction with DIEAP flap.
Microsurgery 2008, vol. 28, no. 4
p. 301-2
Gravvanis-Andreas, Caulfield-Robert-H, Ramakrishnan-Venkat, Niranjan- Niri.
Microsurgery 2008, vol. 28, no. 4
p. 301-2
Gravvanis-Andreas, Caulfield-Robert-H, Ramakrishnan-Venkat, Niranjan- Niri.
Pressure dressing in breast surgery
Pressure dressing in breast surgery: is this the solution for seroma formation?
Journal of B.U.ON. : official journal of the Balkan Union of Oncology Jan-Mar 2008, vol. 13, no. 1, p. 65-7
Kontos-M, Petrou-A, Prassas-E, Tsigris-C, Roy-P, Trafalis-D, Bastounis-E, Karamanakos-P.
Author affiliation
Hedley Atkins Breast Unit, Guy's Hospital, London, UK. Michalis _Kontos@yahoo.com.
Abstract
PURPOSE: Pressure dressing (PD) after modified radical mastectomy (MRM) for breast cancer is investigated here as an easy-to-apply method to reduce seroma formation and subsequent need for clinical care. PATIENTS AND METHODS: Two hundred mastectomized patients who were treated with PD on the skin flaps and the axilla immediately postoperatively (group A) were compared with a similar non-PD group (B). Surgical technique and perioperative care were the same. Drains were removed when drain output was reduced to 30 ml per day, or on postoperative day 8 regardless of output. RESULTS: Mean time with drains kept in situ was 4.9 and 5.5 days in group A and B, respectively. Five (2.5%) patients in group A and 16 (8%) in group B developed seromas after the removal of the drains. In total, 9 seroma needle aspirations were performed in group A and 26 in group B. Differences were statistically significant. CONCLUSION: Our findings are supportive of PD as an effective, cheap and easy-to-apply method for the reduction (a) of the time with drains in situ after MRM, (b) of the number of patients developing seromas and (c) of the seroma aspirations. This can potentially reduce further complications, needed medical care and cut expenditure.
Journal of B.U.ON. : official journal of the Balkan Union of Oncology Jan-Mar 2008, vol. 13, no. 1, p. 65-7
Kontos-M, Petrou-A, Prassas-E, Tsigris-C, Roy-P, Trafalis-D, Bastounis-E, Karamanakos-P.
Author affiliation
Hedley Atkins Breast Unit, Guy's Hospital, London, UK. Michalis _Kontos@yahoo.com.
Abstract
PURPOSE: Pressure dressing (PD) after modified radical mastectomy (MRM) for breast cancer is investigated here as an easy-to-apply method to reduce seroma formation and subsequent need for clinical care. PATIENTS AND METHODS: Two hundred mastectomized patients who were treated with PD on the skin flaps and the axilla immediately postoperatively (group A) were compared with a similar non-PD group (B). Surgical technique and perioperative care were the same. Drains were removed when drain output was reduced to 30 ml per day, or on postoperative day 8 regardless of output. RESULTS: Mean time with drains kept in situ was 4.9 and 5.5 days in group A and B, respectively. Five (2.5%) patients in group A and 16 (8%) in group B developed seromas after the removal of the drains. In total, 9 seroma needle aspirations were performed in group A and 26 in group B. Differences were statistically significant. CONCLUSION: Our findings are supportive of PD as an effective, cheap and easy-to-apply method for the reduction (a) of the time with drains in situ after MRM, (b) of the number of patients developing seromas and (c) of the seroma aspirations. This can potentially reduce further complications, needed medical care and cut expenditure.
Archives of dermatology May 2008, vol. 144, no. 5
The treatment of diffuse dermal angiomatosis of the breast with reduction mammaplasty.
Full text available at American Medical Association
Archives of dermatology, May 2008, vol. 144, no. 5, p. 693-4
Villa-Mark-T, White-Lucile-E, Petronic-Rosic-Vesna, Song-David-H.
Publication type
Case-Reports, Letter.
Full text available at American Medical Association
Archives of dermatology, May 2008, vol. 144, no. 5, p. 693-4
Villa-Mark-T, White-Lucile-E, Petronic-Rosic-Vesna, Song-David-H.
Publication type
Case-Reports, Letter.
BMJ 26 April 2008; Vol. 336, No. 7650
Editorials
Sentinel lymph node biopsy in malignant melanoma
Is unnecessary as clinically important micrometastases can be identified by ultrasound
When melanoma spreads, it invariably does so by the lymphatic system. The first lymph node to be affected is called the sentinel node, and this node can be identified by injecting dye and a radioactive tracer at the primary tumour site. During sentinel lymph node biopsy, the sentinel node is located by a hand held probe and confirmed as the sentinel node using blue dye staining; it is then removed for histology. About 80% of patients have no melanoma in the sentinel node. In the remaining patients, the tumour burden varies from tiny deposits of melanoma in the subcapsular sinus to complete replacement of several sentinel nodes with extracapsular spread. Patients who are sentinel node negative have a better prognosis than those who are sentinel node positive, and the prognosis worsens as the tumour burden increases. But evidence is accumulating that some tiny deposits of melanoma in the sentinel node . . . [Full text of this article]
J Meirion Thomas, consultant surgeon
Sentinel lymph node biopsy in malignant melanoma
Is unnecessary as clinically important micrometastases can be identified by ultrasound
When melanoma spreads, it invariably does so by the lymphatic system. The first lymph node to be affected is called the sentinel node, and this node can be identified by injecting dye and a radioactive tracer at the primary tumour site. During sentinel lymph node biopsy, the sentinel node is located by a hand held probe and confirmed as the sentinel node using blue dye staining; it is then removed for histology. About 80% of patients have no melanoma in the sentinel node. In the remaining patients, the tumour burden varies from tiny deposits of melanoma in the subcapsular sinus to complete replacement of several sentinel nodes with extracapsular spread. Patients who are sentinel node negative have a better prognosis than those who are sentinel node positive, and the prognosis worsens as the tumour burden increases. But evidence is accumulating that some tiny deposits of melanoma in the sentinel node . . . [Full text of this article]
J Meirion Thomas, consultant surgeon
Archives of pathology & laboratory medicine Jun 2008, vol. 132, no. 6
Is surgical excision necessary for the management of atypical lobular hyperplasia and lobular carcinoma in situ diagnosed on core needle biopsy?: a report of 38 cases and review of the literature
p. 979-83
Cangiarella-Joan, Guth-Amber, Axelrod-Deborah, Darvishian-Farbod, Singh-Baljit, Simsir-Aylin, Roses-Daniel, Mercado-Cecilia.
Abstract
CONTEXT: Both atypical lobular hyperplasia (ALH) and lobular carcinoma in situ (LCIS) have traditionally been considered to be risk factors for the development of invasive carcinoma and are followed by close observation. Recent studies have suggested that these lesions may represent true precursors with progression to invasive carcinoma. Due to the debate over the significance of these lesions and the small number of cases reported in the literature, the treatment for lobular neoplasia diagnosed by percutaneous core biopsy (PCB) remains controversial. OBJECTIVE: To review our experience with pure LCIS or ALH diagnosed by PCB and correlate the radiologic findings and surgical excision diagnoses to develop management guidelines for lobular neoplasia diagnosed by PCB. DESIGN: We searched the pathology database for patients who underwent PCB with a diagnosis of either pure LCIS or ALH and had subsequent surgical excision. We compared the core diagnoses with the surgical excision diagnoses and the radiologic findings. RESULTS: Thirty-eight PCBs with a diagnosis of ALH (18 cases) or LCIS (20 cases) were identified. Carcinoma was present at excision in 1 (6%) of the ALH cases and in 2 (10%) of the LCIS cases. In summary, 8% (3/38) of PCBs diagnosed as lobular neoplasia (ALH or LCIS) were upgraded to carcinoma (invasive carcinoma or ductal carcinoma in situ) at excision. CONCLUSIONS: Surgical excision is indicated for all PCBs diagnosed as ALH or LCIS, as a significant percentage will show carcinoma at excision.
p. 979-83
Cangiarella-Joan, Guth-Amber, Axelrod-Deborah, Darvishian-Farbod, Singh-Baljit, Simsir-Aylin, Roses-Daniel, Mercado-Cecilia.
Abstract
CONTEXT: Both atypical lobular hyperplasia (ALH) and lobular carcinoma in situ (LCIS) have traditionally been considered to be risk factors for the development of invasive carcinoma and are followed by close observation. Recent studies have suggested that these lesions may represent true precursors with progression to invasive carcinoma. Due to the debate over the significance of these lesions and the small number of cases reported in the literature, the treatment for lobular neoplasia diagnosed by percutaneous core biopsy (PCB) remains controversial. OBJECTIVE: To review our experience with pure LCIS or ALH diagnosed by PCB and correlate the radiologic findings and surgical excision diagnoses to develop management guidelines for lobular neoplasia diagnosed by PCB. DESIGN: We searched the pathology database for patients who underwent PCB with a diagnosis of either pure LCIS or ALH and had subsequent surgical excision. We compared the core diagnoses with the surgical excision diagnoses and the radiologic findings. RESULTS: Thirty-eight PCBs with a diagnosis of ALH (18 cases) or LCIS (20 cases) were identified. Carcinoma was present at excision in 1 (6%) of the ALH cases and in 2 (10%) of the LCIS cases. In summary, 8% (3/38) of PCBs diagnosed as lobular neoplasia (ALH or LCIS) were upgraded to carcinoma (invasive carcinoma or ductal carcinoma in situ) at excision. CONCLUSIONS: Surgical excision is indicated for all PCBs diagnosed as ALH or LCIS, as a significant percentage will show carcinoma at excision.
Acta oncologica 2008, vol. 47, no. 4
Organized nation-wide implementation of sentinel lymph node biopsy in Denmark.
p. 556-60
Friis-Esbern, Galatius-Hanne, Garne-Jens-Peter
Abstract
Prior to the initiation of a nationwide study of the sentinel node staging technique the Danish Breast Cancer Cooperative Group (DBCG) defined a set of minimum requirements to be met by surgical departments before they could include patients in the study. The requirements specified a minimum patient load in the individual surgical unit, a minimum surgical training in the sentinel node biopsy technique and a minimum quality outcome in a validating learning series of SNLB procedures. A working group assisted departments in meeting these terms and later audited and certified departments before they could include patients into the study. As a result of this strategy the sentinel lymph node staging was fully implemented in all Danish surgical breast cancer centres within three years and all sentinel node biopsies in the period were recorded in the DBCG data centre. Furthermore, the strategy accelerated the ongoing process of centralizing breast surgery in specialized departments.
Shoulder disability and late symptoms following surgery for early breast cancer.
p. 569-75
Lauridsen-Mette-Cathrine, Overgaard-Marie, Overgaard-Jens, Hessov-I- B, Cristiansen-Peer.
Abstract
INTRODUCTION: Axillary dissection in combination with radiation therapy is thought to be the main reason why patients surgically treated for breast cancer may develop decreased shoulder mobility on the operated side. The surgery performed on the breast has not been ascribed any considerable importance. In order to evaluate the influence of the surgical technique and the adjuvant oncological therapy on the development of shoulder morbidity, we assessed the physical disability in 132 breast cancer patients with a median follow-up time of 3 years after surgery. METHODS AND METHODS: Eighty nine (67%) patients had been subjected to modified radical mastectomy and 43 (33%) to breast conserving therapy (BCT). All patients had axillary dissection of level I and II. The shoulder function was assessed by the Constant Shoulder Score including both subjective parameters on pain and ability to perform the normal tasks of daily living, and objective parameters assessing active range of motion and muscle strength. RESULTS: Shoulder disability seems to be a frequent late complication to the treatment of early breast cancer (35%). When equal axillary dissection and radiation therapy had been applied, BCT patients were found to suffer less frequent from this complication than patients treated with mastectomy.
p. 556-60
Friis-Esbern, Galatius-Hanne, Garne-Jens-Peter
Abstract
Prior to the initiation of a nationwide study of the sentinel node staging technique the Danish Breast Cancer Cooperative Group (DBCG) defined a set of minimum requirements to be met by surgical departments before they could include patients in the study. The requirements specified a minimum patient load in the individual surgical unit, a minimum surgical training in the sentinel node biopsy technique and a minimum quality outcome in a validating learning series of SNLB procedures. A working group assisted departments in meeting these terms and later audited and certified departments before they could include patients into the study. As a result of this strategy the sentinel lymph node staging was fully implemented in all Danish surgical breast cancer centres within three years and all sentinel node biopsies in the period were recorded in the DBCG data centre. Furthermore, the strategy accelerated the ongoing process of centralizing breast surgery in specialized departments.
Shoulder disability and late symptoms following surgery for early breast cancer.
p. 569-75
Lauridsen-Mette-Cathrine, Overgaard-Marie, Overgaard-Jens, Hessov-I- B, Cristiansen-Peer.
Abstract
INTRODUCTION: Axillary dissection in combination with radiation therapy is thought to be the main reason why patients surgically treated for breast cancer may develop decreased shoulder mobility on the operated side. The surgery performed on the breast has not been ascribed any considerable importance. In order to evaluate the influence of the surgical technique and the adjuvant oncological therapy on the development of shoulder morbidity, we assessed the physical disability in 132 breast cancer patients with a median follow-up time of 3 years after surgery. METHODS AND METHODS: Eighty nine (67%) patients had been subjected to modified radical mastectomy and 43 (33%) to breast conserving therapy (BCT). All patients had axillary dissection of level I and II. The shoulder function was assessed by the Constant Shoulder Score including both subjective parameters on pain and ability to perform the normal tasks of daily living, and objective parameters assessing active range of motion and muscle strength. RESULTS: Shoulder disability seems to be a frequent late complication to the treatment of early breast cancer (35%). When equal axillary dissection and radiation therapy had been applied, BCT patients were found to suffer less frequent from this complication than patients treated with mastectomy.
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