The role of trade-offs in biodiversity conservation planning: linking ...

Indian Academy of Sciences (India)

Unknown

[Faith D P and Walker P A 2002 The role of trade-offs in biodiversity conservation planning: linking local management, regional planning and global conservation efforts; J. Biosci. 27 (Suppl. 2) 393–407]. 1. Introduction. A reality of biodiversity conservation planning is that it requires taking into account many things other than ...

Breast conserving surgery versus mastectomy: cancer practice by general surgeons in Iran

International Nuclear Information System (INIS)

Najafi, Massoome; Ebrahimi, Mandana; Kaviani, Ahmad; Hashemi, Esmat; Montazeri, Ali

2005-01-01

There appear to be geographical differences in decisions to perform mastectomy or breast conserving surgery for early-stage breast cancer. This study was carried out to evaluate general surgeons' preferences in breast cancer surgery and to assess the factors predicting cancer practice in Iran. A structured questionnaire was mailed to 235 general surgeons chosen from the address list of the Iranian Medical Council. The questionnaire elicited information about the general surgeons' characteristics and about their work experience, posts they have held, number of breast cancer operations performed per year, preferences for mastectomy or breast conserving surgery, and the reasons for these preferences. In all, 83 surgeons returned the completed questionnaire. The results indicated that only 19% of the surgeons routinely performed breast conserving surgery (BCS) and this was significantly associated with their breast cancer case load (P < 0.01). There were no associations between BCS practice and the other variables studied. The most frequent reasons for not performing BCS were uncertainty about conservative therapy results (46%), uncertainty about the quality of available radiotherapy services (32%), and the probability of patients' non-compliance in radiotherapy (32%). The findings indicate that Iranian surgeons do not routinely perform BCS as the first and the best treatment modality. Further research is recommended to evaluate patients' outcomes after BCS treatment in Iran, with regard to available radiotherapy facilities and cultural factors (patients' compliance)

Adjuvant radiotherapy after breast conserving surgery - a comparative effectiveness research study.

Science.gov (United States)

Corradini, Stefanie; Niyazi, Maximilian; Niemoeller, Olivier M; Li, Minglun; Roeder, Falk; Eckel, Renate; Schubert-Fritschle, Gabriele; Scheithauer, Heike R; Harbeck, Nadia; Engel, Jutta; Belka, Claus

2015-01-01

The purpose of this retrospective outcome study was to validate the effectiveness of postoperative radiotherapy in breast conserving therapy (BCT) and to evaluate possible causes for omission of radiotherapy after breast conserving surgery (BCS) in a non-trial population. Data were provided by the population-based Munich Cancer Registry. The study included epidemiological data of 30.811 patients diagnosed with breast cancer from 1998 to 2012. The effect of omitting radiotherapy was analysed using Kaplan-Meier-estimates and Cox proportional hazard regression. Variables predicting omission of radiotherapy were analysed using multivariate logistic regression. Use of postoperative radiotherapy after BCS was associated with significant improvements in local control and survival. 10-year loco-regional recurrence-free-survival was 90.8% with postoperative radiotherapy vs. 77.6% with surgery alone (pstudy shows a decrease in local control and a survival disadvantage if postoperative radiotherapy after breast conserving surgery is omitted in an unselected cohort of primary breast cancer patients. Due to its epidemiological nature, it cannot answer the question in whom postoperative radiotherapy can be safely omitted. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

The influence of radiotherapy on cosmetic outcome after breast conservative surgery

International Nuclear Information System (INIS)

McCormick, Beryl; Sacchini, Virgilio; Luini, Alberto; Agresti, Roberto; Greco, Marco; Manzari, Antonella; Mariani, Luigi; Zucali, Roberto

1995-01-01

Purpose: The influence of radiotherapy in the cosmetic outcome after conservative surgery for breast cancer was evaluated using an objective method of calculating the asymmetry between the two breasts. Methods and Materials: One hundred and one patients treated with the same conservative surgery were evaluated for cosmetic outcome. Sixty-one of them received external radiotherapy (50 + 10 Gy) to the residual breast; the remaining 40 underwent surgery only. The aspect of the patients' breasts was objectively assessed for symmetry by means of a computerized technique. A subjective assessment of the cosmetic outcome was performed both by physician and patient. These objective and subjective assessments were compared in the two groups treated with or without radiotherapy. Results: The results obtained did not show significant differences in terms of cosmetic outcome in the two groups. Skin telangectasia was noted in two radiotherapy patients, while hypertrophic breast scars were only noted in six nonirradiated patients. Conclusions: We found that standard radiotherapy does not seem to influence the symmetry and the cosmetic results in breast conservative treatment when compared to a similar group of patients with the same quadrantectomy procedure and no radiotherapy

Maximal conservation and minimal usage of blood products in open heart surgery.

Science.gov (United States)

Newland, P E; Pastoriza-Pinol, J; McMillan, J; Smith, B F; Stirling, G R

1980-05-01

Open heart surgery has previously been associated with the use of large volumes of blood products. This paper describes methods of blood conservation and a simple method of intraoperative autotransfusion that together have resulted in minimal blood product usage in elective open heart surgery cases. This has reduced our dependence on blood bank supplies for the performance of elective open heart surgery.

Sonographic diagnosis of abscess following breast-conserving surgery with insertion of nonabsorbable mesh.

Science.gov (United States)

Song, Sung Eun; Seo, Bo Kyoung; Son, Gil-Soo; Kim, Young-Sik

2014-09-01

Immediate mesh insertion has been recently used for breast reconstruction after breast-conserving surgery. We report a case of abscess formation following immediate nonabsorbable mesh insertion with breast-conserving surgery. In this article, we demonstrate multimodal breast imaging features and pathologic correlations of the case. In addition, we illustrate characteristic sonographic findings of nonabsorbable mesh fibers to differentiate them from a gossypiboma caused by a retained surgical sponge or tumor recurrence. © 2014 Wiley Periodicals, Inc.

Multicenter prospective study of magnetic resonance imaging prior to breast-conserving surgery for breast cancer.

Science.gov (United States)

Liu, Qian; Liu, Yinhua; Xu, Ling; Duan, Xuening; Li, Ting; Qin, Naishan; Kang, Hua; Jiang, Hongchuan; Yang, Deqi; Qu, Xiang; Jiang, Zefei; Yu, Chengze

2014-01-01

This multicenter prospective study aimed to assess the utility of dynamic enhanced magnetic resonance imaging (MRI) prior to breast-conserving surgery for breast cancer. The research subjects were drawn from patients with primary early resectable breast cancer treated in the breast disease centers of six three-level hospitals in Beijing from 1 January 2010 to 31 December 2012. The participants were allocated to a breast-conserving surgery group (breast-conserving group) or a total mastectomy group (total mastectomy group). Enhanced MRI was used to measure breast volume, longest diameter of tumor and tumor volume. The correlations between these measurements and those derived from histopathologic findings were assessed. The relationships between the success rate of breast-conserving surgery and MRI- and pathology-based measurement results were statistically analyzed in the breast-conserving group. The study included 461 cases in the total mastectomy group and 195 in the breast-conserving group. Allocation to these groups was based on clinical indications and patient preferences. The cut-off for concurrence between MRI- and pathology-based measurements of the longest diameter of tumor was set at 0.3 cm. In the total mastectomy group, the confidence interval for 95% concurrence of these measurements was 35.41%-44.63%. Correlation coefficients for MRI and histopathology-based measurements of breast volume, tumor volume and tumor volume/breast volume ratio were r = 0.861, 0.569, and 0.600, respectively (all P surgery were 100% and 88.54%, respectively. There were significant correlations between dynamic enhanced MRI- and histopathology-based measurements of the longest diameter of breast lesions, breast and tumor volumes, and breast volume/tumor volume ratios. Preoperative MRI examination improves the success rate of breast-conserving surgery.

Soft tissue sarcomas of the extremities: survival and patterns of failure with conservative surgery and postoperative irradiation compared to surgery alone

International Nuclear Information System (INIS)

Leibel, S.A.; Tranbaugh, R.F.; Wara, W.M.; Beckstead, J.H.; Bovill, E.G.; Phillips, T.L.

1982-01-01

Between 1960 and 1978, 81 patients received their primary treatment for localized soft tissue sarcomas of the extremities, buttock and shoulder at the University of California, San Francisco. Initial treatment consisted of surgery alone in 47 patients, planned conservative surgery followed by radiation therapy in 29 patients, and irradiation alone in five patients. The two- and five-year determinate survival for all cases was 86% and 73%, respectively. The local control rate achieved with surgery alone was related to the extent of surgery. Eighty-seven percent (14/16) of the patients undergoing amputation were locally controlled. Seventy-two percent (8/11) were treated with wide en bloc resection and had local tumor control while only 30% (6/20) having simple excision were controlled. The local control rate with surgery and postoperative irradiation was 90% (26/29). No patients treated with irradiation therapy alone were controlled. This review suggests that local tumor control achieved with limb preserving conservative surgery and postoperative irradiation is superior to limited surgery alone. The survival and patterns of failure of patients undergoing radical surgery is comparable to combined treatment with the risk-benefit ratio favoring the latter

Re-resection rates and risk characteristics following breast conserving surgery for breast cancer and carcinoma in situ

DEFF Research Database (Denmark)

Kryh, C G; Pietersen, C A; Rahr, Hans

2014-01-01

OBJECTIVES: To examine the frequency of re-resections and describe risk characteristics: invasive carcinoma or carcinoma in situ (CIS), palpability of the lesion, and neoadjuvant chemotherapy. RESULTS: 1703 breast conserving surgeries were performed: 1575 primary breast conserving surgeries (BCS...

Epithelioid sarcoma: results of conservative surgery and radiotherapy

International Nuclear Information System (INIS)

Callister, Matthew D.; Ballo, Matthew T. M.D.; Pisters, Peter W.T.; Patel, Shreyaskumar R.; Feig, Barry W.; Pollock, Raphael E.; Benjamin, Robert S.; Zagars, Gunar K

2001-01-01

Purpose: To determine the outcome and prognostic factors for patients with localized epithelioid sarcoma treated with conservative surgery and radiotherapy (RT). Methods and Materials: The medical records of 24 patients with nonmetastatic epithelioid sarcoma treated with conservative surgery and RT were reviewed. Preoperative RT was given to 3 patients (median 46.4 Gy) and postoperative RT to 21 patients (median 64.5 Gy). A local (limb-sparing) surgical procedure was performed in all patients. Results: At a median follow-up of 131 months, 14 patients had relapsed and 13 patients had died. The actuarial overall and disease-free survival rate at 10 years was 50% and 37%, respectively. Local, nodal, and metastatic failure occurred in 7, 4, and 10 patients, respectively, yielding a 10-year actuarial local, nodal, and metastatic control rate of 63%, 81%, and 56%, respectively. Univariate analysis revealed that size ≤5 cm and extremity location were favorable prognostic factors for overall, disease-free, and metastasis-free survival. The actuarial 5-year overall, disease-free, and metastasis-free survival rate was 79% vs. 25% (p=0.002), 51% vs. 13% (p=0.03), and 79% vs. 13% (p 5 cm. The actuarial 5-year overall, disease-free, and metastasis-free survival rate was 77% vs. 39% (p 0.002), 56% vs. 0% (p=0.01), and 78% vs. 17% (p=0.01), respectively, for extremity vs. nonextremity location. Multivariate analysis of the factors correlating with the overall, disease-free, and metastasis-free survival confirmed the favorable prognostic significance of small lesion size. The prognostic significance of extremity location on univariate analysis was explained by an imbalance in the mean tumor sizes. Conclusions: Epithelioid sarcoma is an aggressive soft-tissue sarcoma, with high rates of local and distant relapse. Local control with conservative surgery and RT compares favorably to published surgical series. The poor outcome for tumors ≥5 cm in size emphasizes the need for

Why do younger women have higher breast cancer recurrence rates after breast-conserving surgery?

International Nuclear Information System (INIS)

Nishimura, Reiki; Matsuda, Masakazu; Miyayama, Haruhiko; Okazaki, Shinji; Kai, Chiharu; Ozaki, N.

2003-01-01

Preventing breast cancer recurrence after breast-conserving surgery is an important issue. The main factors contributing to such recurrence are positive margins, absence of radiotherapy and young age. To investigate the clinical significance of age in breast-conserving surgery, we examined the relationship between clinicopathological findings or outcome and age, especially young age. The cases were divided into three groups by age; 35 years old or less, 36-50y.o. and 51y.o. or higher. Between April 1989 and March 2003, 743 patients were treated with breast-conserving surgery. There were 49 patients aged 35 years old or less (6.6%). Younger age significantly correlated with positive surgical margin, lymph node metastases, higher proliferative activity, negative estrogen receptor (ER) or progesterone receptor (PgR), larger tumor size, and shorter nipple-tumor distances. Although younger patients had a higher recurrence rate irrespective of radiotherapy, margin status had an impact on recurrence rate. Thus, the reason young age was a significant factor for breast recurrence after breast-conserving surgery was that young patients frequently had numerous risk factors such as positive margin, higher proliferative activity, positive nodes, negative ER/PgR and larger tumor. However, negative surgical margins could reduce recurrence rates even in young women. These results suggest that more suitable criteria and strategies may be needed for young patients with breast cancer. (author)

[Local recurrence based on size after conservative surgery in breast cancer stage T1-T2. A population-based study].

Science.gov (United States)

Martínez-Ramos, David; Fortea-Sanchis, Carlos; Escrig-Sos, Javier; Prats-de Puig, Miguel; Queralt-Martín, Raquel; Salvador-Sanchis, José Luís

2014-01-01

Conservative surgery can be regarded as the standard treatment for most early stage breast tumors. However, a minority of patients treated with conservative surgery will present local or locoregional recurrence. Therefore, it is of interest to evaluate the possible factors associated with this recurrence. A population-based retrospective study using data from the Tumor Registry of Castellón (Valencia, Spain) of patients operated on for primary nonmetastatic breast cancer between January 2000 and December 2008 was designed. Kaplan-Meier curves and log-rank test to estimate 5-year local recurrence were used. Two groups of patients were defined, one with conservative surgery and another with nonconservative surgery. Cox multivariate analysis was conducted. The total number of patients was 410. Average local recurrence was 6.8%. In univariate analysis, only tumor size and lymph node involvement showed significant differences. On multivariate analysis, independent prognostic factors were conservative surgery (hazard ratio [HR] 4.62; 95% confidence interval [CI]: 1.12-16.82), number of positive lymph nodes (HR 1.07; 95% CI: 1.01-1.17) and tumor size (in mm) (HR 1.02; 95% CI: 1.01-1.06). Local recurrence after breast-conserving surgery is higher in tumors >2 cm. Although tumor size should not be a contraindication for conservative surgery, it should be a risk factor to be considered.

Perioperative coagulation management and blood conservation in cardiac surgery: a Canadian Survey.

Science.gov (United States)

Taneja, Ravi; Fernandes, Philip; Marwaha, Gulshan; Cheng, Davy; Bainbridge, Daniel

2008-10-01

To determine which strategies are currently used for (anti)coagulation management and blood conservation during cardiac surgery in Canada. Institutional survey. University hospital. All sites performing cardiac surgery in Canada. None. The response rate was 85%. Anticoagulation with heparin is monitored routinely through the activated coagulation time (ACT). Less than 10% of centers use heparin concentrations (Hepcon HMS, Medtronic), thromboelastography, or other point-of-care tests perioperatively. Eighty percent of centers routinely use tranexamic acid as the primary antifibrinolytic agent; however aprotinin until recently, was used more commonly for patients at increased risk for bleeding. Retrograde autologous prime is commonly used (62%); however, cell savers are uncommon for routine patients undergoing cardiac surgery (29%). Although most hospitals use a hematocrit of 20% to 21% for transfusing red blood cells, more than 50% of intensive care units do not have written guidelines for the administration of protamine, fresh frozen plasma, platelets, or factor VIIa. At least one third of centers do not audit their transfusion practices regularly. The majority of Canadian institutions do not use point-of-care tests other than ACT. Most institutions do not have algorithms for management of bleeding following cardiac surgery and at least 30% do not monitor their transfusion practice perioperatively. Cardiac surgery patients in Canada may benefit from a standardized approach to blood conservation in the perioperative period.

Link polynomial, crossing multiplier and surgery formula

International Nuclear Information System (INIS)

Deguchi, Tetsuo; Yamada, Yasuhiko.

1989-01-01

Relations between link polynomials constructed from exactly solvable lattice models and topological field theory are reviewed. It is found that the surgery formula for a three-sphere S 3 with Wilson lines corresponds to the Markov trace constructed from the exactly solvable models. This indicates that knot theory intimately relates various important subjects such as exactly solvable models, conformal field theories and topological quantum field theories. (author)

A study of the indication for conservative surgery in adult hydronephrosis based on presurgery post-contrast computed tomography (CT) finding

International Nuclear Information System (INIS)

Kawai, Noriyasu; Tsugaya, Masayuki; Sakagami, Hiroshi; Sasaki, Shoichi; Kohri, Kenjiro

1997-01-01

The cases with adult hydronephrosis are usually performed either conservative surgery or nephrectomy according to the grade of residual renal function. The residual renal function of adult hydronephrosis are usually suspected with analysis of concentration and/or clearance of the renal urine content after percutaneous nephrostomy. However, percutaneous nephrostomy is invasive and risky. On the other hand, post-contrast computed tomography (CT) is non-invasive. We studied whether post-contrast CT is available for the assessment of residual renal function of adult hydronephrosis and also studied the indication for conservative surgery of adult hydronephrosis on post-contrast CT. Conservative surgery or nephrectomy was performed in 14 patients with adult hydronephrosis in the duration from April, 1986 to March, 1995. All of 14 patients (14 kidneys) hydronephrosis were retrospectively studied of the character in the indication for conservative surgery by post-contrast CT before surgery. The indication for conservative surgery of adult hydronephrosis on post-contrast CT are well enhanced renal parenchyma exist round the kidney, even if it is very thin, and excretion of contrast medium to renal calyx are showed. It was concluded that post-contrast CT might be useful for the assessment of residual renal function of adult hydronephrosis. (author)

Facial nerve function after vestibular schwannoma surgery following failed conservative management

DEFF Research Database (Denmark)

Kaltoft, Mikkel; Stangerup, Sven-Eric; Cayé-Thomasen, Per

2012-01-01

the risk of impaired facial nerve function post-surgery. OBJECTIVE:: To compare facial nerve function in patients operated soon after diagnosis with patients allocated to conservative management, and the subgroup of these who later had surgery due to tumor growth. METHODS:: 1378 consecutive patients...... patients had normal facial nerve function at the end of observation. Good facial nerve outcome was found in 87 % of patients operated at diagnosis, and in 84 % of patients operated after established tumor growth. For the subgroup of small extrameatal tumors this difference was significant. Pooling all...... to preservation of the facial nerve function. Tumor growth during observation is found in only a minor proportion of the patients, and in these cases surgery or irradiation should be performed immediately....

Methods and clinical utility of intraoperative radiotherapy (IORT) in breast-conserving surgery

International Nuclear Information System (INIS)

Miyauchi, Mitsuru; Yamamoto, Naoto; Fujita, Yoshihiro; Honda, Ichiro; Hatano, Kazuo; Sekiya, Yuichi; Suzuki, Masato; Nakajima, Nobuyuki.

1996-01-01

We have developed an intraoperative radiotherapy technique in breast-conserving surgery. Following lumpectomy and axillary dissection up to Level II, the subcutaneous fat layer was lifted from the gland over the entire breast. Electron beams of 25 Gy were irradiated within cylinder, avoiding the skin and subcutaneous tissue. The surface of the gland was covered with cotton swabs saturated with normal saline to equalize the energy depth to the chest wall. This technique has so far been applied to 8 patients, all of whom went through a successful postoperative period without serious complications. The cosmetic results were satisfactory from immediately after the operation. Intraoperative radiotherapy combined with breast-conserving surgery may be helpful in improving the QOL of patients by eliminating the adverse effects associated radiation injury to the skin of the breast and long-term postoperative follow-up. (author)

Craniopharyngioma: treatment by conservative surgery and radiation therapy.

Directory of Open Access Journals (Sweden)

Nagpal R

1992-10-01

Full Text Available Benign neoplasms are curable only when excised. This applies even to craniopharyngiomas. The proximity of craniopharyngiomas to the hypothalamus and neurovascular structures makes total excision difficult to achieve. Over the last 3-4 decades, it has become increasingly obvious that craniopharyngiomas respond to radiation therapy. Early, unhappy results with major excisions have prompted us to adopt a policy of conservative surgery and radiation therapy to the residual tumour. Preliminary results suggest a good outcome in 35 of the 63 patients so treated from 1981. Details of the study are presented.

Breast Conserving Surgery and Sentinel Lymph Node Biopsy in Locally Advanced Breast Cancer: Single Center Experience

Directory of Open Access Journals (Sweden)

Atakan Sezer

2011-06-01

Full Text Available Objective: Patients with locally advanced breast cancer may undergo breast conserving surgery after neoadjuvant chemotherapy. The aim of the study is to evaluate the results of locally advanced breast cancer patients who underwent breast conserving surgery, axillary dissection and sentinel lymph node biopsy in a single center. Material and Methods: 12 patients with locally advanced breast cancer stage IIIA/IIIB were included in the study between 2002-2009. The patients were given anthracycline-based regimen before surgery. Patients underwent breast conserving surgery, axillary dissection, and sentinel lymph node biopsy followed by radiotherapy. Results: There were five patients in stage IIIA, six in stage IIIB, and one in stage IIIC. Patients had received 3-6 regimen of FAC/FEC. Eight had partial and four had complete response. Five positive axilla were detected. The median value of the lymph nodes was 12 (n:8-19. Five patients underwent sentinel lymph node biopsy. The biopsy has failed in one patient and the median value of dissected sentinel node was 3.5 (n:3-4. Locoregional recurrence was not observed in any patients. The mean follow-up of the patients was 29.8 months and median time was 16 (n:2-80 months.Of the 12 patients 10 are alive and 2 were deceased. Conclusion: In selected locally advanced patients, breast conserving surgery and sentinel lymph node biopsy may be applied by a multidisciplinary approach, and excellent success may be achieved in those patients as in early breast cancer patients.

Cosmetic outcome and curative effect of radiotherapy for early breast cancer after conservative surgery

International Nuclear Information System (INIS)

Ma Changuo; Ma Yuanyuan; Zhao Shuhong; Wang Hong

2007-01-01

Objective: To study the cosmetic outcome and curative effect of 6 MV X-ray tangential field radiotherapy for early stage breast cancer after conservative surgery. Methods: The eligible criteria were single tumor ≤3 cm in diameter, surgical margin negative and lymph node negative. The exclusive criteria were inflammatory carcinoma or male breast cancer. After conservative surgery, 42 patients with stage 0, I or II breast cancer were treated with conventional radiotherapy with a total dose of 50 Gy to the whole breast and 10 Gy boost to the tumor bed. The efficacy and the cosmetic outcome of radiotherapy were evaluated every 3 months for the first 2 years and every 6 months after that and every 12 months after 5 years. Results: The follow up time was 19-90 months (median 56 months). Two patients died of metastasis after 16 months and 36 months, which was diagnosed by CT scan. Excellent or good cosmetic outcome was > 93% at 36 months. The local control rate was 100%. The 1- and 3-year survival rates was 100% and 98%, respectively. Conclusions: Tangential field radiotherapy for early breast cancer after conservative surgery has a satisfied result in both tumor control and cosmetic outcome, which can definitely improve the life quality of the patients. (authors)

The impact of a multidisciplinary blood conservation protocol on patient outcomes and cost after cardiac surgery.

Science.gov (United States)

Ad, Niv; Holmes, Sari D; Patel, Jay; Shuman, Deborah J; Massimiano, Paul S; Choi, Elmer; Fitzgerald, David; Halpin, Linda; Fornaresio, Lisa M

2017-03-01

Although associations between transfusion and inferior outcomes have been documented, there is a lack of blood transfusion standardization in cardiac surgery. At the Inova Heart and Vascular Institute, a multidisciplinary, criterion-driven algorithm for transfusion management was implemented. We examined the effect of our blood conservation protocol on transfusion rates and outcomes after cardiac surgery and on stability of transfusion over time. Patients undergoing first-time cardiac surgery from 2006 (full year before protocol) were compared with those in 2009 (after protocol) and propensity score matched to improve balance. Data were prospectively collected. Stability of transfusion incidence also was compared (2005-2006 vs 2008-2014). After matching, 890 patients from each year were included. Use of blood products decreased from 54% in 2006 to 25% in 2009 (P platelets (P conservation program can significantly control blood transfusion rates, improve outcomes, and be sustained over time. Efforts are needed to implement evidence-based protocols to standardize and decrease blood use in cardiac surgery to improve outcomes and reduce cost. Copyright © 2016 The American Association for Thoracic Surgery. Published by Elsevier Inc. All rights reserved.

Endoscope-assisted conservative condylectomy combined with orthognathic surgery in the treatment of mandibular condylar osteochondroma.

Science.gov (United States)

Yu, Hongbo; Jiao, Feifei; Li, Biao; Zhang, Lei; Shen, Steve Guofang; Wang, Xudong

2014-07-01

Mandibular condylar osteochondroma (OC) results in asymmetric prognathism with facial morphologic and functional disturbance. The aim of this study was to explore the feasibility of endoscope-assisted conservative condylectomy combined with simultaneous orthognathic surgery in the treatment of condylar OC. Thirteen patients with OC of the mandibular condyle were enrolled in this study. With the aid of endoscope, condylar OC resection and conservative condylectomy were carried out via intraoral approach. A direct vision of the magnified and illuminated operative field was realized. Simultaneous orthognathic surgery was used to correct facial asymmetry and malocclusion. All patients healed uneventfully. No facial nerve injury and salivary fistula occurred. Facial symmetry and morphology were greatly improved, and stable occlusion was obtained in all cases. The patients showed no signs of recurrence and temporomandibular joint ankylosis in the 16 to 54 months of follow-up. Endoscope-assisted tumor resection and condylectomy combined with simultaneous orthognathic surgery provide us a valuable option in the treatment of mandibular condylar OC.

Usefulness of a Lateral Thoracodorsal Flap after Breast Conserving Surgery in Laterally Located Breast Cancer

Directory of Open Access Journals (Sweden)

Jung Dug Yang

2013-07-01

Full Text Available BackgroundBreast-conserving surgery is widely accepted as an appropriate method in breast cancer, and the lateral thoracodorsal flap provides a simple, reliable technique, especially when a mass is located in the lateral breast. This study describes the usefulness of a lateral thoracodorsal flap after breast conserving surgery in laterally located breast cancer.MethodsFrom September 2008 to February 2013, a lateral thoracodorsal flap was used in 20 patients with laterally located breast cancer treated at our institution. The technique involves a local medially based, wedge shaped, fasciocutaneous transposition flap from the lateral region of the thoracic area. Overall satisfaction and aesthetic satisfaction surveys were conducted with the patients during a 6-month postoperative follow-up period. Aesthetic results in terms of breast shape and symmetry were evaluated by plastic surgeons.ResultsThe average specimen weight was 76.8 g. The locations of the masses were the upper lateral quadrant (n=15, the lower lateral quadrant (n=2, and the central lateral area (n=3. Complications developed in four of the cases, partial flap necrosis in one, wound dehiscence in one, and fat necrosis in two. The majority of the patients were satisfied with their cosmetic outcomes.ConclusionsPartial breast reconstruction using a lateral thoracodorsal flap is well matched with breast color and texture, and the surgery is less aggressive than other techniques with few complications. Therefore, the lateral thoracodorsal flap can be a useful, reliable technique in correcting breast deformity after breast conserving surgery, especially in laterally located breast cancer.

Usefulness of a Lateral Thoracodorsal Flap after Breast Conserving Surgery in Laterally Located Breast Cancer

Directory of Open Access Journals (Sweden)

Ho Yong Park

2013-07-01

Full Text Available Background Breast-conserving surgery is widely accepted as an appropriate method in breast cancer, and the lateral thoracodorsal flap provides a simple, reliable technique, especially when a mass is located in the lateral breast. This study describes the usefulness of a lateral thoracodorsal flap after breast conserving surgery in laterally located breast cancer.Methods From September 2008 to February 2013, a lateral thoracodorsal flap was used in 20 patients with laterally located breast cancer treated at our institution. The technique involves a local medially based, wedge shaped, fasciocutaneous transposition flap from the lateral region of the thoracic area. Overall satisfaction and aesthetic satisfaction surveys were conducted with the patients during a 6-month postoperative follow-up period. Aesthetic results in terms of breast shape and symmetry were evaluated by plastic surgeons.Results The average specimen weight was 76.8 g. The locations of the masses were the upper lateral quadrant (n=15, the lower lateral quadrant (n=2, and the central lateral area (n=3. Complications developed in four of the cases, partial flap necrosis in one, wound dehiscence in one, and fat necrosis in two. The majority of the patients were satisfied with their cosmetic outcomes.Conclusions Partial breast reconstruction using a lateral thoracodorsal flap is well matched with breast color and texture, and the surgery is less aggressive than other techniques with few complications. Therefore, the lateral thoracodorsal flap can be a useful, reliable technique in correcting breast deformity after breast conserving surgery, especially in laterally located breast cancer.

Blood conservation strategies reduce the need for transfusions in ascending and aortic arch surgery.

Science.gov (United States)

Chu, M W A; Losenno, K L; Moore, K; Berta, D; Hewitt, J; Ralley, F

2013-07-01

Ascending and aortic arch surgery is associated with higher levels of blood loss and subsequent need for allogeneic blood transfusions. We hypothesized that aggressive, comprehensive blood conservation strategies may limit the need for transfusions and, subsequently, improve postoperative outcomes. Over a five-year period, 189 patients underwent proximal aortic surgery at our institution. Fifty-one patients underwent surgery using a comprehensive blood conservation strategy (BCS), including preoperative hemoglobin optimization, antifibrinolytic therapy, intraoperative acute normovolemic hemodilution, cell salvage and meticulous surgical technique. The remaining 138 patients underwent surgery using conventional techniques (CONV). Patients in the BCS group required fewer transfusions during their hospital stay compared to the conventional group (56.9% vs. 72.5%, p=0.041). When examining elective cases, this trend widens, with 40.0% of BCS patients requiring any transfusions compared to 72.9% patients in the conventional group (p=0.001). Red cell (47.1% vs. 62.3%, p=0.06), plasma (43.1% vs. 61.6%, p=0.02) and platelets (27.5% vs. 47.8%, p=0.01) were also less frequently required in the BCS group than the conventional group, respectively. When a transfusion was required, patients in the BCS group received significantly fewer units of red blood cells (2.8 ± 7.0 units) than the conventional group (5.81 ± 9.5 units; p=0.039). Mortality was similar in both groups (BCS 7.8%, conventional 10.9%, p=0.54); however, there was significantly less morbidity in the BCS group, using a composite of any of 10 major postoperative complications (23.5% vs. 39.1%; p=0.046). Median intensive care unit (ICU) and hospital lengths of stay were 2 and 7 days in the BCS group and 2 and 8 days in the CONV group (p=0.15), respectively. The aggressive use of a comprehensive blood conservation strategy in ascending and aortic arch surgery can significantly reduce the need for blood transfusions

[Evaluation of the clinical effect of the teeth with subgingivally involved defect conserved by crown lengthening surgery].

Science.gov (United States)

Wang, Yong; Ding, Xiao-Hong; Yao, Li-Li; Huang, Zhong-Suo; Bian, Hua-Qin

2005-02-01

To evaluate the clinical effect of the teeth with subgingivally involved defect which were conserved by crown lengthening surgery. 62 teeth, with defect subgingivally from 1.5 mm to 4 mm, mobility degree(MD)lengthening surgery by combining flap surgery and osteoectomy, and restored 4 weeks after operation and followed-up for one year. The parameters of MD, sulcus bleeding index (SBI) and maximal defect probing depth (PD) at different times were measured respectively. 46 anterior teeth were divided into two groups based on PD of pre-operation. The groups were as follows: minor defect group (0.05), but a significant increase about MD occurred in the major defect group one year after restoration (Pstage after operation and PD of pre-operation in anterior teeth (r=0.489, 0.526, 0.531, Plengthening surgery may conserve these teeth with subgingivally involved defect, and has a good, long-time clinical effect. But MD showed an increasing trend after operation and significant cor.

Quality of life following total mastectomy with and without reconstruction versus breast-conserving surgery for breast cancer: A case-controlled cohort study.

Science.gov (United States)

Howes, Benjamin H L; Watson, David I; Xu, Chris; Fosh, Beverley; Canepa, Maximiliano; Dean, Nicola R

2016-09-01

Patient-reported outcomes and quality of life following mastectomy are not well understood. This study evaluates the quality of life following surgery for breast cancer and compares outcomes following breast-conserving surgery versus total mastectomy with or without reconstruction. A case-controlled cross-sectional study was conducted using the validated BREAST-Q™ questionnaire and a study-specific questionnaire to determine patient's views about surgical outcomes. Questionnaires were completed by patients following breast-conserving surgery and total mastectomy with or without reconstruction and by controls without breast cancer. A one-way ANOVA was used to compare mean BREAST-Q™ scores between groups and post hoc analysis using Tukey's and Kruskal-Wallis tests. BREAST-Q™ questionnaires were completed by 400 women (123 controls, 97 breast conservations, 93 mastectomies without reconstruction, 87 mastectomies with reconstruction). Women who had undergone mastectomy and reconstruction had higher scores in satisfaction with breast and sexual well-being domains compared with women who had breast-conserving surgery, and women who had total mastectomy without reconstruction had the lowest scores in these two domains. There was no difference in psychosocial well-being between the groups. Women who had undergone breast-conserving surgery scored the lowest in the physical well-being chest domain and the majority reported breast asymmetry. Our study suggests that women who undergo total mastectomy and breast reconstruction for cancer achieve a quality-of-life outcome that is at least as good as that following breast-conserving surgery. Furthermore, breast conservation has been found to be associated with lower physical well-being (i.e., more pain and discomfort) in the chest area and poorer sexual well-being outcomes. Copyright © 2016 British Association of Plastic, Reconstructive and Aesthetic Surgeons. All rights reserved.

Linking diversity and distribution to understand biodiversity gradients and inform conservation assessments

Directory of Open Access Journals (Sweden)

Fabricio Villalobos

2014-03-01

Full Text Available Broad-scale patterns of species richness result from differential coexistence among species in distinct regions of the globe, determined by the species’ ranges and their properties such as size, shape and location. Thus, species richness and ranges are inherently linked. These two biodiversity features also yield primary information for conservation assessments. However, species richness and range size have been usually studied separately and no formal analytical link has been established. In my PhD thesis, I applied and extended a recently developed conceptual and methodological framework to study geographical association among species and similarity among sites. This range–diversity framework, along with stochastic simulation modelling, allowed me to jointly evaluate the relationship between diversity and distribution, to infer potential processes underlying composite patterns of phyllostomid bats, and to use this approach to inform conservation assessments for the Mexican avifauna. I highlight the need to explore composite patterns for understanding biodiversity patterns and show how combining diversity and distributional data can help describe complex biogeographical patterns, providing a transparent and explicit application for initial conservation assessments.

Pectoral nerve block (Pecs block) with sedation for breast conserving surgery without general anesthesia.

Science.gov (United States)

Moon, Eun-Jin; Kim, Seung-Beom; Chung, Jun-Young; Song, Jeong-Yoon; Yi, Jae-Woo

2017-09-01

Most regional anesthesia in breast surgeries is performed as postoperative pain management under general anesthesia, and not as the primary anesthesia. Regional anesthesia has very few cardiovascular or pulmonary side-effects, as compared with general anesthesia. Pectoral nerve block is a relatively new technique, with fewer complications than other regional anesthesia. We performed Pecs I and Pec II block simultaneously as primary anesthesia under moderate sedation with dexmedetomidine for breast conserving surgery in a 49-year-old female patient with invasive ductal carcinoma. Block was uneventful and showed no complications. Thus, Pecs block with sedation could be an alternative to general anesthesia for breast surgeries.

A Prospective Study of the Conservative Management of Asymptomatic Preoperative and Postoperative Gallbladder Disease in Bariatric Surgery.

Science.gov (United States)

Pineda, Omar; Maydón, Hernán G; Amado, Mónica; Sepúlveda, Elisa M; Guilbert, Lizbeth; Espinosa, Omar; Zerrweck, Carlos

2017-01-01

Bariatric surgery is the most effective therapy for weight loss in patients with morbid obesity. One of the most common long-term complications includes cholelithiasis. There is not a clear consensus in how to treat an asymptomatic gallbladder disease before and after bariatric surgery. Prospective study with every patient submitted to bariatric surgery from 2012 to 2014. The gallbladder status was assessed with an ultrasound before and after surgery (12 months), and a conservative management was conducted for patients with asymptomatic disease (preoperative and de novo); the need for delayed cholecystectomy was reported. Secondarily, an analysis of weight loss (%EWL) and gallbladder status was performed. Two-hundred and two bariatric surgeries were performed. The global incidence of preoperative gallbladder disease was 34.3 %, with 14.2 % presenting sludge, 20.1 % asymptomatic gallstones, and 2.3 % symptomatic gallstones. The final analysis was based on 146 patients; female sex comprised 81.1 % of cases with a mean age of 38.5 years. After 12 months, de novo gallbladder disease was observed in 21.2 %. The overall rate of cholecystectomy because of symptomatic disease after 12 months was 3.4 % (2 % developed acute cholecystitis). There were no differences in %EWL between patients with de novo gallbladder disease and those without. Conservative management of asymptomatic gallbladder disease in candidates to bariatric surgery is safe and can be offered in every case, based on the low percentage of patients requiring further cholecystectomy after 12 months. Also, a conservative management can be offered to patients developing de novo sludge/cholelithiasis without related symptoms.

Blood conservation in cardiac surgery. Preliminary results with an institutional commitment.

Science.gov (United States)

Tyson, G S; Sladen, R N; Spainhour, V; Savitt, M A; Ferguson, T B; Wolfe, W G

1989-06-01

To evaluate the effect of blood conservation in cardiac surgery, use of blood products was analyzed in patients undergoing CABG before and after implementation of blood conservation techniques. Age, sex, coronary anatomy, ejection fraction, cardiopulmonary bypass time, and the preoperative hematocrit, platelet count, and clotting studies were similar in both groups. Methods of blood conservation included autologous transfusion of blood withdrawn before bypass, autotransfusion of shed mediastinal blood, strict protocols for transfusion, and acceptance of normovolemic anemia. With blood conservation, 25.5% of patients received no transfusions and 54.9% received blood only. Significant reductions (p less than 0.001) were achieved in the transfusion of blood from 6.8 +/- 2.4 to 2.3 +/- 2.6 units per patient and of plasma from 2.5 +/- 2.2 to 0.6 +/- 2.0 units per patient. Reductions in the use of platelets and cryoprecipitate were substantial, although not significant. Total donor exposure was reduced significantly from 13.1 +/- 7.3 to 4.3 +/- 6.7 donors per patient. The postoperative hematocrit was significantly lower and remained so at discharge. However, 30 days later there was no difference. This reduction in transfusion requirements decreased costs and donor exposure.

10 year survival after breast-conserving surgery plus radiotherapy compared with mastectomy in early breast cancer in the Netherlands : a population-based study

NARCIS (Netherlands)

van Maaren, Marissa C.; de Munck, Linda; de Bock, Geertruida H.; Jobsen, Jan J.; van Dalen, Thijs; Linn, Sabine C.; Poortmans, Philip; Strobbe, Luc J A; Siesling, Sabine

Background Investigators of registry-based studies report improved survival for breast-conserving surgery plus radiotherapy compared with mastectomy in early breast cancer. As these studies did not present long-term overall and breast cancer-specific survival, the effect of breast-conserving surgery

Breast conserving surgery in locoregional treatment of breast carcinoma after Hodgkin lymphoma

International Nuclear Information System (INIS)

Haberer, S.; Le Scodan, R.; Kirova, Y.M.; Moisson, P.; Campana, F.; Fourquet, A.; Bollet, M.A.; Belin, L.; Savignoni, A.; Stevens, D.; Decaudin, D.; Pierga, J.Y.; Reyal, F.

2012-01-01

Purpose. - To report characteristics and outcome of breast cancer after irradiation for Hodgkin lymphoma with special focus on breast conservation surgery. Patients and methods. - Medical records of 72 women who developed either ductal carcinoma in situ or stage I-III invasive carcinoma of the breast after Hodgkin lymphoma between 1978 and 2009 were retrospectively reviewed. Results. - Median age at Hodgkin lymphoma diagnosis was 23 years old. Median total dose received by the mediastinum was 40 Gy, mostly by a mantle field technique. Breast cancer occurred after a median time interval of 21 years. Ductal invasive carcinoma and ductal carcinoma in situ represented respectively 71% and 19% of the cases. Locoregional treatment for breast cancer consisted of mastectomy with or without radiotherapy in 39 patients and of lumpectomy with or without adjuvant radiotherapy in 32 patients. The isocentric lateral decubitus radiation technique was used in 17 patients after breast conserving surgery (57%). With a median follow-up of 7 years, 5-year overall survival rate and locoregional control rate were respectively 74.5% and 82% for invasive carcinoma and 100% and 92% for in situ carcinoma. Thirteen patients died of progressive breast cancer and contralateral breast cancer was diagnosed in ten patients (14%). Conclusions. - Breast conserving treatment can be an option for breast cancers that occur after Hodgkin lymphoma despite prior thoracic irradiation. It should consist of lumpectomy and adjuvant breast radiotherapy with use of adequate techniques, such as the lateral decubitus isocentric position. (authors)

Myocardial infarction among women with early-stage breast cancer treated with conservative surgery and breast irradiation

International Nuclear Information System (INIS)

Rutqvist, Lars E.; Liedberg, Anette; Hammar, Niklas; Dalberg, Kristina

1998-01-01

Purpose: To assess the possible impact of the irradiation on the risk of acute myocardial infarction among breast cancer patients treated with conservative surgery and postoperative radiation therapy. Methods and Materials: The incidence of and mortality from acute myocardial infarction was assessed in a group of 684 women with early-stage breast cancer diagnosed during 1976-1987 who had been treated with breast conserving surgery plus postoperative radiation therapy given with tangential photon fields. In 94% of the patients the total dose was between 48-52 Gy given with 2 Gy daily fractions 5 days per week for a total treatment period of about 4 (1(2)) - 5 (1(2)) weeks. In 88% of the patients the target volume included the breast parenchyma alone. In the remaining patients regional nodal areas were also irradiated. A concurrent group of 4,996 breast cancer patients treated with mastectomy without postoperative radiation therapy was used as a reference. Results: After a median follow-up of 9 years (range: 5-16 years) 12 conservatively treated patients (1.8%) had developed an acute myocardial infarction and 5 (0.7%) had died due to this disease. The age-adjusted relative hazard of acute myocardial infarction for the conservative group vs. the mastectomy group was 0.6 (95% C.I.: 0.4-1.2) and for death due to this disease 0.4 (0.2-1.1). The incidence of acute myocardial infarction among the conservatively treated women was similar irrespective of tumor laterality. Conclusions: There was no indication of an increased risk of acute myocardial infarction with the radiation therapy among the women treated with conservative surgery. However, due to the small number of events the study could not exclude the possibility that cardiac problems may arise in some patients with left-sided cancers who have their heart located anteriorly in the mediastinum. Individual, three-dimensional dose planning represents one method to identify such patients and is basic to technical changes

Blood conservation in cardiac surgery. Preliminary results with an institutional commitment.

Science.gov (United States)

Tyson, G S; Sladen, R N; Spainhour, V; Savitt, M A; Ferguson, T B; Wolfe, W G

1989-01-01

To evaluate the effect of blood conservation in cardiac surgery, use of blood products was analyzed in patients undergoing CABG before and after implementation of blood conservation techniques. Age, sex, coronary anatomy, ejection fraction, cardiopulmonary bypass time, and the preoperative hematocrit, platelet count, and clotting studies were similar in both groups. Methods of blood conservation included autologous transfusion of blood withdrawn before bypass, autotransfusion of shed mediastinal blood, strict protocols for transfusion, and acceptance of normovolemic anemia. With blood conservation, 25.5% of patients received no transfusions and 54.9% received blood only. Significant reductions (p less than 0.001) were achieved in the transfusion of blood from 6.8 +/- 2.4 to 2.3 +/- 2.6 units per patient and of plasma from 2.5 +/- 2.2 to 0.6 +/- 2.0 units per patient. Reductions in the use of platelets and cryoprecipitate were substantial, although not significant. Total donor exposure was reduced significantly from 13.1 +/- 7.3 to 4.3 +/- 6.7 donors per patient. The postoperative hematocrit was significantly lower and remained so at discharge. However, 30 days later there was no difference. This reduction in transfusion requirements decreased costs and donor exposure. Images Fig. 1. Fig. 2. Fig. 3. Fig. 4. Fig. 5. Fig. 6. Fig. 7. PMID:2730184

Subclinical ductal carcinoma in situ of the breast: treatment with conservative surgery and radiotherapy.

Science.gov (United States)

Amichetti, M; Caffo, O; Richetti, A; Zini, G; Rigon, A; Antonello, M; Roncadin, M; Coghetto, F; Valdagni, R; Fasan, S; Maluta, S; Di Marco, A; Neri, S; Vidali, C; Panizzoni, G; Aristei, C

1999-01-01

In spite of the fact that ductal carcinoma in situ (DCIS) of the breast is a frequently encountered clinical problem, there is no consensus about the optimal treatment of clinically occult (i.e., mammographic presentation only) DCIS. Interest in breast conservation therapy has recently increased. Few data are available in Italy on the conservative treatment with surgery and adjuvant postoperative radiotherapy. A retrospective multi-institutional study was performed in 15 Radiation Oncology Departments in northern Italy involving 112 women with subclinical DCIS of the breast treated between 1982 and 1993. Age of the patients ranged between 32 and 72 years (median, 50 years). All of them underwent conservative surgery: quadrantectomy in 89, tumorectomy in 11, and wide excision in 12 cases. The most common histologic subtype was comedocarcinoma (37%). The median pathologic size was 10 mm (range 1 to 55 mm). Axillary dissection was performed in 83 cases: all the patients were node negative. All the patients received adjunctive radiation therapy with 60Co units (77%) or 6 MV linear accelerators (23%) for a median total dose to the entire breast of 50 Gy (mean, 49.48 Gy; range, 45-60 Gy). Seventy-six cases (68%) received a boost to the tumor bed at a dose of 8-20 Gy (median 10 Gy) for a minimum tumor dose of 58 Gy. At a median follow-up of 66 months, 8 local recurrences were observed, 4 intraductal and 4 invasive. All recurrent patients had a salvage mastectomy and are alive and free of disease at this writing. The 10-year actuarial overall, cause-specific, and recurrence-free survival was of 98.8%, 100%, and 91%, respectively. The retrospective multicentric study, with a local control rate of more than 90% at 10 years with 100% cause-specific survival, showed that conservative surgery and adjuvant radiation therapy is a safe and efficacious treatment for patients with occult, non-palpable DCIS.

Quality of life and disability 12 months after surgery vs. conservative management for unruptured brain arteriovenous malformations: Scottish population-based and Australian hospital-based studies.

Science.gov (United States)

O'Donnell, Joan Margaret; Al-Shahi Salman, Rustam; Manuguerra, Maurizio; Assaad, Nazih; Morgan, Michael Kerin

2018-03-01

Few data are available on disability and quality of life (QOL) after surgery versus conservative management for unruptured brain arteriovenous malformations (uAVMs). The aim of this study was to test the hypothesis that QOL and disability are worse after surgery ± preoperative embolisation for uAVM compared with conservative management. We included consecutive patients diagnosed with uAVM from a prospective population-based study in Scotland (1999-2003; 2006-2010) and a prospective hospital-based series in Australia (2011-2015). We assessed outcomes on the modified Rankin Scale (mRS) and the Short Form (SF)-36 at ~ 12 months after surgery or conservative treatment and compared these groups using continuous ordinal regression in the two cohorts separately. Surgery was performed for 29% of all uAVM cases diagnosed in Scotland and 84% of all uAVM referred in Australia. There was no statistically significant difference between surgery and conservative management at 12 months among 79 patients in Scotland (mean SF-36 Physical Component Score (PCS) 39 [SD 14] vs. 39 [SD 13]; mean SF-36 Mental Component Score (MCS) 38 [SD 14] vs. 39 [SD 14]; mRS > 1, 24 vs. 9%), nor among 37 patients in Australia (PCS 51 [SD 10] vs. 49 [SD 6]; MCS 48 [SD 12] vs. 49 [SD 10]; mRS > 1, 19 vs. 30%). In the Australian series, there was no statistically significant change in the MCS and PCS between baseline before surgery or conservative management and 12 months. We did not find a statistically significant difference between surgery ± preoperative embolisation and conservative management in disability or QOL at 12 months.

Malignant fibrous histiocytoma: outcome and prognostic factors following conservation surgery and radiotherapy

International Nuclear Information System (INIS)

Zagars, Gunar K.; Mullen, John R.; Pollack, Alan

1996-01-01

Purpose: Malignant fibrous histiocytoma is the most common type of soft tissue sarcoma. This communication presents an analysis of outcome and prognostic factors based on a retrospective review of patients with this disease treated by conservation surgery and radiotherapy. Methods and Materials: From 1966 to 1991, 271 consecutive patients with malignant fibrous histiocytoma were treated with conservation surgery and radiotherapy. The outcome with local control, metastatic relapse, and survival as end points was evaluated by univariate and multivariate statistics to delineate independently significant prognostic factors. Results: Postoperative radiation at a mean dose of 62.8 Gy was used in 195 patients and preoperative radiation at a mean dose of 50 Gy was used in 76 patients. At a median follow-up of 7.3 years, 123 patients (45%) developed disease relapse at some site. Fifty-seven (21%) developed local recurrence leading to an actuarial local relapse rate of 26% at 10 years, 83 (31%) developed metastatic relapse for a 10-year actuarial metastatic rate of 33%, and the 5-, 10-, and 15-year survival rates were 68, 60, and 46%, respectively. For local control, prior local recurrence (in 53 patients) was identified as an adverse factor, yielding a 10-year recurrence rate of 42% compared to 22% for 218 patients without prior disease (p 5 cm), and histology (myxoid vs. nonmyxoid) were not significant determinants of local outcome. For metastatic relapse, the major determinants of outcome were histology (myxoid vs. nonmyxoid) and tumor size. Myxoid tumors (59 patients) had a low metastatic propensity (13% 10-year metastatic rate) compared to nonmyxoid tumors (212 patients) (40% 10-year metastatic rate) (p 5 cm) were the only independent determinants of outcome. Conclusion: Malignant fibrous histiocytoma is a heterogeneous disease and its myxoid variant must be recognized as a distinct entity. Both variants are locally aggressive and require equally aggressive local

Community Markets for Conservation (COMACO) links biodiversity conservation with sustainable improvements in livelihoods and food production.

Science.gov (United States)

Lewis, Dale; Bell, Samuel D; Fay, John; Bothi, Kim L; Gatere, Lydiah; Kabila, Makando; Mukamba, Mwangala; Matokwani, Edwin; Mushimbalume, Matthews; Moraru, Carmen I; Lehmann, Johannes; Lassoie, James; Wolfe, David; Lee, David R; Buck, Louise; Travis, Alexander J

2011-08-23

In the Luangwa Valley, Zambia, persistent poverty and hunger present linked challenges to rural development and biodiversity conservation. Both household coping strategies and larger-scale economic development efforts have caused severe natural resource degradation that limits future economic opportunities and endangers ecosystem services. A model based on a business infrastructure has been developed to promote and maintain sustainable agricultural and natural resource management practices, leading to direct and indirect conservation outcomes. The Community Markets for Conservation (COMACO) model operates primarily with communities surrounding national parks, strengthening conservation benefits produced by these protected areas. COMACO first identifies the least food-secure households and trains them in sustainable agricultural practices that minimize threats to natural resources while meeting household needs. In addition, COMACO identifies people responsible for severe natural resource depletion and trains them to generate alternative income sources. In an effort to maintain compliance with these practices, COMACO provides extension support and access to high-value markets that would otherwise be inaccessible to participants. Because the model is continually evolving via adaptive management, success or failure of the model as a whole is difficult to quantify at this early stage. We therefore test specific hypotheses and present data documenting the stabilization of previously declining wildlife populations; the meeting of thresholds of productivity that give COMACO access to stable, high-value markets and progress toward economic self-sufficiency; and the adoption of sustainable agricultural practices by participants and other community members. Together, these findings describe a unique, business-oriented model for poverty alleviation, food production, and biodiversity conservation.

Clinical efficacy of breast-conserving surgery combined with neoadjuvant chemotherapy for locally advanced breast cancer: a report of 81 cases

Directory of Open Access Journals (Sweden)

Zhi-yu CAO

2015-07-01

Full Text Available Objective　To investigate the clinical efficacy of neoadjuvant chemotherapy combined with breast-conserving surgery for locally advanced breast cancer. Methods　Eighty-one patients with locally advanced breast cancer were selected from those who were admitted into 309 Hospital of PLA from January 2009 to October 2013, consisting of 65 patients in stage Ⅲa and 16 in stage Ⅲb, and they were treated with neoadjuvant chemotherapy combined with breast-conserving surgery. The clinical efficacy [complete response (CR, partial response (PR, stable disease (SD and progress disease (PD] was observed during follow-up. Results　All the patients were followed-up for 12-60 months with a median of 34 months. There were 12 CR patients (14.8%, including 4 with pathological complete response (4.9%, and 52 PR patients (64.2%, 17 SD patients (21.0%. No PD was observed. The overall response rate(ORR was 79.0%(64/81. After follow-up for 12-60 months (median 34 months, distant metastasis to the lung, liver, meninges and bone occurred in 3 patients (3.7%, 3/81 and 1 of them died. Forty-eight patients received breastconserving surgery. The local recurrence rate was 6.3% (3/48. Assessment of cosmetic result was carried out in 48 patients who received breast-conserving surgery and comprehensive treatment for one year, and excellent results were obtained in 14.6% (7/48, good in 43.8% (21/48, and poor in 41.7% (20/48. Conclusions　The therapeutic efficacy of locally advanced breast cancer is satisfactory by neoadjuvant chemotherapy and breast-conserving surgery. Standardization of excision and postoperative radiotherapy, systemic comprehensive treatment is the key to the success of the treatment. DOI: 10.11855/j.issn.0577-7402.2015.06.14

A Regression Model for Predicting Shape Deformation after Breast Conserving Surgery

Directory of Open Access Journals (Sweden)

Hooshiar Zolfagharnasab

2018-01-01

Full Text Available Breast cancer treatments can have a negative impact on breast aesthetics, in case when surgery is intended to intersect tumor. For many years mastectomy was the only surgical option, but more recently breast conserving surgery (BCS has been promoted as a liable alternative to treat cancer while preserving most part of the breast. However, there is still a significant number of BCS intervened patients who are unpleasant with the result of the treatment, which leads to self-image issues and emotional overloads. Surgeons recognize the value of a tool to predict the breast shape after BCS to facilitate surgeon/patient communication and allow more educated decisions; however, no such tool is available that is suited for clinical usage. These tools could serve as a way of visually sensing the aesthetic consequences of the treatment. In this research, it is intended to propose a methodology for predict the deformation after BCS by using machine learning techniques. Nonetheless, there is no appropriate dataset containing breast data before and after surgery in order to train a learning model. Therefore, an in-house semi-synthetic dataset is proposed to fulfill the requirement of this research. Using the proposed dataset, several learning methodologies were investigated, and promising outcomes are obtained.

A Regression Model for Predicting Shape Deformation after Breast Conserving Surgery

Science.gov (United States)

Zolfagharnasab, Hooshiar; Bessa, Sílvia; Oliveira, Sara P.; Faria, Pedro; Teixeira, João F.; Cardoso, Jaime S.

2018-01-01

Breast cancer treatments can have a negative impact on breast aesthetics, in case when surgery is intended to intersect tumor. For many years mastectomy was the only surgical option, but more recently breast conserving surgery (BCS) has been promoted as a liable alternative to treat cancer while preserving most part of the breast. However, there is still a significant number of BCS intervened patients who are unpleasant with the result of the treatment, which leads to self-image issues and emotional overloads. Surgeons recognize the value of a tool to predict the breast shape after BCS to facilitate surgeon/patient communication and allow more educated decisions; however, no such tool is available that is suited for clinical usage. These tools could serve as a way of visually sensing the aesthetic consequences of the treatment. In this research, it is intended to propose a methodology for predict the deformation after BCS by using machine learning techniques. Nonetheless, there is no appropriate dataset containing breast data before and after surgery in order to train a learning model. Therefore, an in-house semi-synthetic dataset is proposed to fulfill the requirement of this research. Using the proposed dataset, several learning methodologies were investigated, and promising outcomes are obtained. PMID:29315279

A patient with angiosarcoma of the breast after breast-conserving surgery and radiotherapy for breast cancer

International Nuclear Information System (INIS)

Yasuoka, Rie; Mitsuo, Manabu; Hanioka, Keisuke

2014-01-01

An 89-year-old woman underwent breast-conserving surgery and axillary lymph node dissection (right AC region, T2N0M0, stage 2A, invasive ductal carcinoma, papillotubular type) for right breast cancer in February 2005. She received postoperative radiotherapy to the residual breast. She then developed marked edema of the right arm and right breast. A mass developed in the right breast in March 2011 and March 2013. This was originally suspected to be an ipsilateral breast recurrence of the cancer, but turned to be angiosarcoma after developing recurrent mass in March 2013, which histopathology was proved to be showed angiosarcoma of the breast. The patient subsequently had repeated intradermal and subcutaneous metastases and recurrence. She is currently receiving chemotherapy with docetaxel (30 mg/m 2 biweekly). This interesting case of angiosarcoma of the breast after breast-conserving surgery for breast cancer is reported. (author)

Clinical significance of radiation therapy in breast recurrence and prognosis in breast-conserving surgery

International Nuclear Information System (INIS)

Nishimura, Reiki; Nagao, Kazuharu; Miyayama, Haruhiko

1999-01-01

Significant risk factors for recurrence of breast cancer after breast-conserving therapy, which has become a standard treatment for breast cancer, are positive surgical margins and the failure to perform radiation therapy. In this study, we evaluated the clinical significance of radiation therapy after primary surgery or breast recurrence. In 344 cases of breast-conserving surgery, disease recurred in 43 cases (12.5%), which were classified as follows: 17 cases of breast recurrence, 13 cases of breast and distant metastasis, and 13 cases of distant metastasis. Sixty-two patients (16.7%) received radiation therapy. A positive surgical margin and younger age were significant risk factors for breast recurrence in patients not receiving postoperative radiation therapy but not in patients receiving radiation therapy. Radiation therapy may be beneficial for younger patients with positive surgical margins. Furthermore, radiation therapy after recurrence was effective in the cases not treated with postoperative radiation but not in cases with inflammatory recurrence. Patients with breast recurrence alone had significantly higher survival rates than did patients with distant metastases regardless of breast recurrence. These findings suggest that the adaptation criteria of radiation therapy for local control must be clarified. (author)

Clinical significance of radiation therapy in breast recurrence and prognosis in breast-conserving surgery

Energy Technology Data Exchange (ETDEWEB)

Nishimura, Reiki; Nagao, Kazuharu; Miyayama, Haruhiko [Kumamoto City Hospital (Japan)] [and others

1999-03-01

Significant risk factors for recurrence of breast cancer after breast-conserving therapy, which has become a standard treatment for breast cancer, are positive surgical margins and the failure to perform radiation therapy. In this study, we evaluated the clinical significance of radiation therapy after primary surgery or breast recurrence. In 344 cases of breast-conserving surgery, disease recurred in 43 cases (12.5%), which were classified as follows: 17 cases of breast recurrence, 13 cases of breast and distant metastasis, and 13 cases of distant metastasis. Sixty-two patients (16.7%) received radiation therapy. A positive surgical margin and younger age were significant risk factors for breast recurrence in patients not receiving postoperative radiation therapy but not in patients receiving radiation therapy. Radiation therapy may be beneficial for younger patients with positive surgical margins. Furthermore, radiation therapy after recurrence was effective in the cases not treated with postoperative radiation but not in cases with inflammatory recurrence. Patients with breast recurrence alone had significantly higher survival rates than did patients with distant metastases regardless of breast recurrence. These findings suggest that the adaptation criteria of radiation therapy for local control must be clarified. (author)

Gender-linked impact of epicardial adipose tissue volume in patients who underwent coronary artery bypass graft surgery or non-coronary valve surgery

OpenAIRE

Maimaituxun, Gulinu; Shimabukuro, Michio; Salim, Hotimah Masdan; Tabata, Minoru; Yuji, Daisuke; Morimoto, Yoshihisa; Akasaka, Takeshi; Matsuura, Tomomi; Yagi, Shusuke; Fukuda, Daiju; Yamada, Hirotsugu; Soeki, Takeshi; Sugimoto, Takaki; Tanaka, Masashi; Takanashi, Shuichiro

2017-01-01

Background Traditional and non-traditional risk factors for atherosclerotic cardiovascular disease (ASCVD) are different between men and women. Gender-linked impact of epicardial adipose tissue volume (EATV) in patients undergoing coronary artery bypass grafting (CABG) remains unknown. Methods Gender-linked impact of EATV, abdominal fat distribution and other traditional ASCVD risk factors were compared in 172 patients (men: 115; women: 57) who underwent CABG or non-coronary valvular surgery ...

A case of postirradiation angiosarcoma developed in the residual breast after breast-conserving surgery

International Nuclear Information System (INIS)

Nomura, Shinji; Okazaki, Yoshikazu; Fujii, Masakazu; Akiyama, Norio; Tomozawa, Naofumi; Morishige, Ichiro

2008-01-01

The patient was a 50-year-old woman who had undergone breast-conserving surgery for right breast cancer (C area, Bp+Ax, T2N0M0, Stage I, and scirrhous carcinoma), followed by irradiation at a total dose of 50 Gy in 1998. When 6 years 5 months had elapsed after the operation, redness and induration developed in the A area of the right breast. A biopsy via wedge resection was performed and the histopathological diagnosis was angiosarcoma. We could not rule out a possibility of positive surgical stump, and performed additional resection+skin grafting. No sarcoma remnant was demonstrated in the material resected additionally, but 2 years later, the patient experienced recurrence. Thus mastectomy+extended resection of the full thickness of the skin+skin grafting were performed. Postirradiation sarcoma involving the skin and vessels is a rare entity and occurs in 0.03-0.8% of all cases after radiation therapy. It metastasizes to the distant organs in an early stage and carries poor prognosis. No standard therapy for the disease has been established as yet. Early detection and extended resection are considered to contribute to an improvement of the prognosis. This paper deals with such a rare entity as postirradiation angiosarcoma developed in the residual breast after breast-conserving surgery. (author)

Strategic Grassland Bird Conservation throughout the Annual Cycle: Linking Policy Alternatives, Landowner Decisions, and Biological Population Outcomes.

Directory of Open Access Journals (Sweden)

Ryan G Drum

Full Text Available Grassland bird habitat has declined substantially in the United States. Remaining grasslands are increasingly fragmented, mostly privately owned, and vary greatly in terms of habitat quality and protection status. A coordinated strategic response for grassland bird conservation is difficult, largely due to the scope and complexity of the problem, further compounded by biological, sociological, and economic uncertainties. We describe the results from a collaborative Structured Decision Making (SDM workshop focused on linking social and economic drivers of landscape change to grassland bird population outcomes. We identified and evaluated alternative strategies for grassland bird conservation using a series of rapid prototype models. We modeled change in grassland and agriculture cover in hypothetical landscapes resulting from different landowner decisions in response to alternative socio-economic conservation policy decisions. Resulting changes in land cover at all three stages of the annual cycle (breeding, wintering, and migration were used to estimate changes in grassland bird populations. Our results suggest that successful grassland bird conservation may depend upon linkages with ecosystem services on working agricultural lands and grassland-based marketing campaigns to engage the public. With further development, spatial models that link landowner decisions with biological outcomes can be essential tools for making conservation policy decisions. A coordinated non-traditional partnership will likely be necessary to clearly understand and systematically respond to the many conservation challenges facing grassland birds.

Strategic Grassland Bird Conservation throughout the annual cycle: Linking policy alternatives, landowner decisions, and biological population outcomes

Science.gov (United States)

Drum, Ryan G.; Ribic, Christine; Koch, Katie; Lonsdorf, Eric V.; Grant, Edward C.; Ahlering, Marissa; Barnhill, Laurel; Dailey, Thomas; Lor, Socheata; Mueller, Connie; Pavlacky, D.C.; Rideout, Catherine; Sample, David W.

2015-01-01

Grassland bird habitat has declined substantially in the United States. Remaining grasslands are increasingly fragmented, mostly privately owned, and vary greatly in terms of habitat quality and protection status. A coordinated strategic response for grassland bird conservation is difficult, largely due to the scope and complexity of the problem, further compounded by biological, sociological, and economic uncertainties. We describe the results from a collaborative Structured Decision Making (SDM) workshop focused on linking social and economic drivers of landscape change to grassland bird population outcomes. We identified and evaluated alternative strategies for grassland bird conservation using a series of rapid prototype models. We modeled change in grassland and agriculture cover in hypothetical landscapes resulting from different landowner decisions in response to alternative socio-economic conservation policy decisions. Resulting changes in land cover at all three stages of the annual cycle (breeding, wintering, and migration) were used to estimate changes in grassland bird populations. Our results suggest that successful grassland bird conservation may depend upon linkages with ecosystem services on working agricultural lands and grassland-based marketing campaigns to engage the public. With further development, spatial models that link landowner decisions with biological outcomes can be essential tools for making conservation policy decisions. A coordinated non-traditional partnership will likely be necessary to clearly understand and systematically respond to the many conservation challenges facing grassland birds.

Brachytherapy Combined With Surgery for Conservative Treatment of Children With Bladder Neck and/or Prostate Rhabdomyosarcoma

Energy Technology Data Exchange (ETDEWEB)

Chargari, Cyrus, E-mail: cyrus.chargari@gustaveroussy.fr [Brachytherapy Unit, Department of Radiotherapy, Gustave Roussy, Villejuif (France); Institut de Recherche Biomédicale des Armées, Bretigny-sur-Orge (France); French Military Health Service Academy, Ecole du Val-de-Grâce, Paris (France); Haie-Meder, Christine [Brachytherapy Unit, Department of Radiotherapy, Gustave Roussy, Villejuif (France); Guérin, Florent [Department of Pediatric Surgery, Bicêtre Hospital, Hôpitaux Universitaires Paris Sud, Assistance Publique des Hôpitaux de Paris, Le Kremlin-Bicêtre (France); Minard-Colin, Véronique [Department of Pediatric and Adolescent Oncology, Gustave Roussy, Villejuif (France); Lambert, Guénolée de [Department of Pediatric Surgery, Bicêtre Hospital, Hôpitaux Universitaires Paris Sud, Assistance Publique des Hôpitaux de Paris, Le Kremlin-Bicêtre (France); Mazeron, Renaud; Escande, Alexandre; Marsolat, Fanny; Dumas, Isabelle [Brachytherapy Unit, Department of Radiotherapy, Gustave Roussy, Villejuif (France); Deutsch, Eric [Brachytherapy Unit, Department of Radiotherapy, Gustave Roussy, Villejuif (France); Faculté de Médecine Paris Sud, Université Paris Sud, Université Paris Saclay, Paris (France); Valteau-Couanet, Dominique [Department of Pediatric and Adolescent Oncology, Gustave Roussy, Villejuif (France); and others

2017-06-01

Purpose: To report the results of a conservative strategy based on partial surgery combined with brachytherapy in a prospective cohort of children with bladder–prostate rhabdomyosarcoma (BP RMS). Methods and Materials: We prospectively documented the outcome of children treated in our department between 1991 and 2015 for BP RMS and undergoing a multimodal approach combining conservative surgery (partial cystectomy and/or partial prostatectomy) and perioperative interstitial low-dose-rate or pulse-dose-rate brachytherapy. Before brachytherapy, children had received chemotherapy with modalities depending on their risk group of treatment. Results: A total of 100 patients were identified, with a median age of 28 months (range, 5.6 months-14 years). According to the Intergroup Rhabdomyosarcoma Study (IRS) group, 84 were IRS-III, and 12 were IRS-IV tumors. Four patients were treated at relapse. The median number of chemotherapy cycles before local therapy was 6 (range, 4-13). After surgery, 63 patients had a macroscopic tumor residuum. Five patients underwent a brachytherapy boost before pelvic external beam radiation therapy because of nodal involvement, and 95 had exclusive brachytherapy. Median follow-up was 64 months (range, 6 months-24.5 years). Five-year disease-free and overall survival rates were 84% (95% confidence interval 80%-88%) and 91% (95% confidence interval 87%-95%), respectively. At last follow-up most survivors presented with only mild to moderate genitourinary sequelae and a normal diurnal urinary continence. Five patients required a secondary total cystectomy: 3 for a nonfunctional bladder and 2 for relapse. Conclusion: Brachytherapy is effective as part of a conservative strategy for BP RMS, with a relatively low delayed toxicity as compared with previously published studies using external beam radiation therapy. Longer follow-up is required to ensure that the functional results are maintained over time.

Brachytherapy Combined With Surgery for Conservative Treatment of Children With Bladder Neck and/or Prostate Rhabdomyosarcoma

International Nuclear Information System (INIS)

Chargari, Cyrus; Haie-Meder, Christine; Guérin, Florent; Minard-Colin, Véronique; Lambert, Guénolée de; Mazeron, Renaud; Escande, Alexandre; Marsolat, Fanny; Dumas, Isabelle; Deutsch, Eric; Valteau-Couanet, Dominique

2017-01-01

Purpose: To report the results of a conservative strategy based on partial surgery combined with brachytherapy in a prospective cohort of children with bladder–prostate rhabdomyosarcoma (BP RMS). Methods and Materials: We prospectively documented the outcome of children treated in our department between 1991 and 2015 for BP RMS and undergoing a multimodal approach combining conservative surgery (partial cystectomy and/or partial prostatectomy) and perioperative interstitial low-dose-rate or pulse-dose-rate brachytherapy. Before brachytherapy, children had received chemotherapy with modalities depending on their risk group of treatment. Results: A total of 100 patients were identified, with a median age of 28 months (range, 5.6 months-14 years). According to the Intergroup Rhabdomyosarcoma Study (IRS) group, 84 were IRS-III, and 12 were IRS-IV tumors. Four patients were treated at relapse. The median number of chemotherapy cycles before local therapy was 6 (range, 4-13). After surgery, 63 patients had a macroscopic tumor residuum. Five patients underwent a brachytherapy boost before pelvic external beam radiation therapy because of nodal involvement, and 95 had exclusive brachytherapy. Median follow-up was 64 months (range, 6 months-24.5 years). Five-year disease-free and overall survival rates were 84% (95% confidence interval 80%-88%) and 91% (95% confidence interval 87%-95%), respectively. At last follow-up most survivors presented with only mild to moderate genitourinary sequelae and a normal diurnal urinary continence. Five patients required a secondary total cystectomy: 3 for a nonfunctional bladder and 2 for relapse. Conclusion: Brachytherapy is effective as part of a conservative strategy for BP RMS, with a relatively low delayed toxicity as compared with previously published studies using external beam radiation therapy. Longer follow-up is required to ensure that the functional results are maintained over time.

Evolutionary rescue: linking theory for conservation and medicine.

Science.gov (United States)

Alexander, Helen K; Martin, Guillaume; Martin, Oliver Y; Bonhoeffer, Sebastian

2014-12-01

Evolutionary responses that rescue populations from extinction when drastic environmental changes occur can be friend or foe. The field of conservation biology is concerned with the survival of species in deteriorating global habitats. In medicine, in contrast, infected patients are treated with chemotherapeutic interventions, but drug resistance can compromise eradication of pathogens. These contrasting biological systems and goals have created two quite separate research communities, despite addressing the same central question of whether populations will decline to extinction or be rescued through evolution. We argue that closer integration of the two fields, especially of theoretical understanding, would yield new insights and accelerate progress on these applied problems. Here, we overview and link mathematical modelling approaches in these fields, suggest specific areas with potential for fruitful exchange, and discuss common ideas and issues for empirical testing and prediction.

Diffusion of breast conserving surgery in medical communities.

Science.gov (United States)

Jerome-D'Emilia, Bonnie; Begun, James W

2005-01-01

Excluding skin cancers, breast cancer is the most common form of cancer in women. Due to an increased focus on early detection, many more cases of breast cancer are now diagnosed at an early stage, which makes the use of breast conserving surgery (BCS) an efficacious and often more desirable treatment choice than mastectomy. An analysis of the variation in the use of BCS in the United States was performed using data from the years 1988 and 1994, and stratifying hospitals on the basis of teaching status. In both 1988 and 1994, BCS was highest in academic teaching hospitals and lowest in community hospitals. This finding is interpreted within the framework of classical diffusion theory. Social and cultural norms in local medical communities have a strong effect on the degree to which innovations diffuse rapidly or not. This analysis is useful in the understanding of geographic and hospital-based variations in treatment for early stage breast cancer and other illnesses that have long and strongly held traditions of treatment.

10 year survival after breast-conserving surgery plus radiotherapy compared with mastectomy in early breast cancer in the Netherlands : a population-based study

NARCIS (Netherlands)

van Maaren, Marissa C.; de Munck, Linda; de Bock, Geertruida H.; Jobsen, Jan J.; van Dalen, Thijs; Linn, Sabine C.; Poortmans, Philip; Strobbe, Luc J. A.; Siesling, Sabine

BACKGROUND: Investigators of registry-based studies report improved survival for breast-conserving surgery plus radiotherapy compared with mastectomy in early breast cancer. As these studies did not present long-term overall and breast cancer-specific survival, the effect of breast-conserving

10 year survival after breast-conserving surgery plus radiotherapy compared with mastectomy in early breast cancer in the Netherlands: a population-based study

NARCIS (Netherlands)

Maaren, M.C. van; Munck, L.; Bock, G.H. de; Jobsen, J.J.; Dalen, T. van; Linn, S.C.; Poortmans, P.; Strobbe, L.J.A.; Siesling, S.

2016-01-01

BACKGROUND: Investigators of registry-based studies report improved survival for breast-conserving surgery plus radiotherapy compared with mastectomy in early breast cancer. As these studies did not present long-term overall and breast cancer-specific survival, the effect of breast-conserving

Non-pharmacological strategies for blood conservation in cardiac surgery.

Science.gov (United States)

Ruel, M A; Rubens, F D

2001-04-01

Of all surgical specialties, cardiac operations are most often associated with coagulopathy, blood loss, and the need for transfusions. This not only represents a major burden on blood procurement and banking organizations at all levels, but also constitutes a risk for each patient receiving allogeneic blood products. This paper reviews current non-pharmacological strategies aimed at decreasing blood use in patients undergoing cardiac surgery. The literature pertaining to each blood conservation strategy was searched, reviewed, and appraised. Meta- analyses were also consulted and their results complemented with subsequent reports when available. Preoperative autologous donation programs are effective in decreasing allogeneic transfusions, but are costly and applicable to elective patients only. Off-pump revascularization strategies also appear to decrease transfusion requirements in suitable patients. The effectiveness of acute normovolemic hemodilution, retrograde autologous priming, small volume cardiopulmonary bypass circuits, platelet-rich plasmapheresis, alternative heparin strategies, and postoperative cell salvage are more difficult to appraise as a high proportion of available studies suffer from lack of transfusion guidelines or the absence of blinding. Biological glues, surgical adhesives, and postoperative increases in positive end-expiratory pressure (PEEP) have no demonstrated efficacy. The applicability or effectiveness of many of these modalities remains controversial and more studies are needed before they may be employed routinely in cardiac surgical patients. The judicious use of rational transfusion guidelines may still be the simplest and most cost-effective means of blood conservation today.

Ultrasound guided pectoral nerve blockade versus thoracic spinal blockade for conservative breast surgery in cancer breast: A randomized controlled trial

Directory of Open Access Journals (Sweden)

Hala M.S. ELdeen

2016-01-01

Conclusion: In conclusion, both Pecs and TSB provide effective intraoperative anesthesia and prolonged postoperative pain relief after breast surgery, but the Pecs block is technically simple and easy to learn with few contraindications, provides hemodynamic stability, and has a low complication rate and it is therefore a safe and effective technique in performing intraoperative anesthesia and controlling postoperative pain after unilateral conservative breast surgery.

Bilateral breast cancer treated with breast-conserving surgery and definitive irradiation

International Nuclear Information System (INIS)

Man, C. Fung; Schultz, Delray; Solin, Lawrence J.

1996-01-01

Objective: To assess whether patients with early stage bilateral breast cancer can be treated with definitive irradiation following breast-conserving surgery with acceptable survival, local control, complication rates, and cosmetic outcomes. Material and Methods: We reviewed 55 cases of patients with synchronous or sequential bilateral breast cancer treated with definitive irradiation following breast-conserving surgery at our institution from 1977 to 1992. Analysis of cases was limited to women who were AJCC clinical Stage 0, I, and II. The records of these 55 patients with 110 treated breasts were reviewed for tumor size, histology, AJCC stage, pathologic axillary lymph nodes status, first and overall site(s) of failure, and adjuvant chemotherapy or hormonal therapy. Analysis regarding matching technique, cosmetic outcome, and complication rate was also performed. The 5- and 10-year overall survival (OS), no evidence of disease (NED) survival, relapse-free survival (RFS), and local control rates were evaluated. Twelve women (22%) presented with synchronous bilateral carcinoma, and 43 women (78%) had sequential bilateral carcinoma. Of the 12 patients with synchronous cancer, 5 received adjuvant chemotherapy, 2 received Tamoxifen, and 1 received both adjuvant therapies. Of the 43 patients with sequential cancer, 6 received chemotherapy, 1 received Tamoxifen, and 1 received both adjuvant therapies for the first cancer treatment; seven received chemotherapy and 6 received Tamoxifen for the second cancer treatment. Results: The median age at the time of treatment of the first cancer was 56 years (range 26-86 years). For the 12 patients with synchronous cancer, the median follow-up was 48 months (range 9-164). For the 43 patients with sequential cancer, the median follow-up was 112 months (range 52-188 months) after the first cancer, and 59 months (range 11-153 months) after the second. The median dose delivered was 64 Gy (range 42-72 Gy) using a combination of

Endoscopic surgery versus conservative treatment for the moderate-volume hematoma in spontaneous basal ganglia hemorrhage (ECMOH: study protocol for a randomized controlled trial

Directory of Open Access Journals (Sweden)

Zan Xin

2012-06-01

Full Text Available Abstract Background Spontaneous intracerebral hemorrhage is a disease with high morbidity, high disability rate, high mortality, and high economic burden. Whether patients can benefit from surgical evacuation of hematomas is still controversial, especially for those with moderate-volume hematomas in the basal ganglia. This study is designed to compare the efficacy of endoscopic surgery and conservative treatment for the moderate-volume hematoma in spontaneous basal ganglia hemorrhage. Methods Patients meet the criteria will be randomized into the endoscopic surgery group (endoscopic surgery for hematoma evacuation and the best medical treatment or the conservative treatment group (the best medical treatment. Patients will be followed up at 1, 3, and 6 months after initial treatment. The primary outcomes include the Extended Glasgow Outcome Scale and the Modified Rankin Scale. The secondary outcomes consist of the National Institutes of Health Stroke Scale and the mortality. The Barthel Index(BI will also be evaluated. The sample size is 100 patients. Discussion The ECMOH trial is a randomized controlled trial designed to evaluate if endoscopic surgery is better than conservative treatment for patients with moderate-volume hematomas in the basal ganglia. Trial registration Chinese Clinical Trial Registry: ChiCTR-TRC-11001614 (http://www.chictr.org/en/proj/show.aspx?proj=1618

Blood-conservation techniques for coronary-artery bypass surgery at a private hospital.

Science.gov (United States)

Davies, M J; Picken, J; Buxton, B F; Fuller, J A

1988-11-21

The utilization of homologous blood and blood products was recorded in 100 consecutive patients who underwent primary coronary-artery bypass surgery. Nine patients underwent saphenous-vein grafts only, 55 patients underwent a single internal-mammary-artery graft that was supplemented by vein grafts and 36 patients underwent bilateral internal-mammary-artery grafts and vein grafts. All patients underwent normovolaemic haemodilution, and autologous blood was collected before bypass surgery. Residual blood was collected from the cardiopulmonary bypass machine and was washed and concentrated in a cell processor, and blood also was scavenged postoperatively from the mediastinal drainage tubes as methods to conserve blood. The mean (+/- SD) utilization of homologous blood was 1.3 +/- 1.5 units with 0.2 +/- 0.7 units of fresh-frozen plasma being used, and 0.8 +/- 2.1 units of platelets being used. The utilization of homologous blood was not different among the three different methods of coronary-artery bypass surgery, but patients who underwent bilateral internal-mammary-artery grafts suffered a greater postoperative loss of blood than did those patients who underwent saphenous-vein grafts or single internal-mammary-artery grafts. A comparison of patients who were taking aspirin or a non-steroidal anti-inflammatory drug preoperatively with those patients who were not showed no difference in the utilization of homologous blood but a statistically-significant difference was found in the loss of blood postoperatively.

A new method of boosting irradiation for breast cancer after conservative surgery

International Nuclear Information System (INIS)

Gao Hong; Li Gaofeng; Liu Mingyuan

2007-01-01

Objective: Based on the position of postoperative surgical clips and scars, a new boost irradiation technique for breast cancer after conservative surgery is devised. Methods: Tenty-six patients with early breast cancer after conservative surgery, were investigated. The medial, lateral, superior, inferior incisional margin of all tumor beds were marked by surgical clips, but posterior incisional margin was not marked before CT simulation. The postoperative scars were tagged by lead wires. After CT sanning, the nipple, clips and scars were delineated. Vitural simulation was implemented as follows: first, when the gantry was zero, place the center of beam in the center of clips marking the incisional margin, then rotate the gantry toward the medial or lateral tangent direction till more than three clips project lining on the beam eye view, second, rerotate gantry by orthogonal angle, then adjust the fields including the clips and scars. Results: More than 85% (88/103) of clips were placed on the surface of pectoralis major and ribs. The type of lining clips projection on the beam: 14 patients showed three clips lining, in the other's 12 patients revealed four clips lining. The mean depth of tumor bed was 4.37 cm, 95% confidence interal of depth varied from 3.98 to 4.96 cm, the range of depth varied from 2.40-6.20 cm, showing the depth of tumor bed less than 5 cm in 77% (20/26) of patients. Conclusion: The boost irradiation technique suggested in this paper is based on surgical scar's to irradiate the three dimensional tumor bed accurately. The aim of this work is not to miss the tumor three dimensionally including the operative scars. (authors)

Management of intraoperative fluid balance and blood conservation techniques in adult cardiac surgery.

Science.gov (United States)

Vretzakis, George; Kleitsaki, Athina; Aretha, Diamanto; Karanikolas, Menelaos

2011-02-01

Blood transfusions are associated with adverse physiologic effects and increased cost, and therefore reduction of blood product use during surgery is a desirable goal for all patients. Cardiac surgery is a major consumer of donor blood products, especially when cardiopulmonary bypass (CPB) is used, because hematocrit drops precipitously during CPB due to blood loss and blood cell dilution. Advanced age, low preoperative red blood cell volume (preoperative anemia or small body size), preoperative antiplatelet or antithrombotic drugs, complex or re-operative procedures or emergency operations, and patient comorbidities were identified as important transfusion risk indicators in a report recently published by the Society of Cardiovascular Anesthesiologists. This report also identified several pre- and intraoperative interventions that may help reduce blood transfusions, including off-pump procedures, preoperative autologous blood donation, normovolemic hemodilution, and routine cell saver use.A multimodal approach to blood conservation, with high-risk patients receiving all available interventions, may help preserve vital organ perfusion and reduce blood product utilization. In addition, because positive intravenous fluid balance is a significant factor affecting hemodilution during cardiac surgery, especially when CPB is used, strategies aimed at limiting intraoperative fluid balance positiveness may also lead to reduced blood product utilization.This review discusses currently available techniques that can be used intraoperatively in an attempt to avoid or minimize fluid balance positiveness, to preserve the patient's own red blood cells, and to decrease blood product utilization during cardiac surgery.

Usefulness of Oncoplastic Volume Replacement Techniques after Breast Conserving Surgery in Small to Moderate-sized Breasts

Directory of Open Access Journals (Sweden)

Jung Dug Yang

2012-09-01

Full Text Available BackgroundIn Korean women, many of whom have small to moderate-sized breasts, it is difficult to cover a partial breast defect using oncoplastic volume displacement techniques after removal of an adequate volume of tissue during oncologic surgery. In such cases, oncoplastic volume replacement techniques are more useful.MethodsFrom January 2007 to December 2011, 104 women underwent a total of 107 breast-conserving surgeries with various kinds of oncoplastic volume replacement techniques. We used latissimus dorsi (LD myocutaneous flap for cases in which the resection mass was greater than 150 g. In case with a resection mass less than 150 g, we used regional flaps such as a lateral thoracodorsal flap, a thoracoepigastric flap, or perforator flaps such as an intercostal artery perforator (ICAP flap or a thoracodorsal artery perforator (TDAP flap.ResultsThe mean age was 46.1 years, and the average follow-up interval was 10.3 months. The patients underwent oncoplastic volume replacement techniques with a lateral thoracodorsal flap (n=9, thoracoepigastric flap (n=7, ICAP flap (n=25, TDAP flap (n=12, and LD flap (n=54. There was one case of congestion in an LD flap, and two cases of fat necrosis in an ICAP flap. Most of the patients were satisfied with the cosmetic results.ConclusionsOncoplastic volume replacement techniques can be reliable and useful for the correction of breast deformity after breast-conserving surgery, especially in patients with small to moderate-sized breasts.

Early-stage bilateral breast cancer treated with breast-conserving surgery and definitive irradiation: the university of Pennsylvania experience

International Nuclear Information System (INIS)

Fung, Man C.; Schultz, Delray J.; Solin, Lawrence J.

1997-01-01

Purpose: To determine whether patients with early-stage bilateral breast cancer can be treated with definitive irradiation following breast-conserving surgery with acceptable survival, local control, complications, and cosmesis. Methods and Materials: During the period 1977-1992, 55 women with Stage 0, I, or II concurrent (n = 12) or sequential (n = 43) bilateral breast cancer were treated with definitive irradiation following breast-conserving surgery. The records of these 55 patients with 110 treated breasts were reviewed for tumor size, histology, pathologic axillary lymph node status, first and overall site(s) of failure, and adjuvant chemotherapy or hormonal therapy. Curves for survival, local control, and regional control were determined. Cosmetic outcome, complication rates, and matching technique were analyzed. The median total radiation dose delivered was 64 Gy (range 42-72) using tangential whole-breast irradiation followed by an electron or iridium implant boost. The tangential fields were matched with no overlap in 40 patients (73%); there was overlap on skin of up to 4 cm in 14 patients (25%); and the matching technique was unknown in 1 patient (2%). The median follow-up for the 12 women with concurrent bilateral breast cancer was 4.0 years. The median follow-up for the other 43 women with sequential cancer was 9.3 and 4.9 years, respectively, after the first and second cancers. Results: For the overall group of 55 patients, the 5- and 10-year overall survival rates were 96% and 94%, respectively, after treatment of the first cancer, and 96% and 92%, respectively, after treatment of the second cancer. The 5- and 10-year actuarial relapse-free survival rates were 90% and 75%, respectively, after treatment of the first cancer, and 83% and 72%, respectively, after treatment of the second cancer. For the 110 treated breast cancers, the 5- and 10-year actuarial local failure rates were 5% and 15%, respectively. Complication rates were: 28% breast edema, 8

Conserved properties of Drosophila Insomniac link sleep regulation and synaptic function.

Science.gov (United States)

Li, Qiuling; Kellner, David A; Hatch, Hayden A M; Yumita, Tomohiro; Sanchez, Sandrine; Machold, Robert P; Frank, C Andrew; Stavropoulos, Nicholas

2017-05-01

Sleep is an ancient animal behavior that is regulated similarly in species ranging from flies to humans. Various genes that regulate sleep have been identified in invertebrates, but whether the functions of these genes are conserved in mammals remains poorly explored. Drosophila insomniac (inc) mutants exhibit severely shortened and fragmented sleep. Inc protein physically associates with the Cullin-3 (Cul3) ubiquitin ligase, and neuronal depletion of Inc or Cul3 strongly curtails sleep, suggesting that Inc is a Cul3 adaptor that directs the ubiquitination of neuronal substrates that impact sleep. Three proteins similar to Inc exist in vertebrates-KCTD2, KCTD5, and KCTD17-but are uncharacterized within the nervous system and their functional conservation with Inc has not been addressed. Here we show that Inc and its mouse orthologs exhibit striking biochemical and functional interchangeability within Cul3 complexes. Remarkably, KCTD2 and KCTD5 restore sleep to inc mutants, indicating that they can substitute for Inc in vivo and engage its neuronal targets relevant to sleep. Inc and its orthologs localize similarly within fly and mammalian neurons and can traffic to synapses, suggesting that their substrates may include synaptic proteins. Consistent with such a mechanism, inc mutants exhibit defects in synaptic structure and physiology, indicating that Inc is essential for both sleep and synaptic function. Our findings reveal that molecular functions of Inc are conserved through ~600 million years of evolution and support the hypothesis that Inc and its orthologs participate in an evolutionarily conserved ubiquitination pathway that links synaptic function and sleep regulation.

CT-guided thermoplastic assisted segmentectomy is an optimal breast conserving surgery for breast cancer with nipple discharge

International Nuclear Information System (INIS)

Makita, Masujiro; Gomi, Naoya; Tachikawa, Tomohiro

2004-01-01

Improvement of imaging by injecting contrast agents into the discharging duct and immobilizing the breast mound with a drape-type thermoplastic shell in breast conserving surgery was assessed by evaluating 96 cases of breast cancer patients with nipple discharge treated by partial mastectomy between April 1998 and August 2003. These patients were divided to three groups: Group A was treated by ordinary partial mastectomy or microdochectomy without new methods. Group B underwent contrast imaging without shell immobilization, and Group C received both shell immobilization and contrast imaging. The negative rates of surgical margins in Groups A, B and C were 19.0%, 17.2%, and 37.5%, respectively. The rates of negative ''lateral'' surgical margins in Groups A, B and C were 23.8%, 27.6%, and 50%, respectively. The rate of negative ''lateral'' surgical margins in Group C was significantly higher than that in Group A. Our findings suggest CT-guided thermoplastic assisted segmentectomy, adopting both ductography CT and immobilization by shell, is an optimal breast conserving surgery for breast cancer with nipple discharge. (author)

Analysis of whole Breast Radiotherapy Methods for Treatment of Early Stage Breast Cancer after Conserving Surgery

International Nuclear Information System (INIS)

Utehina, O.; Popovs, S.; Berzins, J.

2007-01-01

Introduction. At present moment breast cancer in Latvia is at second place for whole population and at first place among women. In year 2004 there were 1012 new breast cancer cases discovered. There was growth in number of breast cancer patients from 58.6 per 100 000 inhabitants in 1995 to 80.4 per 100 000 inhabitants in 2004. This growth is primarily attributed to breast cancer screening program which is nowadays active in Latvia. Breast cancer is third death cause among cancers in Latvia, - in 1995 there where 27.4 deaths per 100 000 inhabitants and in 2004 - 36.2 deaths per 100 000 inhabitants. Due to screening program there is increasing number of patients with stage I and II breast cancer. In 2004 toe where 9884 women with breast cancer registered in Latvian Cancer Registry and among them 79 percent were presented as stage I or II. Breast conservative surgery with adjuvant radiotherapy as standard part of it plays great role in breast cancer treatment in our Center. In year 2004 there were 103 breast conservative surgeries performed in our Center. Radiotherapy is a standard part of treatment in modem breast saving operations for early stage breast cancer, At present, only whole breast postoperative irradiation is performed in Latvia. For selected group of patients this treatment can be substituted with other radiotherapy methods in order to reduce acute reactions and/or late toxicity, maintaining the same tumor control. Aim of this work is to show that during whole breast irradiation dose maximum and tissue volume which receives doses more than 105% from prescribed dose, is linked with size of treated volume (treated volume - tissue volume receiving > 95% from prescribed dose), which is strictly linked with breast volume. Because of this for large breast volumes there is higher complication probability performing whole breast irradiation, and it seems to be meaningful to use Intensity Modulated Radiotherapy or Accelerated Partial Breast Irradiation for

Preliminary results of intersticial HDR brachytherapy in association with conservative surgery for soft tissue sarcomas

International Nuclear Information System (INIS)

Pellizzon, A.C.A; Ferrigno, R.; Trippe, N.; Novaes, P.; Salvajoli, J.V.; Fogareli, R.; Maja, M.A.C.; Baraldi, H.

1996-01-01

From january 1994 to january 1995 seven patients were treated with conservative surgery in association to postoperative HDR brachytherapy through Micro-Selectron HDR. Four patients were male and three female, the ages ranged from 20 to 60 years old and the main site of the tumor were at the extremities and just one had a perineal lesion. The follow up ranged from 4 to 24 months. Most of the implants were done through single plane technic. Definition of the treatment volume was based on CT scans and metallic clips inserted during the surgery. The prescribed dose was at 10mm from the implant plane. The patient with perineal lesion had a volumetric implant and the dose prescription was based on Paris System, in which the total volume of the tumor bed must be included in a 85% isodose curve. The number of catheters used ranged from 6 to 14 and the active length from 20 to 150mm, placed intraoperatively. The volumetric implant was performed through perineal template to guide the needles in number of nine and an active length of 60mm. The prescribed dose ranged from 20 to 25Gy when associated with EBRT and 30 to 35Gy when brachytherapy alone was used. Results: All patients had local control. Acute complications were observed only in the skin, limited to mild erytema and dry descanation. Conclusions: Although the number of the patients is small, this procedure has been shown to be effective in local control when associated to conservative surgery, can be easily and safely done and gives the possibilities of dose optimization

A case of fat necrosis with ulceration after breast-conserving surgery and postoperative radiation therapy

International Nuclear Information System (INIS)

Nomoto, Yuki; Kijima, Yuko; Hirata, Munetsugu; Shinden, Yoshiaki; Arima, Hideo; Nakajo, Akihiro; Hiraki, Tsubasa; Natsugoe, Shoji

2017-01-01

An 82 year-old woman was diagnosed with right breast cancer, and partial mastectomy with sentinel lymph node biopsy was performed in another hospital. Lateral subcutaneous fat was mobilized and used to fill mammary gland defect. Two months after surgery, she received postoperative radiation therapy and endocrine therapy. Two years and six months after surgery, induration of the left breast was marked and skin redness appeared. It then became exposed, and the lesion was diagnosed as fat necrosis and abscess the core needle biopsy. Conservative observation was then conducted. Pain developed and pus exudatation continued from the necrotic tissue. Two years and nine months after surgery, she was admitted to our hospital for treatment. Deformity, induration with a fistula, and skin redness were found in the surgically treated and irradiated right breast. The lesion was diagnosed as fat necrosis based on several imaging examinations. Simple mastectomy was performed for pain reduction and to treat the continuous fistula leakage. Since the mass showed firm adhesion with the major pectoral muscle, a part of the muscle was excised. Histology revealed necrotic fat and an abscess with a skin fistula, but not malignancy. The endocrine therapy has been continued, and she has survived without recurrent disease for a year and eight months since surgery. (author)

Conservative approach to rectosigmoid endometriosis: a cohort study.

Science.gov (United States)

Egekvist, Anne G; Marinovskij, Edvard; Forman, Axel; Kesmodel, Ulrik S; Riiskjaer, Mads; Seyer-Hansen, Mikkel

2017-06-01

The aim of the study was to assess the risk of surgery after initial conservative treatment of rectosigmoid endometriosis in relation to demographic data. The study was conducted on the tertiary endometriosis referral unit, Aarhus University Hospital. Medical records, from patients seen from January 2009 onwards with a diagnosis of rectosigmoid endometriosis and more than 6 months' follow up were audited. Demographic data, results of magnetic resonance imaging and time to secondary surgery for rectosigmoid endometriosis were registered. Data on 238 patients diagnosed with rectosigmoid endometriosis were included. In all, 78 (32.8%) patients had primary surgery, 27 (11.3%) had secondary surgery and 133 (55.9%) continued conservative treatment throughout the observation period. Patients who underwent primary or secondary surgery were younger than patients continuing conservative treatment. In a tertiary referral center where about half of patients with rectosigmoid endometriosis were scheduled for conservative treatment, more than 80% of these avoided surgery. © 2017 Nordic Federation of Societies of Obstetrics and Gynecology.

Pattern of local recurrence after conservative surgery and whole-breast irradiation

International Nuclear Information System (INIS)

Freedman, Gary M.; Anderson, Penny R.; Hanlon, Alexandra L.; Eisenberg, Debra F.; Nicolaou, Nicos

2005-01-01

Purpose: Most recurrences in the breast after conservative surgery and whole-breast irradiation have been reported to occur within the same quadrant as the initial primary tumor. We analyzed the long-term risk of recurrence by area of the breast after whole-breast irradiation. Materials and Methods: In all, 1,990 women with Stage 0-II breast cancer were treated with conservative surgery and whole-breast irradiation from 1970-1998. Stage was ductal carcinoma in situ in 237, T1 in 1273, and T2 in 480 patients. Of 120 local recurrences, 71 were classified as true local (confined to the original quadrant) and 49 as elsewhere (involving outside the original quadrant). Kaplan-Meier methodology was used to calculate 5-year, 10-year, and 15-year rates of recurrence (95% confidence intervals in parentheses). The median follow-up is 80 months. Results: There was no apparent difference in the 15-year rate of true local vs. elsewhere recurrence, but the time to recurrence was different. The rate of true local recurrence was 2%, 5%, and 7% (5-9%) at 5, 10, and 15 years, respectively. The recurrences elsewhere in the breast were rare at 5 (1%) and 10 (2%) years, but increased to 6 (3-9%) at 15 years. This 15-year rate of elsewhere recurrence was half the rate of contralateral breast cancers of 13% (10-16%). Conclusions: Recurrence elsewhere in the breast is rare for the first 10 years, but by 15 years is nearly equal to true local recurrence even after whole-breast irradiation. The 15-year rate of elsewhere recurrence was half the rate of contralateral breast cancers. This may indicate a therapeutic effect of whole-breast radiation for other areas of the breast. Very long follow-up will be needed for partial breast irradiation with or without tamoxifen to show that the risk of elsewhere recurrence is not significantly different than after whole-breast irradiation

Information requirements of young women with breast cancer treated with mastectomy or breast conserving surgery: A systematic review.

Science.gov (United States)

Recio-Saucedo, Alejandra; Gerty, Sue; Foster, Claire; Eccles, Diana; Cutress, Ramsey I

2016-02-01

Young women with breast cancer have poorer prognosis, greater lifetime risk of local recurrence, contralateral recurrence, and distant disease, regardless of surgery received. Here we systematically review published evidence relating to the information requirements and preferences of young women diagnosed with early-stage breast cancer offered a choice between mastectomy and Breast Conservation Surgery (BCS). Findings will inform the development of a surgical decision aid for young women. Eight databases were searched to identify research examining information requirements of young women facing breast oncological surgery treatment decisions (MESH headings). Twelve studies met the inclusion criteria. Data were extracted and summarised in a narrative synthesis. Findings indicate that young women prefer greater and more detailed information regarding treatment side effects, sexuality, and body image. Younger age of diagnosis leads to an increased risk perception of developing a second breast cancer. Young women's choices are influenced by factors associated with family and career. Information is required in a continuum throughout the treatment experience and not only at diagnosis when treatment decisions are made. Young women show differing levels of participation preferences. Young women find decision-making challenging when the characteristics of diagnosis provide a surgical choice between mastectomy and breast conservation surgery. Efforts should be made to provide information regarding sexuality, body image, reconstruction, fertility and likelihood of familial predisposition. Further research is needed to identify the specific level and information requirements of this young-onset group. The low number of studies indicate a need to design studies targeting specifically this age group of breast cancer patients. Copyright © 2015 Elsevier Ltd. All rights reserved.

Does adjuvant systemic therapy contribute to decrease of breast recurrence after breast-conserving surgery?

International Nuclear Information System (INIS)

Nishimura, Reiki; Matsuda, Masakazu; Okazaki, Shinji; Kai, K.; Hiyoshi, Y.

2005-01-01

Preventing breast recurrence after breast-conserving surgery is an important issue. The main factors contributing to breast recurrences are positive margins and absence of radiotherapy. In late years a standard adjuvant treatment is widely used in Japan. We examined whether these standard treatments contributed to reduction of a breast recurrence. By March 2003, 845 patients were treated by breast-conserving surgery, and the cases were divided into two groups by operation period; 426 cases until 1998 (the first half group) and 202 patients with follow-up periods more than 2 years (the latter group). There were much positive margins and patients with radiotherapy in a latter group in background factor. An endocrine therapy for estrogen receptor (ER) positive was performed in 68.1% in first half period, and in contrast 94.2% in the latter period, and chemotherapy was performed in 87% (mainly Epirubicin) for ER negative in the latter period, and 77% (mainly oral agent) in the first half period. There was a significant difference of breast recurrence-free survival between 2 groups; an early recurrence was seen in 19 cases (4.5%) in the first half period and 2 cases (1.0%) in the latter group. In particular the difference was significant in patients with absence of radiotherapy or negative ER. Multivariate analysis revealed that the operation time was a significant factor for breast recurrence. In conclusion, an apparent reduction of breast recurrence may be brought by a standard adjuvant therapy. (authors)

Speckle-tracking echocardiography for predicting outcome in chronic aortic regurgitation during conservative management and after surgery

DEFF Research Database (Denmark)

Olsen, Niels Thue; Søgaard, Peter; Larsson, Henrik B W

2011-01-01

Objectives The aim of this study was to test myocardial deformation imaging using speckle-tracking echocardiography for predicting outcomes in chronic aortic regurgitation. Background In chronic aortic regurgitation, left ventricular (LV) dysfunction must be detected early to allow timely surgery....... Speckle-tracking echocardiography has been proposed for this purpose, but the clinical value of this method in aortic regurgitation has not been established. Methods A longitudinal study was performed in 64 patients with moderate to severe aortic regurgitation. Thirty-five patients were managed...... conservatively with frequent clinical visits and sequential echocardiography and followed for an average of 19 ± 8 months, while 29 patients underwent surgery for the valve lesion and were followed for 6 months post-operatively. Baseline LV function by speckle-tracking and conventional echocardiography...

Correlation of breast recurrence (inflammatory type or not) after breast conserving surgery with radiation therapy and clinicopathological factors in breast cancer

International Nuclear Information System (INIS)

Nishimura, Reiki; Koyama, Hiroki

1998-01-01

To clarify risk factors for breast recurrence of inflammatory type after breast conserving therapy, we examined clinicopathological findings and therapies given after initial surgery. Nine cases of inflammatory breast recurrence out of 133 recurrent cases collected from a collaborative group supported by a grant-in-aid for Cancer Research by Japanese Ministry of Health and Welfare (7-24, Chairman: H. Koyama) were analyzed by a case control study. And forty-three recurrent cases in Kumamoto City Hospital were also analyzed similarly. Inflammatory breast recurrence after breast conserving surgery is characterized as follows: Most cases have negative surgical margin and may be unresponsive to radiation therapy, unlike non-inflammatory breast recurrence. Lymph node metastasis is involved in recurrence, but the difference in patients with only distant metastasis was positive lymphatic invasion. Distant metastasis coexisted at the time of recurrence, and secondary surgery was impossible in most cases. The prognosis after recurrence was unfavorable. These findings suggest that inflammatory recurrence is manifestation of so-called ''occult'' inflammatory breast cancer. (author)

Correlation of breast recurrence (inflammatory type or not) after breast conserving surgery with radiation therapy and clinicopathological factors in breast cancer

Energy Technology Data Exchange (ETDEWEB)

Nishimura, Reiki [Kumamoto City Hospital (Japan); Koyama, Hiroki

1998-09-01

To clarify risk factors for breast recurrence of inflammatory type after breast conserving therapy, we examined clinicopathological findings and therapies given after initial surgery. Nine cases of inflammatory breast recurrence out of 133 recurrent cases collected from a collaborative group supported by a grant-in-aid for Cancer Research by Japanese Ministry of Health and Welfare (7-24, Chairman: H. Koyama) were analyzed by a case control study. And forty-three recurrent cases in Kumamoto City Hospital were also analyzed similarly. Inflammatory breast recurrence after breast conserving surgery is characterized as follows: Most cases have negative surgical margin and may be unresponsive to radiation therapy, unlike non-inflammatory breast recurrence. Lymph node metastasis is involved in recurrence, but the difference in patients with only distant metastasis was positive lymphatic invasion. Distant metastasis coexisted at the time of recurrence, and secondary surgery was impossible in most cases. The prognosis after recurrence was unfavorable. These findings suggest that inflammatory recurrence is manifestation of so-called ``occult`` inflammatory breast cancer. (author)

Oncoplastia surgery breast conservation. First results

International Nuclear Information System (INIS)

Morales Tirado, Roxana; Breff Frometa, Alain; Alfonso Coto, Juan Carlos; Galvez Chavez, Julio Cesar

2009-01-01

Oncoplastic surgery is an important tool in the treatment patients with breast cancer stages I and II. A prospective study descriptive period between October 2005 and October 2006, which included 10 patients younger than 60 years in stages I and II, selected from the universe that came to the National Cancer Institute and Havana Radiobiology (INOR), following the inclusion criteria and exclusion. Were assessed before and after surgery from surveys that collected data questioning the patients and data clinical examination performed by the plastic surgeon. The predominant lesion was invasive ductal cancer and most patients were in stage I. There were no loco-regional recurrence in 2 year period. The most common complication was dehiscence surgical wound. Good aesthetic results were obtained in sixty percent of cases. It is confirmed that the surgery is Breast Oncoplastic very effective for the oncological safety and promising in terms of aesthetic results. (Author)

Identification of the boundary between normal breast tissue and invasive ductal carcinoma during breast-conserving surgery using multiphoton microscopy

Science.gov (United States)

Deng, Tongxin; Nie, Yuting; Lian, Yuane; Wu, Yan; Fu, Fangmeng; Wang, Chuan; Zhuo, Shuangmu; Chen, Jianxin

2014-11-01

Breast-conserving surgery has become an important way of surgical treatment for breast cancer worldwide nowadays. Multiphoton microscopy (MPM) has the ability to noninvasively visualize tissue architectures at the cellular level using intrinsic fluorescent molecules in biological tissues without the need for fluorescent dye. In this study, MPM is used to image the microstructures of terminal duct lobular unit (TDLU), invasive ductal carcinoma and the boundary region between normal and cancerous breast tissues. Our study demonstrates that MPM has the ability to not only reveal the morphological changes of the cuboidal epithelium, basement membrane and interlobular stroma but also identify the boundary between normal breast tissue and invasive ductal carcinoma, which correspond well to the Hematoxylin and Eosin (H and E) images. Predictably, MPM can monitor surgical margins in real time and provide considerable accuracy for resection of breast cancerous tissues intraoperatively. With the development of miniature, real-time MPM imaging technology, MPM should have great application prospects during breast-conserving surgery.

Re-excision rates after breast conserving surgery following the 2014 SSO-ASTRO guidelines.

Science.gov (United States)

Heelan Gladden, Alicia A; Sams, Sharon; Gleisner, Ana; Finlayson, Christina; Kounalakis, Nicole; Hosokawa, Patrick; Brown, Regina; Chong, Tae; Mathes, David; Murphy, Colleen

2017-12-01

In 2014, SSO-ASTRO published guidelines which recommended "no ink on tumor" as adequate margins for patients undergoing breast conservation for invasive breast cancer. In 2016, new SSO-ASTRO-ASCO guidelines recommended 2 mm margins for DCIS. We evaluated whether these guidelines affected re-excision rates at our institution. Patients treated with breast conservation surgery from January 1, 2010-March 1, 2016 were identified. Re-excision rates, tumor characteristics, and presence of residual disease were recorded. The 2016 guidelines were retrospectively applied to the same cohort and expected re-excision rates calculated. Re-excision rates did not significantly decline before and after 2014 guideline adoption (11.9% before, 10.9% after; p = 0.65) or when the 2016 guidelines were retrospectively applied (8.4%; p = 0.10). The 2014 and 2016 guidelines had minimal impact on our re-excision rates, as most re-excisions were done for DCIS and 2016 guidelines supported our prior institutional practices of 2 mm margins for these patients. Copyright © 2017 Elsevier Inc. All rights reserved.

Linking the benefits of ecosystem services to sustainable spatial planning of ecological conservation strategies.

Science.gov (United States)

Huang, Lin; Cao, Wei; Xu, Xinliang; Fan, Jiangwen; Wang, Junbang

2018-09-15

The maintenance and improvement of ecosystem services on the Tibet Plateau are critical for national ecological security in China and are core objectives of ecological conservation in this region. In this paper, ecosystem service benefits of the Tibet Ecological Conservation Project were comprehensively assessed by estimating and mapping the spatiotemporal variation patterns of critical ecosystem services on the Tibet Plateau from 2000 to 2015. Furthermore, we linked the benefit assessment to the sustainable spatial planning of future ecological conservation strategies. Comparing the 8 years before and after the project, the water retention and carbon sink services of the forest, grassland and wetland ecosystems were slightly increased after the project, and the ecosystem sand fixation service has been steadily enhanced. The increasing forage supply service of grassland significantly reduced the grassland carrying pressure and eased the conflict between grassland and livestock. However, enhanced rainfall erosivity occurred due to increased rainfall, and root-layer soils could not recover in a short period of time, both factors have led to a decline in soil conservation service. The warm and humid climate is beneficial for the restoration of ecosystems on the Tibet Plateau, and the implementation of the Tibet Ecological Conservation Project has had a positive effect on the local improvement of ecosystem services. A new spatial planning strategy for ecological conservation was introduced and aims to establish a comprehensive, nationwide system to protect important natural ecosystems and wildlife, and to promote the sustainable use of natural resources. Copyright © 2018 Elsevier Ltd. All rights reserved.

Blood-conservation techniques in craniofacial surgery.

Science.gov (United States)

Meara, John G; Smith, Ebonie M; Harshbarger, Raymond J; Farlo, Joe N; Matar, Marla M; Levy, Mike L

2005-05-01

Attempts at reducing exposure to allogeneic transfusions, using blood conservation techniques such as controlled hypotension and normovolemic hemodilution, have met with mixed results and are not always practical in small infants. Recombinant human erythropoietin (RHE), a hormone that stimulates RBC production, increases the hematocrit when administered to infants. A retrospective chart review of all patients undergoing fronto-orbital advancement for craniosynostosis by the same plastic surgeon between January 2002 and December 2002 was conducted. A subgroup of patients (10/19) received RHE as a blood-conservation strategy. Transfusion requirements were lower in the RHE group (5/10) versus the control group (9/9). Total volume of blood products transfused was statistically lower in the RHE group (154 mL RHE group versus 421 mL control) (P conservation techniques was associated with a decreased need for blood transfusion, thus exposing the patient to fewer risks associated with allogeneic transfusion.

Protocol for a multicentre, parallel-arm, 12-month, randomised, controlled trial of arthroscopic surgery versus conservative care for femoroacetabular impingement syndrome (FASHIoN).

Science.gov (United States)

Griffin, D R; Dickenson, E J; Wall, P D H; Donovan, J L; Foster, N E; Hutchinson, C E; Parsons, N; Petrou, S; Realpe, A; Achten, J; Achana, F; Adams, A; Costa, M L; Griffin, J; Hobson, R; Smith, J

2016-08-31

Femoroacetabular impingement (FAI) syndrome is a recognised cause of young adult hip pain. There has been a large increase in the number of patients undergoing arthroscopic surgery for FAI; however, a recent Cochrane review highlighted that there are no randomised controlled trials (RCTs) evaluating treatment effectiveness. We aim to compare the clinical and cost-effectiveness of arthroscopic surgery versus best conservative care for patients with FAI syndrome. We will conduct a multicentre, pragmatic, assessor-blinded, two parallel arm, RCT comparing arthroscopic surgery to physiotherapy-led best conservative care. 24 hospitals treating NHS patients will recruit 344 patients over a 26-month recruitment period. Symptomatic adults with radiographic signs of FAI morphology who are considered suitable for arthroscopic surgery by their surgeon will be eligible. Patients will be excluded if they have radiographic evidence of osteoarthritis, previous significant hip pathology or previous shape changing surgery. Participants will be allocated in a ratio of 1:1 to receive arthroscopic surgery or conservative care. Recruitment will be monitored and supported by qualitative intervention to optimise informed consent and recruitment. The primary outcome will be pain and function assessed by the international hip outcome tool 33 (iHOT-33) measured 1-year following randomisation. Secondary outcomes include general health (short form 12), quality of life (EQ5D-5L) and patient satisfaction. The primary analysis will compare change in pain and function (iHOT-33) at 12 months between the treatment groups, on an intention-to-treat basis, presented as the mean difference between the trial groups with 95% CIs. The study is funded by the Health Technology Assessment Programme (13/103/02). Ethical approval is granted by the Edgbaston Research Ethics committee (14/WM/0124). The results will be disseminated through open access peer-reviewed publications, including Health Technology

Cirurgia conservadora de próteses aórtica e mitral na endocardite infecciosa Conservative surgery for aortic and mitral prosthesis in infective endocarditis

Directory of Open Access Journals (Sweden)

Kanim Kalil KASSAB

2001-03-01

Full Text Available A endocardite infecciosa (EI acometendo próteses valvares é uma complicação freqüente, sendo tratada geralmente com cirurgia, devido ao seu difícil controle clínico e má resposta à antibioticoterapia. Este relato descreve o caso de uma paciente com EI, acometendo simultaneamente as biopróteses aórtica (Ao e mitral (Mi após vinte e quatro meses de cirurgia de implantes valvares, submetida a tratamento cirúrgico conservador, e com resultado favorável. Discutem-se as vantagens deste procedimento em situações específicas.Infective endocarditis is a frequent complication for valvar prosthesis currently treated with surgery, orving to its difficult control and poor response to therapy with antibiotics. Although conservative surgery for infective endocarditis of prosthesis is not a procedure of choice, this report shows a case of infective endocarditis of aortic and mitral prosthesis, after 24 months of implantation, treated by conservative surgery with favorable outcome.

Prolonged conservative treatment or 'early' surgery in sciatica caused by a lumbar disc herniation: rationale and design of a randomized trial [ISRCT 26872154

Science.gov (United States)

Peul, Wilco C; van Houwelingen, Hans C; van der Hout, Wilbert B; Brand, Ronald; Eekhof, Just AH; Tans, Joseph ThJ; Thomeer, Ralph TWM; Koes, Bart W

2005-01-01

Background The design of a randomized multicenter trial is presented on the effectiveness of a prolonged conservative treatment strategy compared with surgery in patients with persisting intense sciatica (lumbosacral radicular syndrome). Methods/design Patients presenting themselves to their general practitioner with disabling sciatica lasting less than twelve weeks are referred to the neurology outpatient department of one of the participating hospitals. After confirmation of the diagnosis and surgical indication MRI scanning is performed. If a distinct disc herniation is discerned which in addition covers the clinically expected site the patient is eligible for randomization. Depending on the outcome of the randomization scheme the patient will either be submitted to prolonged conservative care or surgery. Surgery will be carried out according to the guidelines and between six and twelve weeks after onset of complaints. The experimental therapy consists of a prolonged conservative treatment under supervision of the general practitioner, which may be followed by surgical intervention in case of persisting or progressive disability. The main primary outcome measure is the disease specific disability of daily functioning. Other primary outcome measures are perceived recovery and intensity of legpain. Secondary outcome measures encompass severity of complaints, quality of life, medical consumption, absenteeism, costs and preference. The main research question will be answered at 12 months after randomization. The total follow-up period covers two years. Discussion Evidence is lacking concerning the optimal treatment of lumbar disc induced sciatica. This pragmatic randomized trial, focusses on the 'timing' of intervention, and will contribute to the decision of the general practictioner and neurologist, regarding referral of patients for surgery. PMID:15707491

Reoperation Rates in Ductal Carcinoma In Situ vs Invasive Breast Cancer After Wire-Guided Breast-Conserving Surgery

DEFF Research Database (Denmark)

Langhans, Linnea; Jensen, Maj-Britt; Talman, Maj-Lis M

2017-01-01

Importance: New techniques for preoperative localization of nonpalpable breast lesions may decrease the reoperation rate in breast-conserving surgery (BCS) compared with rates after surgery with the standard wire-guided localization. However, a valid reoperation rate for this procedure needs...... to be established for comparison, as previous studies on this procedure include a variety of malignant and benign breast lesions. Objectives: To determine the reoperation rate after wire-guided BCS in patients with histologically verified nonpalpable invasive breast cancer (IBC) or ductal carcinoma in situ (DCIS......) and to examine whether the risk of reoperation is associated with DCIS or histologic type of the IBC. Design, Setting, and Participants: This nationwide study including women with histologically verified IBC or DCIS having wire-guided BCS performed between January 1, 2010, and December 31, 2013, used data from...

Eleven-year follow-up results in the delay of breast irradiation after conservative breast surgery in node-negative breast cancer patients

International Nuclear Information System (INIS)

Vujovic, Olga; Yu, Edward; Cherian, Anil; Dar, A. Rashid; Stitt, Larry; Perera, Francisco

2006-01-01

Purpose: This retrospective review was conducted to determine if delay in the start of radiotherapy after conservative breast surgery had any detrimental effect on local recurrence or disease-free survival in node-negative breast cancer patients. Methods and Materials: A total of 568 patients with T1 and T2, N0 breast cancer were treated with breast-conserving surgery and breast irradiation, without adjuvant systemic therapy, between January 1, 1985 and December 31, 1992 at the London Regional Cancer Centre. The time intervals from definitive breast surgery to breast irradiation used for analysis were 0 to 8 weeks (201 patients), greater than 8 to 12 weeks (235 patients), greater than 12 to 16 weeks (91 patients), and greater than 16 weeks (41 patients). Kaplan-Meier estimates of time to local-recurrence and disease-free survival rates were calculated. Results: Median follow-up was 11.2 years. Patients in all 4 time intervals were similar in terms of age and pathologic features. No statistically significant difference was seen between the 4 groups in local recurrence or disease-free survival with surgery radiotherapy interval (p = 0.521 and p = 0.222, respectively). The overall local-recurrence rate at 5 and 10 years was 4.6% and 11.3%, respectively. The overall disease-free survival at 5 and 10 years was 79.6% and 67.0%, respectively. Conclusion: This retrospective study suggests that delay in the start of breast irradiation of up to 16 weeks from definitive surgery does not increase the risk of recurrence in node-negative breast cancer patients. The certainty of these results is limited by the retrospective nature of this analysis

Breast-conserving surgery in locally advanced breast cancer submitted to neoadjuvant chemotherapy. Safety and effectiveness based on ipsilateral breast tumor recurrence and long-term follow-up

Directory of Open Access Journals (Sweden)

Guilherme Freire Angotti Carrara

Full Text Available OBJECTIVE: To evaluate ipsilateral breast tumor recurrence after breast-conserving surgery for locally advanced breast cancer. METHODS: A retrospective observational cohort study was performed in patients with locally advanced breast cancer submitted to breast-conserving surgery after neoadjuvant chemotherapy based on an adriamycin-cyclophosphamide-paclitaxel regimen. We evaluated the clinical, pathologic, immunohistochemistry, and surgical factors that contribute to ipsilateral breast tumor recurrence and locoregional recurrence. A Kaplan-Meier analysis and Cox model were used to evaluate the main factors related to disease-free survival. RESULTS: Of the 449 patients who received neoadjuvant chemotherapy, 98 underwent breast-conserving surgery. The average diameter of the tumors was 5.3 cm, and 87.2% reached a size of up to 3 cm. Moreover, 86.7% were classified as clinical stage III, 74.5% had T3-T4 tumors, 80.5% had N1-N2 axilla, and 89.8% had invasive ductal carcinoma. A pathologic complete response was observed in 27.6% of the tumors, and 100.0% of samples had free margins. The 5-year actuarial overall survival rate was 81.2%, and the mean follow-up was 72.8 months. The rates of ipsilateral breast tumor recurrence and locoregional recurrence were 11.2% and 15.3%, respectively. Multifocal morphology response was the only factor related to ipsilateral breast tumor recurrence disease-free survival (p=0.04. A multivariate analysis showed that the pathologic response evaluation criteria in solid tumors (RECIST-breast cutoff was the only factor related to locoregional recurrence disease-free survival (p=0.01. CONCLUSIONS: Breast-conserving surgery is a safe and effective therapy for selected locally advanced breast tumors.

Optimizing transfusion in vascular surgery: is bloodless surgery an option?

Science.gov (United States)

Shander, Aryeh

2008-01-01

The prospect of surgery without blood loss is an emerging reality. Use of a blood conservation strategy is gaining increasing recognition as a sound and practical approach, especially for the majority of large blood loss surgeries. However, critical situations still occur in which transfusions are necessary or unavoidable for the short-term survival of the patient. The decision-making processes for determining when to transfuse, which blood products to give, and how much are presented here with an evaluation of the risks of transfusion and a discussion on blood conservation strategies. Modalities that may be used in such strategies include restricted phlebotomy, the implementation of restrictive transfusion triggers, acute normovolemic hemodilution, intraoperative and postoperative blood salvage, and refined operative techniques to achieve meticulous hemostasis. In addition, the proper use of erythropoiesis-stimulating agents well before surgery can reduce the number of units transfused. The risks and costs of allogeneic blood transfusions underscore the need for and value of blood conservation techniques. Increasingly, hospitals are adopting blood conservation strategies as part of their routine practice. Blood conservation is a rapidly evolving field in which active research is expanding our understanding of the molecular, physiologic, and clinical aspects of hematopoiesis, circulatory response, coagulation enigmas, artificial oxygen carriers, and the impact of anemia on organ function. Ongoing research offers the possibility of replacement or elimination of allogeneic blood transfusions in a variety of clinical settings.

Persistent ectopic pregnancy after linear salpingotomy: a non-predictable complication to conservative surgery for tubal gestation

DEFF Research Database (Denmark)

Lund, Claus Otto; Nilas, Lisbeth; Bangsgaard, Nannie

2002-01-01

BACKGROUND: The drawback of conservative surgery for ectopic pregnancy (EP) is the risk of persistent trophoblast. The purpose was to characterize patients who develop persistent ectopic pregnancy (PEP) after salpingotomy for EP and to assess prognostic factors. METHODS: The medical records of 417...... patients treated by salpingotomy for EP were reviewed. Forty-eight (11.5%) patients were diagnosed with persistent EP. The data were analyzed using the Mann-Whitney U-test, Fischer's exact test or the chi2-test. RESULTS: Of 417 women, 48 (11,5%) were treated for PEP by either repeat surgery (n = 25......) or methotrexate (n = 23). Oral methotrexate failed in 4/19 cases while intramuscular (i.m.) methotrexate was successful in 4/4 cases. Women treated for PEP had a higher preoperative and a slower postoperative decline of serum human chorionic gonadotropin (hCG). Both the preoperative and the early postoperative h...

Linked and knotted beams of light, conservation of helicity and the flow of null electromagnetic fields

International Nuclear Information System (INIS)

Irvine, William T M

2010-01-01

Maxwell's equations allow for some remarkable solutions consisting of pulsed beams of light which have linked and knotted field lines. The preservation of the topological structure of the field lines in these solutions has previously been ascribed to the fact that the electric and magnetic helicities, a measure of the degree of linking and knotting between field lines, are conserved. Here we show that the elegant evolution of the field is due to the stricter condition that the electric and magnetic fields be everywhere orthogonal. The field lines then satisfy a 'frozen field' condition and evolve as if they were unbreakable filaments embedded in a fluid. The preservation of the orthogonality of the electric and magnetic field lines is guaranteed for null, shear-free fields such as the ones considered here by a theorem of Robinson. We calculate the flow field of a particular solution and find it to have the form of a Hopf fibration moving at the speed of light in a direction opposite to the propagation of the pulsed light beam, a familiar structure in this type of solution. The difference between smooth evolution of individual field lines and conservation of electric and magnetic helicities is illustrated by considering a further example in which the helicities are conserved, but the field lines are not everywhere orthogonal. The field line configuration at time t = 0 corresponds to a nested family of torus knots but unravels upon evolution.

More patients should undergo surgery after sigmoid volvulus.

Science.gov (United States)

Ifversen, Anne Kathrine Wewer; Kjaer, Daniel Willy

2014-12-28

To assess the outcome of patients treated conservatively vs surgically during their first admission for sigmoid volvulus. We conducted a retrospective study of 61 patients admitted to Aarhus University Hospital in Denmark between 1996 and 2011 for their first incidence of sigmoid volvulus. The condition was diagnosed by radiography, sigmoidoscopy or surgery. Patients treated with surgery underwent either a sigmoid resection or a percutaneous endoscopic colostomy (PEC). Conservatively treated patients were managed without surgery. Data was recorded into a Microsoft Access database and calculations were performed with Microsoft Excel. Kaplan-Meier plotting and Mantel-Cox (log-rank) testing were performed using GraphPad Prism software. Mortality was defined as death within 30 d after intervention or surgery. Among the total 61 patients, 4 underwent emergency surgery, 55 underwent endoscopy, 1 experienced resolution of the volvulus after contrast enema, and 1 died without treatment because of large bowel perforation. Following emergency treatment, 28 patients underwent sigmoid resection (semi-elective n = 18; elective n = 10). Two patients who were unfit for surgery underwent PEC and both died, 1 after 36 d and the other after 9 mo, respectively. The remaining 26 patients were managed conservatively without sigmoid resection. Patients treated conservatively on their first admission had a poorer survival rate than patients treated surgically on their first admission (95%CI: 3.67-14.37, P = 0.036). Sixty-three percent of the 26 conservatively treated patients had not experienced a recurrence 3 mo after treatment, but that number dropped to 24% 2 years after treatment. Eight of the 14 patients with recurrence after conservative treatment had surgery with no 30-d mortality. Surgically-treated sigmoid volvulus patients had a higher long-term survival rate than conservatively managed patients, indicating a benefit of surgical resection or PEC insertion if feasible.

Long-term outcome of adipose-derived regenerative cell-enriched autologous fat transplantation for reconstruction after breast-conserving surgery for Japanese women with breast cancer.

Science.gov (United States)

Ito, Shuhei; Kai, Yuichiro; Masuda, Takaaki; Tanaka, Fumiaki; Matsumoto, Toshifumi; Kamohara, Yukio; Hayakawa, Hiroshi; Ueo, Hiroaki; Iwaguro, Hideki; Hedrick, Marc H; Mimori, Koshi; Mori, Masaki

2017-12-01

More effective methods are needed for breast reconstruction after breast-conserving surgery for breast cancer. The aim of this clinical study was to assess the perioperative and long-term outcomes of adipose-derived regenerative cell (ADRC)-enriched autologous fat grafting. Ten female patients who had undergone breast-conserving surgery and adjuvant radiotherapy for breast cancer were enrolled. An ADRC-enriched fat graft prepared from the patient's adipose tissue was implanted at the time of adipose tissue harvest. The perioperative and long-term outcomes of the grafts, which included safety, efficacy, and questionnaire-based patient satisfaction, were investigated. The mean operation time was 188 ± 30 min, and the mean duration of postoperative hospitalization was 1.2 ± 0.4 days. No serious postoperative complications were associated with the procedure. Neither recurrence nor metastatic disease was observed during the follow-up period (7.8 ± 1.5 years) after transplantation. Of 9 available patients, "more than or equal to average" satisfaction with breast appearance and overall satisfaction were reported by 6 (66.7%) and 5 (55.6%) patients, respectively. ADRC-enriched autologous fat transplantation is thus considered to be safe perioperatively, with no long-term recurrence, for patients with breast cancer treated by breast-conserving surgery, and it may be an option for breast reconstruction, even after adjuvant radiotherapy.

A structured blood conservation programme reduces transfusions and costs in cardiac surgery.

Science.gov (United States)

Ternström, Lisa; Hyllner, Monica; Backlund, Erika; Schersten, Henrik; Jeppsson, Anders

2014-11-01

Transfusions of blood products can be lifesaving, but they are also associated with considerable risks and adverse effects, including immune response and infections. In cardiac surgery, transfusions have also been associated with increased mortality. We prospectively studied the effects of a structured programme to reduce transfusions and transfusion-associated costs in cardiac surgery. The programme included: (i) education of all staff about the risks and benefits of blood transfusions; (ii) revised guidelines for transfusions; and (iii) a transfusion log where indication for transfusion, status of the patient and prescribing physician were registered. Transfusion prevalence, complications and costs for blood products were registered for all acute and elective cardiac operations during a 12-month period before (n = 1128) and after (n = 1034) the programme was started. The two time periods were compared. In addition, the prevalence of transfusions was registered for 2 more years after the programme was initiated. The first year after the programme was initiated the proportion of patients transfused with red blood cell concentrate decreased by 21.8% (from 58.2 to 45.5%, P platelets by 21.0% (from 20.5 to 16.2%, P = 0.010). Reoperations for bleeding (5.8 vs 5.0%), early complication rate and 30-day mortality (2.5 vs 2.6%) were not significantly different before and after the start date. Based on the 2009 institutional prices for red blood cell concentrate (102 €/unit), plasma (35 €/unit) and platelets (290 €/unit), the savings on blood products were €161,623 during the first 12 months after the programme was launched. The proportion of patients transfused with any blood product was 60.9% before the programme was started and 48.3, 54.0 and 50.7% 1-3 years after its start (all P conservation programme reduces transfusions and costs for blood products in cardiac surgery, without any signs of compromised medical safety. The effects of introducing such a programme

Timing of surgery for sciatica

NARCIS (Netherlands)

Peul, Wilco C.

2008-01-01

The frequently diagnosed lumbar disc herniation can disappear by natural course, but still leads to high low back surgery rates. The optimal period of conservative care, before surgery is executed, was unknown. It is surprising that scientific evidence was lacking which justified “early” surgery.

Results of conservative surgery and radiation therapy for breast cancer

Energy Technology Data Exchange (ETDEWEB)

Osteen, R.T.; Smith, B.L. (Harvard Medical School, Boston, MA (USA))

1990-10-01

For stage I or II breast cancer, conservative surgery and radiation therapy are as effective as modified radical or radical mastectomy. In most cases, cosmetic considerations and the availability of therapy are the primary concerns. The extent of a surgical resection less than a mastectomy has not been a subject of a randomized trial and is controversial. It appears that removal of a quadrant of the breast for small lesions is safe but excessive. It may be possible to limit the breast resection to gross tumor removal for most patients while using wider resections for patients with an extensive intraductal component or for invasive lobular carcinoma. It also appears that excluding patients from breast conservation on the basis of positive margins on the first attempt at tumor excision may be unnecessarily restrictive. Although patients with an extensive intraductal component or invasive lobular carcinoma should have negative margins, it appears that a patient with predominantly invasive ductal carcinoma can be treated without re-excision if all gross tumor has been resected and there is no reason to suspect extensive microscopic disease. Patients with indeterminate margins should have a re-excision. Axillary dissection provides prognostic information and prevents progression of the disease within the axilla. Axillary dissections limited to level I will accurately identify a substantial number of patients who have pathologically positive but clinically negative nodes. When combined with radiation therapy to the axilla, a level I dissection results in a limited number of patients with progressive axillary disease. Patients with pathologically positive axillas and patients at particularly high risk for systemic disease because of the extent of axillary node involvement can be identified by dissections of levels I and II. 60 references.

Outcomes in breast cancer patients relative to margin status after treatment with breast-conserving surgery and radiation therapy: the University of Pennsylvania experience

International Nuclear Information System (INIS)

Peterson, Michael E.; Schultz, Delray J.; Reynolds, Carol; Solin, Lawrence J.

1999-01-01

Purpose: To evaluate the significance of final microscopic resection margin status on treatment outcomes in women with early breast cancer who are treated with breast-conserving surgery and definitive breast irradiation. Methods and Materials: An analysis was performed of 1021 consecutive women with clinical Stage I or II invasive carcinoma of the breast treated with breast-conserving surgery and definitive breast irradiation. Complete gross excision of tumor was performed in all cases, and an axillary staging procedure was performed to determine pathologic axillary lymph node status. The 1021 patients were divided into four groups based on the final microscopic margin from the tumor excision or from the re-excision if performed. These four groups were: (a) 518 patients with negative margins; (b) 124 patients with focally positive margins; (c) 96 patients with focally close margins (≤ 2 mm); and (d) 283 patients with unknown margins. Results: Local failure was not significantly different in patients with negative, focally positive, focally close or unknown final pathologic margins of resection at 8 years (8% vs. 10% vs. 17% vs. 16%, respectively, p = 0.21). The 8-year outcome also was not different among the four groups for overall survival (86% vs. 83% vs. 88% vs. 81%, respectively, p = 0.13), cause-specific survival (89% vs. 86% vs. 88% vs. 83%, respectively, p 0.14), no evidence of disease survival (81% vs. 73% vs. 86% vs. 77%, respectively, p = 0.09), and freedom from distant metastases (85% vs. 75% vs. 86% vs. 79%, respectively, p = 0.08). Conclusion: These results demonstrate that selected patients with focally positive or focally close microscopic resection margins can be treated with breast-conserving surgery and definitive breast irradiation with 8-year local control rates and survival rates that are similar to those seen in breast-conservation patients with negative or unknown final resection margins

Preservation of cosmesis with low complication risk after conservative surgery and radiotherapy for ductal carcinoma in situ of the breast

International Nuclear Information System (INIS)

Mills, Janete M.; Schultz, Delray J.; Solin, Lawrence J.

1997-01-01

Purpose: Although the clinical outcome after treatment of ductal carcinoma in situ (DCIS) using breast-conservation surgery and radiation therapy has been well documented, little data has been reported on cosmetic outcome or treatment complications. Therefore, the present study was performed to evaluate cosmesis and complications after breast-conservation treatment for DCIS and to analyze various factors that might affect cosmesis and predispose to complications. Methods and Materials: The records of 90 patients who were alive without evidence of disease with a 3-year minimum follow-up were evaluated for cosmetic results and treatment complications following breast-conservation surgery and radiation therapy for DCIS. Complete gross excision of the primary tumor had been performed in all patients. Additionally, 24 patients had undergone an axillary lymph node dissection in the earlier years of the study. The majority of the patients had received 50-50.4 Gy to the whole breast followed by an electron boost for a total dose of 60-66 Gy. Results: The cosmetic results of 90 evaluable patients at 3 years were: excellent in 69 (77%), good in 19 (21%), and fair in 2 (2%). The cosmetic results of 64 evaluable patients at 5 years were: excellent in 46 (72%), good in 16 (25%), and fair in 2 (3%). Factors associated with worse cosmetic results were an increased volume of tissue excised (>70 cm 3 ) and a negative ipsilateral breast biopsy after radiotherapy. Complications in the 24 patients with an axillary dissection were: arm edema (n = 6), cellulitis of the arm (n = 5), and axillary vein thrombosis (n = 1). Complications in the 66 patients without an axillary dissection were: cellulitis of the arm (n = 1) and cellulitis of the breast (n = 1). Discussion: Breast-conservation surgery followed by radiation therapy achieved excellent or good cosmetic results in 98 and 97% of patients at 3 years and 5 years, respectively. Complications were associated primarily with axillary

Patients with Invasive Lobular Breast Cancer Are Less Likely to Undergo Breast-Conserving Surgery: A Population Based Study in The Netherlands

NARCIS (Netherlands)

Truin, W.; Roumen, R.M.; Siesling, Sabine; van der Heiden-van der Loo, M.; Duijm, E.M.; Tjan-Heijnen, V.C.G.; Voogd, A.C.

2015-01-01

Purpose The aim of this study was to compare the frequency of breast-conserving surgery (BCS) between early-stage invasive ductal (IDC) and invasive lobular breast cancer (ILC). Methods Women with primary non-metastatic pT1 and pT2 IDC or ILC diagnosed between 1990 and 2010 were selected from the

Efficacy of vitreoretinal surgery in the treatment of X-linked retinoschisis with serious complications

Directory of Open Access Journals (Sweden)

Chen Zhao

2013-10-01

Full Text Available AIM: To evaluate the efficacy of vitreoretinal surgery in the treatment of X-linked retinoschisis(XLRSand its complications. METHODS: A retrospective study was made on all the XLRS patients with severe complications after operation in this hospital. All the 25 patients(31 eyespresent with macular abnormalities with/without peripheral retina split bypreoperative OCT examination. Among the 31 eyes, there were 7 eyes with vitreous hemorrhage, 8 eyes with retinal detachment and vitreous hemorrhage, and 16 eyes with rhegmatogenous retinal detachment. All the 31 eyes were divided into 2 groups: group A included 15 eyes which underwent photocoagulation before the surgery, while the other 16 eyes in group B didn't perform photocoagulation before the surgery. All the patients underwent a pars plana vitrectomy without lensectomy associated with internal limiting membrane peeling. Photocoagulation was done to the retinal holes and degeneration areas in group A. Gas or silicone oil was filled in group B after retinal photocoagulation treatment. Three years later, analysis was made on the results of the visual acuity, postoperative anatomical and functional outcome in these 2 groups. Statistical analysis was made on the results of average visual acuity before and after operation by SPSS software method, the difference was statistically significant(PRESULTS: Postoperative anatomical and functional outcome were satisfied at the last visit. A total of 23 eyes'(74.2%visual acuity were improved with the mean visual acuity increasing from 0.13±0.08 to 0.24±0.16, the difference was statistically significant(t=-5.354,P=0.000. The average visual acuity in group A was improved from 0.11±0.08 to 0.22±0.15 after operation(t=-4.391, P=0.000. While the average visual acuity in group B increased from 0.14±0.08 to 0.26±0.15(t=-4.488, P=0.000. The visual changes in two groups were statistical significance. But when compared the average changes of visual acuity before

Fractionated stereotactic conformal radiotherapy following conservative surgery in the control of craniopharyngiomas

International Nuclear Information System (INIS)

Minniti, Giuseppe; Saran, Frank; Traish, Daphne; Soomal, Rubin; Sardell, Susan; Gonsalves, Adam; Ashley, Susan; Warrington, Jim; Burke, Kevin; Mosleh-Shirazi, Amin; Brada, Michael

2007-01-01

Purpose: To describe the technique and results of stereotactically guided conformal radiotherapy (SCRT) in patients with craniopharyngioma after conservative surgery. Methods and materials: Thirty-nine patients with craniopharyngioma aged 3-68 years (median age 18 years) were treated with SCRT between June 1994 and January 2003. All patients were referred for radiotherapy after undergoing one or more surgical procedures. Treatment was delivered in 30-33 daily fractions over 6-6.5 weeks to a total dose of 50 Gy using 6 MV photons. Outcome was assessed prospectively. Results: At a median follow-up of 40 months (range 3-88 months) the 3- and 5-year progression-free survival (PFS) was 97% and 92%, and 3- and 5-year survival 100%. Two patients required further debulking surgery for progressive disease 8 and 41 months after radiotherapy. Twelve patients (30%) had acute clinical deterioration due to cystic enlargement of craniopharyngioma following SCRT and required cyst aspiration. One patient with severe visual impairment prior to radiotherapy had visual deterioration following SCRT. Seven out of 10 patients with a normal pituitary function before SCRT had no endocrine deficits following treatment. Conclusion: SCRT as a high-precision technique of localized RT is suitable for the treatment of incompletely excised craniopharyngioma. The local control, toxicity and survival outcomes are comparable to results reported following conventional external beam RT. Longer follow-up is required to assess long-term efficacy and toxicity, particularly in terms of potential reduction in treatment related late toxicity

Prolonged conservative care versus early surgery in patients with sciatica caused by lumbar disc herniation : two year results of a randomised controlled trial

NARCIS (Netherlands)

Peul, W.C.; Hout, van den W.B.; Brand, R.; Thomeer, R.T.W.M.; Koes, B.W.

2008-01-01

Objectives: To evaluate the effects of early lumbar disc surgery compared with prolonged conservative care for patients with sciatica over two years of follow-up. Design: Randomised controlled trial. Setting: Nine Dutch hospitals. Participants: 283 patients with 6-12 weeks of sciatica.

Ten-year results of treatment of ductal carcinoma in situ (DCIS) of the breast with conservative surgery and radiotherapy.

Science.gov (United States)

Amichetti, M; Caffo, O; Richetti, A; Zini, G; Rigon, A; Antonello, M; Arcicasa, M; Coghetto, F; Valdagni, R; Maluta, S; Di Marco, A

1997-09-01

The optimal treatment of ductal carcinoma in situ (DCIS) of the breast has not yet been established. The effectiveness of adjuvant postoperative radiotherapy after conservative surgery is debated. Few data are available in Italy on the combined treatment. A collaborative multi-institutional study on this issue in 10 radiation oncology departments of the north-east of Italy was conducted. One hundred and thirty nine women with DCIS of the breast were treated between 1980 and 1990. Age ranged between 28 and 88 years (median 50 years). Surgical procedures were: quadrantectomy in 108, lumpectomy in 22 and wide excision in 9 cases. The axilla was surgically staged in 97 cases: all the patients were node-negative. Radiation therapy was delivered with 60Co units (78%) or 6 MV linear accelerators (22%) for a median total dose to the entire breast of 50 Gy (mean 49.48 Gy; range 45-60 Gy). The tumour bed was boosted in 109 cases (78%) at a dose of 4-30 Gy (median 10 Gy) for a minimum tumour dose of 58 Gy. Median follow-up was 81 months. Thirteen local recurrences were recorded, 7 intraductal and 6 invasive. All recurrent patients had a salvage mastectomy and are alive and free of disease. Actuarial overall, cause-specific and recurrence-free survival at 10 years are of 93%, 100% and 86%, respectively. The results of this retrospective multicentric study substantiate the favourable data reported in the literature and confirm the efficacy of the breast-conserving treatment of DCIS employing conservative surgery and adjuvant radiation therapy.

Linking plastic ingestion research with marine wildlife conservation.

Science.gov (United States)

Avery-Gomm, Stephanie; Borrelle, Stephanie B; Provencher, Jennifer F

2018-05-16

Plastic is an increasingly pervasive marine pollutant. Concomitantly, the number of studies documenting plastic ingestion in wildlife is accelerating. Many of these studies aim to provide a baseline against which future levels of plastic ingestion can be compared, and are motivated by an underlying interest in the conservation of their study species and ecosystems. Although this research has helped to raise the profile of plastic as a pollutant of emerging concern, there is a disconnect between research examining plastic pollution and wildlife conservation. We present ideas to further discussion about how plastic ingestion research could benefit wildlife conservation by prioritising studies that elucidates the significance of plastic pollution as a population-level threat, identifies vulnerable populations, and evaluates strategies for mitigating impacts. The benefit of plastic ingestion research to marine wildlife can be improved by establishing a clearer understanding of how discoveries will be integrated into conservation and policy actions. Copyright © 2018. Published by Elsevier B.V.

Diffusion of good practices of care and decline of the association with case volume: the example of breast conserving surgery

Science.gov (United States)

Fedeli, Ugo; Alba, Natalia; Schievano, Elena; Visentin, Cristiana; Rosato, Rosalba; Zorzi, Manuel; Ruscitti, Giancarlo; Spolaore, Paolo

2007-01-01

Background Several previous studies conducted on cancer registry data and hospital discharge records (HDR) have found an association between hospital volume and the recourse to breast conserving surgery (BCS) for breast cancer. The aim of the current study is to depict concurrent time trends in the recourse to BCS and its association with hospital volume. Methods Admissions of breast cancer patients for BCS or mastectomy in the period 2000–2004 were identified from the discharge database of the Veneto Region (Italy). The role of procedural volume (low 100 breast cancer surgeries/year), and of individual risk factors obtainable from HDR was assessed through a hierarchical log-binomial regression. Results Overall, the recourse to BCS was higher in medium (risk ratio = 1.12, 95% confidence interval 1.07–1.18) and high-volume (1.09, 1.03–1.14) compared to low-volume hospitals. The proportion of patients treated in low-volume hospitals dropped from 22% to 12%, with a concurrent increase in the activity of medium-volume providers. The increase over time in breast conservation (globally from 56% to 67%) was steeper in the categories of low- and medium-volume hospitals with respect to high caseload. Conclusion The growth in the recourse to BCS was accompanied by a decline of the association with hospital volume; larger centers probably acted as early adopters of breast conservation strategies that subsequently spread to smaller providers. PMID:17945000

Blood and Blood Product Conservation: Results of Strategies to Improve Clinical Outcomes in Open Heart Surgery Patients at a Tertiary Hospital.

Science.gov (United States)

Khan, Junaid H; Green, Emily A; Chang, Jimmin; Ayala, Alexandria M; Barkin, Marilyn S; Reinys, Emily E; Stanton, Jeffrey; Stanten, Russell D

2017-12-01

Blood product usage is a quality outcome for patients undergoing cardiac surgery. To address an increase in blood product usage since the discontinuation of aprotinin, blood conservation strategies were initiated at a tertiary hospital in Oakland, CA. Improving transfusion rates for open heart surgery patients requiring Cardiopulmonary bypass (CPB) involved multiple departments in coordination. Specific changes to conserve blood product usage included advanced CPB technology upgrades, and precise individualized heparin dose response titration assay for heparin and protamine management. Retrospective analysis of blood product usage pre-implementation, post-CPB changes and post-Hemostasis Management System (HMS) implementation was done to determine the effectiveness of the blood conservation strategies. Statistically significant decrease in packed red blood cells, fresh frozen plasma, cryoprecipitate, and platelet usage over the stepped implementation of both technologies was observed. New oxygenator and centrifugal pump technologies reduced active circuitry volume and caused less damage to blood cells. Individualizing heparin and protamine dosing to a patient using the HMS led to transfusion reductions as well. Overall trends toward reductions in hospital length of stay and intensive care unit stay, and as a result, blood product cost and total hospitalization cost are positive over the period of implementation of both CPB circuit changes and HMS implementation. Although they are multifactorial in nature, these trends provide positive enforcement to the changes implemented.

The Role of Conserved N-Linked Glycans on Ebola Virus Glycoprotein 2.

Science.gov (United States)

Lennemann, Nicholas J; Walkner, Madeline; Berkebile, Abigail R; Patel, Neil; Maury, Wendy

2015-10-01

N-linked glycosylation is a common posttranslational modification found on viral glycoproteins (GPs) and involved in promoting expression, cellular attachment, protection from proteases, and antibody evasion. The GP subunit GP2 of filoviruses contains 2 completely conserved N-linked glycosylation sites (NGSs) at N563 and N618, suggesting that they have been maintained through selective pressures. We assessed mutants lacking these glycans for expression and function to understand the role of these sites during Ebola virus entry. Elimination of either GP2 glycan individually had a modest effect on GP expression and no impact on antibody neutralization of vesicular stomatitis virus pseudotyped with Ebola virus GP. However, loss of the N563 glycan enhanced entry by 2-fold and eliminated GP detection by a well-characterized monoclonal antibody KZ52. Loss of both sites dramatically decreased GP expression and abolished entry. Surprisingly, a GP that retained a single NGS at N563, eliminating the remaining 16 NGSs from GP1 and GP2, had detectable expression, a modest increase in entry, and pronounced sensitivity to antibody neutralization. Our findings support the importance of the GP2 glycans in GP expression/structure, transduction efficiency, and antibody neutralization, particularly when N-linked glycans are also removed from GP1. © The Author 2015. Published by Oxford University Press on behalf of the Infectious Diseases Society of America. All rights reserved. For Permissions, please e-mail: journals.permissions@oup.com.

Assessment of complications in a randomized controlled study on multimodality therapy for patients following breast-conserving surgery

International Nuclear Information System (INIS)

Hiraoka, Masahiro; Inoue, Toshihiko; Kodama, Hiroshi; Sako, Masao

2002-01-01

We conducted a randomized controlled study to evaluate the safety and usefulness of a combined treatment of radiotherapy and chemotherapy with doxifluridine (5'-DFUR) plus tamoxifen (TAM) as an adjuvant therapy for breast cancer patients after conservative surgery. The complications observed in this trial are reported herein. A total of 550 patients were registered and randomized (based on factors such as T, N, with/without radiotherapy) to groups A and B. Drug regimens were: group A, 5'-DFUR 600 mg/body/day for 6 months and TAM 20 mg/body/day for 2 years; group B, 5'-DFUR 600 mg/body/day for 2 years and TAM 20 mg/body/day for 2 years. Radiotherapy (2 Gy x 5 times/week, for 5 weeks) was administered to 88.6% of evaluable patients (481/543). Radiation-related acute adverse reactions occurred in 28.5% of the 481 patients and moderate to severe reactions occurred in 1.5% of the patients. Delayed radiation-related adverse reactions occurred in 17.9% of group A patients and 25.6% of group B patients. Grade 3 reactions occurred in 6 of the group A patients (2.4%) and in 5 of the group B patients (1.9%); all adverse reactions subsided after dose reduction or discontinuation. These findings suggest that the combination therapy of irradiation and 5'-DFUR with TAM is safe for patients after breast conserving surgery. (author)

Percutaneous drainage in conservative therapy for perforated gastroduodenal ulcers.

Science.gov (United States)

Oida, Takatsugu; Kano, Hisao; Mimatsu, Kenji; Kawasaki, Atsushi; Kuboi, Youichi; Fukino, Nobutada; Kida, Kazutoshi; Amano, Sadao

2012-01-01

The management of peptic ulcers has dramatically changed and the incidence of elective surgery for gastroduodenal peptic ulcers has markedly decreased; hence, the incidence of emergency surgery for perforated peptic ulcers has slightly increased. In select cases, conservative therapy can be used as an alternative for treating perforated gastroduodenal ulcers. In this study, we evaluated the efficacy of percutaneous abdominal drainage for the conservative treatment of perforated gastroduodenal ulcers. We retrospectively studied 51 patients who had undergone conservative therapy for perforated gastroduodenal ulcers. These patients were divided into 2 groups on the basis of the initial treatment with conservative therapy with or without percutaneous drainage: group PD included patients who had undergone percutaneous drainage and group NPD, patients who had undergone non-percutaneous drainage. In the PD group, 14.3% (n=3) of the patients did not respond to conservative therapy, while this value was 43.3% (n=13) in the NPD group. The 2 groups differed significantly with respect to conversion from conservative therapy to surgery (pperforated gastroduodenal ulcers should be performed only in the case of patients meeting the required criteria; its combination with percutaneous intraperitoneal drainage is effective as initial conservative therapy.

Laparoscopic Bladder -Conserving Surgery: Case Series

African Journals Online (AJOL)

advantages of minimal access surgery, upholds quality of life, improves patient's body image and preserves function. Methods: We present our experience in .... of the bladder, reporting an operative time of 205 min with minimal blood loss and R0 resection margins. (1,13). One patient has required salvage chemotherapy.

Cost Analysis of a Surgical Consensus Guideline in Breast-Conserving Surgery.

Science.gov (United States)

Yu, Jennifer; Elmore, Leisha C; Cyr, Amy E; Aft, Rebecca L; Gillanders, William E; Margenthaler, Julie A

2017-08-01

The Society of Surgical Oncology and American Society of Radiation Oncology consensus statement was the first professional guideline in breast oncology to declare "no ink on tumor" as a negative margin in patients with stages I/II breast cancer undergoing breast-conservation therapy. We sought to analyze the financial impact of this guideline at our institution using a historic cohort. We identified women undergoing re-excision after breast-conserving surgery for invasive breast cancer from 2010 through 2013 using a prospectively maintained institutional database. Clinical and billing data were extracted from the medical record and from administrative resources using CPT codes. Descriptive statistics were used in data analysis. Of 254 women in the study population, 238 (93.7%) had stage I/II disease and 182 (71.7%) had invasive disease with ductal carcinoma in situ. A subcohort of 83 patients (32.7%) who underwent breast-conservation therapy for stage I/II disease without neoadjuvant chemotherapy had negative margins after the index procedure, per the Society of Surgical Oncology and American Society of Radiation Oncology guideline. The majority had invasive ductal carcinoma (n = 70 [84.3%]) and had invasive disease (n = 45 [54.2%]), and/or ductal carcinoma in situ (n = 49 [59.0%]) within 1 mm of the specimen margin. Seventy-nine patients underwent 1 re-excision and 4 patients underwent 2 re-excisions, accounting for 81 hours of operative time. Considering facility fees and primary surgeon billing alone, the overall estimated cost reduction would have been $195,919, or $2,360 per affected patient, under the guideline recommendations. Implementation of the Society of Surgical Oncology and American Society of Radiation Oncology consensus guideline holds great potential to optimize resource use. Application of the guideline to a retrospective cohort at our institution would have decreased the overall re-excision rate by 5.6% and reduced costs by nearly $200

Using surface markers for MRI guided breast conserving surgery: a feasibility survey

Science.gov (United States)

Ebrahimi, Mehran; Siegler, Peter; Modhafar, Amen; Holloway, Claire M. B.; Plewes, Donald B.; Martel, Anne L.

2014-04-01

Breast MRI is frequently performed prior to breast conserving surgery in order to assess the location and extent of the lesion. Ideally, the surgeon should also be able to use the image information during surgery to guide the excision and this requires that the MR image is co-registered to conform to the patient’s position on the operating table. Recent progress in MR imaging techniques has made it possible to obtain high quality images of the patient in the supine position which significantly reduces the complexity of the registration task. Surface markers placed on the breast during imaging can be located during surgery using an external tracking device and this information can be used to co-register the images to the patient. There remains the problem that in most clinical MR scanners the arm of the patient has to be placed parallel to the body whereas the arm is placed perpendicular to the patient during surgery. The aim of this study is to determine the accuracy of co-registration based on a surface marker approach and, in particular, to determine what effect the difference in a patient’s arm position makes on the accuracy of tumour localization. Obtaining a second MRI of the patient where the patient’s arm is perpendicular to body axes (operating room position) is not possible. Instead we obtain a secondary MRI scan where the patient’s arm is above the patient’s head to validate the registration. Five patients with enhancing lesions ranging from 1.5 to 80 cm3 in size were imaged using contrast enhanced MRI with their arms in two positions. A thin-plate spline registration scheme was used to match these two configurations. The registration algorithm uses the surface markers only and does not employ the image intensities. Tumour outlines were segmented and centre of mass (COM) displacement and Dice measures of lesion overlap were calculated. The relationship between the number of markers used and the COM-displacement was also studied. The lesion COM

Using surface markers for MRI guided breast conserving surgery: a feasibility survey

International Nuclear Information System (INIS)

Ebrahimi, Mehran; Siegler, Peter; Modhafar, Amen; Martel, Anne L; Holloway, Claire M B; Plewes, Donald B

2014-01-01

Breast MRI is frequently performed prior to breast conserving surgery in order to assess the location and extent of the lesion. Ideally, the surgeon should also be able to use the image information during surgery to guide the excision and this requires that the MR image is co-registered to conform to the patient’s position on the operating table. Recent progress in MR imaging techniques has made it possible to obtain high quality images of the patient in the supine position which significantly reduces the complexity of the registration task. Surface markers placed on the breast during imaging can be located during surgery using an external tracking device and this information can be used to co-register the images to the patient. There remains the problem that in most clinical MR scanners the arm of the patient has to be placed parallel to the body whereas the arm is placed perpendicular to the patient during surgery. The aim of this study is to determine the accuracy of co-registration based on a surface marker approach and, in particular, to determine what effect the difference in a patient’s arm position makes on the accuracy of tumour localization. Obtaining a second MRI of the patient where the patient’s arm is perpendicular to body axes (operating room position) is not possible. Instead we obtain a secondary MRI scan where the patient’s arm is above the patient’s head to validate the registration. Five patients with enhancing lesions ranging from 1.5 to 80 cm 3 in size were imaged using contrast enhanced MRI with their arms in two positions. A thin-plate spline registration scheme was used to match these two configurations. The registration algorithm uses the surface markers only and does not employ the image intensities. Tumour outlines were segmented and centre of mass (COM) displacement and Dice measures of lesion overlap were calculated. The relationship between the number of markers used and the COM-displacement was also studied. The lesion

Science framework for conservation and restoration of the sagebrush biome: Linking the Department of the Interior’s Integrated Rangeland Fire Management Strategy to long-term strategic conservation actions

Science.gov (United States)

J.C. Chambers; J.L. Beck; J.B. Bradford; J. Bybee; S. Campbell; J. Carlson; T.J. Christiansen; K.J. Clause; G. Collins; M.R. Crist; J.B. Dinkins; K.E. Doherty; F. Edwards; S. Espinosa; K.A. Griffin; P. Griffin; J.R. Haas; S.E. Hanser; D.W. Havlina; K.F. Henke; J.D. Hennig; L.A. Joyce; F.M. Kilkenny; S.M. Kulpa; L.L. Kurth; J.D. Maestas; M. Manning; K.E. Mayer; B.A. Mealor; C. McCarthy; M. Pellant; M.A. Perea; K.L. Prentice; D.A. Pyke; L.A. Wiechman; A. Wuenschel

2017-01-01

The Science Framework is intended to link the Department of the Interior’s Integrated Rangeland Fire Management Strategy with long-term strategic conservation actions in the sagebrush biome. The Science Framework provides a multiscale approach for prioritizing areas for management and determining effective management strategies within the sagebrush biome. The emphasis...

Modeling the impact of future development and public conservation orientation on landscape connectivity for conservation planning

DEFF Research Database (Denmark)

Lechner, Alex Mark; Brown, Greg; Raymond, Christopher Mark

2015-01-01

aspects of conservation planning. Objectives We present an approach for characterizing the potential effects of public conservation orientation and projected future development land use scenarios on landscape connectivity. Methods Using public participation GIS techniques (mail-based surveys linked...... to a mapping component), we classified spatially explicit conservation values and preferences into a conservation orientation index consisting of positive, negative, or neutral scores. Connectivity was then modeled using a least-cost path and graph-network approach for a range of conservation orientation...... and development scenarios in the Lower Hunter region, Australia. Scenarios were modelled through either adding vegetation (positive orientation) or removing vegetation (negative orientation, development). Results Scenarios that included positive conservation orientation link the isolated eastern and western...

The efficacy of postoperative radiotherapy in localized primary soft tissue sarcoma treated with conservative surgery

International Nuclear Information System (INIS)

Zhao, Ru-Ping; Yu, Xiao-Li; Zhang, Zhen; Jia, Li-Juan; Feng, Yan; Yang, Zhao-Zhi; Chen, Xing-Xing; Wang, Jian; Ma, Sheng-Lin; Guo, Xiao-Mao

2016-01-01

To evaluate the efficacy of postoperative radiotherapy (RT) on local failure-free survival (LFFS), distant metastasis-free survival (DMFS) and overall survival (OS) in patients with localized primary soft tissue sarcoma (STS) and to identify prognostic factors. Between January 2000 and July 2010, 220 consecutive patients with localized primary STS, who received conservative surgery with or without postoperative RT, were enrolled in the study. Survival curves were constructed by the Kaplan-Meier method and log-rank test was used to assess statistical significance. Multivariate analysis was applied to identify the prognostic factors. After a median follow-up of 68 months (range, 5–127 months), the 5-year LFFS, DMFS and OS were 70.0, 78.2 and 71.2 %, respectively. Tumor size, histological subtypes, margin status and postoperative RT were independent predictors for OS. Postoperative RT was associated with a significant reduced local recurrence risk versus surgery alone (hazard ratio [HR] = 0.408, 95 % confidence interval [CI] 0.235–0.707, P = 0.001), with 5-year LFFS of 81.1 and 63.6 %, respectively (log-rank, P = 0.004). The log-rank test showed that postoperative RT had a tendency of improving OS compared with surgery alone, with 5-year OS of 74.8 and 65.0 %, respectively (P = 0.089). Multivariate analysis demonstrated that postoperative RT significantly reduced mortality rate compared with surgery alone (HR = 0.512, 95 % CI 0.296–0.886, p = 0.017), especially in patients with liposarcoma (p = 0.034). Postoperative radiotherapy reduce both local recurrence and STS mortality in patients with localized primary STS. The efficacy of RT on survival warrants further prospective study. The online version of this article (doi:10.1186/s13014-016-0605-y) contains supplementary material, which is available to authorized users

Comparison of extracapillary and endocapillary blood flow oxygenators for open heart surgery in dogs: efficiency of gas exchange and platelet conservation.

Science.gov (United States)

Hoshi, Katsuichiro; Tanaka, Ryou; Shibazaki, Akira; Nagashima, Yukiko; Hirao, Hidehiro; Namiki, Ryosuke; Takashima, Kazuaki; Noishiki, Yasuharu; Yamane, Yoshihisa

2003-03-01

The goal of the current study was to compare the efficiency of gas exchange and platelet conservation of a new extracapillary blood flow oxygenator versus an endocapillary blood flow oxygenator during open heart surgery with extracorporeal circulation in dogs. Dilation and remodeling of the right ventricular outflow tract of dogs was performed using a patch graft technique to simulate pulmonary stenosis. Sequential pre- and post-operative blood analysis revealed that gas exchange efficiency and platelet conservation was significantly greater with the extracapillary blood flow oxygenator than with the endocapillary blood flow oxygenator. However, the priming volume of the extracapillary blood flow oxygenator was significantly greater, leading to hemodilution. We conclude that while the extracapillary blood flow oxygenator provided benefits in terms of gas exchange and platelet conservation, development of a smaller extracapillary blood flow type oxygenator to reduce hemodilution effects would be beneficial.

Vaginal carcinoma in a young woman who underwent fertility-sparing treatment involving chemotherapy and conservative surgery.

Science.gov (United States)

Mabuchi, Yasushi; Yahata, Tamaki; Kobayashi, Aya; Tanizaki, Yuko; Minami, Sawako; Ino, Kazuhiko

2015-06-01

Vaginal carcinoma is a rare gynecological malignancy that is usually treated by radiation therapy and/or surgery combined with chemotherapy. Here, we report a case of invasive vaginal carcinoma in a young woman who underwent fertility-sparing treatment involving neoadjuvant chemotherapy and conservative surgery. A 36-year-old non-parous woman had a solid tumor in the vagina. Positron emission tomography/computed tomography showed a tumor in the vagina with high FDG uptake (SUV = 17.33) but no metastatic lesions. The patient was diagnosed with vaginal squamous cell carcinoma, FIGO stage I, T1N0M0. Because she wished to retain her fertility, neoadjuvant chemotherapy consisting of irinotecan hydrochloride and nedaplatin was initiated. After four courses of chemotherapy, partial vaginectomy was carried out and the pathological diagnosis of the residual lesion was VAIN 3. Following two further courses of the same chemotherapy, she obtained complete response, and has shown no evidence of disease for 14 months. © 2014 The Authors. Journal of Obstetrics and Gynaecology Research © 2014 Japan Society of Obstetrics and Gynecology.

Conservative treatment of perforated upper gastrointestinal tract

International Nuclear Information System (INIS)

Naoi, Daishi; Sano, Wataru; Nakata, Yasuyuki; Yano, Kentaro; Suzuki, Takeshi; Chiku, Tsuyoshi; Tashiro, Tsuguhiko

2009-01-01

In order to clarify the validity of indication criteria of the conservative treatment for perforated upper gastrointestinal tract, a retrospective study was carried out. We enrolled 28 patients with perforation of the gastrointestinal tract who were determined to receive conservative treatment at the time of hospitalization from January 2000 to December 2007. When the following criteria were satisfied, we treated the patients by the conservative treatment after informed consent was gained from them and their families: stable condition of vital signs; peritoneal signs localized in the upper abdomen; and no or slight fluid collection at the Douglas' pouch determined by computed tomography. Patients who showed changes for the worse of peritonitis or increased fluid collection during follow-up were promptly converted to surgery. Six patients were converted to surgery, but all of them were discharged very much improved. We compared patient's data of the conservative treatment group and the converted surgery group at the time of consultation. All data were not statistically different between two groups. If all criteria are satisfied, it seemed that we can start conservative treatment for perforated gastrointestinal tract with careful observation and the system of prompt conversion to operation for patients who showed changes for the worse of peritonitis or increased fluid collection. (author)

Recent advances in radiotherapy: Partial Breast Irradiation (PBI) in breast cancer patients after breast conserving surgery

International Nuclear Information System (INIS)

Niwinska, A.

2003-01-01

The interest in accelerated partial breast irradiation (PBI) after conservative surgery has increased over the past decade as a result of many factors, including clinical and pathological data questioning the efficacy of whole breast irradiation in highly selected patients, as well as factors related to patient's convenience. High dose rate and low dose rate brachytherapy, brachytherapy MammoSite, Electron Intraoperative Therapy - ELIOT and Targeted Intraoperative Radiotherapy - TARGIT are the subject of investigation. The tolerability and efficacy of the treatment are of special interest. In this review article, methods of accelerated PBI, eligibility criteria, techniques of radiotherapy, early results and side effects are reviewed. (author)

Implementation of a comprehensive blood conservation program can reduce blood use in a community cardiac surgery program.

Science.gov (United States)

Xydas, Steve; Magovern, Christopher J; Slater, James P; Brown, John M; Bustami, Rami; Parr, Grant V; Thurer, Robert L

2012-04-01

The study objective was to determine the effects of implementing a blood conservation algorithm on blood product use and outcomes in a community cardiac surgery program. A blood management strategy including lower hemoglobin transfusion threshold and algorithm-driven decisions was adopted. Intraoperatively, point-of-care testing was used to avoid inappropriate component transfusion. A low prime perfusion circuit was adopted. Blood was withdrawn from patients before initiating bypass when possible. Patients undergoing coronary and valve procedures were included. Outlier patients receiving more than 10 units packed red blood cells were excluded. Data were collected for 6 months as a baseline group (group I). A 3-month period of program implementation was allotted. Data were subsequently collected for 6 months and comprised the study patients (group II). Prospective data were collected on demographics, blood use, and outcomes. Group I comprised 481 patients, and group II comprised 551 patients. Group II received fewer units of packed red blood cells, fresh-frozen plasma, and cryoprecipitate than group I. There was no difference in platelets transfused. Total blood product use was reduced by 40% in group II (P conservation algorithm can be rapidly introduced, leading to reductions in blood and component use with no detrimental effect on early outcomes. Point-of-care testing can direct component transfusion in coagulopathic cases, with most coagulopathic patients requiring platelets. Further research will determine the effects of reduced transfusions on long-term outcomes. Copyright © 2012 The American Association for Thoracic Surgery. Published by Mosby, Inc. All rights reserved.

Comparing oncoplastic breast conserving surgery with mastectomy and immediate breast reconstruction: Case-matched patient reported outcomes.

Science.gov (United States)

Kelsall, Jennett E; McCulley, Stephen J; Brock, Lisa; Akerlund, Malin T E; Macmillan, R Douglas

2017-10-01

Oncoplastic breast conserving surgery (OBCS) allows women who may otherwise have mastectomy and immediate reconstruction (MxIR) the choice to conserve their breast yet avoid deformity. We compared the outcome of these options. Two cohorts meeting study criteria were identified from prospectively audited series of women undergoing OBCS or MxIR. After case matching for age, tumour size and date of surgery, stratification by breast size and controlling for radiotherapy; body image scale (BIS) scores of psychosocial function and patient reported outcome measures (PROMs) for breast appearance and return to function were analysed. A total of 567 women (286 treated by OBCS and 281 by MxIR) fulfilled inclusion criteria. Demographics were similar between the two unmatched cohorts, except for radiotherapy, age and tumour size (all p < 0.001). Overall, BIS score (p = 0.002), self-rated breast appearance, return to work and function (all p < 0.001) significantly favoured OBCS. Case-matched women with larger breasts treated by OBCS reported better BIS scores (mean 3.30 vs. 5.37, p = 0.011) and self-rated breast appearance score (p < 0.001) than MxIR, whereas no significant difference was observed for smaller breasts. BIS and appearance favoured OBCS, regardless of whether radiotherapy would have been avoided if treated by MxIR. OBCS offers suitable women the option to avoid MxIR while providing faster recovery. Better psychosocial and self-rated satisfaction with breast appearance is achieved for OBCS in all groups, regardless of the need for radiotherapy, apart from those women with smaller breasts for whom the results are comparable. Copyright © 2017 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.

Blood conservation in cardiac surgery: guidelines and controversies.

Science.gov (United States)

Mazer, C David

2014-02-01

Bleeding related to cardiac surgery is an important clinical problem. Perioperative anemia and transfusion of allogeneic blood products have both been associated with adverse outcome including mortality and major morbidity. Guidelines exist to help determine when the risks of anemia outweigh the risks of transfusion. Perioperative bleeding may be related to several factors including the use of new antithrombotic drugs. A variety of hemostatic drugs have been studied to reduce bleeding and transfusion, although several questions and concerns about them exist. Patient blood management programs can be valuable for management of patients undergoing cardiac surgery. Copyright © 2014. Published by Elsevier Ltd.

A population-based validation study of the DCIS Score predicting recurrence risk in individuals treated by breast-conserving surgery alone

OpenAIRE

Rakovitch, Eileen; Nofech-Mozes, Sharon; Hanna, Wedad; Baehner, Frederick L.; Saskin, Refik; Butler, Steven M.; Tuck, Alan; Sengupta, Sandip; Elavathil, Leela; Jani, Prashant A.; Bonin, Michel; Chang, Martin C.; Robertson, Susan J.; Slodkowska, Elzbieta; Fong, Cindy

2015-01-01

Validated biomarkers are needed to improve risk assessment and treatment decision-making for women with ductal carcinoma in situ (DCIS) of the breast. The Oncotype DX? DCIS Score (DS) was shown to predict the risk of local recurrence (LR) in individuals with low-risk DCIS treated by breast-conserving surgery (BCS) alone. Our objective was to confirm these results in a larger population-based cohort of individuals. We used an established population-based cohort of individuals diagnosed with DC...

Does Concurrent Radiochemotherapy Affect Cosmetic Results in the Adjuvant Setting After Breast-Conserving Surgery? Results of the ARCOSEIN Multicenter, Phase III Study: Patients' and Doctors' Views

International Nuclear Information System (INIS)

Toledano, Alain H.; Bollet, Marc A.; Fourquet, Alain; Azria, David; Gligorov, Joseph; Garaud, Pascal; Serin, Daniel; Bosset, Jean-Francois; Miny-Buffet, Joelle; Favre, Anne; Le Foch, Olivier; Calais, Gilles

2007-01-01

Purpose: To evaluate the cosmetic results of sequential vs. concurrent adjuvant chemotherapy with radiotherapy after breast-conserving surgery for breast cancer, and to compare ratings by patients and physicians. Methods and Materials: From 1996 to 2000, 716 patients with Stage I-II breast cancers were included in a multicenter, Phase III trial (the ARCOSEIN study) comparing, after breast-conserving surgery with axillary dissection, sequential treatment with chemotherapy first followed by radiotherapy vs. chemotherapy administered concurrently with radiotherapy. Cosmetic results with regard to both the overall aspect of the breast and specific changes (color, scar) were evaluated in a total of 214 patients (107 in each arm) by means of questionnaires to both the patient and a physician whose rating was blinded to treatment allocation. Results: Patients' overall satisfaction with cosmesis was not statistically different between the two arms, with approximately 92% with at least satisfactory results (p = 0.72), although differences between the treated and untreated breasts were greater after the concurrent regimen (29% vs. 14% with more than moderate differences; p 0.0015). Physician assessment of overall cosmesis was less favorable, with lower rates of at least satisfactory results in the concurrent arm (60% vs. 85%; p = 0.001). Consequently, the concordance for overall satisfaction with cosmesis between patients and doctors was only fair (κ = 0.62). Conclusion: After breast-conserving surgery, the concurrent use of chemotherapy with radiotherapy is significantly associated with greater differences between the breasts. These differences do not translate into patients' lessened satisfaction with cosmesis

Ipsilateral breast tumor recurrence after breast conservation therapy: Outcomes of salvage mastectomy vs. salvage breast-conserving surgery and prognostic factors for salvage breast preservation

International Nuclear Information System (INIS)

Alpert, Tracy E.; Kuerer, Henry M.; Arthur, Douglas W.; Lannin, Donald R.; Haffty, Bruce G.

2005-01-01

Purpose: To compare outcomes of salvage mastectomy (SM) and salvage breast-conserving surgery (SBCS) and study the feasibility of SBCS. Methods and Materials: Of 2,038 patients treated with breast-conserving therapy at Yale-New Haven Hospital before 1999, 166 sustained an ipsilateral breast tumor recurrence (IBTR). Outcomes and prognostic factors of patients treated with SM or SBCS were compared. Patients were considered amenable to SBCS if the recurrence was localized on mammogram and physical examination, and had pathologic size <3 cm, confined to the biopsy site, without skin or lymphovascular invasion, and with ≤3 positive nodes. Results: Of the 146 patients definitively managed at IBTR, surgery was SM (n = 116) or SBCS (n 30). The median length of follow-up after IBTR was 13.8 years. The SM and SBCS cohorts had no significant differences, except at IBTR the SM cohort had a greater tumor size (p = 0.049). Of the SM cohort, 65.5% were considered appropriate for SBCS, and a localized relapse was predicted by estrogen-receptor positive, diploid, and detection of recurrence by mammogram. Multicentric disease correlated with BRCA1/2 mutation, estrogen-receptor negative, lymph node positive at relapse, and detection of recurrence by physical examination. Survival after IBTR was 64.5% at 10 years, with no significant difference between SM (65.7%) and SBCS (58.0%). Only 2 patients in the SBCS cohort subsequently had a second IBTR, and were salvaged with mastectomy. Conclusions: While mastectomy is considered the standard surgical salvage of IBTR, SBCS is feasible and prognostic factors are related to favorable tumor biology and early detection. Patients with BRCA1/2 germline mutations may be less appropriate for SBCS, as multicentric disease was more prevalent. Patients who underwent SBCS had comparable outcomes as those who underwent SM, but remain at continued risk for IBTR. A prospective trial evaluating repeat lumpectomy and partial breast reirradiation is

Conservative therapy of breast cancer in Queensland

International Nuclear Information System (INIS)

Burke, Marie-Frances; Allison, Roger; Tripcony, Lee

1995-01-01

Purpose: Primary radiation therapy following breast-conserving surgery has been an accepted alternative to mastectomy in Europe and North America for many years. In Australia, however, the history of breast conservation for early invasive breast cancer is much shorter. The purpose of this study was to evaluate the results of breast conservation in a state-wide Australian radiotherapy service. Methods and Materials: Between January 1982 and December 1989, 512 patients were treated with primary radiation therapy after breast conserving surgery. This analysis is based on a review of these patients, all of whom had Stage I or II breast cancer. Results: With a median follow-up of 50 months, the 5-year actuarial rate of overall survival was 84% and disease-free survival was 80%. There have been 22 isolated local recurrences in the breast. The time to an isolated breast recurrence ranged from 12 to 83 months (median, 26 months). The 5-year actuarial rate of an isolated breast recurrence was 4%. The recurrence rate was higher for patients with involved margins (15% vs. 2%, p < 0.01). Local recurrence was also more likely in the presence of extensive ductal carcinoma insitu (DCIS), as opposed to no extensive DCIS (10% vs. 2%, p < 0.01). Conclusion: These results affirm that primary radiation therapy after breast conserving surgery in Queensland, has been given with a low rate of local recurrence, comparable to that obtained in other centers

Conservative therapy of breast cancer in Queensland

Energy Technology Data Exchange (ETDEWEB)

Burke, Marie-Frances; Allison, Roger; Tripcony, Lee

1995-01-15

Purpose: Primary radiation therapy following breast-conserving surgery has been an accepted alternative to mastectomy in Europe and North America for many years. In Australia, however, the history of breast conservation for early invasive breast cancer is much shorter. The purpose of this study was to evaluate the results of breast conservation in a state-wide Australian radiotherapy service. Methods and Materials: Between January 1982 and December 1989, 512 patients were treated with primary radiation therapy after breast conserving surgery. This analysis is based on a review of these patients, all of whom had Stage I or II breast cancer. Results: With a median follow-up of 50 months, the 5-year actuarial rate of overall survival was 84% and disease-free survival was 80%. There have been 22 isolated local recurrences in the breast. The time to an isolated breast recurrence ranged from 12 to 83 months (median, 26 months). The 5-year actuarial rate of an isolated breast recurrence was 4%. The recurrence rate was higher for patients with involved margins (15% vs. 2%, p < 0.01). Local recurrence was also more likely in the presence of extensive ductal carcinoma insitu (DCIS), as opposed to no extensive DCIS (10% vs. 2%, p < 0.01). Conclusion: These results affirm that primary radiation therapy after breast conserving surgery in Queensland, has been given with a low rate of local recurrence, comparable to that obtained in other centers.

Conservation and Sustainable Development : Linking Practice and ...

International Development Research Centre (IDRC) Digital Library (Canada)

1 janv. 2012 ... En matière de gestion des ressources naturelles, les liens entre les politiques ... la part de l'Union internationale pour la conservation de la nature (UICN) et ... Félicitations à la première cohorte de chercheuses en science des ...

Breast conserving surgery following primary irradiation in 3-7 cm breast cancer: pathologic response and outcome

International Nuclear Information System (INIS)

Saint-Gaudens, Anne Bareille; Vilcoq, Jacques R.; Campana, Francois; Gautier, Chantal; Asselain, Bernard; Rocherfordiere, Anne de la; Clough, Krishna B.; Fourquet, Alain

1997-01-01

Purpose: To retrospectively evaluate histologic response and outcome of patients treated by primary irradiation followed by conservative surgery. Materials and Methods: Between 1981 and 1993, 1742 patients (pts.) with large 3-7 cm invasive breast cancer were treated by primary breast and nodes irradiation in our institution. Of these, 311 pts. (18%) further underwent a wide excision of the residual tumor. Median age was 55 years (yrs.) (29 - 79 yrs.). Median breast tumor size was 40 mm (35 - 70mm). 149 pts. (48%) were premenopausal. 142 pts (46%) had clinically palpable axillary nodes. Diagnosis of invasive breast cancer was performed in all patients by drill biopsy. Following diagnosis, all 311 patients were treated by external irradiation to the breast and regional nodes. Median dose to the breast was 55 Gy (50 - 64 Gy) over 5.5 weeks. Following this irradiation, all patients underwent a wide surgical excision with (140 pts; 45%) or without (171 pts; 55%) axillary node dissection. In addition, 70 pts (22.5%) received adjuvant chemotherapy and 70 pts. received hormone therapy after local treatment. All patients were then regularly followed. Results: Median residual breast tumor size after completion of irradiation was 20 mm (0 - 50mm). On pathologic examination, 34 (11%) tumors had no residual malignant cells (complete response), 137 tumors (44%) had residual fibrosis with clusters of viable cells (partial response), and 138 tumors (45%) had residual viable malignant cells (no response). Median follow up was 106 months (10 - 188 months). Actuarial 9-year overall survival rate was 69 % ± 6%. The 9-year metastasis-free interval was 58 % ± 6%. The 9-year breast recurrence rate was 22 % ± 5 %. The 9-year breast preservation rate was 84% ± 5%. Pathologic response was not predictive of outcome, either distant or local. Conclusion: This retrospective study showed that in patients with tumors too large to be treated by upfront breast-conserving surgery, primary breast

Value of multiparametric magnetic resonance imaging of the breast for the differentiation of fat necrosis and tumor recurrence after breast-conserving surgery. A case report

Energy Technology Data Exchange (ETDEWEB)

Doerner, Jonas; Krug, Kathrin Barbara [University Hospital Cologne (Germany). Dept. of Diagnostic and Interventional Radiology; Malter, Wolfram [University Hospital Cologne (Germany). Dept. of Obstetrics and Gynaecology; Markiefka, Birgid [University Hospital Cologne (Germany). Inst. of Pathology

2018-02-15

In rare cases the differentiation of tumor recurrence and fat necrosis in patients with breast-conserving surgery with or without radiotherapy can be challenging. In such cases magnetic resonance imaging features, in particular strong vs. faint contrast enhancement and diffusion restriction vs. non-restriction can help to characterize such lesions.

Clinical outcome and cosmetic results of conservative surgery plus radiation therapy in early stage breast cancer patients

International Nuclear Information System (INIS)

Jin Yening; Wang Yajie; Zhang Xiaoqing; Meng Yan; Li Rongqing; Shi Junyi

2005-01-01

Objective: To evaluate the clinical outcome and cosmetic results in early stage breast cancer patients treated with conservative surgery plus radiation therapy. Methods: From May 1995 to December 2002, 109 such patients were so treated. The post-operative radiotherapy consisted of whole-breast 6 MV linear accelerator irradiation with two tangential half-fields to a total dose of 45-52 Gy (mean 48.6 Gy), followed by a boost irradiation to the tumor bed. Among them, 79 patients received 10-12 Gy (DB) boost by interstitial implantation brachytherapy ( 192 Ir HDR, Nucletron), with single plane implantation for T1 and double plane implantation for T2 tumor. Thirty patients received 15 Gy boost by electron beam. Adjuvant/concurrent chemotherapy (CMF or CEF) and hormonotherapy were also used according to the patients' clinical characteristics. The cosmetic results were scored by both the doctor and the patients. Results: The overall actuarial 5-year survival was 93.8%, with local recurrence of 6.5%. No radiation-induced ulcer was observed in the breast except for acute inflammation at skin pinholes in 5 patients treated by interstitial implant brachytherapy. Among the 75 patients who had had breast examination, cosmetic result scored as good by patient and doctor were 81% and 87%, respectively. The good rate assessed by doctor in brachytherapy boost group and electron beam boost group were 81.2% (39/48) and 85.2% (23/27), There was no significant difference between these two boost techniques (P>0.05). Conclusions: Tumor bed boost irradiation by either brachytherapy or electron beam technique can provide satisfactory local control in early breast cancer treated with conservative surgery plus radiotherapy without increasing the side effects. There is no significant difference in cosmetic result between these two boost techniques. (authors)

The role of trade-offs in biodiversity conservation planning: linking ...

Indian Academy of Sciences (India)

Unknown

local management, regional planning and global conservation efforts .... conservation and the vertical axis indicates total amount of biodiversity protection “forgone” – not protected by .... tem services” that include such things as water quality,.

Optimisation of the link volume for weakest link failure prediction in NBG-18 nuclear graphite

International Nuclear Information System (INIS)

Hindley, Michael P.; Groenwold, Albert A.; Blaine, Deborah C.; Becker, Thorsten H.

2014-01-01

This paper describes the process for approximating the optimal size of a link volume required for weakest link failure calculation in nuclear graphite, with NBG-18 used as an example. As part of the failure methodology, the link volume is defined in terms of two grouping criteria. The first criterion is a factor of the maximum grain size and the second criterion is a function of an equivalent stress limit. A methodology for approximating these grouping criteria is presented. The failure methodology employs finite element analysis (FEA) in order to predict the failure load, at 50% probability of failure. The average experimental failure load, as determined for 26 test geometries, is used to evaluate the accuracy of the weakest link failure calculations. The influence of the two grouping criteria on the failure load prediction is evaluated by defining an error in prediction across all test cases. Mathematical optimisation is used to find the minimum error across a range of test case failure predictions. This minimum error is shown to deliver the most accurate failure prediction across a whole range of components, although some test cases in the range predict conservative failure load. The mathematical optimisation objective function is penalised to account for non-conservative prediction of the failure load for any test case. The optimisation is repeated and a link volume found for conservative failure prediction. The failure prediction for each test case is evaluated, in detail, for the proposed link volumes. Based on the analysis, link design volumes for NBG-18 are recommended for either accurate or conservative failure prediction

Congenital scoliosis - presentation of three severe cases treated conservatively.

Science.gov (United States)

Weiss, H-R

2008-01-01

In view of the very limited data about conservative treatment of patients with congenital scoliosis (CS) available, early surgery is suggested already in mild cases with formation failures in the first three years of life. It is common sense that patients with failures of segmentation will not benefit from conservative treatment at all and the same applies to failures of formation with curves of >50 degrees in infancy. Two patients with rib synostosis denied surgery before entering the pubertal growth spurt. These patients have been treated conservatively with braces and Scoliosis In-Patient Rehabilitation (SIR) and now are beyond the pubertal growth spurt. One patient with a formation failure and a curve of >50 degrees lumbar has been treated with the help of braces and physiotherapy from 1.6 years on and is still under treatment now at the age of 15 years. Severe decompensation was prevented in the two patients with failure of segmentation, however a severe thoracic deformity is evident with underdeveloped lung function and severe restrictive ventilation disorder. The patient with failure of formation is well developed, now without cosmetic or physical complaints although his curve progressed at the end of the growth spurt due to final mal-compliance. Failures of segmentation should be advised to have surgery before entering the pubertal growth spurt. In case they deny, conservative treatment can at least in part be beneficial. For patients with failures of formation conservative treatment should be suggested in the first place because long-term outcomes of early surgery beyond pubertal growth spurt are not yet revealed.

Multi-Institutional Experience of Ductal Carcinoma In Situ in Black vs White Patients Treated With Breast-Conserving Surgery and Whole Breast Radiation Therapy

International Nuclear Information System (INIS)

Nelson, Carl; Bai, Harrison; Neboori, Hanmanth; Takita, Cristiane; Motwani, Sabin; Wright, Jean L.; Hobeika, Georges; Haffty, Bruce G.; Jones, Tiffanie; Goyal, Sharad; Moran, Meena S.

2012-01-01

Purpose: Given the paucity of data on racial disparities in ductal carcinoma in situ (DCIS), the data from a multi-institutional cohort of DCIS patients treated with breast-conserving surgery and whole breast radiation therapy (RT) were analyzed to determine whether racial disparities or differences exist. Methods and Materials: A total of 533 white and 76 black DCIS patients from 3 university-based cancer centers were uniformly treated with breast-conserving surgery and RT. All patient data were collected and analyzed as a function of race. Results: The median follow-up was 5.2 years. No significant racial differences were seen in tumor size, age at diagnosis, estrogen receptor status, necrosis, or grade (all P>.05). Of the treatment parameters, the RT dose delivered, boost, positive margin rates, frequency of hormone receptor status assessment, and receipt of hormonal therapy for the 2 cohorts did not significantly differ (all P>.05). The local relapse-free survival was similar at 5 years (96.1% and 98.1%, P=.399) and 10 years (92.8% vs 95.8%, P=.360), with no significant overall survival difference at 10 years (94.0% vs 88.9%, P=.290) between the white and black patients, respectively. On multivariate analysis, race was not an independent predictor of local relapse-free survival or overall survival when accounting for age, grade, and margin status. Conclusion: In our large cohort of DCIS patients uniformly treated at 3 institutions with breast conservation without any apparent differences in treatment delivery parameters, we demonstrated that the clinical and pathologic features and local survival outcomes did not differ as a function of race. Our results suggest that when black patients with DCIS are appropriately selected for breast conservation and receive adjuvant RT without racial disparities in the treatment parameters, differences in the outcomes as a function of race do not exist.

Mechanisms driving local breast cancer recurrence in a model of breast-conserving surgery.

LENUS (Irish Health Repository)

Smith, Myles J

2012-02-03

OBJECTIVE: We aimed to identify mechanisms driving local recurrence in a model of breast-conserving surgery (BCS) for breast cancer. BACKGROUND: Breast cancer recurrence after BCS remains a clinically significant, but poorly understood problem. We have previously reported that recurrent colorectal tumours demonstrate altered growth dynamics, increased metastatic burden and resistance to apoptosis, mediated by upregulation of phosphoinositide-3-kinase\\/Akt (PI3K\\/Akt). We investigated whether similar characteristics were evident in a model of locally recurrent breast cancer. METHODS: Tumours were generated by orthotopic inoculation of 4T1 cells in two groups of female Balb\\/c mice and cytoreductive surgery performed when mean tumour size was above 150 mm(3). Local recurrence was observed and gene expression was examined using Affymetrix GeneChips in primary and recurrent tumours. Differential expression was confirmed with quantitative real-time polymerase chain reaction (qRT-PCR). Phosphorylation of Akt was assessed using Western immunoblotting. An ex vivo heat shock protein (HSP)-loaded dendritic cell vaccine was administered in the perioperative period. RESULTS: We observed a significant difference in the recurrent 4T1 tumour volume and growth rate (p < 0.05). Gene expression studies suggested roles for the PI3K\\/Akt system and local immunosuppression driving the altered growth kinetics. We demonstrated that perioperative vaccination with an ex vivo HSP-loaded dendritic cell vaccine abrogated recurrent tumour growth in vivo (p = 0.003 at day 15). CONCLUSION: Investigating therapies which target tumour survival pathways such as PI3K\\/Akt and boost immune surveillance in the perioperative period may be useful adjuncts to contemporary breast cancer treatment.

About Hand Surgery

Science.gov (United States)

... Find a hand surgeon near you. © 2009 American Society for Surgery of the Hand. Definition developed by ASSH Council. Other Links CME Mission Statement and Disclaimer Policies and Technical Requirements Exhibits and Partners ASSH 822 W. Washington Blvd. ... 2018 by American Society for Surgery of the Hand × Search Tips Tip ...

Evaluation of anxiety and salivary chromogranin a secretion in women receiving breast conserving surgery followed by radiation therapy

International Nuclear Information System (INIS)

Seki-Nakamura, Kaori; Maebayashi, Katsuya; Nasu-Izumi, Sachiko; Akimoto, Tetsuo; Mitsuhashi, Norio

2011-01-01

We conducted a prospective study to assess the anxiety and salivary Chromogranin A (CgA), which is considered to be a biomarker of the stress response, in outpatients receiving breast conserving surgery followed by radiation therapy (RT) to the whole breast. Fifty consecutive patients who received whole-breast RT were enrolled in this study. The anxiety levels were measured by the State-Trait Anxiety Inventory (STAI) at the beginning of RT (baseline), 30 Gy, completion of RT, and 1 and 3 months after RT. Salivary CgA levels were also measured at the same time. The mean state anxiety score for all patients was 46.16 with a standard error (SE) of 1.57 at the beginning of RT (baseline) which continued to decline during and after RT. It reached its lowest score with 36.34±1.56 at 3 months after RT (p<0.0001). The mean trait anxiety score for all patients was 43.10±1.54 at baseline and remained constant during RT but began to decline after completion of RT and reached a low level at 3 months after RT (p=0.0021). The mean salivary CgA concentration for all patients demonstrated no consistent trends over time, but at 30 Gy the concentration showed a significant decreasing pattern (p=0.0473). Salivary CgA concentrations and state anxiety and trait anxiety scores at all time points showed no correlation. The mean anxiety scores measured by State Trait Anxiety Inventory (STAI) showed no positive correlation with salivary CgA concentration for breast cancer patients undergoing radiation therapy following breast conserving surgery. (author)

Subsets of Women With Close or Positive Margins After Breast-Conserving Surgery With High Local Recurrence Risk Despite Breast Plus Boost Radiotherapy

International Nuclear Information System (INIS)

Lupe, Krystine; Truong, Pauline T.; Alexander, Cheryl; Lesperance, Mary; Speers, Caroline; Tyldesley, Scott

2011-01-01

Purpose: (1) To examine the effect of surgical margin status on local recurrence (LR) and survival following breast-conserving therapy; (2) To identify subsets with close or positive margins with high LR risk despite whole breast radiotherapy (RT) plus boost. Methods and Materials: Subjects were 2,264 women with pT1–3, any N, M0 invasive breast cancer, treated with breast-conserving surgery and whole breast ± boost RT. Five-year Kaplan-Meier (KM) LR, breast cancer–specific and overall survival (BCSS and OS) were compared between cohorts with negative (n = 1,980), close (n = 222), and positive (n = 62) margins. LR rates were analyzed according to clinicopathologic characteristics. Multivariable Cox regression modeling and matched analysis of close/positive margin cases and negative margin controls were performed. Results: Median follow-up was 5.2 years. Boost RT was used in 92% of patients with close or positive margins. Five-year KM LR rates in the negative, close and positive margin cohorts were 1.3%, 4.0%, and 5.2%, respectively (p = 0.001). BCSS and OS were similar in the three margin subgroups. In the close/positive margin cohort, LR rates were 10.2% with age 10% despite whole breast plus boost RT. These patients should be considered for more definitive surgery.

Effectiveness of early decompressive surgery for massive hemispheric embolic infarction

International Nuclear Information System (INIS)

Osada, Hideo; Mori, Kentaro; Yamamoto, Takuji; Nakao, Yasuaki; Oyama, Kazutaka; Esaki, Takanori; Watanabe, Mitsuya

2008-01-01

Massive hemispheric embolic infarction associated with acute brain swelling and rapid clinical deterioration is known as malignant infarction because of the significant rates of mortality and morbidity. Decompressive hemicraniectomy is effective; however, the timing and outcome still remain unclear. Ninety-four patients with massive embolic hemispheric infarctions (infarct volume >200 ml) were retrospectively divided into 3 groups: 29 patients, treated conservatively (conservative group); 33 patients, operated on after the appearance of signs of brain herniation (late surgery group); and 32 patients, operated on before the onset of signs of brain herniation signs (early surgery group). The mortality at 1 and 6 months in the late surgery group (15.2% and 24.2%, respectively) was significantly improved as compared to the conservative group (62.1% and 69.0%, respectively) (p 200 ml) should be performed before the onset of brain herniation. Early surgery may achieve a satisfactory functional recovery. (author)

Concurrent administration of adjuvant chemotherapy and radiotherapy after breast-conserving surgery enhances late toxicities: Long-term results of the ARCOSEIN multicenter randomized study

International Nuclear Information System (INIS)

Toledano, Alain; Garaud, Pascal; Serin, Daniel; Fourquet, Alain; Bosset, Jean-Francois; Breteau, Noel; Body, Gilles; Azria, David; Le Floch, Olivier; Calais, Gilles

2006-01-01

Purpose: In 1996, a multicenter randomized study was initiated that compared sequential vs. concurrent adjuvant chemotherapy (CT) with radiation therapy (RT) after breast-conserving surgery (ARCOSEIN study). After a median follow-up of 6.7 years (range, 4.3-9 years), we decided to prospectively evaluate the late effects of these 2 strategies. Methods and Materials: A total of 297 patients from the 5 larger participating institutions were asked to report for a follow-up examination. Seventy-two percent (214 patients) were eligible for evaluation of late toxicity. After breast-conserving surgery, patients were treated either with sequential treatment with CT first followed by RT (Arm A) or CT administered concurrently with RT (Arm B). In all patients, CT regimen consisted of mitoxantrone (12 mg/m 2 ), 5-FU (500 mg/m 2 ), and cyclophosphamide (500 mg/m 2 ), 6 cycles (Day 1 to Day 21). Conventional RT was delivered to the whole breast by administration of a 2 Gy per fraction protocol to a total dose of 50 Gy (± boost to the primary tumor bed). The assessment of toxicity was blinded to treatment and was graded by the radiation oncologist, according to the LENT/SOMA scale. Skin pigmentation was also evaluated according to a personal 5-points scoring system (excellent, good, moderate, poor, very poor). Results: Among the 214 evaluable patients, 107 were treated in each arm. The 2 populations were homogeneous for patient, tumor, and treatment characteristics. Subcutaneous fibrosis (SF), telangectasia (T), skin pigmentation (SP), and breast atrophy (BA) were significantly increased in Arm B. No statistical difference was observed between the 2 arms of the study concerning Grade 2 or higher pain, breast edema, or lymphedema. No deaths were caused by late toxicity. Conclusion: After breast-conserving surgery, the concurrent use of CT with RT is significantly associated with an increase incidence of Grade 2 or greater late side effects

For-profit hospital ownership status and use of brachytherapy after breast-conserving surgery.

Science.gov (United States)

Sen, Sounok; Soulos, Pamela R; Herrin, Jeph; Roberts, Kenneth B; Yu, James B; Lesnikoski, Beth-Ann; Ross, Joseph S; Krumholz, Harlan M; Gross, Cary P

2014-05-01

Little is known about the relationship between operative care for breast cancer at for-profit hospitals and subsequent use of adjuvant radiation therapy (RT). Among Medicare beneficiaries, we examined whether hospital ownership status is associated with the use of breast brachytherapy--a newer and more expensive modality--as well as overall RT. We conducted a retrospective study of female Medicare beneficiaries who received breast-conserving surgery for invasive breast cancer in 2008 and 2009. We assessed the relationship between hospital ownership and receipt of brachytherapy or overall RT by using hierarchical generalized linear models. The sample consisted of 35,118 women, 8.0% of whom had breast-conserving operations at for-profit hospitals. Among patients who received RT, those who underwent operation at for-profit hospitals were more likely to receive brachytherapy (20.2%) than patients treated at not-for-profit hospitals (15.2%; odds ratio [OR] for for-profit versus not-for-profit: 1.50; 95% confidence interval [95% CI] 1.23-1.84; P profit hospital was associated with greater overall use of RT (OR 1.22; 95% CI 1.03-1.45, P = .03) and brachytherapy use (OR 1.66; 95% CI 1.18-2.34, P = .003). Operative care at for-profit hospitals was associated with increased use of the newer and more expensive RT modality, brachytherapy. Among the oldest women who are least likely to benefit from RT, operative care at a for-profit hospital was associated with greater overall use of RT, with this difference largely driven by the use of brachytherapy. Copyright © 2014 Mosby, Inc. All rights reserved.

Cosmetic results of conservative treatment for early breast cancer

International Nuclear Information System (INIS)

Kim, Bo Kyoung; Shin, Seong Soo; Kim, Seong Deok; Ha, Sung Whan; Noh, Dong Young

2001-01-01

This study was performed to evaluate the cosmetic outcome of conservative treatment for early breast cancer and to analyze the factors influencing cosmetic outcome. From February 1992 through January 1997, 120 patients with early breast cancer were treated with conservative surgery and postoperative radiotherapy. The types of conservative surgery were quadrantectomy and axillary node dissection for 108 patients (90%) and lumpectomy or excisional biopsy for 10 patients (8.3%). Forty six patients (38%) received adjuvant chemotherapy (CMF or CAF). Cosmetic result evaluation was carried out between 16 and 74 months (median, 33 months) after surgery. The cosmetic results were classified into four categories, i.e., excellent, good, fair, and poor. The appearances of the patients' breasts were also analyzed for symmetry using the differences in distances from the stemal notch to right and left nipples. A logistic regression analysis was performed to identify independent variables influencing the cosmetic outcome. Cosmetic score was excellent or good in 76% (91/120), fair in 19% (23/120) and poor in 5% (6/ 120) of the patients. Univariate analysis showed that tumor size (T1 versus T2) (p=0.04), axillary node status (NO versus N1) (p=0.0002), extent of surgery (quadrantectomy versus lumpectomy or excisional biopsy) (p=0.02), axillary node irradiation (p=0.0005) and chemotherapy (p=0,0001) affected cosmetic score. Multivariate analysis revealed that extent of surgery (p=0.04) and chemotherapy (p=0.0002) were significant factors. For breast symmetry, univariate analysis confirmed exactly the same factors as above. Multivariate analysis revealed that tumor size (p=0.003) and lymph node status (p=0.007) affected breast symmetry. Conservative surgery and postoperative radiotherapy resulted in excellent or good cosmetic outcome in a large portion of the patients. Better cosmetic results were achieved generally in the group of patients with smaller tumor size, without axillary

Cancer of the breast: Conservation surgery and curative radiation therapy - Technique

International Nuclear Information System (INIS)

Brady, L.W.; Bedwinek, J.M.; Markoe, A.M.; Micaily, B.; Damsker, J.I.; Karlsson, U.L.

1987-01-01

Current evidence strongly suggests that radiation therapy following conservation surgery in the primary local management of stage I and stage II breast cancer can achieve survival and local-regional control rates that are comparable to those obtained by radical and modified radical mastectomy. Since primary radiation therapy has the benefit of leaving the patient with intact and cosmetically acceptable breasts, it should be considered as a viable and reasonable alternative to radical mastectomy. An analysis of current series of primary radiation data suggests that total excision of the tumor should be carried out. An axillary node sampling or dissection including level 1 and level 2 axillary nodes (those lying beneath and lateral to the pectoralis minor muscle) should be carried out in addition to tumor excision since knowledge of the axillary nodal status serves as a prognostic indicator and facilitates the intelligent selection of those patients for adjuvant hormonal or chemotherapy. Technique then becomes a critical and important part of the management of the patient. No effort should be spared to insure that the volumes irradiated are properly chosen, receive the appropriate dose to maximize the potential for local-regional control and done within the context of minimization of complication from the treatment program. It is only under these circumstances that the best in terms of long-term survival and cosmetic can be achieved

Mechanistic species distribution modelling as a link between physiology and conservation.

Science.gov (United States)

Evans, Tyler G; Diamond, Sarah E; Kelly, Morgan W

2015-01-01

Climate change conservation planning relies heavily on correlative species distribution models that estimate future areas of occupancy based on environmental conditions encountered in present-day ranges. The approach benefits from rapid assessment of vulnerability over a large number of organisms, but can have poor predictive power when transposed to novel environments and reveals little in the way of causal mechanisms that define changes in species distribution or abundance. Having conservation planning rely largely on this single approach also increases the risk of policy failure. Mechanistic models that are parameterized with physiological information are expected to be more robust when extrapolating distributions to future environmental conditions and can identify physiological processes that set range boundaries. Implementation of mechanistic species distribution models requires knowledge of how environmental change influences physiological performance, and because this information is currently restricted to a comparatively small number of well-studied organisms, use of mechanistic modelling in the context of climate change conservation is limited. In this review, we propose that the need to develop mechanistic models that incorporate physiological data presents an opportunity for physiologists to contribute more directly to climate change conservation and advance the field of conservation physiology. We begin by describing the prevalence of species distribution modelling in climate change conservation, highlighting the benefits and drawbacks of both mechanistic and correlative approaches. Next, we emphasize the need to expand mechanistic models and discuss potential metrics of physiological performance suitable for integration into mechanistic models. We conclude by summarizing other factors, such as the need to consider demography, limiting broader application of mechanistic models in climate change conservation. Ideally, modellers, physiologists and

Conservative management in ureteric hydronephrosis due to deep endometriosis: Could the levonorgestrel-intrauterine device be an option?

Science.gov (United States)

Simón, Elisa; Tejerizo, Álvaro; Muñoz, José Luis; Álvarez, Carmen; Marqueta, Laura; Jiménez, Jesús S

2017-07-01

Endometriosis can affect up to 10% of women of reproductive age, in a wide range of clinical presentations that vary from mild to severe or deep endometriosis. Deep endometriosis can affect the urinary tract in 1-5% to 15-25% cases. Even though deep endometriosis' surgeries are usually complex with higher rate of complications, conservative management is not always considered as an option because of its high failure rates. This paper describes two cases of deep endometriosis with ureteric involvement (hydronephrosis) treated conservatively with a double-pigtail stent plus a Levonorgestrel intrauterine device, after conservative surgery, who remained symptom free with no evidence of recurrence at 3 years follow-up, avoiding radical high-risk surgery. Impact statement Several treatments have been described for endometriosis. From a symptomatic perspective, conservative medical management has been proposed with a variable response. Concerning deep endometriosis (affecting the urinary or digestive tract), the definitive treatment has always been thought to be radical surgery. However, this can lead to several complications. To illustrate a possible more conservative approach this paper describes two cases of deep infiltrating endometriosis affecting the ureter, treated conservatively with a temporary pigtail ureter stent plus a Levonorgestrel intrauterine device. The management demonstrates that, in a selected population, conservative treatment solves the urinary disease avoiding the surgical complications and, what is more, improving patients' symptoms in a permanent way. Further prospective studies are needed to confirm whether the introduction of this management in clinical practice would reduce the need for surgery thereby, avoiding high-risk surgery and improving the success rate of conservative management.

Ten-year results of the treatment of early-stage breast carcinoma in elderly women using breast-conserving surgery and definitive breast irradiation

International Nuclear Information System (INIS)

Solin, Lawrence J.; Schultz, Delray J.; Fowble, Barbara L.

1995-01-01

Purpose: The optimal management of breast cancer in elderly women is not well established. Therefore, the present study was undertaken to evaluate the outcome of breast cancer in elderly women treated with breast-conserving surgery and definitive breast irradiation. Methods and Materials: An analysis was performed of 558 women age ≥ 50 years treated with breast-conserving surgery and definitive breast irradiation for Stages I-II invasive carcinoma of the breast. Of the 558 total women, there were 173 elderly women age ≥ 65 years and a comparison group of 385 women age 50-64 years. Treatment for all women included complete gross excision of the primary tumor, pathologic axillary lymph node staging, and definitive breast irradiation. Adjuvant systemic chemotherapy was used in 18% (102 out of 558) of the overall group. Adjuvant tamoxifen was used in 17% (94 out of 558) of the overall group. The median follow-up after treatment was 6.2 years (mean = 6.4 years; range 0.1-15.4 years). Results: Elderly patients age ≥ 65 years and patients age 50-64 years were both found to have tumors with adverse prognostic features, including clinical T2 lesions (43 vs. 34%, respectively; p = 0.055), estrogen receptor negativity (9 vs. 16%, respectively; p = 0.13), and progesterone receptor negativity (17 vs. 21%, respectively; p = 0.50). Pathologic axillary lymph node staging showed that 24% of the elderly women were node positive, including 8% with four or more positive nodes, which was not different from women age 50-64 years (p = 0.23). There was no difference between the two age groups for the rate of deaths from breast cancer at 10 years (13 vs. 13%, respectively; p = 0.71). However, there was a significant difference between the two age groups for the rate of deaths from intercurrent disease at 10 years (11 vs. 2%, respectively; p = 0.0006). There were no differences between the two age groups for the 10-year rates of overall survival (77 vs. 85%, respectively; p = 0

Breast cancer screening-opportunistic use of registry and linked screening data for local evaluation.

Science.gov (United States)

Roder, David; Farshid, Gelareh; Gill, Grantley; Kollias, Jim; Koczwara, Bogda; Karapetis, Chris; Adams, Jacqui; Joshi, Rohit; Keefe, Dorothy; Powell, Kate; Fusco, Kellie; Eckert, Marion; Buckley, Elizabeth; Beckmann, Kerri

2017-06-01

Screening has been found to reduce breast cancer mortality at a population level in Australia, but these studies did not address local settings where numbers of deaths would generally have been too low for evaluation. Clinicians, administrators, and consumer groups are also interested in local service outcomes. We therefore use more common prognostic and treatment measures and survivals to gain evidence of screening effects among patients attending 4 local hospitals for treatment. To compare prognostic, treatment, and survival measures by screening history to determine whether expected screening effects are occurring. Employing routine clinical registry and linked screening data to investigate associations of screening history with these measures, using unadjusted and adjusted analyses. Screened women had a 10-year survival from breast cancer of 92%, compared with 78% for unscreened women; and 79% of screened surgical cases had breast conserving surgery compared with 64% in unscreened women. Unadjusted analyses indicated that recently screened cases had earlier tumor node metastasis stages, smaller diameters, less nodal involvement, better tumor differentiation, more oestrogen and progesterone receptor positive lesions, more hormone therapy, and less chemotherapy. Radiotherapy tended to be more common in screening participants. More frequent use of adjunctive radiotherapy applied when breast conserving surgery was used. Results confirm the screening effects expected from the scientific literature and demonstrate the value of opportunistic use of available registry and linked screening data for indicating to local health administrations, practitioners, and consumers whether local screening services are having the effects expected. © 2016 John Wiley & Sons, Ltd.

Should breast density influence patient selection for breast-conserving surgery?

Science.gov (United States)

Kapoor, Nimmi S; Eaton, Anne; King, Tari A; Patil, Sujata; Stempel, Michelle; Morris, Elizabeth; Brogi, Edi; Morrow, Monica

2013-02-01

In a previous study of the relationship between breast density and primary tumor features, we observed a higher mastectomy rate in patients with extremely dense breasts. Here we examine possible reasons for this finding. Data were obtained from a prospectively maintained database of 1,056 invasive breast cancer patients from January 2005 to June 2007. Mammographic density was assigned by Breast Imaging-Reporting and Data System (BI-RADS) classification. Initial and final surgical procedures, and patient and tumor variables were recorded. Breast-conserving surgery (BCS) was attempted in 758 patients (72 %), 385 (51 %) of whom had preoperative magnetic resonance imaging (MRI). Initial BCS was less common among patients with the highest (BI-RADS 4) breast density compared to patients with less-dense breasts (52 vs. 74 %; p mastectomy compared to patients with less-dense breasts. After initial BCS, 387 patients (51 %) had positive shaved margins, 96 (25 %) of whom converted to mastectomy. MRI did not correlate with the rate of positive margins overall or among those with dense breasts. Adjusting for clinical and pathologic variables, density did not predict margin status or conversion to mastectomy. In a multivariate model, age, histologic grade, extensive intraductal component, and multicentricity/multifocality were independently associated with conversion to mastectomy. Density alone seems to influence the decision to proceed with initial mastectomy. When BCS was attempted, breast density was not associated with positive margins or conversion to mastectomy. A benefit of MRI in decreasing positive margins was not observed. These data do not support the use of breast density as a selection criterion for BCS.

TMJ surgery following orthognathic surgery: A case series

Directory of Open Access Journals (Sweden)

C. Politis

2018-06-01

Full Text Available Orthognathic surgery may affect or cause temporomandibular joint (TMJ complaints. This study evaluated the need for TMJ surgery after orthognathic surgery.A retrospective cohort study was carried out on 630 consecutive patients undergoing at least a Le Fort I or bilateral sagittal split osteotomy (BSSO. The mean follow-up time was 2,3 years. Clinical, surgical and radiographic findings were collected.Ten of the 630 patients (1.6% had additional arthroscopic TMJ-surgery in one (9 or in both (1 joints because of internal derangement, resistant to conventional therapy. Only 4/10 patients had successful outcomes following arthroscopic surgery. One patient with unsuccessful outcome required multiple additional open TMJ-surgeries, all remaining ineffective to relieve pain and restricted mouth opening. If arthroscopy failed to relieve symptoms (5/10 patients, further conservative management was opted. Arthroscopy seemed effective mainly in patients without pre-existing TMJ complaints.A further five of the 630 patients (0.8% required more treatment because of bilateral postoperative condylar resorption, but none of them required TMJ-surgery.In contrast to patients with bilateral condylar resorption where the skeletal relapse remained the issue of concern, patients with internal derangement/osteoarthrosis exhibited major occlusal changes in one patient only (1/10, leaving the TMJ complaints as the main concern. Keywords: Sagittal split osteotomy, Le Fort I osteotomy, Orthognathic surgery, Condylar remodelling, Condylar resorption, Osteoarthrosis, Internal derangement, Relapse, Arthroscopy

Locoregional Recurrence of Breast Cancer in Patients Treated With Breast Conservation Surgery and Radiotherapy Following Neoadjuvant Chemotherapy

International Nuclear Information System (INIS)

Min, Sun Young; Lee, Seung Ju; Shin, Kyung Hwan; Park, In Hae; Jung, So-Youn; Lee, Keun Seok; Ro, Jungsil; Lee, Seeyoun; Kim, Seok Won; Kim, Tae Hyun; Kang, Han-Sung; Cho, Kwan Ho

2011-01-01

Purpose: Breast conservation surgery (BCS) and radiotherapy (RT) following neoadjuvant chemotherapy (NCT) have been linked with high locoregional recurrence (LRR) rates and ipsilateral breast tumor recurrence (IBTR) rates. The purpose of this study was to analyze clinical outcomes in patients who exhibited LRR and IBTR after being treated by BCS and RT following NCT. Methods and Materials: In total, 251 breast cancer patients treated with BCS and RT following NCT between 2001 and 2006 were included. All patients had been shown to be clinically node-positive. Clinical stage at diagnosis (2003 AJCC) was II in 68% of patients and III in 32% of patients. Of those, 50%, 35%, and 15% of patients received anthracycline-based, taxane-based, and combined anthracycline-taxane NCT, respectively. All patients received RT. Results: During follow-up (median, 55 months), 26 (10%) patients had LRR, 19 of these patients had IBTR. Five-year actuarial rates of IBTR-free and LRR-free survival were 91% and 89%, respectively. In multivariate analyses, lack of hormone suppression therapy was found to increase both LRR and IBTR rates. Hazard ratios were 7.99 (p < 0.0001) and 4.22 (p = 0.004), respectively. Additionally, pathology stage N2 to N3 increased LRR rate (hazard ratio, 4.22; p = 0.004), and clinical AJCC stage III IBTR rate (hazard ratio, 9.05; p = 0.034). Achievement of pathological complete response and presence of multifocal tumors did not affect LRR or IBTR. Conclusions: In patients with locally advanced disease, who were clinically node-positive at presentation, BCS after NCT resulted in acceptably low rates of IBTR and LRR. Mastectomy should be considered as an option in patients who present with clinical stage III tumors or who are not treated with adjuvant hormone suppression therapy, because they exhibit high IBTR rates after NCT and BCS.

Locoregional Recurrence of Breast Cancer in Patients Treated With Breast Conservation Surgery and Radiotherapy Following Neoadjuvant Chemotherapy

Energy Technology Data Exchange (ETDEWEB)

Min, Sun Young [Center for Breast Cancer, Research Institute and Hospital, National Cancer Center, Goyang (Korea, Republic of); Department of Surgery, Kyung Hee University, Seoul (Korea, Republic of); Lee, Seung Ju [Center for Breast Cancer, Research Institute and Hospital, National Cancer Center, Goyang (Korea, Republic of); Shin, Kyung Hwan, E-mail: radiat@ncc.re.kr [Center for Breast Cancer, Research Institute and Hospital, National Cancer Center, Goyang (Korea, Republic of); Proton Therapy Center, Research Institute and Hospital, National Cancer Center, Goyang (Korea, Republic of); Park, In Hae; Jung, So-Youn; Lee, Keun Seok; Ro, Jungsil; Lee, Seeyoun; Kim, Seok Won [Center for Breast Cancer, Research Institute and Hospital, National Cancer Center, Goyang (Korea, Republic of); Kim, Tae Hyun [Proton Therapy Center, Research Institute and Hospital, National Cancer Center, Goyang (Korea, Republic of); Kang, Han-Sung [Center for Breast Cancer, Research Institute and Hospital, National Cancer Center, Goyang (Korea, Republic of); Cho, Kwan Ho [Proton Therapy Center, Research Institute and Hospital, National Cancer Center, Goyang (Korea, Republic of)

2011-12-01

Purpose: Breast conservation surgery (BCS) and radiotherapy (RT) following neoadjuvant chemotherapy (NCT) have been linked with high locoregional recurrence (LRR) rates and ipsilateral breast tumor recurrence (IBTR) rates. The purpose of this study was to analyze clinical outcomes in patients who exhibited LRR and IBTR after being treated by BCS and RT following NCT. Methods and Materials: In total, 251 breast cancer patients treated with BCS and RT following NCT between 2001 and 2006 were included. All patients had been shown to be clinically node-positive. Clinical stage at diagnosis (2003 AJCC) was II in 68% of patients and III in 32% of patients. Of those, 50%, 35%, and 15% of patients received anthracycline-based, taxane-based, and combined anthracycline-taxane NCT, respectively. All patients received RT. Results: During follow-up (median, 55 months), 26 (10%) patients had LRR, 19 of these patients had IBTR. Five-year actuarial rates of IBTR-free and LRR-free survival were 91% and 89%, respectively. In multivariate analyses, lack of hormone suppression therapy was found to increase both LRR and IBTR rates. Hazard ratios were 7.99 (p < 0.0001) and 4.22 (p = 0.004), respectively. Additionally, pathology stage N2 to N3 increased LRR rate (hazard ratio, 4.22; p = 0.004), and clinical AJCC stage III IBTR rate (hazard ratio, 9.05; p = 0.034). Achievement of pathological complete response and presence of multifocal tumors did not affect LRR or IBTR. Conclusions: In patients with locally advanced disease, who were clinically node-positive at presentation, BCS after NCT resulted in acceptably low rates of IBTR and LRR. Mastectomy should be considered as an option in patients who present with clinical stage III tumors or who are not treated with adjuvant hormone suppression therapy, because they exhibit high IBTR rates after NCT and BCS.

Craniofacial Surgery Fellowship Websites.

Science.gov (United States)

Silvestre, Jason; Agarwal, Divyansh; Taylor, Jesse A

2016-06-01

Applicants for craniofacial surgery fellowships utilize Internet-based resources like the San Francisco (SF) Match to manage applications. The purpose of this study was to evaluate the accessibility and content of craniofacial surgery fellowship websites (CSFWs). A list of available craniofacial surgery fellowships was compiled from directories of the American Society of Craniofacial Surgery (ACSFS) and SF Match. Accessibility of CSFWs was assessed via links from these directories and a Google search. Craniofacial surgery fellowship websites were evaluated on education and recruitment content and compared via program characteristics. Twenty-four of the 28 US-based craniofacial surgery fellowship programs had a CSFW (86%). The ACSFS and SF Match databases had limited CSFW accessibility, but a Google search revealed most CSFWs had the top search result (76%). In total, CSFWs provided an average of 39% of education and recruitment variables. While most programs provided fellowship program descriptions (96%), application links (96%), and faculty listings (83%), relatively few provided rotation schedules (13%), fellow selection process information (13%), or interview dates (8%). CSFW content did not vary by program location, faculty size, accreditation status, or institutional affiliations (P > 0.05). Craniofacial surgery fellowships often lack readily accessible websites from national program lists and have limited information for interested applicants. The consistent lack of online information across programs suggests future opportunities exist to improve these educational resources.

Community Forestry and Forest Conservation

DEFF Research Database (Denmark)

Milhøj, Anders; Casse, Thorkil

2011-01-01

This paper is a meta-study of local forest management experiences in developing countries drawn from a review of 56 case-studies presented in 52 papers. Many case-studies report positive links between community forestry and forest conservation. In international organizations and NGOs there is a g......This paper is a meta-study of local forest management experiences in developing countries drawn from a review of 56 case-studies presented in 52 papers. Many case-studies report positive links between community forestry and forest conservation. In international organizations and NGOs...

Basics of LASIK Eye Surgery

Science.gov (United States)

... Vea esta página en español The Basics of LASIK Eye Surgery Share This Page Facebook Twitter Linked- ... Surgery Surgical Alternatives to LASIK For More Information  LASIK Basics If you wear glasses or contact lenses, ...

Breast conserving therapy: the role of surgery

International Nuclear Information System (INIS)

Dongen, J.A. van

1994-01-01

Breast conserving therapy generally is considered to be a safe alternative to mastectomy in a large proportion of operable breast cancer patients. Small tumor size, wide excisions, absence of vascular invasion and of extensive intraductal component are prognosticators for therapy success. Good results depend on technique and on patient selection. For some tumor situations specific therapy modifications are under investigation. (author)

Radical vs. Conservative Surgical Treatment of Hepatic Hydatid Cyst: A 10- Year Experience

Directory of Open Access Journals (Sweden)

M Ghaemi

2009-07-01

Full Text Available Introduction: Hepatic hydatid cyst is caused by echinococcosis granulosis. It is a major health problem in endemic areas. The modern treatment of hydatid cysts of the liver varies from surgical intervention to percutaneous drainage or medical therapy. A high rate of complications following percutaneous drainage, and ineffectiveness of medical therapy have shown not to be the definitive treatments for the disease. Thus, surgery is still the best choice for the treatment of hydatid cyst of the liver. Surgical treatment methods can be divided into radical and conservative approaches. There is controversy regarding efficacy of the two surgical methods. In this study, we aimed to present a retrospective evaluation of the two surgical methods in patients treated for the hepatic hydatid cyst. Methods: This retrospective study reviewed medical records of 135 patients who underwent surgery for hepatic hydatid cyst from 1997 to 2007. Surgery comprised conservative methods (evacuation of the cyst content and excision of the inner cyst layers and radical methods (total excision of the cyst and removal of its outer layer. Results: One hundred thirty five patients underwent liver surgery. Conservative surgery was performed for 71 (53%, whereas, the remaining 64 patients (47% underwent radical surgery. Postoperative complications were 28% and 19%, respectively. Recurrence of the cyst in the conservative and radical surgery groups was noted to be 12.5 and 1.5%, respectively. The mean length of hospital stay was shorter in the radical surgery group (5 vs. 15 days. Conclusion: Radical surgery may be the preferred treatment for the hepatic hydatid cyst because of its low rate of postoperative complications and recurrence, as well as short hospital stay. Selection of the most appropriate treatment depends on the size, number, and location of the cyst(s, and presence of cystobiliary communications, and the availability of an experienced surgeon.

Perfusionist strategies for blood conservation in pediatric cardiac surgery.

Science.gov (United States)

Durandy, Yves

2010-02-26

There is increasing concern about the safety of homologous blood transfusion during cardiac surgery, and a restrictive transfusion practice is associated with improved outcome. Transfusion-free pediatric cardiac surgery is unrealistic for the vast majority of procedures in neonates or small infants; however, considerable progress has been made by using techniques that decrease the need for homologous blood products or even allow bloodless surgery in older infants and children. These techniques involve a decrease in prime volume by downsizing the bypass circuit with the help of vacuum-assisted venous drainage, microplegia, autologous blood predonation with or without infusion of recombinant (erythropoietin), cell salvaging, ultrafiltration and retrograde autologous priming. The three major techniques which are simple, safe, efficient, and cost-effective are: a prime volume as small as possible, cardioplegia with negligible hydric balance and circuit residual blood salvaged without any alteration. Furthermore, these three techniques can be used for all the patients, including emergencies and small babies. In every pediatric surgical unit, a strategy to decrease or avoid blood bank transfusion must be implemented. A strategy to minimize transfusion requirement requires a combined effort involving the entire surgical team with pre-, peri-, and postoperative planning and management.

[Conservative treatment of idiopathic scoliosis with physical therapy and orthoses].

Science.gov (United States)

Weiss, H-R

2003-02-01

Opinions differ in the international literature about the efficacy of conservative approaches to scoliosis treatment. Because this divergence of opinion corresponds to a great discrepancy in the standards applied to conservative treatment methods, it is not astonishing that the results of conservative treatment as described in the literature also differ. Scoliosis normally does not have such dramatic effects that immediate surgery would be indicated.Moreover, it is clear from the published literature that it is the functional and physiological impairments of scoliosis patients--including pain, torso deformity, psychological disturbance, and pulmonary dysfunction--which require therapeutic intervention. In Germany the triad of outpatient physiotherapy, intensive inpatient rehabilitation, and bracing has proven effective in conservative scoliosis treatment.Indication, content, and results of the individual treatment procedures are described and discussed. The positive outcomes of this practice validate a policy of offering conservative scoliosis treatment as an alternative to patients, including those for whom surgery is indicated.

[Blood conservation effect and safety of shed mediastinal blood autotransfusion after cardiac surgery].

Science.gov (United States)

Komiya, T; Ban, K; Yamazaki, K; Date, O; Nakamura, T; Kanzaki, Y

1998-10-01

Autotransfusion of shed mediastinal blood after cardiac surgery has been used to reduce risks related to homologous blood transfusions. To document the efficacy and safety of autotransfusion, we compared clinical findings of 80 patients receiving shed mediastinal blood (autotransfusion group) with those of the control group of 52 patients. The amount of the autotransfusion was limited to 800 ml, given the potentially harmful effects of shed blood transfusion. The mean transfused shed volume was 314 +/- 236 ml (S.D.). The serum levels of FDP-E, D-dimer and TAT after autotransfusion were higher in the autotransfusion group than in the control group (p = 0.01, p = 0.0004, p = 0.001, respectively). However, postoperative blood loss and the rate of reexploration for bleeding were similar in the two groups. The patients receiving blood products were fewer in the autotransfusion group than those in the control group (21% vs 44%; p = 0.005). Autotransfusion did not increase postoperative complications, including infection. Thus, although autotransfusion of mediastinal shed blood has the potential to affect hemostasis, unless the amount of autotransfusion exceeds 800 ml, it appears that this method is clinically safe and effective as a mean of blood conservation.

Superior Mesenteric Artery Syndrome: An Infrequent Complication of Scoliosis Surgery

Directory of Open Access Journals (Sweden)

Metin Keskin

2014-01-01

Full Text Available Superior mesenteric artery syndrome is a rare condition that causes a proximal small intestinal obstruction due to contraction of the angle between the superior mesenteric artery and the aorta. Scoliosis surgery is one of the 15 reasons for superior mesenteric artery syndrome, which can present with acute or chronic manifestations. Although conservative treatment is usually possible, surgical treatment is required in certain cases that cannot be treated using conservative methods. In this paper, we describe a patient who developed superior mesenteric artery syndrome after scoliosis surgery and was treated with duodenojejunostomy due to failure and complications of conservative treatment.

Method of localization and implantation of the lumpectomy site for high dose rate brachytherapy after conservative surgery for T1 and T2 breast cancer

International Nuclear Information System (INIS)

Perera, F.; Chisela, F.; Engel, J.; Venkatesan, V.

1995-01-01

Purpose: This article describes our technique of localization and implantation of the lumpectomy site of patients with T1 and T2 breast cancer. Our method was developed as part of our Phase I/II pilot study of high dose rate (HDR) brachytherapy alone after conservative surgery for early breast cancer. Methods and Materials: In March 1992, we started a pilot study of HDR brachytherapy to the lumpectomy site as the sole radiotherapy after conservative surgery for clinical T1 or T2 invasive breast cancer. Initially, the protocol required intraoperative placement of the interstitial needles at the time of definitive surgery to the breast. The protocol was then generalized to allow the implantation of the lumpectomy site after definitive surgery to the breast, either at the time of subsequent axillary nodal dissection or postoperatively. To date, five patients have been implanted intraoperatively at the time of definitive breast surgery. Twelve patients were implanted after definitive breast surgery, with 7 patients being done at the time of axillary nodal dissection and 5 patients postoperatively. We devised a method of accurately localizing and implanting the lumpectomy site after definitive breast surgery. The method relies on the previous placement of surgical clips by the referring surgeon to mark the lumpectomy site. For each patient, a breast mold is made with radio-opaque angiocatheters taped onto the mold in the supero-inferior direction. A planning CT scan is then obtained through the lumpectomy site. The volume of the lumpectomy site, the number of implant planes necessary, and the orientation of the implants are then determined from the CT scan. The angiocatheters provide a reference grid on the CT films to locate the entry and exit points of the interstitial needles on the plastic mold. The entry and exit points for reference needles are then transferred onto the patient's skin enabling implantation of the lumpectomy site. Needle positions with respect to

Conservative approach to rectosigmoid endometriosis

DEFF Research Database (Denmark)

Egekvist, Anne G; Marinovskij, Edvard; Forman, Axel

2017-01-01

INTRODUCTION: The aim of the study was to assess the risk of surgery after initial conservative treatment of rectosigmoid endometriosis in relation to demographic data. MATERIAL AND METHODS: The study was conducted on the tertiary endometriosis referral unit, Aarhus University Hospital. Medical...

Long-term quality of life after conservative treatment versus surgery for different stages of acute sigmoid diverticulitis.

Science.gov (United States)

Brandlhuber, Martina; Genzinger, Christian; Brandlhuber, Bernhard; Sommer, Wieland H; Müller, Mario H; Kreis, Martin E

2018-03-01

It is controversial whether patients fare better with conservative or surgical treatment in certain stages of acute diverticulitis (AD), in particular when phlegmonous inflammation or covered micro- or macro-perforation are present. The aim of this study was to determine long-term quality of life (QoL) for AD patients who received either surgery or conservative treatment in different stages. We included patients treated for AD at the University Hospital Grosshadern, Munich, Germany, between January 1, 2000, and December 31, 2010. Patients were classified by the Hansen and Stock (HS) classification, the modified Hinchey classification, and the German classification of diverticular disease (CDD). Pre-therapeutic staging was based on multidetector computed tomography. Long-term QoL was assessed by the Cleveland Global Quality of Life (CGQL) questionnaire, the Short Form 36 (SF-36), and the Gastrointestinal Quality of Life Index (GIQLI). Data are mean ± SEM. Patients with phlegmonous AD (HS type 2a, Hinchey Ia and CDD 1b, respectively) had a better long-term QoL on the GIQLI when they were operated (78.5 ± 2.5 vs. 70.7 ± 2.1; p life, patients fare better after elective sigmoid colectomy when abscess size exceeds 1 cm.

Cosmetic results in early stage breast cancer patients with high-dose brachytherapy after conservative surgery

International Nuclear Information System (INIS)

Torres, Felipe; Pineda, Beatriz E

2004-01-01

Purpose: to reveal cosmetic results in patients at early stages of low risk breast cancer treated with partial accelerated radiotherapy using high dose rate brachytherapy. Methods and materials: from March 2001 to July 2003,14 stages l and ll breast cancer patients were treated at the Colombian national cancer institute in Bogota with conservative surgery and radiotherapy upon the tumor bed (partial accelerated radiotherapy), using interstitial implants with iridium 192 (high dose rate brachytherapy) with a dose of 32 Gys, over 4 days, at 8 fractions twice a day. Results: with an average follow up of 17.7 months, good cosmetic results were found among 71.4 % of patients and excellent results among 14.3% of patients, furthermore none of the patients neither local nor regional or distant relapses. Conclusion: among patients who suffer from breast cancer at early stages, it showed is possible to apply partial accelerated radiotherapy upon the tumor bed with high doses over 4 days with good to excellent cosmetic results

Real-time 3-dimensional virtual reality navigation system with open MRI for breast-conserving surgery

International Nuclear Information System (INIS)

Tomikawa, Morimasa; Konishi, Kozo; Ieiri, Satoshi; Hong, Jaesung; Uemura, Munenori; Hashizume, Makoto; Shiotani, Satoko; Tokunaga, Eriko; Maehara, Yoshihiko

2011-01-01

We report here the early experiences using a real-time three-dimensional (3D) virtual reality navigation system with open magnetic resonance imaging (MRI) for breast-conserving surgery (BCS). Two patients with a non-palpable MRI-detected breast tumor underwent BCS under the guidance of the navigation system. An initial MRI for the breast tumor using skin-affixed markers was performed immediately prior to excision. A percutaneous intramammary dye marker was applied to delineate an excision line, and the computer software '3D Slicer' generated a real-time 3D virtual reality model of the tumor and the puncture needle in the breast. Under guidance by the navigation system, marking procedures were performed without any difficulties. Fiducial registration errors were 3.00 mm for patient no.1, and 4.07 mm for patient no.2. The real-time 3D virtual reality navigation system with open MRI is feasible for safe and accurate excision of non-palpable MRI-detected breast tumors. (author)

Body image of Greek breast cancer patients treated with mastectomy or breast conserving surgery.

Science.gov (United States)

Anagnostopoulos, Fotios; Myrgianni, Spyridoula

2009-12-01

The aim of this study was to assess and compare the body image of breast cancer patients (n = 70) whom underwent breast conserving surgery or mastectomy, as well as to compare patients' scores with that of a sample of healthy control women (n = 70). A secondary objective of this study was to examine the reliability and validity of the 10-item Greek version of the Body Image Scale, a multidimensional measure of body image changes and concerns. Exploratory and confirmatory factor analyses on the items of this scale resulted in a two factor solution, indicating perceived attractiveness, and body and appearance satisfaction. Comparison of the two surgical groups revealed that women treated with mastectomy felt less attractive and more self-conscious, did not like their overall appearance, were dissatisfied with their scar, and avoided contact with people. Hierarchical regression analysis showed that more general body image concerns were associated with belonging to the mastectomy group, compared to the cancer-free group of women. Implications for clinical practice and recommendations for future investigations are discussed.

Tumour bed boost radiotherapy for women after breast-conserving surgery.

Science.gov (United States)

Kindts, Isabelle; Laenen, Annouschka; Depuydt, Tom; Weltens, Caroline

2017-11-06

Breast-conserving therapy, involving breast-conserving surgery followed by whole-breast irradiation and optionally a boost to the tumour bed, is a standard therapeutic option for women with early-stage breast cancer. A boost to the tumour bed means that an extra dose of radiation is applied that covers the initial tumour site. The rationale for a boost of radiotherapy to the tumour bed is that (i) local recurrence occurs mostly at the site of the primary tumour because remaining microscopic tumour cells are most likely situated there; and (ii) radiation can eliminate these causative microscopic tumour cells. The boost continues to be used in women at high risk of local recurrence, but is less widely accepted for women at lower risk. Reasons for questioning the boost are twofold. Firstly, the boost brings higher treatment costs. Secondly, the potential adverse events are not negligible. In this Cochrane Review, we investigated the effect of the tumour bed boost on local control and side effects. To assess the effects of tumour bed boost radiotherapy after breast-conserving surgery and whole-breast irradiation for the treatment of breast cancer. We searched the Cochrane Breast Cancer Specialised Register, the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE (January 1966 to 1 March 2017), Embase (1980 to 1 March 2017), the World Health Organization International Clinical Trials Registry Platform, and ClinicalTrials.gov on 1 March 2017. We also searched the European Society of Radiotherapy and Oncology Annual Meeting, the St Gallen Oncology Conferences, and the American Society for Radiation Oncology Annual Meeting for abstracts. Randomised controlled trials comparing the addition and the omission of breast cancer tumour bed boost radiotherapy. Two review authors (IK and CW) performed data extraction and assessed risk of bias using Cochrane's 'Risk of bias' tool, resolving any disagreements through discussion. We entered data into Review Manager 5 for

Indicators for surgery in adhesive bowel obstruction.

Science.gov (United States)

Rajanikmanth, P V; Kate, V; Ananthakrishnan, N

2001-01-01

There is lack of data on risk factors, which, if present, would indicate the need for surgery in patients with adhesive bowel obstruction. A Cohort of 100 consecutive patients with adhesive obstruction was studied prospectively to compare clinical and investigative parameters between the operative and conservative group. It was found that female gender, previous obstetric or gynaecological procedures, pulse and BP on admission, nature of nasogastric aspirate, single distended loop on abdominal x-ray as also predominant ileal distension were independent factors indicating a high probability of surgical intervention. Patients with 2 or more risk factors had 12 times higher probability of surgery and in those with 3 or more the relative risk was 30 times. Patients with such risk factors should be monitored closely after admission and should be taken for surgery after an initial short trial of conservative measures.

Soft Tissue Sarcoma: A Prognostic Variables and Treatment Outcomes after Chemo - Radiotherapy and Conservative Surgery

International Nuclear Information System (INIS)

Abaza, A.; El-Shanshoury, H.

2015-01-01

Soft tissue sarcomas (STS) constitute a group of rare and heterogeneous cancers, that diverse a wide spectrum of histology and varied clinical behavior. The aim was to study, retrospectively the clinico-epidemiologic manifestation, response to therapy and prognostic factors of retroperitoneal (RPS), extremity and other STS patients treated with conservative surgery plus chemo - radiotherapy (CRT) attending the Pediatric Oncology Clinic, National Cancer Institute (NCI), Cairo University during 6 years period (inclusive). Files of 66 STS patients were revised for history, staging, investigations, treatment modalities and outcome of therapy. Their ages ranged from 6 months to 21 years. The male to female ratio was 1.87:1. Most of the patients belong to stage 3 and 1. Radiotherapy (RTH) and surgery remains the backbone of the multi - modality treatment plan. Complete remission (CR) was obtained in 80.3% of STS patients. Meanwhile, 6% of cases had disease progression and 6% died. The 2 - years overall survival rate (OS) and Disease - free survivals (DFS) we re 74.2% and 57.6% respectively. However, 20.8% of patients develop relapse>2 years after the end of treatment. Age at diagnosis, stage of the disease, tumor mass, pathological subtype and the RTH used were statistically significant prognostic variables affecting survival. Finally, the use of RTH in the treatment of STS gives positive impact on the survival of patients. Recommendation regarding further studies would be required to identify methods of increasing the radiation dose selectively. Also, using the newly developed radiation technologies to make dose escalation and sparing normal tissue

Linking pipefishes and seahorses to their habitat: implications for species conservation in the Venice lagoon

Directory of Open Access Journals (Sweden)

Luca Scapin

2015-11-01

Full Text Available Seagrass meadows of the Venice lagoon (Northern Adriatic Sea, Italy are spatially heterogeneous systems, with attributes such as degree of coverage and plant assemblages varying along multiple environmental gradients. They play a particularly relevant role in conservation of fish diversity, since they provide vital habitats for pipefish and seahorse species (family Syngnathidae. Aim of the study was to investigate the diversity of syngnathid assemblages in the Venice lagoon and link species distributions to habitat characteristics, in order to evaluate the importance of seagrass meadows of the lagoon for the conservation of these species. The analyses of this work are based on eight years of fish data collected between 2001 and 2014 in 186 shallow water sites across the entire lagoon. Water parameters, presence of macroalgae, seagrass presence and coverage, as well as meadows species composition, were considered as predictors in a modelling framework, to explain the distribution of each species. Overall, two species of seahorses and seven species of pipefishes including the Adriatic endemism Syngnathus taenionotus were found. Three species (S. abaster, S. typhle and Nerophis ophidion were the most abundant, together accounting for 98% of total individuals caught. Both seagrass presence and its coverage resulted significant predictors, with densities of S. abaster, S. typhle, N. ophidion and Hippocampus guttulatus being positively associated with higher percentages of seagrass cover. In addition, some evidences suggested a different functionality of different meadow types in supporting both S. typhle and N. ophidion. The study highlighted the role of Venice lagoon as biodiversity hotspot for syngnathids, since it supports nine out of the 10 species known in the Mediterranean (with only S. phlegon being absent. Results also suggested the importance of habitat management, which should aim at compensating for seagrass habitat loss and therefore

Clinical outcome and cosmetics in breast cancer patients treated with conservative surgery and radiotherapy

International Nuclear Information System (INIS)

Li Rongqing; Jin Yening; Wang Yajie

2005-01-01

Objective: To evaluate the effectiveness and the cosmetics result of radiotherapy after conservative surgery for early breast cancer. Methods: Altogether 109 patients were treated by post-operative whole-breast irradiation and a tumor bed boost from May, 1995 to December, 2002. Among them 79 cases received a brachytherapy boost ( 192 Ir HDR implant Nucletron ) of 10-12 Gy(DB) by single plan of implantation with 1.5 cm between the needles for T1 and double plan for T2-4 tumors, and 30 cases received an electron beam boost with 15 Gy. External beam irradiation was applied to the whole breast with 45-52 Gy(mean 48.6 Gy) in 25 fractions over 5 weeks followed or concurrently with chemotherapy (CMF or CEF) and hormonotherapy. The cosmetic result was scored by a doctor and patients via questionnaire. Results: The median follow-up time was 52 months. The actuarial 5-year overall survival rate was 93.8% using Kaplan-Meier method and the within breast recurrence rate was 6.5%. No radiation- induced ulcer in the breast occurred except acute inflammation of skin around the pinholes in 5 patients. Cosmetic results were scored to be good by patients and the doctor (81% and 87%, respectively) for 75 followed-up cases, and good cosmetic rate was reported by the doctor for 82% (39/48) of the cases treated with brachytherapy boost and 85.2%(23/27) for those treated with external beam boost. There was no difference in cosmetic results between these two groups(P>0.05). Conclusion: In patients at high risk for local recurrence, tumor-bed boost with brachytherapy or electron beam carried out after limited surgery and external radiotherapy can provide satisfactory local control without morbidity. Cosmetic result may not be influenced by the boost technique. (authors)

Nursing Approach Based on Roy Adaptation Model in a Patient Undergoing Breast Conserving Surgery for Breast Cancer.

Science.gov (United States)

Ursavaş, Figen Erol; Karayurt, Özgül; İşeri, Özge

2014-07-01

The use of models in nursing provides nurses to focus on the role of nursing and its applications rather than medical practice. In addition, it helps patient care to be systematic, purposeful, controlled and effective. One of the commonly used models in nursing is Roy Adaptation Model. According to Roy adaptation model, the aim of nursing is to increase compliance and life expectancy. Roy Adaptation Model evaluates the patient in physiologic mode, self-concept mode, role function mode and interdependence mode aiming to provide holistic care. This article describes the use of Roy Adaptation Model in the care of a patient who has been diagnosed with breast cancer and had breast-conserving surgery. Patient data was evaluated in the four modes of Roy adaptation model (physiologic, self-concept, role function, and interdependence modes) and the nursing process was applied.

Magnetic resonance imaging-guided navigation with a thermoplastic shell for breast-conserving surgery.

Science.gov (United States)

Abe, M; Kiryu, T; Sonoda, K; Kashiki, Y

2011-11-01

The aim of this study was to evaluate the accuracy of a magnetic resonance imaging (MRI) marking technique with a drape-type thermoplastic shell for planning breast-conserving surgery (BCS). A prospective review was performed on 35 consecutive patients who underwent MRI in the supine position and used the specified MRI marking technique. Eleven cases underwent pre-operative chemotherapy and 24 cases did not. After immobilizing the breast mound with a drape-type thermoplastic shell, patients underwent MRI, and the location of the lesion was marked on the shell. Resection lines were dyed blue by indigo carmine, which was pushed through the pores of the shell. Specimens obtained during BCS were sliced into 5-mm contiguous sections, and the margin was assessed for each specimen. Cancer foci less than 5 mm from the margin were classified as positive. Of 35 patients, 33 were included in the analysis; 2 were excluded due to a lack of effect of pre-operative chemotherapy. Of these 33 patients, 25 (75.8%) had negative margins and 7 (21.2%) had positive margins. Our MRI marking technique may be useful for evaluating the extent of tumors that were determined by MRI alone. Long-term outcomes of this technique should be evaluated further. Copyright © 2011 Elsevier Ltd. All rights reserved.

The value of radiotherapy in breast-conserving treatment

International Nuclear Information System (INIS)

Kurtz, J.M.

1994-01-01

Breast conserving treatment owes its legitimacy to the ability of radiotherapy (RT), in conjunction with limited surgery, to provide local control equivalent to that associated with total mastectomy. This paper will be concerned exclusively with the treatment of the breast, since indications for RT of lymph node areas are independent of the type of breast surgery employed. Randomized trials have enabled quantitation of the effect of reduction in recurrence risk compared to surgery alone. Even though local recurrence is a predictor of metastatic disease, its prevention by breast RT has not yet been shown to improve survival. Thus the main benefits of breast RT relate to preventing the consequences of local failure, namely breast loss. With modern RT techniques, cosmetic results should be satisfactory in 90% of preserved breast. The main clinical research areas concern the optimal sequencing of surgery, RT and chemotherapy, the improvement of local control in high-risk patients, the extension of breast conservation to more advanced cases by the use of neo-adjuvant chemotherapy and RT, the identification of early-stage patients who could be treated with wide excision alone, and the value of RT in ductal in situ carcinomas. (author)

Conservative approach to the acute management of a large mesenteric cyst.

Science.gov (United States)

Leung, Billy C; Sankey, Ruth; Fronza, Matteo; Maatouk, Mohamed

2017-09-16

Mesenteric cysts are rare, benign gastrointestinal cystic lesions, which are often non-troublesome and present as an incidental radiological finding. However, surgery is often performed in the acute setting to remove lesions that are symptomatic. This report highlights the case of a large, symptomatic mesenteric cyst managed successfully with initial conservative measures followed by planned elective surgery. A 44-year-old female presented with a four-day history of generalised abdominal pain associated with distension, fever, diarrhoea and vomiting. Computer tomography revealed a large (21.7 cm × 11.8 cm × 14 cm) mesenteric cyst within the left abdomen cavity. She was admitted and treated conservatively with intravenous fluids and antibiotics for four days, which lead to complete symptom resolution. Follow-up at intervals of one and three months revealed no return of symptoms. An elective laparotomy and excision of the mesenteric cyst was then scheduled and performed safely at nine months after the initial presentation. Compared to acute surgery, acute conservative management followed by planned elective resection of a symptomatic mesenteric cyst may prove safer. The withholding of an immediate operation may potentially avoid unnecessary operative risk and should be considered in patients without obstructive and peritonitic symptoms. Our case demonstrated the safe use of initial conservative management followed by planned elective surgery of a mesenteric cyst found in the acute setting, which was symptomatic but was not obstructive or causing peritonitic symptoms.

Evolution of apomixis loci in Pilosella and Hieracium (Asteraceae) inferred from the conservation of apomixis-linked markers in natural and experimental populations

Science.gov (United States)

Hand, M L; Vít, P; Krahulcová, A; Johnson, S D; Oelkers, K; Siddons, H; Chrtek, J; Fehrer, J; Koltunow, A M G

2015-01-01

The Hieracium and Pilosella (Lactuceae, Asteraceae) genera of closely related hawkweeds contain species with two different modes of gametophytic apomixis (asexual seed formation). Both genera contain polyploid species, and in wild populations, sexual and apomictic species co-exist. Apomixis is known to co-exist with sexuality in apomictic Pilosella individuals, however, apomictic Hieracium have been regarded as obligate apomicts. Here, a developmental analysis of apomixis within 16 Hieracium species revealed meiosis and megaspore tetrad formation in 1 to 7% of ovules, for the first time indicating residual sexuality in this genus. Molecular markers linked to the two independent, dominant loci LOSS OF APOMEIOSIS (LOA) and LOSS OF PARTHENOGENESIS (LOP) controlling apomixis in Pilosella piloselloides subsp. praealta were screened across 20 phenotyped Hieracium individuals from natural populations, and 65 phenotyped Pilosella individuals from natural and experimental cross populations, to examine their conservation, inheritance and association with reproductive modes. All of the tested LOA and LOP-linked markers were absent in the 20 Hieracium samples irrespective of their reproductive mode. Within Pilosella, LOA and LOP-linked markers were essentially absent within the sexual plants, although they were not conserved in all apomictic individuals. Both loci appeared to be inherited independently, and evidence for additional genetic factors influencing quantitative expression of LOA and LOP was obtained. Collectively, these data suggest independent evolution of apomixis in Hieracium and Pilosella and are discussed with respect to current knowledge of the evolution of apomixis. PMID:25026970

Results of conservative surgery and radiation for mammographically detected ductal carcinoma in situ (DCIS)

International Nuclear Information System (INIS)

Fowble, B.; Hanlon, A.L.; Fein, D.A.; Hoffman, J.P.; Sigurdson, E.R.; Patchefsky, A.; Kessler, H.

1996-01-01

Purpose: The role of conservative surgery and radiation for mammographically detected DCIS is controversial. In particular, there is a paucity of data for outcome with radiation in a group of patients comparable to those treated with local excision and surveillance (mammographically detected DCIS ≤2.5 cm, negative resection margins, negative post-biopsy mammogram). The purpose of this study is to report long term outcome of conservative surgery and radiation for mammographically detected DCIS with emphasis on the results in patients (pts.) considered candidates for excision alone. Materials and Methods: From 1983 to 1992, 110 women with mammographically detected DCIS (calcifications 72%, mass ± calcifications 27%) and no prior history of breast cancer underwent needle localization biopsy followed by radiation. The median age of the patient population was 56 yrs. (range 37-81). The median followup was 5.3 yrs. (range .5-12). Re-excision was performed in 55%. Final margins of resection were negative in 62%, positive 7%, close 11%, and unknown 20%. Axillary dissection was performed in 31 pts. and all had negative nodes. 31% had a positive family history of breast cancer (1 affected relative-25 pts., two-7 pts., three-2 pts.). The most common predominant histologic subtype was comedo (54%) followed by cribriform (22%). The median pathologic tumor size was 8 mm (range 2 mm to 5 cm). A post-biopsy mammogram prior to radiation was performed in 46% of the patients. Radiation consisted of treatment to the entire breast (median 5000 cGy) with a boost to the primary site (97%) of an additional 1000 cGy. The median total dose to the primary site was 6040 cGy (range 5000 to 6660). Results: Three patients developed a recurrence in the treated breast at 52, 106, and 107 months. All 3 recurrences were invasive ductal cancers and all were treated with mastectomy. The location of the recurrence was in the same quadrant as the primary in 1 pt. and in a separate quadrant in 2 pts

A systematic review and meta-analysis of Harmonic technology compared with conventional techniques in mastectomy and breast-conserving surgery with lymphadenectomy for breast cancer

OpenAIRE

Clymer, Jeffrey; Cheng,Hang; Ferko,Nicole; Patel,Leena; Soleas,Ireena M; Cameron,Chris G; Hinoul,Piet

2016-01-01

Hang Cheng,1 Jeffrey W Clymer,1 Nicole C Ferko,2 Leena Patel,2 Ireena M Soleas,2 Chris G Cameron,2 Piet Hinoul1 1Ethicon Inc., Cincinnati, OH, USA; 2Cornerstone Research Group, Burlington, ON, Canada Background: Mastectomy and breast-conserving surgery (BCS) are important treatment options for breast cancer patients. A previous meta-analysis demonstrated that the risk of certain complications can be reduced with the Harmonic technology compared with conventional methods in mastectomy. However...

Local tumor control and cosmetic outcome following breast-conserving surgery and radiation up to a total dose of 56 Gy without boost in breast cancer patients

International Nuclear Information System (INIS)

Bayerl, A.

2001-01-01

Purpose: To evaluate overall survival, local tumor control and cosmetic outcome after breast-conserving surgery followed by radiotherapy without boost irradiation. Patients and Methods: In a retrospective study 270 breast cancer patients were treated with breast conserving surgery combined with a homogenous radiation of the tumor bearing breast up to a total dose of 56 Gy without local boost irradiation. Mean follow-up was 48 months. Local tumor control, side effects, cosmetic results and contentment with treatment were assessed using physical examinations and interviews based on a standardized questionnaire. Results: Cause-specific survival at 5 years after treatment was 88.3%, actuarial disease-free survival at 5 years was 76.1%. Within 23 to 78 months after treatment 12 patients suffered from ipsilateral breast recurrence. The actuarial freedom from local recurrence (single tumor manifestation) was 96.8% at 5 years after treatment, 89% at 10 years. The occurrence of local failures was not significantly correlated to tumor size, margins, grading, nodal status, age or lymphangiosis. 15.6% of the patients developed distant metastases. In all patients treatment was performed without interruption. Side effects were predominantly of mild degree, no severe side effects were detected. 73% of physicians and 81% of patients scored their cosmetic outcome as excellent or good. 93% of patients would again decide in favor of this procedure. Whereas, use of adjuvant chemotherapy as well as subcutaneous reconstruction of breast tissue did not significantly affect breast cosmesis, analysis demonstrated impaired cosmetic results related to a larger breast size. Conclusion: The data of this study show that tumor control achieved by breast conserving surgery in combination with a radiation technique up to a total dose of 56 Gy which omits boost irradiation is within the range of literature data. Side effects of the therapy were tolerable. The treatment displayed a good

Quality of life in patients with ductal carcinoma in situ of the breast treated with conservative surgery and postoperative irradiation.

Science.gov (United States)

Amichetti, M; Caffo, O; Arcicasa, M; Roncadin, M; Lora, O; Rigon, A; Zini, G; Armaroli, L; Coghetto, F; Zorat, P; Neri, S; Teodorani, N

1999-03-01

To evaluate the quality of life (QL) in patients with ductal carcinoma in situ of the breast treated with conservative surgery and postoperative irradiation. A self-completed questionnaire covering many disease-, symptom-, and treatment-specific issues was administered to 106 conservatively treated patients affected by non-infiltrating breast cancer. The questionnaire was based on a series of 34 items assessing five main fields of post-treatment adjustment: physical well being, sexual adaptation, aesthetic outcome, emotional/psychological well being, relational behaviour. Furthermore, the patients were requested to evaluate the degree of information provided by the medical staff concerning surgical procedures and radiation therapy, and to evaluate the effects of the treatment on their social and overall life. The questionnaire was completed by 83 patients (78%), who had a median follow-up of 54.5 months. This final sample had a median age of 50 years (range 29-88) at the time of treatment and 54 years (range 32-94) at the time of study. The patients claimed to be in good physical condition. Data relating to sexual life were provided by 93% of the sample. Some limitations in sexuality, some interference with sexual desire, and some modifications during intercourse were reported by 5, 6, and 5 patients, respectively. The subjective evaluations of the cosmetic results of the therapies were generally good. Only 13 patients (16%) reported the perception of a worsened body image. Forty-six percent of the sample (38 patients) declared that they felt tense, 48% (39 patients) nervous, 29% (38 patients) lonely, 59% (41 patients) anxious, and 41% (34 patients) depressed. Only seven patients (8%) declared that the treatment had had a bad effect on their social life, and 15 (18%) thought that their current life had been affected by the treatment. The amount of information received concerning the disease and treatment (surgery and radiotherapy) was considered sufficient by 79

Scoliosis in patients with Prader Willi Syndrome – comparisons of conservative and surgical treatment

Directory of Open Access Journals (Sweden)

Goodall Deborah

2009-05-01

Full Text Available Abstract In children with Prader Willi syndrome (PWS, besides growth hormone (GH therapy, control of the food environment and regular exercise, surgical treatment of scoliosis deformities seems the treatment of choice, even though the risks of spinal surgery in this specific population is very high. Therefore the question arises as to whether the risks of spinal surgery outweigh the benefits in a condition, which bears significant risks per se. The purpose of this systematic review of the Pub Med literature was to find mid or long-term results of spinal fusion surgery in patients with PWS, and to present the conservative treatment in a case study of nine patients with this condition. Methods Types of studies included; all kinds of studies; retrospective and prospective ones, which reported upon the outcome of scoliosis surgery in patients with PWS. Types of participants included: patients with scoliosis and PWS. Type of intervention: surgery. Search strategy for identification of the studies; Pub Med; limited to English language and bibliographies of all reviewed articles. Nine patients with PWS from our data-base treated conservatively have been found, being 19 years or over at the time this study has been performed. The results of conservative management are described and related to the natural history and treatment results found in the Pub Med review. Results From 2210 titles displayed in the Pub Med database with the key word being "Prader Willi syndrome", 5 different papers were displayed at the date of the search containing some information on the outcome of surgery and none appeared to contain a mid or long-term follow-up. The PWS patients treated conservatively from our series all stayed below 70° and some of which improved. Discussion If the curve of scoliosis patients with PWS can be kept within certain limits (usually below 70 degrees conservatively, this treatment seems to have fewer complications than surgical treatments. The

Studies on correlation of positive surgical margin with clinicopathological factors and prognoses in breast conserving surgery

International Nuclear Information System (INIS)

Nishimura, Reiki; Nagao, Kazuharu; Miyayama, Haruhiko

1999-01-01

Out of 484 cases with breast conserving surgery between April 1989 and March 1999, surgical procedures of 34 cases were changed to total mastectomy due to positive surgical margins. In this study we evaluated a clinical significance of surgical margin in relation to clinicopathological factors and prognoses. Ninety-nine cases (20.5%) had positive margins that were judged when cancer cells existed within 5 mm from margin. In multivariate analysis of factors for surgical margin, EIC-comedo status, ly, located site, proliferative activity, and age were significant and independent factors. Regarding local recurrence, positive margin, age, ER and proliferative activity were significant factors in multivariate analysis, especially in cases not receiving postoperative radiation therapy. Radiation therapy may be beneficial for patients with positive surgical margin. And patients with breast recurrence alone had significantly higher survival rates. Therefore, it is suggested that surgical margin may not reflect survival, although it is a significant factor for local recurrence. (author)

Studies on correlation of positive surgical margin with clinicopathological factors and prognoses in breast conserving surgery

Energy Technology Data Exchange (ETDEWEB)

Nishimura, Reiki; Nagao, Kazuharu; Miyayama, Haruhiko [Kumamoto City Hospital (Japan)

1999-09-01

Out of 484 cases with breast conserving surgery between April 1989 and March 1999, surgical procedures of 34 cases were changed to total mastectomy due to positive surgical margins. In this study we evaluated a clinical significance of surgical margin in relation to clinicopathological factors and prognoses. Ninety-nine cases (20.5%) had positive margins that were judged when cancer cells existed within 5 mm from margin. In multivariate analysis of factors for surgical margin, EIC-comedo status, ly, located site, proliferative activity, and age were significant and independent factors. Regarding local recurrence, positive margin, age, ER and proliferative activity were significant factors in multivariate analysis, especially in cases not receiving postoperative radiation therapy. Radiation therapy may be beneficial for patients with positive surgical margin. And patients with breast recurrence alone had significantly higher survival rates. Therefore, it is suggested that surgical margin may not reflect survival, although it is a significant factor for local recurrence. (author)

Dosimetric comparison of three intensity-modulated radiation therapies for left breast cancer after breast-conserving surgery.

Science.gov (United States)

Zhang, Huai-Wen; Hu, Bo; Xie, Chen; Wang, Yun-Lai

2018-05-01

This study aimed to evaluate dosimetric differences of intensity-modulated radiation therapy (IMRT) in target and normal tissues after breast-conserving surgery. IMRT five-field plan I, IMRT six-field plan II, and field-in-field-direct machine parameter optimization-IMRT plan III were designed for each of the 50 patients. One-way analysis of variance was performed to compare differences, and P mean dose (D mean ) for the heart (P optimization-IMRT plans III can reduce doses and volumes to the lungs and heart better while maintaining satisfying conformity index and homogeneity index of target. Nevertheless, plan II neglects target movements caused by respiration. In the same manner, plan III can substantially reduce MU and shorten patient treatment time. Therefore, plan III, which considers target movement caused by respiration, is a more practical radiation mode. © 2018 The Authors. Journal of Applied Clinical Medical Physics published by Wiley Periodicals, Inc. on behalf of American Association of Physicists in Medicine.

Climate, Carbon, Conservation and Communities

Energy Technology Data Exchange (ETDEWEB)

Vaugn, Kit; Brickell, Emily [WWF-UK (United Kingdom); Roe, Dilys; Reid, Hannah; Elliot, Jo

2007-07-01

The growing market for carbon offers great opportunities for linking greenhouse gas mitigation with conservation of forests and biodiversity, and the generation of local livelihoods. For these combined objectives to be achieved, strong governance is needed along with institutions that ensure poor people win, rather than lose out, from the new challenges posed by climate change. This briefing paper explores the opportunities from and limitations to carbon-based funds for conservation and development. It highlights mechanisms that may help secure benefits for climate, conservation and communities.

Effect of radiotherapy after breast-conserving surgery on 10-year recurrence and 15-year breast cancer death: meta-analysis of individual patient data for 10,801 women in 17 randomised trials

DEFF Research Database (Denmark)

Darby, S; McGale, P; Correa, C

2011-01-01

After breast-conserving surgery, radiotherapy reduces recurrence and breast cancer death, but it may do so more for some groups of women than for others. We describe the absolute magnitude of these reductions according to various prognostic and other patient characteristics, and relate the absolute...

Angiosarcoma after breast-conserving therapy: experience with hyperfractionated radiotherapy

International Nuclear Information System (INIS)

Feigenberg, Steven J.; Price Mendenhall, Nancy; Reith, John D.; Ward, Jon R.; Copeland, Edward M.

2002-01-01

Purpose: To report our promising results of hyperfractionated radiotherapy (RT) in conjunction with surgery for angiosarcoma occurring after breast-conserving therapy for early-stage breast cancer. Methods and Materials: Since 1997, 3 cases of angiosarcoma after breast-conserving therapy have been managed at the University of Florida. The histologic specimens in each case were reviewed and graded by one of us (J.D.R.). Results: Explosive growth of discolored skin lesions coincident with histologic evidence of angiosarcoma characterized all 3 cases but was preceded by a fairly indolent period (almost 2 years) of atypical vascular hyperplasia in 2 patients. All 3 patients were treated initially with radical surgery for the angiosarcoma, but extensive recurrences were noted within 1 to 2 months of surgery. Because of the extremely rapid growth noted before and after surgery, hyperfractionated RT was used. Two of the patients underwent planned resection after RT, and neither specimen demonstrated any evidence of high-grade angiosarcoma. All 3 patients were alive without any recurrent disease 22, 38, and 39 months after treatment. Conclusions: Hyperfractionated irradiation appears to be effective treatment for rapidly proliferating angiosarcoma. For previously untreated angiosarcoma, we now recommend hyperfractionated RT followed by surgery to enhance disease control and remove as much reirradiated tissue as possible

Relativistic helicity and link in Minkowski space-time

International Nuclear Information System (INIS)

Yoshida, Z.; Kawazura, Y.; Yokoyama, T.

2014-01-01

A relativistic helicity has been formulated in the four-dimensional Minkowski space-time. Whereas the relativistic distortion of space-time violates the conservation of the conventional helicity, the newly defined relativistic helicity conserves in a barotropic fluid or plasma, dictating a fundamental topological constraint. The relation between the helicity and the vortex-line topology has been delineated by analyzing the linking number of vortex filaments which are singular differential forms representing the pure states of Banach algebra. While the dimension of space-time is four, vortex filaments link, because vorticities are primarily 2-forms and the corresponding 2-chains link in four dimension; the relativistic helicity measures the linking number of vortex filaments that are proper-time cross-sections of the vorticity 2-chains. A thermodynamic force yields an additional term in the vorticity, by which the vortex filaments on a reference-time plane are no longer pure states. However, the vortex filaments on a proper-time plane remain to be pure states, if the thermodynamic force is exact (barotropic), thus, the linking number of vortex filaments conserves

[Temporo-mandibular joints and orthognathic surgery].

Science.gov (United States)

Bouletreau, P

2016-09-01

Temporo-Mandibular Joints (TMJ) and orthognathic surgery are closely linked. In the past, some authors have even described (with mixed results) the correction of some dysmorphosis through direct procedures on the TMJs. Nowadays, performing orthognathic surgery involves the TMJ in three different occasions: (1) TMJ disorders potentially responsible for dento-maxillary dysmorphosis, (2) effects of orthognathic surgery on TMJs, and (3) condylar positioning methods in orthognathic surgery. These three chapters are developed in order to focus on the close relationships between TMJ and orthognathic surgery. Some perspectives close this article. Copyright © 2016 Elsevier Masson SAS. All rights reserved.

[Thromboelastography and its use in cardiac surgery].

Science.gov (United States)

Ak, Koray; Atalan, Nazan; Tekeli, Atike; Işbir, Selim; Civelek, Ali; Emekli, Nesrin; Arsan, Sinan

2008-04-01

Thromboelastography is an alternative method to conventional coagulation tests for the general evaluation of hemostatic system. Cardiac surgery with cardiopulmonary bypass is accomplished by complex alterations of hemostasis, including acquired dysfunction of platelets, consumption coagulopathy and increased fibrinolysis. Despite major advances in blood conservation methods and perioperative care of the patients, transfusion rates in cardiac surgery remain high. Thromboelastography has an ability to assess almost all components of haemostatic system globally. Currently, thromboelastography is used with standard coagulation tests to decrease the microvascular bleeding and homologous blood transfusion in cardiac surgery with cardiopulmonary bypass. In this review, we aimed to discuss thromboelastography technology and its usage in cardiac surgery.

Rectum-conserving surgery in the era of chemoradiotherapy.

LENUS (Irish Health Repository)

Smith, F M

2012-01-31

BACKGROUND: A complete pathological response occurs in 10-30 per cent of patients with locally advanced rectal cancer undergoing neoadjuvant chemoradiotherapy (CRT). The standard of care has been radical surgery with high morbidity risks and the challenges of stomata despite the favourable prognosis. This review assessed minimalist approaches (transanal excision or observation alone) to tumours with a response to CRT. METHODS: A systematic review was performed using PubMed and Embase databases. Keywords included: \\'rectal\\

Quantifying the role of online news in linking conservation research to Facebook and Twitter.

Science.gov (United States)

Papworth, S K; Nghiem, T P L; Chimalakonda, D; Posa, M R C; Wijedasa, L S; Bickford, D; Carrasco, L R

2015-06-01

Conservation science needs to engage the general public to ensure successful conservation interventions. Although online technologies such as Twitter and Facebook offer new opportunities to accelerate communication between conservation scientists and the online public, factors influencing the spread of conservation news in online media are not well understood. We explored transmission of conservation research through online news articles with generalized linear mixed-effects models and an information theoretic approach. In particular, we assessed differences in the frequency conservation research is featured on online news sites and the impact of online conservation news content and delivery on Facebook likes and shares and Twitter tweets. Five percent of articles in conservation journals are reported in online news, and the probability of reporting depended on the journal. There was weak evidence that articles on climate change and mammals were more likely to be featured. Online news articles about charismatic mammals with illustrations were more likely to be shared or liked on Facebook and Twitter, but the effect of news sites was much larger. These results suggest journals have the greatest impact on which conservation research is featured and that news site has the greatest impact on how popular an online article will be on Facebook and Twitter. © 2015 Society for Conservation Biology.

Risk of Post-Discharge Venous Thromboembolism and Associated Mortality in General Surgery: A Population-Based Cohort Study Using Linked Hospital and Primary Care Data in England.

Science.gov (United States)

Bouras, George; Burns, Elaine Marie; Howell, Ann-Marie; Bottle, Alex; Athanasiou, Thanos; Darzi, Ara

2015-01-01

Trends towards day case surgery and enhanced recovery mean that postoperative venous thromboembolism (VTE) may increasingly arise after hospital discharge. However, hospital data alone are unable to capture adverse events that occur outside of the hospital setting. The National Institute for Health and Care Excellence has suggested the use of primary care data to quantify hospital care-related VTE. Data in surgical patients using these resources is lacking. The aim of this study was to measure VTE risk and associated mortality in general surgery using linked primary care and hospital databases, to improve our understanding of harm from VTE that arises beyond hospital stay. This was a longitudinal cohort study using nationally linked primary care (Clinical Practice Research Datalink, CPRD), hospital administrative (Hospital Episodes Statistics, HES), population statistics (Office of National Statistics, ONS) and National Cancer Intelligence Network databases. Routinely collected information was used to quantify 90-day in-hospital VTE, 90-day post-discharge VTE and 90-day mortality in adults undergoing one of twelve general surgical procedures between 1st April 1997 and 31st March 2012. The earliest postoperative recording of deep vein thrombosis or pulmonary embolism in CPRD, HES and ONS was counted in each patient. Covariates from multiple datasets were combined to derive detailed prediction models for VTE and mortality. Limitation included the capture of VTE presenting to healthcare only and the lack of information on adherence to pharmacological thromboprophylaxis as there was no data linkage to hospital pharmacy records. There were 981 VTE events captured within 90 days of surgery in 168005 procedures (23.7/1000 patient-years). Overall, primary care data increased the detection of postoperative VTE by a factor of 1.38 (981/710) when compared with using HES and ONS only. Total VTE rates ranged between 3.2/1000 patient-years in haemorrhoidectomy to 118

Intraoperative Boost Radiotherapy during Targeted Oncoplastic Breast Surgery: Overview and Single Center Experiences

Directory of Open Access Journals (Sweden)

Wolfram Malter

2014-01-01

Full Text Available Breast-conserving surgery followed by whole-breast irradiation is the standard local therapy for early breast cancer. The international discussion of reduced importance of wider tumor-free resection margins than “tumor not touching ink” leads to the development of five principles in targeted oncoplastic breast surgery. IORT improves local recurrence risk and diminishes toxicity since there is less irradiation of healthy tissue. Intraoperative radiotherapy (IORT can be delivered in two settings: an IORT boost followed by a conventional regimen of external beam radiotherapy or a single IORT dose. The data from TARGIT-A and ELIOT reinforce the conviction that intraoperative radiotherapy during breast-conserving surgery is a reliable alternative to conventional postoperative fractionated irradiation, but only in a carefully selected population at low risk of local recurrence. We describe our experiences with IORT boost (50 kV energy X-rays; 20 Gy in combination with targeted oncoplastic breast surgery in a routine clinical setting. Our experiences demonstrate the applicability and reliability of combining IORT boost with targeted oncoplastic breast surgery in breast-conserving therapy of early breast cancer.

CT planning of boost irradiation in radiotherapy of breast cancer after conservative surgery

International Nuclear Information System (INIS)

Messer, Peter M.; Kirikuta, Ion C.; Bratengeier, Klaus; Flentje, Michael

1997-01-01

Background and purpose: A study was performed to compare the accuracy of clinical treatment set-up and CT planning of boost irradiation in radiotherapy of breast cancer. Material and methods: Between September 1993 and October 1994, 45 women who underwent breast conserving surgery and irradiation containing a boost to the tumour bed were investigated. Prospective evaluation of CT planning of the boost was carried out. The target volume/boost field, electron energy and treatment set-up had been defined on the basis of clinical examination, initial and postsurgical mammograms by one radiotherapist. Next, a planning CT was performed in treatment position and a CT-based treatment plan was calculated according to a target volume defined by another radiotherapist. The clinical treatment set-up was imported into our computer planning system and the resulting isodose plots were compared with those from CT planning and reviewed critically. Results: The clinically defined treatment set-up had to be modified in 80% of the patients. Most discrepancies observed were related to the size of the boost field itself and the chosen electron energy. Minor changes had to be made with respect to angle of table and gantry. Conclusions: Critical review of the isodose plots from both methods showed clear advantages for CT planning. Guidelines for target definition in CT planning of boost irradiation and subgroups of patients benefiting from this technique are described

Conservation of transcription factor binding events predicts gene expression across species

Science.gov (United States)

Hemberg, Martin; Kreiman, Gabriel

2011-01-01

Recent technological advances have made it possible to determine the genome-wide binding sites of transcription factors (TFs). Comparisons across species have suggested a relatively low degree of evolutionary conservation of experimentally defined TF binding events (TFBEs). Using binding data for six different TFs in hepatocytes and embryonic stem cells from human and mouse, we demonstrate that evolutionary conservation of TFBEs within orthologous proximal promoters is closely linked to function, defined as expression of the target genes. We show that (i) there is a significantly higher degree of conservation of TFBEs when the target gene is expressed in both species; (ii) there is increased conservation of binding events for groups of TFs compared to individual TFs; and (iii) conserved TFBEs have a greater impact on the expression of their target genes than non-conserved ones. These results link conservation of structural elements (TFBEs) to conservation of function (gene expression) and suggest a higher degree of functional conservation than implied by previous studies. PMID:21622661

Preoperative autologous plateletpheresis in patients undergoing open heart surgery.

OpenAIRE

Tomar Akhlesh; Tempe Deepak; Banerjee A; Hegde R; Cooper A; Khanna S

2003-01-01

Blood conservation is an important aspect of care provided to the patients undergoing cardiac operations with cardiopulmonary bypass (CPB). It is even more important in patients with anticipated prolonged CPB, redo cardiac surgery, patients having negative blood group and in patients undergoing emergency cardiac surgery. In prolonged CPB the blood is subjected to more destruction of important coagulation factors, in redo surgery the separation of adhesions leads to increased bleeding and diff...

Timing of surgery for sciatica: Subgroup analysis alongside a randomized trial

NARCIS (Netherlands)

W.C. Peul (Wilco); M.P. Arts (Mark); R. Brand (René); B.W. Koes (Bart)

2009-01-01

textabstractSurgery speeds up recovery for sciatica. Prolonged conservative care with surgery for those patients with persistent sciatica however, yields similar results at 1 year. To investigate whether baseline variables modify the difference in recovery rates between these treatment strategies,

Gender-linked impact of epicardial adipose tissue volume in patients who underwent coronary artery bypass graft surgery or non-coronary valve surgery.

Science.gov (United States)

Maimaituxun, Gulinu; Shimabukuro, Michio; Salim, Hotimah Masdan; Tabata, Minoru; Yuji, Daisuke; Morimoto, Yoshihisa; Akasaka, Takeshi; Matsuura, Tomomi; Yagi, Shusuke; Fukuda, Daiju; Yamada, Hirotsugu; Soeki, Takeshi; Sugimoto, Takaki; Tanaka, Masashi; Takanashi, Shuichiro; Sata, Masataka

2017-01-01

Traditional and non-traditional risk factors for atherosclerotic cardiovascular disease (ASCVD) are different between men and women. Gender-linked impact of epicardial adipose tissue volume (EATV) in patients undergoing coronary artery bypass grafting (CABG) remains unknown. Gender-linked impact of EATV, abdominal fat distribution and other traditional ASCVD risk factors were compared in 172 patients (men: 115; women: 57) who underwent CABG or non-coronary valvular surgery (non-CABG). In men, EATV, EATV index (EATV/body surface area) and the markers of adiposity such as body mass index, waist circumference and visceral fat area were higher in the CABG group than in the non-CABG group. Traditional ASCVD risk factors were also prevalent in the CABG group. In women, EATV and EATV index were higher in the CABG group, but other adiposity markers were comparable between CABG and non-CABG groups. Multivariate logistic regression analysis showed that in men, CABG was determined by EATV Index and other ASCVD risk factors including hypertension, dyslipidemia, adiponectin, high sensitive C-reactive protein (hsCRP) and type 2 diabetes mellitus (Corrected R2 = 0.262, p EATV Index (Corrected R2 = 0.266, p = 0.005). Our study found that multiple risk factors, including epicardial adipose tissue volume and traditional ASCVD factors are determinants for CABG in men, but type 2 diabetes mellitus was the sole determinant in women. Gender-specific disparities in risk factors of CABG prompt us to evaluate new diagnostic and treatment strategies and to seek underlying mechanisms.

CT scanning may adversely influence choice of surgery in paediatric ...

African Journals Online (AJOL)

Kurt

with a thyroid mass. Computed tomography (CT) revealed a lesion, missed by ultrasonography, which reversed the decision to perform con- servative thyroid surgery. The lesion proved to be non-neoplastic. CT may be a useful adjunct when ultrasound demonstrates a solitary lesion and conservative surgery is considered,.

Cirurgia conservadora no câncer de mama Breast-conserving surgery for breast cancer

Directory of Open Access Journals (Sweden)

Daniel Guimarães Tiezzi

2007-08-01

Full Text Available O tratamento cirúrgico do câncer de mama sofreu expressivas mudanças nas últimas décadas. A cirurgia conservadora é o tratamento padrão para o câncer de mama em estádio inicial. Com a implementação dos programas de rastreamento e o uso emergente de tratamento sistêmico neoadjuvante, um crescente número de pacientes está sendo considerado elegível para o tratamento conservador. No entanto, uma série de fatores importantes merecem ser considerados no planejamento terapêutico destas pacientes. Esta revisão fornece uma visão geral da metodologia cirúrgica no tratamento conservador do carcinoma da mama.The surgical strategy for breast cancer treatment has changed considerably over the last decade. The breast conserving surgery (BCS is the standard treatment for early stage breast cancer nowadays. With the current population breast cancer screening programs and the emerging use of systemic neoadjuvant therapy, an increasing number of patients have been eligible to BCS. However, several specific factors must be considered for the therapeutic planning for these patients. This review provides a surgical methodology overview for the BCS in breast carcinoma.

Linking terrestrial and marine conservation planning and threats analysis.

Science.gov (United States)

Tallis, Heather; Ferdaña, Zach; Gray, Elizabeth

2008-02-01

The existence of the Gulf of Mexico dead zone makes it clear that marine ecosystems can be damaged by terrestrial inputs. Marine and terrestrial conservation planning need to be aligned in an explicit fashion to fully represent threats to marine systems. To integrate conservation planning for terrestrial and marine systems, we used a novel threats assessment that included 5 cross-system threats in a site-prioritization exercise for the Pacific Northwest coast ecoregion (U.S.A.). Cross-system threats are actions or features in one ecological realm that have effects on species in another realm. We considered bulkheads and other forms of shoreline hardening threats to terrestrial systems and roads, logging, agriculture, and urban areas threats to marine systems. We used 2 proxies of freshwater influence on marine environments, validated against a mechanistic model and field observations, to propagate land-based threats into marine sites. We evaluated the influence of cross-system threats on conservation priorities by comparing MARXAN outputs for 3 scenarios that identified terrestrial and marine priorities simultaneously: (1) no threats, (2) single-system threats, and (3) single- and cross-system threats. Including cross-system threats changed the threat landscape dramatically. As a result the best plan that included only single-system threats identified 323 sites (161,500 ha) at risk from cross-system threats. Including these threats changed the location of best sites. By comparing the best and sum solutions of the single- and cross-system scenarios, we identified areas ideal for preservation or restoration through integrated management. Our findings lend quantitative support to the call for explicitly integrated decision making and management action in terrestrial and marine ecosystems.

Aesthetic surgery of the male genitalia.

Science.gov (United States)

Alter, Gary J; Salgado, Christopher J; Chim, Harvey

2011-08-01

Appearance of the male genitalia is linked with self-esteem and sexual identity. Aesthetic surgery of the male genitalia serves to correct perceived deficiencies as well as physical deformities, which may cause psychological distress. Attention to patient motivation for surgery and to surgical technique is key to achieving optimal results. In this review, the authors describe aesthetic surgical techniques for treatment of penile and scrotal deficiencies. They also discuss techniques for revision in patients with previous surgery.

Understanding conservationists' perspectives on the new-conservation debate.

Science.gov (United States)

Holmes, George; Sandbrook, Chris; Fisher, Janet A

2017-04-01

A vibrant debate about the future direction of biodiversity conservation centers on the merits of the so-called new conservation. Proponents of the new conservation advocate a series of positions on key conservation ideas, such as the importance of human-dominated landscapes and conservation's engagement with capitalism. These have been fiercely contested in a debate dominated by a few high-profile individuals, and so far there has been no empirical exploration of existing perspectives on these issues among a wider community of conservationists. We used Q methodology to examine empirically perspectives on the new conservation held by attendees at the 2015 International Congress for Conservation Biology (ICCB). Although we identified a consensus on several key issues, 3 distinct positions emerged: in favor of conservation to benefit people but opposed to links with capitalism and corporations, in favor of biocentric approaches but with less emphasis on wilderness protection than prominent opponents of new conservation, and in favor of the published new conservation perspective but with less emphasis on increasing human well-being as a goal of conservation. Our results revealed differences between the debate on the new conservation in the literature and views held within a wider, but still limited, conservation community and demonstrated the existence of at least one viewpoint (in favor of conservation to benefit people but opposed to links with capitalism and corporations) that is almost absent from the published debate. We hope the fuller understanding we present of the variety of views that exist but have not yet been heard, will improve the quality and tone of debates on the subject. © 2016 The Authors. Conservation Biology published by Wiley Periodicals, Inc. on behalf of Society for Conservation Biology.

Original Article Surgical Margin Status after Breast Conservation ...

African Journals Online (AJOL)

KIGZ

analysis of breast surgery for breast cancer patients was done from 2008 to 2011 at Aga Khan. University ... early breast cancer, thus breast conservation therapy is becoming more available. Excision of the ... palpable nodes. Histology was ...

Tendril perversion-a physical implication of the topological conservation law

International Nuclear Information System (INIS)

Pieranski, Piotr; Baranska, Justyna; Skjeltorp, Arne

2004-01-01

Tendril perversion-a phenomenon ruled by the topological conservation law-is presented. A contemporary, quantitative analysis of the phenomenon is confronted with its qualitative, intuitive analysis carried out by Charles Darwin. The linking number, twist and writhe are defined. The topological conservation law is introduced. The Gauss formula for calculating the linking number and the Calugareanu formula for calculating writhe are derived and discussed using physical arguments

Tendril perversion-a physical implication of the topological conservation law

Energy Technology Data Exchange (ETDEWEB)

Pieranski, Piotr [Laboratory of Computational Physics and Semiconductors, Poznan University of Technology, Nieszawska 13A, 60 965 Poznan (Poland); Baranska, Justyna [Laboratory of Computational Physics and Semiconductors, Poznan University of Technology, Nieszawska 13A, 60 965 Poznan (Poland); Skjeltorp, Arne [Institute for Energy Technology, Kjeller (Norway)

2004-09-10

Tendril perversion-a phenomenon ruled by the topological conservation law-is presented. A contemporary, quantitative analysis of the phenomenon is confronted with its qualitative, intuitive analysis carried out by Charles Darwin. The linking number, twist and writhe are defined. The topological conservation law is introduced. The Gauss formula for calculating the linking number and the Calugareanu formula for calculating writhe are derived and discussed using physical arguments.

Conservation and Sustainable Development: Linking Practice and ...

International Development Research Centre (IDRC) Digital Library (Canada)

1 janv. 2012 ... Nous finançons des chercheurs qui inspirent des changements mondiaux. Abonnez-vous · Carrières · Communiquez avec nous · Désabonnez-vous · Plan du site. Suivez-nous; Facebook · Twitter · Youtube · Linked In · RSS Feed · Droits d'auteur · Éthique de la recherche · Politique de libre accès · Politique ...

Training in breast surgery in Spain.

Science.gov (United States)

Miguelena, José M; Domínguez Cunchillos, Fernando

2016-01-01

Breast surgery is a key part of training and competency in general surgery in Spain and is a "frontier area" that can be efficiently managed by general surgeons and gynecologists. The main objective of the training process consists of the surgical treatment of breast cancer, including conservative surgery, oncoplastic and reconstructive techniques. This article analyses the current status of breast surgery training in Spain and schematically proposes potential targets of the different training programs, to improve access and training for surgeons and residents in this area, taking into account the RD 639/2014 and European regulation. The priority is to specify the level of training that should be achieved, in relation to the group of professionals involved, considering their area of competency: surgery resident, educational programs, and surgeons with special dedication to this area. Copyright © 2016 AEC. Publicado por Elsevier España, S.L.U. All rights reserved.

Timing of surgery for sciatica: subgroup analysis alongside a randomized trial

Science.gov (United States)

Arts, Mark P.; Brand, Ronald; Koes, Bart W.

2009-01-01

Surgery speeds up recovery for sciatica. Prolonged conservative care with surgery for those patients with persistent sciatica however, yields similar results at 1 year. To investigate whether baseline variables modify the difference in recovery rates between these treatment strategies, baseline data of 283 patients enrolled in a randomized trial, comparing early surgery with prolonged conservative care, were used to analyse effect modification of the allotted treatment strategy. For predictors shown to modify the effect of the treatment strategy, repeated measurement analyses with the Roland Disability Questionnaire and visual analogue scale pain as continuous outcomes were performed for every level of that predictor. Presumed predictive variables did not have any interaction with treatment, while “sciatica provoked by sitting” showed to be a significant effect modifier (P = 0.07). In a Cox model we estimated a hazard ratio (HR, surgery versus conservative) of 2.2 (95% CI 1.7–3.0) in favour of surgery when sciatica was provoked by sitting, while the HR was 1.3 (95% CI 0.8–2.2) when this sign was absent. The interaction effect is marginally significant (interactions are usually tested at the 10% level) but the patterns generated by the repeated measurement analyses of all primary outcomes are completely consistent with the inferred pattern from the survival analysis. Classical signs did not show any contribution as decision support tools in deciding when to operate for sciatica, whereas treatment effects of early surgery are emphasized when sciatica is provoked by sitting and negligible when this symptom is absent. PMID:19132412

A prospective study of conservative surgery without radiation therapy in select patients with Stage I breast cancer

International Nuclear Information System (INIS)

Lim, May; Bellon, Jennifer R.; Gelman, Rebecca; Silver, Barbara B.A.; Recht, Abram; Schnitt, Stuart J.; Harris, Jay R.

2006-01-01

Purpose: The effectiveness of radiation therapy (RT) in reducing local recurrence after breast-conserving surgery (BCS) in unselected patients with early stage invasive breast cancer has been demonstrated in multiple randomized trials. Whether a subset of women can achieve local control without RT is unknown. In 1986, we initiated a prospective one-arm trial of BCS alone for highly selected breast-cancer patients. This report updates those results. Methods and Materials: Eighty-seven (of 90 planned) patients enrolled from 1986 until closure in 1992, when a predefined stopping boundary was crossed. Patients were required to have a unicentric, T1, pathologic node-negative invasive ductal, mucinous, or tubular carcinoma without an extensive intraductal component or lymphatic-vessel invasion. Surgery included local excision with margins of at least 1 cm or a negative re-excision. No RT or systemic therapy was given. Results: Results are available on 81 patients (median follow-up, 86 months). Nineteen patients (23%) had local recurrence (LR) as a first site of failure (average annual LR: 3.5 per 100 patient-years of follow-up). Other sites of first failure included 1 ipsilateral axilla, 2 contralateral breast cancers, and 4 distant metastases. Six patients developed other (nonbreast) malignancies. Nine patients have died, 4 of metastatic breast cancer and 5 of unrelated causes. Conclusions: Even in this highly selected cohort, a substantial risk of local recurrence occurred after BCS alone with margins of 1.0 cm or more. These results suggest that with the possible exception of elderly women with comorbid conditions, radiation therapy after BCS remains standard treatment

Pharmacological strategies for blood conservation in cardiac surgery: erythropoietin and antifibrinolytics.

Science.gov (United States)

Hardy, J F

2001-04-01

We review the clinically important benefits of the two principal pharmacological strategies, erythropoietin (EPO) and antifibrinolytics (aprotinin and lysine analogues), to decrease transfusion of allogeneic blood products (ABP) during and after cardiac surgery. Articles were selected from an ongoing review of the literature, with special attention to meta-analyses dealing with EPO and/or antifibrinolytics and cardiac surgery. The few studies available include a number of patients insufficient to allow definitive conclusions on the benefits of EPO in cardiac surgery. Further studies are required to determine the optimal dose of EPO and to compare its cost-effectiveness with other blood sparing strategies in this context. Both aprotinin and lysine analogues effectively decrease ABP transfusions and the incidence of re-thoracotomy. In addition, high-dose aprotinin reduces cerebrovascular morbidity and mortality after cardiopulmonary bypass. Several mechanisms have been put forward to explain these beneficial effects, some of which could well be common to all antifibrinolytics. The clinical benefits of aprotinin's unique anti-inflammatory effect are not entirely clear but the finding that it reduces the incidence of stroke and death is certainly a major argument in favor of its utilization. Yet, we have to ensure that aprotinin's benefits are not offset by side-effects such as allergy. We still need large scale studies to definitely confirm the benefits and exclude the deleterious effects of these drugs on outcomes other than ABP requirements. At present, aprotinin is the only agent that has been shown to reduce the risk of cerebrovascular accident and mortality after cardiac surgery in adults.

Transforming conservation science and practice for a postnormal world.

Science.gov (United States)

Colloff, Matthew J; Lavorel, Sandra; van Kerkhoff, Lorrae E; Wyborn, Carina A; Fazey, Ioan; Gorddard, Russell; Mace, Georgina M; Foden, Wendy B; Dunlop, Michael; Prentice, I Colin; Crowley, John; Leadley, Paul; Degeorges, Patrick

2017-10-01

We examine issues to consider when reframing conservation science and practice in the context of global change. New framings of the links between ecosystems and society are emerging that are changing peoples' values and expectations of nature, resulting in plural perspectives on conservation. Reframing conservation for global change can thus be regarded as a stage in the evolving relationship between people and nature rather than some recent trend. New models of how conservation links with transformative adaptation include how decision contexts for conservation can be reframed and integrated with an adaptation pathways approach to create new options for global-change-ready conservation. New relationships for conservation science and governance include coproduction of knowledge that supports social learning. New processes for implementing adaptation for conservation outcomes include deliberate practices used to develop new strategies, shift world views, work with conflict, address power and intergenerational equity in decisions, and build consciousness and creativity that empower agents to act. We argue that reframing conservation for global change requires scientists and practitioners to implement approaches unconstrained by discipline and sectoral boundaries, geopolitical polarities, or technical problematization. We consider a stronger focus on inclusive creation of knowledge and the interaction of this knowledge with societal values and rules is likely to result in conservation science and practice that meets the challenges of a postnormal world. © 2017 The Authors. Conservation Biology published by Wiley Periodicals, Inc. on behalf of Society for Conservation Biology.

Cosmetic Evaluation of long term results following intraoperative radiotherapy (IORT) of conservative surgery for breast carcinoma

International Nuclear Information System (INIS)

Fussl, C. M.

2009-01-01

Introduction In breast conserving therapy (BCT) of breast cancer, cosmetic results have become next to tumor-related outcome parameters a criterion of increasing awareness. The aim of this study is the evaluation of long term cosmetic results after conservative surgery and intraoperative radiotherapy with 10 Gy electrons (IOERT), followed by whole breast radiotherapy (WBRT) with 50-54 Gy. Patients and Methods From October 1998 to October 2005, 818 patients (median age 57.89 years) were treated by IOERT during breast conserving surgery, 12 of them for bilateral cancer. 32 patients were referred to mastectomy within primary treatment, 50 were reported as dead at the beginning of the study, 4 patients had developed an in-breast-recurrence and had been salvaged by secondary mastectomy, and in 41 cases an intercurrent dissemination was noted. All 679 remaining patients were invited in written form to participate in the cosmesis study. 403 of them (59.4%) have answered and were object of the evaluation (August 2006 to April 2007). To provide reproducible examination conditions, a standardized photo-documentation in four positions (frontal, loose-hanging and elevated arms; left and right lateral, elevated arms) was accomplished. Patients and treating physicians evaluated the cosmetic results separately within a 5-point-score (Excellent, Good, Moderate, Bad, Complications). Patient-, tumor- and treatment-related factors were investigated with regard to possible impact on the cosmetic outcome in all patients (group 1). A separate subgroup analysis was carried out for 261 patients with a follow-up of at least three years after completion of local treatment (group 2). For computation of the statistic correlation between the variables and the cosmetic evaluation the rank correlation coefficients Kendall's τ Spearman's ρ were used. A correlation is significant below a p-value of 0.05. Results The self-assessment of the patients in group 1 yielded around 69% excellent, 25

Mammographically detected ductal carcinoma in situ of the breast treated with breast-conserving surgery and definitive breast irradiation: long-term outcome and prognostic significance of patient age and margin status

International Nuclear Information System (INIS)

Solin, Lawrence J.; Fourquet, Alain; Vicini, Frank A.; Haffty, Bruce; Taylor, Marie; McCormick, Beryl; McNeese, Marsha; Pierce, Lori J.; Landmann, Christine; Olivotto, Ivo A.; Borger, Jacques; Kim, Jung-Soo; Rochefordiere, Anne de la; Schultz, Delray J.

2001-01-01

Purpose: This study was performed to determine the long-term outcome for women with mammographically detected ductal carcinoma in situ (DCIS; intraductal carcinoma) of the breast treated with breast-conserving surgery followed by definitive breast irradiation. Methods and Materials: An analysis was performed of 422 mammographically detected intraductal breast carcinomas in 418 women from 11 institutions in North America and Europe. All patients were treated with breast-conserving surgery followed by definitive breast irradiation. The median follow-up time was 9.4 years (mean, 9.4 years; range, 0.1-19.8 years). Results: The 15-year overall survival rate was 92%, and the 15-year cause-specific survival rate was 98%. The 15-year rate of freedom from distant metastases was 94%. There were 48 local failures in the treated breast, and the 15-year rate of any local failure was 16%. The median time to local failure was 5.0 years (mean, 5.7 years; range, 1.0-15.2 years). Patient age at the time of treatment and final pathology margin status from the primary tumor excision were both significantly associated with local failure. The 10-year rate of local failure was 31% for patient age ≤ 39 years, 13% for age 40-49 years, 8% for age 50-59 years, and 6% for age ≥ 60 years (p=0.0001). The 10-year rate of local failure was 24% when the margins of resection were positive, 9% when the margins of resection were negative, 7% when the margins of resection were close, and 12% when the margins of resection were unknown (p=0.030). Patient age ≤ 39 years and positive margins of resection were both independently associated with an increased risk of local failure (p=0.0006 and p=0.023, respectively) in the multivariable Cox regression model. Conclusions: The 15-year results from the present study demonstrated high rates of overall survival, cause-specific survival, and freedom from distant metastases following the treatment of mammographically detected ductal carcinoma in situ of the

Leaving the placenta in situ versus conservative and radical surgery in the treatment of placenta accreta spectrum disorders.

Science.gov (United States)

Kutuk, Mehmet S; Ak, Mehmet; Ozgun, Mahmut T

2018-03-01

To compare different treatment methods in the management of placenta accreta spectrum (PAS) disorders. In a retrospective cohort study, medical records were retrieved for patients who underwent elective surgery at 24 weeks of pregnancy or more after a diagnosis of PAS disorder (creta, increta, or percreta) at a center in Turkey between May 2, 2010, and August 10, 2016. The final analysis included patients whose diagnosis was confirmed intraoperatively and for whom complete data were available. Patients were divided into three groups: group 1 included those who underwent hysterectomy without placental removal, group 2 included patients whose placenta was left in situ, and group 3 included those who underwent placental removal and conservative surgery. Among 79 included patients (33 creta, 18 increta, 28 percreta), 27 (34%) were in group 1, 15 (19%) in group 2, and 37 (47%) in group 3. Total blood loss and the amounts of blood products transfused were lowest in group 2; significant differences between groups were noted (all P ≤ 0.001). Surgical complication rates were similar between groups (4/27 [15%], 1/15 [7%], and 11/37 [30%], respectively; P=0.119). Overall uterine preservation rates were not significantly different between groups 2 and 3 (14/15 [93%] vs 33/37 [89%]; P>0.99). Leaving the placenta in situ could become the treatment of choice for PAS disorders. © 2017 International Federation of Gynecology and Obstetrics.

Conservative management of epithelial ovarian cancer.

Science.gov (United States)

Dexeus, S; Labastida, R; Dexeus, D

2005-01-01

We are currently faced with a progressive delay in the age at which women conceive for the first time. This raises the possibility of the appearance of gynecologic disorders that may affect fertility, including neoplasms of the ovary. Fertility-sparing surgery is defined as the preservation of ovarian tissue in one or both adnexa and/or the uterus. Borderline ovarian tumor should be treated with conservative surgery. Salpingo-oophorectomy, or even ovarian cystectomy, are the procedures of choice, with recurrence rates of 2-3% and up to 20% if a simple cystectomy is performed. Cystectomy is indicated in patients with bilateral borderline tumors or in patients with a residual ovary. Borderline tumors with invasive peritoneal implants behave as an invasive cancer in 10-30% of cases with a survival rate of 10-66% compared with 100% in borderline tumors without invasive implants. Prophylactic oophorectomy is recommended when desire of conception has been accomplished. Conservative surgery in invasive epithelial ovarian cancer is limited to Stage IA, grade 1 tumor, and in some highly selected grade 2 tumors of serous, mucinous or endometrioid type, well-encapsulated and free of adhesions. The standard oncological surgical procedure with preservation of the uterus and normal appearing ovary is recommended. This includes salpingo-oophorectomy, excision of any suspicious peritoneal lesion, multiple peritoneal biopsies, appendectomy (particularly in mucinous tumors), and pelvic and paraaortic lymphadenectomy.

[Feasibility and cosmetic outcome of oncoplastic surgery in breast cancer treatment].

Science.gov (United States)

Sherwell-Cabello, Santiago; Maffuz-Aziz, Antonio; Villegas-Carlos, Felipe; Domínguez-Reyes, Carlos; Labastida-Almendaro, Sonia; Rodríguez-Cuevas, Sergio

2015-01-01

Breast cancer is the leading oncological cause of death in Mexican women over 25 years old. Given the need to improve postoperative cosmetic results in patients with breast cancer, oncoplastic surgery has been developed, which allows larger tumour resections and minor cosmetic alterations. To determine the oncological feasibility and cosmetic outcome of oncoplastic surgery at the Instituto de Enfermedades de la Mama, FUCAM, AC. A review was conducted from January 2010 to July 2013, which included patients with breast cancer diagnosis treated with conventional breast-conserving surgery or with oncoplastic surgery in the Institute of Diseases of the Breast, FUCAM AC. Clinical and histopathological parameters were compared between the two groups, and a questionnaire of cosmetic satisfaction and quality of life was applied. Of the 171 patients included, 95 of them were treated with conventional breast-conserving surgery and 76 with oncoplastic surgery. Pathological tumour size was significantly larger in patients treated with oncoplastic surgery (p = 0.002). There were no differences found between the groups as regards the number of patients with positive surgical margin, the rate of complications, and cosmetic satisfaction. This study demonstrates the oncological feasibility and high cosmetic satisfaction of oncoplastic surgery with minimal psycho-social impact on patients. Copyright © 2015 Academia Mexicana de Cirugía A.C. Published by Masson Doyma México S.A. All rights reserved.

A population-based study of the effectiveness of breast conservation for newly diagnosed breast cancer

International Nuclear Information System (INIS)

Paszat, Lawrence F.; Groome, Patti A.; Schulze, Karleen; Holowaty, Eric J.; Mackillop, William J.

2000-01-01

Purpose: Our objective was to evaluate the effectiveness of breast conservation for newly diagnosed breast cancer. Effectiveness was operationalized as two outcomes within 5 years of the diagnosis of breast cancer: the probability of mastectomy-free survival (either death or mastectomy count as event, whichever comes first), and the probability of mastectomy conditional on survival (mastectomy counts as event, observations censored at death). Methods and Materials: We linked records of 46,687 new cases of breast cancer from 1982 to 1991 in the Ontario Cancer Registry to records of surgery from 1982 to 1995, radiotherapy (RT) from 1982 to 1992, and median household income from the 1986 census. We labeled breast surgery within 4 months and postoperative RT within 12 months of diagnosis as treatment for newly diagnosed breast cancer. Surgery was categorized as mastectomy, lumpectomy plus RT, lumpectomy alone, or no surgical procedure. Among cases that did not undergo mastectomy within 4 months of diagnosis, we labeled mastectomy subsequent to 4 months after diagnosis as treatment failure. We performed life-table analysis and Cox proportional hazards regression, to describe the probability of mastectomy conditional on survival and the probability of mastectomy-free survival. Results: A total of 16,279 cases underwent lumpectomy as the maximum procedure on the breast within 4 months of diagnosis, and 49.7% of these received postoperative RT. Compared to the provincial mean, regions with higher rates of lumpectomy plus RT have higher probability of mastectomy-free survival and lower probability of mastectomy conditional upon survival 5 years after diagnosis of breast cancer. Conclusions: These findings are consistent with a hypothesis that breast conservation is effective in the overall breast cancer population of Ontario within the first 5 years after diagnosis

Factors determining esthetic outcome after breast cancer conservative treatment

DEFF Research Database (Denmark)

Cardoso, Maria J; Cardoso, Jaime; Santos, Ana C

2007-01-01

with lower body mass index (BMI) and premenopausal status obtained better cosmetic results. In the group of tumor- and treatment-related factors, larger removed specimens, clearly visible scars, the use of chemotherapy and longer follow-up period were associated with less satisfactory results......The aim of this study was to evaluate the factors that determine esthetic outcome after breast cancer conservative treatment, based on a consensual classification obtained with an international consensus panel. Photographs were taken from 120 women submitted to conservative unilateral breast cancer...... surgery (with or without axillary surgery) and radiotherapy. The images were sent to a panel of observers from 13 different countries and consensus on the classification of esthetic result (recorded as excellent, good, fair or poor) was obtained in 113 cases by means of a Delphi method. For each patient...

Local recurrences after conservative surgery and irradiation for breast cancer: Diagnosis with mammography and ultrasound. Mammographie und Sonographie in der Rezidivdiagnostik nach brusterhaltender Therapie des Mammakarzinoms

Energy Technology Data Exchange (ETDEWEB)

Buchberger, W; Hamberger, L; Schoen, G [Innsbruck Univ. (Austria). Universitaetsklinik fuer Radiodiagnostik; Steixner, G; Fritsch, E [Innsbruck Univ. (Austria). Universitaetsklinik fuer Strahlentherapie

1991-06-01

89 patients, who underwent conservative surgery for breast cancer were followed up with mammography and real-time sonography. 78 patients underwent postoperative irradiation. Depending on the time interval between irradiation and examination various alterations in mammographic and sonographic patterns were evident. Of 14 biospy-confirmed local recurrences, 11 were diagnosed by mammography and 12 by sonography. Combined use of mammography and sonography should therefore lead to better results in the diagnosis of local recurrences and to a reduction of unnecessary biopsies. (orig./GDG).

Perioperative blood transfusion and blood conservation in cardiac surgery: the Society of Thoracic Surgeons and The Society of Cardiovascular Anesthesiologists clinical practice guideline.

Science.gov (United States)

Ferraris, Victor A; Ferraris, Suellen P; Saha, Sibu P; Hessel, Eugene A; Haan, Constance K; Royston, B David; Bridges, Charles R; Higgins, Robert S D; Despotis, George; Brown, Jeremiah R; Spiess, Bruce D; Shore-Lesserson, Linda; Stafford-Smith, Mark; Mazer, C David; Bennett-Guerrero, Elliott; Hill, Steven E; Body, Simon

2007-05-01

A minority of patients having cardiac procedures (15% to 20%) consume more than 80% of the blood products transfused at operation. Blood must be viewed as a scarce resource that carries risks and benefits. A careful review of available evidence can provide guidelines to allocate this valuable resource and improve patient outcomes. We reviewed all available published evidence related to blood conservation during cardiac operations, including randomized controlled trials, published observational information, and case reports. Conventional methods identified the level of evidence available for each of the blood conservation interventions. After considering the level of evidence, recommendations were made regarding each intervention using the American Heart Association/American College of Cardiology classification scheme. Review of published reports identified a high-risk profile associated with increased postoperative blood transfusion. Six variables stand out as important indicators of risk: (1) advanced age, (2) low preoperative red blood cell volume (preoperative anemia or small body size), (3) preoperative antiplatelet or antithrombotic drugs, (4) reoperative or complex procedures, (5) emergency operations, and (6) noncardiac patient comorbidities. Careful review revealed preoperative and perioperative interventions that are likely to reduce bleeding and postoperative blood transfusion. Preoperative interventions that are likely to reduce blood transfusion include identification of high-risk patients who should receive all available preoperative and perioperative blood conservation interventions and limitation of antithrombotic drugs. Perioperative blood conservation interventions include use of antifibrinolytic drugs, selective use of off-pump coronary artery bypass graft surgery, routine use of a cell-saving device, and implementation of appropriate transfusion indications. An important intervention is application of a multimodality blood conservation program

Physical function and pain after surgical or conservative management of multiple rib fractures - a follow-up study.

Science.gov (United States)

Fagevik Olsén, Monika; Slobo, Margareta; Klarin, Lena; Caragounis, Eva-Corina; Pazooki, David; Granhed, Hans

2016-10-28

There is scarce knowledge of physical function and pain due to multiple rib fractures following trauma. The purpose of this follow-up was to assess respiratory and physical function, pain, range of movement and kinesiophobia in patients with multiple rib fractures who had undergone stabilizing surgery and compare with conservatively managed patients. A consecutive series of 31 patients with multiple rib fractures who had undergone stabilizing surgery were assessed >1 year after the trauma concerning respiratory and physical function, pain, range of movement in the shoulders and thorax, shoulder function and kinesiophobia. For comparison, 30 patients who were treated conservatively were evaluated with the same outcome measures. The results concerning pain, lung function, shoulder function and level of physical activity were similar in the two groups. The patients who had undergone surgery had a significantly larger range of motion in the thorax (p pain, better thoracic range of motion and physical function which would indicate that surgery is preferable. If operation technique could improve in the future with a less invasive approach, it would presumably decrease post-operative pain and the benefit of surgery would be greater than the morbidity of surgery. Patients undergoing surgery have a similar long-term recovery to those who are treated conservatively except for a better range of motion in the thorax and fewer limitations in physical function. Surgery seems to be beneficial for some patients, the question remains which patients. FoU i Sverige (R&D in Sweden), No 106121.

Survival and breast relapse in 3834 patients with T1-T2 breast cancer after conserving surgery and adjuvant treatment

International Nuclear Information System (INIS)

Livi, Lorenzo; Paiar, Fabiola; Saieva, Calogero; Scoccianti, Silvia; Dicosmo, Dora; Borghesi, Simona; Agresti, Benedetta; Nosi, Fabiano; Orzalesi, Lorenzo; Santini, Roberto; Barca, Raffaella; Biti, Giampaolo P.

2007-01-01

Purpose: The aim of the present analysis is to determine the long-term results in terms of breast relapse and specific survival in patients treated with conserving surgery and adjuvant treatment for early breast cancer. Methods: From January 1980 to December 2001, 3834 patients with pT1-T2 breast cancer were treated consecutively at the University of Florence. The median age of the patient population was 55 years (range 30-80). All patients were followed for a median of 7.4 years (range 0.6 year to 22.5 years). The crude probability of survival (or local recurrence) was estimated by using Kaplan-Meier method, and survival (or local recurrence) comparisons were carried out using Cox proportional hazard regression models. Results: The Cox regression model by stepwise selection showed some parameters, such as chemotherapy (HR 1.53; CI 1.19-1.95), pT status (HR 1.62, CI 1.31-2.01), positive axillary lymph nodes (HR 1.92, CI 1.66-2.22), and local recurrence (HR 4.58; CI 3.66-5.73), as independent prognostic factors for breast cancer death. Moreover, we found lower rate survival among patients treated before 1991 in comparison to women treated after 1991 (p = 0.0001) probably due to inadequate treatment. For local disease free survival, age at presentation (HR 0.47; CI 0.35-0.63), use of tamoxifen (HR 0.42; CI 0.25-0.71), surgical margins (HR 2.00; CI 1.21-3.30), and chemotherapy (HR 0.53; CI 0.31-0.91) emerged by multivariate analyses as significant breast relapse predictors. Conclusion: In our experience breast conserving surgery followed by adjuvant radiotherapy treatment gives high rates of local control in women with early breast cancer. The use of routinely adjuvant chemotherapy and hormone therapy lowered the local recurrence and probably the modification of therapeutic approach in the last decades also improved the specific survival

Conservation narratives and contested protected areas in Zambia: a ...

African Journals Online (AJOL)

Conservation narratives and contested protected areas in Zambia: a political ecological analysis. ... Mgbakoigba: Journal of African Studies ... This paper uses a political ecological perspective to examine the link between environmental conservation narratives and resource conflicts and degradation in Zambia's protected ...

Re-resection rates after breast-conserving surgery as a performance indicator: introduction of a case-mix model to allow comparison between Dutch hospitals.

Science.gov (United States)

Talsma, A K; Reedijk, A M J; Damhuis, R A M; Westenend, P J; Vles, W J

2011-04-01

Re-resection rate after breast-conserving surgery (BCS) has been introduced as an indicator of quality of surgical treatment in international literature. The present study aims to develop a case-mix model for re-resection rates and to evaluate its performance in comparing results between hospitals. Electronic records of eligible patients diagnosed with in-situ and invasive breast cancer in 2006 and 2007 were derived from 16 hospitals in the Rotterdam Cancer Registry (RCR) (n = 961). A model was built in which prognostic factors for re-resections after BCS were identified and expected re-resection rate could be assessed for hospitals based on their case mix. To illustrate the opportunities of monitoring re-resections over time, after risk adjustment for patient profile, a VLAD chart was drawn for patients in one hospital. In general three out of every ten women had re-surgery; in about 50% this meant an additive mastectomy. Independent prognostic factors of re-resection after multivariate analysis were histological type, sublocalisation, tumour size, lymph node involvement and multifocal disease. After correction for case mix, one hospital was performing significantly less re-resections compared to the reference hospital. On the other hand, two were performing significantly more re-resections than was expected based on their patient mix. Our population-based study confirms earlier reports that re-resection is frequently required after an initial breast-conserving operation. Case-mix models such as the one we constructed can be used to correct for variation between hospitals performances. VLAD charts are valuable tools to monitor quality of care within individual hospitals. Copyright © 2011 Elsevier Ltd. All rights reserved.

Locoregional control and survival after breast conserving therapy

International Nuclear Information System (INIS)

Rajer, M.; Majdic, E.

2006-01-01

Background. The purpose of our study was to present a 5-year survival and locoregional control rates in breast cancer patients and to establish eventual impact of the treatment and patient characteristics on locoregional control and survival. Methods. From January 1998 to December 1999 564 stage 1 and 2 breast cancer patients were treated with breast conserving therapy. We evaluated the following characteristics: age, histological diagnosis, grade, size, number of metastatic lymph nodes, hormonal receptor status, extensive intraductal component (EIDC), vascular invasion, pathologic tumour margins, type of surgery and use of adjuvant therapy. Results. The mean age of our patients was 54.2 years. Invasive ductal carcinoma was the most common diagnosis (82.4%), followed by invasive lobular carcinoma (10.6%). Most of the tumours were grade 2. Seventy-two % of patients had T1 tumours, 24% T2 and 3% T is tumours. Metastatic lymph nodes were present in 44% of patients. All patients were treated with breast conserving surgery followed by radiotherapy (RT). Fifty % of patients received adjuvant chemotherapy and/ or hormonal therapy. The 5-year survival rate was 88.5%. Tumour size, number of metastatic lymph nodes, grade, hormonal receptors and vascular invasion proved to be statistically significant prognostic factors for the survival, while age and histological diagnosis were not. Local recurrence developed in 4.3% of our patients, while in 3.4% regional recurrence developed. Conclusions. Breast conserving surgery followed by RT was associated with good rates of locoregional control and survival, comparable to those reported in the literature. (author)

The functional outcome of blow-out fractures managed surgically and conservatively

DEFF Research Database (Denmark)

Felding, Ulrik Ascanius; Rasmussen, Janne; Toft, Peter Bjerre

2016-01-01

of diplopia and enophthalmus was determined by reviewing the medical records. Data from the patients' initial consultation and their 3-month follow-up were also collected. Of the 60 patients whose data could be analysed, 36 had been managed surgically and 24 conservatively. Of the patients managed surgically......, 25 had diplopia in peripheral gaze before surgery and 12 at 3-month follow-up. Nine had diplopia in primary gaze before surgery and none at 3-month follow-up. Five had enophthalmus before surgery and two at 3-month follow-up. Of the patients managed conservatively, eight had diplopia in peripheral...... gaze initially and seven at 3-month follow-up. Three had diplopia in primary gaze initially and one at 3-month follow-up. One had enophthalmus initially which was still present at 3-month follow-up. Primary gaze diplopia disappeared while secondary gaze diplopia was present in about a third of patients...

Applying the dark diversity concept to nature conservation

DEFF Research Database (Denmark)

Lewis, Rob; de Bello, Francesco; A Bennett, Jonathan

2017-01-01

is currently an underappreciated source of information that is valuable for conservation applications ranging from macroscale conservation prioritization to more locally scaled restoration ecology and the management of invasive species. Introduction Conservation biology has strong scientific underpinnings (e...... to improve understanding of how biological diversity is governed and maintained. We illustrate our viewpoint by clarifying how measuring, monitoring, and understanding dark diversity can prove beneficial in the context of 3 facets of conservation biology: biodiversity conservation, habitat restoration......Linking diversity to biological processes is central for developing informed and effective conservation decisions. Unfortunately, observable patterns provide only a proportion of the information necessary for fully understanding the mechanisms and processes acting on a particular population...

Influence of surgery-radiotherapy interval on recurrence in breast-conserving treatment of small breast cancer

International Nuclear Information System (INIS)

Fourquet, A.; Dreyfus, H.; Maher, M.; Gozy, M.; Campana, F.; Vilcoq, J. R.; Colombani, H.

1995-01-01

Purpose: To retrospectively evaluate the possible influence of surgery-radiotherapy interval (SRI) on breast recurrence in patients (pts.) with small breast cancers who had a breast-conserving treatment. Materials and Methods: Between January 1981 and December 1988, of 2012 pts. with stage I-II breast cancers treated with wide excision, axillary node dissection and breast irradiation, 1839 (91%) did not received adjuvant chemotherapy and were included in this study. Median age was 51 yrs. [23-88]. Mean tumor size was 2.1 cm [0.5-5]. Median tumor bed irradiation dose was 65 Gy [50-90]. The median SRI was 32 days [5-137]. Pts. were distributed among three SRI groups: 56 days (61 pts). Breast recurrence risk and survival were determined by Kaplan-Meier estimates. The following prognostic factors were evaluated for their possible influence on breast recurrence: age, tumor size, node involvement, estrogen receptor levels, Bloom and Richardson grading (SBR). Therapeutic factors were also analyzed: place of surgery (inside or outside the institution), breast and tumor bed radiation dose, and SRI as a time-dependent variable. A multivariate analysis of breast recurrence risk was performed to adjust for the various confounding factors. A prognostic index was established and the influence of SRI on recurrence was determined within the various prognostic groups. Results: Median follow-up for living pts. was 78 months [3-158]. Breast recurrence rate at 7 years was 11 % [10-13]. The 7-year survival rate was 89 % [88-91]. The 7-year breast recurrence risks in the three SRI groups were 12 %, 9 %, and 18%, respectively (p=0.045). The relative risk (RR) of breast failure was significantly lower in the 35-56 days SRI group compared with the 56 days) were also associated with a higher risk of recurrence, though not statistically significant because of the small numbers. The effect of SRI was time-dependent, i. e. influencing early recurrences and disappearing after 5 years. It was

The role of trade-offs in biodiversity conservation planning: linking ...

Indian Academy of Sciences (India)

A recent whole-country planning study for Papua New Guinea illustrates the importance of complementarity-based trade-offs in determining priority areas for biodiversity conservation, and for designing economic instruments such as biodiversity levies and offsets. Two international biodiversity programs provide important ...

Comparative adequacy of surgery and radiation therapy in 175 T2 glottic carcinomas: 116 cases treated with surgery and 59 with radiation therapy

International Nuclear Information System (INIS)

Cellai, E.; Olmi, P.; Chiavacci, A.; Fallai, C.; Aulisi, L.; Bottai, G.A.; De Meester, W.

1991-01-01

The results were analyzed of 175 patients with glottic squamous cell carcinomas who were treated with curative purposes (1970-1986). Overall 10-year local control rates were 74% for the surgical series and 69% for the cases treated by radiation therapy. After salvage therapy 10-year survival rates were 83% and 76% respectively. The analysis of the results showed no statistically significant difference. In the group treated by radical surgery 80% local control was observed, versus 66% in the cases treated with conservative surgery. 10-year survival rate was higher in the latter group (89% versus 81%) because of better results of salvage therapy: 7 of 10 recurrences were salvaged with the second treatment. Several prognostic factors were evaluated-i.e., T extent, anterior commissure involvement, subglottic invasion, vocal cord mobility impairment, and ventricular involvement. Anterior commissure involvement was the main factor affecting out-come in the surgical series: in the presence of this factor, 64% 10-year local control was observed versus 85% in the patients without commissure involvement. This factor proved more important in the patients treated with conservative surgery (10-year control: 42 versus 88%) than in those undergoing radical surgery (78% versus 85%). Anterior commissure involvement and the number of involved subsites were found to worsen prognosis in the serial treated by radiation therapy: cases with anterior commissure involvement had 59% 10-year local control versus 83%. The cases with a deeper spread had 60% local control versus 75%. Vocal cord mobility impairment was a less important prognosis factor in both series. Our results suggest radiation therapy as a valuable method in a treatment of the small T2 laryngeal cancers which are not suitable for conservative surgery

Evolution in breast cancer suspicion and extent of surgery at a radio-oncology center

International Nuclear Information System (INIS)

Lopez L, Veronica; Carvajal C, Claudia; Gallardo M, Manuel; Russo N, Moies

2014-01-01

Introduction: Breast cancer diagnosis and treatment ad evolved over the past quarter century. From self-examination to mammography as main suspicion tool and from radical to conservative surgery plus radiotherapy as prefered treatment. The aim of this review was to assess the evolution of presentation and local management of breast cancer at a Chilean radio-oncology center. Materials and Methods: We analyzed 1.204 breast cancer patients who received postoperative irradiation on two four-years periods.The first period included 223 patients and coincides with the introduction of mammography and conservative surgery. The second included 981 patients managed according to current guidelines. The variables analyzed were type of clinical suspicion, time between clinical suspicion and diagnosis confirmation, type of surgery, histology and tumor size. Data were obtained from medical records and analyzed using STATA 2. Results: In the second period mammographic suspicion reached 39.88%. Time between clinical suspicion and histological diagnosis was reduced to 50%, the proportion of tumors larger than 2 cm was reduced from 61 to 45%, the proportion of DCIS was tripled from 6 to 18%, use of conservative surgery as an absolute increase of 28%. All of these differences were statistically significant (p < 0.01). Conclusion: The introduction of mammography and conservative management allowed early diagnosis of breast cancer in the analyzed population

Conventional surgery in breast cancer

International Nuclear Information System (INIS)

Tapia Herrera, Andres

2013-01-01

General aspects of breast cancer were described from the epidemiological point of view, clinical and pathological, as well as its impact at global and national levels. Parenchyma conservative surgery and/or breast skin was analyzed exhaustively as a cancer treatment analyzed exhaustively, to your specifications, requirements, technical aspects, risks, benefits, degree of oncological safety and benefits for patients [es

Gender-linked impact of epicardial adipose tissue volume in patients who underwent coronary artery bypass graft surgery or non-coronary valve surgery.

Directory of Open Access Journals (Sweden)

Gulinu Maimaituxun

Full Text Available Traditional and non-traditional risk factors for atherosclerotic cardiovascular disease (ASCVD are different between men and women. Gender-linked impact of epicardial adipose tissue volume (EATV in patients undergoing coronary artery bypass grafting (CABG remains unknown.Gender-linked impact of EATV, abdominal fat distribution and other traditional ASCVD risk factors were compared in 172 patients (men: 115; women: 57 who underwent CABG or non-coronary valvular surgery (non-CABG.In men, EATV, EATV index (EATV/body surface area and the markers of adiposity such as body mass index, waist circumference and visceral fat area were higher in the CABG group than in the non-CABG group. Traditional ASCVD risk factors were also prevalent in the CABG group. In women, EATV and EATV index were higher in the CABG group, but other adiposity markers were comparable between CABG and non-CABG groups. Multivariate logistic regression analysis showed that in men, CABG was determined by EATV Index and other ASCVD risk factors including hypertension, dyslipidemia, adiponectin, high sensitive C-reactive protein (hsCRP and type 2 diabetes mellitus (Corrected R2 = 0.262, p < 0.0001, while in women, type 2 diabetes mellitus is a single strong predictor for CABG, excluding EATV Index (Corrected R2 = 0.266, p = 0.005.Our study found that multiple risk factors, including epicardial adipose tissue volume and traditional ASCVD factors are determinants for CABG in men, but type 2 diabetes mellitus was the sole determinant in women. Gender-specific disparities in risk factors of CABG prompt us to evaluate new diagnostic and treatment strategies and to seek underlying mechanisms.

[The history of pediatric plastic surgery].

Science.gov (United States)

Glicenstein, J

2016-10-01

The history of pediatric plastic surgery is linked to that of paediatrics. Until the early 19th century, there was no children's hospital. Only some operations were performed before the discovery of anesthesia, aseptic and antisepsis: cleft lip repair, amputation for polydactyly. Many operations were described in the 19th century for cleft lip and palate repair, hypospadias, syndactylies. The first operation for protruding ears was performed in 1881. Pediatric plastic surgery is diversified in the 2nd half of the 20th century: cleft lip and palate, burns, craniofacial surgery, hand surgery become separate parts of the speciality. Copyright © 2016 Elsevier Masson SAS. All rights reserved.

The missing link : bridging the gap between science and conservation

NARCIS (Netherlands)

Hoeven, van der C.A.

2007-01-01

Conservation biology is faced with an implementation crisis. This crisis is the result of a “knowledge-doing” or “assessment-planning” gap. One reason for this is that there is a discrepancy between systematic classical scientific assessments or surveys, and actual implementation in the field. This

Glaucoma Drainage Device Erosion Following Ptosis Surgery.

Science.gov (United States)

Bae, Steven S; Campbell, Robert J

2017-09-01

To highlight the potential risk of glaucoma drainage device erosion following ptosis surgery. Case report. A 71-year-old man underwent uncomplicated superotemporal Ahmed glaucoma valve implantation in the left eye in 2008. Approximately 8 years later, the patient underwent bilateral ptosis repair, which successfully raised the upper eyelid position. Three months postoperatively, the patient's glaucoma drainage implant tube eroded through the corneal graft tissue and overlying conjunctiva to become exposed. A graft revision surgery was successfully performed with no further complications. Caution and conservative lid elevation may be warranted when performing ptosis repair in patients with a glaucoma drainage implant, and patients with a glaucoma implant undergoing ptosis surgery should be followed closely for signs of tube erosion.

The role of total dose in conservative surgery and radiation therapy for early stage breast cancer: is there a critical level?

Energy Technology Data Exchange (ETDEWEB)

White, Julia; Brown, Douglas; Gustafson, Greg; Chen, Peter; Matter, Richard; Cook, Carla; Martinez, Alvaro; Vicini, Frank A

1995-07-01

Purpose: Over the past several years, it has been our standard policy after breast conserving surgery to treat the entire breast to 45-50 Gy followed by a supplemental boost dose to the tumor bed to a minimum of 60 Gy with standard fractionation. We reviewed patients who received < 60 Gy to the tumor bed to identify any differences in recurrence rates in the breast. Materials and Methods: From 1/1/75 through 12/31/87, 443 consecutive patients diagnosed with stage I and II breast cancer (unilateral) were treated with conservative surgery and radiation therapy (CSRT) at William Beaumont Hospital. All patients underwent at least an excisional biopsy and 268 (60%) patients were re-excised. An ipsilateral axillary lymph node dissection was performed on 420 patients (95%). All patients received whole breast irradiation to 45-50 Gy. A supplemental boost dose was delivered to the tumor bed with either an implant, electrons, or photons in 404 (91%) patients. Median follow-up of surviving patients is 88 months. Results: Thirty-three patients of the 443 have suffered a failure in the treated breast for a 5 and 10 yr actuarial rate of local recurrence of 5 and 10%, respectively. Evaluation by total dose to the tumor bed is as follows: The distribution of patient's respective histology, tumor size, hormonal status, age, re-excision status, and adjuvant systemic therapy was similar among the dose groups. On multivariate analysis (Cox), in addition to total dose to tumor bed (p=0.002), the only other factor which was significantly associated with local recurrence was patient age {<=} 35 (p=0.002). Conclusions: Patients who receive {<=} 50 Gy to the tumor bed without careful attention to excisional status are at a significantly higher risk of local failure. This underlies the importance of supplementing the tumor bed dose after whole breast radiation therapy in those patients whose status of excision is not definitely known.

Efficacy of Pectoral Nerve Block Type II for Breast-Conserving Surgery and Sentinel Lymph Node Biopsy: A Prospective Randomized Controlled Study

Directory of Open Access Journals (Sweden)

Doo-Hwan Kim

2018-01-01

Full Text Available Objectives. The pectoral nerve block type II (PECS II block is widely used for postoperative analgesia after breast surgery. This study evaluated the analgesic efficacy of PECS II block in patients undergoing breast-conserving surgery (BCS and sentinel lymph node biopsy (SNB. Methods. Patients were randomized to the control group (n=40 and the PECS II group (n=40. An ultrasound-guided PECS II block was performed after induction of anesthesia. The primary outcome measure was opioid consumption, and the secondary outcome was pain at the breast and axillary measured using the Numerical Rating Scale (NRS 24 hours after surgery. Opioid requirement was assessed according to tumor location. Results. Opioid requirement was lower in the PECS II than in the control group (43.8 ± 28.5 µg versus 77.0 ± 41.9 µg, p<0.001. However, the frequency of rescue analgesics did not differ between these groups. Opioid consumption in the PECS II group was significantly lower in patients with tumors in the outer area than that in patients with tumors in the inner area (32.5 ± 23.0 µg versus 58.0 ± 29.3 µg, p=0.007. The axillary NRS was consistently lower through 24 hr in the PECS II group. Conclusion. Although the PECS II block seemed to reduce pain intensity and opioid requirements for 24 h after BCS and SNB, these reductions may not be clinically significant. This trial is registered with Clinical Research Information Service KCT0002509.

Effectiveness of surgery for adults with hallux valgus deformity: a systematic review.

Science.gov (United States)

Klugarova, Jitka; Hood, Victoria; Bath-Hextall, Fiona; Klugar, Miloslav; Mareckova, Jana; Kelnarova, Zuzana

2017-06-01

Hallux valgus (HV) is a common foot deformity. In severe stages of this condition, surgery is often necessary. Currently, there is no systematic review comparing the effectiveness of surgery over conservative treatment. The objective of this review was to establish the effectiveness of surgery compared to conservatory management for adults with HV. The current review included adults (18 years or over) with HV deformity, excluding adults with neurological problems causing foot deformities, for example, cerebral palsy, neuropathy, stroke and multiple sclerosis. The review included any type of HV surgery compared to no surgery, conservative treatment or different types of HV surgeries. The primary outcome was gait measurement, and secondary outcomes included quality of life, patient satisfaction, pain assessed using any validated assessment tool and adverse events. The review included randomized controlled trials. The search strategy aimed to find both published and unpublished studies. A three-step search strategy was utilized in 16 databases without language and date limitations. Papers selected for retrieval were assessed by two independent reviewers for methodological validity prior to inclusion in the review using standardized critical appraisal instruments developed by the Joanna Briggs Institute (JBI). Data were extracted from papers included in the review using the standardized data extraction tool developed by the JBI. Quantitative data were, where possible, pooled in statistical meta-analysis using RevMan5 (Copenhagen: The Nordic Cochrane Centre, Cochrane). Effect sizes expressed as risk ratio (for categorical data) and mean differences (MD) or standardized MD (for continuous data) and their 95% confidence intervals were calculated for analysis. Where statistical pooling was not possible, the findings have been presented in narrative form. Searching identified 2412 citations. After removal of duplicates, paper retrieval and critical appraisal, 25 studies

Surgery of the cancer of Uterine Neck Past, present and Future

International Nuclear Information System (INIS)

Escudero Fernandez, M.

2009-01-01

The evolution of the surgery of the cancer of cervix has passed for several stages. First the boarding was indisputably vaginal. Thanks to the anestesea, antibioterapia and transfusion was produced a change that has come to our days to the abdominal route with Wertheim Meigs's intervention. From 1987 Dargent he introduced the route laparoscopica, the conservative surgery and the return to the vaginal boarding. Today the robotic surgery is imposed with the Da Vinci. (Author) 16 refs.

Comprehensive blood conservation program in a new congenital cardiac surgical program allows bloodless surgery for the Jehovah Witness and a reduction for all patients.

Science.gov (United States)

Olshove, Vincent; Berndsen, Nicole; Sivarajan, Veena; Nawathe, Pooja; Phillips, Alistair

2018-04-01

Cardiac surgery on Jehovah's Witnesses (JW) can be challenging, given the desire to avoid blood products. Establishment of a blood conservation program involving the pre-, intra- and post-operative stages for all patients may lead to a minimized need for blood transfusion in all patients. Pre-operatively, all JW patients were treated with high dose erythropoietin 500 IU/kg twice a week. JW patients were compared to matching non-JW patients from the congenital cardiac database, two per JW to serve as control. Blood use, ventilation time, bypass time, pre-operative hematocrit, first in intensive care unit (ICU) and at discharge and 24 hour chest drainage were compared. Pre-operative huddle, operating room huddle and post-operative bedside handoff were done with the congenital cardiac surgeon, perfusionist, anesthesiologist and intensive care team in all patients for goal alignment. Five JW patients (mean weight 24.4 ± 25.0 Kg, range 6.3 - 60 Kg) were compared to 10 non-JW patients (weight 22.0 ± 22.8 Kg, range 6.2 - 67.8 Kg). There was no difference in bypass, cross-clamp, time to extubation (0.8 vs. 2.1 hours), peak inotrope score (2.0 vs. 2.3) or chest drainage. No JW patient received a blood product compared to 40% of non-JW. The pre-operative hematocrit (Hct) was statistically greater for the JW patients (46.1 ± 3.3% vs. 36.3 ± 4.7%, pconservation techniques across the continuum of care allowed bloodless surgery for JW and non-JW patients alike. Blood conservation is a team sport and to make significant strides requires participation and input by all care providers.

EPA Linked Open Data: Resource Conservation and Recovery Act Handlers (RCRA)

Data.gov (United States)

U.S. Environmental Protection Agency — RCRAInfo is EPA’s comprehensive information system that supports the Resource Conservation and Recovery Act (RCRA) of 1976 and the Hazardous and Solid Waste...

Criticism of conservative surgery for primary operable breast cancer

International Nuclear Information System (INIS)

Urban, J.A.

1977-01-01

A critical evaluation about the adoption of a less adequate primary surgical procedure is done with respect to patients with similar extent of disease. A comparison is done between the results obtained for groups of patients submitted to conservative surgical treatment and to radical mastectomy, both accompanied by radiotherapy. Emphasis is given to the need for removing all disease in breast and regional nodes at the time of original surgical treatment. (M.A.) [pt

Arthroscopic surgery using radio-frequency electrocautery

International Nuclear Information System (INIS)

Takatsuka, Shigeyuki; Yoshida, Kan; Nakagawa, Kiyomasa; Yamamoto, Etsuhide; Kubota, Yoshiyuki; Narinobou, Masayoshi; Terai, Koichi; Hasegawa, Hiroshi

2008-01-01

Arthroscopic surgery using radio-frequency electrocautery was carried out on 23 temporomandibular joints (TMJs) in 13 patients. Because these patients did not respond to conservative therapy, surgery was indicated. Preoperative MRI showed anterior disc displacement without reduction in all patients. Disturbed translation was also recognized in all of the discs and mandibular condyles. Intraoperative arthroscopic examination showed severe fibrous adhesion in the upper joint compartment and disc displacement. Four joints showed perforation between the disc and retrodiscal tissue. Postoperative findings included an increased range of vertical maximal mouth opening and decreased pain on mandibular movement. Analyses of postoperative MRI indicated recovery of disc and condylar translation. These results suggested that the introduction of arthroscopic surgery using radiofrequency electrocautery would significantly reduce the number of patients with osteoarthritic TMJ disorders. (author)

Shifted Baselines Reduce Willingness to Pay for Conservation

Directory of Open Access Journals (Sweden)

Loren McClenachan

2018-02-01

Full Text Available A loss of memory of past environmental degradation has resulted in shifted baselines, which may result in conservation and restoration goals that are less ambitious than if stakeholders had a full knowledge of ecosystem potential. However, the link between perception of baseline states and support for conservation planning has not been tested empirically. Here, we investigate how perceptions of change in coral reef ecosystems affect stakeholders' willingness to pay (WTP for the establishment of protected areas. Coral reefs are experiencing rapid, global change that is observable by the public, and therefore provide an ideal ecosystem to test links between beliefs about baseline states and willingness to support conservation. Our survey respondents perceived change to coral reef communities across six variables: coral abundance, fish abundance, fish diversity, fish size, sedimentation, and water pollution. Respondants who accurately perceived declines in reef health had significantly higher WTP for protected areas (US $256.80 vs. $102.50 per year, suggesting that shifted baselines may reduce engagement with conservation efforts. If WTP translates to engagement, this suggests that goals for restoration and recovery are likely to be more ambitious if the public is aware of long term change. Therefore, communicating the scope and depth of environmental problems is essential in engaging the public in conservation.

A systematic review and meta-analysis of Harmonic technology compared with conventional techniques in mastectomy and breast-conserving surgery with lymphadenectomy for breast cancer.

Science.gov (United States)

Cheng, Hang; Clymer, Jeffrey W; Ferko, Nicole C; Patel, Leena; Soleas, Ireena M; Cameron, Chris G; Hinoul, Piet

2016-01-01

Mastectomy and breast-conserving surgery (BCS) are important treatment options for breast cancer patients. A previous meta-analysis demonstrated that the risk of certain complications can be reduced with the Harmonic technology compared with conventional methods in mastectomy. However, the meta-analysis did not include studies of BCS patients and focused on a subset of surgical complications. The objective of this study was to compare Harmonic technology and conventional techniques for a range of clinical outcomes and complications in both mastectomy and BCS patients, including axillary lymph node dissection. A comprehensive literature search was performed for randomized controlled trials comparing Harmonic technology and conventional methods in breast cancer surgery. Outcome measures included blood loss, drainage volume, total complications, seroma, necrosis, wound infections, ecchymosis, hematoma, hospital length of stay, and operating time. Risk of bias was analyzed for all studies. Meta-analysis was performed using random-effects models for mean differences of continuous variables and a fixed-effects model for risk ratios of dichotomous variables. Twelve studies met the inclusion criteria. Across surgery types, compared to conventional techniques, Harmonic technology reduced total complications by 52% (P=0.002), seroma by 46% (Pmastectomy patients with lymph node dissection, Harmonic technology showed significant reductions in complications in the BCS study subgroup. In this meta-analysis of both mastectomy and BCS procedures, the use of Harmonic technology reduced the risk of most complications by about half across breast cancer surgery patients. These benefits may be due to superior hemostatic capabilities of Harmonic technology and better dissection, particularly lymph node dissection. Reduction in complications and other resource outcomes may engender lower downstream health care costs.

One life saved by four prevented recurrencies? Update of the early breast cancer trialists confirms. Postoperative radiotherapy improves survival after breast conserving surgery

International Nuclear Information System (INIS)

Sautter-Bihl, M.L.; Budach, W.

2012-01-01

The debate about the impact of local control on survival in early breast cancer patients is still going on, in spite of the continuously growing evidence that avoidance of locoregional disease reduces the risk of tumor-specific death. Recently, B. Fisher, one of the pioneers of breast conserving therapy claimed that during the last two decades, as a result of the use of systemic therapy in conjunction with breast conserving surgery and radiation, the incidence of locoregional recurrence has been reduced to a level where further reduction is likely to have little impact on survival. The penultimate meta-analysis of the Early Breast Cancer Trialists' Collaborative Group (EBCTCG) reported the effect of radiotherapy in early breast cancer on recurrence and survival in 2005 and provided the essential message that four prevented local recurrences at 5 years would avoid one breast cancer death in 15 years. The scientific community has eagerly awaited the quinquennial update of the EBCTCG which has now been published. A total of 17 randomized studies comparing postoperative radiotherapy vs. none were analyzed and comprised 7 new studies in addition to follow-up data of from 9 previously reported trials. A total of 10,801 patients with pT1-2 tumors were included, the majority of whom (n=7,287) were node negative, while 1,050 were node positive (2,464 unknown). In contrast to the previous meta-analysis, all patients received breast conserving surgery, consisting of lumpectomy (n=8,422) or more extensive techniques like quadrantectomy or sectoral resection (n= 2,399). The effect of radiotherapy on 10-year recurrences of any type and their relation to the 15-year breast cancer death rate were studied in correlation to various prognostic parameters and treatment characteristics (e.g., surgery, tamoxifen use). Moreover, a subgroup analysis was performed according to low, intermediate, and high initial risk of recurrence, from which the expected absolute benefit was derived by

Effects on quality of life, anti-cancer responses, breast conserving surgery and survival with neoadjuvant docetaxel: a randomised study of sequential weekly versus three-weekly docetaxel following neoadjuvant doxorubicin and cyclophosphamide in women with primary breast cancer

Directory of Open Access Journals (Sweden)

Wiseman Janice

2011-05-01

Full Text Available Abstract Background Weekly docetaxel has occasionally been used in the neoadjuvant to downstage breast cancer to reduce toxicity and possibly enhance quality of life. However, no studies have compared the standard three weekly regimen to the weekly regimen in terms of quality of life. The primary aim of our study was to compare the effects on QoL of weekly versus 3-weekly sequential neoadjuvant docetaxel. Secondary aims were to determine the clinical and pathological responses, incidence of Breast Conserving Surgery (BCS, Disease Free Survival (DFS and Overall Survival (OS. Methods Eighty-nine patients receiving four cycles of doxorubicin and cyclophosphamide were randomised to receive twelve cycles of weekly docetaxel (33 mg/m2 or four cycles of 3-weekly docetaxel (100 mg/m2. The Functional Assessment of Cancer Therapy-Breast and psychosocial questionnaires were completed. Results At a median follow-up of 71.5 months, there was no difference in the Trial Outcome Index scores between treatment groups. During weekly docetaxel, patients experienced less constipation, nail problems, neuropathy, tiredness, distress, depressed mood, and unhappiness. There were no differences in overall clinical response (93% vs. 90%, pathological complete response (20% vs. 27%, and breast-conserving surgery (BCS rates (49% vs. 42%. Disease-free survival and overall survival were similar between treatment groups. Conclusions Weekly docetaxel is well-tolerated and has less distressing side-effects, without compromising therapeutic responses, Breast Conserving Surgery (BCS or survival outcomes in the neoadjuvant setting. Trial registration ISRCTN: ISRCTN09184069

Role of lifestyle modifications for patients with laryngeal granuloma caused by gastro-esophageal reflux: comparison between conservative treatment and the surgical approach.

Science.gov (United States)

Kobayashi, Rika; Tsunoda, Koichi; Ueha, Rumi; Fujimaki, Yoko; Nito, Takaharu; Yamasoba, Tatsuya

2017-03-01

It is considered that a regimen combining pharmacologic management and lifestyle modifications is the most effective treatment for laryngeal granulomas caused by GER. This study compared the results of the combination therapy and surgery to determine the best treatment of laryngeal granuloma caused by gastro-esophageal reflux in 51 patients. Prospective study. In the conservative treatment group, the CR rate was 89.7% and recurrence rate was 2.6%, while the lesions remained in patients (7.7%). This study compared the CR and recurrence rates between conservative treatment and surgery for granuloma. The results showed that the laryngeal granuloma recurrence rate was significantly lower with the conservative treatment regimen compared with surgery (p = .0016).

Robotic surgery claims on United States hospital websites.

Science.gov (United States)

Jin, Linda X; Ibrahim, Andrew M; Newman, Naeem A; Makarov, Danil V; Pronovost, Peter J; Makary, Martin A

2011-11-01

To examine the prevalence and content of robotic surgery information presented on websites of U.S. hospitals. We completed a systematic analysis of 400 randomly selected U.S. hospital websites in June of 2010. Data were collected on the presence and location of robotic surgery information on a hospital's website; use of images or text provided by the manufacturer; use of direct link to manufacturer website; statements of clinical superiority; statements of improved cancer outcome; mention of a comparison group for a statement; citation of supporting data and mention of specific risks. Forty-one percent of hospital websites described robotic surgery. Among these, 37% percent presented robotic surgery on their homepage, 73% used manufacturer-provided stock images or text, and 33% linked to a manufacturer website. Statements of clinical superiority were made on 86% of websites, with 32% describing improved cancer control, and 2% described a reference group. No hospital website mentioned risks. Materials provided by hospitals regarding the surgical robot overestimate benefits, largely ignore risks and are strongly influenced by the manufacturer. © 2011 National Association for Healthcare Quality.

Putting the baby back in the bathwater: the interpretation of randomised trials in surgery.

Science.gov (United States)

Gandhi, R; Perruccio, A V; Kakar, S; Haddad, F S

2015-11-01

Recently, several high impact randomised controlled trials have been published suggesting no greater benefit from orthopaedic surgery over conservative treatment, or limited surgical intervention. These studies can have profound effects on clinical practice, leading to the abandonment of previously widely-used operations. How do surgeons who believe these operations are beneficial over conservative treatment rationalise these findings, and justify their use with hospital administrators and health care funders who require evidence for the value and efficacy of surgical treatment? ©2015 The British Editorial Society of Bone & Joint Surgery.

Making the Most of World Natural Heritage—Linking Conservation and Sustainable Regional Development?

Directory of Open Access Journals (Sweden)

Katharina Conradin

2016-03-01

Full Text Available Today, more than 1000 World Heritage (WH sites are inscribed on UNESCO’s list, 228 of which are natural and mixed heritage sites. Once focused primarily on conservation, World Natural Heritage (WNH sites are increasingly seen as promoters of sustainable regional development. Sustainability-oriented regions, it is assumed, are safeguards for conservation and positively influence local conservation goals. Within UNESCO, discussions regarding the integration of sustainable development in official policies have recently gained momentum. In this article, we investigate the extent to which WNH sites trigger sustainability-oriented approaches in surrounding regions, and how such approaches in turn influence the WNH site and its protection. The results of the study are on the one hand based on a global survey with more than 60% of the WNH sites listed in 2011, and on the other hand on a complementary literature research. Furthermore, we analyze the policy framework necessary to support WNH sites in this endeavor. We conclude that a regional approach to WNH management is necessary to ensure that WNH sites support sustainable regional development effectively, but that the core focus of WNH status must remain environmental conservation.

Back Surgery: When Is It a Good Idea?

Science.gov (United States)

... one of the most common ailments seen by family doctors. Back problems typically respond to nonsurgical treatments — such as anti-inflammatory medications, heat and physical therapy. Back surgery might be an option if conservative treatments haven't worked and your pain is ...

Breast conservation surgery versus total mastectomy among women with localized breast cancer in Soweto, South Africa

Science.gov (United States)

Dietz, Donald; Rosenbaum, Evan; Murugan, Nivashni; Chih, Ming Tsai; Ayeni, Oluwatosin; Dickens, Caroline; Crew, Katherine

2017-01-01

Purpose Breast conserving surgery (BCS) has become the preferred surgical option for the management of patients with nonmetastatic breast cancer in high-income countries. However, little is known about the distribution and determinants of BCS in low-and middle-income countries, especially those with high HIV prevalence. Methods We compared demographic and clinical characteristics of female patients who received BCS and those who received total mastectomy (TM) for nonmetastatic invasive carcinoma of the breast in Soweto, South Africa, 2009–2011. We also developed a multivariable logistic regression model of predictors of type of surgery. Results Of 445 patients, 354 (80%) underwent TM and 91 (20%) BCS. Of 373 patients screened for HIV, 59 (15.8%) tested positive. Eighty-two of 294 patients with stage I/II disease (28%), but just 9 of 151 (6%) with stage III disease had BCS (p<0.001). All women who received BCS (except for seven who received completion mastectomy within 6 weeks of BCS) and 235 (66.4%) women who received TM were referred for radiation therapy (RT). In our multivariable analysis, age group 50–59 years (OR = 2.28, 95% CI = 1.1–4.8) and ≥70 years (OR = 9.55, 95% CI = 2.9–31.2) vs. age group <40 years, stage at diagnosis (stage II (OR = 3.79, 95% CI = 1.6–8.2) and stage III (OR = 27.8, 95% CI = 9.0–78.8) vs. stage 1, HIV (HIV positive (OR = 3.19, 95% CI = 1.3–7.9) vs. HIV negative) and HER2-enriched subtype (OR = 3.50, 95% CI = 1.2–10.1) vs. triple negative were independently associated with TM. Conclusion TM was more common than BCS among patients with nonmetastatic breast cancer in Soweto, not only among patients with locally advanced disease at diagnosis, but also among women with stage I and II disease. PMID:28797046

Mastectomy or breast conserving surgery? Factors affecting type of surgical treatment for breast cancer – a classification tree approach

International Nuclear Information System (INIS)

Martin, Michael A; Meyricke, Ramona; O'Neill, Terry; Roberts, Steven

2006-01-01

A critical choice facing breast cancer patients is which surgical treatment – mastectomy or breast conserving surgery (BCS) – is most appropriate. Several studies have investigated factors that impact the type of surgery chosen, identifying features such as place of residence, age at diagnosis, tumor size, socio-economic and racial/ethnic elements as relevant. Such assessment of 'propensity' is important in understanding issues such as a reported under-utilisation of BCS among women for whom such treatment was not contraindicated. Using Western Australian (WA) data, we further examine the factors associated with the type of surgical treatment for breast cancer using a classification tree approach. This approach deals naturally with complicated interactions between factors, and so allows flexible and interpretable models for treatment choice to be built that add to the current understanding of this complex decision process. Data was extracted from the WA Cancer Registry on women diagnosed with breast cancer in WA from 1990 to 2000. Subjects' treatment preferences were predicted from covariates using both classification trees and logistic regression. Tumor size was the primary determinant of patient choice, subjects with tumors smaller than 20 mm in diameter preferring BCS. For subjects with tumors greater than 20 mm in diameter factors such as patient age, nodal status, and tumor histology become relevant as predictors of patient choice. Classification trees perform as well as logistic regression for predicting patient choice, but are much easier to interpret for clinical use. The selected tree can inform clinicians' advice to patients

Current status of accelerated corneal cross-linking

Directory of Open Access Journals (Sweden)

Michael Mrochen

2013-01-01

Full Text Available Corneal cross-linking with riboflavin is a technique to stabilize or reduce corneal ectasia, in diseases such as keratoconus and post-laser-assisted in situ keratomileusis (LASIK ectasia. There is an interest by patient as well as clinicians to reduce the overall treatment time. Especially, the introduction of corneal cross-linking in combination with corneal laser surgery demands a shorter treatment time to assure a sufficient patient flow. The principles and techniques of accelerated corneal cross-linking is discussed.

Predictors for the need of surgery in antenatally detected hydronephrosis due to UPJ obstruction--a prospective multivariate analysis.

Science.gov (United States)

Arora, S; Yadav, P; Kumar, M; Singh, S Kumar; Sureka, S Kumar; Mittal, V; Ansari, M S

2015-10-01

Disagreement exists over the ability of different diagnostic tests to define obstruction, indications and timing of surgery and which patients will benefit from surgical intervention in antenatal hydronephrosis (ANH) due to ureteropelvic junction obstruction (UPJO). We try to find a way to predict which patients of ANH due to UPJO will eventually need surgery during conservative management. Prospective single centre study involving 122 renal units at a referral centre in India. Patients on conservative management were followed using a standard protocol and operated for pre-defined indications defining failure of conservative management. Patients who underwent surgery were compared with the non-operated group in terms of sex, side, baseline grade of hydronephrosis, maximum anterioposterior diameter on first postnatal ultrasound and differential renal function on first renal scan. A total of 109 renal units qualified for conservative management. Of those, 23.9% required operative intervention during follow-up. Median time to failure of conservative management was 37 weeks. The median follow-up of non-operated cases was 54 months. Univariate analysis revealed that society of fetal urology (SFU) grade of hydronephrosis, anteroposterior diameter (APD), cortical thickness (CT), and pre-operative differential renal function (DRF) had a significant association with surgery (P hydronephrosis were not. Receiver operating curve analysis showed that an APD of 24.3 mm could predict the need for surgery, with a sensitivity of 73.1% and a specificity of 88.0%. APD and DRF are the predictive factors for surgery. We stop short of recommending surgery only on the basis of APD. Instead we recommend that efforts be made to improve the specificity of this criterion, or by using APD in perspective with the differential renal function. We can reduce the burden of investigations in those with APD 24 mm can be more comprehensively monitored. Copyright © 2015 Journal of Pediatric Urology

Hypoglossal Nerve Palsy After Cervical Spine Surgery.

Science.gov (United States)

Ames, Christopher P; Clark, Aaron J; Kanter, Adam S; Arnold, Paul M; Fehlings, Michael G; Mroz, Thomas E; Riew, K Daniel

2017-04-01

Multi-institutional retrospective study. The goal of the current study is to quantify the incidence of 2 extremely rare complications of cervical spine surgery; hypoglossal and glossopharyngeal nerve palsies. A total of 8887 patients who underwent cervical spine surgery from 2005 to 2011 were included in the study from 21 institutions. No glossopharyngeal nerve injuries were reported. One hypoglossal nerve injury was reported after a C3-7 laminectomy (0.01%). This deficit resolved with conservative management. The rate by institution ranged from 0% to 1.28%. Although not directly injured by the surgical procedure, the transient nerve injury might have been related to patient positioning as has been described previously in the literature. Hypoglossal nerve injury during cervical spine surgery is an extremely rare complication. Institutional rates may vary. Care should be taken during posterior cervical surgery to avoid hyperflexion of the neck and endotracheal tube malposition.

Climate Change Denial Books and Conservative Think Tanks

Science.gov (United States)

Jacques, Peter J.

2013-01-01

The conservative movement and especially its think tanks play a critical role in denying the reality and significance of anthropogenic global warming (AGW), especially by manufacturing uncertainty over climate science. Books denying AGW are a crucial means of attacking climate science and scientists, and we examine the links between conservative think tanks (CTTs) and 108 climate change denial books published through 2010. We find a strong link, albeit noticeably weaker for the growing number of self-published denial books. We also examine the national origins of the books and the academic backgrounds of their authors or editors, finding that with the help of American CTTs climate change denial has spread to several other nations and that an increasing portion of denial books are produced by individuals with no scientific training. It appears that at least 90% of denial books do not undergo peer review, allowing authors or editors to recycle scientifically unfounded claims that are then amplified by the conservative movement, media, and political elites. PMID:24098056

Mammographic Features of Local Recurrence after Conservative Surgery and Radiation Therapy: Comparison with that of the Primary Tumor

International Nuclear Information System (INIS)

Guenhan-Bilgen, I.; Oktay, A.

2007-01-01

Purpose: To compare the mammographic features of recurrent breast cancer with those of the primary tumor and to determine whether certain mammographic features are associated with a higher risk of local recurrence after breast-conserving therapy. Material and Methods: A retrospective review of mammograms of 421 patients who were treated with conservative surgery and radiotherapy revealed 41 recurrent tumors. Mammographic findings, location, and histopathologic characteristics were retrospectively compared between primary and recurrent tumors. Results: Recurrent tumors were similar in mammographic appearance to primary tumors in 27 (66%) cases. Of 27 primary tumors that occurred as masses without calcifications, 19 (70%) recurred as a mass, and of the six isolated calcifications, five (83%) recurred with calcifications. Ten (53%) of the 19 recurrent masses and five (100%) of the five recurrent calcifications had morphologic features that were similar to those of the primary tumor. Ninety-two percent (11/12) of the recurrences containing microcalcifications (isolated or associated with a mass) had microcalcifications in their primary tumor. Of 27 masses that recurred, the morphology of the primary tumor was obscured in 13 (48%), ill defined in 10 (37%), and spiculated in four (15%) of the masses. Seventy-six percent (31/41) of recurrences were within the lumpectomy quadrant. In 25 (61%) cases, the histologic findings from the primary tumor and the recurrence were identical. Conclusion: The majority of recurrent tumors appear to be mammographically similar to primary tumors. Therefore, it is important to review preoperative mammograms during follow-up of these patients. Although the study population is small, it was noted that mass with spiculated contour is associated with a lower risk for local recurrence

A fungal perspective on conservation biology.

Science.gov (United States)

Heilmann-Clausen, Jacob; Barron, Elizabeth S; Boddy, Lynne; Dahlberg, Anders; Griffith, Gareth W; Nordén, Jenni; Ovaskainen, Otso; Perini, Claudia; Senn-Irlet, Beatrice; Halme, Panu

2015-02-01

Hitherto fungi have rarely been considered in conservation biology, but this is changing as the field moves from addressing single species issues to an integrative ecosystem-based approach. The current emphasis on biodiversity as a provider of ecosystem services throws the spotlight on the vast diversity of fungi, their crucial roles in terrestrial ecosystems, and the benefits of considering fungi in concert with animals and plants. We reviewed the role of fungi in ecosystems and composed an overview of the current state of conservation of fungi. There are 5 areas in which fungi can be readily integrated into conservation: as providers of habitats and processes important for other organisms; as indicators of desired or undesired trends in ecosystem functioning; as indicators of habitats of conservation value; as providers of powerful links between human societies and the natural world because of their value as food, medicine, and biotechnological tools; and as sources of novel tools and approaches for conservation of megadiverse organism groups. We hope conservation professionals will value the potential of fungi, engage mycologists in their work, and appreciate the crucial role of fungi in nature. © 2014 Society for Conservation Biology.

Can medicine be aesthetic? Disentangling beauty and health in elective surgeries.

Science.gov (United States)

Edmonds, Alexander

2013-06-01

This article analyzes tensions between aesthetics and health in medicine. The blurring of distinctions between reconstructive and cosmetic procedures, and the linking of plastic surgery with other medical treatments, have added to the legitimacy of an emerging "aesthetic medicine." As cosmetic surgeries become linked to other medical procedures with perceived greater medical necessity, health and aesthetics become entangled. One consequence is that medical needs are magnified while perceptions of the risks of surgery are minimized. Drawing on ethnographic work on plastic surgery, as well as other studies of obstetrics and cosmetic surgery, I illustrate this entanglement of health and aesthetics within the field of women's reproductive health care in Brazil. I argue that while it would be difficult to wholly disentangle aesthetics and health, analysis of how risk-benefit calculations are made in clinical practice offers a useful critical strategy for illuminating ethical problems posed by aesthetic medicine. © 2013 by the American Anthropological Association.

[Accelerated partial breast irradiation with image-guided intensity-modulated radiotherapy following breast-conserving surgery - preliminary results of a phase II clinical study].

Science.gov (United States)

Mészáros, Norbert; Major, Tibor; Stelczer, Gábor; Zaka, Zoltán; Mózsa, Emõke; Fodor, János; Polgár, Csaba

2015-06-01

The purpose of the study was to implement accelerated partial breast irradiation (APBI) by means of image-guided intensity-modulated radiotherapy (IG-IMRT) following breast-conserving surgery (BCS) for low-risk early invasive breast cancer. Between July 2011 and March 2014, 60 patients with low-risk early invasive (St I-II) breast cancer who underwent BCS were enrolled in our phase II prospective study. Postoperative APBI was given by means of step and shoot IG-IMRT using 4 to 5 fields to a total dose of 36.9 Gy (9×4.1 Gy) using a twice-a-day fractionation. Before each fraction, series of CT images were taken from the region of the target volume using a kV CT on-rail mounted in the treatment room. An image fusion software was used for automatic image registration of the planning and verification CT images. Patient set-up errors were detected in three directions (LAT, LONG, VERT), and inaccuracies were adjusted by automatic movements of the treatment table. Breast cancer related events, acute and late toxicities, and cosmetic results were registered and analysed. At a median follow-up of 24 months (range 12-44) neither locoregional nor distant failure was observed. Grade 1 (G1), G2 erythema, G1 oedema, and G1 and G2 pain occurred in 21 (35%), 2 (3.3%), 23 (38.3%), 6 (10%) and 2 (3.3%) patients, respectively. No G3-4 acute side effects were detected. Among late radiation side effects G1 pigmentation, G1 fibrosis, and G1 fat necrosis occurred in 5 (8.3%), 7 (11.7%), and 2 (3.3%) patients, respectively. No ≥G2 late toxicity was detected. Excellent and good cosmetic outcome was detected in 45 (75%) and 15 (25%) patients. IG-IMRT is a reproducible and feasible technique for the delivery of APBI following conservative surgery for the treatment of low-risk, early-stage invasive breast carcinoma. Preliminary results are promising, early radiation side effects are minimal, and cosmetic results are excellent.

True Local Recurrences after Breast Conserving Surgery have Poor Prognosis in Patients with Early Breast Cancer

Science.gov (United States)

Sarsenov, Dauren; Ilgun, Serkan; Ordu, Cetin; Alco, Gul; Bozdogan, Atilla; Elbuken, Filiz; Nur Pilanci, Kezban; Agacayak, Filiz; Erdogan, Zeynep; Eralp, Yesim; Dincer, Maktav

2016-01-01

Background: This study was aimed at investigating clinical and histopathologic features of ipsilateral breast tumor recurrences (IBTR) and their effects on survival after breast conservation therapy. Methods: 1,400 patients who were treated between 1998 and 2007 and had breast-conserving surgery (BCS) for early breast cancer (cT1-2/N0-1/M0) were evaluated. Demographic and pathologic parameters, radiologic data, treatment, and follow-up related features of the patients were recorded. Results: 53 patients (3.8%) had IBTR after BCS within a median follow-up of 70 months. The mean age was 45.7 years (range, 27-87 years), and 22 patients (41.5%) were younger than 40 years. 33 patients (62.3%) had true recurrence (TR) and 20 were classified as new primary (NP). The median time to recurrence was shorter in TR group than in NP group (37.0 (6-216) and 47.5 (11-192) months respectively; p = 0.338). Progesterone receptor positivity was significantly higher in the NP group (p = 0.005). The overall 5-year survival rate in the NP group (95.0%) was significantly higher than that of the TR group (74.7%, p 20 mm), high grade tumor and triple-negative molecular phenotype along with developing TR negatively affected overall survival (hazard ratios were 4.2 (CI 0.98-22.76), 4.6 (CI 1.07-13.03), 4.0 (CI 0.68-46.10), 6.5 (CI 0.03-0.68), and 6.5 (CI 0.02- 0.80) respectively, p 2 cm), high grade, triple negative phenotype, and having true recurrence were identified as independent prognostic factors with a negative impact on overall survival in this dataset of patients with recurrent breast cancer. In conjunction with a more intensive follow-up program, the role of adjuvant therapy strategies should be explored further in young patients with large and high-risk tumors to reduce the risk of TR. PMID:27158571

The conserved baculovirus protein p33 (Ac92) is a flavin adenine dinucleotide-linked sulfhydryl oxidase

International Nuclear Information System (INIS)

Long, C.M.; Rohrmann, G.F.; Merrill, G.F.

2009-01-01

Open reading frame 92 of the Autographa californica baculovirus (Ac92) is one of about 30 core genes present in all sequenced baculovirus genomes. Computer analyses predicted that the Ac92 encoded protein (called p33) and several of its baculovirus orthologs were related to a family of flavin adenine dinucleotide (FAD)-linked sulfhydryl oxidases. Alignment of these proteins indicated that, although they were highly diverse, a number of amino acids in common with the Erv1p/Alrp family of sulfhydryl oxidases are present. Some of these conserved amino acids are predicted to stack against the isoalloxazine and adenine components of FAD, whereas others are involved in electron transfer. To investigate this relationship, Ac92 was expressed in bacteria as a His-tagged fusion protein, purified, and characterized both spectrophotometrically and for its enzymatic activity. The purified protein was found to have the color (yellow) and absorption spectrum consistent with it being a FAD-containing protein. Furthermore, it was demonstrated to have sulfhydryl oxidase activity using dithiothreitol and thioredoxin as substrates.

The influence of infiltrating lobular carcinoma on the outcome of patients treated with breast-conserving surgery and radiation therapy

International Nuclear Information System (INIS)

Bornstein, Bruce A.; Peiro, Gloria; Connolly, James L.; Gelman, Rebecca; Schnitt, Stuart J.; Hetelekidis, Stella; Nixon, Asa J.; Recht, Abram; Silver, Barbara; Harris, Jay R.

1996-01-01

PURPOSE: To examine the clinical characteristics of patients with lobular or mixed lobular-ductal histology in relation to those with pure ductal histology and to compare treatment outcome in patients in these histologic groups treated with breast-conserving surgery and radiation therapy. MATERIALS AND METHODS: Between 1970 and 1986, 1863 patients were treated for clinical Stage I or II invasive breast cancer with breast-conserving surgery and radiation therapy. The original slides were reviewed in 1536 cases (82%). Of these, 1089 patients had pure invasive ductal carcinoma, 93 had invasive lobular carcinoma, and 59 had mixed histology; these constitute the study population. The median follow-up time was 133 months. RESULTS: The distribution of clinical stage I or II, tumor stage T1 or T2, and clinical nodal stage N0 or N1 was similar in all three groups. Positive lymph nodes were found in 31% of patients with lobular cancer compared to 38% of those with ductal cancer and 48% of patients with mixed lobular-ductal histology (p=0.05). The use of adjuvant chemo/hormonal therapy followed the same pattern (20%, 29%, 37%, respectively [p=0.07]). Lymphatic vessel invasion was more common in patients with ductal cancer (38%) than in those with mixed histology (27%) or pure lobular cancer (15%, p<0.0001). Patients with ductal carcinoma tended to be younger, with a median age of 50 years compared to 51 years for patients with mixed lobular-ductal histology and 58 years for patients with lobular histology (p=0.0001). Among 410 patients with evaluable margins, margins were less likely to be positive in patients with ductal histology (39% versus 66% for pure lobular and 67% for mixed lobular-ductal histology [p=0.0004]). The 5- and 10-year crude results by site of first failure for patients evaluable at those times were similar for patients with lobular, mixed and ductal carcinomas. In a multivariate analysis for survival including established prognostic factors, neither

Photobiomodulation therapy for the management of radiation-induced dermatitis. A single-institution experience of adjuvant radiotherapy in breast cancer patients after breast conserving surgery

International Nuclear Information System (INIS)

Strouthos, Iosif; Chatzikonstantinou, Georgios; Tselis, Nikolaos; Bon, Dimitra; Karagiannis, Efstratios; Zoga, Eleni; Ferentinos, Konstantinos; Maximenko, Julia; Nikolettou-Fischer, Vassiliki; Zamboglou, Nikolaos

2017-01-01

Radiation therapy (RT) comprises a key component in the treatment of breast cancer. Radiation-induced skin toxicity is the major adverse event experienced by patients; however, radiodermatitis (RD) prevention and management remains trivial. It is proven that photobiomodulation (PBM) therapy using light-emitting diode (LED) increases wound healing and depicts an anti-inflammatory effect. This single-institute study evaluates the beneficial role of PBM-LED in preventing/reducing RD during breast cancer RT. Of 70 consecutively treated patients, 25 patients were treated with PBM-LED twice a week prior to adjuvant 3D conformal RT after breast-conserving surgery. RD was reported using Common Toxicity Criteria for Adverse Events Version 4.0 and pain intensity using a visual analog scale (VAS). For comparison, a control group (n = 45) received RT without PBM-LED. In addition, a ''matched'' group (n = 25) was generated from the control group based on propensity for potentially confounding variables. In the PBM group, 22 patients (88%) presented grade 1 and 3 (12%) grade 2 RD. In the control group, 25 patients (55.6%) developed grade 1 reactions, 18 patients (40%) grade 2, and 2 (4.4%) patients grade 3 RD. Concerning pain intensity, 15 patients (60%) of the PBM treatment arm reported no pain, 5 patients (20%) VAS 2, and 5 (20%) VAS 3. In the control group, 13 patients (28.9%) reported no pain, 2 (4.4%) VAS 1, 7 (15.6%) VAS 2, 9 patients (20%) reported VAS 3, 12 (26.7%) patients VAS 4, and 2 (4.4%) patients VAS 5. PBM-LED therapy applied prior to RT might be effective in decreasing the incidence and sequelae of radiation-induced skin toxicity in breast cancer patients treated with breast-conserving surgery. (orig.) [de

Ultrasound elastography as an objective diagnostic measurement tool for lymphoedema of the treated breast in breast cancer patients following breast conserving surgery and radiotherapy

International Nuclear Information System (INIS)

Adriaenssens, Nele; Belsack, Dries; Buyl, Ronald; Ruggiero, Leonardo; Breucq, Catherine; De Mey, Johan; Lievens, Pierre; Lamote, Jan

2012-01-01

Lymphoedema of the operated and irradiated breast is a common complication following early breast cancer treatment. There is no consensus on objective diagnostic criteria and standard measurement tools. This study investigates the use of ultrasound elastography as an objective quantitative measurement tool for the diagnosis of parenchymal breast oedema. The elasticity ratio of the subcutis, measured with ultrasound elastography, was compared with high-frequency ultrasound parameters and subjective symptoms in twenty patients, bilaterally, prior to and following breast conserving surgery and breast irradiation. Elasticity ratio of the subcutis of the operated breast following radiation therapy increased in 88.9% of patients, was significantly higher than prior to surgery, unlike the non operated breast and significantly higher than the non operated breast, unlike preoperative results. These results were significantly correlated with visibility of the echogenic line, measured with high-frequency ultrasound. Big preoperative bra cup size was a significant risk factor for the development of breast oedema. Ultrasound elastography is an objective quantitative measurement tool for the diagnosis of parenchymal breast oedema, in combination with other objective diagnostic criteria. Further research with longer follow-up and more patients is necessary to confirm our findings

Woman experiencing gynecologic surgery: coping with the changes imposed by surgery 1

Science.gov (United States)

Silva, Carolina de Mendonça Coutinho e; Vargens, Octavio Muniz da Costa

2016-01-01

ABSTRACT Objectives: to describe the feelings and perceptions resulting from gynecologic surgery by women and analyze how they experience the changes caused by the surgery. Method: a qualitative, descriptive and exploratory study, which had Symbolic Interactionism and Grounded Theory as its theoretical framework. Participants of the study: 13 women submitted to surgery: Total Abdominal Hysterectomy, Total Abdominal Hysterectomy with bilateral Adnexectomy, Wertheim-Meigs surgery, Oophorectomy, Salpingectomy, Mastectomy, Quadrantectomy and Tracheloplasty. Individual interviews were conducted, recorded and analyzed according to the comparative analysis technique of the Grounded Theory. Results: from the data two categories emerged - Perceiving a different body and feeling as a different person and; building the meaning of mutilation. The changes experienced make women build new meanings and change the perception of themselves and their social environment. From the interaction with their inner self, occurred a reflection on relationships, the difference in their body and themselves, the functions it performs and the harm caused by the surgery. Conclusions: the participants felt like different women; the mutilation developed in concrete feelings, due the loss of the organ, and in abstract, linked to the impact of social identity and female functionality. The importance of the nurse establishing a multidimensional care, to identify the needs that go beyond the biological body is perceived. PMID:27579935

Drought Resilience and Water Conservation Technical Brief

Science.gov (United States)

In many areas of the US, the frequency, intensity, and duration of drought events are increasing, this brief highlights EPA drought and conservation activities across the nation and includes links to additional materials and reference documents.

Rectal surgery for endometriosis--should we be aggressive?

Science.gov (United States)

Varol, Nesrin; Maher, Peter; Healey, Martin; Woods, Rod; Wood, Carl; Hill, David; Lolatgis, Nick; Tsaltas, Jim

2003-05-01

To assess the outcome of aggressive but conservative laparoscopic surgery in the treatment of severe endometriosis involving the rectum. Retrospective study (Canadian Task Force classification III). Endosurgery unit of a tertiary referral center. One hundred sixty-nine women. Laparoscopy or laparotomy. The procedure was completed successfully laparoscopically in 145 (86%) and by laparotomy in 24 women (14%). The rate of preoperative symptoms was higher in 25 women who underwent bowel resection compared with those who had other bowel surgery. In addition to bowel surgery, excision of uterosacral ligaments, adhesiolysis, excision of endometrioma, and oophorectomy were the four most commonly performed procedures. At 35-month follow-up 61 patients (36%) required further surgery for pain. The average time between primary and repeat surgery was 16 months. This second operation was performed by laparoscopy in over three-fourths of the women. Overall recurrent endometriosis was found in 26 patients (15%). Overall morbidity associated with all surgery was 12.4%. Surgery for endometriosis of the cul-de-sac and bowel involves some of the most difficult dissections encountered, but it can be accomplished successfully with the low postoperative morbidity typical of laparoscopy.

Hospitalization, frequency of interventions, and quality of life after endoscopic, surgical, or conservative treatment in patients with chronic pancreatitis.

Science.gov (United States)

Rutter, Karoline; Ferlitsch, A; Sautner, T; Püspök, A; Götzinger, P; Gangl, A; Schindl, M

2010-11-01

Patients with chronic pancreatitis usually have a long and debilitating history of disease with frequent hospital admissions, episodes of intractable pain and multiple interventions. The sequences of treatment at initial presentation, endoscopy, surgery, or conservative treatment may affect the time course and admissions needed for disease control, thereby determining quality of life and overall outcome. A total of 292 patients with initial endoscopic, surgical, or conservative pharmacological treatment were retrospectively analyzed regarding frequency of interventions, days in hospital, symptom-free intervals, morbidity, and mortality. Quality of life (QoL) at the latest follow-up was measured by two standardized quality of life questionnaires (EORTC C30 and PAN26). Endoscopic treatment was initially performed in 150 (51.4%) patients, whereas 99 (33.9%) underwent surgery and 43 (14.7%) patients were treated conservatively at their initial presentation. Patients who underwent surgery had a significantly shorter time in the hospital (25.3 ± 24.6, 34.4 ± 35.1, 61.1 ± 37.9; P surgical treatment (P ≤ 0.001), whereas patients after endoscopic intervention developed acute or chronic pancreatitis or pseudocyst formation (P = 0.023). Patients who undergo surgery as their initial treatment for chronic pancreatitis require less consecutive interventions, a shorter hospital stay, and have a better quality of life compared with any other treatment. Surgery should therefore be considered early for the treatment of chronic pancreatitis, when endoscopic or conservative treatment fails and patients require further intervention.

Correlation of clinical and pathologic features with outcome in patients with ductal carcinoma in situ of the breast treated with breast-conserving surgery and radiotherapy

International Nuclear Information System (INIS)

Rodrigues, Neesha; Carter, Darryl; Dillon, Deborah; Parisot, Nicole; Choi, Doo Ho; Haffty, Bruce G.

2002-01-01

Purpose: Although breast-conserving surgery followed by radiotherapy (RT) has become a standard treatment option for patients with ductal carcinoma in situ of the breast, risk factors for ipsilateral breast tumor recurrence (IBTR) in these patients remain an active area of investigation. The purpose of this study was to evaluate the impact of clinical and pathologic features on long-term outcome in a cohort of DCIS patients treated with breast-conserving surgery plus RT. Methods and Materials: Between 1973 and 1998, 230 patients with DCIS were treated with breast-conserving surgery plus RT at our institution. All patients were treated by local excision followed by RT to the breast to a total median tumor bed dose of 64 Gy. Adjuvant hormonal therapy was used in only 20 patients (9%). All available clinical, pathologic, and outcome data, including ipsilateral and contralateral events, were entered into a computerized database. The clinical and pathologic variables evaluated included detection method, mammographic appearance, age, family history, histologic subtype, presence of necrosis, nuclear grade, final margin status, and use of adjuvant hormonal therapy. Results: As of December 15, 2000, with a median follow-up of 8.2 years, 17 patients had developed a recurrence in the ipsilateral breast, resulting in a 5- and 10-year IBTR rate of 5% and 13%, respectively. Contralateral breast cancer developed in 8 patients, resulting in a 10-year contralateral recurrence rate of 5%. Patient age, family history, histologic subtype, margin status, and tumor grade were not significantly associated with recurrence on univariate analysis. A significantly higher rate of local relapse was observed in patients with the presence of necrosis. The 10-year relapse rate was 22% in 88 patients with necrosis compared with 7% in 142 patients without necrosis (p <0.01). In multivariate analysis, the presence of necrosis remained a significant predictor of local relapse. No breast relapses

Long-Term Results of Targeted Intraoperative Radiotherapy (Targit) Boost During Breast-Conserving Surgery

Energy Technology Data Exchange (ETDEWEB)

Vaidya, Jayant S., E-mail: jayant.vaidya@ucl.ac.uk [Research Department of Surgery, Division of Surgery and Interventional Science, University College London, London (United Kingdom); Baum, Michael [Research Department of Surgery, Division of Surgery and Interventional Science, University College London, London (United Kingdom); Tobias, Jeffrey S. [Department of Radiation Oncology, University College London Hospitals, London (United Kingdom); Wenz, Frederik [Radiation Oncology and Gynaecology, University Medical Centre of Mannheim (Germany); Massarut, Samuele [Surgery and Radiation Oncology, Centro di Riferimento Oncologico (CRO), Aviano (Italy); Keshtgar, Mohammed [Research Department of Surgery, Division of Surgery and Interventional Science, University College London, London (United Kingdom); Hilaris, Basil [Radiation Oncology, Our Lady of Mercy, New York Medical College, New York (United States); Saunders, Christobel [Institute of Health and Rehabilitation Research, University of Notre Dame, Fremantle, Western Australia (Australia); Williams, Norman R.; Brew-Graves, Chris [Research Department of Surgery, Division of Surgery and Interventional Science, University College London, London (United Kingdom); Corica, Tammy [Institute of Health and Rehabilitation Research, University of Notre Dame, Fremantle, Western Australia (Australia); Roncadin, Mario [Surgery and Radiation Oncology, Centro di Riferimento Oncologico (CRO), Aviano (Italy); Kraus-Tiefenbacher, Uta; Suetterlin, Marc [Radiation Oncology and Gynaecology, University Medical Centre of Mannheim (Germany); Bulsara, Max [Institute of Health and Rehabilitation Research, University of Notre Dame, Fremantle, Western Australia (Australia); Joseph, David [Radiation Oncology, Sir Charles Gairdner Hospital and School of Surgery, University of Western Australia, Perth (Australia)

2011-11-15

Purpose: We have previously shown that delivering targeted radiotherapy to the tumour bed intraoperatively is feasible and desirable. In this study, we report on the feasibility, safety, and long-term efficacy of TARGeted Intraoperative radioTherapy (Targit), using the Intrabeam system. Methods and Materials: A total of 300 cancers in 299 unselected patients underwent breast-conserving surgery and Targit as a boost to the tumor bed. After lumpectomy, a single dose of 20 Gy was delivered intraoperatively. Postoperative external beam whole-breast radiotherapy excluded the usual boost. We also performed a novel individualized case control (ICC) analysis that computed the expected recurrences for the cohort by estimating the risk of recurrence for each patient using their characteristics and follow-up period. Results: The treatment was well tolerated. The median follow up was 60.5 months (range, 10-122 months). Eight patients have had ipsilateral recurrence: 5-year Kaplan Meier estimate for ipsilateral recurrence is 1.73% (SE 0.77), which compares well with that seen in the boosted patients in the European Organization for Research and Treatment of Cancer study (4.3%) and the UK STAndardisation of breast RadioTherapy study (2.8%). In a novel ICC analysis of 242 of the patients, we estimated that there should be 11.4 recurrences; in this group, only 6 recurrences were observed. Conclusions: Lumpectomy and Targit boost combined with external beam radiotherapy results in a low local recurrence rate in a standard risk patient population. Accurate localization and the immediacy of the treatment that has a favorable effect on tumour microenvironment may contribute to this effect. These long-term data establish the long-term safety and efficacy of the Targit technique and generate the hypothesis that Targit boost might be superior to an external beam boost in its efficacy and justifies a randomized trial.

A prospective study comparing endoscopic subcutaneous mastectomy plus immediate reconstruction with implants and breast conserving surgery for breast cancer.

Science.gov (United States)

Fan, Lin-Jun; Jiang, Jun; Yang, Xin-Hua; Zhang, Yi; Li, Xing-Gang; Chen, Xian-Chun; Zhong, Ling

2009-12-20

Breast conserving surgery (BCS) has been the standard surgical procedure for the treatment of early breast cancer. Endoscopic subcutaneous mastectomy (ESM) plus immediate reconstruction with implants is an emerging procedure. The objective of this prospective study was to evaluate the clinical outcomes of these two surgical procedures in our clinical setting. From March 2004 to October 2007, 43 patients with breast cancer underwent ESM plus axillary lymph node dissection and immediate reconstruction with implants, while 54 patients underwent BCS. The clinical and pathological characteristics, surgical safety, and therapeutic effects were compared between the two groups. There were no significant differences in the age, clinical stage, histopathologic type of tumor, operative blood loss, postoperative drainage time, and postoperative complications between the two groups (P > 0.05). The postoperative complications were partial necrosis of the nipple and superficial skin flap in the ESM patients, and hydrops in the axilla and residual cavity in the BCS patients. There was no significant difference in the rate of satisfactory postoperative cosmetic outcomes between the ESM (88.4%, 38/43) and BCS (92.6%, 50/54) patients (P > 0.05). During follow-up of 6 months to 4 years, all patients treated with ESM were disease-free, but 3 patients who underwent BCS had metastasis or recurrence -one of these patients died of multiple organ metastasis. After considering the wide indications for use, high surgical safety, and favorable cosmetic outcomes, we conclude that ESM plus axillary lymph node dissection and immediate reconstruction with implants - the new surgery of choice for breast cancer - warrants serious consideration as the prospective next standard surgical procedure.

The Prognostic Impact of Molecular Subtypes and Very Young Age on Breast Conserving Surgery in Early Stage Breast Cancer

Science.gov (United States)

McGuire, Kandace; Alco, Gul; Nur Pilanci, Kezban; Koksal, Ulkuhan I; Elbüken, Filiz; Erdogan, Zeynep; Agacayak, Filiz; Ilgun, Serkan; Sarsenov, Dauren; Öztürk, Alper; İğdem, Şefik; Okkan, Sait; Eralp, Yeşim; Dincer, Maktav; Ozmen, Vahit

2016-01-01

Background Premenopausal breast cancer with a triple-negative phenotype (TNBC) has been associated with inferior locoregional recurrence free survival (LRFS) and overall survival (OS) after breast conserving surgery (BCS). The aim of this study is to analyze the association between age, subtype, and surgical treatment on survival in young women (≤40 years) with early breast cancer in a population with a high rate of breast cancer in young women. Methods Three hundred thirty-two patients ≤40 years old with stage I-II invasive breast cancer who underwent surgery at a single institution between 1998 and 2012 were identified retrospectively. Uni- and multivariate analysis evaluated predictors of LRFS, OS, and disease free survival (DFS). Results Most patients (64.2%) underwent BCS. Mean age and follow-up time were 35 (25 ± 3.61) years, and 72 months (range, 24–252), respectively. In multivariate analysis, multicentricity/multifocality and young age (<35 years) independently predicted for poorer DFS and OS. Those aged 35–40 years had higher LRFS and DFS than those <35 in the mastectomy group (p=0.007 and p=0.039, respectively). Patients with TNBC had lower OS compared with patients with luminal A subtype (p=0.042), and those who underwent BCS had higher OS than patients after mastectomy (p=0.015). Conclusion Young age (< 35 years) is an independent predictor of poorer OS and DFS as compared with ages 35–40, even in countries with a lower average age of breast cancer presentation. In addition, TNBC in the young predicts for poorer OS. BCS can be performed in young patients with TNBC, despite their poorer overall survival. PMID:27433412

Conservative management of anal and rectal cancer

International Nuclear Information System (INIS)

Gerard, J.P.; Romestaing, P.; Montbarbon, X.

1989-01-01

The role of irradiation in the management of anal and rectal cancer has changed during the past ten years. In small epidermoid carcinomas of the anal canal (T1 T2) irradiation is in most departments considered the primary treatment, giving a 5-year survival rate of between 60 and 80% with good sphincter preservation. Even in larger tumors, irradiation can still offer some chance of cure without colostomy. Surgery remains the basic treatment of rectal cancer but irradiation is used in association with surgery in many cases. Radiotherapy is of value in the conservative management of cancer of the rectum in three situations: In small polypoid cancers contact X-ray therapy can give local control in about 90%. In cancers of the middle rectum, preoperative external irradiation may increase the chances of restorative surgery and reduce the risk of local relapse. In inoperable patients, external radiotherapy and/or intracavitary irradiation may cure some patients with infiltrating tumors (T2 T3) without colostomy. (orig.)

Intramolecular cross-linking in a bacterial homolog of mammalian SLC6 neurotransmitter transporters suggests an evolutionary conserved role of transmembrane segments 7 and 8

DEFF Research Database (Denmark)

Kniazeff, Julie; Loland, Claus Juul; Goldberg, Naomi

2005-01-01

The extracellular concentration of the neurotransmitters dopamine, serotonin, norepinephrine, GABA and glycine is tightly controlled by plasma membrane transporters belonging to the SLC6 gene family. A very large number of putative transport proteins with a remarkable homology to the SLC6...... proximity between TM 7 and 8 in the tertiary structure of TnaT as previously suggested for the mammalian counterparts. Furthermore, the inhibition of uptake upon cross-linking the two cysteines provides indirect support for a conserved conformational role of these transmembrane domains in the transport...

History of cervical spine surgery: from nihilism to advanced reconstructive surgery.

Science.gov (United States)

Dweik, A; Van den Brande, E; Kossmann, T; Maas, A I R

2013-11-01

Review of literature. To review and analyze the evolution of cervical spine surgery from ancient times to current practice. The aim is to present an accessible overview, primarily intended for a broad readership. Descriptive literature review and analysis of the development of cervical spine surgery from the prehistoric era until today. The first evidence for surgical treatment of spinal disorders dates back to approximately 1500 BC. Conservative approaches to treatment have been the hallmark for thousands of years, but over the past 50 years progress has been rapid. We illustrate how nations have added elements to this complex subject and how knowledge has surpassed borders and language barriers. Transferral of knowledge occurred from Babylon (Bagdad) to Old Egypt, to the Greek and Roman empires and finally via the Middle East (Bagdad and Damascus) back to Europe. Recent advances in the field of anesthesia, imaging and spinal instrumentation have changed long-standing nihilism in the treatment of cervical spine pathologies to the current practice of advanced reconstructive surgery of the cervical spine. A critical approach to the evaluation of benefits and complications of these advanced surgical techniques for treatment of cervical spine disorders is required. Advances in surgery now permit full mechanical reconstruction of the cervical spine. However, despite substantial experimental progress, spinal cord repair and restoration of lost functions remain a challenge. Modern surgeons are still looking for the best way to manage spine disorders.

Novel urban ecosystems, biodiversity, and conservation

International Nuclear Information System (INIS)

Kowarik, Ingo

2011-01-01

With increasing urbanization the importance of cities for biodiversity conservation grows. This paper reviews the ways in which biodiversity is affected by urbanization and discusses the consequences of different conservation approaches. Cities can be richer in plant species, including in native species, than rural areas. Alien species can lead to both homogenization and differentiation among urban regions. Urban habitats can harbor self-sustaining populations of rare and endangered native species, but cannot replace the complete functionality of (semi-)natural remnants. While many conservation approaches tend to focus on such relict habitats and native species in urban settings, this paper argues for a paradigm shift towards considering the whole range of urban ecosystems. Although conservation attitudes may be challenged by the novelty of some urban ecosystems, which are often linked to high numbers of nonnative species, it is promising to consider their associated ecosystem services, social benefits, and possible contribution to biodiversity conservation. - Highlights: → This paper reviews biotic responses to urbanization and urban conservation approaches. → Cities may be rich in both native and nonnative species. → Urban habitats cannot replace the functionality of natural remnants. → However, even novel urban habitats may harbour rare and endangered species. → Conservation approaches should consider the perspective of novel urban ecosystems. - This paper reviews the ways in which biodiversity is affected by urbanization and argues for expanding urban conservation approaches.

Novel urban ecosystems, biodiversity, and conservation

Energy Technology Data Exchange (ETDEWEB)

Kowarik, Ingo, E-mail: kowarik@tu-berlin.de [Department of Ecology, Technische Universitaet Berlin, Rothenburgstr. 12, D 12165 Berlin (Germany)

2011-08-15

With increasing urbanization the importance of cities for biodiversity conservation grows. This paper reviews the ways in which biodiversity is affected by urbanization and discusses the consequences of different conservation approaches. Cities can be richer in plant species, including in native species, than rural areas. Alien species can lead to both homogenization and differentiation among urban regions. Urban habitats can harbor self-sustaining populations of rare and endangered native species, but cannot replace the complete functionality of (semi-)natural remnants. While many conservation approaches tend to focus on such relict habitats and native species in urban settings, this paper argues for a paradigm shift towards considering the whole range of urban ecosystems. Although conservation attitudes may be challenged by the novelty of some urban ecosystems, which are often linked to high numbers of nonnative species, it is promising to consider their associated ecosystem services, social benefits, and possible contribution to biodiversity conservation. - Highlights: > This paper reviews biotic responses to urbanization and urban conservation approaches. > Cities may be rich in both native and nonnative species. > Urban habitats cannot replace the functionality of natural remnants. > However, even novel urban habitats may harbour rare and endangered species. > Conservation approaches should consider the perspective of novel urban ecosystems. - This paper reviews the ways in which biodiversity is affected by urbanization and argues for expanding urban conservation approaches.

No more broken hearts: weight loss after bariatric surgery returns patients' postoperative risk to baseline following coronary surgery.

Science.gov (United States)

Baimas-George, Maria; Hennings, Dietric L; Al-Qurayshi, Zaid; Emad Kandil; DuCoin, Christopher

2017-06-01

The obesity epidemic is associated with a rise in coronary surgeries because obesity is a risk factor for coronary artery disease. Bariatric surgery is linked to improvement in cardiovascular co-morbidities and left ventricular function. No studies have investigated survival advantage in postoperative bariatric patients after coronary surgery. To determine if there is a benefit after coronary surgery in patients who have previously undergone bariatric surgery. National Inpatient Sample. We performed a retrospective, cross-sectional analysis of the National Inpatient Sample database from 2003 to 2010. We selected bariatric surgical patients who later underwent coronary surgery (n = 257). A comparison of postoperative complications and mortality after coronary surgery were compared with controls (n = 1442) using χ 2 tests, linear regression analysis, and multivariate logistical regression models. A subset population was identified as having undergone coronary surgery (n = 1699); of this population, 257 patients had previously undergone bariatric surgery. They were compared with 1442 controls. The majority was male (67.2%), white (82.6%), and treated in an urban environment (96.8%). Patients with bariatric surgery assumed the risk of postoperative complications after coronary surgery that was associated with their new body mass index (BMI) (BMI999.9, 95% CI .18 to>999.9, P = .07). Length of stay was significantly longer in postbariatric patients (BMIbariatric patients have a return to baseline risk of morbidity and mortality after coronary surgery. Copyright © 2017 American Society for Bariatric Surgery. Published by Elsevier Inc. All rights reserved.

Comparing the effects of conventional and hypofractionated radiotherapies on early skin toxicity and cosmetic outcomes after breast cancer conserving surgery

Directory of Open Access Journals (Sweden)

Amouzegar Hashemi F

2012-12-01

Full Text Available Background: The high number of breast cancer patients who receive radiation therapy after surgery has caused many to think about a shorter period of radiotherapy, which can significantly reduce the radiotherapy machine time, labor hours, and fewer patient visits. This study was designed to evaluate the acute skin effects and cosmetic outcomes of short course radiotherapy in early-stage breast cancer in comparison with the conventional treatment method.Methods: Fifty-two patients with operable breast cancer (pT1-3pN0M0 who underwent breast conservation surgery in Tehran Cancer Institute during January 2011 to January 2012, were randomly assigned to undergo radiotherapy by either receiving conventional treatment (dose: 50 Gy in 25 fractions with subsequent electron boost or a short-course hypofractionated radiotherapy (dose: 42.5 Gy in 16 fractions and a subsequent electron boost.Results: There were no skin changes during the first or the second week of treatment in the two groups. Cutaneous complications began after the third week as grade 1 skin toxicity after termination of the short-course radiotherapy but there were no difference in complication rate after four weeks of treatment. Six months and one year after treatment, there were no differences in terms of skin complications or cosmetic outcomes between the two groups.Conclusion: Although the use of a whole-breast irradiation with a hypofractionated schedule was associated with desirable outcomes, in term of skin toxicity and cosmetics, but longer follow-up periods with larger sample sizes are needed to confirm these results.

Dosimetric study comparing volumetric arc modulation with RapidArc and fixed dynamic intensity-modulated radiation therapy for breast cancer radiotherapy after breast-conserving surgery

International Nuclear Information System (INIS)

Tie Jian; Sun Yan; Gong Jian; Han Shukui; Jiang Fan; Wu Hao

2011-01-01

Objective: To compare the dosimetric difference between volumetric are modulation with RapidArc and fixed field dynamic IMRT for breast cancer radiotherapy after breast-conserving surgery. Methods: Twenty patients with early left-sided breast cancer received radiotherapy after breast-conserving surgery. After target definition, treatment planning was performed by RapidArc and two fixed fields dynamic IMRT respectively on the same CT scan. The target dose distribution, homogeneity of the breast, and the irradiation dose and volume for the lungs, heart, and contralateral breast were read in the dose-volume histogram (DVH) and compared between RapidArc and IMRT. The treatment delivery time and monitor units were also compared. Results: In comparison with the IMRT planning,the homogeneity of clinical target volume (CTV), the volume proportion of 95% prescribed dose (V 95% ) was significantly higher by 0.65% in RapidArc (t=5.16, P=0.001), and the V 105% and V 110% were lower by 10.96% and 1.48 % respectively, however, without statistical significance (t=-2.05, P=0.055 and t=-1.33, P=0.197). The conformal index of planning target volume (PTV) by the RapidArc planning was (0.88±0.02), significantly higher than that by the IMRT planning [(0.74±0.03), t=18.54, P<0.001]. The homogeneity index (HI) of PTV by the RapidArc planning was 1.11±0.01, significantly lower than that by the IMRT planning (1.12±0.02, t=-2.44, P=0.02). There were no significant differences in the maximum dose (D max ) and V 20 for the ipsilateral lung between the RapidArc and IMRT planning, but the values of V 10 , V 5 , D min and D mean by RapidArc planning were all significantly higher than those by the IMRT planning (all P<0.01). The values of max dose and V 30 for the heart were similar by both techniques, but the values of V 10 and V 5 by the RapidArc planning were significantly higher (by 18% and 50%, respectively). The V 5 of the contralateral breast and lung by the RapidArc planning were

Does conservation on farmland contribute to halting the biodiversity decline?

Science.gov (United States)

Kleijn, David; Rundlöf, Maj; Scheper, Jeroen; Smith, Henrik G; Tscharntke, Teja

2011-09-01

Biodiversity continues to decline, despite the implementation of international conservation conventions and measures. To counteract biodiversity loss, it is pivotal to know how conservation actions affect biodiversity trends. Focussing on European farmland species, we review what is known about the impact of conservation initiatives on biodiversity. We argue that the effects of conservation are a function of conservation-induced ecological contrast, agricultural land-use intensity and landscape context. We find that, to date, only a few studies have linked local conservation effects to national biodiversity trends. It is therefore unknown how the extensive European agri-environmental budget for conservation on farmland contributes to the policy objectives to halt biodiversity decline. Based on this review, we identify new research directions addressing this important knowledge gap. Copyright © 2011 Elsevier Ltd. All rights reserved.

Intraoperative boost radiation effects on early wound complications in breast cancer patients undergoing breast-conserving surgery

Science.gov (United States)

Gülçelik, Mehmet Ali; Doğan, Lütfi; Karaman, Niyazi; Turan, Müjdat; Kahraman, Yavuz Selim; Akgül, Gökhan Giray; Özaslan, Cihangir

2017-08-23

Background/aim: Intraoperative radiation therapy (IORT) may pose a risk for wound complications. All technical aspects of IORT regarding early wound complications were evaluated. Materials and methods: Ninety-three consecutive patients operated on with the same surgical technique and given (study group) or not given (control group) IORT were included. Wound complications were evaluated in two groups. Results: Forty-three patients were treated with boost dose IORT and 50 patients were treated with breast-conserving surgery without IORT. When both groups were compared in terms of early postoperative complications, there were 11 (25.5%) patients with seroma in the IORT group and 3 patients (6%) in the control group (P = 0.04). While 9 (21%) patients were seen to have surgical site infection (SSI) in the IORT group, there was 1 (2%) SSI in the control group (P = 0.005). There were 15 (35%) patients with delayed wound healing in the IORT group and 4 patients (8%) in the control group (P = 0.006). Conclusion: IORT could have a negative effect on seroma formation, SSI, and delayed healing. It should be kept in mind, however, that in centers with IORT implementation, the complication rate could also increase. Necessary measures for better sterilization in the operating room should be taken, while patient wound healing should be monitored closely.

Study of problems with appendicitis in children undergoing laparoscopic surgery

International Nuclear Information System (INIS)

Kosumi, Takuya; Yonekura, Takeo; Yamauchi, Katsuji; Kuroda, Seika; Kimura, Takuya; Ihara, Yoshiyuki

2011-01-01

Seventy-one children who underwent laparoscopic appendectomy over the 8 years previous to the study were investigated. The patients were divided into 2 groups: those who had undergome surgery within 24 hours (EA group) and after conservative treatment (IA group). The condition of appendicitis on CT was classified into appendiceal mass (Group A), perforation (Group B), and non-perforation (Group C). Perioperative complications were mainly investigated in these groups. The EA group included 45 patients, and postoperative complications occurred in 2 of 12 patients in Group A (wound infection and intraperitoneal abscess in 1 each) and 2 of 14 patients in Group B (postoperative ileus and intraperitoneal abscess in 1 each). The IA group included 26 patients, and complications occurred only during conservative treatment in 2 of 7 patients in Group A (recurrence of inflammation and ileus in 1 each) and 2 of 2 patients in Group B (recurrence of inflammation and emergency surgery for the aggravation of symptoms in 1 each). No complication occurred in Group C of either the EA or IA group. Treatment was not switched to laparotomy in any patient in the EA or IA group, and no complication occurred during surgery. The total duration of hospitalization was shorter in the EA than in the IA group in all Groups A, B, and C. The risk of postoperative complications was high in the EA group, whereas complications during conservative treatment were problematic in the IA group. (author)

[Extensive conservative treatment of obesity].

Science.gov (United States)

Buri, Caroline; Laederach, Kurt

2013-02-01

The treatment of obesity is complex due to the multifactorial etiology. A modern therapy concept must therefore be tailored to the individual needs and problems and depends on various factors such as degree of obesity, the presence of physical complications, psychological co-morbidities, any treatment measures the patient underwent up to now as well as on motivational factors. Before deciding on a therapeutic measure a structured multidisciplinary cooperation is essential including psychosomatic medicine/psychiatry/psychotherapy, endocrinology, sports medicine, nutritional medicine and surgery as well. The treatment must be carried out in a multidisciplinary team and includes an adequate therapy of comorbidities and sometimes a psychopharmacological support. The success of a conservative treatment of obesity is remarkable and long-lasting and can be straightforwardly compared to bariatric surgery in financial as well as ethical terms, although for patients and their physicians the latter often carries the allure of quick success.

Conservative surgery and radiotherapy for stage I/II breast cancer using lung density correction: 10-year and 15-year results

International Nuclear Information System (INIS)

Pierce, Lori J.; Griffith, Kent A.; Hayman, James A.; Douglas, Kathye R.; Lichter, Allen S.

2005-01-01

Purpose: Radiotherapy (RT) planning for breast cancer using lung density correction improves dose homogeneity. Its use obviates the need for a medial wedge, thus reducing scatter to the opposite breast. Although lung density correction is used at many centers in planning for early-stage breast cancer, long-term results of local control and survival have not been reported. Since 1984, we have used lung density correction for dose calculations at the University of Michigan. We now present our 10-year and 15-year results. Methods and Materials: The records of 867 patients with Stage I/II breast cancer treated with breast-conserving surgery and RT with or without systemic therapy were reviewed. Tangential fields delivering 45-50 Gy to the whole breast calculated using lung density correction were used. A boost was added in 96.8% of patients for a total median dose of 61.8 Gy. Results: With a median follow-up of 6.6 years (range, 0.2-18.9 years), 5-, 10-, and 15-year actuarial rates of in-breast tumor recurrence as only first failure were 2.2%, 3.6%, and 5.4%, respectively. With surgical salvage, the 15-year cumulative rate of local control was 99.7%. Factors that significantly predicted for increased rate of local recurrence in multivariate analysis were age ≤ 35 years, hazard ratio 4.8 (95% confidence interval [CI], 1.6-13.9) p = 0.004; negative progesterone receptor status, hazard ratio 6.8 (95% CI, 2.3-20.3) p = < 0.001; negative estrogen receptor status, hazard ratio 4.0 (95% CI, 1.5-11.1) p = 0.007; and lack of adjuvant tamoxifen therapy, hazard ratio 7.7 (95% CI, 1.7-33.3) p = 0.008. Relapse-free survival rates at 5, 10, and 15 years were 84.6%, 70.8%, and 55.9%, respectively; breast cancer-specific survival rates were 94.4%, 90.5%, and 86.9%, respectively; and corresponding estimates for overall survival were 89.7%, 75.7%, and 61.3%. Conclusions: Use of lung density correction was associated with high rates of local control, relapse-free survival, breast

Identifying all moiety conservation laws in genome-scale metabolic networks.

Science.gov (United States)

De Martino, Andrea; De Martino, Daniele; Mulet, Roberto; Pagnani, Andrea

2014-01-01

The stoichiometry of a metabolic network gives rise to a set of conservation laws for the aggregate level of specific pools of metabolites, which, on one hand, pose dynamical constraints that cross-link the variations of metabolite concentrations and, on the other, provide key insight into a cell's metabolic production capabilities. When the conserved quantity identifies with a chemical moiety, extracting all such conservation laws from the stoichiometry amounts to finding all non-negative integer solutions of a linear system, a programming problem known to be NP-hard. We present an efficient strategy to compute the complete set of integer conservation laws of a genome-scale stoichiometric matrix, also providing a certificate for correctness and maximality of the solution. Our method is deployed for the analysis of moiety conservation relationships in two large-scale reconstructions of the metabolism of the bacterium E. coli, in six tissue-specific human metabolic networks, and, finally, in the human reactome as a whole, revealing that bacterial metabolism could be evolutionarily designed to cover broader production spectra than human metabolism. Convergence to the full set of moiety conservation laws in each case is achieved in extremely reduced computing times. In addition, we uncover a scaling relation that links the size of the independent pool basis to the number of metabolites, for which we present an analytical explanation.

Identifying all moiety conservation laws in genome-scale metabolic networks.

Directory of Open Access Journals (Sweden)

Andrea De Martino

Full Text Available The stoichiometry of a metabolic network gives rise to a set of conservation laws for the aggregate level of specific pools of metabolites, which, on one hand, pose dynamical constraints that cross-link the variations of metabolite concentrations and, on the other, provide key insight into a cell's metabolic production capabilities. When the conserved quantity identifies with a chemical moiety, extracting all such conservation laws from the stoichiometry amounts to finding all non-negative integer solutions of a linear system, a programming problem known to be NP-hard. We present an efficient strategy to compute the complete set of integer conservation laws of a genome-scale stoichiometric matrix, also providing a certificate for correctness and maximality of the solution. Our method is deployed for the analysis of moiety conservation relationships in two large-scale reconstructions of the metabolism of the bacterium E. coli, in six tissue-specific human metabolic networks, and, finally, in the human reactome as a whole, revealing that bacterial metabolism could be evolutionarily designed to cover broader production spectra than human metabolism. Convergence to the full set of moiety conservation laws in each case is achieved in extremely reduced computing times. In addition, we uncover a scaling relation that links the size of the independent pool basis to the number of metabolites, for which we present an analytical explanation.

Timing of radiotherapy (RT) and chemotherapy (CT) following breast conserving surgery (BCS) for patients with node-positive breast cancer

Energy Technology Data Exchange (ETDEWEB)

Wallgren, A; Bernier, J; Gelber, RD; Roncadin, M; Joseph, D; Castiglione, M

1995-07-01

Purpose: To evaluate the effects of delaying RT until after different durations of initial courses of CT for pts with node-positive breast cancer. Methods and Materials: From 7/86-4/93, the IBCSG enrolled 1475 eligible node-positive pre- and perimenopausal pts in Trial 6 and 1212 eligible node-positive postmenopausal pts in Trial 7. Pts in Trial 6 were randomized to receive one of four treatments: (1) CMF x 6 cycles (1 cycle=28 days; cyclophosphamide 100 mg/m{sup 2} orally days 1-14; methotrexate 40 mg/m{sup 2} iv. days 1 and 8; 5-fluorouracil 600 mg/m{sup 2} iv days 1 and 8); (2) CMF x 6 cycles followed by single cycles at months 9, 12 and 15; (3) CMF x 3 cycles; (4) CMF x 3 followed by single cycles at months 6, 9 and 12. Pts in Trial 7 were randomized to receive one of four treatments: (5) tamoxifen (TAM: 20 mg daily) plus CMF x 3 cycles, months 1,2,3; (6) TAM plus CMF x 3 plus single cycles of CMF at months 9, 12 and 15; (7) TAM alone for five yrs; (8) TAM plus single cycles of CMF at months 9, 12 and 15. The randomizations were stratified according to type of surgery; 434 pts in Trial 6 (29%) and 285 pts in Trial 7 (24%) had breast conserving surgery and are the subjects of this report. Pts were randomized to receive RT to the conserved breast AFTER completing the initial block of CT if assigned; i.e. month 7 for arms 1 and 2; month 4 for arms 3 and 4; month 4 for arms 5 and 6; month 1 for arms 7 and 8. 24% of pts in Trial 6 and 27% of pts in Trial 7 had four or more axillary lymph nodes involved. Possible prognostic factors including age, estrogen receptor status, nodal status and tumor size were balanced across randomized groups. Four-year actuarial total failure rates (failure at any site), risks of developing distant metastases (DM) (at any time during observation), and overall survival (OS) were estimated using the Kaplan-Meier method. To avoid potential bias due to competing causes of failure, only patients who could be followed for at least 4 years

An evaluation of factors predicting breast recurrence and prognosis after recurrence, on distinguishing intramammary and extramammary recurrence, in breast-conserving surgery

Energy Technology Data Exchange (ETDEWEB)

Nishimura, Reiki; Nagao, Kazuharu; Miyayama, Haruhiko [Kumamoto City Hospital (Japan)] (and others)

2001-06-01

Recurrence of cancer in the breast is an important problem in breast-conserving therapy. We evaluated risk factors for recurrence from the viewpoint of recurrence type and outcome after recurrence. Of 533 cases of breast cancer treated with breast-conserving surgery from April 1989 through July 2000, disease in 66 recurred (12.4%) and were classified as 23 cases of breast recurrence only, 16 cases of both breast recurrence and distant metastasis, and 27 cases of distant metastasis only. The clinical factors examined included age, lymphatic invasion, nodal status, extensive intraductal component (EIC), proliferative activity, and estrogen receptor (ER) status. Of the 39 cases of breast recurrence, 19 had intramammary tumors and 20 had extramammary tumors of the skin, subcutaneous tissue, or muscle, including 8 cases with inflammatory breast recurrence. Multivariate analysis showed that factors correlated with breast recurrence were age, ER status, proliferative activity, and surgical margin. EIC-comedo was related to intramammary recurrence, whereas lymphatic invasion and nodal status were related to extramammary recurrence. Postoperative irradiation was an effective treatment for tumors in young women and tumors with positive margins or a comedo component. Outcome after breast recurrence depended on nodal status at primary operation, and survival rates were worst in patients with inflammatory breast recurrence. In conclusion, age, EIC-comedo status, the surgical margin, and negative ER status were correlated with breast recurrence. Countermeasures against these factors should be investigated. (author)

An evaluation of factors predicting breast recurrence and prognosis after recurrence, on distinguishing intramammary and extramammary recurrence, in breast-conserving surgery

International Nuclear Information System (INIS)

Nishimura, Reiki; Nagao, Kazuharu; Miyayama, Haruhiko

2001-01-01

Recurrence of cancer in the breast is an important problem in breast-conserving therapy. We evaluated risk factors for recurrence from the viewpoint of recurrence type and outcome after recurrence. Of 533 cases of breast cancer treated with breast-conserving surgery from April 1989 through July 2000, disease in 66 recurred (12.4%) and were classified as 23 cases of breast recurrence only, 16 cases of both breast recurrence and distant metastasis, and 27 cases of distant metastasis only. The clinical factors examined included age, lymphatic invasion, nodal status, extensive intraductal component (EIC), proliferative activity, and estrogen receptor (ER) status. Of the 39 cases of breast recurrence, 19 had intramammary tumors and 20 had extramammary tumors of the skin, subcutaneous tissue, or muscle, including 8 cases with inflammatory breast recurrence. Multivariate analysis showed that factors correlated with breast recurrence were age, ER status, proliferative activity, and surgical margin. EIC-comedo was related to intramammary recurrence, whereas lymphatic invasion and nodal status were related to extramammary recurrence. Postoperative irradiation was an effective treatment for tumors in young women and tumors with positive margins or a comedo component. Outcome after breast recurrence depended on nodal status at primary operation, and survival rates were worst in patients with inflammatory breast recurrence. In conclusion, age, EIC-comedo status, the surgical margin, and negative ER status were correlated with breast recurrence. Countermeasures against these factors should be investigated. (author)

A comparison of microdebrider assisted endoscopic sinus surgery and conventional endoscopic sinus surgery for nasal polypi.

Science.gov (United States)

Singh, Rohit; Hazarika, Produl; Nayak, Dipak Ranjan; Balakrishnan, R; Gangwar, Navneeta; Hazarika, Manali

2013-07-01

Nasal polyposis is often encountered in rhinology practice. Those who fail conservative management, a definitive surgery is essential to achieve sufficient ventilation and drainage of the affected sinuses by using either microdebrider or conventional instruments for functional endoscopic sinus surgery (FESS). A prospective study was conducted on 40 cases of nasal polypi in a tertiary care hospital. 20 cases were operated by conventional endoscopic instruments and 20 using the microdebrider. The study aimed at comparing the intra operative (blood loss, duration of surgery) and post operative results (crusting, scarring, discharge, symptoms, recurrence) between the two groups using Lund-Mackay scoring system and the data was statistically analysed. There was no statistically significant difference in surgical outcome for patients when either conventional endoscopic instruments or microdebrider was used. However, there was a significant symptomatic improvement in cases undergoing microdebrider FESS. Microdebrider assisted polypectomy is precise, relatively bloodless surgery though the precision depends on the surgeon's anatomical knowledge and operative skills. Study substantiates that these instruments are helpful but not a prerequisite for successful outcomes in FESS. The study re-emphasises the utility of the microdebrider to young learning FESS surgeons.

The presence of proliferative breast disease with atypia does not significantly influence outcome in early-stage invasive breast cancer treated with conservative surgery and radiation

International Nuclear Information System (INIS)

Fowble, B.; Hanlon, A.L.; Patchefsky, A.; Freedman, G.; Hoffman, J.P.; Sigurdson, E.R.; Goldstein, L.J.

1998-01-01

Purpose: To evaluate the influence of the benign background breast-tissue change of atypical hyperplasia (AH) on outcome in patients with early-stage invasive breast cancer treated with conservative surgery and radiation. Materials and Methods: Four hundred and sixty women with Stage I--II breast cancer treated with conservative surgery and radiation from 1982-1994 had pathologic assessment of their background adjacent benign breast tissue. The median follow-up was 5.6 years (range 0.1-15). The median age was 55 years (range 24-88). Of these, 23% had positive axillary nodes; 25% received adjuvant chemotherapy (CMF or CAF) with (9%) or without (17%) tamoxifen. Of the total, 24% received adjuvant tamoxifen alone. The patients were divided into 2 groups: 131 patients with atypical hyperplasia (ductal, 99 patients; lobular, 20 pts; and type not specified, 12 pts), and 329 patients with no proliferative changes or proliferative changes without atypia. Result: A statistically significant difference was observed between the 2 groups for method of detection, primary tumor size, presence of lobular carcinoma in situ (LCIS), pathologic nodal status, region(s) treated with radiation, and type of adjuvant therapy. Patients with atypical hyperplasia (AH) had smaller primary tumors (T1 80% vs. 70%) more often detected solely by mammography (51% vs. 36%) with negative axillary nodes (87% vs. 73%) and radiation treatment to the breast only (93% vs. 78%). LCIS was observed in 9% of the patients with AH and 3% of those without AH. Patients with AH more often received tamoxifen alone (32% vs. 21%), rather than chemotherapy (15% vs. 29%). There were no statistically significant differences between the 2 groups for race, age, menopausal status, family history, histology, histologic subtype DCIS when present, the presence or absence of an extensive intraductal component, final margin status, estrogen or progesterone receptor status, use of re-excision, or total radiation dose to the

Prognosis after local recurrence after conservative surgery and radiation for early-stage breast cancer

International Nuclear Information System (INIS)

Galper, Sharon; Blood, Emily; Gelman, Rebecca; Abner, Anthony; Recht, Abram; Kohli, Anita; Wong, Julia S.; Smith, Darrell; Bellon, Jennifer; Connolly, James; Schnitt, Stuart; Winer, Eric; Silver, Barbara B.A.; Harris, Jay R.

2005-01-01

Purpose: To determine the long-term prognosis of patients who develop a local recurrence (LR) after conservative surgery (CS) and radiation therapy (RT) for early-stage invasive breast cancer. Methods and materials: Between 1970 and 1987, 2102 patients with clinical Stage I-II breast cancer were treated with CS+RT. LR was defined as any recurrence within the ipsilateral breast with or without simultaneous regional nodal or distant metastasis. Patients were at risk for a LR until the first of distant metastases, second nonbreast malignancy, or death (DF/S/D). The final study population comprised 341 patients with LR. The median time to LR was 72 months. The median follow-up time after LR was 85 months. A proportional hazards model of time from LR to DF/S/D was done to investigate the influence of factors at initial diagnosis and at LR on subsequent outcome. Results: The actuarial freedom from DF/S/D 5 years after LR was 65% and the survival was 81%. Variables significantly associated with time to DF/S/D were: LR histology (invasive vs. ductal carcinoma in situ, hazard ratio [HR] = 4.1, p 5 years, HR = 2.6, p 5 years, HR = 1.8, p = 0.006); and age at initial diagnosis (≥60 vs. < 60, HR = 1.6, p = 0.01). Conclusions: Many patients with LR after CS+RT have prolonged distant disease-free survival, particularly those able to be treated with mastectomy. Patients with a noninvasive LR, longer interval to LR, or age <60 had a longer time to distant failure, second malignancy, or death than other patients

[Bladder-conserving treatment for bladder cancer: potential of and developments in radiotherapy].

Science.gov (United States)

Hulshof, Maarten C C M; Pieters, Bradley R; Koning, Caro C E

2013-01-01

The standard treatment for muscle-invasive bladder cancer is surgical removal of the bladder and construction of a neobladder. Recently, important improvements have been made in the potential for bladder-conserving treatment using radiotherapy. External beam radiotherapy has undergone technological improvements, as a result of which it is possible to radiate the tumour more precisely while decreasing radiation to healthy tissue. Radiochemotherapy improves local recurrence-free and overall survival compared with radiotherapy alone. The results of this combined treatment are comparable with those of surgery. Additionally, Dutch radiotherapy departments have collected data in a national database of 1040 selected patients with confined bladder cancer. These patients were treated with external beam radiation, limited surgery and brachytherapy. The 5-year local recurrence-free survival was 75%. Bladder conserving treatment options for muscle-invasive bladder cancer should be discussed during the multidisciplinary meeting.

A comparison of behavioral and psychological characteristics of patients opting for surgical and conservative treatment for morbid obesity.

Science.gov (United States)

Kvalem, Ingela Lundin; Bergh, Irmelin; von Soest, Tilmann; Rosenvinge, Jan H; Johnsen, Tina Avantis; Martinsen, Egil W; Mala, Tom; Kristinsson, Jon A

2015-01-01

Little is known about the psychological prerequisites for weight loss maintenance after bariatric surgery. A first step in investigating whether existing knowledge of conservative weight loss treatment is applicable for lifestyle interventions postoperatively is to compare specific psychological characteristics at baseline. The aim of this study was to compare patients scheduled for bariatric surgery with patients receiving conservative treatment for morbid obesity on measures of behavioral and psychosocial characteristics considered predictors of their adoption of and adherence to long-term lifestyle recommendations. Baseline clinical and questionnaire data from the prospective "Oslo Bariatric Surgery Study" were used to examine potential differences between bariatric surgery patients (n = 301) and patients receiving conservative weight loss treatment (n = 261). The surgical group was characterized by their younger age (43.8 vs. 46.2 years, p changing their eating behaviors (OR = 1.80, 95 % CI 1.06, 1.93). The surgical patients were also less ready to change physical activity levels (OR = 0.59, 95 % CI 0.48, 0.73), had tried more types of unhealthy weight loss methods in the past (OR = 1.16, 95 % CI 1.01, 1.33), drank soda more frequently (OR = 1.24, 95 % CI 1.02, 1.50), had fewer binge eating episodes (OR = 0.38, 95 % CI 0.20, 0.71), and had more depressive symptoms (OR = 1.19, 95 % CI 1.09, 1.29). Patients opting for bariatric surgery had more positive expectations of the treatment outcomes and stronger beliefs in their ability to achieve these outcomes. Those starting conservative treatment had stronger beliefs in readiness to change physical activity levels. Future studies should explore the effect of interventions for bariatric surgery patients, promoting postoperative physical activity and stress realistic outcome expectations. The potential effects of incorporating this knowledge in intervention strategies remain to be

Effectiveness of conservative management of uncomplicated acute appendicitis: A single hospital based prospective study

Directory of Open Access Journals (Sweden)

Mumtaz KH. Alnaser

Full Text Available Background: Acute appendicitis is one of the commonest causes of acute abdomen. There is a wide discussion and controversy on the surgical and nonsurgical treatment of acute uncomplicated appendicitis. The aim of this study was to evaluate the efficacy and outcomes of the conservative management of selected cases of acute appendicitis with an antibiotic first plan. Patients and methods: This was a single hospital-based prospective study with a duration of 25 months. Patients with clinical and radiological features of acute appendicitis presenting within 72 h of the beginning of abdominal pain with Alvarado score ≥5 were included. The patients received a therapeutic dose of broad-spectrum antibiotics and symptomatic treatment. The follow-up period was 6 months. Results: 90 patients were evaluated, 54 (60% patients were female and 36 (40% patients were male with mean age 34.4 years. Conservative treatment was successful in 68 (75.6% patients and failed in 22 (24.4% patients. No mortality recorded in this study. The main complications which occurred in those patients who failed to respond to conservative treatment were perforated appendicitis (3 patients, appendicular abscess (3 patients and appendicular mass (4 patients. Conclusion: Majority of cases of the first attack of uncomplicated acute appendicitis can be treated successfully by conservative treatment. However, conservative treatment demands precise communication, close monitoring and follow-up to recognize failure which needs to be treated immediately by surgery. Keywords: Acute appendicitis, Conservative treatment, Surgery, Antibiotics

Conservation Evo-Devo: Preserving Biodiversity by Understanding Its Origins.

Science.gov (United States)

Campbell, Calum S; Adams, Colin E; Bean, Colin W; Parsons, Kevin J

2017-10-01

Unprecedented rates of species extinction increase the urgency for effective conservation biology management practices. Thus, any improvements in practice are vital and we suggest that conservation can be enhanced through recent advances in evolutionary biology, specifically advances put forward by evolutionary developmental biology (i.e., evo-devo). There are strong overlapping conceptual links between conservation and evo-devo whereby both fields focus on evolutionary potential. In particular, benefits to conservation can be derived from some of the main areas of evo-devo research, namely phenotypic plasticity, modularity and integration, and mechanistic investigations of the precise developmental and genetic processes that determine phenotypes. Using examples we outline how evo-devo can expand into conservation biology, an opportunity which holds great promise for advancing both fields. Copyright © 2017 Elsevier Ltd. All rights reserved.

Organizational Factors and Long-Term Mortality after Hip Fracture Surgery. A Cohort Study of 6143 Consecutive Patients Undergoing Hip Fracture Surgery

DEFF Research Database (Denmark)

Lund, Caterina A; Møller, Ann M; Wetterslev, Jørn

2014-01-01

OBJECTIVE: In hospital and health care organizational factors may be changed to reduce postoperative mortality. The aim of this study is to evaluate a possible association between mortality and 'length of hospital stay', 'priority of surgery', 'time of surgery', or 'surgical delay' in hip fracture...... surgery. DESIGN: Observational cohort study. SETTING: Prospectively and consecutively reported data from the Danish Anaesthesia Database were linked to The Danish National Registry of Patients and The Civil Registration System. Records on vital status, admittance, discharges, codes of diagnosis......; therefore cluster randomized clinical trials comparing different clinical set ups may be warranted evaluating health care organizational factors....

Science framework for conservation and restoration of the sagebrush biome: Linking the Department of the Interior’s Integrated Rangeland Fire Management Strategy to long-term strategic conservation actions, Part 1. Science basis and applications

Science.gov (United States)

Chambers, Jeanne C.; Beck, Jeffrey L.; Bradford, John B.; Bybee, Jared; Campbell, Steve; Carlson, John; Christiansen, Thomas J; Clause, Karen J.; Collins, Gail; Crist, Michele R.; Dinkins, Jonathan B.; Doherty, Kevin E.; Edwards, Fred; Espinosa, Shawn; Griffin, Kathleen A.; Griffin, Paul; Haas, Jessica R.; Hanser, Steven E.; Havlina, Douglas W.; Henke, Kenneth F.; Hennig, Jacob D.; Joyce, Linda A; Kilkenny, Francis F.; Kulpa, Sarah M; Kurth, Laurie L; Maestas, Jeremy D; Manning, Mary E.; Mayer, Kenneth E.; Mealor, Brian A.; McCarthy, Clinton; Pellant, Mike; Perea, Marco A.; Prentice, Karen L.; Pyke, David A.; Wiechman , Lief A.; Wuenschel, Amarina

2017-01-01

The Science Framework is intended to link the Department of the Interior’s Integrated Rangeland Fire Management Strategy with long-term strategic conservation actions in the sagebrush biome. The Science Framework provides a multiscale approach for prioritizing areas for management and determining effective management strategies within the sagebrush biome. The emphasis is on sagebrush (Artemisia spp.) ecosystems and Greater sage-grouse (Centrocercus urophasianus). The approach provided in the Science Framework links sagebrush ecosystem resilience to disturbance and resistance to nonnative, invasive plant species to species habitat information based on the distribution and abundance of focal species. A geospatial process is presented that overlays information on ecosystem resilience and resistance, species habitats, and predominant threats and that can be used at the mid-scale to prioritize areas for management. A resilience and resistance habitat matrix is provided that can help decisionmakers evaluate risks and determine appropriate management strategies. Prioritized areas and management strategies can be refined by managers and stakeholders at the local scale based on higher resolution data and local knowledge. Decision tools are discussed for determining appropriate management actions for areas that are prioritized for management. Geospatial data, maps, and models are provided through the U.S. Geological Survey (USGS) ScienceBase and Bureau of Land Management (BLM) Landscape Approach Data Portal. The Science Framework is intended to be adaptive and will be updated as additional data become available on other values and species at risk. It is anticipated that the Science Framework will be widely used to: (1) inform emerging strategies to conserve sagebrush ecosystems, sagebrush dependent species, and human uses of the sagebrush system, and (2) assist managers in prioritizing and planning on-the-ground restoration and mitigation actions across the sagebrush biome.

Radiotherapy boost dose-escalation for invasive breast cancer after breast-conserving surgery: 2093 Patients treated with a prospective margin-directed policy

International Nuclear Information System (INIS)

Livi, Lorenzo; Meattini, Icro; Franceschini, Davide; Saieva, Calogero; Meacci, Fiammetta; Marrazzo, Livia; Gerlain, Elena; Desideri, Isacco; Scotti, Vieri; Nori, Jacopo; Sanchez, Luis Jose; Orzalesi, Lorenzo; Bonomo, Pierluigi; Greto, Daniela; Bianchi, Simonetta; Biti, Giampaolo

2013-01-01

Purpose: To investigate the outcome of invasive early breast cancer patients that underwent breast-conserving surgery and adjuvant radiotherapy (RT), treated with a prospective margin-directed institutional policy for RT boost dose, based on final margins status (FMS). Methods and materials: A total of 2093 patients were treated between 2000 and 2008. 10 Gy boost was prescribed in case of FMS > 5 mm; 16 Gy boost with FMS between 2 and 5 mm; 20 Gy boost in case of FMS 5 mm. At multivariate analysis, higher nuclear grade (p = 0.045), triple negative subtype (p = 0.036) and higher T-stage (p = 0.02) resulted as the independent predictors of LR occurrence. Conclusions: Our experience showed that a margin-directed policy of RT boost dose-escalation seems to reduce the negative impact of FMS on LR, but it is not able to overcome the unfavorable effect of higher nuclear grade, higher T stage and triple negative subtype

Prospective comparison of breast pain in patients participating in a randomized trial of breast-conserving surgery and tamoxifen with or without radiotherapy

International Nuclear Information System (INIS)

Rayan, Gamal; Dawson, Laura A.; Bezjak, Andrea; Lau, Anthea; Fyles, Anthony W.; Yi, Q.-L.; Merante, Pat; Vallis, Katherine A.

2003-01-01

Purpose: To determine whether breast pain affects quality of life (QOL) after breast-conserving surgery and tamoxifen (TAM) with or without adjuvant breast radiotherapy (RT). Methods and Materials: A randomized clinical trial was carried out at the Princess Margaret Hospital between 1992 and 2000 to evaluate the need for breast RT in addition to TAM in women ≥50 years treated with breast-conserving surgery for T1-T2N0 breast cancer. A companion study to assess breast pain was carried out during the last 2 years of the randomized clinical trial. The short-form McGill Pain Questionnaire (SF-MPQ), the European Organization for Research and Treatment of Cancer (EORTC) QOL (QLQ-C30) and EORTC breast cancer module (QLQ-BR23) questionnaires were completed by patients within 1 week of randomization in the randomized clinical trial (baseline) and at 3, 6, and 12 months. Results: Eighty-six patients participated in the breast pain study; 41 received RT plus TAM and 45 received TAM alone. The median age was 70 years (range 51-80). The baseline pain and QOL scores were similar for the two groups. No significant difference was found between the two groups for each scale of the QLQ-C30 and QLQ-BR23 questionnaires at 3, 6, or 12 months (p>0.100), except that at 12 months, the score for role function (QLQ-C30) was higher in the RT plus TAM group than in the RT-only group (p=0.02). At 3 months, the difference between the mean scores for the SF-MPQ was 0.553 (p=0.47). At 12 months, the pain scores had decreased in both groups; the difference was 0.199 (p=0.71). The number of breast operations or surgical complications did not correlate with breast pain in either group. Acute RT toxicity scores did not correlate with breast pain or QOL scores at 12 months. Conclusion: These results suggest that breast RT does not significantly contribute to breast pain or adversely impact the QOL up to 12 months after treatment in postmenopausal patients with node-negative breast cancer who take

Safety in surgery: is selection the missing link?

Science.gov (United States)

Paice, Alistair G; Aggarwal, Rajesh; Darzi, Ara

2010-09-01

Health care providers comprise an example of a "high risk organization." Safety failings within these organizations have the potential to cause significant public harm. Significant safety improvements in other high risk organizations such as the aviation industry have led to the concept of a high reliability organization (HRO)--a high risk organization that has enjoyed a prolonged safety record. A strong organizational culture is common to all successful HROs, encompassing powerful systems of selection and training. Aircrew selection processes provide a good example of this and are examined in detail in this article using the Royal Air Force process as an example. If the lessons of successful HROs are to be applied to health care organizations, candidate selection to specialties such as surgery must become more objective and robust. Other HROs can provide valuable lessons in how this may be approached.

Donor cross-linking for keratoplasty: a laboratory evaluation.

Science.gov (United States)

Mukherjee, Achyut; Hayes, Sally; Aslanides, Ioannis; Lanchares, Elena; Meek, Keith M

2015-12-01

This laboratory-based investigation compares the topographic outcomes of conventional penetrating keratoplasty with that of a novel procedure in which donor corneas are cross-linked prior to keratoplasty. Penetrating keratoplasty procedures with continuous running sutures were carried out in a porcine whole globe model. Sixty eyes were randomly paired as 'donor' and 'host' tissue before being assigned to one of two groups. In the cross-linked group, donor corneas underwent riboflavin/UVA cross-linking prior to being trephined and sutured to untreated hosts. In the conventional keratoplasty group, both host and donor corneas remained untreated prior to keratoplasty. Topographic and corneal wavefront measurements were performed following surgery, and technical aspects of the procedure evaluated. Mean keratometric astigmatism was significantly lower in the cross-linked donor group at 3.67D (SD 1.8 D), vs. 8.43 D (SD 2.4 D) in the conventional keratoplasty group (p < 0.005). Mean wavefront astigmatism was also significantly reduced in the cross-linked donor group 4.71 D (SD 2.1) vs. 8.29D (SD 3.6) in the conventional keratoplasty group (p < 0.005). Mean RMS higher order aberration was significantly lower in the cross-linked donor group at 1.79 um (SD 0.98), vs. 3.05 um (SD 1.9) in the conventional keratoplasty group (P = 0.02). Qualitative analysis revealed less tissue distortion at the graft-host junction in the cross-linked group. Cross-linking of donor corneas prior to keratoplasty reduces intraoperative induced astigmatism and aberrations in an animal model. Further studies are indicated to evaluate the implications of this potential modification of keratoplasty surgery.

Current Practices and Barriers to the Integration of Oncoplastic Breast Surgery: A Canadian Perspective.

Science.gov (United States)

Maxwell, Jessica; Roberts, Amanda; Cil, Tulin; Somogyi, Ron; Osman, Fahima

2016-10-01

Despite the safety and popularity of oncoplastic surgery, there is limited data examining utilization and barriers associated with its incorporation into practice. This study examines the use of oncoplastic techniques in breast conserving surgery and determines the barriers associated with their implementation. A 13-item survey was mailed to all registered general surgeons in Ontario, Canada. The survey assessed surgeon demographics, utilization of specific oncoplastic techniques, and perceived barriers. A total of 234 survey responses were received, representing a response rate of 32.2 % (234 of 725). Of the respondents, 166 surgeons (70.9 %) reported a practice volume of at least 25 % breast surgery. Comparison was made between general surgeons performing oncoplastic breast surgery (N = 79) and those who did not use these techniques (N = 87). Surgeon gender, years in practice, fellowship training, and access to plastic surgery were similar across groups. Both groups rated the importance of breast cosmesis similarly. General surgeons with a practice volume involving >50 % breast surgery were more likely to use oncoplastic techniques (OR 8.82, p < .001) and involve plastic surgeons in breast conserving surgery (OR 2.21, p = .02). For surgeons not performing oncoplastic surgery, a lack of training and access to plastic surgeons were identified as significant barriers. For those using oncoplastic techniques, the absence of specific billing codes was identified as a limiting factor. Lack of training, access to plastic surgeons, and absence of appropriate reimbursement for these cases are significant barriers to the adoption of oncoplastic techniques.

Duodenal-jejunal bypass sleeve - a potential alternative to bariatric surgery?

DEFF Research Database (Denmark)

Rohde, Ulrich; Gylvin, Silas; Vilmann, Peter

2014-01-01

Overweight and obesity are risk factors for several co-morbidities reducing life expectancy. Conservative treatment of obesity is generally ineffective in the long-term. Bariatric surgery has proven effective, but is associated with potential complications. Duodenal-jejunal bypass sleeve is a novel...

African Journal of Paediatric Surgery - Vol 11, No 2 (2014)

African Journals Online (AJOL)

African Journal of Paediatric Surgery. ... High drain amylase and lipase values predict post-operative pancreatitis for ... Intractable chronic constipation in children: Outcome after anorectal myectomy · EMAIL FULL TEXT EMAIL FULL TEXT ... Outcomes of conservative treatment of giant omphaloceles with dissodic 2% ...

Conservatives report, but liberals display, greater happiness.

Science.gov (United States)

Wojcik, Sean P; Hovasapian, Arpine; Graham, Jesse; Motyl, Matt; Ditto, Peter H

2015-03-13

Research suggesting that political conservatives are happier than political liberals has relied exclusively on self-report measures of subjective well-being. We show that this finding is fully mediated by conservatives' self-enhancing style of self-report (study 1; N = 1433) and then describe three studies drawing from "big data" sources to assess liberal-conservative differences in happiness-related behavior (studies 2 to 4; N = 4936). Relative to conservatives, liberals more frequently used positive emotional language in their speech and smiled more intensely and genuinely in photographs. Our results were consistent across large samples of online survey takers, U.S. politicians, Twitter users, and LinkedIn users. Our findings illustrate the nuanced relationship between political ideology, self-enhancement, and happiness and illuminate the contradictory ways that happiness differences can manifest across behavior and self-reports. Copyright © 2015, American Association for the Advancement of Science.

Analysis of Margin Index as a Method for Predicting Residual Disease After Breast-Conserving Surgery in a European Cancer Center.

LENUS (Irish Health Repository)

Bolger, Jarlath C

2011-06-03

INTRODUCTION: Breast-conserving surgery (BCS), followed by appropriate adjuvant therapies is established as a standard treatment option for women with early-stage invasive breast cancers. A number of factors have been shown to correlate with local and regional disease recurrence. Although margin status is a strong predictor of disease recurrence, consensus is yet to be established on the optimum margin necessary. Margenthaler et al. recently proposed the use of a "margin index," combining tumor size and margin status as a predictor of residual disease after BCS. We applied this new predictive tool to a population of patients with primary breast cancer who presented to a symptomatic breast unit to determine its suitability in predicting those who require reexcision surgery. METHODS: Retrospective analysis of our breast cancer database from January 1, 2000 to June 30, 2010 was performed, including all patients who underwent BCS. Of 531 patients who underwent BCS, 27.1% (144\\/531) required further reexcision procedures, and 55 were eligible for inclusion in the study. Margin index was calculated as: margin index = closest margin (mm)\\/tumor size (mm) × 100, with index >5 considered optimum. RESULTS: Of the 55 patients included, 31% (17\\/55) had residual disease. Fisher\\'s exact test showed margin index not to be a significant predictor of residual disease on reexcision specimen (P = 0.57). Of note, a significantly higher proportion of our patients presented with T2\\/3 tumors (60% vs. 38%). CONCLUSIONS: Although an apparently elegant tool for predicting residual disease after BCS, we have shown that it is not applicable to a symptomatic breast unit in Ireland.

Analysis of margin index as a method for predicting residual disease after breast-conserving surgery in a European cancer center.

LENUS (Irish Health Repository)

Bolger, Jarlath C

2012-02-01

INTRODUCTION: Breast-conserving surgery (BCS), followed by appropriate adjuvant therapies is established as a standard treatment option for women with early-stage invasive breast cancers. A number of factors have been shown to correlate with local and regional disease recurrence. Although margin status is a strong predictor of disease recurrence, consensus is yet to be established on the optimum margin necessary. Margenthaler et al. recently proposed the use of a "margin index," combining tumor size and margin status as a predictor of residual disease after BCS. We applied this new predictive tool to a population of patients with primary breast cancer who presented to a symptomatic breast unit to determine its suitability in predicting those who require reexcision surgery. METHODS: Retrospective analysis of our breast cancer database from January 1, 2000 to June 30, 2010 was performed, including all patients who underwent BCS. Of 531 patients who underwent BCS, 27.1% (144\\/531) required further reexcision procedures, and 55 were eligible for inclusion in the study. Margin index was calculated as: margin index = closest margin (mm)\\/tumor size (mm) x 100, with index >5 considered optimum. RESULTS: Of the 55 patients included, 31% (17\\/55) had residual disease. Fisher\\'s exact test showed margin index not to be a significant predictor of residual disease on reexcision specimen (P = 0.57). Of note, a significantly higher proportion of our patients presented with T2\\/3 tumors (60% vs. 38%). CONCLUSIONS: Although an apparently elegant tool for predicting residual disease after BCS, we have shown that it is not applicable to a symptomatic breast unit in Ireland.

Patients with invasive lobular breast cancer are less likely to undergo breast-conserving surgery: a population based study in the Netherlands.

Science.gov (United States)

Truin, W; Roumen, R M; Siesling, S; van der Heiden-van der Loo, M; Duijm, L E M; Tjan-Heijnen, V C G; Voogd, A C

2015-05-01

The aim of this study was to compare the frequency of breast-conserving surgery (BCS) between early-stage invasive ductal (IDC) and invasive lobular breast cancer (ILC). Women with primary non-metastatic pT1 and pT2 IDC or ILC diagnosed between 1990 and 2010 were selected from the NCR. All patients underwent BCS or primary mastectomy without neoadjuvant treatment and proportions per year were calculated. Logistic regression analysis with adjustment for period, age, nodal status and tumor size was performed to determine the impact of histology on the likelihood of undergoing BCS. A total of 152,574 patients underwent surgery in the period between 1990 and 2010, of which 89 % had IDC and 11 % had ILC. In the group of IDC with pT1 and pT2 tumors combined, 54 % underwent BCS compared with 43 % of patients with ILC (p < 0.0001). The proportion of patients with IDC treated by BCS increased from 46 % in 1990 to 62 % in 2010. The BCS rate among ILC patients increased from 39 % in 1990 to 48 % in 2010. Patients with ILC were less likely to undergo BCS compared with patients with IDC (odds ratio 0.69; 95 % confidence interval 0.66-0.71). The incidence of BCS for patients with IDC or ILC is rising in The Netherlands. However, the increase of BCS is less explicit in patients with ILC, with a higher chance of undergoing mastectomy compared with patients with IDC.

Factors affecting local recurrence and distant metastases of invasive breast cancer after breast-conserving surgery in Chiang Mai University Hospital.

Science.gov (United States)

Ditsatham, Chagkrit; Somwangprasert, Areewan; Watcharachan, Kirati; Wongmaneerung, Phanchaporn; Khorana, Jiraporn

2016-01-01

The purpose of this study was to collect data regarding breast cancer profiles and factors that affect local recurrence and distant metastasis after breast-conserving surgery (BCS) in Chiang Mai University Hospital. This study was a retrospective review in a single institution of newly diagnosed invasive breast cancer patients who were treated with BCS between April 9, 2001 and December 25, 2011. A total of 185 patients treated with BCS were included in this study, with an average age of 46.83 years. The average recurrence age was 41.1 years and the average nonrecurrence age was 47.48 years, with a recurrence rate of 10.27%. Premenopause was significant in recurrence (P=0.047), as well as non-estrogen-expression patients (P=0.001) and patients who did not receive antihormonal treatment (P=0.011). The recurrence rate in our institute was 10.27%. Factors affecting recurrence after BCS included young age, premenopausal status, nonexpression of the estrogen receptor, and patients who had not received antihormonal treatment. The recurrence rate was higher in the first 90 postoperative months.

Symmetries and conserved quantities in geodesic motion

International Nuclear Information System (INIS)

Hojman, S.; Nunez, L.; Patino, A.; Rago, H.

1986-01-01

Recently obtained results linking several constants of motion to one (non-Noetherian) symmetry to the problem of geodesic motion in Riemannian space-times are applied. The construction of conserved quantities in geodesic motion as well as the deduction of geometrical statements about Riemannian space-times are achieved

Indications and contraindications for surgery in esophageal cancer

International Nuclear Information System (INIS)

Carriquiry, G.

2004-01-01

In this story we will present the main problems that we have as a surgeons at the moment to decide the indication for surgery in patients with esophageal cancer. Undoubtedly, the patient that will be submitted to surgery must have strict criteria in order to obtain good results. The patient must be compensated from respiratory, cardiovascular, hepatic and renal point of view with a (IMC) above 20, with Karnofsky index above 80% (wanders well), that declares the acceptance of surgery as well as the conserved appetite. After deciding the surgery according to the general conditions, should be discuss the type of procedure, based primarily on tumor topography, because there are different results both morbidity and long-term survival. The indications for resection or palliative surgery depend on the tumor stage. The indications for resection surgery with conventional or eventual extended lymphadenectomy require a patient in good condition, good experience the surgical team and a good hospital support. In tumor stage I the indication is a supposedly curative surgery. The tumor stages II b, III and IV are the heritage of palliative surgery, with or without tumor resection. The age is not an absolute contraindication for surgery, but the hypertension, liver cirrhosis, respiratory diseases with severe functional impact, ischemic heart disease, dilated heart with lowered LVEF, severe psychological disorders and the loss of appetite are contraindication. The morbidity and mortality has declined markedly due to technological advances and specialization of surgical groups, so that surgery is still the best treatment for selected patients

Remote cerebellar hemorrhage after lumbar spinal surgery

International Nuclear Information System (INIS)

Cevik, Belma; Kirbas, Ismail; Cakir, Banu; Akin, Kayihan; Teksam, Mehmet

2009-01-01

Background: Postoperative remote cerebellar hemorrhage (RCH) as a complication of lumbar spinal surgery is an increasingly recognized clinical entity. The aim of this study was to determine the incidence of RCH after lumbar spinal surgery and to describe diagnostic imaging findings of RCH. Methods: Between October 1996 and March 2007, 2444 patients who had undergone lumbar spinal surgery were included in the study. Thirty-seven of 2444 patients were scanned by CT or MRI due to neurologic symptoms within the first 7 days of postoperative period. The data of all the patients were studied with regard to the following variables: incidence of RCH after lumbar spinal surgery, gender and age, coagulation parameters, history of previous arterial hypertension, and position of lumbar spinal surgery. Results: The retrospective study led to the identification of two patients who had RCH after lumbar spinal surgery. Of 37 patients who had neurologic symptoms, 29 patients were women and 8 patients were men. CT and MRI showed subarachnoid hemorrhage in the folia of bilateral cerebellar hemispheres in both patients with RCH. The incidence of RCH was 0.08% among patients who underwent lumbar spinal surgery. Conclusion: RCH is a rare complication of lumbar spinal surgery, self-limiting phenomenon that should not be mistaken for more ominous pathologic findings such as hemorrhagic infarction. This type of bleeding is thought to occur secondary to venous infarction, but the exact pathogenetic mechanism is unknown. CT or MRI allowed immediate diagnosis of this complication and guided conservative management.

Quality of online information to support patient decision-making in breast cancer surgery.

Science.gov (United States)

Bruce, Jordan G; Tucholka, Jennifer L; Steffens, Nicole M; Neuman, Heather B

2015-11-01

Breast cancer patients commonly use the internet as an information resource. Our objective was to evaluate the quality of online information available to support patients facing a decision for breast surgery. Breast cancer surgery-related queries were performed (Google and Bing), and reviewed for content pertinent to breast cancer surgery. The DISCERN instrument was used to evaluate websites' structural components that influence publication reliability and ability of information to support treatment decision-making. Scores of 4/5 were considered "good." 45 unique websites were identified. Websites satisfied a median 5/9 content questions. Commonly omitted topics included: having a choice between breast conservation and mastectomy (67%) and potential for 2nd surgery to obtain negative margins after breast conservation (60%). Websites had a median DISCERN score of 2.9 (range 2.0-4.5). Websites achieved higher scores on structural criteria (median 3.6 [2.1-4.7]), with 24% rated as "good." Scores on supporting decision-making questions were lower (2.6 [1.3-4.4]), with only 7% scoring "good." Although numerous breast cancer-related websites exist, most do a poor job providing women with essential information necessary to actively participate in decision-making for breast cancer surgery. Providing easily- accessible, high-quality online information has the potential to significantly improve patients' experiences with decision-making. © 2015 Wiley Periodicals, Inc.

Conserved Metabolic Changes in Nondiabetic and Type 2 Diabetic Bariatric Surgery Patients: Global Metabolomic Pilot Study

Directory of Open Access Journals (Sweden)

Konrad Sarosiek

2016-01-01

Full Text Available The goal of this study was to provide insight into the mechanism by which bariatric surgical procedures led to weight loss and improvement or resolution of diabetes. Global biochemical profiling was used to evaluate changes occurring in nondiabetic and type 2 diabetic (T2D patients experiencing either less extreme sleeve gastrectomy or a full gastric bypass. We were able to identify changes in metabolism that were affected by standard preoperation liquid weight loss diet as well as by bariatric surgery itself. Preoperation weight-loss diet was associated with a strong lipid metabolism signature largely related to the consumption of adipose reserves for energy production. Glucose usage shift away from glycolytic pyruvate production toward pentose phosphate pathway, via glucose-6-phosphate, appeared to be shared across all patients regardless of T2D status or bariatric surgery procedure. Our results suggested that bariatric surgery might promote antioxidant defense and insulin sensitivity through both increased heme synthesis and HO activity or expression. Changes in histidine and its metabolites following surgery might be an indication of altered gut microbiome ecology or liver function. This initial study provided broad understanding of how metabolism changed globally in morbidly obese nondiabetic and T2D patients following weight-loss surgery.

Results of conservative treatment with surgery and radiation therapy of 132 non-palpable ductal carcinomas in situ of the breast; Resultats du traitement par chirurgie conservatrice et irradiation de 132 carcinomes canalaires in situ non palpables du sein

Energy Technology Data Exchange (ETDEWEB)

Amalric, R.; Brandone, H.; Dubau, A.; Hans, D.; Brandone, J.M.; Robert, F.; Pollet, J.F.; Amalric, F.; Rouah, Y.; Thomassin, L.; Giraud, D.; Henric, A.; Martin, P.M.; Romain, S. [Academie mediterraneenne d`oncologie clinique, Polyclinique Clairval, 13 - Marseille (France)

1998-01-01

Retrospective analysis of results of treatment of 132 subclinical ductal carcinomas in situ, non-palpable. Patients were treated with limited surgery and 70 Gy radiation therapy (70 Gy). With a median follow-up of 7 years, the total recurrence rate was 6 % and the actuarial rate at 5 years 4 % and at 10 years 13 % at. These have no influence on recurrence on the specific actuarial survival rate which was 100 % at 10 years. In spite of five infiltrating recurrences of seven, no metastasis appeared 48 months after the salvage surgery. The global rate of breast. The global rate of breast preservation was 92 % at 7 years. Therapeutic indications were developed taking into account the present analysis and a literature review (2,338 in situ ductal carcinomas, palpable or not, treated with conservative surgery, with or without adjuvant radio-therapy). (author)

Young adult conservation jobs and worker health

Science.gov (United States)

Kathleen L. Wolf; Elizabeth Housley

2017-01-01

Decades of research studies demonstrate links between healthy environment, healthy lifestyles, and healthy people. This study evaluated the correlations between young adult conservation workers’ perceived stress, personal effectiveness, and nature experience using quantitative and qualitative social science methods. The study cohort numbered nearly 300 individuals...

Cosmetic Outcome and Seroma Formation After Breast-Conserving Surgery With Intraoperative Radiation Therapy Boost for Early Breast Cancer

International Nuclear Information System (INIS)

Senthi, Sashendra; Link, Emma; Chua, Boon H.

2012-01-01

Purpose: To evaluate cosmetic outcome and its association with breast wound seroma after breast-conserving surgery (BCS) with targeted intraoperative radiation therapy (tIORT) boost for early breast cancer. Methods and Materials: An analysis of a single-arm prospective study of 55 patients with early breast cancer treated with BCS and tIORT boost followed by conventional whole breast radiation therapy (WBRT) between August 2003 and January 2006 was performed. A seroma was defined as a fluid collection at the primary tumor resection site identified clinically or radiologically. Cosmetic assessments using the European Organization for Research and Treatment of Cancer rating system were performed at baseline before BCS and 30 months after WBRT was completed. Results: Twenty-eight patients (51%) developed a seroma, with 18 patients (33%) requiring at least 1 aspiration. Tumor location was significantly associated with seroma formation (P=.001). Ten of 11 patients with an upper inner quadrant tumor developed a seroma. Excellent or good overall cosmetic outcome at 30 months was observed in 34 patients (62%, 95% confidence interval 53%-80%). Seroma formation was not associated with the overall cosmetic result (P=.54). Conclusion: BCS with tIORT boost followed by WBRT was associated with an acceptable cosmetic outcome. Seroma formation was not significantly associated with an adverse cosmetic outcome.

Cognitive outcome of surgery.

Science.gov (United States)

Gallagher, Anne; Jambaqué, Isabelle; Lassonde, Maryse

2013-01-01

Epilepsy surgery is now widely accepted as an effective therapeutic option for carefully selected children with medically refractory epilepsy. The surgical procedure may cause cognitive deficits or exacerbate existing impairments, but it may also improve cognitive abilities by the restoration of functions located in adjacent or contralateral areas that had been secondarily affected by the epilepsy or the underlying pathology. Compared to adults, better cognitive outcome has been reported in children, a finding probably due to the developing state of the brain, which possesses considerable structural and functional plasticity. More extensive and effective surgery such as hemispherectomy is more commonly used in the pediatric population, and this must also influence surgical outcome. However, studies related to cognitive outcome of epilepsy surgery in children are limited, and controversial results are often reported. In this chapter, we provide a current overview of the literature on cognitive outcomes in children who undergo different types of epilepsy surgery, including focal resections as well as corpus callosotomy and hemispherectomy. Early surgical intervention appears to be a rational option for the treatment of childhood epilepsy since many cognitive deficits are linked to the epileptic process and may disappear when seizures are controlled. Copyright © 2013 Elsevier B.V. All rights reserved.

Conservation and human rights: the need for international standards

Energy Technology Data Exchange (ETDEWEB)

Oviedo, Gonzalo [International Union for the Conservation of Nature (International organizations without location); Pabon, Luis [The Nature Conservancy (United States); Painter, Michael; Redford, Kent [The Wildlife Conservation Society (United States); Siegele, Linda [Foundation for International Environmental Law and Development (United Kingdom); Springer, Jenny [WWF-US (United States); Thomas, David [Birdlife International (International organizations without location); Painemilla, Kristen Walker [Conservation International (United States); Roe, Dilys

2010-05-15

Conservation doesn't happen in a vacuum. In recent years, awareness has grown of the relationship of international conservation practice to indigenous peoples and local communities, and especially the links between conservation and human rights. The impacts protected areas can have on rural communities – such as evictions and lost access to natural resources – are now under particular scrutiny. Concern is meanwhile rising over the human rights implications of some climate change mitigation and adaptation measures. But awareness is also growing of the positive contributions of nature conservation to the rights of people to secure their livelihoods, enjoy healthy and productive environments, and live with dignity. International NGOs can play a central role in supporting and promoting conservation actions that respect the rights of indigenous peoples and local communities, and help sustain their livelihoods. Many conservation organisations have long worked towards this. It is vital that they hold to consistent principles and implement measures that ensure their application, so their action on conservation remains accountable, transparent and sustainable.

Combined conservative surgery, chemotherapy and radiation therapy in treatment of the breast cancer patient: the influence of the interval between surgery and start of irradiation

International Nuclear Information System (INIS)

Willers, Henning; Wuerschmidt, F.; Janik, I.; Buenemann, H.; Heilmann, H.-P.

1996-01-01

Purpose: To analyze our experience treating breast cancer patients with combined breast conserving surgery, chemotherapy and radiation therapy in the light of considerable discussion on the role of the interval between surgery and radiation therapy (S-RT). Materials and Methods: Between 1985 and 1992, 100 patients with invasive breast cancer underwent radiation treatment at our institution after conservative surgery with axillary dissection and some form of chemotherapy. Criteria for inclusion in this retrospective analysis were: Stage M0, no simultaneous malignancies, gross total resection of primary and involved lymph nodes, at least three cycles of postoperative polychemotherapy, complete radiation treatment, complete follow-up information. Seventy-four patients fulfilling these criteria form the basis of this report. For patients alive at last observation date, median follow-up time was five years (i.e., 59 months; range, 36-112 months). Age at diagnosis ranged between 20 and 69 years (median, 48 years). Fifty-four patients were pre- or perimenopausal (73%) and 20 were postmenopausal (27%). Tumors were staged using the AJCC-system. Distribution of T-Stage was: T1 (n=36), T2 (n=37), T3 (n=1). In 95% of patients, axillary lymph nodes were positive: 1-3 nodes (n=50), ≥ 4 nodes (n=20), and 0 nodes (n=3). Thus, 91% of patients were Stage II. In 65% of patients, final pathological margins were negative. Margins showed invasive and intraductal carcinoma in 5 and 11% of cases, respectively (margins unknown in 19%). Chemotherapy regimens and doses varied according to the referring physicians as well as during the study period. Seventy percent of patients received six cycles of chemotherapy (predominan CMF) before onset of irradiation. The median S-RT interval was 20.5 weeks (range, 8.4-31.9 weeks). Usually, the breast was treated to 50 Gy, 2 Gy per fraction, five fractions per week, using Cobalt-60 (n=66) or 5 MeV photons (n=8). Then the tumor bed was boosted with

Heart of borneo as a ′Jalan Tikus′: Exploring the links Between indigenous rights, extractive and exploitative industries, and conservation at the World Conservation Congress 2008

Directory of Open Access Journals (Sweden)

Hitchner Sarah

2010-01-01

Full Text Available At the Fourth World Conservation Congress in Barcelona in October 2008, a number of motions were passed that emphasised human and indigenous rights and the role of the private sector, particularly extractive and exploitative industries, in conservation. These issues are highly relevant to the ongoing World Wide Fund for Nature (WWF-led Heart of Borneo (HoB conservation initiative, which is situated in an area with overlapping political jurisdictions and an array of possible futures, which could include new or expanded protected areas, community-managed conservation programmes, or oil palm plantations potentially covering millions of hectares. The HoB initiative is ambiguous in the sense that its borders are not fixed, its land and resource management strategies are not clearly defined, its projects are not predetermined, and its policies regarding who benefits from it are not obvious. HoB is also ambitious, and its actors must negotiate a number of different types of scales: geographic, political, economic, institutional, and ecological. These factors offer both opportunities and weaknesses both for conservation and for local and indigenous communities living within the HoB area. Using HoB as an example, I show how small NGOs, national branches of multinational NGOs like WWF, and local and indigenous communities must walk a ′jalan tikus′ to accomplish conservation and indigenous rights goals. I also offer suggestions on how the motions passed by the International Union for Conservation of Nature (IUCN membership can be incorporated into HoB planning on the ground.

Linking Community Communication to Conservation of the Maned Wolf in Central Brazil

Science.gov (United States)

Bizerril, Marcelo Ximenes A.; Soares, Carla Cruz; Santos, Jean Pierre

2011-01-01

This article describes the environmental education (EE) program developed in the neighboring community of Serra da Canastra National Park based on a research project focused on the maned wolf conservation. The article assesses three tools used to foster the community's participation in discussing local issues: (1) communal production of a book…

A case of bullous pemphigoid exacerbated by irradiation after breast conservative radiotherapy

International Nuclear Information System (INIS)

Isohashi, Fumiaki; Konishi, Koji; Umegaki, Noriko; Tanei, Tomonori; Koizumi, Masahiko; Yoshioka, Yasuo

2011-01-01

We present a case, considered to be a form of the Koebner phenomenon, of bullous pemphigoid that was exacerbated mainly within the irradiated field after breast conservative radiotherapy. In May 2009, a 60-year-old woman was diagnosed with bullous pemphigoid, which was treated with steroid therapy. The following month, she was diagnosed with breast cancer (invasive ductal carcinoma, pT1cN0M0). After breast conservative surgery in December 2009, conservative radiotherapy to the right breast was performed (50 Gy in 25 fractions). Portal skin showed no serious change (up to grade 1 skin erythema) and no bullous neogenesis during conservative radiotherapy. However, 2 months after conservative radiotherapy, new blisters became exacerbated mainly within the irradiated field but also in the area outside the irradiated field. Increasing the dosage of oral steroid and minocycline resulted in relief of bullous pemphigoid, although patchy skin pigmentation remained especially in the irradiated skin. (author)

A new approach to conservation: using community empowerment for sustainable well-being

Directory of Open Access Journals (Sweden)

Alaka Wali

2017-12-01

Full Text Available The global environmental conservation community recognizes that the participation of local communities is essential for the success of conservation initiatives; however, much work remains to be done on how to integrate conservation and human well-being. We propose that an assets-based approach to environmental conservation and human well-being, which is grounded in a biocultural framework, can support sustainable and adaptive management of natural resources by communities in regions adjacent to protected areas. We present evidence from conservation and quality of life initiatives led by the Field Museum of Natural History over the past 17 years in the Peruvian Amazon. Data were derived from asset mapping in 37 communities where rapid inventories were conducted and from 38 communities that participated in longer term quality of life planning. Our main findings are that Amazonian communities have many characteristics, or assets, that recent scholarship has linked to environmental sustainability and good natural resource stewardship, and that quality of life plans that are based on these assets tend to produce priorities that are more consistent with environmental conservation. Importantly, we found that validating social and ecological assets through our approach can contribute to the creation of protected areas and to their long-term management. As strategies to engage local communities in conservation expand, research on how particular methodologies, such as an assets-based approach, is needed to determine how these initiatives can best empower local communities, how they can be improved, and how they can most effectively be linked to broader conservation and development processes.

Climate Change Denial Books and Conservative Think Tanks: Exploring the Connection.

Science.gov (United States)

Dunlap, Riley E; Jacques, Peter J

2013-06-01

The conservative movement and especially its think tanks play a critical role in denying the reality and significance of anthropogenic global warming (AGW), especially by manufacturing uncertainty over climate science. Books denying AGW are a crucial means of attacking climate science and scientists, and we examine the links between conservative think tanks (CTTs) and 108 climate change denial books published through 2010. We find a strong link, albeit noticeably weaker for the growing number of self-published denial books. We also examine the national origins of the books and the academic backgrounds of their authors or editors, finding that with the help of American CTTs climate change denial has spread to several other nations and that an increasing portion of denial books are produced by individuals with no scientific training. It appears that at least 90% of denial books do not undergo peer review, allowing authors or editors to recycle scientifically unfounded claims that are then amplified by the conservative movement, media, and political elites.

Robotic liver surgery: results for 70 resections.

Science.gov (United States)

Giulianotti, Pier Cristoforo; Coratti, Andrea; Sbrana, Fabio; Addeo, Pietro; Bianco, Francesco Maria; Buchs, Nicolas Christian; Annechiarico, Mario; Benedetti, Enrico

2011-01-01

Robotic surgery is gaining popularity for digestive surgery; however, its use for liver surgery is reported scarcely. This article reviews a surgeon's experience with the use of robotic surgery for liver resections. From March 2002 to March 2009, 70 robotic liver resections were performed at 2 different centers by a single surgeon. The surgical procedure and postoperative outcome data were reviewed retrospectively. Malignant tumors were indications for resections in 42 (60%) patients, whereas benign tumors were indications in 28 (40%) patients. The median age was 60 years (range, 21-84) and 57% of patients were female. Major liver resections (≥ 3 liver segments) were performed in 27 (38.5%) patients. There were 4 conversions to open surgery (5.7%). The median operative time for a major resection was 313 min (range, 220-480) and 198 min (range, 90-459) for minor resection. The median blood loss was 150 mL (range, 20-1,800) for minor resection and 300 mL (range, 100-2,000) for major resection. The mortality rate was 0%, and the overall rate of complications was 21%. Major morbidity occurred in 4 patients in the major hepatectomies group (14.8%) and in 4 patients in the minor hepatectomies group (9.3%). All complications were managed conservatively and none required reoperation. This preliminary experience shows that robotic surgery can be used safely for liver resections with a limited conversion rate, blood loss, and postoperative morbidity. Robotics offers a new technical option for minimally invasive liver surgery. Copyright © 2011 Mosby, Inc. All rights reserved.

Improving utility conservation programs: outcomes, interventions, and evaluations

Energy Technology Data Exchange (ETDEWEB)

Condelli, L; Archer, D; Aronson, E; Curbow, B; McLeod, B; Pettigrew, T F; White, L T; Yates, S

1984-06-01

Four major California utility companies have active energy conservation programs mandated by the State's Public Utilities Commission (CPUC). These companies evaluate their programs and send reports of the evaluations to the CPUC. A review of 213 of these reports revealed a marketing research approach toward promoting conservation. Advertising and informational campaigns characterize most programs, and attitudes and self-reported behavior were the major outcome measures. This approach is shown to be ineffective. Suggestions for improvement include: (1) the use of actual energy consumption as the primary outcome measure in evaluating conservation programs; (2) the abandonment of conventional advertising, and the use of it only for the promotion of ''hard'' interventions; (3) increased use of social diffusion methods to disseminate information; (4) the design of more effective educational material by incorporating cognitive social psychological principles; and (5) the utilization of ''hard'' interventions that have a direct, verifiable link to conservation.

Underuse of Radiation Therapy After Breast Conservation Surgery in Puerto Rico: A Puerto Rico Central Cancer Registry–Health Insurance Linkage Database Study

Directory of Open Access Journals (Sweden)

William W. Chance

2017-05-01

Full Text Available Purpose: To identify rates of postoperative radiation therapy (RT after breast conservation surgery (BCS in women with stage I or II invasive breast cancer treated in Puerto Rico and to examine the sociodemographic and health services characteristics associated with variations in receipt of RT. Methods: The Puerto Rico Central Cancer Registry–Health Insurance Linkage Database was used to identify patients diagnosed with invasive breast cancer between 2008 and 2012 in Puerto Rico. Claims codes identified the type of surgery and the use of RT. Logistic regression models were used to examine the independent association between sociodemographic and clinical covariates. Results: Among women who received BCS as their primary definitive treatment, 64% received adjuvant RT. Significant predictors of RT after BCS included enrollment in Medicare (odds ratio [OR], 2.14; 95% CI, 1.46 to 3.13; P ≤ .01 and dual eligibility for Medicare and Medicaid (OR, 1.61; 95% CI, 1.14 to 2.27; P 2.0 cm and ≤ 5.0 cm (OR, 0.61; 95% CI, 0.40 to 0.93; P = .02 and those with tumor size > 5.0 cm (OR, 0.37; 95% CI, 0.15 to 0.92; P = .03 were found to be significantly less likely to receive RT. Conclusion: Underuse of RT after BCS was identified in Puerto Rico. Patients enrolled in Medicare and those who were dually eligible for Medicaid and Medicare were more likely to receive RT after BCS compared with patients with Medicaid alone. There were geographic variations in the receipt of RT on the island.

Is lymph node irradiation useful after conservative for early breast cancer

International Nuclear Information System (INIS)

Gava, A.; Coghetto, F.

1989-01-01

Twenty-four lectures were reviewed of the XXXIII SIRMN National Congress (Rome october 1988) on the conservative radiosurgical treatment of breast cancer. A whole of 3462 cases were divided into 2 groups: group A - 2824 patients who underwent targeted radiotherapy after conservative surgery (mostly quadrantectomy) - and group B - 638 patients where, in case of N+ and internal quadrant tumors, irradiation was extended to lymph nodes. No significant differences were demonstrated between group A and group B as far as locoregional relapse were concerned. Thus, no significant advantage seems to be yielded by lymphnode irradiation in the early treatment of breast cancer

Organ preservation in head and neck cancer: myth or reality? the case for the larynx; La conservation d`organes en cancerologie ORL: mythe ou realite. A propos de la conservation laryngee

Energy Technology Data Exchange (ETDEWEB)

Eschwege, F.; Bourhis, J.; Luboinski, B. [Institut Gustave Roussy, 94 - Villejuif (France); Lefebvre, J.L. [Centre de Lutte Contre le Cancer Oscar-Lambret, 59 - Lille (France)

1998-09-01

The conservation of a functional larynx is an important goal in the various attempts to improve the treatment of locally advanced pharyngo-laryngeal cancers. Several axes have been followed: conservative surgery (subtotal laryngectomy), exclusive irradiation (with conventional or non-conventional fractionation), initial chemotherapy (followed by surgery or irradiation ) or concomitant chemotherapy-radiotherapy. The numerous studies, including some major randomized trials, dealing with the issue of larynx preservation are reviewed in the present article. A critical comparison of their results and its integration in a consistent approach are difficult, especially because the different options are aimed at different patients. Total laryngectomy and its psychological and social consequences can be avoided in a significant number of patients, although the long term functional outcome is poorly known and the choice of the optimal treatment modality is largely dependent on the expertise and experience of the medical team. (author)

Increased Risk for Adhesive Capsulitis of the Shoulder following Cervical Disc Surgery.

Science.gov (United States)

Kang, Jiunn-Horng; Lin, Herng-Ching; Tsai, Ming-Chieh; Chung, Shiu-Dong

2016-05-27

Shoulder problems are common in patients with a cervical herniated intervertebral disc (HIVD). This study aimed to explore the incidence and risk of shoulder capsulitis/tendonitis following cervical HIVD surgery. We used data from the Taiwan "Longitudinal Health Insurance Database". We identified all patients who were hospitalized with a diagnosis of displacement of a cervical HIVD and who underwent cervical surgery (n = 1625). We selected 8125 patients who received cervical HIVD conservative therapy only as the comparison group matched with study patients. We individually tracked these sampled patients for 6 months to identify all patients who received a diagnosis of shoulder tendonitis/capsulitis. We found that incidence rates of shoulder tendonitis/capsulitis during the 6-month follow-up period were 3.69 (95% CI: 2.49~5.27) per 100 person-years for the study group and 2.33 (95% CI: 1.89~2.86) per 100 person-years for the comparison group. Cox proportional hazard regressions showed that the adjusted hazard ratio for shoulder tendonitis/capsulitis among patients who underwent cervical disc surgery was 1.66 (95% CI = 1.09~2.53) when compared to comparison group. We concluded that patients who underwent surgery for a cervical HIVD had a significantly higher risk of developing shoulder capsulitis/tendonitis in 6 months follow-up compared to patients who received cervical HIVD conservative therapy only.

Complications After Cosmetic Surgery Tourism.

Science.gov (United States)

Klein, Holger J; Simic, Dario; Fuchs, Nina; Schweizer, Riccardo; Mehra, Tarun; Giovanoli, Pietro; Plock, Jan A

2017-04-01

Cosmetic surgery tourism characterizes a phenomenon of people traveling abroad for aesthetic surgery treatment. Problems arise when patients return with complications or need of follow-up care. To investigate the complications of cosmetic surgery tourism treated at our hospital as well as to analyze arising costs for the health system. Between 2010 and 2014, we retrospectively included all patients presenting with complications arising from cosmetic surgery abroad. We reviewed medical records for patients' characteristics including performed operations, complications, and treatment. Associated cost expenditure and Diagnose Related Groups (DRG)-related reimbursement were analyzed. In total 109 patients were identified. All patients were female with a mean age of 38.5 ± 11.3 years. Most procedures were performed in South America (43%) and Southeast (29.4%) or central Europe (24.8%), respectively. Favored procedures were breast augmentation (39.4%), abdominoplasty (11%), and breast reduction (7.3%). Median time between the initial procedure abroad and presentation was 15 days (interquartile range [IQR], 9) for early, 81.5 days (IQR, 69.5) for midterm, and 4.9 years (IQR, 9.4) for late complications. Main complications were infections (25.7%), wound breakdown (19.3%), and pain/discomfort (14.7%). The majority of patients (63.3%) were treated conservatively; 34.8% became inpatients with a mean hospital stay of 5.2 ± 3.8 days. Overall DRG-related reimbursement premiums approximately covered the total costs. Despite warnings regarding associated risks, cosmetic surgery tourism has become increasingly popular. Efficient patients' referral to secondary/tertiary care centers with standardized evaluation and treatment can limit arising costs without imposing a too large burden on the social healthcare system. 4. © 2016 The American Society for Aesthetic Plastic Surgery, Inc. Reprints and permission: journals.permissions@oup.com

Knots and links

CERN Document Server

Rolfsen, Dale

2003-01-01

Rolfsen's beautiful book on knots and links can be read by anyone, from beginner to expert, who wants to learn about knot theory. Beginners with a basic background find an inviting introduction to the elements of topology, emphasizing the tools needed for understanding knots, the fundamental group and van Kampen's theorem, for example, which are then applied to concrete problems, such as computing knot groups. For experts, Rolfsen explains advanced topics, such as the connections between knot theory and surgery and how they are useful to understanding three-manifolds. Besides providing a guide

Conservative treatment of breast ductal carcinoma in situ: results of an Italian multi-institutional retrospective study

International Nuclear Information System (INIS)

Vidali, Cristiana; Neri, Stefano; Pietta, Nicoletta; Caffo, Orazio; Aristei, Cynthia; Bertoni, Filippo; Bonetta, Alberto; Guenzi, Marina; Iotti, Cinzia; Leonardi, Maria Cristina; Mussari, Salvatore

2012-01-01

The incidence of ductal carcinoma in situ (DCIS) has increased markedly in recent decades. In the past, mastectomy was the primary treatment for patients with DCIS, but as with invasive cancer, breast-conserving surgery followed by radiation therapy (RT) has become the standard approach. We present the final results of a multi-institutional retrospective study of an Italian Radiation Oncology Group for the study of conservative treatment of DCIS, characterized by a very long period of accrual, from February 1985 to March 2000, and a median follow-up longer than 11 years. A collaborative multi-institutional study was conducted in Italy in 10 Radiation Oncology Departments. A consecutive series of 586 women with DCIS histologically confirmed, treated between February 1985 and March 2000, was retrospectively evaluated. Median age at diagnosis was 55 years (range: 29–84); 32 patients were 40 years old or younger. All women underwent conservative surgery followed by whole breast RT. Irradiation was delivered to the entire breast, for a median total dose of 50 Gy; the tumour bed was boosted in 295 cases (50%) at a median dose of 10 Gy. After a median follow-up of 136 months (range: 16–292 months), 59/586 patients (10%) experienced a local recurrence: invasive in 37 cases, intraductal in 20 and not specified in two. Salvage mastectomy was the treatment of choice in 46 recurrent patients; conservative surgery in 10 and it was unknown in three patients. The incidence of local recurrence was significantly higher in women younger than 40 years (31.3%) (p= 0.0009). Five patients developed distant metastases. Furthermore 40 patients developed a contralateral breast cancer and 31 a second primary tumour in a different site. The 10-year actuarial overall survival (OS) was 95.5% and the 10-year actuarial disease-specific survival (DSS) was 99%. Our results are consistent with those reported in the literature. In particular it has been defined the importance of young age (40

Surgery versus conservative management of endometriomas in subfertile women

DEFF Research Database (Denmark)

Brink Laursen, Jacob; Schroll, Jeppe Bennekou; Macklon, Kirsten T

2017-01-01

INTRODUCTION: Endometriomas are present in up to 44% of all women with endometriosis and have a detrimental effect on fertility. However, it is controversial whether endometriomas should be surgically removed before assisted reproduction technology (ART). Our purpose was to evaluate whether...... surgical stripping of endometriomas in subfertile women improves the chance of a live birth. Secondary outcomes were impact on ovarian reserve and pain. Material and methods We conducted a systematic review and metaanalysis with results reported in accordance to the PRISMA guidelines. Summary of findings...... with conservative management before in vitro fertilization (IVF)/ intracytoplasmic sperm injection (ICSI)) was 0.87 (95% CI; 0.64-1.18, six studies, I(2) = 3%; ⨁◯◯◯, VERY LOW quality). The mean difference of antral follicle count was -2.09 (95% CI; -4.84 - +0.67, four studies). No difference was observed regarding...

Late-onset superior mesenteric artery syndrome four years following scoliosis surgery – a case report

Directory of Open Access Journals (Sweden)

Abol Oyoun Nariman

2015-01-01

Full Text Available Background: Superior mesenteric artery (SMA syndrome has been reported as an uncommon condition of external vascular compression of the SMA particularly after rapid weight loss, body casts, or after corrective surgery for spinal deformities, usually within the first few weeks after surgery. Methods: This is a retrospective report of a case of a non-verbal autistic female patient who started to develop SMA syndrome at the age of 16, 4 years after posterior spinal fusion surgery for scoliosis. She was treated conservatively by increasing oral caloric intake, which resulted in increased body weight and relief of symptoms. Results: Seen at 10 years’ follow up, the patient is doing well, and is functional within the limits of her suboptimal cognitive and verbal conditions. She maintains good trunk balance with solid spinal fusion and intact instrumentation at latest follow up. Conclusion: Spinal surgeons should maintain a high index of suspicion for diagnosis of SMA syndrome even years after scoliosis surgery, especially for patients with communication problems, like the case we present here. Appropriate conservative measures can succeed in relieving the symptoms, increasing body weight, and preventing complications including the risk of death.

What Can Computed Tomography Scans of the Thorax Show after Breast Surgery?

Directory of Open Access Journals (Sweden)

Afsaneh Alikhassi

2016-06-01

Full Text Available Background: Postoperative breast abnormalities after breast conserving surgery or modified radical mastectomy are frequently overlooked and inaccurately assessed or reported using multidetector computed tomography (MDCT. These inaccurate results may have legal ramifications for the clinicians, cause patients avoidable anxiety, and lead to additional unnecessary diagnostic follow-up testing and costs.Methods: The patients with a history of breast cancer who had undergone breast-conserving surgery or modified radical mastectomy up to 6 months prior to undergoing a thoracic MDCT scan consented and enrolled in this study. These patients underwent a thoracic MDCT scan either because of respiratory or cardiac clinical symptoms or as part of breast cancer staging.Results: Forty women were included in this study. Different postoperative breast changes observed on thoracic MDCT scans including fibrous scar tissue, fat necrosis, seroma, abscess, hematoma, and recurrent and residual tumor were described.Conclusions: MDCT scans offer sufficient evidence in many postoperative cases to allow a confident diagnosis. General radiologists who review thoracic MDCT scans should know how to characterize breast lesions incidentally found on MDCT scans after breast surgeries. This information would enhance the value of the radiologist’s report for appropriate case management.

A systematic review and meta-analysis of Harmonic technology compared with conventional techniques in mastectomy and breast-conserving surgery with lymphadenectomy for breast cancer

Directory of Open Access Journals (Sweden)

Cheng H

2016-07-01

Full Text Available Hang Cheng,1 Jeffrey W Clymer,1 Nicole C Ferko,2 Leena Patel,2 Ireena M Soleas,2 Chris G Cameron,2 Piet Hinoul1 1Ethicon Inc., Cincinnati, OH, USA; 2Cornerstone Research Group, Burlington, ON, Canada Background: Mastectomy and breast-conserving surgery (BCS are important treatment options for breast cancer patients. A previous meta-analysis demonstrated that the risk of certain complications can be reduced with the Harmonic technology compared with conventional methods in mastectomy. However, the meta-analysis did not include studies of BCS patients and focused on a subset of surgical complications. The objective of this study was to compare Harmonic technology and conventional techniques for a range of clinical outcomes and complications in both mastectomy and BCS patients, including axillary lymph node dissection.Methods: A comprehensive literature search was performed for randomized controlled trials comparing Harmonic technology and conventional methods in breast cancer surgery. Outcome measures included blood loss, drainage volume, total complications, seroma, necrosis, wound infections, ecchymosis, hematoma, hospital length of stay, and operating time. Risk of bias was analyzed for all studies. Meta-analysis was performed using random-effects models for mean differences of continuous variables and a fixed-effects model for risk ratios of dichotomous variables.Results: Twelve studies met the inclusion criteria. Across surgery types, compared to conventional techniques, Harmonic technology reduced total complications by 52% (P=0.002, seroma by 46% (P<0.0001, necrosis by 49% (P=0.04, postoperative chest wall drainage by 46% (P=0.0005, blood loss by 38% (P=0.0005, and length of stay by 22% (P=0.007. Although benefits generally appeared greatest in mastectomy patients with lymph node dissection, ­Harmonic technology showed significant reductions in complications in the BCS study subgroup.Conclusion: In this meta-analysis of both mastectomy and

Risk of Post-Discharge Venous Thromboembolism and Associated Mortality in General Surgery: A Population-Based Cohort Study Using Linked Hospital and Primary Care Data in England.

Directory of Open Access Journals (Sweden)

George Bouras

Full Text Available Trends towards day case surgery and enhanced recovery mean that postoperative venous thromboembolism (VTE may increasingly arise after hospital discharge. However, hospital data alone are unable to capture adverse events that occur outside of the hospital setting. The National Institute for Health and Care Excellence has suggested the use of primary care data to quantify hospital care-related VTE. Data in surgical patients using these resources is lacking. The aim of this study was to measure VTE risk and associated mortality in general surgery using linked primary care and hospital databases, to improve our understanding of harm from VTE that arises beyond hospital stay.This was a longitudinal cohort study using nationally linked primary care (Clinical Practice Research Datalink, CPRD, hospital administrative (Hospital Episodes Statistics, HES, population statistics (Office of National Statistics, ONS and National Cancer Intelligence Network databases. Routinely collected information was used to quantify 90-day in-hospital VTE, 90-day post-discharge VTE and 90-day mortality in adults undergoing one of twelve general surgical procedures between 1st April 1997 and 31st March 2012. The earliest postoperative recording of deep vein thrombosis or pulmonary embolism in CPRD, HES and ONS was counted in each patient. Covariates from multiple datasets were combined to derive detailed prediction models for VTE and mortality. Limitation included the capture of VTE presenting to healthcare only and the lack of information on adherence to pharmacological thromboprophylaxis as there was no data linkage to hospital pharmacy records.There were 981 VTE events captured within 90 days of surgery in 168005 procedures (23.7/1000 patient-years. Overall, primary care data increased the detection of postoperative VTE by a factor of 1.38 (981/710 when compared with using HES and ONS only. Total VTE rates ranged between 3.2/1000 patient-years in haemorrhoidectomy to 118

Conservative management of small renal tumors

International Nuclear Information System (INIS)

Matsuzaki, Masato; Kawano, Yoshiyuki; Morikawa, Hirofumi; Shiga, Yoshiyuki; Murata, Hirokatsu; Komatsu, Hideki

2007-01-01

With the widespread use of imaging modalities, incidentally discovered small renal cell carcinomas have increased. Some patients, however, are too old or weak due to various diseases to undergo surgery and other patients occasionally refuse surgery. To investigate the natural history of small renal cell carcinoma, we retrospectively reviewed patients with small renal tumors suggestive of carcinoma. We retrospectively reviewed 15 patients with contrast-enhancing renal masses less than 4.0 cm in diameter who were observed without treatment. The mean follow-up period was 38 months (range, 8-91). The average patient age was 67 years (range, 44-87). The initial average tumor diameter was 2.2 cm (range, 1.0-3.9). The average growth rate was 0.06 cm per year (range, -0.09-0.28). Only 4 tumors grew obviously during the follow-up period. Three tumors were removed surgically by radical nephrectomy, and all tumors were pathologically diagnosed as renal cell carcinoma. None of the patients developed metastases during the follow-up period or after surgery. Two patients died of other causes. Nonsurgical watchful waiting may be an acceptable treatment option for elderly or severely comorbid patients; however, it is not known whether this conservative management can he applied to young or otherwise healthy patients. (author)

Adhesions small bowel obstruction in emergency setting: conservative or operative treatment?

Science.gov (United States)

Assenza, M; De Gruttola, I; Rossi, D; Castaldi, S; Falaschi, F; Giuliano, G

2016-01-01

Adhesions small bowel obstructions (aSBO) are among the leading causes of emergency operative intervention. About the 80% of aSBO cases resolve without a surgical treatment. It's important to identify which patients could undergo a conservative treatment to prevent an useless surgery The aim of this study is to determine findings that can indicate whether patients with aSBO should undergo a conservative or a surgical treatment. 313 patients with diagnosis of submission of aSBO were restudied. Patients were divided into two groups based on the different type of treatment received, 225 patients who underwent surgical treatment within 24 hours after admission, 88 patients which underwent conservative treatment successfully. For each patient, clinical, hematochemical and radiological findings have been analysed. The treatment of aSBO should be, at the beginning, conservative except that cases that presents clinical and/or CT-scan findings predictive for a surgical treatment (free peritoneal fluid, mesenterial edema, transitional point) or a peritonitis (pneumatosis intestinalis, pneumoperitoneum).

Science priorities for seamounts: research links to conservation and management.

Directory of Open Access Journals (Sweden)

Malcolm R Clark

Full Text Available Seamounts shape the topography of all ocean basins and can be hotspots of biological activity in the deep sea. The Census of Marine Life on Seamounts (CenSeam was a field program that examined seamounts as part of the global Census of Marine Life (CoML initiative from 2005 to 2010. CenSeam progressed seamount science by collating historical data, collecting new data, undertaking regional and global analyses of seamount biodiversity, mapping species and habitat distributions, challenging established paradigms of seamount ecology, developing new hypotheses, and documenting the impacts of human activities on seamounts. However, because of the large number of seamounts globally, much about the structure, function and connectivity of seamount ecosystems remains unexplored and unknown. Continual, and potentially increasing, threats to seamount resources from fishing and seabed mining are creating a pressing demand for research to inform conservation and management strategies. To meet this need, intensive science effort in the following areas will be needed: 1 Improved physical and biological data; of particular importance is information on seamount location, physical characteristics (e.g. habitat heterogeneity and complexity, more complete and intensive biodiversity inventories, and increased understanding of seamount connectivity and faunal dispersal; 2 New human impact data; these shall encompass better studies on the effects of human activities on seamount ecosystems, as well as monitoring long-term changes in seamount assemblages following impacts (e.g. recovery; 3 Global data repositories; there is a pressing need for more comprehensive fisheries catch and effort data, especially on the high seas, and compilation or maintenance of geological and biodiversity databases that underpin regional and global analyses; 4 Application of support tools in a data-poor environment; conservation and management will have to increasingly rely on predictive

Science priorities for seamounts: research links to conservation and management.

Science.gov (United States)

Clark, Malcolm R; Schlacher, Thomas A; Rowden, Ashley A; Stocks, Karen I; Consalvey, Mireille

2012-01-01

Seamounts shape the topography of all ocean basins and can be hotspots of biological activity in the deep sea. The Census of Marine Life on Seamounts (CenSeam) was a field program that examined seamounts as part of the global Census of Marine Life (CoML) initiative from 2005 to 2010. CenSeam progressed seamount science by collating historical data, collecting new data, undertaking regional and global analyses of seamount biodiversity, mapping species and habitat distributions, challenging established paradigms of seamount ecology, developing new hypotheses, and documenting the impacts of human activities on seamounts. However, because of the large number of seamounts globally, much about the structure, function and connectivity of seamount ecosystems remains unexplored and unknown. Continual, and potentially increasing, threats to seamount resources from fishing and seabed mining are creating a pressing demand for research to inform conservation and management strategies. To meet this need, intensive science effort in the following areas will be needed: 1) Improved physical and biological data; of particular importance is information on seamount location, physical characteristics (e.g. habitat heterogeneity and complexity), more complete and intensive biodiversity inventories, and increased understanding of seamount connectivity and faunal dispersal; 2) New human impact data; these shall encompass better studies on the effects of human activities on seamount ecosystems, as well as monitoring long-term changes in seamount assemblages following impacts (e.g. recovery); 3) Global data repositories; there is a pressing need for more comprehensive fisheries catch and effort data, especially on the high seas, and compilation or maintenance of geological and biodiversity databases that underpin regional and global analyses; 4) Application of support tools in a data-poor environment; conservation and management will have to increasingly rely on predictive modelling

Science Priorities for Seamounts: Research Links to Conservation and Management

Science.gov (United States)

Clark, Malcolm R.; Schlacher, Thomas A.; Rowden, Ashley A.; Stocks, Karen I.; Consalvey, Mireille

2012-01-01

Seamounts shape the topography of all ocean basins and can be hotspots of biological activity in the deep sea. The Census of Marine Life on Seamounts (CenSeam) was a field program that examined seamounts as part of the global Census of Marine Life (CoML) initiative from 2005 to 2010. CenSeam progressed seamount science by collating historical data, collecting new data, undertaking regional and global analyses of seamount biodiversity, mapping species and habitat distributions, challenging established paradigms of seamount ecology, developing new hypotheses, and documenting the impacts of human activities on seamounts. However, because of the large number of seamounts globally, much about the structure, function and connectivity of seamount ecosystems remains unexplored and unknown. Continual, and potentially increasing, threats to seamount resources from fishing and seabed mining are creating a pressing demand for research to inform conservation and management strategies. To meet this need, intensive science effort in the following areas will be needed: 1) Improved physical and biological data; of particular importance is information on seamount location, physical characteristics (e.g. habitat heterogeneity and complexity), more complete and intensive biodiversity inventories, and increased understanding of seamount connectivity and faunal dispersal; 2) New human impact data; these shall encompass better studies on the effects of human activities on seamount ecosystems, as well as monitoring long-term changes in seamount assemblages following impacts (e.g. recovery); 3) Global data repositories; there is a pressing need for more comprehensive fisheries catch and effort data, especially on the high seas, and compilation or maintenance of geological and biodiversity databases that underpin regional and global analyses; 4) Application of support tools in a data-poor environment; conservation and management will have to increasingly rely on predictive modelling

Mortality after endophthalmitis following contemporary phacoemulsification cataract surgery.

Science.gov (United States)

Crosby, Niall; Polkinghorne, Philip J; Kim, Bia; McGhee, Charles; Welch, Sarah; Riley, Andrew

2018-04-24

To determine if endophthalmitis following cataract surgery is linked to increased mortality. Increased mortality has been linked to patients with cataract and cataract surgery. We tested the hypothesis that post-cataract endophthalmitis has a greater risk of death than pseudophakes who do not develop this complication. Case-control study conducted in a tertiary public hospital. The study group comprised 50 consecutive patients with post-cataract endophthalmitis, and these were matched with selected controls. Patients with endophthalmitis following cataract surgery were identified from a prospective electronic surgical database. Subsequently, it was determined if the patient was deceased at the time of sequestration (September 2015), and the date of death was recorded. A previously described population who had undergone cataract surgery in the same facility was selected as a control group, and the population was case-matched in terms age, gender, presence or absence of diabetes and/or hypertension. The median survival rates were determined for the control group and the patients with post-cataract endophthalmitis. Fifty patients were identified as undergoing endophthalmitis post-cataract surgery, and 48 (n = 48) met inclusion criteria (mean age 72 years ±12 SD with 30:18 F:M); 17% were diabetic, and 50% had systemic hypertension. No statistically significant difference in median survival between the study and control cases was identified (100 months (95% confidence interval 86-114) vs. 106 months (95% confidence interval 66-146), respectively, P = 0.756). Post-cataract endophthalmitis was not associated with an increased rate of mortality in this study. © 2018 Royal Australian and New Zealand College of Ophthalmologists.

Surgical margin reporting in breast conserving surgery: Does compliance with guidelines affect re-excision and mastectomy rates?

Science.gov (United States)

Persing, Sarah; Jerome, Mairin A; James, Ted A; Callas, Peter; Mace, John; Sowden, Michelle; Goodwin, Andrew; Weaver, Donald L; Sprague, Brian L

2015-10-01

Margin status is important in guiding decisions to re-excise following breast-conserving surgery (BCS) for breast cancer. The College of American Pathologists (CAP) developed guidelines to standardize pathology reporting; however, compliance with margin documentation guidelines has been shown to vary. The aim of this retrospective study was to determine whether compliance with CAP guidelines affects re-excision and mastectomy rates. We identified 1423 patients diagnosed with breast cancer between 1998 and 2006 who underwent BCS with negative margins. CAP compliance was categorized as maximal, minimal, or non-compliant. Statistical analyses were performed comparing the frequency of re-excision and mastectomy after initial BCS according to CAP margin reporting guideline compliance. Data were adjusted for provider facility by including a clustering variable within the regression model. Patients with non-compliant margin reporting were 1.7 times more likely to undergo re-excision and/or mastectomy than those with maximally compliant reporting. Level of compliance was most strongly associated with the frequency of mastectomy; non-compliant margin reporting was associated with a 2.5-fold increase in mastectomy rates compared to maximally compliant reporting. The results did not substantially change when the analyses accounted for clustering at the provider facility level. Our findings suggest that compliance with CAP guidelines in pathology reporting may be associated with variation in re-excision and mastectomy rates following BCS. Copyright © 2015 Elsevier Ltd. All rights reserved.

Rescue surgery post-failure of the radiotherapy in early glottis carcinoma

International Nuclear Information System (INIS)

Dodero, Alberto; Piazza, Carlos; Ugarte, Marcelo; Kulay, Yolanda

2006-01-01

The treatment of the laryngeal carcinoma is controversial in the otolaryngology literature; in glottis cancer that can be managed with radiotherapy, conservative laryngeal surgery and micro-endoscope by laser. At present time, the main objective in the treatment of the early glottis cancer is the control of the tumor and preservation of a good voice. In small injuries, the surgery and the radiotherapy offer equivalent cure rates. The handling of the failure of radiotherapy is controversial; the options go from the resection endoscope with laser, to the total laryngectomy, with local controls [es

Placenta Previa Percreta: A Case Report of Successful Management via Conservative Surgery

Directory of Open Access Journals (Sweden)

Silvia Canonico

2013-01-01

Full Text Available Placenta percreta is one of the most serious complications of placenta previa and is frequently associated with severe obstetric hemorrhage usually necessitating hysterectomy. We present a case of placenta previa percreta diagnosed by ultrasound and magnetic resonance imaging techniques, in which we accomplished conservative management of postpartum hemorrhage. The management we propose includes the following steps: preventive catheterization of the descending aorta via transhumeral access; Stark cesarean delivery; uterotonics drugs; Affronti endouterine square hemostatic sutures; intrauterine application of Bakri balloon and partial filling with 100 mL of normal saline; B Lynch suture, hysterorrhaphy, and filling a Bakri balloon with up to 500 mL of normal saline; reversible radiological embolization; and/or surgical ligation of the uterine arteries. The bleeding stopped following placement of Affronti sutures combined with external (B-Lynch suture and internal (Bakri balloon uterine compression. Our experience indicates that this conservative method can be considered an option in the management of selected cases of pregnancy at high risk for intrapartum hemorrhage.

An analytical framework for linking biodiversity to poverty

NARCIS (Netherlands)

Hengsdijk, H.; Meijerink, G.W.; Tonneijck, A.E.G.; Bindraban, P.S.

2005-01-01

This report aims to develop a framework linking poverty reduction and biodiversity conservation in order to identify research questions and to contribute to improved policy formulation. A general overview of the subject, definitions and concepts of poverty and biodiversity are described.

[Type 2 dens fracture in the elderly and therapy-linked mortality : Conservative or operative treatment].

Science.gov (United States)

Stein, G; Meyer, C; Marlow, L; Christ, H; Müller, L P; Isenberg, J; Eysel, P; Schiffer, G; Faymonville, C

2017-02-01

Type II fractures of the odontoid process of the axis are the most common injury of the cervical spine in elderly patients. Only little evidence exists on whether elderly patients should be treated conservatively or surgically. The mortality and survival probability of 51 patients were determined in a retrospective study. The range of motion, pain and the neck disability index were clinically investigated. Of the 51 patients 37 were treated surgically and 14 conservatively. The conservatively treated group showed a higher mortality (64 % vs. 32 %). Kaplan-Meier analysis revealed a median survival of the conservatively treated group of 29 months, whereby during the first 3 months of treatment this group showed a higher survival probability and afterwards the surgically treated group showed a higher survival probability. The clinical examination of 20 patients revealed limited range of motion of the cervical spine. Additionally, moderate levels of pain and complaints were recorded using the neck disability index. Fractures of the odontoid process pose a far-reaching danger for elderly patients. A balanced assessment of the general condition should be carried out at the beginning of treatment of these patients. In the early phase following trauma no differences were found with respect to survival rates but for long-term survival the operatively treated group showed advantages; however, these advantages cannot be causally attributed to the choice of therapy.

Conservation of transcription factor binding events predicts gene expression across species

OpenAIRE

Hemberg, Martin; Kreiman, Gabriel

2011-01-01

Recent technological advances have made it possible to determine the genome-wide binding sites of transcription factors (TFs). Comparisons across species have suggested a relatively low degree of evolutionary conservation of experimentally defined TF binding events (TFBEs). Using binding data for six different TFs in hepatocytes and embryonic stem cells from human and mouse, we demonstrate that evolutionary conservation of TFBEs within orthologous proximal promoters is closely linked to funct...

Gastric bypass surgery reveals independency of obesity and diabetes melitus type 2

DEFF Research Database (Denmark)

Fenger, Mogens; Hansen, Dorte Lindqvist; Worm, Dorte

2016-01-01

BACKGROUND: Roux-en-Y gastric bypass surgery is widely applied to ameliorate morbid obesity, including diabetes in people with type 2 diabetes. The latter vanish a few days after surgery for many, but not in all patients before any weight reduction has occurred. The explanation for this change...... in metabolic status is poorly understood, but the observation may suggest that the fate obesity and diabetes is only partly linked after surgery. METHODS: The trajectories of weight reduction measured as reduced body mass index (BMI) in 741obese subjects with and without diabetes were evaluated. Evaluation...... was performed on three groups: 1) subjects that were non-diabetic before and after surgery; 2) subjects that were diabetics before surgery but non-diabetics after surgery; and 3) subjects that were diabetics before surgery and remained diabetics after surgery. The diabetic state was established at HbA1c above...

Medical tourism and bariatric surgery: who pays?

Science.gov (United States)

Sheppard, Caroline E; Lester, Erica L W; Chuck, Anderson W; Kim, David H; Karmali, Shahzeer; de Gara, Christopher J; Birch, Daniel W

2014-12-01

The objective of this study was to determine the short-term cost impact that medical tourism for bariatric surgery has on a public healthcare system. Due to long wait times for bariatric surgery services, Canadians are venturing to private clinics in other provinces/countries. Postoperative care in this population not only burdens the provincial health system with intervention costs required for complicated patients, but may also impact resources allotted to patients in the public clinic. A chart review was performed from January 2009 to June 2013, which identified 62 medical tourists requiring costly interventions related to bariatric surgery. Secondarily, a survey was conducted to estimate the frequency of bariatric medical tourists presenting to general surgeons in Alberta, necessary interventions, and associated costs. A threshold analysis was used to compare costs of medical tourism to those from our institution. A conservative cost estimate of $1.8 million CAD was calculated for all interventions in 62 medical tourists. The survey established that 25 Albertan general surgeons consulted 59 medical tourists per year: a cost of approximately $1 million CAD. Medical tourism was calculated to require a complication rate ≤ 28% (average intervention cost of $37,000 per patient) to equate the cost of locally conducted surgery: a rate less than the current supported evidence. Conducting 250 primary bariatric surgeries in Alberta is approximately $1.9 million less than the modeled cost of treating 250 medical tourists returning to Alberta. Medical tourism has a substantial impact on healthcare costs in Alberta. When compared to bariatric medical tourists, the complication rate for locally conducted surgery is less, and the cost of managing the complications is also much less. Therefore, we conclude that it is a better use of resources to conduct bariatric surgery for Albertan residents in Alberta than to fund patients to seek surgery out of province/country.

Optimal fire histories for biodiversity conservation.

Science.gov (United States)

Kelly, Luke T; Bennett, Andrew F; Clarke, Michael F; McCarthy, Michael A

2015-04-01

Fire is used as a management tool for biodiversity conservation worldwide. A common objective is to avoid population extinctions due to inappropriate fire regimes. However, in many ecosystems, it is unclear what mix of fire histories will achieve this goal. We determined the optimal fire history of a given area for biological conservation with a method that links tools from 3 fields of research: species distribution modeling, composite indices of biodiversity, and decision science. We based our case study on extensive field surveys of birds, reptiles, and mammals in fire-prone semi-arid Australia. First, we developed statistical models of species' responses to fire history. Second, we determined the optimal allocation of successional states in a given area, based on the geometric mean of species relative abundance. Finally, we showed how conservation targets based on this index can be incorporated into a decision-making framework for fire management. Pyrodiversity per se did not necessarily promote vertebrate biodiversity. Maximizing pyrodiversity by having an even allocation of successional states did not maximize the geometric mean abundance of bird species. Older vegetation was disproportionately important for the conservation of birds, reptiles, and small mammals. Because our method defines fire management objectives based on the habitat requirements of multiple species in the community, it could be used widely to maximize biodiversity in fire-prone ecosystems. © 2014 Society for Conservation Biology.

DOES BARIATRIC SURGERY AFFECT SEXUALITY: A SYSTEMATIC REVIEW

Directory of Open Access Journals (Sweden)

Dilek Aygin

2017-09-01

Full Text Available Obesity affects sexual health negatively due to several reasons such as impaired body image, psychological disorders and hormonal changes. Bariatric surgery is frequently used in the treatment of obesity. Besides positive effects such as an increase in physical activity due to weight loss and hormonal changes after surgery, there are some adverse effects of bariatric surgery such as sagging and wrinkling of skin due to rapid weight loss. The purpose of this study is to determine the effects of bariatric surgery on sexual function. The literature between 2004 and 2015 was reviewed by searching Scopus, Science Direct, PubMed, Ebsco, Coochrane, Medline Complete, Ovid, Springer Link, Google Scholar, Taylor & Francis, PsychInfo databases, national thesis center and Ulakbim databases; ten studies appropriate to the criteria were included in the study. A total of 524 patients (152 males underwent bariatric surgery were included in study. Sexual function has been found to improve in all the studies. Also weight loss has been shown to have positive effects on reproductive hormones in both sexes. Bariatric surgery has positive effects on weight-loss and consequently on sexual function and reproductive hormones. [J Contemp Med 2017; 7(3.000: 284-296

Determining environmental causes of biological effects: the need for a mechanistic physiological dimension in conservation biology.

Science.gov (United States)

Seebacher, Frank; Franklin, Craig E

2012-06-19

The emerging field of Conservation Physiology links environmental change and ecological success by the application of physiological theory, approaches and tools to elucidate and address conservation problems. Human activity has changed the natural environment to a point where the viability of many ecosystems is now under threat. There are already many descriptions of how changes in biological patterns are correlated with environmental changes. The next important step is to determine the causative relationship between environmental variability and biological systems. Physiology provides the mechanistic link between environmental change and ecological patterns. Physiological research, therefore, should be integrated into conservation to predict the biological consequences of human activity, and to identify those species or populations that are most vulnerable.

Lightweight link dimensioning using sFlow sampling

DEFF Research Database (Denmark)

de Oliviera Schmidt, Ricardo; Sadre, Ramin; Sperotto, Anna

2013-01-01

not be trivial in high-speed links. Aiming scalability, operators often deploy packet sampling on monitoring, but little is known how it affects link dimensioning. In this paper we assess the feasibility of lightweight link dimensioning using sFlow, which is a widely-deployed traffic monitoring tool. We...... implement sFlow sampling algorithm and use a previously proposed and validated dimensioning formula that needs traffic variance. We validate our approach using packet captures from real networks. Results show that the proposed procedure is successful for a range of sampling rates and that, due to randomness...... of sampling algorithm, the error introduced by scaling the traffic variance yields more conservative results that cope with short-term traffic fluctuations....

Improving conservation outcomes with insights from local experts and bureaucracies.

Science.gov (United States)

Haenn, Nora; Schmook, Birgit; Reyes, Yol; Calmé, Sophie

2014-08-01

We describe conservation built on local expertise such that it constitutes a hybrid form of traditional and bureaucratic knowledge. Researchers regularly ask how local knowledge might be applied to programs linked to protected areas. By examining the production of conservation knowledge in southern Mexico, we assert local expertise is already central to conservation. However, bureaucratic norms and social identity differences between lay experts and conservation practitioners prevent the public valuing of traditional knowledge. We make this point by contrasting 2 examples. The first is a master's thesis survey of local experts regarding the biology of the King Vulture (Sarcoramphus papa) in which data collection took place in communities adjacent to the Calakmul Biosphere Reserve. The second is a workshop sponsored by the same reserve that instructed farmers on how to monitor endangered species, including the King Vulture. In both examples, conservation knowledge would not have existed without traditional knowledge. In both examples, this traditional knowledge is absent from scientific reporting. On the basis of these findings, we suggest conservation outcomes may be improved by recognizing the knowledge contributions local experts already make to conservation programming. © 2014 Society for Conservation Biology.

[Acute cholecystitis in cholelithiasis: importance of early surgery (a comparative study)].

Science.gov (United States)

Meissner, K; Meiser, G; Schwaiger, E

1989-01-20

The results of early surgery (ES) for acute calculous cholecystitis obtained in 74 patients operated on between 3/78 and 12/87 were compared with relevant data obtained in 74 sex- and age-matched patients with a history of acute cholecystitis operated on for biliary colic or jaundice during the same period. Operative procedures, incidence of jaundice and common bile duct calculi, duration of operation, number of patients requiring blood transfusions, surgical and general complications and mortality showed no significant difference. Only operative blood loss was significantly higher in the ES group, but this was of no practical relevance. ES precludes the sequelae of emergency surgery in the delayed surgery group not infrequently necessary for failure of conservative treatment of acute cholecystitis, which necessarily precedes planned delayed surgery, and thus renders a significant reduction of over-all risk. This forms the rationale for ES as treatment concept.

Desmoid-type fibromatosis: a front-line conservative approach to select patients for surgical treatment.

Science.gov (United States)

Fiore, Marco; Rimareix, Françoise; Mariani, Luigi; Domont, Julien; Collini, Paola; Le Péchoux, Cecile; Casali, Paolo G; Le Cesne, Axel; Gronchi, Alessandro; Bonvalot, Sylvie

2009-09-01

Surgery is still the standard treatment for desmoid-type fibromatosis (DF). Recently, the Institut Gustave Roussy (IGR), Villejuif, France, reported a series of patients treated with a front-line conservative approach (no surgery and no radiotherapy). The disease remained stable in more than half of patients. This study was designed to evaluate this approach on the natural history of the disease in a larger series of patients. A total of 142 patients presenting to the IGR or Istituto Nazionale Tumori (INT), Milan, Italy, were initially treated using a front-line deliberately conservative policy. Their progression-free survival (PFS) was observed and a multivariate analysis was performed for major clinical variables. Seventy-four patients presented with primary tumor, 68 with recurrence. Eighty-three patients received a "wait & see" policy (W&S), whereas 59 were initially offered medical therapy (MT), mainly hormonal therapy and chemotherapy. A family history of sporadic colorectal cancer was present in 8% of patients. The 5-year PFS was 49.9% for the W&S group and 58.6% for the medically treated patients (P = 0.3196). Similar results emerged for primary and recurrent DF. Multivariate analysis identified no clinical variables as independent predictors of PFS. In the event of progression, all patients were subsequently managed safely. A conservative policy could be a safe approach to primary and recurrent DF, which could avoid unnecessary morbidity from surgery and/or radiation therapy. Half of patients had medium-term stable disease after W&S or MT. A multidisciplinary, stepwise approach should be prospectively tested in DF.

Global sea turtle conservation successes.

Science.gov (United States)

Mazaris, Antonios D; Schofield, Gail; Gkazinou, Chrysoula; Almpanidou, Vasiliki; Hays, Graeme C

2017-09-01

We document a tendency for published estimates of population size in sea turtles to be increasing rather than decreasing across the globe. To examine the population status of the seven species of sea turtle globally, we obtained 299 time series of annual nesting abundance with a total of 4417 annual estimates. The time series ranged in length from 6 to 47 years (mean, 16.2 years). When levels of abundance were summed within regional management units (RMUs) for each species, there were upward trends in 12 RMUs versus downward trends in 5 RMUs. This prevalence of more upward than downward trends was also evident in the individual time series, where we found 95 significant increases in abundance and 35 significant decreases. Adding to this encouraging news for sea turtle conservation, we show that even small sea turtle populations have the capacity to recover, that is, Allee effects appear unimportant. Positive trends in abundance are likely linked to the effective protection of eggs and nesting females, as well as reduced bycatch. However, conservation concerns remain, such as the decline in leatherback turtles in the Eastern and Western Pacific. Furthermore, we also show that, often, time series are too short to identify trends in abundance. Our findings highlight the importance of continued conservation and monitoring efforts that underpin this global conservation success story.

Robot-assisted gastroesophageal surgery: usefulness and limitations.

Science.gov (United States)

Diez Del Val, Ismael; Martinez Blazquez, Cándido; Loureiro Gonzalez, Carlos; Vitores Lopez, Jose Maria; Sierra Esteban, Valentin; Barrenetxea Asua, Julen; Del Hoyo Aretxabala, Izaskun; Perez de Villarreal, Patricia; Bilbao Axpe, Jose Esteban; Mendez Martin, Jaime Jesus

2014-06-01

Robot-assisted surgery overcomes some of the limitations of traditional laparoscopic surgery. We present our experience and lessons learned in two surgical units dedicated to gastro-esophageal surgery. From June 2009 to January 2013, we performed 130 robot-assisted gastroesophageal procedures, including Nissen fundoplication (29), paraesophageal hernia repair (18), redo for failed antireflux surgery (11), esophagectomy (19), subtotal (5) or wedge (4) gastrectomy, Heller myotomy for achalasia (22), gastric bypass for morbid obesity (12), thoracoscopic leiomyomectomy (4), Morgagni hernia repair (3), lower-third esophageal diverticulectomy (1) and two diagnostic procedures. There were 80 men and 50 women with a median age of 54 years (interquartile range: 46-65). Ten patients (7.7 %) had severe postoperative complications: eight after esophagectomy (three leaks-two cervical and one thoracic-managed conservatively), one stapler failure, one chylothorax, one case of gastric migration to the thorax, one case of biliary peritonitis, and one patient with a transient ventricular dyskinesia. One redo procedure needed reoperation because of port-site bleeding, and one patient died of pulmonary complications after a giant paraesophageal hernia repair; 30-day mortality was, therefore, 0.8 %. There were six elective and one forced conversions (hemorrhage), so total conversion was 5.4 %. Median length of stay was 4 days (IQ range 3-7). Robot-assisted gastroesophageal surgery is feasible and safe, and may be applied to most common procedures. It seems of particular value for Heller myotomy, large paraesophageal hernias, redo antireflux surgery, transhiatal dissection, and hand-sewn intrathoracic anastomosis.

Bilateral Acute Angle-closure after Intraocular Surgery.

Science.gov (United States)

Hoskens, Kirsten; Pinto, Luis Abegão; Vandewalle, Evelien; Verdonk, Nancy; Stalmans, Ingeborg

2014-01-01

We report the case of a 75-year-old woman who developed an acute bilateral angle-closure associated with choroidal effusion a day after an uneventful cataract surgery. The same patient had undergone a similarly uneventful cataract surgery two weeks before, under the same protocol, with no postoperative complication in the other eye. Medical treatment, including the use of oral sulfamide-related drugs (acetazolamide), topical beta-blockers and steroids led to a gradual decrease in intraocular pressure (IOP) and choroidal effusion. Despite initial reports suggesting a link between sulfamide-exposure and these rare forms of angle-closure, our report would suggest a more complex pathophysiology behind this intriguing phenomenon. How to cite this article: Hoskens K, Pinto LA, Vandewalle E, Verdonk N, Stalmans I. Bilateral Acute Angle-closure after Intraocular Surgery. J Curr Glaucoma Pract 2014;8(3):113-114.

Successful conservative treatment of enterocutaneous fistula with cyanoacrylate surgical sealant: case report.

Science.gov (United States)

Musa, N; Aquilino, F; Panzera, P; Martines, G

2017-01-01

Enterocutaneous (EC) fistula is an abnormal communication between the gastrointestinal tract and the skin. The majority of EC fistulas result from surgery. Only 15-25% of EC fistulas are spontaneous and they often result from underlying diseases such as Crohn's disease, radiation and chemotherapy. A 62-year old woman who, in 2012, underwent Pylorus-preserving cephalic pancreaticoduodenectomy (PPPD sec. Traverso-Longmire), due to an advanced pancreatic ductal adenocarcinoma (pT3N1M1). After surgery, the patient underwent chemotherapy with folfirinox regimen. In December 2016, as a result of the appearance of metastatic liver lesions and perianastomotic recurrence, the patient underwent second line treatment with Gemcitabine and pab-paclitaxel. After five months from the beginning of this new second line therapy she presented an EC fistula. The fistula of the patient was successfully treated with total parenteral nutrition and with percutaneous injection of cyanoacrylic sealant. The result suggests the advisability of percutaneous injection of sealant devices, such as cyanoacrylate glue; in order to successfully control stable Enterocutaneous fistulas with acceptable morbidity and mortality especially in particular situations, such as, with low output EC fistulas without signs of complications or on patients considered not suitable for surgery, a conservative approach could ensure the control of the fistula. This approach is easy and safe, viable and useful for future trials on the efficacy in conservative treatment of EC fistula.

Facial nerve decompression surgery using bFGF-impregnated biodegradable gelatin hydrogel in patients with Bell palsy.

Science.gov (United States)

Hato, Naohito; Nota, Jumpei; Komobuchi, Hayato; Teraoka, Masato; Yamada, Hiroyuki; Gyo, Kiyofumi; Yanagihara, Naoaki; Tabata, Yasuhiko

2012-04-01

Basic fibroblast growth factor (bFGF) promotes the regeneration of denervated nerves. The aim of this study was to evaluate the regeneration-facilitating effects of novel facial nerve decompression surgery using bFGF in a gelatin hydrogel in patients with severe Bell palsy. Prospective clinical study. Tertiary referral center. Twenty patients with Bell palsy after more than 2 weeks following the onset of severe paralysis were treated with the new procedure. The facial nerve was decompressed between tympanic and mastoid segments via the mastoid. A bFGF-impregnated biodegradable gelatin hydrogel was placed around the exposed nerve. Regeneration of the facial nerve was evaluated by the House-Brackmann (H-B) grading system. The outcomes were compared with the authors' previous study, which reported outcomes of the patients who underwent conventional decompression surgery (n = 58) or conservative treatment (n = 43). The complete recovery (H-B grade 1) rate of the novel surgery (75.0%) was significantly better than the rate of conventional surgery (44.8%) and conservative treatment (23.3%). Every patient in the novel decompression surgery group improved to H-B grade 2 or better even when undergone between 31 and 99 days after onset. Advantages of this decompression surgery are low risk of complications and long effective period after onset of the paralysis. To the authors' knowledge, this is the first clinical report of the efficacy of bFGF using a new drug delivery system in patients with severe Bell palsy.

Predictive factors for the development of persistent pain after breast cancer surgery

DEFF Research Database (Denmark)

Andersen, Kenneth Geving; Duriaud, Helle Molter; Jensen, Helle Elisabeth

2015-01-01

Previous studies have reported that 15% to 25% of patients treated for breast cancer experience long-term moderate-to-severe pain in the area of surgery, potentially lasting for several years. Few prospective studies have included all potential risk factors for the development of persistent pain...... after breast cancer surgery (PPBCS). The aim of this prospective cohort study was to comprehensively identify factors predicting PPBCS. Patients scheduled for primary breast cancer surgery were recruited. Assessments were conducted preoperatively, the first 3 days postoperatively, and 1 week, 6 months...... were included, and 475 (88%) were available for analysis at 1 year. At 1-year follow-up, the prevalence of moderate-to-severe pain at rest was 14% and during movement was 7%. Factors associated with pain at rest were age breast conserving surgery (OR: 2.0, P...

Conservative treatment of excessive anterior pelvic tilt

DEFF Research Database (Denmark)

Brekke, Anders Falk

of Clinical Research, University of Southern Denmark, Denmark 3Department of Physiotherapy, University College Zealand, Denmark 4Center for Evidence-Based Medicine, Odense University Hospital, Denmark Correspondence Anders Falk Brekke E-mail: afbrekke@health.sdu.dk Mob: +45 7248 2626 Add: Sdr. Boulevard 29......Conservative treatment of excessive anterior pelvic tilt: A systematic review Anders Falk Brekke1,2,3, Søren Overgaard1,2, Asbjørn Hróbjartsson4, Anders Holsgaard-Larsen1,2 1Orthopaedic Research Unit, Department of Orthopaedic Surgery and Traumatology, Odense University Hospital 2Department...

Cost-effectiveness of radiation therapy following conservative surgery for ductal carcinoma in situ of the breast

International Nuclear Information System (INIS)

Suh, W. Warren; Hillner, Bruce E.; Pierce, Lori J.; Hayman, James A.

2005-01-01

Purpose: To assess the cost-effectiveness of radiation therapy (RT) in patients with ductal carcinoma in situ (DCIS) after breast-conserving surgery (BCS). Methods and materials: A Markov model was constructed for a theoretical cohort of 55-year-old women with DCIS over a life-time horizon. Probability estimates for local noninvasive (N-INV), local invasive (INV), and distant recurrences were obtained from National Surgical Adjuvant Breast and Bowel Project (NSABP) B-17. Utilities for eight nonmetastatic health states were collected from both healthy women and DCIS patients. Direct medical (2002 Medicare fee schedule) and nonmedical costs (time and transportation) of RT were ascertained. Results: For BCS + RT vs. BCS alone, the estimated N-INV and INV rates at 12 years were 9% and 8% vs. 16% and 18%, respectively. The incremental cost of adding RT was $3300 despite an initial RT cost of $8700 due to higher local recurrence-related salvage costs incurred with the BCS alone strategy. An increase of 0.09 quality-adjusted life-years (QALYs) primarily reflected the lower risk of INV with RT, resulting in an incremental cost-effectiveness ratio (ICER) of $36,700/QALY. Sensitivity analyses revealed the ICER to be affected by baseline probability of a local recurrence, relative efficacy of RT in preventing INV, negative impact of an INV on quality of life, and cost of initial RT. Cost of salvage BCS + RT and source of utilities (healthy women vs. DCIS patients) influenced the ICER albeit to a lesser degree. Conclusions: Addition of RT following BCS for patients with DCIS should not be withheld because of concerns regarding its cost-effectiveness

Mainstreaming ecosystem services in state-level conservation planning: progress and future needs

Directory of Open Access Journals (Sweden)

Ryan R. Noe

2017-12-01

Full Text Available Ecosystem services (ES have become an important focus of the conservation movement but have yet to be mainstreamed into environmental policy and management, especially at the state and federal levels. Adoption of an ES approach requires agency personnel to have knowledge or experience in implementing an ES approach and metrics that link potential actions to impacts on ES. We characterize the degree to which ES considerations are taken into account in setting priorities for conservation acquisitions in the U.S. state of Minnesota. We assess two core dimensions of an ES approach: (1 multiobjective targeting and (2 measuring program benefits in terms of increases in human well-being. We assess the degree to which these two dimensions occur in statute and in conservation program decision making. We find that state statute provides clear support for an ES approach in conservation funding mechanisms. However, we find that many of the programs funded through those mechanisms have more traditional habitat-centric approaches. In contrast to statutory emphasis, water quality related metrics were not prominent. We recommend expanding current prioritization systems to include a broader suite of metrics that are linked to human well-being to further mainstream ES in Minnesota. These metrics can be generated from existing data and would allow program managers to better communicate the public benefits of conservation spending.

Role of 10-Gy boost radiation after breast-conserving surgery for stage I-II breast cancer with a 5-mm negative margin

International Nuclear Information System (INIS)

Notani, Masafumi; Uchida, Nobue; Kitagaki, Hajime

2007-01-01

According to the Guidelines for breast-conserving therapy of the Japanese Breast Cancer Society, the surgical margin is ''negative'' when the minimum distance between the tumor edge and the margin of the resected specimen is more than 5 mm. The value of boost radiation for early breast cancer with a 5-mm negative margin remains unclear. A total of 137 patients with stage I-II breast cancer underwent breast-conserving surgery between July 1987 and August 2002. All of the patients had negative margins according to the Japanese guidelines. Their median age was 50 years and the median follow-up period was 62 months. The entire ipsilateral breast was irradiated to a total dose of 50 Gy (25 fractions). Then an additional 10 Gy (5 fractions) was given to 79 patients, using 6- to 12-MeV electrons (boost group), while 58 patients (no-boost group) received no further radiation. Factors influencing local recurrence were evaluated by univariate and multivariate analyses. For the entire population, the 5-year overall survival, cause-specific survival, disease-free survival, and local recurrence rates were 96.0%, 96.8%, 94.2%, and 1.67%, respectively. Boost radiation reduced local recurrence, but the improvement was not significant (P=0.070). Univariate and multivariate analyses failed to detect any factors that were significantly associated with local control. There were no severe complications in either group and there were no differences between the groups in the cosmetic outcome. Boost radiation can be performed for stage I-II breast cancer with negative margins (Japanese guidelines), and showed a tendency to decrease local recurrence. A large randomized controlled study is necessary to establish final conclusions. (author)

A multicenter investigation of late adverse events in Japanese women treated with breast-conserving surgery plus conventional fractionated whole-breast radiation therapy

International Nuclear Information System (INIS)

Nozaki, Miwako; Kagami, Yoshikazu; Mitsumori, Michihide; Hiraoka, Masahiro

2012-01-01

The objective of this study was to investigate late adverse events in Japanese women treated with breast-conserving surgery plus conventional fractionated radiation therapy in 24 hospitals. This is a prospective investigation into patients who have been followed for 3 years or more after the completion of radiation therapy. The women visited hospitals for routine medical follow-up between 1 March and 31 May 2008. All patients underwent interviews and visual/palpating examinations. Their clinical chart, past chest X-rays and laboratory findings were reviewed. Evaluation criteria for late adverse events and breast cosmetic outcome were based on the Common Terminology Criteria for Adverse Events v.3 and the European Organization for Research and Treatment of Cancer Global Cosmetic Rating System. Seven hundred and three women, including 448 treated with whole-breast irradiation and 255 treated with whole-breast and boost irradiation, were examined by radiation oncologists in 24 hospitals. The frequent adverse events were breast pain (Grade 1, 115; Grade 2, 2), breast fibrosis (Grade 1, 72; Grade 2, 8), chest wall pain (Grade 1, 67; Grade 2, 3), telangiectasia (Grade 1, 29; Grade 2, 5) and pneumonitis (Grade 1, 20; Grade 2, 6; Grade 3, 3). Adverse events of Grade 2 or 3 were found in 27 patients (3.8%); 3 presented with radiation pneumonitis of Grade 3. The percentage of patients with an excellent or good cosmetic outcome was 69.1%. In the first multicenter investigation for Japanese women after breast-conserving therapy, the evaluation of late adverse events and breast cosmetic outcome was similar to several other reports from clinical trials in North America and Europe. (author)

Bird diversity, birdwatching tourism and conservation in Peru: a geographic analysis.

Directory of Open Access Journals (Sweden)

Liisa Puhakka

Full Text Available In the face of the continuing global biodiversity loss, it is important not only to assess the need for conservation, through e.g. gap analyses, but also to seek practical solutions for protecting biodiversity. Environmentally and socially sustainable tourism can be one such solution. We present a method to spatially link data on conservation needs and tourism-based economic opportunities, using bird-related tourism in Peru as an example. Our analysis highlighted areas in Peru where potential for such projects could be particularly high. Several areas within the central and northern Andean regions, as well as within the lowland Amazonian regions of Madre de Dios and Loreto emerge as promising for this type of activity. Mechanisms to implement conservation in these areas include e.g. conservation and ecotourism concessions, private conservation areas, and conservation easements. Some of these mechanisms also offer opportunities for local communities seeking to secure their traditional land ownership and use rights. (Spanish language abstract, Abstract S1.

Bird diversity, birdwatching tourism and conservation in Peru: a geographic analysis.

Science.gov (United States)

Puhakka, Liisa; Salo, Matti; Sääksjärvi, Ilari E

2011-01-01

In the face of the continuing global biodiversity loss, it is important not only to assess the need for conservation, through e.g. gap analyses, but also to seek practical solutions for protecting biodiversity. Environmentally and socially sustainable tourism can be one such solution. We present a method to spatially link data on conservation needs and tourism-based economic opportunities, using bird-related tourism in Peru as an example. Our analysis highlighted areas in Peru where potential for such projects could be particularly high. Several areas within the central and northern Andean regions, as well as within the lowland Amazonian regions of Madre de Dios and Loreto emerge as promising for this type of activity. Mechanisms to implement conservation in these areas include e.g. conservation and ecotourism concessions, private conservation areas, and conservation easements. Some of these mechanisms also offer opportunities for local communities seeking to secure their traditional land ownership and use rights. (Spanish language abstract, Abstract S1).

A common framework for conservation planning: Linking individual and metapopulation models [Chapter 7

Science.gov (United States)

Barry R. Noon; Kevin S. McKelvey

1996-01-01

Many populations exhibit pronounced spatial structure: dispersed areas of high population density embedded in areas of low density, with population centers connected through dispersal. This recognition has led many conservation biologists to embrace the metapopulation concept (Levins 1970) as the appropriate paradigm for reserve design structures (reviewed in Hanski...

Conservation law of plants' energy value dependence of plants ...

African Journals Online (AJOL)

The plants differences in biochemical composition are analyzed, and the conservation law of energy value in plants is obtained. The link between the need for the nutrients and the plants biochemical composition is examined, Liebig's law is specified. Keywords: plant's biochemical composition, biochemistry, energy value in ...

Targeted intraoperative radiotherapy tumour bed boost during breast-conserving surgery after neoadjuvant chemotherapy

Energy Technology Data Exchange (ETDEWEB)

Kolberg, Hans-Christian; Akpolat-Basci, Leyla; Stephanou, Miltiades [Marienhospital Bottrop gGmbH, Department of Gynecology and Obstetrics, Bottrop (Germany); Loevey, Gyoergy [BORAD, Bottrop (Germany); Fasching, Peter A. [University of Erlangen, Erlangen (Germany); Untch, Michael [Helios Klinikum Berlin-Buch, Berlin (Germany); Liedtke, Cornelia [University Hospital Schleswig-Holstein/Campus Luebeck, Luebeck (Germany); Bulsara, Max [University of Notre Dame, Fremantle (Australia); University College, London (United Kingdom); Vaidya, Jayant S. [University College, London (United Kingdom)

2017-01-15

The use of targeted intraoperative radiotherapy (TARGIT-IORT) as a tumour bed boost during breast-conserving surgery (BCS) for breast cancer has been reported since 1998. We present its use in patients undergoing breast conservation following neoadjuvant therapy (NACT). In this retrospective study involving 116 patients after NACT we compared outcomes of 61 patients who received a tumour bed boost with IORT during lumpectomy versus 55 patients treated in the previous 13 months with external (EBRT) boost. All patients received whole breast radiotherapy. Local recurrence-free survival (LRFS), disease-free survival (DFS), distant disease-free survival (DDFS), breast cancer mortality (BCM), non-breast cancer mortality (NBCM) and overall mortality (OS) were compared. Median follow up was 49 months. The differences in LRFS, DFS and BCM were not statistically significant. The 5-year Kaplan-Meier estimate of OS was significantly better by 15% with IORT: IORT 2 events (96.7%, 95%CI 87.5-99.2), EBRT 9 events (81.7%, 95%CI 67.6-90.1), hazard ratio (HR) 0.19 (0.04-0.87), log rank p = 0.016, mainly due to a reduction of 10.1% in NBCM: IORT 100%, EBRT 89.9% (77.3-95.7), HR (not calculable), log rank p = 0.015. The DDFS was as follows: IORT 3 events (95.1%, 85.5-98.4), EBRT 12 events (69.0%, 49.1-82.4), HR 0.23 (0.06-0.80), log rank p = 0.012. IORT during lumpectomy after neoadjuvant chemotherapy as a tumour bed boost appears to give results that are not worse than external beam radiotherapy boost. These data give further support to the inclusion of such patients in the TARGIT-B (boost) randomised trial that is testing whether IORT boost is superior to EBRT boost. (orig.) [German] Die intraoperative Radiotherapie (TARGIT-IORT) als vorgezogener Boost im Rahmen der brusterhaltenden Therapie (BET) ist seit 1998 Gegenstand der wissenschaftlichen Diskussion. Wir praesentieren Daten zum Einsatz der IORT bei der BET nach neoadjuvanter Therapie (NACT). In diese retrospektive Analyse

Conservative Management of an Epicardial Collateral Perforation During Retrograde Chronic Total Occlusion Percutaneous Coronary Intervention.

Science.gov (United States)

Ngo, Christian; Christopoulos, George; Brilakis, Emmanouil S

2016-01-01

Coronary artery perforation is a highly feared complication of chronic total occlusion (CTO) percutaneous coronary intervention (PCI) and can lead to pericardial effusion, tamponade, and, rarely, emergent cardiac surgery. Perforation of epicardial collaterals during retrograde CTO-PCI may be particularly challenging to treat, as embolization from both sides of the perforation may be required to control the bleeding. However, conservative measures can occasionally be effective. We present a case of epicardial collateral vessel perforation that was managed conservatively with anticoagulation reversal.

Mass, matter, materialization, mattergenesis and conservation of charge

International Nuclear Information System (INIS)

Tsan, Ung Chan

2013-01-01

Conservation of mass in classical physics and in chemistry is considered to be equivalent to conservation of matter and is a necessary condition together with other universal conservation laws to account for observed experiments. Indeed matter conservation is associated to conservation of building blocks (molecules, atoms, nucleons, quarks and leptons). Matter is massive but mass and matter are two distinct concepts even if conservation of mass and conservation of matter represent the same reality in classical physics and chemistry. Conservation of mass is a consequence of conservation of atoms. Conservation of mass is valid because in these cases it is a very good approximation, the variation of mass being tiny and undetectable by weighing. However, nuclear physics and particle physics clearly show that conservation of mass is not valid to express conservation of matter. Mass is one form of energy, is a positive quantity and plays a fundamental role in dynamics allowing particles to be accelerated. Origin of mass may be linked to recently discovered Higgs bosons. Matter conservation means conservation of baryonic number A and leptonic number L, A and L being algebraic numbers. Positive A and L are associated to matter particles, negative A and L are associated to antimatter particles. All known interactions do conserve matter thus could not generate, from pure energy, a number of matter particles different from that of number of antimatter particles. But our universe is material and neutral, this double message has to be deciphered simultaneously. Asymmetry of our universe demands an interaction which violates matter conservation but obeys all universal conservation laws, in particular conservation of electric charge Q. Expression of Q shows that conservation of (A–L) and total flavor TF are necessary and sufficient to conserve Q. Conservation of A and L is indeed a trivial case of conservation of (A–L) and is valid for all known interactions of the standard

[Controversies about instrumented surgery and pain relief in degenerative lumbar spine pain. Results of scientific evidence].

Science.gov (United States)

Robaina-Padrón, F J

2007-10-01

Investigation and development of new techniques for intrumented surgery of the spine is not free of conflicts of interest. The influence of financial forces in the development of new technologies an its immediately application to spine surgery, shows the relationship between the published results and the industry support. Even authors who have defend eagerly fusion techniques, it have been demonstrated that them are very much involved in the revision of new articles to be published and in the approval process of new spinal technologies. When we analyze the published results of spine surgery, we must bear in mind what have been call in the "American Stock and Exchange" as "the bubble of spine surgery". The scientific literature doesn't show clear evidence in the cost-benefit studies of most instrumented surgical interventions of the spine compare with the conservative treatments. It has not been yet demonstrated that fusion surgery and disc replacement are better options than the conservative treatment. It's necessary to point out that at present "there are relationships between the industry and back pain, and there is also an industry of the back pain". Nonetheless, the "market of the spine surgery" is growing up because patients are demanding solutions for their back problems. The tide of scientific evidence seams to go against the spinal fusions in the degenerative disc disease, discogenic pain and inespecific back pain. After decades of advances in this field, the results of spinal fusions are mediocre. New epidemiological studies show that "spinal fusion must be accepted as a non proved or experimental method for the treatment of back pain". The surgical literature on spinal fusion published in the last 20 years following the Cochrane's method establish that: 1- this is at least incomplete, not reliable and careless; 2- the instrumentation seems to slightly increase the fusion rate; 3- the instrumentation doesn't improve the clinical results in general, lacking

Limiting the usage of blood products in cardiovascular surgery.

Science.gov (United States)

Horowitz, P E; Lorenzen, C M; Rhydderch, R D

1991-03-01

We studied the effect of the initiation of a five part program of blood component conservation on blood product utilization in patients undergoing major cardiovascular surgery. We encouraged physicians and nurses to adhere to a set of guidelines that would limit the exposure of these patients to complications associated with blood product administration. Through this effort the amounts of packed red cells, fresh frozen plasma, platelets, and cryoprecipitate used were markedly reduced. After the start of the conservation program, overall blood product usage was reduced 29% despite a 46% increase in the surgical caseload, and there was a 53% decrease in the amount of donor exposure (units of individual blood products administered) per patient.

Topological field theory and surgery on three-manifolds

International Nuclear Information System (INIS)

Guadagnini, E.; Panicucci, S.

1992-01-01

The solution of the SU(2) quantum Chern-Simons field theory defined on a closed, connected and orientable three-manifold is presented. The vacuum expectation values of Wilson line operators, associated with framed links in a generic manifold, are computed in terms of the expectation values of the three-sphere. The method consists of using an operator realization of Dehn surgery. The rules, corresponding to the surgery instructions in the three-sphere, are derived and the three-manifold invariant defined by the Chern-Simons theory is constructed. Several examples are considered and explicit results are reported. (orig.)

Efficacy of conservative treatment, without necrosectomy, for infected pancreatic necrosis: a systematic review and meta-analysis.

Science.gov (United States)

Mouli, Venigalla Pratap; Sreenivas, Vishnubhatla; Garg, Pramod Kumar

2013-02-01

Conservative treatment (intensive care, a combination of antimicrobial agents, and nutritional support, with or without drainage of the infected fluid) has recently been shown to be effective for patients with infected pancreatic necrosis (IPN), but the data from individual studies are not robust enough to recommend it as the standard of care. We performed a systematic review and meta-analysis of studies related to primary conservative management for IPN. We performed a literature search of MEDLINE/PubMed from January 1990 to March 2012 for studies of a priori protocols for primary conservative treatment, without necrosectomy, for consecutive patients with IPN. We analyzed data from 8 studies, comprising 324 patients with IPN who received primary conservative management. We then analyzed an additional 4 studies (comprising 157 patients) that reported the efficacy of percutaneous drainage in nonconsecutive patients with IPN. Outcome measures were the success of conservative management strategy, need for necrosectomy, and mortality. There was significant heterogeneity in results among the studies. Based on a random effects model, conservative management was successful for 64% of patients (95% confidence interval [CI], 51%-78%); mortality was 12% (95% CI, 6%-18%), and 26% of patients required necrosectomy or additional surgery for complications (95% CI, 15%-37%). A separate analysis of 4 studies that reported outcomes of nonconsecutive patients with IPN following percutaneous drainage had comparable results; 50% had successful outcomes (95% CI, 43%-58%), mortality was 18% (95% CI, 6%-30%), and 38% of patients required surgery (95% CI, 20%-56%). Conservative management without necrosectomy is a successful approach for 64% of patients with IPN. This approach has low mortality and prevents surgical necrosectomy. Copyright © 2013 AGA Institute. Published by Elsevier Inc. All rights reserved.

A survey of healthcare industry representatives' participation in surgery: some new ethical concerns.

Science.gov (United States)

Bedard, Jeffrey; Moore, Crystal Dea; Shelton, Wayne

2014-01-01

To provide preliminary evidence of the types and amount of involvement by healthcare industry representatives (HCIRs) in surgery, as well as the ethical concerns of those representatives. A link to an anonymous, web-based survey was posted on several medical device boards of the website http://www. cafepharma.com. Additionally, members of two different medical device groups on LinkedIn were asked to participate. Respondents were self-identified HCIRs in the fields of orthopedics, cardiology, endoscopic devices, lasers, general surgery, ophthalmic surgery, oral surgery, anesthesia products, and urologic surgery. A total of 43 HCIRs replied to the survey over a period of one year: 35 men and eight women. Respondents reported attending an average of 184 surgeries in the prior year and had an average of 17 years as an HCIR and six years with their current employer. Of the respondents, 21 percent (nine of 43) had direct physical contact with a surgical team or patient during a surgery, and 88 percent (38 of 43) provided verbal instruction to a surgical team during a surgery. Additionally, 37 percent (16 of 43) had participated in a surgery in which they felt that their involvement was excessive, and 40 percent (17 of 43) had attended a surgery in which they questioned the competence of the surgeon. HCIRs play a significant role in surgery. Involvement that exceeds their defined role, however, can raise serious ethical and legal questions for surgeons and surgical teams. Surgical teams may at times be substituting the knowledge of the HCIR for their own competence with a medical device or instrument. In some cases, contact with the surgical team or patient may violate the guidelines not only of hospitals and medical device companies, but the law as well. Further study is required to determine if the patients involved have any knowledge or understanding of the role that an HCIR played in their surgery. Copyright 2014 The Journal of Clinical Ethics. All rights reserved.

Bird Diversity, Birdwatching Tourism and Conservation in Peru: A Geographic Analysis

OpenAIRE

Puhakka, Liisa; Salo, Matti; S??ksj?rvi, Ilari E.

2011-01-01

In the face of the continuing global biodiversity loss, it is important not only to assess the need for conservation, through e.g. gap analyses, but also to seek practical solutions for protecting biodiversity. Environmentally and socially sustainable tourism can be one such solution. We present a method to spatially link data on conservation needs and tourism-based economic opportunities, using bird-related tourism in Peru as an example. Our analysis highlighted areas in Peru where potential...

Lagrange and Noether analysis of polarization laws of conservation for electromagnetic field

International Nuclear Information System (INIS)

Krivskij, I.Yu.; Simulik, V.M.

1988-01-01

Both well-known Bessel-Hagen conservation laws and conservation laws of polarized character are derived for electromagnetic field in the Lagrange approach to electrodynamics in terms of intensities (without using the A μ potentials as variation variables). The laws mentioned are derived according to Noether theorem because symmetry to which such concervation laws correspond is lost during the transition from intensities to potentials. Based on Noether theorem (and its generalization for Naeik's symmetries) and Lagrange function scalar in relation to complete Poincare group in terms of intensity tensor, a convenient formula for calculating and values conserved for electromagnetic field is derived which sets up a physically adequate symmetry operator -conservation law correlation and thus links the presence of conservation laws of polarized character with symmetry properties of Maxwell equations. Adiabaticity of conservation laws of polarized character under the presence of interaction with currents and charges is indicated

Conservation of living resources in a changing world

Science.gov (United States)

Teer, James G.

1996-11-01

Conservation of living resources is no longer parochial in scope; it is a global challenge. Ecological, social, political, and business interests operate in a network that reaches across seas, continents, and nations. Industries, including the electric utility industry, are diversifying in products and expanding into international markets. They soon discover that, while all nations have common goals for their peoples, conservation and environmental issues in less-developed nations have different dimensions and norms than are encountered in Western, affluent societies. In developing countries, survival is more of an issue than quality of life, and burgeoning human numbers have put tremendous pressures on resources including wildlife and its habitats. Human population, urbanization of society, changes in single-species to ecosystem and landscape levels of management, and protectionists and animal rights philosophies are influences with which conservation of resources and the environment must contend. The human condition and conservation efforts are inextricably linked. Examples to demonstrate this fact are given for Project Tiger in India, the jaguar in Latin America, and the Serengeti ecosystem in Kenya and Tanzania.

Childhood craniopharyngioma: greater hypothalamic involvement before surgery is associated with higher homeostasis model insulin resistance index

Science.gov (United States)

Trivin, Christine; Busiah, Kanetee; Mahlaoui, Nizar; Recasens, Christophe; Souberbielle, Jean-Claude; Zerah, Michel; Sainte-Rose, Christian; Brauner, Raja

2009-01-01

Background Obesity seems to be linked to the hypothalamic involvement in craniopharyngioma. We evaluated the pre-surgery relationship between the degree of this involvement on magnetic resonance imaging and insulin resistance, as evaluated by the homeostasis model insulin resistance index (HOMA). As insulin-like growth factor 1, leptin, soluble leptin receptor (sOB-R) and ghrelin may also be involved, we compared their plasma concentrations and their link to weight change. Methods 27 children with craniopharyngioma were classified as either grade 0 (n = 7, no hypothalamic involvement), grade 1 (n = 8, compression without involvement), or grade 2 (n = 12, severe involvement). Results Despite having similar body mass indexes (BMI), the grade 2 patients had higher glucose, insulin and HOMA before surgery than the grade 0 (P = 0.02, craniopharyngioma before surgery seems to determine the degree of insulin resistance, regardless of the BMI. The pre-surgery HOMA values were correlated with the post-surgery weight gain. This suggests that obesity should be prevented by reducing inn secretion in those cases with hypothalamic involvement. PMID:19341477

Breast-Conservative Surgery With Close or Positive Margins: Can the Breast Be Preserved With High-Dose-Rate Brachytherapy Boost?

International Nuclear Information System (INIS)

Guinot, Jose Luis; Roldan, Susana; Maronas, Maria; Tortajada, Isabel; Carrascosa, Maria; Chust, Maria Luisa; Estornell, Marian; Mengual, Jose Luis; Arribas, Leoncio

2007-01-01

Purpose: To evaluate the likelihood of preserving the breast in women who show close or positive margins after conservative surgery for early breast carcinoma. Methods and Materials: Since 1996, 125 women with less than 5 mm or positive margins and positive separate cavity margin sampling were entered in a prospective trial with high-dose radiotherapy. A standard dose of 50 Gy to the whole breast was followed by a high-dose-rate brachytherapy application delivering 3 fractions of 4.4 Gy in 24 hours. The median follow-up was 84 months. Results: There were only seven local recurrences, with an actuarial local control rate of 95.8% at 5 years and 91.1% at 9 years. Actuarial overall and cause-specific survival rates were 92.6% and 95% at 5 years and 86.7% and 90.4% at 9 years, respectively. Late fibrosis was the most common complication, in 30% of patients, with good or excellent cosmetic results in 77%. The final result was that 95.2% of breasts were preserved. Conclusions: Close or positive-margin breast cancer can be well managed with a high-dose boost in a wide tumor bed by means of high-dose-rate brachytherapy. This technique can avoid mastectomy or poor cosmetic resection, with minimal risk of local or general failure

Rare Complications of Cervical Spine Surgery: Pseudomeningocoele.

Science.gov (United States)

Ailon, Tamir; Smith, Justin S; Nassr, Ahmad; Smith, Zachary A; Hsu, Wellington K; Fehlings, Michael G; Fish, David E; Wang, Jeffrey C; Hilibrand, Alan S; Mummaneni, Praveen V; Chou, Dean; Sasso, Rick C; Traynelis, Vincent C; Arnold, Paul M; Mroz, Thomas E; Buser, Zorica; Lord, Elizabeth L; Massicotte, Eric M; Sebastian, Arjun S; Than, Khoi D; Steinmetz, Michael P; Smith, Gabriel A; Pace, Jonathan; Corriveau, Mark; Lee, Sungho; Riew, K Daniel; Shaffrey, Christopher

2017-04-01

This study was a retrospective, multicenter cohort study. Rare complications of cervical spine surgery are inherently difficult to investigate. Pseudomeningocoele (PMC), an abnormal collection of cerebrospinal fluid that communicates with the subarachnoid space, is one such complication. In order to evaluate and better understand the incidence, presentation, treatment, and outcome of PMC following cervical spine surgery, we conducted a multicenter study to pool our collective experience. This study was a retrospective, multicenter cohort study of patients who underwent cervical spine surgery at any level(s) from C2 to C7, inclusive; were over 18 years of age; and experienced a postoperative PMC. Thirteen patients (0.08%) developed a postoperative PMC, 6 (46.2%) of whom were female. They had an average age of 48.2 years and stayed in hospital a mean of 11.2 days. Three patients were current smokers, 3 previous smokers, 5 had never smoked, and 2 had unknown smoking status. The majority, 10 (76.9%), were associated with posterior surgery, whereas 3 (23.1%) occurred after an anterior procedure. Myelopathy was the most common indication for operations that were complicated by PMC (46%). Seven patients (53%) required a surgical procedure to address the PMC, whereas the remaining 6 were treated conservatively. All PMCs ultimately resolved or were successfully treated with no residual effects. PMC is a rare complication of cervical surgery with an incidence of less than 0.1%. They prolong hospital stay. PMCs occurred more frequently in association with posterior approaches. Approximately half of PMCs required surgery and all ultimately resolved without residual neurologic or other long-term effects.

Laparoscopic Surgery for the Treatment of Ectopic Pregnancy

Directory of Open Access Journals (Sweden)

Hulusi B ZEYNELOGLU

2005-09-01

Full Text Available OBJECTIVE: To evaluate the outcomes of laparoscopic surgery for the treatment of ectopic pregnancy Design: 43 women with ectopic pregnancy who underwent laparoscopic surgery in our department between 1996 and 2005 were included in this study.\tSetting: Department of Obstetrics and Gynecology, School of Medicine, Baskent University, Ankara Patients: 43 women with ectopic pregnancy who underwent laparoscopic surgery Interventions: Laparoscopic surgery was performed the treatment of ectopic pregnancy Main Outcome Measures: Patients characteristics such as age, parity, gestational age at the time of diagnosis, symptoms, preoperative and postoperative serum _-hCG and hemoglobin levels, sonographic findings, type of laparoscopic surgery, blood transfusion, additional treatments, endometrial sampling and postoperative fertility status were recorded. The size and the location of myomas were obtained from the surgeon’s findings in the operative note. Preoperative and postoperative hemoglobin values, change in hemoglobin values, hemorrhage, blood transfusion, postoperative fewer, duration of operation and length of postoperative hospital stay were the main outcomes. RESULTS: Forty-three women with ectopic pregnancy who underwent laparoscopic surgery were included in this study. Patients were submitted usually with pelvic pain and abnormal vaginal bleeding. Adnexal mass and hemoperitoneum were seen by sonographic evaluation. Ampuller pregnancy was the most common. Most of patients had conservative surgery and 38% of patients underwent salpingectomy. 12 patient had blood transfusion and two ones underwent re-laparoscopy. After treatment 5 intrauterine pregnancies were occurred. Endometrial samplings usually defined as decidual en Aria stella reactions. Serum _-hCG levels were in normal range at the end of the month after the laparoscopy. CONCLUSION: In conclusion according to these findings, laparoscopic surgery remains the definitive and universal

Acute Intestinal Obstruction Complicating Abdominal Pregnancy: Conservative Management and Successful Outcome.

Science.gov (United States)

Udigwe, Gerald Okanandu; Eleje, George Uchenna; Ihekwoaba, Eric Chukwudi; Udegbunam, Onyebuchi Izuchukwu; Egeonu, Richard Obinwanne; Okwuosa, Ayodele Obianuju

2016-01-01

Background. Acute intestinal obstruction during pregnancy is a very challenging and unusual nonobstetric surgical entity often linked with considerable fetomaternal morbidity and mortality. When it is synchronous with abdominal pregnancy, it is even rarer. Case Presentation. A 28-year-old lady in her second pregnancy was referred to Nnamdi Azikiwe University Teaching Hospital, Nnewi, Nigeria, at 27 weeks of gestation due to vomiting, constipation, and abdominal pain. Examination and ultrasound scan revealed a single live intra-abdominal extrauterine fetus. Plain abdominal X-ray was diagnostic of intestinal obstruction. Conservative treatment was successful till the 34-week gestational age when she had exploratory laparotomy. At surgery, the amniotic sac was intact and the placenta was found to be adherent to the gut. There was also a live female baby with birth weight of 2.3 kg and Apgar scores of 9 and 10 in the 1st and 5th minutes, respectively, with the baby having right clubbed foot. Adhesiolysis and right adnexectomy were done. The mother and her baby were well and were discharged home nine days postoperatively. Conclusion. To the best of our knowledge, this is the first report of abdominal pregnancy as the cause of acute intestinal obstruction in the published literature. Management approach is multidisciplinary.

Autonomic nerve-sparing surgery with preoperative or intraoperative radiotherapy for advanced lower rectal cancer

International Nuclear Information System (INIS)

Saito, Norio; Ono, Masato; Sugifuji, Masanori; Kawashima, Kiyotaka; Arai, Tatsuo; Koda, Keishi; Takiguchi, Nobuhiro; Oda, Kenji; Nakajima, Nobuyuki

2000-01-01

Autonomic-nerve-sparing surgery was performed for advanced lower rectal cancer, and the results in patients who had undergone preoperative irradiation plus chemotherapy (RCT group) and intraoperative irradiation (IORT group) were compared. The autonomic nerves of 76 of the 84 patients in the RCT group were conserved. The radiation dose was 42.6 Gy, and surgery was performed 2 weeks after the irradiation. Their curability was A. Urinary function was maintained. The results for sexual function were better in the cases in which the autonomic nerves were completely conserved. The 5-year cumulative survival rate was 84.1%. The local recurrence rate was 7.9% and was no higher after treatment by the conventional method. The autonomic nerves of all 61 patients in the IORT group, were conserved. Patients were irradiated with 15 Gy (5 MeV) to the pelvic nerve plexuses and peripheral region with a cone 4 cm in diameter. Irradiation depth was estimated to be approximately 15 mm. The results for urinary function and sexual function were equivalent to those in the RCT group. The 5-year cumulative survival rate was 79%. The local recurrence rate was 9.8%. The autonomic nerve conservation rate was increased in both groups but the results in terms of QOL, such as sexual function, were inadequate. Further development and improvement of treatment methods for advanced lower rectal cancer are needed. (K.H.)

Diode Laser in Minor Oral Surgery: A Case Series of Laser Removal of Different Benign Exophytic Lesions

OpenAIRE

Sotoode, Somaye Mazarei; Azimi, Somayyeh; Taheri, Sayed Alinaghi; Asnaashari, Mohammad; Khalighi, Hamidreza; Rahmani, Somayeh; Jafari, Soudeh; Elmi Rankohi, Zahra

2015-01-01

Introduction: The role of laser in conservative management of oral disease is well established. Laser procedures are common in the fields of oral surgery, implant dentistry, endodontic, and periodontic therapy.

Influence of previous breast surgery in sentinel lymph node biopsy in patients with breast cancer.

Science.gov (United States)

López-Prior, V; Díaz-Expósito, R; Casáns Tormo, I

The aim of this study was to review the feasibility of selective sentinel lymph node biopsy in patients with previous surgery for breast cancer, as well as to examine the factors that may interfere with sentinel node detection. A retrospective review was performed on 91 patients with breast cancer and previous breast surgery, and who underwent sentinel lymph node biopsy. Patients were divided into two groups according to their previous treatment: aesthetic breast surgery in 30 patients (group I) and breast-conserving surgery in 61 (group II). Lymphoscintigraphy was performed after an intra-tumour injection in 21 cases and a peri-areolar injection in 70 cases. An analysis was made of lymphatic drainage patterns and overall sentinel node detection according to clinical, pathological and surgical variables. The overall detection of the sentinel lymph node in the lymphoscintigraphy was 92.3%, with 7.7% of extra-axillary drainages. The identification rate was similar after aesthetic breast surgery (93.3%) and breast-conserving surgery (91.8%). Sentinel lymph nodes were found in the contralateral axilla in two patients (2.2%), and they were included in the histopathology study. The non-identification rate in the lymphoscintigraphy was 7.7%. There was a significantly higher non-detection rate in the highest histological grade tumours (28.6% grade III, 4.5% grade I and 3.6% grade II). Sentinel lymph node biopsy in patients with previous breast surgery is feasible and deserves further studies to assess the influence of different aspects in sentinel node detection in this clinical scenario. A high histological grade was significantly associated with a lower detection. Copyright © 2017 Elsevier España, S.L.U. y SEMNIM. All rights reserved.

A correlation study on the displacement of the whole breast target after breast-conserving surgery based on four-dimensional computed tomography

International Nuclear Information System (INIS)

Wang Wei; Li Jianbin; Wang Suzhen; Zhang Yingjie; Li Fengxiang; Xu Min; Shang Dongping

2011-01-01

Objective: To investigate the correlations of the whole breast displacement in different respiratory cycle during free breathing (FB) following breast-conserving surgery to the displacement of selected skin marker, nipple, and selected surgical clip based on four-dimensional computed tomography (4D-CT). Methods: Thirteen breast cancer patients who had undergone breast-conserving surgery received whole breast intensity-modulated radiotherapy (IMRT). Respiration-synchronized 4D-CT image data were gathered during FB and were exported to the Varian Eclipse treatment planning system, and the whole breast target, nipple, superior clip,and metal marker on the skin at the anterior body midline were delineated on the CT images of ten phases of the respiratory cycle by the same radiotherapist based on the same delineating criteria. The displacement distances of the delineated target in the mediolateral (x), anteroposterior (y), and superoinferior (z) axles were achieved,and the correlations of the whole breast target displacement to the displacement of the clip, nipple, and skin marker were analyzed. The ipsilateral lung was delineated on the CT images of every phase of the respiratory cycle, and the changes in ipsilateral lung volume were analyzed during the respiratory cycle relative to the displacement of the breast. Results: The maximal displacement distances of the whole breast target in the x, y, and z axles during FB were 0.71, 0.76 and 1.29 mm, respectively (F=5.755, P<0.05). There was no relationship between the three-dimensional (3D) displacement of the whole breast and the volume of the whole breast (r=-0.264, P<0.05), and there was no relationship between the displacement of the whole breast and the volume change of the ipsilateral lung (r=0.346, P<0.05). There was no significant difference among the mean target displacement distances in 3 axles,and among 2 selected successive end-inspiration (EI) phases and 3 selected successive end-expiration (EE) phases. There

A novel diagnostic parameter, foraminal stenotic ratio using three-dimensional magnetic resonance imaging, as a discriminator for surgery in symptomatic lumbar foraminal stenosis.

Science.gov (United States)

Yamada, Kentaro; Abe, Yuichiro; Satoh, Shigenobu; Yanagibashi, Yasushi; Hyakumachi, Takahiko; Masuda, Takeshi

2017-08-01

No previous studies have reported the radiological features of patients requiring surgery in symptomatic lumbar foraminal stenosis (LFS). This study aims to investigate the diagnostic accuracy of a novel technique, foraminal stenotic ratio (FSR), using three-dimensional magnetic resonance imaging for LFS at L5-S by comparing patients requiring surgery, patients with successful conservative treatment, and asymptomatic patients. This is a retrospective radiological comparative study. We assessed the magnetic resonance imaging (MRI) results of 84 patients (168 L5-S foramina) aged ≥40 years without L4-L5 lumbar spinal stenosis. The foramina were divided into three groups following standardized treatment: stenosis requiring surgery (20 foramina), stenosis with successful conservative treatment (26 foramina), and asymptomatic stenotic foramen (122 foramina). Foraminal stenotic ratio was defined as the ratio of the length of the stenosis to the length of the foramen on the reconstructed oblique coronal image, referring to perineural fat obliterations in whole oblique sagittal images. We also evaluated the foraminal nerve angle and the minimum nerve diameter on reconstructed images, and the Lee classification on conventional T1 images. The differences in each MRI parameter between the groups were investigated. To predict which patients require surgery, receiver operating characteristic (ROC) curves were plotted after calculating the area under the ROC curve. The FSR showed a stepwise increase when comparing asymptomatic, conservative, and surgical groups (mean, 8.6%, 38.5%, 54.9%, respectively). Only FSR was significantly different between the surgical and conservative groups (p=.002), whereas all parameters were significantly different comparing the symptomatic and asymptomatic groups. The ROC curve showed that the area under the curve for FSR was 0.742, and the optimal cutoff value for FSR for predicting a surgical requirement in symptomatic patients was 50

Quality of governance and effectiveness of protected areas: crucial concepts for conservation planning.

Science.gov (United States)

Eklund, Johanna; Cabeza, Mar

2017-07-01

Protected areas (PAs) are a key tool for biodiversity conservation and play a central role in the Convention on Biological Diversity. Recently, the effectiveness of PAs has been questioned, and assessing how effective they are in enabling the future persistence of biodiversity is not trivial. Here, we focus on terrestrial PAs and clarify the terminology related to PA effectiveness, distinguishing between management and ecological aspects. We suggest that the quality of governance affects both aspects of effectiveness but recognize a lack of synthetic understanding of the topic. We present a conceptual framework linking the underlying mechanisms by which the quality of governance affects conservation outcomes in PAs and how this relates to conservation planning. We show that it is crucial to separate pressure and response and how these together will lead to the observed conservation outcomes. We urge for more focused attention on governance factors and in particular more empirical research on how to address causality and how to account for the quality of governance when prioritizing actions. Our framework is linked to the classic concepts of systematic conservation planning and clarifies the strategies available to achieve a comprehensive and effective network of PAs. © 2016 The Authors. Annals of the New York Academy of Sciences published by Wiley Periodicals, Inc. on behalf of New York Academy of Sciences.

Conservation of Charge and Conservation of Current

OpenAIRE

Eisenberg, Bob

2016-01-01

Conservation of current and conservation of charge are nearly the same thing: when enough is known about charge movement, conservation of current can be derived from conservation of charge, in ideal dielectrics, for example. Conservation of current is enforced implicitly in ideal dielectrics by theories that conserve charge. But charge movement in real materials like semiconductors or ionic solutions is never ideal. We present an apparently universal derivation of conservation of current and ...

Drug, devices, technologies, and techniques for blood management in minimally invasive and conventional cardiothoracic surgery: a consensus statement from the International Society for Minimally Invasive Cardiothoracic Surgery (ISMICS) 2011.

Science.gov (United States)

Menkis, Alan H; Martin, Janet; Cheng, Davy C H; Fitzgerald, David C; Freedman, John J; Gao, Changqing; Koster, Andreas; Mackenzie, G Scott; Murphy, Gavin J; Spiess, Bruce; Ad, Niv

2012-01-01

-text randomized controlled trials assessed for eligibility, and the final 125 systematic reviews and meta-analyses were used in the consensus conference. The results of the consensus conference, including the evidence-based statements and the recommendations, are outlined in the text, with references given for the relevant evidence that formed the basis for the statements and recommendations. RECOMMENDATIONS FOR ANTIFIBRINOLYTICS: The lysine analogs ?-aminocaproic acid (Amicar) and tranexamic acid (TA) reduce exposure to allogeneic blood inpatients undergoing on-pump cardiac surgery. These agents are recommended to be used routinely as part of a blood conservation strategy especially in patients at risk of undergoing onpump cardiac surgery (Class I, Level A). It is important not to exceed maximum TA total dosages (50Y100mg/kg) because of potential neurotoxicity in the elderly and open-heart procedures (Class IIb, Level C). Aprotinin is not recommended in adult cardiac surgery until further studies on its safety profile have been performed (Class III, Level A). RECOMMENDATIONS FOR TA IN OFF-PUMP CORONARY ARTERY BYPASS: Tranexamic acid may be recommended as part of a blood conservation strategy in high risk patients undergoing off-pump coronary artery bypass (OPCAB) surgery (Class I, Level A).Tranexamic acid dosing in OPCAB surgery needs further study particularly with regard to possible neurotoxicity such as seizures.In addition, the benefit-risk ratio in OPCAB needs further eludication because of the lower inherent risk for bleeding in this group (Class IIb, Level C). RECOMMENDATIONS FOR DDAVP: DDAVP can be considered for prophylaxis in coronary artery bypass grafting (CABG) surgery, in particular, for patients onASA within 7 days or prolonged CPB more than 140 minutes (Class IIa, Level A). Caution should be used with the DDAVP infusion rate to avoid significant systemic hypotension (Class I, Level A). RECOMMENDATIONS FOR TOPICAL HEMOSTATICS: The routine use of topical

Sex reassignment surgery in Thailand.

Science.gov (United States)

Chokrungvaranont, Prayuth; Tiewtranon, Preecha

2004-11-01

Many years ago Thai society considered transsexualism (Gender identity disorder or Gender dysphoria) which is commonly known as Kathoey (a word originally used to denote hermaphrodites), Sao Prapet Song or Tut (as in 'Tootsie') were low class citizens, dirty dressing and had to hide in a dark corner selling their services as prostitutes. This made us unwilling to do sex reassignment surgery for this group of people because the idea of eradicating normal sexual organs for the purpose that was not accepted by the society. Consequently the authors have experience in cases where these people wandered seeking doctors who had no competency nor enough experience to do the surgery. The authors could not inhibit the desire of these people who usually suffer from gender identity disorder from strongly wishing to change their genital sex to the sex they want. The outcome of the surgery was not satisfactory for the patients. There were complications and sequelae which caused the authors to correct them later which might be more difficult than doing the original surgery. In addition there were more studies about the etiology and affect of the disorder on these people that changed the social point of view. The women who wanted to be a him and men who would like to be a her should be considered as patients who need to be cured to set the harmony about their genetic sex and the desire to be the opposite sex and also to be regarded by others as a member of that other sex. The treatments of transsexualism usually begin with conventional psychiatric and endocrinological treatment to adjust the mind to the body. For those who failed conservative treatment in adjusting the mind to the body then sex reassignment surgery will be the only way to transform their body to their mind and give the best result in properly selected patients. Preecha Tiewtranon, the pioneer in sex reassignment surgery in Thailand, did his transsexualism case in 1975 together with Dr. Prakob Thongpeaw. Sex

Assessing quality in cardiac surgery

Directory of Open Access Journals (Sweden)

Samer A.M. Nashef

2005-07-01

Full Text Available There is a the strong temporal, if not causal, link between the intervention and the outcome in cardiac surgery and therefore a link becomes established between operative mortality and the measurement of surgical performance. In Britain the law stipulates that data collected by any public body or using public funds must be made freely available. Tools and mechanisms we devise and develop are likely to form the models on which the quality of care is assessed in other surgical and perhaps medical specialties. Measuring professional performance should be done by the profession. To measure risk there are a number of scores as crude mortality is not enough. A very important benefit of assessing the risk of death is to use this knowledge in the determination of the indication to operate. The second benefit is in the assessment of the quality of care as risk prediction gives a standard against performance of hospitals and surgeons. Peer review and “naming and shaming” are two mechanisms to monitor quality. There are two potentially damaging outcomes from the publication of results in a league-table form: the first is the damage to the hospital; the second is to refuse to operate on high-risk patients. There is a real need for quality monitoring in medicine in general and in cardiac surgery in particular. Good quality surgical work requires robust knowledge of three crucial variables: activity, risk prediction and performance. In Europe, the three major specialist societies have agreed to establish the European Cardiovascular and Thoracic Surgery Institute of Accreditation (ECTSIA. Performance monitoring is soon to become imperative. If we surgeons are not on board, we shall have no control on its final destination, and the consequences may be equally damaging to us and to our patients.

Recurrent Laryngeal Edema Imitating Angioedema Caused by Dislocated Screw after Anterior Spine Surgery

Directory of Open Access Journals (Sweden)

Piotr Wójtowicz

2015-01-01

Full Text Available The anterior cervical spine surgery is a common procedure to stabilize vertebrae damaged by various diseases. The plates and screws are usually used in the spine fixation. This kind of instrumentation may detach from the bones which is a rare but well-known complication. A 77-year-old male presented to the otorhinolaryngology department with throat pain, choking, and dysphagia. At first the angioedema was diagnosed and he was treated conservatively. The endoscopy revealed laryngeal edema, being more defined on the right side with right vocal fold paresis. CT scans showed the stabilizing plate with two screws attached tightly and the back-out of the third screw toward soft tissue of the neck. In the meantime, his condition deteriorated and he needed tracheotomy. In few days the surgical removal of the dislocated screw was performed successfully. Although two-month follow-up reported no obstruction of the larynx, the vocal folds paresis with gradual functional improvement was observed. Long-term complication of anterior spine surgery sometimes may suggest laryngeal angioedema at first. If the conservative treatment is ineffective and there is a history of anterior spine surgery, the clinicians should consider the displacement of the plate or screws in differential diagnosis.

Surgery for portal hypertension in children: A 12-year review.

Science.gov (United States)

Patel, N; Grieve, A; Hiddema, J; Botha, J; Loveland, J

2017-11-06

Portal hypertension is a common and potentially devastating condition in children. Notwithstanding advances in the nonsurgical management of portal hypertension, surgery remains an important treatment modality in select patients. We report here on our experience in the past 12 years. To describe the profile of, indication for, and complications of shunt surgery in children with portal hypertension. Twelve children underwent shunt surgery between 2005 and 2017. Patient records were reviewed. Fourteen procedures were performed on 12 patients during the study period. The median age at surgery was 6.5 (range 1 - 18) years. Six patients were male. Gastrointestinal bleeding that was not amenable to endoscopic control was the most common indication for surgery. Portal vein thrombosis was the most common cause of portal hypertension in our series (n=11). Two-thirds (8/12) of all patients had an identifiable underlying risk factor for portal vein thrombosis. One-third of all patients (4/12) underwent a meso-portal bypass procedure (Rex shunt), while 58% (7/12) were managed with a distal splenorenal shunt. All patients received postoperative thromboprophylaxis. We experienced a single mortality, 1 patient experienced shunt thrombosis that required revision shunt surgery, and 2 patients experienced anastomotic strictures, with one being managed with revision surgery and the other currently awaiting radiological venoplasty. Surgery is a safe and important tool in the management of children with non-cirrhotic portal hypertension and those with sufficient hepatic reserve who fail to respond to more conservative methods for the treatment of side effects of portal hypertension.

Integrating technologies for scalable ecology and conservation

OpenAIRE

David C. Marvin; Lian Pin Koh; Antony J. Lynam; Serge Wich; Andrew B. Davies; Ramesh Krishnamurthy; Emma Stokes; Ruth Starkey; Gregory P. Asner

2016-01-01

Integration of multiple technologies greatly increases the spatial and temporal scales over which ecological patterns and processes can be studied, and threats to protected ecosystems can be identified and mitigated. A range of technology options relevant to ecologists and conservation practitioners are described, including ways they can be linked to increase the dimensionality of data collection efforts. Remote sensing, ground-based, and data fusion technologies are broadly discussed in the ...

High-frequency ultrasound for intraoperative margin assessments in breast conservation surgery: a feasibility study

International Nuclear Information System (INIS)

Doyle, Timothy E; Neumayer, Leigh A; Factor, Rachel E; Ellefson, Christina L; Sorensen, Kristina M; Ambrose, Brady J; Goodrich, Jeffrey B; Hart, Vern P; Jensen, Scott C; Patel, Hemang

2011-01-01

In addition to breast imaging, ultrasound offers the potential for characterizing and distinguishing between benign and malignant breast tissues due to their different microstructures and material properties. The aim of this study was to determine if high-frequency ultrasound (20-80 MHz) can provide pathology sensitive measurements for the ex vivo detection of cancer in margins during breast conservation surgery. Ultrasonic tests were performed on resected margins and other tissues obtained from 17 patients, resulting in 34 specimens that were classified into 15 pathology categories. Pulse-echo and through-transmission measurements were acquired from a total of 57 sites on the specimens using two single-element 50-MHz transducers. Ultrasonic attenuation and sound speed were obtained from time-domain waveforms. The waveforms were further processed with fast Fourier transforms to provide ultrasonic spectra and cepstra. The ultrasonic measurements and pathology types were analyzed for correlations. The specimens were additionally re-classified into five pathology types to determine specificity and sensitivity values. The density of peaks in the ultrasonic spectra, a measure of spectral structure, showed significantly higher values for carcinomas and precancerous pathologies such as atypical ductal hyperplasia than for normal tissue. The slopes of the cepstra for non-malignant pathologies displayed significantly greater values that differentiated them from the normal and malignant tissues. The attenuation coefficients were sensitive to fat necrosis, fibroadenoma, and invasive lobular carcinoma. Specificities and sensitivities for differentiating pathologies from normal tissue were 100% and 86% for lobular carcinomas, 100% and 74% for ductal carcinomas, 80% and 82% for benign pathologies, and 80% and 100% for fat necrosis and adenomas. Specificities and sensitivities were also determined for differentiating each pathology type from the other four using a multivariate

High-frequency ultrasound for intraoperative margin assessments in breast conservation surgery: a feasibility study

Directory of Open Access Journals (Sweden)

Hart Vern P

2011-10-01

Full Text Available Abstract Background In addition to breast imaging, ultrasound offers the potential for characterizing and distinguishing between benign and malignant breast tissues due to their different microstructures and material properties. The aim of this study was to determine if high-frequency ultrasound (20-80 MHz can provide pathology sensitive measurements for the ex vivo detection of cancer in margins during breast conservation surgery. Methods Ultrasonic tests were performed on resected margins and other tissues obtained from 17 patients, resulting in 34 specimens that were classified into 15 pathology categories. Pulse-echo and through-transmission measurements were acquired from a total of 57 sites on the specimens using two single-element 50-MHz transducers. Ultrasonic attenuation and sound speed were obtained from time-domain waveforms. The waveforms were further processed with fast Fourier transforms to provide ultrasonic spectra and cepstra. The ultrasonic measurements and pathology types were analyzed for correlations. The specimens were additionally re-classified into five pathology types to determine specificity and sensitivity values. Results The density of peaks in the ultrasonic spectra, a measure of spectral structure, showed significantly higher values for carcinomas and precancerous pathologies such as atypical ductal hyperplasia than for normal tissue. The slopes of the cepstra for non-malignant pathologies displayed significantly greater values that differentiated them from the normal and malignant tissues. The attenuation coefficients were sensitive to fat necrosis, fibroadenoma, and invasive lobular carcinoma. Specificities and sensitivities for differentiating pathologies from normal tissue were 100% and 86% for lobular carcinomas, 100% and 74% for ductal carcinomas, 80% and 82% for benign pathologies, and 80% and 100% for fat necrosis and adenomas. Specificities and sensitivities were also determined for differentiating each

The Burden of the Fellowship Interview Process on General Surgery Residents and Programs.

Science.gov (United States)

Watson, Shawna L; Hollis, Robert H; Oladeji, Lasun; Xu, Shin; Porterfield, John R; Ponce, Brent A

This study evaluated the effect of the fellowship interview process in a cohort of general surgery residents. We hypothesized that the interview process would be associated with significant clinical time lost, monetary expenses, and increased need for shift coverage. An online anonymous survey link was sent via e-mail to general surgery program directors in June 2014. Program directors distributed an additional survey link to current residents in their program who had completed the fellowship interview process. United States allopathic general surgery programs. Overall, 50 general surgery program directors; 72 general surgery residents. Program directors reported a fellowship application rate of 74.4%. Residents most frequently attended 8 to 12 interviews (35.2%). Most (57.7%) of residents reported missing 7 or more days of clinical training to attend interviews; these shifts were largely covered by other residents. Most residents (62.3%) spent over $4000 on the interview process. Program directors rated fellowship burden as an average of 6.7 on a 1 to 10 scale of disruption, with 10 being a significant disruption. Most of the residents (57.3%) were in favor of change in the interview process. We identified potential areas for improvement including options for coordinated interviews and improved content on program websites. The surgical fellowship match is relatively burdensome to residents and programs alike, and merits critical assessment for potential improvement. Published by Elsevier Inc.

Childhood craniopharyngioma: greater hypothalamic involvement before surgery is associated with higher homeostasis model insulin resistance index

Directory of Open Access Journals (Sweden)

Sainte-Rose Christian

2009-04-01

Full Text Available Abstract Background Obesity seems to be linked to the hypothalamic involvement in craniopharyngioma. We evaluated the pre-surgery relationship between the degree of this involvement on magnetic resonance imaging and insulin resistance, as evaluated by the homeostasis model insulin resistance index (HOMA. As insulin-like growth factor 1, leptin, soluble leptin receptor (sOB-R and ghrelin may also be involved, we compared their plasma concentrations and their link to weight change. Methods 27 children with craniopharyngioma were classified as either grade 0 (n = 7, no hypothalamic involvement, grade 1 (n = 8, compression without involvement, or grade 2 (n = 12, severe involvement. Results Despite having similar body mass indexes (BMI, the grade 2 patients had higher glucose, insulin and HOMA before surgery than the grade 0 (P = 0.02, The data for the whole population before and 6–18 months after surgery showed increases in BMI (P Conclusion The hypothalamic involvement by the craniopharyngioma before surgery seems to determine the degree of insulin resistance, regardless of the BMI. The pre-surgery HOMA values were correlated with the post-surgery weight gain. This suggests that obesity should be prevented by reducing inn secretion in those cases with hypothalamic involvement.

Internet-Based Approaches to Building Stakeholder Networks for Conservation and Natural Resource Management

Science.gov (United States)

Kreakie, B. J.; Hychka, K. C.; Belaire, J. A.; Minor, E.; Walker, H. A.

2016-02-01

Social network analysis (SNA) is based on a conceptual network representation of social interactions and is an invaluable tool for conservation professionals to increase collaboration, improve information flow, and increase efficiency. We present two approaches to constructing internet-based social networks, and use an existing traditional (survey-based) case study to illustrate in a familiar context the deviations in methods and results. Internet-based approaches to SNA offer a means to overcome institutional hurdles to conducting survey-based SNA, provide unique insight into an institution's web presences, allow for easy snowballing (iterative process that incorporates new nodes in the network), and afford monitoring of social networks through time. The internet-based approaches differ in link definition: hyperlink is based on links on a website that redirect to a different website and relatedness links are based on a Google's "relatedness" operator that identifies pages "similar" to a URL. All networks were initiated with the same start nodes [members of a conservation alliance for the Calumet region around Chicago ( n = 130)], but the resulting networks vary drastically from one another. Interpretation of the resulting networks is highly contingent upon how the links were defined.

Conservative surgical management of subungual (matrix derived) melanoma: report of seven cases and literature review.

Science.gov (United States)

Sureda, N; Phan, A; Poulalhon, N; Balme, B; Dalle, S; Thomas, L

2011-10-01

Subungual melanoma (SUM) is a rare entity, comprising approximately 0·7-3·5% of all melanoma subtypes. SUM histopathologically belongs to the acral lentiginous pathological subtype of malignant melanoma. Its diagnosis is helped by dermoscopy but pathological examination of doubtful cases is required. Classical management of SUM is based on radical surgery, namely distal phalanx amputation. Conservative treatment with nonamputative wide excision of the nail unit followed by a skin graft has been insufficiently reported in the medical literature even though it is performed in many centres. To report a series of patients with in situ or minimally invasive SUM treated by conservative surgery, to investigate the postoperative evolution and to evaluate the outcome with a review of the literature. We performed a retrospective extraction study from our melanoma register of all patients with in situ and minimally invasive SUM treated with conservative surgery in the University Hospital Department of Dermatology, Lyon, France from 2004 to 2009. The patient demographics, disease presentation, delay to diagnosis, histopathology and postoperative evolution were reviewed. Seven cases of SUM treated as such were identified in our melanoma database. All cases had a clinical presentation of melanonychia striata. The mean delay to diagnosis was 2years. Surgical excision of the entire nail unit with a 5-10mm safety margin without bone resection followed by full-thickness skin graft taken from the arm was performed in all cases. No recurrence was observed with a mean follow-up of 45months. Functional results were found satisfactory by all patients and their referring physicians. Sixty-two other cases have been found in the literature and are also discussed. Conservative surgical management in patients with in situ or minimally invasive SUM is a procedure with good cosmetic and functional outcome and, in our cases as well as in the literature, the prognosis is not changed. © 2011

The effect of platelet-rich plasma injection on lateral epicondylitis following failed conservative management.

Science.gov (United States)

Brkljac, Milos; Kumar, Shyam; Kalloo, Dale; Hirehal, Kiran

2015-12-01

We assessed the effect PRP injection on pain and function in patients with lateral epicondylitis where conservative management had failed. We prospectively reviewed 34 patients. The mean follow-up was 26 weeks (range 6-114 weeks). We used the Oxford Elbow Score (OES) and progression to surgery to assess outcomes. 88.2% improved their OES. 8.8% reported symptom progression. One patient had no change. No patients suffered adverse reactions. Two patients underwent an open release procedure. One had the injection repeated. An injection of PRP improves pain and function in patients suffering from LE where conservative management has failed.

Collapse of a pollination web in small conservation areas.

Science.gov (United States)

Pauw, Anton

2007-07-01

A suspected global decline in pollinators has heightened interest in their ecological significance. In a worst-case scenario, the decline of generalist pollinators is predicted to trigger cascades of linked declines among the multiple specialist plant species to which they are linked, but this has not been documented. I studied a portion of a pollination web involving a generalist pollinator, the oil-collecting bee Rediviva peringueyi, and a community of oil-secreting plants. Across 27 established conservation areas located in the Cape Floral Region, I found substantial variation in the bees' occurrence in relation to soil type and the successional stage of the vegetation. Anthropogenic declines were detectable against this background of naturally occurring variation: R. peringueyi was absent from small conservation areas (urban matrix. In the absence of the bee, seed set failed in six specialist plant species that are pollinated only by R. peringueyi but remained high in a pollination generalist, which had replacement pollinators. The findings are consistent with theoretical predictions of the importance of generalist pollinators in maintaining the structure of pollination webs.

Management for Patients with De Novo or Recurrent Tumors in the Residual Kidney after Surgery for Nonfamilial Bilateral Renal Cell Carcinoma

Directory of Open Access Journals (Sweden)

Noboru Hara

2009-01-01

Full Text Available The tumor de novo in the residual kidney after surgery for nonfamilial bilateral renal cell carcinoma (RCC is problematic. We reviewed 5 patients who experienced such a situation. Three patients had had metachronous bilateral RCC, treated with radical nephrectomy in one kidney and nephron-sparing surgery (NSS in the other. Two patients had had synchronous disease; one patient had received radical nephrectomy and NSS, and the other bilateral NSS. The 5 patients had another solid mass/de novo tumor in the residual kidney 16–88 (mean 46.8 months after surgery. For the tumor de novo in earlier years (1992–1999, one patient underwent surgery and hemodialysis, and the other selected a conservative observation. In recent years (2000–2007, one patient was conservatively observed; the remaining 2 received computerized-tomography-guided radiofrequency ablation, and the local tumors were well controlled postoperatively for 20 and 12 months with their renal function unimpaired. Ablative techniques can potentially strike a balance between oncological and nephrological outcomes in patients with sporadic multiple RCC, successful management of which was difficult previously.

On-farm conservation of Zaer lentil genetic resources

Directory of Open Access Journals (Sweden)

N. Benbrahim

2018-01-01

Full Text Available Zaer lentil has been on-farm conserved thanks to farmers’ knowledges and practices add to its genetic diversity. Its notoriety is related to its specific adaptation and organoleptic traits. The main objective of this study is to identify farmers’ practices that have allowed a dynamic adaptation potential and an add value on quality product. It was based on (1 farmers’ survey on seed management system, (2 Zaer lentil genetic diversity analysis using agro-morphological traits and (3 technological and nutritional analysis. The results show that the on-farm conservation of Zaer lentil is linked to its specific adaptation related to seed production and seed exchange system, to its genetic diversity (21.7% conservation.

Biodiversity, climate change and poverty: exploring the links

Energy Technology Data Exchange (ETDEWEB)

Reid, Hannah; Swiderska, Krystyna

2008-02-15

Biodiversity — the variety of all life, from genes and species to ecosystems — is intimately linked to Earth's climate and, inevitably, to climate change. Biodiversity and poverty are also inextricably connected. For instance, changes to natural ecosystems influence both climate change and people's ability to cope with some of its damaging impacts. And in their turn climate change, as well as people's responses to it, affect biodiversity. Unpicking all these strands clearly shows that conserving and managing biodiversity can help natural systems and vulnerable people cope with a shifting global climate. Yet compared to activities such as forest conservation and afforestation — widely noted as a way of sequestering carbon and cutting greenhouse gas emissions — biodiversity conservation is a neglected area. That must change: urgent support is needed for local solutions to biodiversity loss that provide benefits on all counts.

Breast conserving surgery in combination with intraoperative radiotherapy after previous external beam therapy: an option to avoid mastectomy.

Science.gov (United States)

Thangarajah, F; Heilmann, J; Malter, W; Kunze, S; Marnitz, S; Mallmann, P; Wenz, F; Sperk, E

2018-04-01

Mastectomy is the standard procedure in patients with in-breast tumor recurrence (IBTR) or breast cancer after irradiation of the chest due to Hodgkin's disease. In certain cases a second breast conserving surgery (BCS) in combination with intraoperative radiotherapy (IORT) is possible. To date, data concerning BCS in combination with IORT in pre-irradiated patients are limited. This is the first pooled analysis of this special indication with a mature follow-up of 5 years. Patients with IBTR after external beam radiotherapy (EBRT; treated in two centers) for breast cancer were included. Patients with previous EBRT including the breast tissue due to other diseases were also included. IORT was performed with the Intrabeam™-device using low kV X-rays. Clinical data including outcome for all patients and toxicity for a representative cohort (LENT-SOMA scales) were obtained. Statistical analyses were done including Kaplan-Meier estimates for local recurrence, distant metastasis and overall survival. A total of 41 patients were identified (39 patients with IBTR, 2 with Hodgkin`s disease in previous medical history). Median follow-up was 58 months (range 4-170). No grade 3/4 acute toxicity occurred within 9 weeks. Local recurrence-free survival rate was 89.9% and overall survival was 82.7% at 5 years. Seven patients developed metastasis within the whole follow-up. BCS in combination with IORT in IBTR in pre-irradiated patients is a feasible method to avoid mastectomy with a low risk of side effects and an excellent local control and good overall survival.

Surgery of the cancer of Uterine Neck Past, present and Future; Cirugia del Cancer de cuello Uterino. Pasado, presente y futuro

Energy Technology Data Exchange (ETDEWEB)

Escudero Fernandez, M.

2009-07-01

The evolution of the surgery of the cancer of cervix has passed for several stages. First the boarding was indisputably vaginal. Thanks to the anestesea, antibioterapia and transfusion was produced a change that has come to our days to the abdominal route with Wertheim Meigs's intervention. From 1987 Dargent he introduced the route laparoscopica, the conservative surgery and the return to the vaginal boarding. Today the robotic surgery is imposed with the Da Vinci. (Author) 16 refs.

Consumer energy conservation options - professional and consumer perspectives

Energy Technology Data Exchange (ETDEWEB)

Ritchie, B.J.R.; Claxton, J.D.; McDougall, G.H.G.

1980-01-01

The objectives of this study were to: identify government policies for reducing Canadian consumption of home heating fuel, electricity, and gasoline; assess probable effectiveness of different policy alternatives as a means of reducing consumer energy consumption; and measure the acceptability to Canadian consumers of the different policy alternatives. Interviews were conducted with energy conservation professionals to identify and evaluate existing energy conservation programs, and interviews were conducted with consumers who had evaluated selected programs previously reviewed by the professionals. Information was also gathered on energy conservation activities of consumers surveyed. A directory of 34 energy conservation programs was also compiled. Some of the conclusions reached in this report are as follows. There is a need for an information system to gather data on existing conservation programs in order to increase the knowledge of relevant parties as to the outcomes of operating programs. This would help evaluation and improvement of current programs and suggest new program possibilities. The professionals rated six of the 34 programs highly, including the Energuide and the Canadian Home Insulation Program (CHIP). Retrofitting programs for houses are recommended for continuation and expansion, with some consideration given to linking these kinds of programs with home audit programs. In the private transport sector, any new conservation programs should be thoroughly tested on a small scale before widespread implementation, as evidence indicates that certain programs favorably evaluated by professionals may not be received favorably by consumers. 3 refs., 24 tabs.

Traumatic injuries: role of imaging in the management of the polytrauma victim (conservative expectation)

International Nuclear Information System (INIS)

Poletti, Pierre-Alexandre; Becker, Christoph D.; Wintermark, Max; Schnyder, Pierre

2002-01-01

Abdominal US and CT play an important role in the initial management of blunt trauma in adults. Ultrasound is an excellent method for detection of free intra-abdominal fluid. It is the modality of choice for initial screening and enables selection of hemodynamically unstable trauma victims with severe hemoperitoneum for immediate surgery. However, even in experienced hands, US is not sufficient to rule out organ injuries reliably. Computed tomography, and particularly multislice CT (MSCT), has several major advantages over US and is currently unsurpassed for the detection of blunt visceral injuries in the abdomen. Computed tomography has a high sensitivity for the detection of parenchymal splenic and hepatic injuries. Injuries of the gastrointestinal tract may be detected with good sensitivity provided that adequate examination technique and careful diagnostic interpretation are combined. The value of CT-based injury-grading systems for predicting the outcome of conservative treatment remains unproven; however, demonstration of direct vascular injuries with CT, e.g., the intrasplenic ''contrast blush'' sign, may indicate a high likelihood that conservative treatment will fail, thus warranting angiographic embolization or surgery. Monitoring of conservatively treated trauma victims by means of repeat CT studies enables early detection of a variety of delayed, clinically silent complications of trauma, e.g., posttraumatic biloma or bowel devascularization. Catheter angiography may be reserved to selected cases with vascular injuries proven on CT. (orig.)

Traumatic injuries: role of imaging in the management of the polytrauma victim (conservative expectation)

Energy Technology Data Exchange (ETDEWEB)

Poletti, Pierre-Alexandre; Becker, Christoph D. [Division of Diagnostic and Interventional Radiology, Geneva University Hospital, Geneva (Switzerland); Wintermark, Max; Schnyder, Pierre [Department of Diagnostic and Interventional Radiology, CHUV, Lausanne (Switzerland)

2002-05-01

Abdominal US and CT play an important role in the initial management of blunt trauma in adults. Ultrasound is an excellent method for detection of free intra-abdominal fluid. It is the modality of choice for initial screening and enables selection of hemodynamically unstable trauma victims with severe hemoperitoneum for immediate surgery. However, even in experienced hands, US is not sufficient to rule out organ injuries reliably. Computed tomography, and particularly multislice CT (MSCT), has several major advantages over US and is currently unsurpassed for the detection of blunt visceral injuries in the abdomen. Computed tomography has a high sensitivity for the detection of parenchymal splenic and hepatic injuries. Injuries of the gastrointestinal tract may be detected with good sensitivity provided that adequate examination technique and careful diagnostic interpretation are combined. The value of CT-based injury-grading systems for predicting the outcome of conservative treatment remains unproven; however, demonstration of direct vascular injuries with CT, e.g., the intrasplenic ''contrast blush'' sign, may indicate a high likelihood that conservative treatment will fail, thus warranting angiographic embolization or surgery. Monitoring of conservatively treated trauma victims by means of repeat CT studies enables early detection of a variety of delayed, clinically silent complications of trauma, e.g., posttraumatic biloma or bowel devascularization. Catheter angiography may be reserved to selected cases with vascular injuries proven on CT. (orig.)

Oncoplastic Approaches to Breast Conservation

Directory of Open Access Journals (Sweden)

Dennis R. Holmes

2011-01-01

Full Text Available When a woman is diagnosed with breast cancer many aspects of her physical, emotional, and sexual wholeness are threatened. The quickly expanding field of oncoplastic breast surgery aims to enhance the physician commitment to restore the patient's image and self-assurance. By combining a multidisciplinary approach to diagnosis and treatment with oncoplastic surgery, successful results in the eyes of the patient and physician are significantly more likely to occur. As a way to aid oncoplastic teams in determining which approach is most suitable for their patient's tumor size, tumor location, body habitus, and desired cosmetic outcome we present a review of several oncoplastic surgical approaches. For resections located anywhere in the breast, the radial ellipse segmentectomy incision and circumareolar approach for segmental resection are discussed. For resections in the upper or central breast, crescent mastopexy, the batwing incision, the hemibatwing incision, donut mastopexy, B-flap resection, and the central quadrantectomy are reviewed. For lesions of the lower breast, the triangle incision, inframammary incision, and reduction mastopexy are discussed. Surgeons who are interested in adding oncoplastic breast conserving therapies to their skill sets are encouraged to implement these surgical techniques where applicable and to seek out breast fellowships or enhanced training when appropriate.

Oncoplastic Approaches to Breast Conservation

International Nuclear Information System (INIS)

Holmes, D.R.; Schooler, W.; Smith, R.

2011-01-01

When a woman is diagnosed with breast cancer many aspects of her physical, emotional, and sexual wholeness are threatened. The quickly expanding field of oncoplastic breast surgery aims to enhance the physician commitment to restore the patient's image and self-assurance. By combining a multidisciplinary approach to diagnosis and treatment with oncoplastic surgery, successful results in the eyes of the patient and physician are significantly more likely to occur. As a way to aid oncoplastic teams in determining which approach is most suitable for their patient's tumor size, tumor location, body habitus, and desired cosmetic outcome we present a review of several oncoplastic surgical approaches. For resections located anywhere in the breast, the radial ellipse segmentectomy incision and circumareolar approach for segmental resection are discussed. For resections in the upper or central breast, crescent mastopexy, the batwing incision, the hemi batwing incision, donut mastopexy, B-flap resection, and the central quadrantectomy are reviewed. For lesions of the lower breast, the triangle incision, infra mammary incision, and reduction mastopexy are discussed. Surgeons who are interested in adding oncoplastic breast conserving therapies to their skill sets are encouraged to implement these surgical techniques where applicable and to seek out breast fellowships or enhanced training when appropriate

Conservative management of neuromuscular scoliosis: personal experience and review of literature.

Science.gov (United States)

Kotwicki, Tomasz; Jozwiak, Marek

2008-01-01

The principles of conservative management of neuromuscular scoliosis in childhood and adolescence are presented. Analysis of personal experience and literature review. The topic is discussed separately for patients with flaccid or spastic paresis. These demonstrate that conservative management might be proposed for patients with neuromuscular scoliosis in many clinical situations. In spastic disorders, it maintains the symmetry around the hip joints. Bracing is technically difficult and often is not tolerated well by cerebral palsy children. In patients with flaccid paresis, the fitting and the use of brace is easier than in spastic patients. The flexibility of the spinal curvature is more important. Functional benefits of conservative management of neuromuscular scoliosis comprise stable sitting, easier use of upper limbs, discharge of the abdomen from the collapsing trunk, increased diaphragm excursion, and, not always, prevention of curve progression. Specific natural history and multiple medical problems associated with the disease make the treatment of children with neuromuscular scoliosis an extremely complex issue, best addressed when a team approach is applied. Continuously improving techniques of conservative management, comprising bracing and physiotherapy, together with correctly timed surgery incorporated in the process of rehabilitation, provide the optimal care for patients.