Necrotising soft tissue infection following mastectomy

Directory of Open Access Journals (Sweden)

Jackson P

2010-03-01

Full Text Available Necrotising fasciitis is a rare but rapidly progressive soft tissue disease which can lead to extensive necrosis, systemic sepsis and death. Including this case, only 7 other cases have been reported in the world literature with only 2 others affecting the patient post mastectomy.This 59 year old Caucasian lady presented with severe soft tissue infection soon after mastectomy, which was successfully treated with a combination of debridement, triangulation, VAC© dressing and skin grafting.Necrotising soft tissue infections following mastectomy are rapidly progressive and potentially extremely serious. It is essential that a high index of clinical suspicion is maintained together with prompt aggressive treatment in a multidisciplinary environment to prevent worsening physical and psychological sequelae.

Prognosis value of molecular sub-types in breast cancers free of ganglionary invasion after mastectomy and impact of radiotherapy; Valeur pronostique des sous-types moleculaires dans les cancers du sein indemnes d'envahissement ganglionnaire apres mastectomie et impact de la radiotherapie

Energy Technology Data Exchange (ETDEWEB)

Selz, J.; Stevens, D.; Jouanneau, L.; Labib, A.; Le Scodan, R. [Hopital Rene-Huguenin, Saint-Cloud (France)

2011-10-15

The authors report the assessment of the prognosis value in terms of local control of molecular subtypes in patients suffering from breast cancer without ganglionary invasion, and of their predictive value for adjuvant irradiation. Medical files of nearly 700 patients have been analyzed. Some had an irradiation after mastectomy, some hadn't. The distribution of molecular sub-types is indicated, and the relationship with relapse is examined. The different molecular sub-types do not allow sub-groups with high risk of relapse to be defined. Breast cancers of stage pN0 after mastectomy seem to have a very good prognosis. Short communication

Modern indications for post-mastectomy radiotherapy application

International Nuclear Information System (INIS)

Parvanova, V.

2002-01-01

Before the effective adjuvant chemotherapy, post-mastectomy chemotherapy was usually used in breast cancer patients. The interest in this approach was revived after a number of studies were successful in identifying patient subgroups with 20 and 40 percent of locoregional relapses following mastectomy and chemotherapy. These subgroups including women presenting 4 and more positive lymph odes or an advanced primary tumor (measuring 5 cm or more, or a neoplasm invading skin or contiguous musculature) are taken to be the most likely to benefit from a course od post-mastectomy radiotherapy. Recent randomized trials demonstrate adequate tumor control and heightened overall survival rates when mastectomy is supplemented by radiotherapy. A currently performed meta-analysis of over 22000 women comparing groups with and without adjuvant radiotherapy point to an improvement in locoregional tumor control rates from 70 to 90 percent. The result of a 20-year follow-up study document a significant improvement of overall and disease-specific survivalship. These are findings lending support to the concept that improving locoregional tumor control rates in breast cancer may account for an increase of overall survivorship. Regardless of a rather short follow-up of women undergoing updated radiotherapy techniques, the preliminary results do not show increased incidence of vascular death, but pos-mastectomy radiotherapy continues to be associated with an elevated hand edema risk. For the time being, the role of post-mastectomy radiotherapy in women presenting 1 to 3 positive axillary lymph nodes remains not well enough clarified, and needs further evaluation in randomized clinical trials. (authors)

Ten-year results of a randomized clinical trial comparing radical mastectomy and total mastectomy with or without radiation

International Nuclear Information System (INIS)

Fisher, B.; Redmond, C.; Fisher, E.R.

1985-01-01

In 1971 a randomized trial was begun to compare alternative local and regional treatments of breast cancer, all of which employ breast removal. Life-table estimates were obtained for 1665 women enrolled in the study for a mean of 126 months. There were no significant differences among three groups of patients with clinically negative auxillary nodes, with respect to disease-free survival, distant-disease-free survival, or overall survival (about 57%) at 10 years. The patients were treated by radical mastectomy, total (simple) mastectomy without auxillary dissection but with regional irradiation, or total mastectomy without irradiation plus auxillary dissection only if nodes were subsequently positive. Similarly, no differences, were observed between patients with clinically positive nodes treated by radical mastectomy or by total mastectomy without auxillary dissection but with regional irradiation. Survival at 10 years was about 38% in both groups. Our findings indicate that the location of a breast tumor does not influence the prognosis and that irradiation of internal mammary nodes in patients with inner-quadrant lesions does not improve survival. The data also demonstrate that the results obtained at five years accurately predict the outcome at 10 years. It was concluded that the variations of local and regional treatment used in this study are not important in determining survival of patients with breast cancer. 25 references, 6 figures, 1 table

Inhibition of Pseudomonas aeruginosa virulence: characterization of the AprA-AprI interface and species selectivity.

Science.gov (United States)

Bardoel, Bart W; van Kessel, Kok P M; van Strijp, Jos A G; Milder, Fin J

2012-01-20

Pseudomonas aeruginosa secretes the virulence factor alkaline protease (AprA) to enhance its survival. AprA cleaves one of the key microbial recognition molecules, monomeric flagellin, and thereby diminishes Toll-like receptor 5 activation. In addition, AprA degrades host proteins such as complement proteins and cytokines. P. aeruginosa encodes a highly potent inhibitor of alkaline protease (AprI) that is solely located in the periplasm where it is presumed to protect periplasmic proteins against secreted AprA. We set out to study the enzyme-inhibitor interactions in more detail in order to provide a basis for future drug development. Structural and mutational studies reveal that the conserved N-terminal residues of AprI occupy the protease active site and are essential for inhibitory activity. We constructed peptides mimicking the N-terminus of AprI; however, these were incapable of inhibiting AprA-mediated flagellin cleavage. Furthermore, we expressed and purified AprI of P. aeruginosa and the homologous (37% sequence identity) AprI of Pseudomonas syringae, which remarkably show species specificity for their cognate protease. Exchange of the first five N-terminal residues between AprI of P. syringae and P. aeruginosa did not affect the observed specificity, whereas exchange of only six residues located at the AprI surface that contacts the protease did abolish specificity. These findings are elementary steps toward the design of molecules derived from the natural inhibitor of the virulence factor AprA and their use in therapeutic applications in Pseudomonas and other Gram-negative infections. Copyright © 2011 Elsevier Ltd. All rights reserved.

Breast conserving surgery versus mastectomy

DEFF Research Database (Denmark)

Christiansen, Peer; Carstensen, Stina Lyck; Ejlertsen, Bent

2018-01-01

Background: Observational studies have pointed at a better survival after breast conserving surgery (BCS) compared with mastectomy. The aim of the present study was to evaluate whether this remains true when more extensive tumor characteristics and treatment data were included. Methods: The cohort...... included patients registered after primary surgery for early invasive breast cancer in the database of the Danish Breast Cancer Cooperative Group, in the period 1995–2012. The cohort was divided into three groups: (i) patients who primarily had a mastectomy, (ii) patients treated by BCS, and (iii) patients...

Role of Liposuction Combined with Subcutaneous Mastectomy in ...

African Journals Online (AJOL)

deformity in two other patients. Conclusions: Liposuction combined with subcutaneous mastectomy is a reliable, versatile, less time consuming and valid procedure for the treatment of gynecomastia. This procedure provides satisfactory aesthetic results. KEY WORDS: Gynecomastia, liposuction, subcutaneous mastectomy.

Nipple- and areola-sparing mastectomy for the treatment of breast cancer.

Science.gov (United States)

Mota, Bruna S; Riera, Rachel; Ricci, Marcos Desidério; Barrett, Jessica; de Castria, Tiago B; Atallah, Álvaro N; Bevilacqua, Jose Luiz B

2016-11-29

The efficacy and safety of nipple-sparing mastectomy and areola-sparing mastectomy for the treatment of breast cancer are still questionable. It is estimated that the local recurrence rates following nipple-sparing mastectomy are very similar to breast-conserving surgery followed by radiotherapy. To assess the efficacy and safety of nipple-sparing mastectomy and areola-sparing mastectomy for the treatment of ductal carcinoma in situ and invasive breast cancer in women. We searched the Cochrane Breast Cancer Group's Specialized Register, the Cochrane Center Register of Controlled Trials (CENTRAL), MEDLINE (via PubMed), Embase (via OVID) and LILACS (via Biblioteca Virtual em Saúde [BVS]) using the search terms "nipple sparing mastectomy" and "areola-sparing mastectomy". Also, we searched the World Health Organization's International Clinical Trials Registry Platform and ClinicalTrials.gov. All searches were conducted on 30th September 2014 and we did not apply any language restrictions. Randomised controlled trials (RCTs) however if there were no RCTs, we expanded our criteria to include non-randomised comparative studies (cohort and case-control studies). Studies evaluated nipple-sparing and areola-sparing mastectomy compared to modified radical mastectomy or skin-sparing mastectomy for the treatment of ductal carcinoma in situ or invasive breast cancer. Two review authors (BS and RR) performed data extraction and resolved disagreements. We performed descriptive analyses and meta-analyses of the data using Review Manager software. We used Cochrane's risk of bias tool to assess studies, and adapted it for non-randomised studies, and we evaluated the quality of the evidence using GRADE criteria. We included 11 cohort studies, evaluating a total of 6502 participants undergoing 7018 procedures: 2529 underwent a nipple-sparing mastectomy (NSM), 818 underwent skin-sparing mastectomy (SSM) and 3671 underwent traditional mastectomy, also known as modified radical

Radiological Impacts Assessment during Normal Decommissioning Operation for EU-APR

Energy Technology Data Exchange (ETDEWEB)

Hwang, Do Hyun; Lee, Keun Sung [KHNP CRI, Daejeon (Korea, Republic of); Lee, ChongHui [KEPCO Engineering and Construction, Gimcheon (Korea, Republic of)

2016-10-15

In this paper, radiological impacts on human beings during normal execution of the decommissioning operations from the current standard design of EU-APR which has been modified and improved from its original design of APR1400 to comply with EUR, are evaluated. Decommissioning is the final phase in the life cycle of a nuclear installation, covering all activities from shutdown and removal of fissile material to environmental restoration of the site. According to article 5.4 specified in chapter 2.20 of European Utility Requirements (EUR), all relevant radiological impacts on human being should be considered during the environmental assessment of decommissioning, including external exposure from direct radiation of plant and other radiation sources, and internal exposure due to inhalation and ingestion. In this paper, radiological impacts on human beings during normal circumstances of the decommissioning operation were evaluated from the current standard design of EU-APR based on the simple transport model and practical generic methodology for assessing the radiological impact provided by IAEA. The results of dose assessment fulfilled the dose limit for all scenarios.

Phantom breast sensations are frequent after mastectomy

DEFF Research Database (Denmark)

Hansen, Dorthe Marie Helbo; Kehlet, Henrik; Gærtner, Rune

2011-01-01

Phantom breast sensation (PBS) following mastectomy has been recognized for many years. PBS is a feeling that the removed breast is still there. The reported prevalence and risk factors have not been established in large well-defined patient series. The purpose of this study was to examine...... the prevalence of PBS following mastectomy and associated risk factors....

Health concerns of women after mastectomy

Directory of Open Access Journals (Sweden)

Groszek Patrycja

2017-03-01

Full Text Available Introduction. Cancer and its treatment can cause serious mental and physical disorders that greatly limit the autonomy and independence of patients and reduce their quality of life. Mastectomy violates woman‘s image both in their self-assessment and in their public reception. Among the consequences after mastectomy, there are problems in the physical sphere, which reduce everyday activities, there also appear problems with the mental state associated with the reduction of the sense of feminity.

Re-irradiation after salvage mastectomy for local recurrence after a conservative treatment: a retrospective analysis of twenty patients (Nancy: 1988-2001); Re-irradiation parietale apres mastectomie de rattrapage pour recidive d'un cancer du sein apres traitement conservateur: etude retrospective sur 20 patientes (Nancy: 1988-2001)

Energy Technology Data Exchange (ETDEWEB)

Racadot, S.; Marchal, C.; Charra-Brunaud, C.; Peiffert, D.; Bey, P. [Centre Alexis-Vautrin, Service de Radiotherapie, 54 - Vandoeuvre-les-Nancy (France); Verhaeghe, J.L. [Centre Alexis-Vautrin, Service de Chirurgie, 54 - Vandoeuvre-les-Nancy (France)

2003-12-01

Purpose. - To retrospectively assess the efficacy of post-mastectomy re-irradiation for local relapse of breast cancer. Patients and methods. - Twenty patients, initially treated by conservative surgery and radiotherapy (50 Gy in 25 fractions over 5 weeks) were treated from 1998 to 2001 for a local relapse by salvage mastectomy and re-irradiation (either electron or photon beams). Mean age was 53 years (31-71). Reasons for re-irradiation were that the local relapses were inflammatory (4 pts), multifocal (5 pts), cutaneous (5 pts), involved the nipple (3 pts) or because the surgical margins (either muscle or skin) were involved (3 pts). The median dose of re-irradiation was 45 Gy (33-65) in 15 fractions over 33 days. Mean follow-up was 48 months (5-97). Results. - Fifteen patients remained free of a second local recurrence and 10 were still alive, without metastasis. Neither the dose of re-irradiation nor the irradiated surfaces were prognostic factors of local control (P = 0.877 and P = 0.424). Five patients developed radiation-induced pneumonitis without functional respiratory impairment. The incidence of pneumonitis seemed to be related to the biological dose of re-irradiation (P = 0.037). Other late complications occurred such as pigmentation changes (12 pts), telangiectasia (8 pts), chondritis (2 pts), parietal fibrosis (7 pts), rib fractures (4 pts), severe pain (11 pts) and lymphedema (2 pts). The increase in biological equivalent dose was highly statistically linked with the occurrence of disabling pain (P = 0.0123). Conclusion. - Parietal re-irradiation achieves good and lasting local control with an acceptable rate of acute complications but with a risk of disabling late sequelae such as severe pain. (author)

THE EXPERIENCES OF WOMEN WITH CANCER FACING MASTECTOMY

Directory of Open Access Journals (Sweden)

Marilene Vicente de Jesus

2013-01-01

Full Text Available The research aimed to understand the experiences of women with mastectomies in the treatment Assistance Unit for High Complexity - (UNACON a Hospital Midsize High Complexity in the South of Santa Catarina. This is a qualitative study, descriptive and field. We carried out semi-structured interviews with ten women. Data were analyzed using the technique proposed by Minayo categorization.The survey results denote that interferes with mastectomies in activities of daily living, interpersonal relationships, self-esteem and self-image of women. The feelings of despair, fear and anxiety, but also the strength to fight for life were reported by women, beyondthe need to help and support arising from the family. The difficulties faced after mastectomy surgery are related to pain, loss of strength in the arm, need for rest, interfering with daily activities of women. We stress the need for support of the healthcare team to mastectomy for women coping and adaptation to the disease process.

The experiences of women with cancer facing mastectomy

Directory of Open Access Journals (Sweden)

Marilene Vicente de Jesus

2013-01-01

Full Text Available The research aimed to understand the experiences of women with mastectomies in the treatment Assistance Unit for High Complexity - (UNACON a Hospital Midsize High Complexity in the South of Santa Catarina. This is a qualitative study, descriptive and field. We carried out semi-structured interviews with ten women. Data were analyzed using the technique proposed by Minayo categorization. The survey results denote that interferes with mastectomies in activities of daily living, interpersonal relationships, self-esteem and self-image of women. The feelings of despair, fear and anxiety, but also the strength to fight for life were reported by women, beyond the need to help and support arising from the family. The difficulties faced after mastectomy surgery are related to pain, loss of strength in the arm, need for rest, interfering with daily activities of women. We stress the need for support of the healthcare team to mastectomy for women coping and adaptation to the disease process.

Respirators: APR Issuer Self Study 33461

Energy Technology Data Exchange (ETDEWEB)

Chochoms, Michael [Los Alamos National Laboratory

2016-07-13

Respirators: APR Issuer Self-Study (course 33461) is designed to introduce and familiarize employees selected as air-purifying respirator (APR) issuers at Los Alamos National Laboratory (LANL) with the responsibilities, limitations, procedures, and resources for issuing APRs at LANL. The goal is to enable these issuers to consistently provide proper, functioning APRs to authorized users

Body image after mastectomy: A thematic analysis of younger women's written accounts.

Science.gov (United States)

Grogan, Sarah; Mechan, Jayne

2017-09-01

This study investigated younger women's body image after mastectomy. In all, 49 women, aged 29-53 years (mean age: 39 years) who had had bilateral ( n = 8) or unilateral ( n = 41) mastectomy responded to open-ended questions online. Inductive thematic analysis revealed that aesthetics were less important than survival between diagnosis and mastectomy. Following mastectomy, women negotiated new body identities. Treatment effects such as weight gain were significant concerns. However, impacts on body confidence varied, and some participants rejected mainstream body shape ideals and reported feeling proud of their scars. Implications for supporting younger women post-mastectomy, including promotion of body acceptance, are discussed.

MDEP Design-Specific Common Position CP-APR1400WG-01. Common position addressing Fukushima Daiichi nuclear power plant accident

International Nuclear Information System (INIS)

2016-05-01

The MDEP APR1400 Working Group (APR1400WG) members consist of members from Republic of Korea, United Arab Emirates, and the United States. A main objectives of MDEP is to encourage convergence of code, standard and safety goals with exploring the opportunities for harmonization of regulatory practice and cooperation on safety review of APR-1400 specific designs. This common position addressing is aimed at sharing knowledge, information and experience on safety improvement related to lessons learned from the Fukushima Daiichi NPP Accident or Fukushima Daiichi NPP Accident-related issues amongst APR-1400 WG member states to achieve the MEDP goal. Because not all of these Regulators have completed the regulatory review of their APR1400 applications yet, this paper identifies common preliminary approaches to address potential safety improvements for APR1400 plants, as well as common general expectations for new nuclear power plants, as related to lessons learned from the Fukushima Daiichi NPP Accident or Fukushima Daiichi NPP Accident-related issues. While some asymmetry exists among those of three Regulators in terms of design, regulatory practice and licensing milestone sharing information and common understanding on post-Fukushima Daiichi NPP Accident enhancement would be promote resilient design for countering beyond design extreme external event like Fukushima Daiichi NPP nuclear disaster. This common position paper aims at identifying characteristics of post-Fukushima Daiichi NPP Accident enhancements putting in place by each country and setting common position to achieve balanced and harmonized APR-1400 design. After the safety reviews of the APR1400 design applications that are currently in review are completed, the regulators will update this paper to reflect their safety conclusions regarding the APR1400 design and how the design could be enhanced to address Fukushima Daiichi NPP Accident-related issues. The common preliminary approaches are organised into

Breast Reconstruction After Mastectomy

Science.gov (United States)

... Cancer Prevention Genetics of Breast & Gynecologic Cancers Breast Cancer Screening Research Breast Reconstruction After Mastectomy On This Page What is breast reconstruction? How do surgeons use implants to reconstruct a woman’s breast? How do surgeons ...

Racial disparities in the use of outpatient mastectomy.

Science.gov (United States)

Salasky, Vanessa; Yang, Rachel L; Datta, Jashodeep; Graves, Holly L; Cintolo, Jessica A; Meise, Chelsey; Karakousis, Giorgos C; Czerniecki, Brian J; Kelz, Rachel R

2014-01-01

Racial disparities exist within many domains of cancer care. This study was designed to identify differences in the use of outpatient mastectomy (OM) based on patient race. We identified patients in the American College of Surgeons National Surgical Quality Improvement Program Participant Use File (during the years 2007-2010) who underwent a mastectomy. The association between mastectomy setting, patient race, patient age, American Society of Anesthesiology physical status classification, functional status, mastectomy type, and hospital teaching status was determined using the chi-square test. A multivariable logistic regression analysis was developed to assess the relative odds of undergoing OM by race, with adjustment for potential confounders. We identified 47,318 patients enrolled in the American College of Surgeons National Surgical Quality Improvement Program Participant Use File who underwent a mastectomy during the study time frame. More than half (62.6%) of mastectomies were performed in the outpatient setting. All racial minorities had lower rates of OM, with 63.8% of white patients; 59.1% of black patients; 57.4% of Asian, Native Hawaiian, or Pacific Islander patients; and 43.9% of American Indian or Alaska Native patients undergoing OM (P black patients, American Indian or Alaska Native patients, and those of unknown race were all less likely to undergo OM (odds ratio [OR], 0.86; 95% confidence interval [CI], 0.80-0.93; OR, 0.55; 95% CI, 0.41-0.72; and OR, 0.70; 95% CI, 0.64-0.76, respectively) compared with white patients. Disparities exist in the use of OM among racial minorities. Further studies are needed to identify the role of cultural preferences, physician attitudes, and insurer encouragements that may influence these patterns of use. Copyright © 2014 Elsevier Inc. All rights reserved.

Transsexual Mastectomy: Selection of Appropriate Technique According to Breast Characteristics

Directory of Open Access Journals (Sweden)

Hüsamettin Top

2017-04-01

Full Text Available Background: Subcutaneous mastectomy for female- to-male transsexuals is usually the first surgical pro- cedure in sexual reassignment. The main objective of subcutaneous mastectomy is to create an aesthetically pleasing male chest contour by removing all glandular tissue while minimizing chest wall scars. Aims: In this paper, we present our experience with subcutaneous mastectomy performed in female-to- male transsexual patients. The authors recommend their point of view to aid in selecting the most suitable subcutaneous mastectomy technique depending on breast characteristics. Study Design: Retrospective cross-sectional study. Methods: Between March 2011 and December 2014, 52 patients underwent bilateral subcutaneous mastec- tomies (total of 104 mastectomies, performed using the following four techniques: Webster semicircular, concentric circular, vertical, and apron flap. The tech- nique decision depended on the breast size, degree of skin excess, skin elasticity, chest width, nipple areolar complex size and position. Results: Seventeen patients (32.7% were operated with Webster semicircular, 7 patients (13.5% with con- centric periareolar, 12 patients with vertical (23%; and 16 patients (30.8% with the apron flap technique. The overall postoperative complication rate was 13.4%. All patients were satisfied with the aesthetic results of their subcutaneous mastectomies within the follow-up period. Conclusion: To obtain higher patient satisfaction with aesthetic results and lower postoperative complication rates, breast characteristics are evaluated in a detailed fashion, while choosing the ideal technique of Female-to-Male (FtM subcutaneous mastectomy. The presented surgical new algorithm facilitates the selection of the most reliable surgical technique

Iranian women's attitude toward prophylactic mastectomy for breast cancer

Directory of Open Access Journals (Sweden)

Keivan Majidzadeh-A

2016-01-01

Conclusion: Preventive mastectomy has a higher rate of acceptability among women who have had a family history of breast cancer. Therefore, it may be concluded that raising public awareness about the advantages of prophylactic mastectomy could help better address breast cancer in Iran.

Comparison of Outcomes in Immediate Implant-Based Breast Reconstruction Versus Mastectomy Alone.

Science.gov (United States)

Sousa, Janelle; Sood, Ravi; Liu, Daniel; Calhoun, Kristine; Louie, Otway; Neligan, Peter; Said, Hakim; Mathes, David

2018-02-01

Immediate implant-based techniques are common practice in post-mastectomy breast reconstruction. Previous studies have shown an increased complication rate in the setting of immediate versus delayed, MD reconstruction. We aimed to quantify any additional risk in complications when implant-based immediate breast reconstruction (IBR) is performed versus mastectomy alone. We retrospectively reviewed all IBR cases and all mastectomies without reconstruction from 2007 to 2011. Patient characteristics, operative details, and complication rates were reviewed and analyzed. IBR was performed in 315 consecutive women; mastectomy alone was performed in 401 women. Patients undergoing mastectomy alone were more often older, diabetic, and more frequently underwent neoadjuvant chemotherapy or radiation. Overall complications were higher in the IBR group, most commonly reoperation and delayed wound healing. In a multivariate analysis, IBR, increasing age, body mass index, history of radiation therapy, smoking, and nipple-sparing mastectomy were independently associated with increased risk of complications. However, IBR was only independently associated with increased risk of major complications such as reoperation or readmission for intravenous antibiotics, not minor complications. Patients selected for IBR are inherently different than those undergoing mastectomy alone. After adjusting for these differences, the increased risk of complications seen in IBR is moderately increased over the risk of complications in mastectomy alone. The observed increased risk of major complications after IBR is largely due to the aggressive management of complications in the setting of a prosthetic implant. IBR is a safe reconstructive strategy with only a slightly increased risk over mastectomy alone.

Predictors of contralateral prophylactic mastectomy and the impact on breast reconstruction.

Science.gov (United States)

Pinell-White, Ximena A; Kolegraff, Keli; Carlson, Grant W

2014-01-01

Contralateral prophylactic mastectomy (CPM) is being performed with increased frequency. Predictors of CPM and their impact on breast reconstruction are examined. A retrospective review of a dually trained oncologic and plastic surgeon's experience with patients undergoing total mastectomy from 2002 to 2012 was performed. Patients who underwent bilateral therapeutic mastectomies or who had previous contralateral mastectomy were excluded from this series. Four hundred forty-six patients were treated with total mastectomy and 174 (39%) underwent CPM. The incidence of CPM nearly tripled over the period studied. Compared to women treated with unilateral mastectomy, women who elected for CPM were younger (mean age, 50.4 vs 56.8 years, P mastectomy. Incidental contralateral cancers were discovered in 4% of women who underwent CPM (n = 7), lobular carcinoma in situ in 2.3% (n = 4), and atypical lesions in an additional 11.6% (n = 20). Women who underwent CPM favored reconstruction with breast implants (60.9% vs 17.3%), whereas the transverse rectus abdominis musculocutaneous flap predominated among their unilateral counterparts (38.6% vs 15.5%). Among women who underwent immediate breast reconstruction, the addition of a contralateral procedure expectedly increased breast complication rates (50.3% vs 35.0%, P = 0.007), especially the more severe complications that required hospitalization or reoperation (18.6% vs 5.0%, P procedure is significant.

Surgical treatment of gynecomastia: mastectomy compared to liposuction technique.

Science.gov (United States)

Song, Yan-Ni; Wang, Yan-Bo; Huang, Rui; He, Xiao-Guang; Zhang, Jin-Feng; Zhang, Guo-Qiang; Ren, Yan-Lv; Pang, Jian-Hua; Pang, Da

2014-09-01

Gynecomastia is a benign enlargement of the male breast. Yet enlarged breasts cause anxiety, embarrassment, psychosocial discomfort, and fear of breast cancer. The aim of this study was to assess the experience of gynecomastia patients undergoing mastectomy and liposuction surgery. Seven hundred thirty-three patients were analyzed for age, chief complaint, position, grade, operation approach, biopsy, and complication between mastectomy group and liposuction group, from 1990 to 2010. Four hundred two patients (436 breasts) were treated with mastectomy and 331 patients (386 breasts) were treated with liposuction techniques. Three hundred thirty (82%) patients complained of breast lump and lump with pain in mastectomy group, and 204 (61%) patients complained of enlargement breast and enlargement with pain in liposuction group (P liposuction acquired pathologic diagnosis through fine needle aspiration and/or core biopsy (P liposuction group were 1.4% and 0.5%, respectively. There were no nipple/areola necrosis and scars in liposuction group. The surgical treatment of gynecomastia required an individual approach, depending on symptoms (lump or enlargement) and requirements of patients. Patients who chose mastectomy were looking for reassurance that their pathologic diagnosis was benign. The increase in the number of liposuction patients was reflected in our study because it was associated with superior esthetic results and few complications.

Mastectomy using ultrasonic dissection

DEFF Research Database (Denmark)

Galatius, Hanne; Okholm, Mette; Hoffmann, Jack

2003-01-01

on seroma formation and other complications: 59 patients with operable breast cancer underwent modified radical mastectomy, performed in 30 of them with an Ultracision Harmonic scalpel and in 29 with scissors and electrocautery. In all cases a standard level II axillary dissection was performed...

Mastectomy, body deconstruction, and impact on identity: a qualitative study.

Science.gov (United States)

Piot-Ziegler, C; Sassi, M-L; Raffoul, W; Delaloye, J-F

2010-09-01

This qualitative study aims at understanding the consequences of body deconstruction through mastectomy on corporality and identity in women with breast cancer. Nineteen women were contacted through the hospital. All had to undergo mastectomy. Some were offered immediate breast reconstruction, others, because of cancer treatments, had no planned reconstruction. A qualitative reflexive methodological background was chosen. Women were invited to participate in three semi-structured interviews, one shortly before or after mastectomy, and the other interviews later in their illness courses, after surgery. All interviews were transcribed verbatim. Thematic analysis was performed. The analysis of the first interview of each woman is presented in this article. Mastectomy provokes a painful experience of body deconstruction. Even when immediate reconstruction is proposed, contrasted feelings and dissonance are expressed when comparing the former healthy body to the present challenged body entity. Body transformations are accompanied with experiences of mutilation, strangeness, and modify the physical, emotional social, symbolic and relational dimensions of the woman's gendered identity. Although the opportunity of breast reconstruction is seen as a possible recovery of a lost physical symmetry and body integrity, grieving the past body and integrating a new corporality leads to a painful identity crisis. With mastectomy, the roots of the woman's identity are challenged, leading to a re-evaluation of her existential values. The consequences of mastectomy transform the woman's corporality and embodiment, and question her identity. Psychological support is discussed in the perspective of our results.

Occupational performance of women subjected to mastectomy

Directory of Open Access Journals (Sweden)

Jamylle Silva de Brito

2014-12-01

Full Text Available Among the several therapeutic approaches to combat breast cancer, mastectomy is the most feared by women, not only because of its aggressive invasive characteristics to the female body, but also because of its biological, functional, emotional, and social repercussions. The objective of the present study was to outline the occupational performance profile through the description of daily life, productive and leisure activities of women that have undergone mastectomy. This is a descriptive cross-sectional study with 21 women carried out at a school hospital in Recife, Pernambuco state, Brazil, from June to September, 2011. We used a sociodemographic questionnaire and occupational assessment by the Canadian Model of Occupational Performance (CMOP. In the occupational performance evaluation, Productivity was the most compromised area, followed by Leisure. Taking care of the body after mastectomy was not a restraint to the development of the daily-life, productive and leisure activities for the operated women, although some reorganization was needed to maintain a satisfactory performance.

Long-term outcomes of patients with breast cancer after nipple-sparing mastectomy/skin-sparing mastectomy followed by immediate transverse rectus abdominis musculocutaneous flap reconstruction: Comparison with conventional mastectomy in a single center study.

Science.gov (United States)

Lee, Sae Byul; Lee, Jong Won; Kim, Hee Jeong; Ko, Beom Seok; Son, Byung Ho; Eom, Jin Sup; Lee, Taik Jong; Ahn, Sei-Hyun

2018-05-01

To evaluate the oncological outcomes of patients with breast cancer after nipple-sparing mastectomy (NSM)/skin-sparing mastectomy (SSM), followed by immediate reconstruction, as compared to conventional mastectomy (CM).SSM/NSM has been increasingly used to treat women with breast cancer who wish to preserve the overlying breast skin, but concern exist regarding its oncological safety due to the potential for residual breast tissue. We report our experience performing SSM/NSM for breast cancer treatment compared to CM with a long follow-up period.All consecutive patients who underwent mastectomy for breast cancer at Asan Medical Center between January 1993 and December 2008 were identified by retrospective medical chart review. The patients who underwent NSM/SSM, followed by immediate breast reconstruction with a pedicled transverse rectus abdominis musculocutaneous flap (TRAM), were compared to the patients who underwent CM in terms of breast-cancer specific survival (BCSS) rate, distant metastasis-free survival (DMFS) rate, and local recurrence (LR) rate.During the study period, 6028 patients underwent mastectomy for breast cancer. Of these, 1032 and 4996 underwent NSM/SSM with TRAM and CM, respectively. Their median follow-up durations were 94.4 (range, 8.1-220.2) and 110.8 (range, 6.1-262.0) months, respectively. Their 5 year BCSS rates were 95.4% and 88.1%, respectively (log-rank, P < .001). Their 5 year DMFS rates were 93.0% and 85.6%, respectively (log-rank, P < .001).Relative to CM, NSM/SSM, followed by immediate breast reconstruction, may be a viable and oncologically safe surgical treatment in selected patients with breast cancer.

Association between unilateral or bilateral mastectomy and breast cancer death in patients with unilateral ductal carcinoma.

Science.gov (United States)

Agarwal, Shailesh; Pappas, Lisa; Agarwal, Jayant

2017-01-01

Utilization of bilateral mastectomy for unilateral breast cancer is increasing despite cost and surgical risks with conflicting reports of survival benefit. Current studies evaluating death after bilateral mastectomy have included patients treated both with breast conservation therapy and unilateral mastectomy. In this study, we directly compared breast cancer-specific death of patients who underwent bilateral or unilateral mastectomy for unilateral breast cancer using a matched cohort analysis. This was an observational study of women diagnosed with unilateral breast cancer from 1998 through 2002, using the Surveillance, Epidemiology, and End Results (SEER) database. A 4-to-1 matched cohort of patients was selected including 14,075 patients. Mortality of the groups was compared using Cox proportional hazards models for cause-specific death. A total of 41,510 patients diagnosed with unilateral breast cancer were included. Unilateral mastectomy was performed in 93% of patients, while bilateral mastectomy was performed in the remaining 7% of patients. When 4-to-1 matching was performed, 11,260 unilateral mastectomy and 2,815 bilateral mastectomy patients were included. Patients with bilateral mastectomy did not have a significantly lower hazard of breast cancer-specific death when compared with patients with unilateral mastectomy (hazard ratio: 0.92 vs 1.00, p =0.11). Bilateral mastectomy did not provide a clinically or statistically significant breast cancer-specific mortality benefit over unilateral mastectomy based on a matched cohort analysis of a nationwide population database. These findings should be interpreted in the context of patient preference and alternative benefits of bilateral mastectomy.

Skin Flap Necrosis After Mastectomy With Reconstruction: A Prospective Study.

Science.gov (United States)

Matsen, Cindy B; Mehrara, Babak; Eaton, Anne; Capko, Deborah; Berg, Anastasia; Stempel, Michelle; Van Zee, Kimberly J; Pusic, Andrea; King, Tari A; Cody, Hiram S; Pilewskie, Melissa; Cordeiro, Peter; Sclafani, Lisa; Plitas, George; Gemignani, Mary L; Disa, Joseph; El-Tamer, Mahmoud; Morrow, Monica

2016-01-01

Rates of mastectomy with immediate reconstruction are rising. Skin flap necrosis after this procedure is a recognized complication that can have an impact on cosmetic outcomes and patient satisfaction, and in worst cases can potentially delay adjuvant therapies. Many retrospective studies of this complication have identified variable event rates and inconsistent associated factors. A prospective study was designed to capture the rate of skin flap necrosis as well as pre-, intra-, and postoperative variables, with follow-up assessment to 8 weeks postoperatively. Uni- and multivariate analyses were performed for factors associated with skin flap necrosis. Of 606 consecutive procedures, 85 (14 %) had some level of skin flap necrosis: 46 mild (8 %), 6 moderate (1 %), 31 severe (5 %), and 2 uncategorized (0.3 %). Univariate analysis for any necrosis showed smoking, history of breast augmentation, nipple-sparing mastectomy, and time from incision to specimen removal to be significant. In multivariate models, nipple-sparing, time from incision to specimen removal, sharp dissection, and previous breast reduction were significant for any necrosis. Univariate analysis of only moderate or severe necrosis showed body mass index, diabetes, nipple-sparing mastectomy, specimen size, and expander size to be significant. Multivariate analysis showed nipple-sparing mastectomy and specimen size to be significant. Nipple-sparing mastectomy was associated with higher rates of necrosis at every level of severity. Rates of skin flap necrosis are likely higher than reported in retrospective series. Modifiable technical variables have limited the impact on rates of necrosis. Patients with multiple risk factors should be counseled about the risks, especially if they are contemplating nipple-sparing mastectomy.

The Acceptance and the Perception of Mastectomy by Males whose ...

African Journals Online (AJOL)

Majority of male spouses of females with breast cancers would not readily accept mastectomy for their female spouses and would have negative perception of their partners after mastectomy. We thus recommend that health care workers should involve men in breast cancer related education. Keywords: Acceptance ...

Breast Reconstruction after a Bilateral Mastectomy Using the BRAVA Expansion System and Fat Grafting

Directory of Open Access Journals (Sweden)

Ondrej Mestak, MD

2013-11-01

Full Text Available Summary: Fat graft breast reconstruction following a mastectomy is always limited by the size of the skin envelope, which affects the amount of graft that can be injected in 1 session. Because the fat graft naturally resorbs in all patients, several sessions of fat grafting are necessary. BRAVA’s negative pressure causes a “reverse” expansion of the skin envelope, thus permitting more space for the fat graft. This allows decreasing number of required procedures for an adequate breast reconstruction. We operated on a 38-year-old patient 4 years after bilateral mastectomy without irradiation for breast cancer. Before the procedure, the patient was instructed to wear the BRAVA system for 12 hours daily for 2 months before the first session, at all times between the sessions and for 1 month following the last fat grafting session. We performed 3 fat grafting sessions, as planned. Altogether, we injected 840 cm3 of fat on the right side and 790 cm3 of fat on the left side. Four months after the last operation, the patient was very satisfied with her new breasts. The breasts were soft, with good sensation and a natural feel. Using the BRAVA external expansion system for the enhancement of fat grafting is a suitable technique for breast reconstruction after a mastectomy. This technique produces soft and natural feeling breasts in fewer operative sessions, with a minimal risk of complications. Patient compliance, however, is greatly needed to achieve the desired results.

Complications after modified radical mastectomy in early breast cancer

International Nuclear Information System (INIS)

Bhatty, I.; Shaharyar; Ibrahim, M.; Chaudhry, M.L.

2004-01-01

Objective: To study the frequency of complications, particularly the lymphedema of the arm, after modified radical mastectomy in early breast cancer patients who have not been given post-operative radiotherapy to axilla. Design: Hospital based descriptive study. Results: Median age of these patients was 47 years with a range of 25-58 years. Majority of these patients were stage II (84%) and infiltrating ductal carcinoma was the most frequent type of cancer (88%). Fifty-six percent of these patients had high grade tumors. None of the patients received radiotherapy to axilla after modified radical mastectomy. Early complications documented from history and medical record revealed that seroma formation was the most frequent early complication seen after modified radical mastectomy (20%). Frequent late complications included anterior chest tightness (56%), shoulder dysfunction (36%), lymphedema (26%) and sensory loss (22%). Shoulder dysfunction included limited range of movement in all 18 patients. Gross multiple restrictions were seen in 11 (61.11%) of these patients. Conclusion: It is concluded from this study that lymphedema and shoulder dysfunction are the two major complications in patients of early breast cancer who have undergone modified radical mastectomy without post-operative axillary radiation. (author)

Breast cancer after bilateral risk-reducing mastectomy

DEFF Research Database (Denmark)

Skytte, A-B; Crüger, Dorthe Gylling; Gerster, M

2011-01-01

This study aims to evaluate the incidence of breast cancer after risk-reducing mastectomy (RRM) in healthy BRCA mutation carriers. This study is a long-term follow-up of 307 BRCA mutation carriers of whom 96 chose RRM. None of the study participants had a previous history of breast or ovarian...... cancer nor had they undergone RRM or risk-reducing bilateral salpingo-oophorectomy (BSO) prior to the time of BRCA testing. The annual incidence of post-mastectomy breast cancer was 0.8% compared with 1.7% in the non-operated group. Implications of these findings in relation to genetic counseling...

PSYCHOSOCIAL MORBIDITY IN PATIENTS UNDERGOING MASTECTOMY FOR BREAST CANCER

Directory of Open Access Journals (Sweden)

Kavitha Konnakkaparambil Ramakrishnan

2018-02-01

Full Text Available BACKGROUND Breast Cancer is the most common female cancer worldwide and carries significant psychosocial morbidity. The diagnosis of the disease and the treatment modalities like surgery and chemotherapy contribute to the morbidity. The recognition of the psychosocial morbidity associated with mastectomy can help us formulate effective counselling strategies. The objectives of this study were- to assess the psychosocial morbidity in patients undergoing mastectomy for carcinoma breast, to identify the preoperative variables that predict the morbidity and to find out the correlation between degree of neuroticism of the individual and morbidity. MATERIALS AND METHODS 35 female patients who had mastectomy for breast cancer were evaluated at three time-points, preoperatively, immediately after surgery and 2 months after surgery. Anxiety and depression was assessed using Hospital Anxiety and Depression Scale (HADS, psychological distress was measured using General Health Questionnaire (GHQ-12 and neuroticism was assessed by Eysenck Personality Inventory Neuroticism subscale (EPI-N. RESULTS There was a high level of anxiety, depression and GHQ scores preoperatively with a further worsening of these over the three interviews. Age, marital status and menopausal status were factors which had an influence on psychosocial morbidity. Preoperative EPI-N scores positively correlated with psychosocial morbidity. CONCLUSION There is a high level of psychosocial morbidity in patients undergoing mastectomy for breast cancer and mastectomy seems to worsen it in the first two months after surgery. Our study shows that psychosocial morbidity is affected by age, marital status, menopausal status and level of neuroticism.

Long-Term Satisfaction and Body Image After Contralateral Prophylactic Mastectomy

Science.gov (United States)

Anderson, Chelsea; Islam, Jessica Y.; Hodgson, M. Elizabeth; Sabatino, Susan A.; Rodriguez, Juan L.; Lee, Clara N.; Sandler, Dale P.; Nichols, Hazel B.

2017-01-01

Background Contralateral prophylactic mastectomy (CPM) rates have been increasing in the U.S. Though some studies have reported high overall satisfaction among women who undergo CPM, it is unclear how long-term satisfaction differs from that of women who undergo unilateral mastectomy (UM). Furthermore, few studies have assessed whether the effects of CPM on body image differ from those of breast conserving surgery (BCS) or UM. Methods We analyzed responses from a survey of women with both a personal and family history of breast cancer who were enrolled in the Sister Study (n=1176). Among women who underwent mastectomy, satisfaction with mastectomy decision and reconstruction was compared between women who underwent CPM and UM. We also evaluated responses on 5 items related to body image according to surgery type (BCS, UM without reconstruction, CPM without reconstruction, UM with reconstruction, and CPM with reconstruction). Results Participants were, on average, 60.8 years old at diagnosis (SD=8.7) and 3.6 years post-diagnosis at the time of survey (SD=1.7). BCS was the most common surgical treatment reported (63%), followed by CPM (22%) and UM (15%). Satisfaction with mastectomy decision was reported by 97% of women who underwent CPM and 89% of those who underwent UM. Compared to other surgery types, women who underwent CPM without reconstruction reported feeling more self-conscious, less feminine, less whole, and less satisfied with the appearance of their breasts. Body image was consistently highest among women who underwent BCS. Conclusions In our sample of women with both a personal and family history of breast cancer, most were highly satisfied with their mastectomy decision, including those who elected to undergo CPM. However, body image was lowest among women who underwent CPM without reconstruction. Our findings may inform decisions among women considering various courses of surgical treatment. PMID:28058563

Primary Buttonhole Mastopexy and Nipple-Sparing Mastectomy: A Preliminary Report.

Science.gov (United States)

Salibian, Arthur H; Harness, Jay K; Mowlds, Donald S

2016-10-01

Patients undergoing nipple-sparing mastectomy and immediate-implant based reconstruction occasionally require a mastopexy based on their breast size and degree of ptosis. Previous reports have shown the feasibility of mastopexy-nipple-sparing mastectomy in selected patients to raise the nipple up to 5 cm. Major mastopexy with nipple transposition more than 6 cm in conjunction with nipple-sparing mastectomy for therapeutic indications has not been described. The authors review their experience with primary buttonhole mastopexy performed in conjunction with nipple-sparing mastectomy. Between 2008 and 2014, 16 patients (32 breasts) underwent bilateral primary mastopexy and nipple-sparing mastectomy with immediate staged implant-based reconstruction. The Passot buttonhole technique was used for the mastopexy in all patients, raising the nipple from 7 to 12 cm. Tumor-related data, risk factors, breast size, degree of ptosis, expander size, fill volume, selection criteria, and complications are discussed. The average follow-up period was 33 months (range, 14 to 80 months). There were no tumor recurrences, and all patients completed their reconstruction. Two patients required removal of the expander and delayed reconstruction because of infection and implant exposure due to nipple-areola loss. The reasons for nipple-areola loss and technical modifications to enhance skin viability by retaining a thin layer of subareolar breast tissue for removal during the second-stage implant exchange are discussed. Primary mastopexy using the buttonhole technique performed together with nipple-sparing mastectomy is a safe procedure with predictable results in patients with very large or ptotic breasts requiring lifts greater than 6 cm. The success of the combined procedure depends on preserving a thin layer of subareolar breast tissue and removing it at the time of implant exchange.

Design Characteristics of Soft Control for APR+

Energy Technology Data Exchange (ETDEWEB)

Kim, Yongsoo; Sung, Chanho; Jung, Yeonsub [KHNP CRI, Daejeon (Korea, Republic of)

2016-10-15

In the global nuclear industry, the design requirements have been largely divided into the US and the European ones. The APR+ design, based on the proven APR1400 design, was developed to fully comply with the US regulatory and utility requirements. It was also developed to improve the technical competitiveness and enlarge the export market share through design uniqueness and the improvement of safety. The robust design of safety and its validation were requested Post-Fukushima accident. So MMIS design and validation for reinforcing safety were accomplished in APR+ development project. In this paper, the design characteristics of soft control for APR+ are presented to enhance the safety of MMIS design. In this paper, the major design characteristics of soft control for APR+ were introduced to increase the safety of MMIS design. In addition to the design characteristics of soft control described above, the following should be investigated closely for APR+ to get into the global nuclear industry.

Design Characteristics of Soft Control for APR+

International Nuclear Information System (INIS)

Kim, Yongsoo; Sung, Chanho; Jung, Yeonsub

2016-01-01

In the global nuclear industry, the design requirements have been largely divided into the US and the European ones. The APR+ design, based on the proven APR1400 design, was developed to fully comply with the US regulatory and utility requirements. It was also developed to improve the technical competitiveness and enlarge the export market share through design uniqueness and the improvement of safety. The robust design of safety and its validation were requested Post-Fukushima accident. So MMIS design and validation for reinforcing safety were accomplished in APR+ development project. In this paper, the design characteristics of soft control for APR+ are presented to enhance the safety of MMIS design. In this paper, the major design characteristics of soft control for APR+ were introduced to increase the safety of MMIS design. In addition to the design characteristics of soft control described above, the following should be investigated closely for APR+ to get into the global nuclear industry

Geographic proximity to treatment for early stage breast cancer and likelihood of mastectomy.

Science.gov (United States)

Boscoe, Francis P; Johnson, Christopher J; Henry, Kevin A; Goldberg, Daniel W; Shahabi, Kaveh; Elkin, Elena B; Ballas, Leslie K; Cockburn, Myles

2011-08-01

Women with early stage breast cancer who live far from a radiation therapy facility may be more likely to opt for mastectomy over breast conserving surgery (BCS). The geographic dimensions of this relationship deserve further scrutiny. For over 100,000 breast cancer patients in 10 states who received either mastectomy or BCS, a newly-developed software tool was used to calculate the shortest travel distance to the location of surgery and to the nearest radiation treatment center. The likelihood of receipt of mastectomy was modeled as a function of these distance measures and other demographic variables using multilevel logistic regression. Women traveling over 75 km for treatment are about 1.4 times more likely to receive a mastectomy than those traveling under 15 km. Geographic barriers to optimal breast cancer treatment remain a valid concern, though most women traveling long distances to receive mastectomies are doing so after bypassing local options. Copyright © 2011 Elsevier Ltd. All rights reserved.

COMPARISON OF HYPOFRACTIONATED RADIATION THERAPY VERSUS CONVENTIONAL RADIATION THERAPY IN POST MASTECTOMY BREAST CANCER

Directory of Open Access Journals (Sweden)

Abhilash

2016-03-01

Full Text Available INTRODUCTION Breast cancer is the most common cancer in women worldwide and a leading cause of cancer death in females and accounts for 1.8 million new cases and approximately 0.5 million deaths annually. Patients who present with locally advanced breast cancer (LABC require multidisciplinary team approach that incorporates diagnostic imaging, surgery, chemotherapy and histopathological assessment, including molecular-based studies, radiation, and, if indicated, biologic and hormonal therapies. Hypofractionated radiation therapy following mastectomy has been used in many institutions for several decades and have demonstrated equivalent local control, cosmetic and normal tissues between 50 Gy in 25 fractions and various hypofractionated radiotherapy prescriptions employing 13-16 fractions. Evidence suggests that hypofractionated radiotherapy may also be safe and effective for regional nodal disease. AIMS AND OBJECTIVES To compare the local control and side effects of hypofractionated radiation therapy with conventional radiation therapy in post mastectomy carcinoma breast with stage II and III and to compare the tolerability and compliance of both schedules. MATERIALS AND METHODS The study was conducted on 60 histopathologically proven patients of carcinoma of breast, treated surgically with modified radical mastectomy. Group I patients were given external radiation to chest flap and drainage areas, a dose of 39 Gy/13 fractions/3.1 weeks, a daily dose 3 Gy for 13 fractions in 4 days a week schedule and Group II patients were given external radiation to chest flap and drainage areas, a dose of 50 Gy/25 fractions/5 weeks, to receive a daily dose 2 Gy for 25 fractions in a 5 days a week schedule. RESULTS The median age at presentation in Group I and II was 48 and 50 years respectively. Locoregional control after completion of radiotherapy in Group I vs. Group II was 26/30 (86.7% vs. 27/30 (90% respectively. Acute reactions and their grades in Group

Sexual life after mastectomy in breast cancer survivors: A qualitative study.

Science.gov (United States)

Fouladi, Nasrin; Pourfarzi, Farhad; Dolattorkpour, Negin; Alimohammadi, Sara; Mehrara, Elham

2018-02-01

Mastectomy is a highly frequent form of breast cancer treatment in Iran, and sexual dysfunction after mastectomy has been reported in the majority of breast cancer survivors in Iran. In this qualitative study, an attempt was made to examine the stages that patients go through in their sexual lives after mastectomy. Using purposeful sampling, 30 married women, who had undergone surgery and had completed an adjuvant treatment period, participated in the study. Data collection was done using in-depth, open, and semistructured interviews. Content analysis was used. Two main categories were identified in the stages the patients go through following mastectomy: sexual function breakdown and restoration of sexual function, each of which involved 3 subcategories, in turn. Subcategories of the first category were perceived physical changes by the survivor and altered sexual behaviors. These 2 factors lead to sexual function breakdown. The third subcategory includes the factors exacerbating the sexual function breakdown. The subcategories of the second category were modification in sexual behaviors, effort for physical restoration, and striving to gain support. It was found that in Iranian society, due to cultural context, some taboos, and patriarchal structure, the patients are placed under added pressure following mastectomy. As a consequence, they suffer emotional problems, in addition to physical complications of the disease and its treatments. Copyright © 2017 John Wiley & Sons, Ltd.

Mastectomy by inverted drip incision and immediate reconstruction: data from 510 cases

NARCIS (Netherlands)

A.N. van Geel (Albert); C.M.E. Contant; R.T.J. Wai (Rudi Tjong Joe); P.I.M. Schmitz (Paul); A.M.M. Eggermont (Alexander); M.B.E. Menke-Pluymers (Marian)

2003-01-01

textabstractBACKGROUND: Immediate reconstruction of the breast can be performed in selected cases after mastectomy for breast cancer or after prophylactic mastectomy in patients with a high risk of developing breast cancer. Despite the frequency with which these procedures are

Factors associated with patients in the Scottish Highlands who chose mastectomy when suitable for breast conservation.

Science.gov (United States)

Shearer, Rosalyn; Rashid, Majid; Hubbard, Gill; Abbott, Nick; Daltrey, Ian; Mullen, Russell

2016-08-01

Despite being suitable for breast conservation surgery (BCS) a proportion of women choose mastectomy. This study aimed to assess the pre-operative pathological and geographic factors associated with choosing mastectomy rather than BCS in a single centre that serves a large geographical area encompassing urban, rural and remote island populations. A retrospective analysis of all patients suitable for BCS between January 2011 and December 2013 was undertaken. Pre-operative pathological features were compared using the Pearson chi squared test as was distance to the treatment centre from the patient's home. A questionnaire was sent to all those who chose mastectomy to identify the factors that influenced their decision. A total of 446 patients suitable for BCS were identified of which 46 (11%) chose to undergo mastectomy. Patients choosing mastectomy were more likely to present symptomatically (P=0.009), have tumours larger than 20 mm at diagnostic imaging (P=0.001) and have positive axillary staging (P=0.004). Patients choosing mastectomy were more likely to live remotely (P=0.051). Those patients who chose mastectomy felt this gave a better long-term outcome (18 patients, 44%) and peace of mind (14 patients, 34%). Adverse pre-operative pathological features were associated with patients choosing mastectomy rather than BCS. There was a trend for patients who chose mastectomy to live remotely from the treatment centre. Patients choosing mastectomy most commonly cited a better long-term outcome and peace of mind as the reason behind their decision. Understanding what influences a patient's surgical choice will allow clinicians and patients to engage in a fully informed pre-operative decision making process.

Readability, complexity, and suitability of online resources for mastectomy and lumpectomy.

Science.gov (United States)

Tran, Bao Ngoc N; Singh, Mansher; Singhal, Dhruv; Rudd, Rima; Lee, Bernard T

2017-05-15

Nearly half of American adults have low or marginal health literacy. This negatively affects patients' participation, decision-making, satisfaction, and overall outcomes especially when there is a mismatch between information provided and the skills of the intended audience. Recommendations that patient information be written below the sixth grade level have been made for over three decades. This study compares online resources for mastectomy versus lumpectomy using expanded metrics including readability level, complexity, and density of data and overall suitability for public consumption. The 10 highest ranked Web sites for mastectomy and lumpectomy were identified using the largest Internet engine (Google). Each Web site was assessed for readability (Simple Measure of Gobbledygook), complexity (PMOSE/iKIRSCH), and suitability (Suitability Assessment of Materials). Scores were analyzed by each Web site and overall. Readability analysis showed a significant reading grade level difference between mastectomy and lumpectomy online information (15.4 and 13.9, P = 0.04, respectively). Complexity analysis via PMOSE/iKIRSCH revealed a mean score of 6.5 for mastectomy materials corresponding to "low" complexity and eighth to 12 th grade education. Lumpectomy literature had a lower PMOSE/iKIRSCH score of 5.8 corresponding to a "very low" complexity and fourth to eighth grade education (P = 0.05). Suitability assessment showed mean values of 41% and 46% (P = 0.83) labeled as the lowest level of "adequacy" for mastectomy and lumpectomy materials, respectively. Inter-rater reliability was high for both complexity and suitability analysis. Online resources for the surgical treatment of breast cancer are above the recommended reading grade level. The suitability level is barely adequate indicating a need for revision. Online resources for mastectomy have a higher reading grade level than do materials for lumpectomy and tend to be more complex. Copyright © 2017 Elsevier

Ultrasonic dissection versus electrocautery in mastectomy for breast cancer - a meta-analysis.

Science.gov (United States)

Currie, A; Chong, K; Davies, G L; Cummins, R S

2012-10-01

Electrocautery has advanced the practice of mastectomy but significant morbidity, such as seroma and blood loss, remains a concern. This has led to newer forms of dissection being introduced including the ultrasonic dissection devices, which are thought to reduce tissue damage. The aim of this systematic review was to compare the outcomes after mastectomy using novel ultrasonic dissection or standard electrocautery in published trials. Medline, Embase, trial registries, conference proceedings and reference lists were searched for comparative trials of ultrasonic dissection versus electrocautery for mastectomy. The primary outcomes were total postoperative drainage, seroma development and intra-operative blood loss. Secondary outcomes were operative time and wound complications. Odds ratios were calculated for categorical outcomes and standardised mean differences for continuous outcomes. Six trials were included in the analysis of 287 mastectomies. There was no effect in total postoperative drainage (pooled analysis weight mean difference: -0.21 (95% CI: -0.70-0.29); p = 0.41) or seroma development (pooled analysis odds ratio: 0.77 (95% CIs 0.43-1.37); p = 0.37). Intra-operative blood was slightly less for ultrasonic dissection compared to standard electrocautery (pooled analysis weight mean difference: -1.04 (95% CI: -2.00 to -0.08); p = 0.03). Ultrasonic dissection and standard electrocautery had similar outcomes with regard to operative time and wound complications. Ultrasonic dissection and standard electrocautery appear to deliver similar results in the mastectomy setting. Further cost-effectiveness analysis may guide surgeon selection in the use of new technologies for mastectomy. Copyright © 2012 Elsevier Ltd. All rights reserved.

Post-external radiotherapy hypothyroidism: 15 cases; Hypothyroidie apres radiotherapie externe. A propos de 15 cas

Energy Technology Data Exchange (ETDEWEB)

Kaffel, N.; Mnif, M.; Abid, M. [Centre Hospitalier Universitaire Hedi Chaker, Sfax (Tunisia); Daoud, J. [Centre Hospitalier Universitaire Habib Bourguiba, Sfax (Tunisia)

2001-06-01

Post-external radiotherapy hypothyroidism: 15 cases. Hypothyroidism frequency is estimated to be between 10 and 45% after radiotherapy alone, and 40 to 67% after radiotherapy associated with thyroidectomy. This hypothyroidism is infra-clinical in 60% of the cases. Our study concerned 15 cases of hypothyroidism after external radiotherapy delivered between and 1991 and 1999. An irradiation of the cervical, cerebral and thorax regions was indicated for different types of cancers. Larynx carcinoma epidermoid was the most frequent cancer (seven cases); the radiation treatment used cobalt 60 with conventional fractionation, i.e., 2 Gy per treatment, five treatments a week. In nine cases, the hypothyroidism was discovered during a systematic examination; it was clinically evident in the six remaining cases. Hypothyroidism appeared after an irradiation dose average of 50 Gy (extremes 30-65 Gy). The average duration of the irradiation was about 7 weeks and the hypothyroidism appeared in a mean 22 months. In all cases, the substituting treatment was initiated with a favorable progression. Faced with the risk of hypothyroidism, it is necessary to check patients who have undergone external irradiation of the neck. (authors)

Body Image in Transmen: Multidimensional Measurement and the Effects of Mastectomy.

Science.gov (United States)

van de Grift, Tim C; Kreukels, Baudewijntje P C; Elfering, Lian; Özer, Müjde; Bouman, Mark-Bram; Buncamper, Marlon E; Smit, Jan Maerten; Mullender, Margriet G

2016-11-01

Transmen are generally dissatisfied with their breasts and often opt for mastectomy. However, little is known about the specific effects of this procedure on this group's body image. To prospectively assess the effect of mastectomy on the body image of transmen, including cognitive, emotional, and behavioral aspects. During a 10-month period, all transmen applying for mastectomy were invited to participate in this study. The 33 participants completed assessments preoperatively and at least 6 months postoperatively. Participants were surveyed on body satisfaction (Body Image Scale for Transsexuals), body attitudes (Multidimensional Body-Self Relations Questionnaire), appearance schemas (Appearance Schemas Inventory), situational bodily feelings (Situational Inventory of Body Image Dysphoria), body image-related quality of life (Body Image Quality of Life Inventory), and self-esteem (Rosenberg Self-Esteem Scale). Control values were retrieved from the literature and a college sample. Before surgery, transmen reported less positive body attitudes and satisfaction, a lower self-esteem and body image-related quality of life compared with cisgender men and women. Mastectomy improved body satisfaction most strongly, although respondents reported improvements in all domains (eg, decreased dysphoria when looking in the mirror and improved feelings of self-worth). Most outcome measurements were strongly correlated. Mastectomy improves body image beyond satisfaction with chest appearance alone. Body satisfaction and feelings of "passing" in social situations are associated with a higher quality of life and self-esteem. Copyright © 2016 The Authors. Published by Elsevier Inc. All rights reserved.

The Angelina Jolie Effect in Jewish Law: Prophylactic Mastectomy and Oophorectomy in BRCA Carriers

Directory of Open Access Journals (Sweden)

Sharon Galper Grossman

2015-10-01

Full Text Available Background: Following the announcement of actress Angelina Jolie’s prophylactic bilateral mastectomies and subsequent prophylactic oophorectomy, there has been a dramatic increase in interest in BRCA testing and prophylactic surgery. Objective: To review current medical literature on the benefits of prophylactic mastectomy and oophorectomy among BRCA-positive women and its permissibility under Jewish law. Results: Recent literature suggests that in BRCA-positive women who undergo prophylactic oophorectomy the risk of dying of breast cancer is reduced by 90%, the risk of dying of ovarian cancer is reduced by 95%, and the risk of dying of any cause is reduced by 77%. The risk of breast cancer is further reduced by prophylactic mastectomy. Prophylactic oophorectomy and prophylactic mastectomy pose several challenges within Jewish law that call into question the permissibility of surgery, including mutilation of a healthy organ, termination of fertility, self-wounding, and castration. A growing number of Jewish legal scholars have found grounds to permit prophylactic surgery among BRCA carriers, with some even obligating prophylactic mastectomy and oophorectomy. Conclusion: Current data suggest a significant reduction in mortality from prophylactic mastectomy and oophorectomy in BRCA carriers. While mutilation of healthy organs is intrinsically forbidden in Jewish law, the ability to preserve human life may contravene and even mandate prophylactic surgery.

Persistent pain after mastectomy with reconstruction.

LENUS (Irish Health Repository)

Hickey, Oonagh T

2011-09-01

To determine the prevalence of persistent postsurgical pain (PPSP) and its influence on functional status, and to examine associations between PPSP and single nucleotide polymorphisms of the catechol-O-methyltransferase (COMT) gene and the guanosine triphosphate cyclohydrolase 1 (GCH1) gene following mastectomy and reconstruction.

Randomized clinical trial of prevention of seroma formation after mastectomy by local methylprednisolone injection

DEFF Research Database (Denmark)

Qvamme, G; Axelsson, C. K.; Lanng, C

2015-01-01

: This was a double-blind randomized placebo-controlled intervention study of a single dose of 80 mg methylprednisolone versus saline on seroma formation after mastectomy. Patients were further classified according to the surgical axillary procedure: mastectomy with sentinel lymph node biopsy (M + SLNB) or mastectomy......BACKGROUND: Seroma formation, the most prevalent postoperative complication after mastectomy, is an inflammatory process that is potentially preventable via local steroid administration. This study investigated the effect of local steroid administration on seroma formation. METHODS...... with level I-II axillary lymph node dissection (M + ALND). Treatments were administered into the wound cavity via the drain orifice following removal of the drain on the first day after surgery. The primary endpoint was seroma formation; secondary endpoints included the frequency of side...

Effect of travel distance and time to radiotherapy on likelihood of receiving mastectomy.

Science.gov (United States)

Goyal, Sharad; Chandwani, Sheenu; Haffty, Bruce G; Demissie, Kitaw

2015-04-01

Breast-conserving surgery (BCS) followed by adjuvant radiation therapy (RT) is the standard of care for women with early-stage breast cancer as an alternative to mastectomy. The purpose of this study was to examine the relationship between receipt of mastectomy and travel distance and time to RT facility in New Jersey (NJ). Data were collected from a cohort of 634 NJ women diagnosed with early-stage breast cancer. In patients receiving RT, the precise RT facility was used, whereas in patients not receiving RT, surgeons were contacted to determine the location of RT referral. Travel distance and time to RT facility from the patients' residential address were modeled separately using multiple binomial regression to examine their association with choice of surgery while adjusting for clinical and sociodemographic factors. Overall, 58.5 % patients underwent BCS with median travel distance to the radiation facility of 4.8 miles (vs. 6.6 miles for mastectomy) and median travel time of 12.0 min (vs. 15.0 min for mastectomy). Patients residing > 9.2 miles compared with ≤ 9.2 miles from radiation facility were 44 % more likely to receive mastectomy. Additionally, patients requiring > 19 min compared with ≤ 19 min of travel time were 36 % more likely to receive mastectomy. These data found that travel distance and time from RT facility act as barriers to undergoing BCS in women with early-stage breast cancer. Despite being in an urban region, a significant number of women in NJ with early-stage breast cancer did not receive BCS.

The Effect of Mastectomy on Mood and Quality of Life in Breast Cancer Patients

Directory of Open Access Journals (Sweden)

H Esmaily

2008-10-01

Full Text Available Introduction: Breast cancer with 22.6% is the most common cancer in Iranian women and mastectomy is the treatment of choice in 81% of cases posted for surgery. Mastectomy can evoke feelings of mutilation, altered body image and decreased sexual attractiveness and function leading to mood disorders. In the last decades, final purpose of treatment strategies in breast cancer is creation of a life with good quality. In this regards, concern is rising about the impact of surgical treatments, especially mastectomy on patient`s quality of life. This study was conducted to determine the relationship of mastectomy with mood and quality of life in breast cancer patients. Methods: This descriptive-analytic study was done in 2005.Case group included mastectomy patients referring to the oncology clinics (n=50.The comparison group consisted of mammography candidates referring to women clinics in Imam Reza and Ghaeem Hospitals. Data collected was based on non-probability and purposeful sampling. The information collected included: demographic and medical information, social support questionnaire, POMS survey for measurement of mood. Quality of life was assessed with FPQOLI. Results: Pearson correlation coefficient showed a significant converse statistical relation between mood and quality of life score in mastectomy women (P<0.001. Independence T test showed that mood and quality of life in mastectomy group were lower than mammography candidate women (P=0.001, P<0.049. The general linear model test showed that group variable had the most effect on women`s mood (P<0.001. Also , mood was the most important factor that predicted level of quality of life in these women (P<0.001. Conclusion: Lack of attention to psychological and spiritual status of the patients after mastectomy may provide conditions for unstable mood and can finally disrupt their quality of life. But, nurses can identify patients with psychological tensions and introduce them to consultancy

Predictors for contralateral prophylactic mastectomy in breast cancer patients

Science.gov (United States)

Fu, Yun; Zhuang, Zhigang; Dewing, Michelle; Apple, Sophia; Chang, Helena

2015-01-01

Background: In recent years, radical breast cancer surgery has been largely replaced by breast conservation treatment, due to early diagnosis and more effective adjuvant treatment. While breast conservation is mostly preferred, the trend of bilateral mastectomy has risen in the United States. The aim of this study is to determine factors influencing patients’ choice for having contralateral prophylactic mastectomy (CPM). Methods: This is a retrospective study of 373 patients diagnosed with primary invasive breast cancer who were treated by bilateral or unilateral mastectomy (BM or UM) at the Revlon/UCLA Breast Center between Jan. 2002 and Dec. 2010. In the BM group, only those with unilateral breast cancer who chose CPM were included in the analysis. Results: When compared with the UM group, the following factors were found to be associated with BM: younger age, pre-menopausal, a family history of breast/ovarian cancer, BRCA mutation, more breast biopsies, history of breast augmentation, having MRI study within 6 months before the surgery, more likely to have reconstruction and sentinel lymph node biopsy (SLNB) and fewer had neoadjuvant/adjuvant chemotherapy/radiation. When patients with bilateral breast cancer were excluded, multivariate logistic regression analysis indicated younger patients with negative nodes, SLNB as the only nodal surgery and positive family history were significant factors predicting CPM and immediate reconstruction using tissue expanders or implants. Conclusion: Younger age, lower TN stage, requiring only SLNB and high risk family history predict contralateral prophylactic mastectomy. Tissue expander/implant-based reconstructions were more frequently chosen by patients with BM. PMID:26097557

Development of Core Simulator (CoSi) for APR1400 And Analysis of LPPT Result using APR1400-CoSi

International Nuclear Information System (INIS)

Moon, Sang-Rae; Kim, Yong-Bae; Lee, Eun-Ki

2014-01-01

According to NRC guidelines, Low Power Physics Test (LPPT) is required to be performed in low temperature/low pressure (160 .deg. C/42.2 kg/cm 2 ) as well as NOT/NOP (291.3 .deg. C/158.2 kg/cm 2 ) because Shin-Kori Unit 3 is FOAK nuclear power plant. Low Power Physics Test (LPPT) is essential to verify the nuclear design and robustness of reactor safety. LPPT consists of initial criticality, Point of Adding Heat (POAH), All Rod Out (ARO) Boron Concentration, Isothermal Temperature Coefficient (ITC), Control Rod Worth measurements and so on. KHNP-CRI has developed the Core Simulator for APR1400 (APR1400-CoSi) in order to improve the ability performing the LPPT. Especially, APR1400-CoSi has enhanced capability to calculate the full Core neutronic parameters by revising RAST-K that is three dimensional real time core kinetic program. APR1400-CoSi has been developed for education-training of Low Power Physics Test(LPPT). Particularly, APR1400-CoSi has an enhanced capability to calculate the full core neutronic parameters by revising RAST-K which is a three dimensional real time core kinetics program. Low Power Physics Test (LPPT) was performed using APR1400-CoSi and the results showed very similar values with the predicted ones. In other words, the initial core model of Shin-Kori Unit 3 in APR1400-CoSi system has been verified to be appropriate enough. Also, it was confirmed that the test range of Low Power Physics Test (LPPT) reamains effective even though the largest incremental bank reactivity is inserted in core by analyzing the power change during the rod SWAP test

Aesthetic results following partial mastectomy and radiation therapy

International Nuclear Information System (INIS)

Matory, W.E. Jr.; Wertheimer, M.; Fitzgerald, T.J.; Walton, R.L.; Love, S.; Matory, W.E.

1990-01-01

This study was undertaken to determine the aesthetic changes inherent in partial mastectomy followed by radiation therapy in the treatment of stage I and stage II breast cancer. A retrospective analysis of breast cancer patients treated according to the National Surgical Adjuvant Breast Project Protocol B-06 was undertaken in 57 patients from 1984 to the present. The size of mastectomy varied between 2 x 1 cm and 15 x 8 cm. Objective aesthetic outcome, as determined by physical and photographic examination, was influenced primarily by surgical technique as opposed to the effects of radiation. These technical factors included orientation of resections, breast size relative to size of resection, location of tumor, and extent and orientation of axillary dissection. Regarding cosmesis, 80 percent of patients treated in this study judged their result to be excellent or good, in comparison to 50 percent excellent or good as judged by the plastic surgeon. Only 10 percent would consider mastectomy with reconstruction for contralateral disease. Asymmetry and contour abnormalities are far more common than noted in the radiation therapy literature. Patients satisfaction with lumpectomy and radiation, however, is very high. This satisfaction is not necessarily based on objective criteria defining aesthetic parameters, but is strongly influenced by retainment of the breast as an original body part

Development of Reactor Coolant Pump for APR1400

Energy Technology Data Exchange (ETDEWEB)

Bang, Sang-Youn; Chu, Sung-Min; Chang, Jin-Young [Doosan Heavy Industries and Construction, Changwon (Korea, Republic of)

2015-10-15

The development was focused on the performance requirements for APR1400 and to achieve the goals of the safety, reliability and adaptability for APR1400 system design. In addition, APR1400 RCP design was customized considering convenience of installation, operation and maintainability. This paper describes the details of the development process, improved design feature and type test results. Based on development of core technology of RCP, DOOSAN supplies the localized and improved APR1400 RCP to Shin-Hanul 1 and 2 Project. This would be good experience that the RCP core technology can break foreign monopoly in supplying the domestic nuclear industry. Also, there expect APR1400 RCP can be sustainable revenue models in nuclear industry. Moreover, development of RCP will be a catalyst to enhance design capacity for equipment and system of nuclear power plant as well as evaluation and verification skills of Korean nuclear industry.

Rescue mastectomy in 192 breast cancer patients with T2 tumors larger than 3 cm or T3 tumors first treated by breast conservation protocols and followed-up for at least ten years

International Nuclear Information System (INIS)

Khayat, D.; Baillet, F.; Simon, J.M.; Sahraoui, S.; Voican, D.; Housset, M.

1997-01-01

Breast conservation therapy was used in 192 breast cancer patients treated between 1980 and 1986 for T2 tumors larger than 3 cm or T3 tumors. Primary chemotherapy was followed by external beam radiation therapy then by boost brachytherapy and adjuvant chemotherapy. Locoregional recurrences were treated whenever possible by tumor-ectomy and/or axillary node clearance. Median follow-up was 13 years. Of the three patients with local therapeutic failures at completion of the locoregional treatment, two were treated by tumor-ectomy and one by mastectomy. Subsequently, 21 mastectomies were performed, for oncological reasons in 20 cases. Overall survival was 55 % after five years, 60 % after ten years, and 56 % after 15 years. Local control rates were 82 %, 77 %, and 75 % after five, ten, and 15 years, respectively. After exclusion of the patients who required mastectomy, cosmetic results were satisfactory in 68 % of patients overall, 67 % of five-year survivors, and 73 % of ten-year survivors. These results show that the conventional approach involving routine initial mastectomy is no longer appropriate in patients with T3 or large T2 breast cancers. (authors)

Quilting after mastectomy significantly reduces seroma formation

African Journals Online (AJOL)

reduce or prevent seroma formation among mastectomy patients ... of this prospective study is to evaluate the effect of surgical quilting ... Seroma was more common in smokers (p=0.003) and was not decreased by the .... explain its aetiology.

What to Expect During a Mastectomy Surgery

Science.gov (United States)

... Médico Datos Para la Vida Komen Guía de herramientas de educación sobre el cancer de seno para ... reconstruction (called a skin-sparing mastectomy ). In some cases, the nipple may also be left intact (called ...

Use of skin stretchers for single-stage bilateral mastectomies in a dog and a cat.

Science.gov (United States)

Miyazaki, Yuta; Aikawa, Takeshi; Shimatsu, Taichi; Nishimura, Masaaki; Sadahiro, Shigeo

2018-04-01

To describe the application of skin stretchers for closure of single-stage bilateral mastectomies in a dog and a cat. Clinical case report. A 12-year-old intact female Miniature Dachshund and a 13-year-old spayed female domestic short-hair cat. Skin stretchers were applied to the site of the skin adjacent to mammary glands for 2-4 days before surgery. Cable tension was adjusted every 6-8 hours to elongate the skin and to achieve primary closure of single-stage bilateral mastectomy without tension. Wound closure after single-stage bilateral mastectomy was achieved without tension or major complication in both animals. Use of skin stretchers allows primary closure of single-stage bilateral mastectomy in dogs and cats. © 2017 The American College of Veterinary Surgeons.

Magnetic resonance imaging (MRI) evaluation of residual breast tissue following mastectomy and reconstruction with silicone implants.

Science.gov (United States)

Zippel, Douglas; Tsehmaister-Abitbol, Vered; Rundstein, Arie; Shalmon, Anat; Zbar, Andrew; Nardini, Gil; Novikov, Ilya; Sklair-Levy, Miri

2015-01-01

We present our use of magnetic resonance (MR) measurement to determine the amount of residual breast tissue (RBT) following total mastectomy with reconstruction. Breast MR images of 45 women who underwent surgery between January and November 2011 were reviewed. The cohort included therapeutic and prophylactic mastectomies. RBT was evaluated at four points with a digital caliper assessing T2-weighted and T1-weighted images. Patients undergoing mastectomy for carcinoma tended to have less RBT than in prophylactic surgery. Greater age and recent surgery both correlated with larger RBT. Variable thickness of RBT is demonstrable following mastectomy and implant reconstruction using MR imaging. Copyright © 2015 Elsevier Inc. All rights reserved.

ITAAC Development for APR1400 NRC Design Certification

International Nuclear Information System (INIS)

Kim, Jin Kwon; Kim, Myoung Ki

2013-01-01

ITAAC (Inspections, Tests, Analyses and Acceptance Criteria) is essential document for Design Certification, which is certified by NRC and ruled as the Appendix of the 10 CFR Part 52. Approximately 870 ITAAC items were selected for APR1400 Design Certification to be submitted to NRC. In this paper, the code and standard related to ITAAC and process of ITACC development are discussed to seek the way to complete the best ITAAC to get the Design Certification of APR1400 from NRC through the lessons learned from other competitive applicants. For saving the time and manpower to complete ITAAC of APR1400 NRC DC and reduction of the RAIs (Request Additional Information) from NRC, we took advantage of the lessons learned from the competitive designs like US-APWR and AP1000 based on KNGR ITAAC. Finally new and different ITAAC from ITAAC of KNGR was developed for APR1400 DC from NRC. RG 1.206 and SRPs were applied first in Korea to the APR1400 DCD preparation. For testability and acceptability check, ITAAC V and V table was completed by the system designers. APR1400 DCD will be submitted by the end of September this year and we hope that NRC issues lees RAIs on ITAAC document

Perception of body image and sexuality for women with mastectomy

DEFF Research Database (Denmark)

Thorup, Charlotte Brun; Laursen, Birgitte Schantz

affect women's perception of quality of life and psychosocial state.In Denmark, no previous studies have focused on perception of body image and sexuality in the acute phase after mastectomy. Furthermore, no study addresses the influence of perceived body image and sexuality on the decision to have...... to provide better quality nursing care to women treated with mastectomy and reconstruction. Results: It is expected that interviews, analysis and interpretation will be conducted in 2010.The results are expected to be edited and published in the beginning of 2011....

Coping after Mastectomy: Antecedents and Outcomes.

Science.gov (United States)

Heinemann, Allen W.; And Others

Psychological well-being following mastectomy is a concern of rehabilitation psychologists as the life expectancy of women treated for breast cancer is increasing. Well-being can be threatened by stress that these women may suffer from the diagnosis of cancer and amputation of a significant body part. A study was conducted to examine the…

Physical rehabilitation of women after mastectomy

Directory of Open Access Journals (Sweden)

Katarzyna Korabiusz

2017-07-01

Full Text Available Introduction: Breast cancer is one of the most frequent causes of death amongst women in Poland. This is why it is so important to minimize complications that occur after oncological treatment. Rehabilitation process is long and complex and rehabilitation should include psychological as well as physical area. Patients mostly suffer from lymphatic swellings of upper limbs on the side that was operated, pain and reduction in range of movement in shoulder joint. Goal of dissertation: Goal of this dissertation is a review of literature about available physiotherapy methods used in women following mastectomy. Conclusion: There are many physiotherapy methods used in women following mastectomy that improve their quality of life. Methods proposed in literature decrease lymphatic swelling of upper limb on operated side. They also increase range of movement in shoulder joint and reduce pain. The most often used methods are: manual and mechanical lymphatic drainage, self-massage, scar work, transdermal nerves stimulation TENS , kinesitherapy (individual as well as group exercises such as nordic walking, yoga, music therapy, choreotherapy, group gymnastics and anti-swelling kinesiotaping.

Male breast cancer: 20-year survival data for post-mastectomy radiotherapy.

Science.gov (United States)

Eggemann, Holm; Ignatov, Atanas; Stabenow, Roland; von Minckwitz, Gunter; Röhl, Friedrich Wilhelm; Hass, Peter; Costa, Serban-Dan

2013-08-01

The goal of this population-based study was to determine the impact of post-mastectomy radiation therapy on long-term overall survival (OS) of male patients with breast cancer. We investigated 20-year OS rates of 664 patients diagnosed with primary stage I-III breast cancer in former East Germany between 1970 and 1989. Patients had a radical mastectomy with axillary lymph node dissection without systemic adjuvant therapy. Median follow-up time was 26.2 years (range 19-38 years). 52.4% of the patients had post-mastectomy radiotherapy. Radiotherapy showed different effects in each stage group after 20 years. Whereas there was an OS trend for radiotherapy to harm patients with stage I disease (hazard ratio (HR) 1.45; 95% confidence interval (CI) 0.98-2.15; p = 0.065), radiotherapy showed no benefit in patients with stage II disease (HR 0.82; 95% CI 0.62-1.1; p = 0.15). There was a significant survival benefit for patients with stage III disease receiving radiotherapy (HR 0.60; 95% CI 0.41-0.88; p = 0.008). Post-mastectomy radiotherapy is associated with longer OS in male patients with stage III breast cancer. Male breast cancer patients at stages I and II do not seem to benefit from radiotherapy, but obsolete irradiation techniques might explain adverse long-term effects in earlier stages.

Optimization Strategy of the APR+ BOP Technical Specifications

International Nuclear Information System (INIS)

Cho, Yoon Sang; Lee, Jae Gon; Han, Sung Heum

2016-01-01

The BOP is one of the key factors for successful project implementation of NPP. In constructing the APR1400 NPP, the BOP procurement has been one of the biggest concerns. Due to the design changes and increased capacity of equipment in NPP, lots of BOPs should be ‘first supplied equipment’ [hereinafter, ‘FSE’]. The manufacture-ability, and the performances of FSEs have not been fully proved and tested, manufacturers and suppliers are requested to submit Reports for Equipment Qualification Evaluation in accordance with 10 CFR 50.49, IEEE 323. They need at least 1-2 years’ tests for Environment Qualification (EQ) and Seismic Qualification (SQ). This study is focused how to prepare the BOP purchase specifications in order to control the FSEs, especially in safety class equipment. With the optimization plan for BOP packages of this study, the FSEs’ occurrence can be reasonably controlled as low as possible. For successful NPP project, the concerns in procuring BOPs shall be fully analyzed beforehand. Now Korea is preparing new era of APR+, with closing the time of APR1400. The technical specification of APR+ BOPs can be developed and prepared successfully and very effectively according to this optimization plan. This will be a great contribution not only in constructing APR+ in time, but also in exporting APR+ overseas, all over the world in the future

Optimization Strategy of the APR+ BOP Technical Specifications

Energy Technology Data Exchange (ETDEWEB)

Cho, Yoon Sang; Lee, Jae Gon; Han, Sung Heum [KHNP CRI, Daejeon (Korea, Republic of)

2016-10-15

The BOP is one of the key factors for successful project implementation of NPP. In constructing the APR1400 NPP, the BOP procurement has been one of the biggest concerns. Due to the design changes and increased capacity of equipment in NPP, lots of BOPs should be ‘first supplied equipment’ [hereinafter, ‘FSE’]. The manufacture-ability, and the performances of FSEs have not been fully proved and tested, manufacturers and suppliers are requested to submit Reports for Equipment Qualification Evaluation in accordance with 10 CFR 50.49, IEEE 323. They need at least 1-2 years’ tests for Environment Qualification (EQ) and Seismic Qualification (SQ). This study is focused how to prepare the BOP purchase specifications in order to control the FSEs, especially in safety class equipment. With the optimization plan for BOP packages of this study, the FSEs’ occurrence can be reasonably controlled as low as possible. For successful NPP project, the concerns in procuring BOPs shall be fully analyzed beforehand. Now Korea is preparing new era of APR+, with closing the time of APR1400. The technical specification of APR+ BOPs can be developed and prepared successfully and very effectively according to this optimization plan. This will be a great contribution not only in constructing APR+ in time, but also in exporting APR+ overseas, all over the world in the future.

Mastectomy by inverted drip incision and immediate reconstruction: data from 510 cases

OpenAIRE

Geel, Albert; Contant, C.M.E.; Wai, Rudi Tjong Joe; Schmitz, Paul; Eggermont, Alexander; Menke-Pluymers, Marian

2003-01-01

textabstractBACKGROUND: Immediate reconstruction of the breast can be performed in selected cases after mastectomy for breast cancer or after prophylactic mastectomy in patients with a high risk of developing breast cancer. Despite the frequency with which these procedures are performed, data from large series of subpectoral implantation of silicone prostheses in combination with a skin-saving approach are lacking. METHODS: In this retrospective study, data on complications and late surgical ...

The APR1400 Core Design by Using APA Code System

International Nuclear Information System (INIS)

Choi, Yu Sun; Koh, Byung Marn

2008-01-01

The nuclear design for APR1400 has been performed to prepare the core model for Automatic Load Follow Operation Simulation. APA (ALPHA/ PHOENIXP/ ANC) code system is a tool for the multi-cycle depletion calculations for APR1400. Its detail versions for ALPHA, PHOENIX-P and ANC are 8.9.3, 8.6.1 and 8.10.5, respectively. The first and equilibrium core depletion calculations for APR1400 have been performed to assure the target cycle length and confirm the safety parameters. The parameters are satisfied within limitation about nuclear design criteria. This APR1400 core models will be based on the design parameters for APR1400 Simulator

Prediction of post-operative necrosis after mastectomy: A pilot study utilizing optical diffusion imaging spectroscopy

Directory of Open Access Journals (Sweden)

Xie Xian-Jin

2009-11-01

Full Text Available Abstract Introduction Flap necrosis and epidermolysis occurs in 18-30% of all mastectomies. Complications may be prevented by intra-operative detection of ischemia. Currently, no technique enables quantitative valuation of mastectomy skin perfusion. Optical Diffusion Imaging Spectroscopy (ViOptix T.Ox Tissue Oximeter measures the ratio of oxyhemoglobin to deoxyhemoglobin over a 1 × 1 cm area to obtain a non-invasive measurement of perfusion (StO2. Methods This study evaluates the ability of ViOptix T.Ox Tissue Oximeter to predict mastectomy flap necrosis. StO2 measurements were taken at five points before and at completion of dissection in 10 patients. Data collected included: demographics, tumor size, flap length/thickness, co-morbidities, procedure length, and wound complications. Results One patient experienced mastectomy skin flap necrosis. Five patients underwent immediate reconstruction, including the patient with necrosis. Statistically significant factors contributing to necrosis included reduction in medial flap StO2 (p = 0.0189, reduction in inferior flap StO2 (p = 0.003, and flap length (p = 0.009. Conclusion StO2 reductions may be utilized to identify impaired perfusion in mastectomy skin flaps.

Treatment of breast cancer with segmental mastectomy alone or segmental mastectomy plus radiation

International Nuclear Information System (INIS)

Kantorowitz, D.A.; Poulter, C.A.; Rubin, P.; Doane, K.; Patterson, E.; Sobel, S.H.; Dvoretsky, P.M.; Michalak, W.A.

1989-01-01

A retrospective review of the outcome of treatment for primary, Stage I and II breast cancer with segmental mastectomy (SGM) alone or segmental mastectomy plus postoperative irradiation (SGM + RT) at four Rochester, New York, city hospitals is reported. Between January 1971 and March 1984, 99 women were treated with SGM and 146 with SGM + RT. Groups were similar regarding significant clinical and histologic prognostic factors; they differed, however, in that the SGM group was considerably older, average = 72, than the SGM + RT group, average = 56). Among SGM patients, local and total locoregional failure was 26.44 and 35.2%, respectively. Local and total locoregional failure (7.6 and 12.4%, respectively) was significantly reduced among patients treated with SGM + RT (p<0.0001). Among SGM patients, there was scant advantage in enlarging the extent of resection from local excision (29.5% local failure) to wide local excision (27.3%) to quadrantectomy (22.2%). Among women receiving SGM + RT, similar rates of local failure occurred among patients receiving local excision (15.5%) and wide local excisiion (12.5%). By contrast, only 2.8% of those receiving quadrantectomy failed. Results are viewed as supportive of findings of NSABP-B06. Findings suggest that SGM constitutes inadequate treatment of Stage I and II breast cancer. Locoregional failure rates of 30-40% may be reduced to around 10% with postoperative irradiation. (author). 21 refs.; 1 fig.; 6 tabs

Minimising contralateral breast dose in post-mastectomy intensity-modulated radiotherapy by incorporating conformal electron irradiation

NARCIS (Netherlands)

van der Laan, Hans Paul; Korevaar, Erik W; Dolsma, Willemtje; Maduro, John H; Langendijk, Johannes A

PURPOSE: To assess the potential benefit of incorporating conformal electron irradiation in intensity-modulated radiotherapy (IMRT) for loco-regional post-mastectomy RT. PATIENTS AND METHODS: Ten consecutive patients that underwent left-sided mastectomy were selected for this comparative planning

Prophylactic Nipple-Sparing Mastectomy and Direct-to-Implant Reconstruction of the Large and Ptotic Breast

DEFF Research Database (Denmark)

Gunnarsson, Gudjon L; Bille, Camilla; Reitsma, Laurens C

2017-01-01

BACKGROUND: Nipple-sparing mastectomy with simultaneous hammock technique direct-to-implant reconstruction is increasingly offered to patients opting for risk-reducing mastectomy. Despite this promising method, patients with macromastia and ptotic breasts remain a challenging group to treat satis...

Locoregional post-mastectomy radiotherapy for breast cancer: literature review

International Nuclear Information System (INIS)

Noel, G.; Mazeron, J.J.

2000-01-01

Postoperative radiotherapy is controversial after radical mastectomy. Recent clinical trials have shown an increase in survival with this irradiation and conclusions of previous meta-analyses should be reconsidered and conclusions of previous meta-analyses should be reconsidered. The results of a large number of randomized clinical trials in which women received post-mastectomy radiotherapy or not have been renewed. These trials showed a decrease in locoregional failure with the use of postoperative radiotherapy but survival advantages have not been clearly identified. A large number of randomized clinical trials compared postoperative radiotherapy alone, chemotherapy alone and the association of the two treatments. They showed that chemotherapy was less active locally than radiotherapy and that radiotherapy and chemotherapy significantly increased both disease-free and overall survival rates in the groups which received postoperative radiotherapy. These favourable results were, however, obtained with optimal radiotherapy techniques and a relative sparing of lung tissue and cardiac muscle. Many retrospective clinical analyses concluded that results obtained in locoregional failure rate were poor and that these failures led to an increase in future risks. Both radiotherapy and systemic treatment should be delivered after mastectomy, reserved for patients with a high risk of with a diameter ≥ 5 cm. However, radiotherapy could produce secondary effects, and techniques of radiotherapy should be optimal. (author)

Antenna Pattern Range (APR)

Data.gov (United States)

Federal Laboratory Consortium — TheAntenna Pattern Range (APR)features a non-metallic arch with a trolley to move the transmit antenna from the horizon to zenith. At the center of the ground plane,...

Diagnostic Strategy in APR1400

International Nuclear Information System (INIS)

Kim, Dongyoung; Kim, Jonghyun

2013-01-01

These features may bring out changes in operator tasks, changing the characteristics of tasks, or creating new tasks. Diagnostic strategy for identifying anomaly may be different especially in APR1400 from that in the analog control room due to the change of human-system interface, i.e. alarm system and display system. Since the first plant of APR1400 is being built at this moment, it is not known what strategies the operators will adopt in diagnosis tasks in the new operating environment. In this light, this paper aims at investigating operator's diagnostic strategies which are appropriate for APR1400. In order to collect data, several different approaches which are complementary are used to identify diagnostic strategies in the digital control room: analysis on audio/video recording of operation, observation in the simulator, and interview with the operators. The result shows that the digital control room introduces new strategies in the diagnosis, compared with the analog control room, and also changed the characteristics of strategies, mostly, by getting more support from the computerized system. This paper investigated how the digitalized control room may influence operator's diagnostic strategies. Several different approaches, i. e., audio/video record, observation of training, and the interview with operators, were used to gather information about the operator's behaviors. As a conclusion, this paper figured out that the digital control room introduces new strategies in the diagnosis, compared with the analog control room, and also changed the characteristics of the strategies, mostly, by getting more support from the computerized system. The operators interviewed also commented that the diagnosis in the APR1400 is quicker, more correct, and easier, compared with the analog control room

Media Exposure and Genetic Literacy Skills to Evaluate Angelina Jolie's Decision for Prophylactic Mastectomy.

Science.gov (United States)

Abrams, Leah R; Koehly, Laura M; Hooker, Gillian W; Paquin, Ryan S; Capella, Joseph N; McBride, Colleen M

2016-01-01

To examine public preparedness to evaluate and respond to Angelina Jolie's well-publicized decision to have a prophylactic mastectomy. A consumer panel (n = 1,008) completed an online survey in November 2013, reporting exposure to Jolie's story, confidence applying genomic knowledge to evaluate her decision, and ability to interpret provided genetic risk information (genetic literacy skills). Linear and logistic regressions tested mediating/moderating models of these factors in association with opinions regarding mastectomies. Confidence with genomics was associated with increased genetic literacy skills and increased media exposure, with a significant interaction between the two. Confidence was also associated with favoring mastectomies for women with BRCA mutations, mediating the relationship with media exposure. Respondents were more likely to form opinions about mastectomies if they had high genetic literacy skills. These findings suggest that having higher genetic literacy skills may increase the public's ability to form opinions about clinical applications of genomic discovery. However, repeated media exposure to high-profile stories may artificially inflate confidence among those with low genetic literacy. © 2016 S. Karger AG, Basel.

A comparison of surgical complications between immediate breast reconstruction and mastectomy: the impact on delivery of chemotherapy--an analysis of 391 procedures.

Science.gov (United States)

Zhong, Toni; Hofer, Stefan O P; McCready, David R; Jacks, Lindsay M; Cook, Francis E; Baxter, Nancy

2012-02-01

To compare the postoperative complications after immediate breast reconstruction (IBR) versus mastectomy alone and to examine the impact on the delivery of chemotherapy. In this prospective series, there were 391 consecutive women who underwent mastectomy (243 mastectomy alone and 148 mastectomy and IBR). The outcome measures were complications (within 3 months after surgery) and time to adjuvant chemotherapy. Compared to the IBR group, patients in the mastectomy alone group were significantly older (P previous radiation or lumpectomy (P mastectomy alone (27.0% vs. 15.6%, P = 0.009). Univariate analyses revealed that mastectomy with IBR [odds ratio (OR) = 2, 95% confidence interval (CI) 1.21-2.30]; bilateral procedure (OR = 1.84, 95% CI 1.07-3.16); previous radiotherapy (OR = 2.4, 95% CI 1.29-4.47); and previous lumpectomy (OR = 1.84, 95% CI 1.11-3.03) were significant predictors of increased complications. With multivariable analysis, none of these variables were significantly associated with increased complications. 106 patients received adjuvant chemotherapy; median time from mastectomy to chemotherapy was 6.8 (0.71-15) weeks in the mastectomy alone group (n = 96) compared to 8.5 (6.3-11) weeks in the IBR group (n = 10) (P = 0.01). Although the incidence of overall and major postoperative complications was higher after IBR than mastectomy alone, there were no significant relationships in the multivariable analysis. IBR was associated with a modest increase in time to chemotherapy that was statistically but not clinically significant.

Helium Neon laser therapy for post mastectomy lymphedema and ...

African Journals Online (AJOL)

Mohamed M. Khalaf

2012-12-08

Dec 8, 2012 ... mastectomy lymphedema and shoulder mobility. Mohamed M. Khalaf *. ,1 .... neurological and orthopedic problems, or diabetes. The patients were ... included 15 patients who received placebo laser therapy in addition to ...

The relationship between the belief in a genetic cause for breast cancer and bilateral mastectomy.

Science.gov (United States)

Petrie, Keith J; Myrtveit, Solbjørg Makalani; Partridge, Ann H; Stephens, Melika; Stanton, Annette L

2015-05-01

Most women develop causal beliefs following diagnosis with breast cancer and these beliefs can guide decisions around their care and management. Bilateral mastectomy rates are increasing, although the benefits of this surgery are only established in a small percentage of women. In this study we investigated the relationship between causal beliefs and the decision to have a bilateral mastectomy. Women (N = 2,269) from the Army of Women's breast cancer research registry completed an online survey. Women were asked what they believed caused their cancer and responses were coded into 8 causal categories. Participants were also asked about the type of surgery they underwent following their breast cancer diagnosis. The odds ratios for having a double mastectomy were calculated for each causal category using random/bad luck as a referent category. Hormonal factors (22%) and genetics (19%) were the most common causal belief, followed by don't know (19%), environmental toxins (11%), negative emotions (9%), poor health behavior (8%), other (6%) and random/bad luck (6%). Compared with the referent category, the odds ratio of having a bilateral mastectomy was significantly higher in both the genetics and hormonal causal belief groups (OR = 2.36, 95% CI [1.38, 4.02] and OR = 1.98, 95% CI [1.16, 3.38], respectively). Beliefs in a genetic cause for breast cancer are common and are associated with high rates of bilateral mastectomy. This is despite evidence that the actual genetic contribution to breast cancer is much lower than perceived and that bilateral mastectomy is, in most cases, unlikely to improve survival. (PsycINFO Database Record (c) 2015 APA, all rights reserved).

Harmonic Scalpel versus Electrocautery Dissection in Modified Radical Mastectomy for Breast Cancer: A Meta-Analysis.

Science.gov (United States)

Huang, Jinbo; Yu, Yinghua; Wei, Changyuan; Qin, Qinghong; Mo, Qinguo; Yang, Weiping

2015-01-01

Despite the common use of conventional electrocautery in modified radical mastectomy for breast cancer, the harmonic scalpel is recently emerging as a dominant surgical instrument for dissection and haemostasis, which is thought to reduce the morbidity, such as seroma and blood loss. But the results of published trials are inconsistent. So we made the meta-analysis to assess the intraoperative and postoperative endpoints among women undergoing modified radical mastectomy with harmonic scalpel or electrocautery. A comprehensive literature search of case-control studies from PubMed, MEDLINE, EMBASE and Cochrane Library databases involving modified radical mastectomy with harmonic scalpel or electrocautery was performed. We carried out a meta-analysis of primary endpoints including postoperative drainage, seroma development, intraoperative blood loss and secondly endpoints including operative time and wound complications. We used odds ratios (ORs) with 95% confidence intervals (CIs) to evaluate the effect size for categorical outcomes and standardised mean differences (SMDs) for continuous outcomes. A total of 11 studies with 702 patients were included for this meta-analysis. There was significant difference in total postoperative drainage (SMD: -0.74 [95%CI: -1.31, -0.16]; Pelectrocautery in modified radical mastectomy for breast cancer. No difference was found as for operative time between harmonic scalpel dissection and standard electrocautery (SMD: 0.04 [95%CI: -0.41, 0.50]; P = 0.85). Compared to standard electrocautery, harmonic scalpel dissection presents significant advantages in decreasing postoperative drainage, seroma development, intraoperative blood loss and wound complications in modified radical mastectomy for breast cancer, without increasing operative time. Harmonic scalpel can be recommended as a preferential surgical instrument in modified radical mastectomy.

Seismic analysis of the APR1400 nuclear reactor system using a verified beam element model

Energy Technology Data Exchange (ETDEWEB)

Park, Jong-beom [Department of Mechanical Engineering, Yonsei University, 50 Yonsei-ro, Seodaemun-gu, Seoul 03722 (Korea, Republic of); Park, No-Cheol, E-mail: pnch@yonsei.ac.kr [Department of Mechanical Engineering, Yonsei University, 50 Yonsei-ro, Seodaemun-gu, Seoul 03722 (Korea, Republic of); Lee, Sang-Jeong; Park, Young-Pil [Department of Mechanical Engineering, Yonsei University, 50 Yonsei-ro, Seodaemun-gu, Seoul 03722 (Korea, Republic of); Choi, Youngin [Korea Institute of Nuclear Safety, 62 Gwahak-ro, Yuseong-gu, Daejeon 34142 (Korea, Republic of)

2017-03-15

Highlights: • A simplified beam element model is constructed based on the real dynamic characteristics of the APR1400. • Time history analysis is performed to calculate the seismic responses of the structures. • Large deformations can be observed at the in-phase mode of reactor vessel and core support barrel. - Abstract: Structural integrity is the first priority in the design of nuclear reactor internal structures. In particular, nuclear reactor internals should be designed to endure external forces, such as those due to earthquakes. Many researchers have performed finite element analyses to meet these design requirements. Generally, a seismic analysis model should reflect the dynamic characteristics of the target system. However, seismic analysis based on the finite element method requires long computation times as well as huge storage space. In this research, a beam element model was developed and confirmed based on the real dynamic characteristics of an advanced pressurized water nuclear reactor 1400 (APR1400) system. That verification process enhances the accuracy of the finite element analysis using the beam elements, remarkably. Also, the beam element model reduces seismic analysis costs. Therefore, the beam element model was used to perform the seismic analysis. Then, the safety of the APR1400 was assessed based on a seismic analysis of the time history responses of its structures. Thus, efficient, accurate seismic analysis was demonstrated using the proposed beam element model.

Seismic analysis of the APR1400 nuclear reactor system using a verified beam element model

International Nuclear Information System (INIS)

Park, Jong-beom; Park, No-Cheol; Lee, Sang-Jeong; Park, Young-Pil; Choi, Youngin

2017-01-01

Highlights: • A simplified beam element model is constructed based on the real dynamic characteristics of the APR1400. • Time history analysis is performed to calculate the seismic responses of the structures. • Large deformations can be observed at the in-phase mode of reactor vessel and core support barrel. - Abstract: Structural integrity is the first priority in the design of nuclear reactor internal structures. In particular, nuclear reactor internals should be designed to endure external forces, such as those due to earthquakes. Many researchers have performed finite element analyses to meet these design requirements. Generally, a seismic analysis model should reflect the dynamic characteristics of the target system. However, seismic analysis based on the finite element method requires long computation times as well as huge storage space. In this research, a beam element model was developed and confirmed based on the real dynamic characteristics of an advanced pressurized water nuclear reactor 1400 (APR1400) system. That verification process enhances the accuracy of the finite element analysis using the beam elements, remarkably. Also, the beam element model reduces seismic analysis costs. Therefore, the beam element model was used to perform the seismic analysis. Then, the safety of the APR1400 was assessed based on a seismic analysis of the time history responses of its structures. Thus, efficient, accurate seismic analysis was demonstrated using the proposed beam element model.

Diagnostic Strategy in APR1400

Energy Technology Data Exchange (ETDEWEB)

Kim, Dongyoung; Kim, Jonghyun [KEPCO International Nuclear Graduate School, Ulsan (Korea, Republic of)

2013-05-15

These features may bring out changes in operator tasks, changing the characteristics of tasks, or creating new tasks. Diagnostic strategy for identifying anomaly may be different especially in APR1400 from that in the analog control room due to the change of human-system interface, i.e. alarm system and display system. Since the first plant of APR1400 is being built at this moment, it is not known what strategies the operators will adopt in diagnosis tasks in the new operating environment. In this light, this paper aims at investigating operator's diagnostic strategies which are appropriate for APR1400. In order to collect data, several different approaches which are complementary are used to identify diagnostic strategies in the digital control room: analysis on audio/video recording of operation, observation in the simulator, and interview with the operators. The result shows that the digital control room introduces new strategies in the diagnosis, compared with the analog control room, and also changed the characteristics of strategies, mostly, by getting more support from the computerized system. This paper investigated how the digitalized control room may influence operator's diagnostic strategies. Several different approaches, i. e., audio/video record, observation of training, and the interview with operators, were used to gather information about the operator's behaviors. As a conclusion, this paper figured out that the digital control room introduces new strategies in the diagnosis, compared with the analog control room, and also changed the characteristics of the strategies, mostly, by getting more support from the computerized system. The operators interviewed also commented that the diagnosis in the APR1400 is quicker, more correct, and easier, compared with the analog control room.

Evolution in Monitoring of Free Flap Autologous Breast Reconstruction after Nipple-Sparing Mastectomy: Is There a Best Way?

Science.gov (United States)

Frey, Jordan D; Stranix, John T; Chiodo, Michael V; Alperovich, Michael; Ahn, Christina Y; Allen, Robert J; Choi, Mihye; Karp, Nolan S; Levine, Jamie P

2018-05-01

Free flap monitoring in autologous reconstruction after nipple-sparing mastectomy remains controversial. The authors therefore examined outcomes in nipple-sparing mastectomy with buried free flap reconstruction versus free flap reconstruction incorporating a monitoring skin paddle. Autologous free flap reconstructions with nipple-sparing mastectomy performed from 2006 to 2015 were identified. Demographics and operative results were analyzed and compared between buried flaps and those with a skin paddle for monitoring. Two hundred twenty-one free flaps for nipple-sparing mastectomy reconstruction were identified: 50 buried flaps and 171 flaps incorporating a skin paddle. The most common flaps used were deep inferior epigastric perforator (64 percent), profunda artery perforator (12.1 percent), and muscle-sparing transverse rectus abdominis myocutaneous flaps (10.4 percent). Patients undergoing autologous reconstructions with a skin paddle had a significantly greater body mass index (p = 0.006). Mastectomy weight (p = 0.017) and flap weight (p < 0.0001) were significantly greater in flaps incorporating a skin paddle. Comparing outcomes, there were no significant differences in flap failure (2.0 percent versus 2.3 percent; p = 1.000) or percentage of flaps requiring return to the operating room (6.0 percent versus 4.7 percent; p = 0.715) between groups. Buried flaps had an absolute greater mean number of revision procedures per nipple-sparing mastectomy (0.82) compared with the skin paddle group (0.44); however, rates of revision procedures per nipple-sparing mastectomy were statistically equivalent between the groups (p = 0.296). Although buried free flap reconstruction in nipple-sparing mastectomy has been shown to be safe and effective, the authors' technique has evolved to favor incorporating a skin paddle, which allows for clinical monitoring and can be removed at the time of secondary revision. Therapeutic, III.

Personality Traits and Decision on Breast Reconstruction in Women after Mastectomy.

Science.gov (United States)

Miśkiewicz, Halina; Antoszewski, Bogusław; Iljin, Aleksandra

2016-09-01

The aim of the study was evaluation of the correlation between selected personality traits in women after mastectomy and their decision on breast reconstruction. The study was conducted between 2013‑2015, in the Department of Plastic, Reconstructive and Aesthetic Surgery, Medical University of Lodz, and Department of Oncological and Breast Surgery, CZMP. Comparative analysis comprised 40 patients, in whom mastectomy and breast reconstruction was done, and 40 women after breast amputation, who did not undergo reconstructive surgery. Basing on self-constructed questionnaire, five features of personality were evaluated in these women: pursue of success in life, ability to motivate others, openness to other people, impact of belonging to a social group on sense of security and the importance of opinion of others about the respondent. Apart from the questionnaire, in both groups of women a psychologic tool was used (SUPIN S30 and C30 tests) to determine the intensity of positive and negative emotions. Women who did not choose the reconstructive option were statistically significantly older at mastectomy than women who underwent breast reconstruction. There were statistically significant differences between both groups in response to question on being open to other people and value of other people's opinion. The differences in responses to question on the impact of belonging to a social group on personal sense of safety were hardly statistically significant. In psychometric studies there were significant differences in responses to SUPIN C30 test for negative emotions and S-30 for positive emotions. The level of negative emotions - feature of group A was in 47.5% in the range of high scores and in 47.5% within low and low-average scores. Among women from group B 57.5% had high scores, while 37.5% low and average scores. There were significant differences in the results of positive emotions evaluation in S-30. Women who did not undergo breast reconstruction usually had

Comparison of early quality of life in patients treated with radiotherapy following mastectomy or breast conservation therapy: A prospective study

International Nuclear Information System (INIS)

Munshi, Anusheel; Dutta, Debnarayan; Kakkar, Sajal; Budrukkar, Ashwini; Jalali, Rakesh; Sarin, Rajiv; Gupta, Sudeep; Parmar, Vani; Badwe, Rajendra

2010-01-01

Introduction: To compare quality of life (QOL) in breast cancer patients from a developing country after breast conservation surgery (BCS) or mastectomy and adjuvant radiotherapy (RT). Materials and methods: In a 6-month period, all consecutive early and locally advanced breast cancer patients treated with either BCS or mastectomy and treated with RT were analyzed. All patients who underwent mastectomy were treated with 45 Gray/20/4 weeks. Patients with BCS were treated with a dose of 45-50 Gray/25/5 weeks to whole breast followed by tumor bed boost (15 Gray/6/6 days with suitable energy electrons). Prospective evaluation of QOL using EORTC QLQ C30 and breast cancer specific QLQ BR23 was done before starting RT (baseline), at mid-RT and at RT conclusion for all patients. Results: One hundred and thirteen patients had mastectomy and 142 patients underwent BCS. Reliability test (Cronbach alpha) for questionnaire filling was 0.669-0.886. At pre-RT assessment, global QOL scores in mastectomy and BCS groups were 71.1 and 71.3, respectively. There was no significant difference in pre-RT EORTC QLQ C30 functional and symptom domains between mastectomy and BCS patients. However, social function domain score was higher in patients who underwent mastectomy (83 versus 73.9; p = 0.018). In QLQ BR23 domains, body image and sexual functioning domains were similar between the two groups. However, sexual enjoyment (10.9 versus 47.6; p = 0.006) and future perspective (7.4 versus 37.1; p = 0.036) domains were significantly better in BCS arm. There was no difference between systemic side effect (BRSSE), breast symptom (BRBS) and arm symptom (BRAS) domain scores between the groups. There was no significant difference in change of QOL scores between mastectomy and BCS patients at RT completion as compared to baseline. Conclusions: There was no significant difference in quality of life in patients with BCS versus those with mastectomy. However, patients who underwent BCS had better

Post-mastectomy radiation therapy and overall survival after neoadjuvant chemotherapy.

Science.gov (United States)

Kantor, Olga; Pesce, Catherine; Singh, Puneet; Miller, Megan; Tseng, Jennifer; Wang, Chi-Hsiung; Winchester, David J; Yao, Katharine

2017-05-01

The role of postmastectomy radiation therapy (PMRT) after neoadjuvant chemotherapy (NAC) and mastectomy is unclear, especially in patients that have post-treatment tumor negative axillary nodes (ypN0). The National Cancer Data Base was used to identify women that had PMRT after NAC and mastectomy for clinically node positive (cN1-2) disease from 2004 to 2008. Median follow-up time was 69 months. 8,321 patients were included for analysis, and 6140 (65.6%) had cN1 disease and 2181 (23.3%) had cN2 disease. On adjusted survival analysis, PMRT was associated with an overall survival (OS) benefit in both patients with cN1 (5-yr OS 75.8% vs. 71.9%, P  0.11) for PMRT compared to those patients who were not ypN0, except for patients with hormone-receptor negative tumors, who had improved OS with PMRT (HR 0.65, P < 0.01). PMRT is associated with improved OS in patients with cN1 and cN2 disease after NAC and mastectomy. However, in the subgroup of patients that were ypN0 after NAC, PMRT improved OS for hormone-receptor negative patients but not hormone-receptor positive patients. © 2017 Wiley Periodicals, Inc.

Aircraft Impact Assessment of APR1400 Reactor Containment Building

International Nuclear Information System (INIS)

Moon, Il Hwan; Kim, Do Yeon; Kim, Jae Hee; Kim, Sang Yun

2011-01-01

The implementation of a protection to withstand aircraft impact on safety-related structures and systems is basically based on a probabilistic evaluation for each site, if the licensing body doesn't require a deterministic approach. Existing nuclear power plants in Korea were designed based on the probabilistic approach, and the aircraft impact hazard remained less than a probability of 10 -7 . However, a man-made aircraft impact have been considered as a possible external accident for the nuclear power plant. New plant designs that are to be constructed in the U.S. after July 2009 must consider the effect of impact from a large commercial aircraft according to the requirements of 10 CFR 50.150. Especially, Reactor Containment Building (RCB) housing the safety-related equipment and fuels should be protected safely against aircraft crash without perforation and scabbing failure of external wall. APR1400 RCB is constructed as a prestressed concrete containment vessel (PCCV) which is surrounded by the auxiliary building housing additional safety-related equipment and other systems. In this study, the aircraft impact analyses for the RCB are carried out using Riera forcing function and aircraft model. Considered external wall thickness is 4 ft 6 in. for the cylindrical wall and 4 ft for the dome. Actual strengths of concrete and steel are considered as the material properties. For these analyses, the dynamic increment factor and concrete aging effect are considered in accordance with NEI 07-13(2011)

Decision-making process of women carrying a BRCA1 or BRCA2 mutation who have chosen prophylactic mastectomy.

Science.gov (United States)

McQuirter, Megan; Castiglia, Luisa Luciani; Loiselle, Carmen G; Wong, Nora

2010-05-01

To explore the decision-making process of women with a BRCA1 or BRCA2 gene mutation who have chosen to undergo prophylactic mastectomy. Cross-sectional, qualitative, descriptive design. Participants were recruited from an outpatient cancer prevention center in the oncology and medical genetics departments of a large university-affiliated hospital in Montreal, Quebec, Canada. 10 women carrying a BRCA1 or BRCA2 mutation; 8 previously had had a prophylactic mastectomy and 2 were scheduled for surgery at the time of study. Semistructured, in-depth interviews were conducted. Field notes were written and audiotapes were transcribed verbatim. The textual data were coded and analyzed. Decision-making process for prophylactic mastectomy. Two broad findings emerged. First, several intrapersonal and contextual factors interacted throughout the process to move women either closer to choosing a prophylactic mastectomy or further from the decision. Second, all women reported experiencing a "pivotal point," an emotionally charged event when the decision to have a prophylactic mastectomy became definitive. Pivotal points for patients included either receiving a positive result for a genetic mutation or a breast cancer diagnosis for herself or a family member in the context of positive mutation status. Decision making about prophylactic mastectomy was an affective and intuitive process incorporating contexts and their relations rather than a rational, straight-forward process of weighing pros and cons. Supportive interventions for women in this population should explicitly address the individual and the inter-relationships of contextual factors that shape decision making about prophylactic mastectomy while recognizing important affective components involved.

Pseudomonas syringae evades host immunity by degrading flagellin monomers with alkaline protease AprA.

Science.gov (United States)

Pel, Michiel J C; van Dijken, Anja J H; Bardoel, Bart W; Seidl, Michael F; van der Ent, Sjoerd; van Strijp, Jos A G; Pieterse, Corné M J

2014-07-01

Bacterial flagellin molecules are strong inducers of innate immune responses in both mammals and plants. The opportunistic pathogen Pseudomonas aeruginosa secretes an alkaline protease called AprA that degrades flagellin monomers. Here, we show that AprA is widespread among a wide variety of bacterial species. In addition, we investigated the role of AprA in virulence of the bacterial plant pathogen P. syringae pv. tomato DC3000. The AprA-deficient DC3000 ΔaprA knockout mutant was significantly less virulent on both tomato and Arabidopsis thaliana. Moreover, infiltration of A. thaliana Col-0 leaves with DC3000 ΔaprA evoked a significantly higher level of expression of the defense-related genes FRK1 and PR-1 than did wild-type DC3000. In the flagellin receptor mutant fls2, pathogen virulence and defense-related gene activation did not differ between DC3000 and DC3000 ΔaprA. Together, these results suggest that AprA of DC3000 is important for evasion of recognition by the FLS2 receptor, allowing wild-type DC3000 to be more virulent on its host plant than AprA-deficient DC3000 ΔaprA. To provide further evidence for the role of DC3000 AprA in host immune evasion, we overexpressed the AprA inhibitory peptide AprI of DC3000 in A. thaliana to counteract the immune evasive capacity of DC3000 AprA. Ectopic expression of aprI in A. thaliana resulted in an enhanced level of resistance against wild-type DC3000, while the already elevated level of resistance against DC3000 ΔaprA remained unchanged. Together, these results indicate that evasion of host immunity by the alkaline protease AprA is important for full virulence of strain DC3000 and likely acts by preventing flagellin monomers from being recognized by its cognate immune receptor.

Autologous inferior dermal sling (autoderm) with concomitant skin-envelope reduction mastectomy: an excellent surgical choice for women with macromastia and clinically significant ptosis.

Science.gov (United States)

Dietz, Jill; Lundgren, P; Veeramani, A; O'Rourke, C; Bernard, S; Djohan, R; Larson, J; Isakov, R; Yetman, R

2012-10-01

Skin-sparing mastectomy and prosthetic reconstruction can be complicated by poor surgical outcomes in large-breasted, obese women. This article describes a single surgeon's experience comparing conventional skin-sparing mastectomy (SSM) and skin-reduction mastectomy using an autologous vascularized inferior dermal/cutaneous sling (autoderm). From July 2007 to May 2012, patients undergoing skin-sparing mastectomy were evaluated for surgical outcomes. After July 2009, the surgeon performed skin-reduction mastectomies with autoderm (SRM-AD) on all patients with macromastia or grade 3-4 ptosis. Remaining patients in this time period (SSM-cont) underwent conventional skin-sparing mastectomies while all previous patients (historical) also underwent skin-sparing mastectomies (SSM-hist). A predictive model was used to compare the large historical patients (who would have had reduction mastectomy if available) with the smaller historical patients to evaluate the effect of the procedure. Body mass index (BMI) and specimen weight were higher in both the SRM group and large historical group. The hazard ratio for having skin-reduction mastectomy was 0.53 (P = 0.51) compared with the historical group. There was a total of 16 complications for the whole study. Smoking was the only significant risk factor. This study shows that mastectomy with prosthetic reconstruction using a skin-reduction technique with autoderm can be done safely with a low complication rate and improved cosmetic outcomes in the traditionally "at-risk" group of women with high BMI and large ptotic breasts.

Development of Reference Source Terms for EU-APR1400

Energy Technology Data Exchange (ETDEWEB)

Kim, ByungIl; Lee, Chonghui; Lee, Dongsu; Ko, Heejin; Kang, Sangho [KEPCO Engineering and Construction Co. Inc., Yongin (Korea, Republic of)

2014-05-15

These source terms are developed for the typical U. S. NPP and do not reflect the design characteristics of EU-APR1400 (1,400 MWe PWR) which will be applied for the EUR certification in European countries. The process of developing the RST for EU-APR1400 is to undergo a similar process that NUREG-1465 had gone through when it came out with its proposed source terms. The purpose of this study is to develop the EU-APR1400 design-specific RST complied with the EUR. The Large LOCA is the reference equence used in the NUREG-1465 evaluation, whereas the EUAPR1400 risk-significant sequences are dominated by small LOCA and non-LOCA sequences. Moreover, when considering the EU-APR1400 has many design features to mitigate the consequences of severe accident phenomena, it is not surprising that the aspects of both release fractions and durations are distinctly different from NUREG-1465. This RST will be continuously updated to reflect to the design features of EU-APR1400, and then, be used as the reference for design purposes such as criteria satisfaction of radioactivity releases, equipment survivability, control room habitability for severe accident, and so on.

EU-APR Design in compliance with EUR Grid Requirement

Energy Technology Data Exchange (ETDEWEB)

Kim, Dong-Hwan; Lee, Keun-Sung [KHNP CRI, Daejeon (Korea, Republic of)

2016-10-15

European Utility Requirements (EUR) provides technical requirements for the generation III nuclear power plant in the European countries. EUR grid requirements present the plant requirements to satisfy the needs of the grid network. The grid requirements are the precondition for the operation of a generating plant on the network. This paper describes EU-APR design which has taken account of EUR grid requirements. In this paper, EU-APR designs according to the EUR grid requirements were described. EU-APR was designed in compliance with the voltage and frequency operation field and also designed to have the capability of load following such as primary control, secondary control, and daily load following. Consequently, the EU-APR design according to the EUR grid requirements is expected to get competitiveness and enhance the license feasibility in the European nuclear market.

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.

Robotic da Vinci Xi-assisted nipple-sparing mastectomy: First clinical report.

Science.gov (United States)

Sarfati, Benjamin; Honart, Jean-Francois; Leymarie, Nicolas; Rimareix, Francoise; Al Khashnam, Heba; Kolb, Frederic

2018-05-01

Nipple-sparing mastectomy (NSM) is increasingly popular for the treatment of selected breast cancers and prophylactic mastectomy. Surgical scarring and esthetic outcomes are important patient-related cosmetic considerations. Today, the concept of minimally invasive surgery has become popular, especially using robotic surgery. The authors report the first case of NSM using the latest version of the da Vinci Xi surgical system (Xi). The final incision used to remove the entire mammary gland was located behind the axillary line. In this position, hidden by the arm of the patient, the incision was not visible and was compatible with immediate breast reconstruction. © 2017 Wiley Periodicals, Inc.

A Probability Analysis of the Generating Cost for APR1000+

Energy Technology Data Exchange (ETDEWEB)

Ha, Gag-Hyeon; Kim, Dae-Hun [KHNP CRI, Daejeon (Korea, Republic of)

2016-10-15

The nuclear power plant market is expected to grow rapidly in order to address issues of global warming, cutting CO{sub 2} emissions and securing stable electricity supplies. Under these circumstances, the main primary goal of the APR1000+ development is to ensure export competitiveness in the developing countries in the Middle East and Southeast Asia. To that end, APR1000+(1,000MWe, 3.5 generation) will be developed based on APR+ (1,500MWe, 3.5 generation). And comparing to OPR1000(Korean Standard Nuclear power Plant, 2.5 generation), APR1000+ have many design features such as the 60 year design life time, comprehensive site requirement of 0.3g seismic design, stability improvement, operability improvement and provisions for severe accidents. In this simulation, the results of generating cost for APR1000+ preliminary conceptual design using a probability method was shown to be 48.37 ~ 74.22 won/kWh(median value 56.51 won/kWh). Those of OPR1000 was 42.08 ~ 61.77 won/kWh(median value 48.63 won/kWh). APR1000+ has -16.2% cost advantage over OPR1000 nuclear power plant. The main reason of this results is due to adding several safety designs.

Radiotherapy of the chest wall following mastectomy for early-stage breast cancer: impact on local recurrence and overall survival

International Nuclear Information System (INIS)

Janni, Wolfgang; Dimpfl, Thomas; Braun, Stephan; Knobbe, Angelika; Peschers, Ursula; Rjosk, Dorothea; Lampe, Bjoern; Genz, Thomas

2000-01-01

Introduction: Recent studies have renewed an old controversy about the efficacy of adjuvant radiotherapy following mastectomy for breast cancer. Radiotherapy is usually recommended for advanced disease, but whether or not to use it in pT1-T2 pN0 situations is still being debated. This study was designed to clarify whether or not routine radiotherapy of the chest wall following mastectomy reduces the risk of local recurrence and if it influences the overall survival rate. Methods: Retrospective analysis of patients treated with mastectomy for pT1-T2 pN0 tumors and no systemic treatment. Patients treated with radiotherapy of the chest wall following mastectomy (Group A) are compared with those treated with mastectomy alone (Group B). Results: A total of 918 patients underwent mastectomy. Patients who received adjuvant radiotherapy after mastectomy (n = 114) had a significantly lower risk for local recurrence. Ten years after the primary diagnosis, 98.1% of the patients with radiotherapy were disease free compared to 86.4% of the patients without radiotherapy. The average time interval from primary diagnosis until local recurrence was 8.9 years in Group A and 2.8 years in Group B. The Cox regression analysis including radiotherapy, tumor size and tumor grading found the highest risk for local recurrence for patients without radiotherapy (p < 0.0004). In terms of overall survival however, the Kaplan-Meier analysis showed no difference between the two groups (p = 0.8787) and the Cox regression analysis failed to show any impact on overall survival. Conclusion: With observation spanning over 35 years, this study shows that adjuvant radiotherapy of the chest wall following mastectomy reduces the risk for local recurrence in node-negative patients with pT1-T2 tumors but has no impact on the overall survival rate

Post-mastectomy radiation in large node-negative breast tumors: Does size really matter?

International Nuclear Information System (INIS)

Floyd, Scott R.; Taghian, Alphonse G.

2009-01-01

Treatment decisions regarding local control can be particularly challenging for T3N0 breast tumors because of difficulty in estimating rates of local failure after mastectomy. Reports in the literature detailing the rates of local failure vary widely, likely owing to the uncommon incidence of this clinical situation. The literature regarding this clinical scenario is reviewed, including recent reports that specifically address the issue of local failure rates after mastectomy in the absence of radiation for large node-negative breast tumors.

The trauma registry compared to All Patient Refined Diagnosis Groups (APR-DRG).

Science.gov (United States)

Hackworth, Jodi; Askegard-Giesmann, Johanna; Rouse, Thomas; Benneyworth, Brian

2017-05-01

Literature has shown there are significant differences between administrative databases and clinical registry data. Our objective was to compare the identification of trauma patients using All Patient Refined Diagnosis Related Groups (APR-DRG) as compared to the Trauma Registry and estimate the effects of those discrepancies on utilization. Admitted pediatric patients from 1/2012-12/2013 were abstracted from the trauma registry. The patients were linked to corresponding administrative data using the Pediatric Health Information System database at a single children's hospital. APR-DRGs referencing trauma were used to identify trauma patients. We compared variables related to utilization and diagnosis to determine the level of agreement between the two datasets. There were 1942 trauma registry patients and 980 administrative records identified with trauma-specific APR-DRG during the study period. Forty-two percent (816/1942) of registry records had an associated trauma-specific APR-DRG; 69% of registry patients requiring ICU care had trauma APR-DRGs; 73% of registry patients with head injuries had trauma APR-DRGs. Only 21% of registry patients requiring surgical management had associated trauma APR-DRGs, and 12.5% of simple fractures had associated trauma APR-DRGs. APR-DRGs appeared to only capture a fraction of the entire trauma population and it tends to be the more severely ill patients. As a result, the administrative data was not able to accurately answer hospital or operating room utilization as well as specific information on diagnosis categories regarding trauma patients. APR-DRG administrative data should not be used as the only data source for evaluating the needs of a trauma program. Copyright © 2016 Elsevier Ltd. All rights reserved.

Evaluation of body esteem and mental health in patients with breast cancer after mastectomy

Directory of Open Access Journals (Sweden)

Mohammad Heidari

2015-01-01

Full Text Available Introduction: Mastectomy in patients with breast cancer can severely affect their body esteem. It also changes the emotions and attitudes of patients toward their body and causes psychological reactions such as depression, anxiety, and stress. Aims: This study was conducted with the aim of assessing correlation between body esteem and mental health in patients with breast cancer after mastectomy. Materials and Methods: This study is a descriptive study. One hundred patients with breast cancer after mastectomy were selected by convenience sampling from Seyed Al Shohada Hospital in Isfahan. Data gathering tools were questionnaires of body esteem and SCL-25 mental health and were analyzed by SPSS-PC (v.17. Results: According to the score of body esteem (2.80 and the overall average score for body esteem (36.46, patients had low body esteem. About dimensions of the mental health, the highest average was associated with depressive disorders. According to the results of the Spearman correlation coefficient, there was a direct linear relationship between body esteem and mental health. Conclusion: Considering the impact of mastectomy on body esteem and mental health and the relationship between the variables, nurses take steps for identifying and referring patients to the counseling centers to prevent psychological disorder aspects.

One-stage nipple and breast reconstruction following areola-sparing mastectomy.

Science.gov (United States)

Kim, Hye Ri; Lim, Jin Soo; Kim, Sue Min; Jung, Sung No; Yoo, Gyeol; Rha, Eun Young

2013-09-01

Skin-sparing mastectomy with immediate breast reconstruction is increasingly becoming a proven surgical option for early-stage breast cancer patients. Areola-sparing mastectomy (ASM) has also recently become a popular procedure. The purpose of this article is to investigate the reconstructive and aesthetic issues experienced with one-stage nipple and breast reconstruction using ASM. Among the patients who underwent mastectomy between March 2008 and March 2010, 5 women with a low probability of nipple-areolar complex malignant involvement underwent ASM and immediate breast reconstruction with simultaneous nipple reconstruction using the modified C-V flap. The cosmetic outcomes of this series were reviewed by plastic surgeons and patient self-assessment and satisfaction were assessed via telephone interview. During the average 11-month follow-up period, there were no cases of cancer recurrence, the aesthetic outcomes were graded as excellent to very good, and all of the patients were satisfied. Two patients developed a gutter-like depression around the reconstructed nipple, and one patient developed skin erosion in a small area of the areola, which healed with conservative dressing. The other complications, such as necrosis of the skin flap or areola, seroma, hematoma, or fat necrosis did not occur. Since one-stage nipple and breast reconstruction following ASM is an oncologically safe, cost-effective, and aesthetically satisfactory procedure, it is a good surgical option for early breast cancer patients.

Radiation exposure reduction in APR1400

International Nuclear Information System (INIS)

Bae, C. J.; Hwang, H. R.; Matteson, D. M.

2002-01-01

The primary contributors to the total occupational radiation exposure in operating nuclear power plants are operation and maintenance activities during refueling outages. The Advanced Power Reactor 1400 (APR1400) includes a number of design improvements and plans to utilize advanced maintenance methods and robotics to minimize the annual collective dose. The major radiation exposure reduction features implemented in APR1400 are a permanent refueling pool seal, quick opening transfer tube blind flange, improved hydrogen peroxide injection at shutdown, improved permanent steam generator work platforms, and more effective temporary shielding. The estimated average annual occupational radiation exposure for APR1400 based on the reference plant experience and an engineering judgment is determined to be in the order of 0.4 man-Sv, which is well within the design goal of 1 man-Sv. The basis of this average annual occupational radiation exposure estimation is an eighteen (18) month fuel cycle with maintenance performed to steam generators and reactor coolant pumps during refueling outage. The outage duration is assumed to be 28 days. The outage work is to be performed on a 24 hour per day basis, seven (7) days a week with overlapping twelve (12) hour work shifts. The occupational radiation exposure for APR1400 is also determined by an alternate method which consists of estimating radiation exposures expected for the major activities during the refueling outage. The major outage activities that cause the majority of the total radiation exposure during refueling outage such as fuel handling, reactor coolant pump maintenance, steam generator inspection and maintenance, reactor vessel head area maintenance, decontamination, and ICI and instrumentation maintenance activities are evaluated at a task level. The calculated value using this method is in close agreement with the value of 0.4 man-Sv, that has been determined based on the experience and engineering judgement

APR1400 Locked Rotor Transient Analysis using KNAP

International Nuclear Information System (INIS)

Lee, Dong-Hyuk; Kim, Yo-Han; Ha, Sang Jun

2007-01-01

KEPRI (Korea Electric Power Research Institute) has developed safety analysis methodology for non-LOCA (Loss Of Coolant Accident) analysis of OPR1000 (Optimized Power Reactor 1000, formerly KSNP). The new methodology, named KNAP (Korea Non-LOCA Analysis Package), uses RETRAN as the main system analysis code for most transients. For locked rotor transient DNBR analysis, UNICORN-TM code is used. UNICORN-TM is the unified code of RETRAN, MASTER and TORC. The UNICORN-TM has 1-D and 3-D neutron kinetics calculation capability. For locked rotor DNBR analysis, 1-D neutron kinetics is used. In this paper, we apply KNAP methodology to APR1400 (Advanced Power Reactor 1400) locked rotor analysis and compare the results with those in the APR1400 SSAR(Standard Safety Analysis Report). The locked rotor transient is one of the 'decrease in reactor coolant system flow rate' events and the results are typically described in the chapter 15.3.3 of SAR (Safety Analysis Report). In this study, to confirm the applicability of the KNAP methodology and code system to APR1400, locked rotor transient is analyzed using UNICORN-TM code and the results are compared with those from APR1400 SSAR

APR1400 Locked Rotor Transient Analysis using KNAP

Energy Technology Data Exchange (ETDEWEB)

Lee, Dong-Hyuk; Kim, Yo-Han; Ha, Sang Jun [Korea Electric Power Research Institute, Daejeon (Korea, Republic of)

2007-07-01

KEPRI (Korea Electric Power Research Institute) has developed safety analysis methodology for non-LOCA (Loss Of Coolant Accident) analysis of OPR1000 (Optimized Power Reactor 1000, formerly KSNP). The new methodology, named KNAP (Korea Non-LOCA Analysis Package), uses RETRAN as the main system analysis code for most transients. For locked rotor transient DNBR analysis, UNICORN-TM code is used. UNICORN-TM is the unified code of RETRAN, MASTER and TORC. The UNICORN-TM has 1-D and 3-D neutron kinetics calculation capability. For locked rotor DNBR analysis, 1-D neutron kinetics is used. In this paper, we apply KNAP methodology to APR1400 (Advanced Power Reactor 1400) locked rotor analysis and compare the results with those in the APR1400 SSAR(Standard Safety Analysis Report). The locked rotor transient is one of the 'decrease in reactor coolant system flow rate' events and the results are typically described in the chapter 15.3.3 of SAR (Safety Analysis Report). In this study, to confirm the applicability of the KNAP methodology and code system to APR1400, locked rotor transient is analyzed using UNICORN-TM code and the results are compared with those from APR1400 SSAR.

Design characteristics of EU-APR1400 on-site power system

International Nuclear Information System (INIS)

Kim, D.H.; Kim, Y.S.; Kim, Y.S.

2014-01-01

In the global nuclear market, US and European design requirements have been largely used to develop the design of nuclear power plants(NPPs). The APR1400 design was developed on the basis of US regulatory guide and EPRI utility requirements document(URD). In order to enlarge the export market of APR1400, KHNP (Korea Hydro & Nuclear Power Co., Ltd) has developed the EU-APR1400 design which complies with the European nuclear design requirements. In this paper, the design characteristics of EU-APR1400 on-site power system developed according to the European design requirements of electrical power system are described. The European main design requirements of electrical power system involve 50 Hz rated frequency, 400/110 kV grid voltage, the application of the diversity and the redundancy, and so on. The EU-APR1400 on-site power system has been developed on the basis of these requirements. The representative designs include the redundancy, diversity, independence design, the emergency power supply design, the design for providing electrical power to the dedicated severe accident systems, and the design for European grid requirements. (author)

[Accepting a mastectomy thanks to socio-aesthetics].

Science.gov (United States)

Arquillière, Agnès; Blanc, Nathalie

2012-12-01

For women of all ages, a mastectomy can affect their body image and femininity. Poor management, both physical and emotional, of a breast removal, can have major consequences on a patient's intimate, family and social life. In the framework of the multi-disciplinary treatment of breast cancer, a team in Lyon carried out a study on the impact of including socio-aesthetic practices in the overall care.

Conservative mastectomies and immediate reconstruction with the use of ADMs.

Science.gov (United States)

Govshievich, Alexander; Somogyi, Ron B; Brown, Mitchell H

2015-12-01

In recent years, a novel approach to immediate breast reconstruction has been introduced with the advent of acellular dermal matrix (ADM). In the setting of conservative mastectomies where the native skin envelope is preserved, placement of ADM at the lower pole in continuity with the pectoralis major muscle (PMM) provides additional support, allowing direct-to-implant breast reconstruction. The following manuscript presents the senior author's experience with ADM-assisted reconstruction and provides a detailed description of surgical technique along with a comprehensive discussion of patient selection and potential complications. A retrospective chart review of patients undergoing direct-to-implant breast reconstruction following skin sparing or nipple sparing mastectomy with the use of ADM (AlloDerm; LifeCell Corp., Branchburg, USA) was conducted at Women's College Hospital in Toronto over a 5-year period [2008-2013]. Demographic data, previous radiation therapy and post-operative complications were recorded. A total of 72 patients representing 119 breasts were identified. Average follow-up was 16 months (range, 3-51 months). Twenty-seven complications were recorded for a complication rate of 22.7% (27/119). Complications included six cases of capsular contracture (Baker III/IV), five cases of red skin syndrome, four cases of rippling, three cases of dehiscence and two cases of seroma. Overall, direct-to-implant reconstruction was successfully completed in 97.5% of breasts (116/119). One case of infection was treated with explantation and conversion to autogenous reconstruction. Two breasts with tissue necrosis or dehiscence had the implants removed and replaced with tissue expanders. Overall reoperation rate was 9.7% (7/72 patients). ADM assisted direct-to-implant breast reconstruction has been shown to be a safe option for women who are candidates for skin sparing or nipple sparing mastectomies. Judicious patient selection, effective collaboration between the

Favorable Outcome with Close Margins in Patients Undergoing Nipple/Skin Sparing Mastectomy with Immediate Breast Reconstruction: 5-year Follow-up

Directory of Open Access Journals (Sweden)

Enver Özkurt1

2018-02-01

Full Text Available Background: Implant-based breast reconstruction after mastectomy has recently been reported to be the preferred type of surgery among breast-specific surgeons and plastic surgeons. Aims: To explore the significant clinicopathological factors associated with long-term outcome related to local recurrences of the nipple among patients who underwent immediate breast reconstruction with tissue expander or implant after mastectomy. Study Design: Retrospective cohort. Methods: From January 2007 to January 2013, 51 breast cancer patients who underwent immediate breast reconstruction with tissue expander or implant were retrospectively analysed. Patients’ demographic data, clinicopathological characteristics, and clinical outcome by disease-free survival and disease-specific survival analyses were determined. Results: The median follow-up was 64 (31-114 months. Of the 57 mastectomies, 41 were skin sparing mastectomy (72% and 16 were nipple-areola sparing mastectomy (28%. Immediate breast reconstruction surgery included tissue expander (n=46, 81% or implant (n=11, 19% placement. The molecular subgroups of 47 invasive cancers were as follows: luminal A (n=23, 49%, luminal B (n=16, 34%, non-luminal HER2 (n=5, 10.6, triple negative breast cancer (n=3, 6.4%. The 5-years disease-specific survival, disease-free survival, and locoregional recurrence-free survival rates were 96.8%, 90%, and 97.6% respectively. Patients with luminal A cancer were found to have an improved 5-year disease-free survival time than other (luminal A; 100% vs. non-luminal A; 78%; p=0.028. Of the 14 nipple-areola sparing mastectomy, 13 had a close median tumour distance to nipple-areola complex (<20 mm with a 5-year locoregional recurrence free survival of 100%. Conclusion: Immediate breast reconstruction with implant or tissue expander can be safely applied in patients undergoing skin sparing mastectomy or nipple-areola sparing mastectomy. Patients with luminal-A type show the most

Aesthetic Female-to-Male Chest Transformation: Power of Combining Modified Mastectomy with a Pectoral Implant

Directory of Open Access Journals (Sweden)

Turkia Abbed, MD

2017-08-01

Full Text Available Summary:. Gender reassignment surgery has gained in popularity with increased media exposure and society’s recognition of gender dysphoria. Female-to-male gender reassignment often begins with the “top” or chest surgery. Mastectomy with free nipple grafting is the most frequently described technique in the literature. This technique is reliable yet lacks the ability to provide a true male chest shape. We discuss our technique for female-to-male “top” surgery combining traditional mastectomy techniques with a lower pole pedicle vascularized areola and a pectoral implant. A 32-year-old African American female with bilateral C cup breast with grade 2/3 ptosis presented for “top” surgery. Intraoperatively, the nipple areola complex was maintained on a lower pole pedicle at a thickness of 1.5 cm to maintain neurovascularity. A superior mastectomy flap was raised at the level of the breast capsule and remaining breast tissue excised. A lateral subpectoral pocket was created for insertion of a silicone pectoral implant. The new nipple position matured in the infero-lateral quadrant of greatest projecting portion of the chest. Lower pole pedicle provided vascularity to the areola, which avoids the need for a free nipple graft and potential hypopigmentation. Pectoral silicone implant provided upper pole fullness to mimic the male chest muscular distribution. Modification of mastectomy-based female-to-male gender reassignment surgery with a lower pole pedicle–based areola and pectoral implant provides an aesthetic improvement over the classic mastectomy with free nipple graft technique.

Surgical Management of Gynecomastia: Subcutaneous Mastectomy and Liposuction.

Science.gov (United States)

Kim, Dae Hwa; Byun, Il Hwan; Lee, Won Jai; Rah, Dong Kyun; Kim, Ji Ye; Lee, Dong Won

2016-12-01

The treatment of gynecomastia depends on multiple factors, and the best modality is controversial. In this study, we aimed to determine the best management approach by comparing outcomes of two groups of patients with gynecomastia who received subcutaneous mastectomy combined with liposuction and liposuction only. We conducted a retrospective analysis of 64 patients who underwent surgery for gynecomastia. We divided the patients into two groups: group A, patients who underwent liposuction only; and group B, patients who underwent liposuction and subcutaneous mastectomy. The serial photographs of all patients were clinically evaluated with respect to size, shape, scarring, and overall outcome by three plastic surgeons, and patient satisfaction was surveyed with regard to palpable lumps, size, shape, scarring, and overall outcome. Of the 64 subjects, 16 received liposuction only, and 48 received the combination procedure. A total of 125 breasts were involved. The doctors' scores for size and overall outcome were significantly better in the combination group, whereas scarring was better in the liposuction-only group. Similarly, patient satisfaction regarding size was significantly higher in the combination group, and satisfaction regarding scarring was significantly higher in the liposuction-only group. The scores for scarring in the combination treatment group were acceptable. Our study shows that combination treatment with liposuction and subcutaneous mastectomy results in satisfactory outcomes, including the extent of scarring. We conclude that this combination treatment should be recommended as the standard surgical treatment for gynecomastia and can provide excellent results in cases where glandular tissue needs to be removed. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www

Harmonic Scalpel versus Electrocautery Dissection in Modified Radical Mastectomy for Breast Cancer: A Meta-Analysis.

Directory of Open Access Journals (Sweden)

Jinbo Huang

Full Text Available Despite the common use of conventional electrocautery in modified radical mastectomy for breast cancer, the harmonic scalpel is recently emerging as a dominant surgical instrument for dissection and haemostasis, which is thought to reduce the morbidity, such as seroma and blood loss. But the results of published trials are inconsistent. So we made the meta-analysis to assess the intraoperative and postoperative endpoints among women undergoing modified radical mastectomy with harmonic scalpel or electrocautery.A comprehensive literature search of case-control studies from PubMed, MEDLINE, EMBASE and Cochrane Library databases involving modified radical mastectomy with harmonic scalpel or electrocautery was performed. We carried out a meta-analysis of primary endpoints including postoperative drainage, seroma development, intraoperative blood loss and secondly endpoints including operative time and wound complications. We used odds ratios (ORs with 95% confidence intervals (CIs to evaluate the effect size for categorical outcomes and standardised mean differences (SMDs for continuous outcomes.A total of 11 studies with 702 patients were included for this meta-analysis. There was significant difference in total postoperative drainage (SMD: -0.74 [95%CI: -1.31, -0.16]; P< 0.01, seroma development[OR: 0.49 (0.34, 0.70; P < 0.01], intraoperative blood loss(SMD: -1.14 [95%CI: -1.81,-0.47]; P < 0.01 and wound complications [OR: 0.38 (0.24, 0.59; P < 0.01] between harmonic scalpel dissection and standard electrocautery in modified radical mastectomy for breast cancer. No difference was found as for operative time between harmonic scalpel dissection and standard electrocautery (SMD: 0.04 [95%CI: -0.41, 0.50]; P = 0.85.Compared to standard electrocautery, harmonic scalpel dissection presents significant advantages in decreasing postoperative drainage, seroma development, intraoperative blood loss and wound complications in modified radical mastectomy for

Tamoxifen with and without radiation after partial mastectomy in patients with involved nodes

Energy Technology Data Exchange (ETDEWEB)

Cooke, Andrew L; Perera, Francisco; Fisher, Barbara; Opeitum, Abiola; Yu, Norman

1995-02-15

Purpose: To determine the effect of tamoxifen on local control after partial mastectomy with and without adjuvant breast irradiation. Methods and Materials: A retrospective study of 97 node positive patients identified from the records of the London Regional Cancer Center included 44 patients who received tamoxifen and breast irradiation (40 or 50 Gy plus booster dose) after partial mastectomy, and 53 patients who received tamoxifen only after partial mastectomy. Base line characteristics of the two groups were similar. Results: At 39 months actuarial follow-up there was a breast tumor recurrence (BTR) in 5% vs. 21% of patients when radiation was omitted (p = 0.0388), but there was no difference in the cause-specific mortality of the two treatment groups. Cox Regression analysis (on only 10 BTR) showed age and adjuvant radiation as significant predictors of BTR. In patients not receiving radiation, no BTR was seen in 22 patients {>=}70 years of age at diagnosis vs. 8 BTR in 31 patients <70 years (p = 0.0130). All BTR occurred while patients were receiving tamoxifen. Conclusion: Tamoxifen alone with omission of radiation after partial mastectomy provides inferior breast tumor control in node positive patients. This is especially true for patients under 70 years of age. Patients aged 70 years or older at the time of diagnosis of breast cancer who receive tamoxifen have a low rate of breast tumor recurrence when radiation is omitted. These patients represent a group for whom radiation might not be necessary.

Hospital organizational factors affect the use of immediate breast reconstruction after mastectomy for breast cancer in the Netherlands

NARCIS (Netherlands)

Schreuder, K.; van Bommel, A.C.M.; de Ligt, K. M.; Maduro, John H.; Vrancken Peeters, M.T.F.D.; Mureau, Marc A.M.; Siesling, S.

2017-01-01

Objectives Significant hospital variation in the use of immediate breast reconstruction (IBR) after mastectomy exists in the Netherlands. Aims of this study were to identify hospital organizational factors affecting the use of IBR after mastectomy for ductal carcinoma in situ (DCIS) or invasive

Review of EU-APR Design for Selected Safety Issues of WERNA RHWG 2013

Energy Technology Data Exchange (ETDEWEB)

Kim, Yong Soo; Kim, Ji Hwan [KHNP CRI, Daejeon (Korea, Republic of)

2016-10-15

Western European Nuclear Regulators' Association (WENRA) was established in 1999 to develop a harmonized approach to nuclear safety and radiation protection and their regulation. In 2013, the Reactor Harmonization Working Group (RHWG) of WENRA sets out the common positions on the seven selected key safety issues. This paper is to introduce the regulatory positions of WENRA RHWG 2013 and to review the compliance of the EU-APR with them. In this paper, we reviewed the compliance of the EUAPR regarding seven safety issues for new NPPs presented by WERNA RHWG in 2013. The EU-APR design fully complies with all WERNA RHWG safety issues since the following measures have been incorporated in it: - Successive five levels of DiD maintaining independence between different levels of DiD - Diverse design against multiple failure events such as ATWS, SBO, Loss of Ultimate Heat Sink, and Loss of Spent Fuel Pool Cooling - SAs dedicated mitigation systems to ensure the containment integrity during the SAs. - Practically eliminates accident sequences with a large or early release of radiological materials by diverse designs for multiple failure events, SAs dedicated mitigation system, and double containment design - Standard site parameters not lead to core melt accidents due to natural or man-made external hazards.

One-Stage Nipple and Breast Reconstruction Following Areola-Sparing Mastectomy

Directory of Open Access Journals (Sweden)

Hye Ri Kim

2013-09-01

Full Text Available BackgroundSkin-sparing mastectomy with immediate breast reconstruction is increasingly becoming a proven surgical option for early-stage breast cancer patients. Areola-sparing mastectomy (ASM has also recently become a popular procedure. The purpose of this article is to investigate the reconstructive and aesthetic issues experienced with one-stage nipple and breast reconstruction using ASM.MethodsAmong the patients who underwent mastectomy between March 2008 and March 2010, 5 women with a low probability of nipple-areolar complex malignant involvement underwent ASM and immediate breast reconstruction with simultaneous nipple reconstruction using the modified C-V flap. The cosmetic outcomes of this series were reviewed by plastic surgeons and patient self-assessment and satisfaction were assessed via telephone interview.ResultsDuring the average 11-month follow-up period, there were no cases of cancer recurrence, the aesthetic outcomes were graded as excellent to very good, and all of the patients were satisfied. Two patients developed a gutter-like depression around the reconstructed nipple, and one patient developed skin erosion in a small area of the areola, which healed with conservative dressing. The other complications, such as necrosis of the skin flap or areola, seroma, hematoma, or fat necrosis did not occur.ConclusionsSince one-stage nipple and breast reconstruction following ASM is an oncologically safe, cost-effective, and aesthetically satisfactory procedure, it is a good surgical option for early breast cancer patients.

Results of a clinical trial comparing conservative and modified radical mastectomy for early breast cancer

International Nuclear Information System (INIS)

Du Xianghui; Wang Yuezhen; Wu Lie; Zhu Yuan; Yang Hongjian; Zou Dehong

2005-01-01

Objective: The influence of conservative mastectomy plus postoperative radiation (CM + RT) in local control, distant failure, cosmetic and psychological outcome for early stage breast cancer was evaluated comparing with modified radical mastectomy. Methods: Between January 1998 and December 2003, 68 early stage breast cancer patients underwent CM + RT. During the save period, 76 similar patients were treated by modified radical mastectomy (MRM + RT). The cosmetic results evaluated as 'excellent', 'fair' or 'poor' using specific guide lines together with their psychological changes. Sex life and marital stability were also recorded. All patients were female with median age of 44.5 years (range, 28-62 years). Guidelines for patient selection reported by National Breast Cancer Cooperative Group was adhered to. In general, CM consisted of wide local excision with the breast conserved and postoperative radiotherapy to the entire breast with tangential fields followed by a boost to the tumor bed. All patients also received adjuvant chemotherapy with CAF. Patients with positive ER or PR assay results received tamoxifen for 5 years. In the 76 MRM + RT patients, the post operative radiotherapy and chemotherapy were given as clinically indicated. Results: There was no failure locally in all. In CM + RT group, the cause of failure was bone metastasis in 1 and mutiple metastasis in 2. In the MRM + RT group, the cause of failure was bone metastasis in 2, brain metastasis in 1 and mutiple metastases in 1. The cosmetic scores were 91.2% excellent, 5.6% fair and 2.9% poor. Conclusions: Breast preservation by conservative mastectomy is preferable to mastectomy in appropriately selected patients as it provides equivalent survival but giving good cosmetic results. (authors)

Unilateral mastectomy as an alternative treatment for gangrenous mastitis in a Saanen goat

Directory of Open Access Journals (Sweden)

Ahmet Sabuncu

2015-06-01

Full Text Available A four-year-old Saanen goat, weighing 52 kg, was referred to the Department of Obstetrics and Gynaecology clinic with black discoloration of the left mammary gland. The goat’s general condition was not good upon initial examination. The goat was anorexic, lethargic, and febrile (rectal temperature of 40 °C with a palpably cold left mammary gland on which there was an accumulation of pus. Somatic cell count (SCC was measured as 820,000/ml in the milk sample collected from the infected gland, and Staphylococcus aureus was isolated. Gangrenous mastitis was diagnosed on the left mammary gland of the goat based on the clinical findings. To treat the condition, a unilateral mastectomy was performed successfully. The goat was fully recovered a week after surgery. This case aimed to establish a surgical approach of unilateral mastectomy as a treatment option for goats with gangrenous mastitis while allowing the other mammary gland to continue lactation. Thus, it can be concluded that unilateral mastectomy is a viable alternative treatment of goats with gangrenous mastitis.

Implant breast reconstruction after salvage mastectomy in previously irradiated patients.

Science.gov (United States)

Persichetti, Paolo; Cagli, Barbara; Simone, Pierfranco; Cogliandro, Annalisa; Fortunato, Lucio; Altomare, Vittorio; Trodella, Lucio

2009-04-01

The most common surgical approach in case of local tumor recurrence after quadrantectomy and radiotherapy is salvage mastectomy. Breast reconstruction is the subsequent phase of the treatment and the plastic surgeon has to operate on previously irradiated and manipulated tissues. The medical literature highlights that breast reconstruction with tissue expanders is not a pursuable option, considering previous radiotherapy a contraindication. The purpose of this retrospective study is to evaluate the influence of previous radiotherapy on 2-stage breast reconstruction (tissue expander/implant). Only patients with analogous timing of radiation therapy and the same demolitive and reconstructive procedures were recruited. The results of this study prove that, after salvage mastectomy in previously irradiated patients, implant reconstruction is still possible. Further comparative studies are, of course, advisable to draw any conclusion on the possibility to perform implant reconstruction in previously irradiated patients.

A survey of the body image of mastectomies women referring to Imam Khomeini and Imam Hussein hospitals in Tehran, Iran

OpenAIRE

Esmaili Roghayeh; Saiidi Jila; Majd Hamid; Esmaieli Mehrdad

2010-01-01

Background: Breast cancer treatment may have severe effects on women body image. As a routine care, mastectomy may enhance the risks for anxiety, depression, low self-esteem, and fear of social relationships among women. An awareness of body image changes following mastectomy may promote adaptation among women. Aim: The present study has sought to determine body image levels following mastectomy among females referring to clinics at Imam Khomeini and Imam Hussein Hospitals in Tehran, Iran. Ma...

Pseudomonas syringae evades host Immunity by degrading flagellin monomers with alkaline protease AprA

OpenAIRE

Pel, M.J.C.; Van Dijken, A.J.H.; Bardoel, B.W.; Seidl, M.F; Van der Ent, S.; Van Strijp, J.A.G.

2014-01-01

Bacterial flagellin molecules are strong inducers of innate immune responses in both mammals and plants. The opportunistic pathogen Pseudomonas aeruginosa secretes an alkaline protease called AprA that degrades flagellin monomers. Here, we show that AprA is widespread among a wide variety of bacterial species. In addition, we investigated the role of AprA in virulence of the bacterial plant athogen P. syringae pv. tomato DC3000. The AprA-deficient DC3000 ΔaprA knockout mutant was significantl...

Recipient vessel selection in immediate breast reconstruction with free abdominal tissue transfer after nipple-sparing mastectomy.

Science.gov (United States)

Yang, Sung Jun; Eom, Jin Sup; Lee, Taik Jong; Ahn, Sei Hyun; Son, Byung Ho

2012-05-01

Nipple-sparing mastectomy (NSM) is gaining popularity due to its superior aesthetic results. When reconstructing the breast with free abdominal tissue transfer, we must readdress the recipient vessel, because NSM can cause difficulty in access to the chest vessel. Between June 2006 and March 2011, a total of 92 women underwent NSM with free abdominal tissue transfer. A lateral oblique incision was used for the nipple-sparing mastectomy. For recipient vessels, the internal mammary vessels were chosen if the mastectomy flap did not block access to the vessels. If it did, the thoracodorsal vessels were used. Age, degree of breast ptosis, weight of the mastectomy specimen, and related complications of the internal mammary vessel group and the thoracodorsal vessel group were compared. Thoracodorsal vessels were used as recipient vessels in 59 cases, and internal mammary vessels in 33 cases including 4 cases with perforators of the internal mammary vessels. Breast reconstruction was successful in all cases except one case involving a total flap failure, which was replaced by a silicone gel implant. The internal mammary group and the thoracodorsal group were similar in terms of age, height, breast weight, and degree of ptosis. The flap related complications such as flap loss and take-back operation rates were not significantly different between the two groups. The rate of nipple necrosis was higher in the internal mammary group. The thoracodorsal vessels could produce comparable outcomes in breast reconstruction after nipple-sparing mastectomies. If access to internal mammary vessels is difficult, the thoracodorsal vessel can be a better choice.

Recipient Vessel Selection in Immediate Breast Reconstruction with Free Abdominal Tissue Transfer after Nipple-Sparing Mastectomy

Directory of Open Access Journals (Sweden)

Sung Jun Yang

2012-05-01

Full Text Available BackgroundNipple-sparing mastectomy (NSM is gaining popularity due to its superior aesthetic results. When reconstructing the breast with free abdominal tissue transfer, we must readdress the recipient vessel, because NSM can cause difficulty in access to the chest vessel.MethodsBetween June 2006 and March 2011, a total of 92 women underwent NSM with free abdominal tissue transfer. A lateral oblique incision was used for the nipple-sparing mastectomy. For recipient vessels, the internal mammary vessels were chosen if the mastectomy flap did not block access to the vessels. If it did, the thoracodorsal vessels were used. Age, degree of breast ptosis, weight of the mastectomy specimen, and related complications of the internal mammary vessel group and the thoracodorsal vessel group were compared.ResultsThoracodorsal vessels were used as recipient vessels in 59 cases, and internal mammary vessels in 33 cases including 4 cases with perforators of the internal mammary vessels. Breast reconstruction was successful in all cases except one case involving a total flap failure, which was replaced by a silicone gel implant. The internal mammary group and the thoracodorsal group were similar in terms of age, height, breast weight, and degree of ptosis. The flap related complications such as flap loss and take-back operation rates were not significantly different between the two groups. The rate of nipple necrosis was higher in the internal mammary group.ConclusionsThe thoracodorsal vessels could produce comparable outcomes in breast reconstruction after nipple-sparing mastectomies. If access to internal mammary vessels is difficult, the thoracodorsal vessel can be a better choice.

APR1400 CEA Withdrawal at Power Accident Analysis using KNAP

International Nuclear Information System (INIS)

Lee, Dong-Hyuk; Yang, Chang-Keun; Kim, Yo-Han; Sung, Chang-Kyung

2006-01-01

KEPRI (Korea Electric Power Research Institute) has been developing safety analysis methodology for non- LOCA (Loss Of Coolant Accident) analysis of OPR1000 (Optimized Power Reactor 1000, formerly KSNP). The new methodology, named KNAP (Korea Non-LOCA Analysis Package), uses RETRAN as the main system analysis code. RETRAN code is a non- LOCA safety analysis code developed by EPRI. The new methodology will replace existing CE (Combustion Engineering) supplied codes and methodologies currently used in non-LOCA analysis of OPR1000. In this paper, we apply KNAP methodology to APR1400 (Advanced Power Reactor 1400). The CEA (Control Element Assembly) withdrawal at power accident is one of the 'reactivity and power distribution anomalies' events and the results are typically described in the chapter 15.4.2 of SAR (Safety Analysis Report). The APR1400 has been designed to generate 1,400MWe of electricity with advanced features for greatly enhanced safety and economic goals. The CEA withdrawal at power analysis in APR1400 SSAR (Standard Safety Analysis Report) is analyzed with CESEC-III computer code. In this study, to confirm the applicability of the KNAP methodology and code system to APR1400, CEA withdrawal at power accident is analyzed using RETRAN code and it is compared with results from APR1400 SSAR

Skin-Reducing Mastectomy in Immediate Reconstruction: How to Limit Complications and Failures.

Science.gov (United States)

Pechevy, Lolita; Carloni, Raphael; Guerid, Samia; Vincent, Pierre-Luc; Toussoun, Gilles; Delay, Emmanuel

2017-06-01

In hypertrophic and/or very ptotic breasts, skin-reducing mastectomy (SRM) is challenging and the risk of complications is high. Few publications have reported the use of an autologous latissimus dorsi flap (ALDF) in this indication. Most studies opt for implant reconstructions, with a high failure rate. We aimed to identify and present the technical refinements that reduce the risk of reconstruction failure in patients with hypertrophic and/or ptotic breasts with breast cancer or at risk of breast cancer after SRM with immediate breast reconstruction (IBR) utilizing an ALDF. Our retrospective study, covering a period of 18 years, included a series of 60 patients with hypertrophic and/or ptotic breasts who underwent 67 SRM and IBR procedures utilizing an ALDF. The complications were recorded and the risk factors analyzed. Sixty-seven SRMs were reviewed. Forty-nine procedures were performed with an inverted-T scar technique and 18 with a vertical scar technique. The nipple-areola complex (NAC) was preserved in 10 cases. There were eight (11.9%) cases of minor mastectomy flap necrosis after skin-reducing reconstructions, 16 (23.8%) wound dehiscences, no infections, no breast seromas, and no reconstruction failures. Smoking increased the risk of minor mastectomy flap necrosis (P = 0.048) and wound dehiscence (P = 0.002). Previous radiotherapy was associated with minor mastectomy flap necrosis (P = 0.001). The use of an ALDF together with technical refinements that preserve the vascular supply of the skin envelope leads to successful IBR with consistently good aesthetic results. Above all, it avoids failure of the reconstruction in very large or ptotic breasts. © 2017 The American Society for Aesthetic Plastic Surgery, Inc. Reprints and permission: journals.permissions@oup.com

Developing Optimal Procedure of Emergency Outside Cooling Water Injection for APR1400 Extended SBO Scenario Using MARS Code

Energy Technology Data Exchange (ETDEWEB)

Hwang, Jong Rok; Oh, Seung Jong [KEPCO International Nuclear Graduate School, Ulsan (Korea, Republic of)

2013-10-15

In this study, we examined optimum operator actions to mitigate extended SBO using MARS code. Particularly, this paper focuses on analyzing outside core cooling water injection scenario, and aimed to develop optimal extended SBO procedure. Supplying outside emergency cooling water is the key feature of flexible strategy in extended SBO situation. An optimum strategy to maintain core cooling is developed for typical extended SBO. MARS APR1400 best estimate model was used to find optimal procedure. Also RCP seal leakage effect was considered importantly. Recent Fukushima accident shows the importance of mitigation capability against extended SBO scenarios. In Korea, all nuclear power plants incorporated various measures against Fukushima-like events. For APR1400 NPP, outside connectors are installed to inject cooling water using fire trucks or portable pumps. Using these connectors, outside cooling water can be provided to reactor, steam generators (SG), containment spray system, and spent fuel pool. In U. S., similar approach is chosen to provide a diverse and flexible means to prevent fuel damage (core and SFP) in external event conditions resulting in extended loss of AC power and loss of ultimate heat sink. Hence, hardware necessary to cope with extended SBO is already available for APR1400. However, considering the complex and stressful condition encountered by operators during extended SBO, it is important to develop guidelines/procedures to best cope with the event.

System Response Analysis of LOCV for APR1400 Using KNAP

International Nuclear Information System (INIS)

Kim, Yo-Han; Sung, Chang-Kyung; Jun, Hwang-Yong

2006-01-01

Korea Electric Power Research Institute (KEPRI) of Korea Electric Power Corporation (KEPCO) has been developed the non-loss-of-coolant accident (non-LOCA) analysis methodology, called as the Korea Non-LOCA Analysis Package (KNAP), for the typical Optimized Power Reactor 1000 (OPR1000) plants. Considering current licensing methodology conducted by ABB-CE, however, the KNAP could be applied to Advanced Power Reactor 1400 (APR1400). In spite of some difference in components of two plant types, there is a close resemblance between their nuclear steam supply systems (NSSS). So, in this study, the loss of condenser vacuum (LOCV) event were analyzed using KNAP for APR1400 to estimate the feasibility of the application and the results were compared with those given in APR1400 Standard Safety Analysis Report (SSAR), which were calculated using the CESEC-III code of ABB-CE. Through the study, it was concluded that the KNAP could be applicable to APR1400 on the view point of LOCV event

Functional Requirement Analysis and Function Allocation for APR 1400

International Nuclear Information System (INIS)

Nuraslinda, Anuar; Florah, Kamanja; Noloyiso, Mtoko and others

2013-01-01

This paper intends to fulfill the FRA and FA of the HFE as required in Chapter 4 of NUREG-0711 rev. 3 for APR1400 to satisfy both plant safety and power generation objectives. This paper aims to evaluate the FRA and FA for APR1400. The allocation of function is done at the system level for all processes for both the power generation and safety goals, following the NUREG/CR-3331 guideline. As a conclusion, this paper has successfully implemented the requirements and methodology specified in NUREG-0711 for APR 1400. The Functional Requirement Analysis (FRA) and Function Allocation (FA) are required by the regulation in the Human Factors Engineering (HFE) program. The FRA defines the functions, processes, and system for plant safety and power generation. The FA allocates the functions to human operator, automation, or a combination of two. The FRA and FA for APR1400 have been performed in the very early stage of development but only for the plant safety. However, the analysis did not include the goal of power generation and also did not fully satisfy the latest revision of NUREG-0711

Impact of Margin Status on Local Recurrence After Mastectomy for Ductal Carcinoma In Situ

International Nuclear Information System (INIS)

Childs, Stephanie K.; Chen, Yu-Hui; Duggan, Margaret M.; Golshan, Mehra; Pochebit, Stephen; Punglia, Rinaa S.; Wong, Julia S.; Bellon, Jennifer R.

2013-01-01

Purpose: To examine the rate of local recurrence according to the margin status for patients with pure ductal carcinoma in situ (DCIS) treated by mastectomy. Methods and Materials: One hundred forty-five consecutive women who underwent mastectomy with or without radiation therapy for DCIS from 1998 to 2005 were included in this retrospective analysis. Only patients with pure DCIS were eligible; patients with microinvasion were excluded. The primary endpoint was local recurrence, defined as recurrence on the chest wall; regional and distant recurrences were secondary endpoints. Outcomes were analyzed according to margin status (positive, close (≤2 mm), or negative), location of the closest margin (superficial, deep, or both), nuclear grade, necrosis, receptor status, type of mastectomy, and receipt of hormonal therapy. Results: The primary cohort consisted of 142 patients who did not receive postmastectomy radiation therapy (PMRT). For those patients, the median follow-up time was 7.6 years (range, 0.6-13.0 years). Twenty-one patients (15%) had a positive margin, and 23 patients (16%) had a close (≤2 mm) margin. The deep margin was close in 14 patients and positive in 6 patients. The superficial margin was close in 13 patients and positive in 19 patients. One patient experienced an isolated invasive chest wall recurrence, and 1 patient had simultaneous chest wall, regional nodal, and distant metastases. The crude rates of chest wall recurrence were 2/142 (1.4%) for all patients, 1/21 (4.8%) for those with positive margins, 1/23 (4.3%) for those with close margins, and 0/98 for patients with negative margins. PMRT was given as part of the initial treatment to 3 patients, 1 of whom had an isolated chest wall recurrence. Conclusions: Mastectomy for pure DCIS resulted in a low rate of local or distant recurrences. Even with positive or close mastectomy margins, the rates of chest wall recurrences were so low that PMRT is likely not warranted

Functional similarities between the dictyostelium protein AprA and the human protein dipeptidyl-peptidase IV.

Science.gov (United States)

Herlihy, Sarah E; Tang, Yu; Phillips, Jonathan E; Gomer, Richard H

2017-03-01

Autocrine proliferation repressor protein A (AprA) is a protein secreted by Dictyostelium discoideum cells. Although there is very little sequence similarity between AprA and any human protein, AprA has a predicted structural similarity to the human protein dipeptidyl peptidase IV (DPPIV). AprA is a chemorepellent for Dictyostelium cells, and DPPIV is a chemorepellent for neutrophils. This led us to investigate if AprA and DPPIV have additional functional similarities. We find that like AprA, DPPIV is a chemorepellent for, and inhibits the proliferation of, D. discoideum cells, and that AprA binds some DPPIV binding partners such as fibronectin. Conversely, rAprA has DPPIV-like protease activity. These results indicate a functional similarity between two eukaryotic chemorepellent proteins with very little sequence similarity, and emphasize the usefulness of using a predicted protein structure to search a protein structure database, in addition to searching for proteins with similar sequences. © 2016 The Protein Society.

Functional similarities between the dictyostelium protein AprA and the human protein dipeptidyl‐peptidase IV

Science.gov (United States)

Herlihy, Sarah E.; Tang, Yu; Phillips, Jonathan E.

2017-01-01

Abstract Autocrine proliferation repressor protein A (AprA) is a protein secreted by Dictyostelium discoideum cells. Although there is very little sequence similarity between AprA and any human protein, AprA has a predicted structural similarity to the human protein dipeptidyl peptidase IV (DPPIV). AprA is a chemorepellent for Dictyostelium cells, and DPPIV is a chemorepellent for neutrophils. This led us to investigate if AprA and DPPIV have additional functional similarities. We find that like AprA, DPPIV is a chemorepellent for, and inhibits the proliferation of, D. discoideum cells, and that AprA binds some DPPIV binding partners such as fibronectin. Conversely, rAprA has DPPIV‐like protease activity. These results indicate a functional similarity between two eukaryotic chemorepellent proteins with very little sequence similarity, and emphasize the usefulness of using a predicted protein structure to search a protein structure database, in addition to searching for proteins with similar sequences. PMID:28028841

A Probability Analysis of the Generating Cost for EU-APR1400 Single Unit

International Nuclear Information System (INIS)

Ha, Gak Hyeon; Kim, Sung Hwan

2014-01-01

The nuclear power plant market is expected to grow rapidly in order to address issues of global warming, reducing CO 2 emissions and securing stable electricity supplies. Under these circumstances, the main primary goal of the EU-APR100 development is to ensure export competitiveness in the European countries. To this end, EU-APR1400 have been developed based one te APR1400 (Advanced Power Reactor, GEN Type) The EU-APR1400 adds many advanced design features to its predecessor, as outlined below in Table 1. In this simulation, the results of the generating cost of the EU-APR1400 single unit were determined using the probability cost analysis technique, the generating cost range was shown to be 56.16 ∼ 70.92 won/kWh.

A Probability Analysis of the Generating Cost for EU-APR1400 Single Unit

Energy Technology Data Exchange (ETDEWEB)

Ha, Gak Hyeon; Kim, Sung Hwan [KHNP CRI, Seoul (Korea, Republic of)

2014-10-15

The nuclear power plant market is expected to grow rapidly in order to address issues of global warming, reducing CO{sub 2} emissions and securing stable electricity supplies. Under these circumstances, the main primary goal of the EU-APR100 development is to ensure export competitiveness in the European countries. To this end, EU-APR1400 have been developed based one te APR1400 (Advanced Power Reactor, GEN Type) The EU-APR1400 adds many advanced design features to its predecessor, as outlined below in Table 1. In this simulation, the results of the generating cost of the EU-APR1400 single unit were determined using the probability cost analysis technique, the generating cost range was shown to be 56.16 ∼ 70.92 won/kWh.

Risk Factor Analysis for Mastectomy Skin Flap Necrosis: Implications for Intraoperative Vascular Analysis.

Science.gov (United States)

Reintgen, Christian; Leavitt, Adam; Pace, Elizabeth; Molas-Pierson, Justine; Mast, Bruce A

2016-06-01

Skin flap necrosis after mastectomy can be a devastating complication significantly affecting patient outcomes. Routine vascular analysis (fluorescein or laser angiography) of mastectomy skin flaps in all patients has been advocated but is of questionable cost-effectiveness. The purpose of this study was to identify the incidence and causative risk factors for mastectomy skin flap necrosis and thereby calculate the fiscal reality of intraoperative vascular screening. This is an institutional review board-approved retrospective study of all patients from 2007 to 2013 who underwent mastectomy related to breast cancer. Skin flap necrosis was defined as major if it necessitated return to the operating room. Data analysis was done for determination of causative factors of necrosis, including age, body mass index, smoking, previous irradiation, coronary artery disease, chronic obstructive pulmonary disorder, hypertension, gastroesophageal reflux disease, hyperlipidemia, obstructive sleep apnea, asthma, diabetes, thyroid disease, history of lumpectomy, and breast reduction or augmentation. During this time, intraoperative vascular screening was not done. Five hundred eighty-one patients underwent 616 mastectomies with a total of 34 necrotic events (5.5%)-16 major and 18 minor. Analyses via Student t tests, univariate analyses, χ testing, and logistic regression showed that history of smoking was the only patient factor associated with postoperative necrosis (P = 0.008). More frequently represented in the necrosis group, but without statistical significance, are previous lumpectomy (P = 0.069) and immediate reconstruction (P = 0.078).For the entire study period, the actual cost to the hospital for major necrotic events was $7,123.10 or $445.19 for each of the 16 major necrotic events and $209.50 for all 34 necrotic events. Per-patient cost-effective screening would need to be less than $11.54 for all patients, $100.33 for highest risk patients (smokers), and $21.65 for

APR1400 Fluidic Device Sensitivity Test

International Nuclear Information System (INIS)

Choi, Nam Hyun; Chu, In Cheol; Min, Kyong Ho; Song, Chul Hwa

2005-12-01

In the safety injection tank at the emergency core cooling system of APR1400, a new safety design feature, passive fluidic device is equipped which includes no active driving system. It is essential to evaluate the new design feature with various experiments. For this reason, three categories of sensitivity tests have been performed in the present study. As the first sensitivity experiment, the effect of the height of the stand pipe was investigated. The second sensitivity test was conducted with removing the insert plate gasket to examine its effect. The effect of the expansion of the control nozzle width was ascertained from the third sensitivity test. The results of each test showed that the passive fluidic device which will be equipped in the SIT tank of APR1400 has great integrity and repeatability

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.

Influence of adjuvant irradiation on shoulder joint function after mastectomy for breast carcinoma

International Nuclear Information System (INIS)

Ryttov, N.; Blichert-Toft, M.; Madsen, E.L.; Weber, J.

1983-01-01

The influence of postoperative radiation therapy on ipsilateral shoulder function following mastectomy was evaluated from a series of 52 women with primarily operable carcinoma of the breast. Mastectomy and partial axillary dissection were carried out in all patients. In addition, 29 of the patients received postoperative irradiation with 36.6 Gy applied mid-axillarily in 12 fractions with irradiation twice a week. A significant impairment of the active shoulder mobility was found in the irradiated group (p<0.01). The passive mobility did not differ significantly between the two groups. The impairment of active shoulder mobility is suggested to be caused by radiation induced subcutaneous fibrosis. (Auth.)

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.

Perception of body image and sexuality for women with mastectomy

DEFF Research Database (Denmark)

Nielsen, H D; Gregersen, A M; Thorup, Charlotte Brun

Background Having cancer and having one breast removed can affect all aspects of a woman's life. The literature shows that many women experience an altered body image and sexuality, loss of femininity, a feeling of less sexual attractiveness and decline in self-esteem. Furthermore mastectomy can...

The Use of Sentinel Lymph Node Biopsy in BRCA1/2 Mutation Carriers Undergoing Prophylactic Mastectomy: A Retrospective Consecutive Case-Series Study

Directory of Open Access Journals (Sweden)

Sara Câmara

2018-01-01

Full Text Available Introduction. Sentinel lymph node biopsy in prophylactic mastectomy is controversial. It avoids lymphadenectomy in occult carcinoma but is associated with increased morbidity. Women with BRCA mutations have a higher incidence of occult carcinoma and our objective was to assess the clinical utility of sentinel lymph node biopsy when these women undergo prophylactic mastectomy. Materials and Methods. Seven-year retrospective consecutive case-series study of women, with a BRCA deleterious mutation, admitted to prophylactic mastectomy, at our center. Breast MRI < 6 months before surgery was routine, unless contraindicated. Results. Fifty-seven patients (43% BRCA1; 57% BRCA2 underwent 80 prophylactic mastectomies. 72% of patients had had breast cancer treated before prophylactic mastectomy or synchronously to it. The occult carcinoma incidence was 5%, and half of the cases were invasive. SLNB was performed in 19% of the prophylactic mastectomies; none of these had tumor invasion. Women with invasive carcinoma who had not undergone sentinel lymph node biopsy were followed closely with axillary ultrasound. The median follow-up was 37 months, with no local recurrence; 1 patient died of primary tumor systemic relapse. Conclusions. Our data do not support this procedure for routine (in agreement with previous literature, in this high risk for occult carcinoma population.

Effectiveness of “Marital Skills training for mastectomy women” in improving marital satisfaction of husbands

Directory of Open Access Journals (Sweden)

Bahman Bahmani

2017-09-01

Full Text Available One of the health issues related to patients suffering from cancer is paying attention to mental health of the patients and their families. This research was carried out to determine the effect of teaching marital life skills for mastectomy women in the increase of marital satisfaction of this group of patients as well as its direct effect on their spouses’ satisfaction. This was a quasi-experimental research designed as pretest/posttest with random assignment and control group. 22 women suffering from breast cancer, undergoing mastectomy, treated by radiotherapy and having marital satisfaction lower than the moderate level based on the short form (40-question of the ENRICH (evaluation and nurturing relationship issues, communication and happiness questionnaire were selected via purposive sampling and divided into experimental and control groups using random assignment. The pretest was carried out on experimental and control groups and the husbands. The intervention was performed during 12 didactic sessions, two a week, for women of the experimental group in the absence of their husbands. Results indicated that the mean score of marital satisfaction in mastectomy women and their husbands in the experimental group was higher than that of the control group, and the difference was statistically significant. In conclusion, the combined intervention method used in this research was effective in increasing marital satisfaction of mastectomy women, and had also a positive effect on their husbands’ marital satisfaction.

Study of dosimetric effects due to metallic heterogeneity of tissue expanders in post-mastectomy radiotherapy

International Nuclear Information System (INIS)

Trombetta, Debora M.; Silva, Ademir X. da; Rosa, Luiz A.R. da

2009-01-01

Breast cancer is the most common cancer among women. In each year approximately 20% of the new cases of cancer in women are breast cancers. Despite the increase in the use of breast-conserving treatment, some women still require mastectomy as their primary surgical management. A large part of these women, whom undergo a mastectomy, realize a breast reconstruction afterwards. The most common options for reconstruction include autogenous tissue techniques and tissue expansion followed by breast implant placement. Many trials have demonstrated a survival benefit associated with post-mastectomy radiotherapy mainly if the treatment starts right after the mastectomy. In such case patients whom were realizing the breast reconstruction using tissue expanders can be irradiated using this. These patients posses a material with high atomic number within the irradiated area, so this metallic port becomes an heterogeneity which can modify the calculated doses distribution for the treatment. The study was due through the quantification of the relative transmission of 6MV and 15MV radiotherapy beam, making use of computer simulations with Monte Carlo method implemented by the MCNPX code. The results show that the presence of this metallic heterogeneity changes the transmission of the beam, causing a reduction up to 13% in the geometric shadowed region. According to dosimetric protocols, which recommend that the reduction in the dose should be bellow of 5%, the difference found in the study could be significant. (author)

Bone scan in breast cancer patients with mastectomy and breast reconstruction with a myocutaneous TRAM flap

International Nuclear Information System (INIS)

Morales, Rosanna; Cano, Roque; Delgado, Ricardo; Munive, Carlos

2014-01-01

Objectives: To report findings in bone scans for breast cancer patients with mastectomy and breast reconstruction with transverse rectus abdominis myocutaneous flap (TRAM). Material and Methods: Inclusion criteria were: confirmed breast cancer, mastectomy, breast reconstruction with TRAM flap and bone scan performed after TRAM. Exclusion criteria were: Absence of bone scan image, breast reconstruction by other approaches. Results: Absence of uptake in TRAM flap in six patients, diminished uptake in skin near TRAM, with peripheral increased uptake in three and increased uptake in TRAM flap, in a patient with cancer recurrence, confirmed by biopsy. Conclusions: Bone scans in breast cancer patients with mastectomy and TRAM flap can have different imaging presentations, procedure details diminish reporting errors. TRAM flap may present fat necrosis areas, which should be differentiated from recurrence in bone scans. Additional imaging and biopsy will be needed to diagnose this finding. (authors).

Mastectomy Skin Necrosis After Breast Reconstruction: A Comparative Analysis Between Autologous Reconstruction and Implant-Based Reconstruction.

Science.gov (United States)

Sue, Gloria R; Lee, Gordon K

2018-05-01

Mastectomy skin necrosis is a significant problem after breast reconstruction. We sought to perform a comparative analysis on this complication between patients undergoing autologous breast reconstruction and patients undergoing 2-stage expander implant breast reconstruction. A retrospective review was performed on consecutive patients undergoing autologous breast reconstruction or 2-stage expander implant breast reconstruction by the senior author from 2006 through 2015. Patient demographic factors including age, body mass index, history of diabetes, history of smoking, and history of radiation to the breast were collected. Our primary outcome measure was mastectomy skin necrosis. Fisher exact test was used for statistical analysis between the 2 patient cohorts. The treatment patterns of mastectomy skin necrosis were then analyzed. We identified 204 patients who underwent autologous breast reconstruction and 293 patients who underwent 2-stage expander implant breast reconstruction. Patients undergoing autologous breast reconstruction were older, heavier, more likely to have diabetes, and more likely to have had prior radiation to the breast compared with patients undergoing implant-based reconstruction. The incidence of mastectomy skin necrosis was 30.4% of patients in the autologous group compared with only 10.6% of patients in the tissue expander group (P care in the autologous group, only 3.2% were treated with local wound care in the tissue expander group (P skin necrosis is significantly more likely to occur after autologous breast reconstruction compared with 2-stage expander implant-based breast reconstruction. Patients with autologous reconstructions are more readily treated with local wound care compared with patients with tissue expanders, who tended to require operative treatment of this complication. Patients considering breast reconstruction should be counseled appropriately regarding the differences in incidence and management of mastectomy skin

In the Modern Treatment Era, Is Breast Conservation Equivalent to Mastectomy in Women Younger Than 40 Years of Age? A Multi-Institution Study

Energy Technology Data Exchange (ETDEWEB)

Frandsen, Jonathan; Ly, David [Department of Radiation Oncology, Huntsman Cancer Hospital, University of Utah School of Medicine, Salt Lake City, Utah (United States); Cannon, George [Department of Radiation Oncology, Intermountain Medical Center, Murray, Utah (United States); Suneja, Gita [Department of Radiation Oncology, Huntsman Cancer Hospital, University of Utah School of Medicine, Salt Lake City, Utah (United States); Matsen, Cindy [Department of General Surgery, Huntsman Cancer Hospital, University of Utah School of Medicine, Salt Lake City, Utah (United States); Gaffney, David K. [Department of Radiation Oncology, Huntsman Cancer Hospital, University of Utah School of Medicine, Salt Lake City, Utah (United States); Wright, Melissa [Oncology Clinical Program, Intermountain Healthcare, Salt Lake City, Utah (United States); Kokeny, Kristine E. [Department of Radiation Oncology, Huntsman Cancer Hospital, University of Utah School of Medicine, Salt Lake City, Utah (United States); Poppe, Matthew M., E-mail: matthew.poppe@hci.utah.edu [Department of Radiation Oncology, Huntsman Cancer Hospital, University of Utah School of Medicine, Salt Lake City, Utah (United States)

2015-12-01

Purpose: Mastectomy is often recommended for women ≤40 years of age with breast cancer, as young women were under-represented in the landmark trials comparing breast conservation therapy (BCT) to mastectomy. We hypothesized that, in the modern treatment era, BCT and mastectomy result in equivalent local control rates in young women. Methods and Materials: Breast cancer cases arising between 1975 and 2013 in women ≤40 years old were collected from the tumor registries of 2 large healthcare systems in Utah. Kaplan-Meier estimates and Cox proportional hazards models were used to analyze freedom from locoregional recurrence (FFLR), overall survival (OS), and relapse-free survival (RFS). Results: This analysis identified 853 BCT candidates. A comparison of BCT to mastectomy after 2000 showed FFLR, RFS, and OS were all similar. Rate for FFLR at 10 years was 94.9% versus 92.1% for BCT and mastectomy, respectively (P=.57). For women whose cancer was diagnosed after 2000, who received BCT, FFLR and RFS rates were improved compared to those whose cancer was diagnosed prior to 2000 (P<.05), whereas OS (P=.46) rates were similar. Among those who underwent mastectomy, FFLR, OS, and RFS were significantly improved (P<.05) with diagnosis after 2000. Conclusions: FFLR rates for young women, ≤40 years of age, have significantly improved for BCT and mastectomy over time. If patients were treated after 2000, BCT appears to be safe and equivalent to mastectomy at 10 years in terms of FFLR, OS, and RFS.

Factors associated with the increasing trend of contralateral prophylactic mastectomy among patients with ductal carcinoma in situ: Analysis of Surveillance, Epidemiology, and End Results data.

Science.gov (United States)

You, Qiuting; Chen, Kai; Li, Yudong; Lai, Jianguo; Fang, Yichao; Shen, Shiyu; Liu, Yicheng; Su, Fengxi; Yu, Fengyan

2018-05-22

Our study aimed to investigate the factors influencing trends of contralateral prophylactic mastectomy (CPM) among patients with unilateral ductal carcinoma in situ (DCIS). We used the Surveillance, Epidemiology, and End Results (SEER) data to identify patients with unilateral DCIS diagnosed from 1998 to 2013. Patients were categorized as breast-conserving surgery (BCS), Unilateral Mastectomy and CPM group. Univariate and multivariate logistic regressions were applied to assess the factors associated with undergoing CPM among mastectomy patients. The trends of CPM among mastectomy patients through year were presented by different subgroups of sociodemographic and pathological characteristics. Of those, 105326 patients with DCIS were identified, and 6370 patients underwent CPM. The proportion of CPM was 6.05% for all surgically-treated patients and 21.09% for mastectomy patients, and it increased more than six-fold between 1998 and 2013 (from 1.74% to 10.89% for all surgically-treated patients and from 5.44% to 37.47% for mastectomy patients). Younger age, white race, married status, smaller tumor size, positive ER and PR status were significantly associated with higher CPM proportion among mastectomy patients. The proportion of CPM was increasing through year, and the increasing trends were obvious in the subgroups of younger, white, married, metropolitan, with higher bachelor degree and higher median family income patients, while there were no apparent differences in the trends between subgroups of pathological characteristics. The trends of CPM among mastectomy patients were increasing through years and influenced by patients' sociodemographic characteristics, but not pathological characteristics. Copyright © 2018 Elsevier Ltd. All rights reserved.

Subcutaneously Placed Breast Implants after a Skin-Sparing Mastectomy: Do We Always Need ADM?

Directory of Open Access Journals (Sweden)

Apresh Singla, MBBS, MSc

2017-07-01

Full Text Available Background:. Immediate breast reconstruction is an acceptable treatment option after mastectomy for prophylaxis of early breast cancer. Different options exist for implant placement, incision technique, patient suitability, and institutional experience. This article is a case series exploring the feasibility and outcomes of patients undergoing immediate breast reconstruction using skin-sparing mastectomy without mesh or acellular dermal matrix (ADM and with a vertical inframammary incision. Methods:. A single-institution retrospective analysis was performed for all patients who underwent immediate single-stage reconstruction with subcutaneous silicon implants without ADM between 2009 and 2014 inclusive. Patient, operative and treatment variables were extracted. All patients with viable mastectomy skin flaps intraoperatively and at least 5 mm of subcutaneous tissue were eligible except for patients who were deemed too slim by the senior surgeon preoperatively and thus at risk of implant visibility or skin rippling. Results:. There were 26 patients (bilateral n = 12 and unilateral n = 14 eligible for analysis, with a median long-term follow-up of 51.5 months. The majority of complications were classified as minor affecting 46.2% of the cohort (n = 12. There were 20 episodes of complications overall. The most frequent episodes were contour defects (x = 5, minor seroma (x = 4, and malrotation and minor infection (x = 3. There was 1 episode of capsular contracture. Conclusion:. Skin-sparing mastectomy with immediate subcutaneous silicon implant reconstruction with a vertical incision and without the need for mesh or ADM is an acceptable and safe treatment option. Accurate patient selection and skin flap viability is the key to achieving optimal outcomes with this approach.

The Relationship between Body Esteem and Hope and Mental Health in Breast Cancer Patients after Mastectomy.

Science.gov (United States)

Heidari, Mohammad; Ghodusi, Mansureh

2015-01-01

Breast cancer and its treatment, including mastectomy, can cause feelings of mutilation, depreciation in the value of the body, reduction in attractiveness, and lead to mental disorders and hopelessness. The present study aimed to determine the relationship between appreciating the body, hope and mental health in women with breast cancer after mastectomy. This study was a descriptive study of 100 breast cancer patients who had undergone mastectomy and referred to the Sayed Al-Shohada Medical Center in Isfahan, Iran. The subjects were selected by convenient sampling. Data gathering tools were the Body Esteem Scale (BES), Herth Hope Index (HHI), and Symptom Checklist 25 (SCL-25) mental health questionnaire. Data analysis was performed using SPSS software. Most of the patients had low body esteem. There was a significant direct linear relationship between body esteem and hope and mental health. This relationship was stronger between valuing the body and hope. Body esteem has a significant linear relationship with hope and mental health.

Associations of physical activity and inactivity with body tissue composition among healthy Polish women and women after mastectomy.

Science.gov (United States)

Czerniak, U; Demuth, A; Skrzypczak, M

2014-10-01

The aim of the study is to determine the relationship between physical activity and body composition among healthy women and women who have had mastectomy. This is in order to establish whether physical activity of women after breast cancer treatment improves composition and distribution of body mass components to a degree which will allow to achieve the body composition of healthy women. Research material consists of anthropometric measurements (body height, weight) of women and bioelectric impedance analysis (BIA) of body composition (using Akern - BIA 101 composition analyzer). Intensity of activity was assessed using the Physical Activity International Questionnaire. The sample consisted of 76 healthy women (active 44.74%, inactive 55.26%) and 70 females after mastectomy (54.29% and 45.71%, respectively). Mean chronological age of women after mastectomy was 53.40 years, SD=7.55, and of the healthy ones 52.38 years SD=11.01). A significant difference in body composition was noted among active and inactive women after mastectomy; namely the active females had lower weight (by approximately 12 kg), body mass index (BMI), level of fat mass (by approximately 8%) and (by approximately 5%) total body water. The active healthy women had 6% less fat mass, almost 4% more body water and 6% more fat free mass. Programmed physical activity undertaken by women after mastectomy is recommended and produces good results in the form of reduction of excessive body fat tissue. Through physical activity these women are able to achieve the same level of fat mass as healthy women. Copyright © 2014 Elsevier GmbH. All rights reserved.

Risk of breast cancer after a diagnosis of ovarian cancer in BRCA mutation carriers: Is preventive mastectomy warranted?

Science.gov (United States)

McGee, Jacob; Giannakeas, Vasily; Karlan, Beth; Lubinski, Jan; Gronwald, Jacek; Rosen, Barry; McLaughlin, John; Risch, Harvey; Sun, Ping; Foulkes, William D; Neuhausen, Susan L; Kotsopoulos, Joanne; Narod, Steven A

2017-05-01

Preventive breast surgery and MRI screening are offered to unaffected BRCA mutation carriers. The clinical benefit of these two modalities has not been evaluated among mutation carriers with a history of ovarian cancer. Thus, we sought to determine whether or not BRCA mutation carriers with ovarian cancer would benefit from preventive mastectomy or from MRI screening. First, the annual mortality rate for ovarian cancer patients was estimated for a cohort of 178 BRCA mutation carriers from Ontario, Canada. Next, the actuarial risk of developing breast cancer was estimated using an international registry of 509 BRCA mutation carriers with ovarian cancer. A series of simulations was conducted to evaluate the reduction in the probability of death (from all causes) associated with mastectomy and with MRI-based breast surveillance. Cox proportional hazards models were used to evaluate the impacts of mastectomy and MRI screening on breast cancer incidence as well as on all-cause mortality. Twenty (3.9%) of the 509 patients developed breast cancer within ten years following ovarian cancer diagnosis. The actuarial risk of developing breast cancer at ten years post-diagnosis, conditional on survival from ovarian cancer and other causes of mortality was 7.8%. Based on our simulation results, among all BRCA mutation-carrying patients diagnosed with stage III/IV ovarian cancer at age 50, the chance of dying before age 80 was reduced by less than 1% with MRI and by less than 2% with mastectomy. Greater improvements in survival with MRI or mastectomy were observed for women who had already survived 10years after ovarian cancer, and for women with stage I or II ovarian cancer. Among BRCA mutation-carrying ovarian cancer patients without a personal history of breast cancer, neither preventive mastectomy nor MRI screening is warranted, except for those who have survived ovarian cancer without recurrence for ten years and for those with early stage ovarian cancer. Copyright © 2017

Evaluation of the Planned Outage Durations in EU-APR

Energy Technology Data Exchange (ETDEWEB)

Jung, Byung Joon; Lee, Keun Sung [KHNP CRI, Daejeon (Korea, Republic of)

2016-10-15

EU-APR has been designed to comply with European Utility Requirements (EUR) and nuclear design requirements of the European countries. And it is modified and improved from its original design of APR1400. The whole duration varies depending on items for additional process. Refueling and regular maintenance outage is comprised of basic processes and Main turbine-generator outage includes dismantling inspection of main generator and high pressure turbine as a critical path in addition to basic processes. In-Service Inspection Outage includes Automatic ultrasonic inspection on the upper side/lower side of a nuclear reactor as a critical path in addition to basic processes. The planned outage durations of EU-APR are optimized according to the above results. And they are complied with EUR Requirement (EUR 2.2.7.2.2 B), respectively. In addition, outage duration can be reduced with improved operating technology and more maintenance friendly environment including betterment of filling, drain and ventilation.

Evaluation of the Planned Outage Durations in EU-APR

International Nuclear Information System (INIS)

Jung, Byung Joon; Lee, Keun Sung

2016-01-01

EU-APR has been designed to comply with European Utility Requirements (EUR) and nuclear design requirements of the European countries. And it is modified and improved from its original design of APR1400. The whole duration varies depending on items for additional process. Refueling and regular maintenance outage is comprised of basic processes and Main turbine-generator outage includes dismantling inspection of main generator and high pressure turbine as a critical path in addition to basic processes. In-Service Inspection Outage includes Automatic ultrasonic inspection on the upper side/lower side of a nuclear reactor as a critical path in addition to basic processes. The planned outage durations of EU-APR are optimized according to the above results. And they are complied with EUR Requirement (EUR 2.2.7.2.2 B), respectively. In addition, outage duration can be reduced with improved operating technology and more maintenance friendly environment including betterment of filling, drain and ventilation

Skin sparing mastectomy: Technique and suggested methods of reconstruction

Directory of Open Access Journals (Sweden)

Ahmed M. Farahat

2014-09-01

Conclusions: Skin Sparing mastectomy through a circum-areolar incision has proven to be a safe and feasible option for the management of breast cancer in Egyptian women, offering them adequate oncologic control and optimum cosmetic outcome through preservation of the skin envelope of the breast when ever indicated. Our patients can benefit from safe surgery and have good cosmetic outcomeby applying different reconstructive techniques.

Effects of Breast Cancer and Mastectomy on Fibrinolytic Activity in ...

African Journals Online (AJOL)

It is good to know if this is also the case in Africans with breast cancer. Africans are known to possess enhanced fibrinolysis. This study was designed to assess the effect of breast cancer on fibrinolytic activity and the effect of mastectomy on fibrinolysis in African women. Sixty histo-patholically proven breast cancer patients ...

Current status of integrated HFE V and V system of APR1400

International Nuclear Information System (INIS)

Lee, M. S.; Hong, J. H.; Lee, S. H.; Lee, Y. K.

2006-01-01

The first Advanced Light Water Reactor called Advanced Power Reactor (APR1400) has many specific features such as passive safety features, digital I and C, and digitalized main control room design. This digital-based neo-concept main control room design needs comprehensive verification and validation process to get the license for construction. An integrated system for APR1400 MMIS design validation is under development by KEPRI with the participating of KHNP. The facility which is based on the NUREG/CR-6393 and ANS3.5 can simulate all of the dynamic functions and responses of APR1400, and measure the human factors by using conventional subject methods and measuring the operator's biological signals. This system will be used in human factors V and V process of the PRM (NUREG0711) of APR1400 MMIS design. (authors)

Skin sparing mastectomy: Technique and suggested methods of reconstruction

International Nuclear Information System (INIS)

Farahat, A.M.; Hashim, T.; Soliman, H.O.; Manie, T.M.; Soliman, O.M.

2014-01-01

To demonstrate the feasibility and accessibility of performing adequate mastectomy to extirpate the breast tissue, along with en-block formal axillary dissection performed from within the same incision. We also compared different methods of immediate breast reconstruction used to fill the skin envelope to achieve the best aesthetic results. Methods: 38 patients with breast cancer underwent skin-sparing mastectomy with formal axillary clearance, through a circum-areolar incision. Immediate breast reconstruction was performed using different techniques to fill in the skin envelope. Two reconstruction groups were assigned; group 1: Autologus tissue transfer only (n= 24), and group 2: implant augmentation (n= 14). Autologus tissue transfer: The techniques used included filling in the skin envelope using Extended Latissimus Dorsi flap (18 patients) and Pedicled TRAM flap (6 patients). Augmentation with implants: Subpectoral implants(4 patients), a rounded implant placed under the pectoralis major muscle to augment an LD reconstructed breast. LD pocket (10 patients), an anatomical implant placed over the pectoralis major muscle within a pocket created by the LD flap. No contra-lateral procedure was performed in any of the cases to achieve symmetry. Results: All cases underwent adequate excision of the breast tissue along with en-block complete axillary clearance (when indicated), without the need for an additional axillary incision. Eighteen patients underwent reconstruction using extended LD flaps only, six had TRAM flaps, four had augmentation using implants placed below the pectoralis muscle along with LD flaps, and ten had implants placed within the LD pocket. Breast shape, volume and contour were successfully restored in all patients. Adequate degree of ptosis was achieved, to ensure maximal symmetry. Conclusions: Skin Sparing mastectomy through a circum-areolar incision has proven to be a safe and feasible option for the management of breast cancer in Egyptian

Erector spinae plane block for radical mastectomy: A new indication?

Science.gov (United States)

Veiga, M; Costa, D; Brazão, I

2018-02-01

The erector spinae plane block is a technique recently described by Forero et al. in September 2016. It has applications in the control of chronic pain with neuropathic component of the chest wall, and for pain control in thoracoscopic surgery. In this article, we describe the use of this technique as part of a multimodal analgesic approach in a 40-year-old woman, who underwent radical mastectomy due to breast cancer. By performing this block before anesthetic induction, we have achieved an opioid sparing effect, avoiding a possible immunomodulatory effect, although not yet proven in humans. During hospitalization, the patient reported no pain (0/10 in numeric scale), without resorting to rescue analgesia. The easy, fast and safe execution of erector spinae plane block makes it a promising technique in the context of surgical pain during radical mastectomy. Copyright © 2017 Sociedad Española de Anestesiología, Reanimación y Terapéutica del Dolor. Publicado por Elsevier España, S.L.U. All rights reserved.

Study on Maintenance Personnel Development Plan For The Exported APR1400 Commissioning

International Nuclear Information System (INIS)

Cho, Sungbae; Kim, Jongdae; Jun, Hokwang; Hwang, Inok; Kang, Jaeyuel

2012-01-01

This paper indicates ways to develop maintenance personnel for the exported APR1400 commissioning. The exported APR1400 has not been experienced ay maintenance yet, and requirements for maintenance personnel have not been clarified yet. Based on sound maintenance experience, KEPCO Plant Service and Engineering Company (KEPCO KPS) has studied on maintenance training and career requirement to establish a development plan of the maintenance personnel for the exported nuclear power plant. By defining manpower and training requirement, and mobilization plan, we expect to secure reliability of the exported APR1400

Nipple-sparing mastectomy with immediate implant reconstruction: cosmetic outcomes and technical refinements.

Science.gov (United States)

Salgarello, Marzia; Visconti, Giuseppe; Barone-Adesi, Liliana

2010-11-01

Nipple-sparing mastectomy is gaining widespread popularity, as it could allow improved aesthetic outcome without increasing oncologic risk. To investigate the reconstructive issues experienced with immediate implant reconstruction, the authors reviewed the cosmetic outcomes of their series. The authors retrospectively analyzed the data on 33 cases of nipple-sparing mastectomy for both cancer and prophylaxis with immediate implant reconstruction using the submusculo-subfascial pocket. Cosmetic evaluation methods were clinical and photography-based assessments and a patient-satisfaction survey. The average follow-up period was 26.8 months. No nipple-areola complex cancer involvement was registered. The reconstructive outcomes ranged from good to excellent in 83 percent of the cases. Patients' satisfaction was high to very high, except in one patient who experienced total nipple-areola complex loss (one breast, 2.4 percent). Overall, early minor complications were registered in four breasts (9.5 percent) and late minor complications in five cases (12 percent). The authors' series suggest that nipple-sparing mastectomy is an option for carefully selected and screened patients. Larger studies with longer follow-up are needed, however. On the whole, the immediate one-stage implant reconstruction with hyperprojected anatomical gel implants represents a valid option. The skin incision algorithm proposed, which is based on the breast size, shape, and previous scars, might aid in the decision-making process to achieve satisfying results using this procedure. The radial approaches represent a good compromise between the oncologic and reconstructive procedures.

Segmental mastectomy and radiotherapy as treatment of stage II breast cancer

International Nuclear Information System (INIS)

Faria, S.L.; Chiminazzo Junior, H.; Schlupp, W.R.; Cunha, L.S.M. da

1987-01-01

The treatment of operable breast cancer with segmental mastectomy and radiotherapy has been described since decade 30. Many recent prospective and retrospective studies have shown the efficacy of this conservative management, particularly in stage I. There are still doubts in its use in stage II. (Author) [pt

Is Radiation Indicated in Patients With Ductal Carcinoma In Situ and Close or Positive Mastectomy Margins?

International Nuclear Information System (INIS)

Chan, Linda W.; Rabban, Joseph; Hwang, E. Shelley; Bevan, Alison; Alvarado, Michael; Ewing, Cheryl; Esserman, Laura; Fowble, Barbara

2011-01-01

Purpose: Resection margin status is one of the most significant factors for local recurrence in patients with ductal carcinoma in situ (DCIS) treated with breast-conserving surgery with or without radiation. However, its impact on chest wall recurrence in patients treated with mastectomy is unknown. The purpose of this study was to determine chest wall recurrence rates in women with DCIS and close ( 5 cm or diffuse disease. Median width of the close final margin was 2 mm. Nineteen patients had margins of <1 mm. One of these 59 patients experienced a chest wall recurrence with regional adenopathy, followed by distant metastases 2 years following skin-sparing mastectomy. The DCIS was high-grade, 4 cm, with a 5-mm deep margin. A second patient developed an invasive cancer in the chest wall 20 years after her mastectomy for DCIS. This cancer was considered a new primary site arising in residual breast tissue. Conclusions: The risk of chest wall recurrence in this series of patients is 1.7% for all patients and 3.3% for high-grade DCIS. One out of 20 (5%) patients undergoing skin sparing or total skin-sparing mastectomy experienced a chest wall recurrence. This risk of a chest wall recurrence appears sufficiently low not to warrant a recommendation for postmastectomy radiation therapy for patients with margins of <5 mm. There were too few patients with positive margins to draw any firm conclusions.

Significance of internal mammary lymph nodes in patients after mastectomy with tissue-expander reconstruction: a case-control study

International Nuclear Information System (INIS)

Kaewlai, R.; Digumarthy, S.R.; Smith, B.L.; Corben, A.D.; Austen, W.G.; Shepard, J.-A.O.; Sharma, A.

2010-01-01

Aim: To retrospectively assess the frequency of internal mammary lymph nodes (IMNs) in patients after mastectomy and tissue-expander reconstruction. Materials and methods: Statistical analysis was performed for all available data in patients with mastectomy and tissue-expander reconstruction from 2004-2007 (study group). The data were compared with that of a control population with mastectomy who did not have reconstruction (control group). Patients with recurrent breast cancers, previous breast reconstruction, surgeries performed at outside hospitals, no available pre- or postoperative computed tomography (CT) or magnetic resonance imaging (MRI) data, or inadequate imaging follow-up were excluded. Results: There were eight patients in the study group (median age 50.5 years, seven breast cancers), and eight patients in the control group (median age 52 years, seven breast cancers). No patients had IMNs on their preoperative imaging examinations. New IMNs were present in postoperative imaging in seven of eight patients (7/8, 87.5%) in the study group. All of them were stable or decreased in size on subsequent imaging examinations. None of the patients in the control group had IMNs (0/8). Conclusion: IMNs are common on imaging after mastectomy and tissue-expander placement. The IMNs decreased or remained stable on follow-up imaging and may represent reactive nodes.

Significance of internal mammary lymph nodes in patients after mastectomy with tissue-expander reconstruction: a case-control study

Energy Technology Data Exchange (ETDEWEB)

Kaewlai, R., E-mail: rathachai@gmail.co [Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Boston, MA (United States); Digumarthy, S.R. [Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Boston, MA (United States); Smith, B.L. [Department of Surgery, Massachusetts General Hospital and Harvard Medical School, Boston, MA (United States); Corben, A.D. [Department of Pathology, Massachusetts General Hospital and Harvard Medical School, Boston, MA (United States); Austen, W.G. [Department of Surgery, Massachusetts General Hospital and Harvard Medical School, Boston, MA (United States); Shepard, J.-A.O.; Sharma, A. [Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Boston, MA (United States)

2010-06-15

Aim: To retrospectively assess the frequency of internal mammary lymph nodes (IMNs) in patients after mastectomy and tissue-expander reconstruction. Materials and methods: Statistical analysis was performed for all available data in patients with mastectomy and tissue-expander reconstruction from 2004-2007 (study group). The data were compared with that of a control population with mastectomy who did not have reconstruction (control group). Patients with recurrent breast cancers, previous breast reconstruction, surgeries performed at outside hospitals, no available pre- or postoperative computed tomography (CT) or magnetic resonance imaging (MRI) data, or inadequate imaging follow-up were excluded. Results: There were eight patients in the study group (median age 50.5 years, seven breast cancers), and eight patients in the control group (median age 52 years, seven breast cancers). No patients had IMNs on their preoperative imaging examinations. New IMNs were present in postoperative imaging in seven of eight patients (7/8, 87.5%) in the study group. All of them were stable or decreased in size on subsequent imaging examinations. None of the patients in the control group had IMNs (0/8). Conclusion: IMNs are common on imaging after mastectomy and tissue-expander placement. The IMNs decreased or remained stable on follow-up imaging and may represent reactive nodes.

Health insurance coverage and racial disparities in breast reconstruction after mastectomy.

Science.gov (United States)

Shippee, Tetyana P; Kozhimannil, Katy B; Rowan, Kathleen; Virnig, Beth A

2014-01-01

Breast reconstruction after mastectomy offers clinical, cosmetic, and psychological benefits compared with mastectomy alone. Although reconstruction rates have increased, racial/ethnic disparities in breast reconstruction persist. Insurance coverage facilitates access to care, but few studies have examined whether health insurance ameliorates disparities. We used the Nationwide Inpatient Sample for 2002 through 2006 to examine the relationships between health insurance coverage, race/ethnicity, and breast reconstruction rates among women who underwent mastectomy for breast cancer. We examined reconstruction rates as a function of the interaction of race and the primary payer (self-pay, private health insurance, government) while controlling for patient comorbidity, and we used generalized estimating equations to account for clustering and hospital characteristics. Minority women had lower breast reconstruction rates than White women (adjusted odds ratio [AOR], 0.57 for African American; AOR, 0.70 for Hispanic; AOR, 0.45 for Asian; p women (AOR, 0.33) and those with public coverage were less likely to undergo reconstruction (AOR, 0.35; p women. Racial/ethnic disparities were less prominent within insurance types. Minority women, whether privately or publicly insured, had lower odds of undergoing reconstruction than White women. Among those without insurance, reconstruction rates did not differ by race/ethnicity. Insurance facilitates access to care, but does not eliminate racial/ethnic disparities in reconstruction rates. Our findings-which reveal persistent health care disparities not explained by patient health status-should prompt efforts to promote both access to and use of beneficial covered services for women with breast cancer. Copyright © 2014 Jacobs Institute of Women's Health. Published by Elsevier Inc. All rights reserved.

Outcomes in Patients Treated With Mastectomy for Ductal Carcinoma In Situ

International Nuclear Information System (INIS)

Owen, Dawn; Tyldesley, Scott; Alexander, Cheryl; Speers, Caroline; Truong, Pauline; Nichol, Alan; Wai, Elaine S.

2013-01-01

Purpose: To examine, in a large, population-based cohort of women, the risk factors for recurrence after mastectomy for pure ductal carcinoma in situ (DCIS) and to identify which patients may benefit from postmastectomy radiation therapy. Methods and Materials: Data were analyzed for 637 subjects with pure DCIS, diagnosed between January 1990 and December 1999, treated initially with mastectomy. Locoregional relapse (LRR), breast cancer-specific survival, and overall survival were described using the Kaplan-Meier method. Reported risk factors for LRR (age, margins, size, Van Nuys Prognostic Index, grade, necrosis, and histologic subtype) were analyzed by univariate (log-rank) and multivariate (Cox modeling) methods. Results: Median follow-up was 12.0 years. Characteristics of the cohort were median age 55 years, 8.6% aged ≤40 years, 30.5% tumors >4 cm, 42.5% grade 3 histology, 37.7% multifocal disease, and 4.9% positive margins. At 10 years, LRR was 1.0%, breast cancer-specific survival was 98.0%, and overall survival was 90.3%. All recurrences (n=12) involved ipsilateral chest wall disease, with the majority being invasive disease (11 of 12). None of the 12 patients with recurrence died of breast cancer; all were successfully salvaged (median follow-up of 4.4 years). Ten-year LRR was higher with age ≤40 years (7.5% vs 1.5%; P=.003). Conclusion: Mastectomy provides excellent locoregional control for DCIS. Routine use of postmastectomy radiation therapy is not justified. Young age (≤40 years) predicts slightly higher LRR, but possibly owing to the small number of cases with multiple risk factors for relapse, a subgroup with a high risk of LRR (ie, approximately 15%) was not identified

48 CFR 1552.235-76 - Treatment of Confidential Business Information (APR 1996).

Science.gov (United States)

2010-10-01

... Business Information (APR 1996). 1552.235-76 Section 1552.235-76 Federal Acquisition Regulations System... Provisions and Clauses 1552.235-76 Treatment of Confidential Business Information (APR 1996). As prescribed in 1535.007-70(c), insert the following clause: Treatment of Confidential Business Information (TSCA...

Analyzing the risk of recurrence after mastectomy for DCIS: a new use for the USC/Van Nuys Prognostic Index.

Science.gov (United States)

Kelley, Leah; Silverstein, Melvin; Guerra, Lisa

2011-02-01

Patients with ductal carcinoma in situ (DCIS) who are treated with mastectomy seldom recur locally or with metastatic disease. When patients with DCIS recur with invasive cancer, they are upstaged and their lives are threatened. We questioned whether histopathologic data could be used to predict these infrequent events. We reviewed a prospective database of 1,472 patients with pure DCIS. All patients were scored from 4 to 12 using the USC Van Nuys Prognostic Index, an algorithm based on DCIS size, nuclear grade, necrosis, margin width, and patient age. Probabilities of recurrence and death were calculated using the Kaplan-Meier method. A total of 496 patients with pure DCIS were treated with mastectomy. None received any form of postmastectomy adjuvant treatment. Average follow-up was 83 months. Eleven patients developed recurrences, all of whom scored 10-12 using the USC/VNPI. No patient who scored 4-9 recurred. All 11 patients who recurred had multifocal disease and comedo-type necrosis. The probability of disease recurrence after mastectomy for patients scoring 10-12 was 9.6% at 12 years, compared with 0% for those scoring 4-9. There was no difference in overall survival. There were no recurrences among mastectomy patients who scored 4-9 using the USC/VNPI. Patients scoring 10-12 were significantly more likely to develop recurrence after mastectomy. At risk were young patients with large, high-grade, and multifocal or multicentric tumors. For every 100 patients with USC/VNPI scores of 10-12, 10 patients will recur by 12 years and 2-3 will develop metastatic disease.

THORACO - ABDOMINAL FLAP FOR RESURFACING LARGE POST MASTECTOMY DEFECTS IN LOCALLY ADVANCED CA. BREAST

Directory of Open Access Journals (Sweden)

Srinivasa Rao

2015-02-01

Full Text Available Covering of large wounds after mastectomy in locally advanced Ca breast with skin that can withstand radiotherapy is a challenge to the surgeon. Here this study we used a local advancement flap from the adjacent area called Thoraco - A bdominal F la p (TA flap for such giant defects. This is based on superficial and lumbar arteries and is thick to with stand consequent RT . MATERIALS AND METHODS: Of the total 107 cases of LABC 32 had post mastectomy defects of larger than 12 cm and could not be closed by simple approximation. Among the 32 cases 17 cases are covered by split thickness skin grafting. 15 cases are covered by TA flap. These cases are assessed for mean operating time, mean blood loss, post - operative stay, flap necrosis and viability of the f lap after radiotherapy. RESULTS: There is minimal extra time or blood loss in these cases . All the flaps healed well except for small edge necrosis in 4 cases. In all the patients we could start radiotherapy in the fourth week of surgery and all the flaps withstood RT well. After further evaluation probably this can be recommended as procedure for giant post mastectomy defects particularly for those who require RT early

The relationship between body esteem and hope and mental health in breast cancer patients after mastectomy

Directory of Open Access Journals (Sweden)

Mohammad Heidari

2015-01-01

Full Text Available Background: Breast cancer and its treatment, including mastectomy, can cause feelings of mutilation, depreciation in the value of the body, reduction in attractiveness, and lead to mental disorders and hopelessness. Objective: The present study aimed to determine the relationship between appreciating the body, hope and mental health in women with breast cancer after mastectomy. Materials and Methods: This study was a descriptive study of 100 breast cancer patients who had undergone mastectomy and referred to the Sayed Al-Shohada Medical Center in Isfahan, Iran. The subjects were selected by convenient sampling. Data gathering tools were the Body Esteem Scale (BES, Herth Hope Index (HHI, and Symptom Checklist 25 (SCL-25 mental health questionnaire. Data analysis was performed using SPSS software. Results: Most of the patients had low body esteem. There was a significant direct linear relationship between body esteem and hope and mental health. This relationship was stronger between valuing the body and hope. Conclusion: Body esteem has a significant linear relationship with hope and mental health.

The Relationship between Body Esteem and Hope and Mental Health in Breast Cancer Patients after Mastectomy

Science.gov (United States)

Heidari, Mohammad; Ghodusi, Mansureh

2015-01-01

Background: Breast cancer and its treatment, including mastectomy, can cause feelings of mutilation, depreciation in the value of the body, reduction in attractiveness, and lead to mental disorders and hopelessness. Objective: The present study aimed to determine the relationship between appreciating the body, hope and mental health in women with breast cancer after mastectomy. Materials and Methods: This study was a descriptive study of 100 breast cancer patients who had undergone mastectomy and referred to the Sayed Al-Shohada Medical Center in Isfahan, Iran. The subjects were selected by convenient sampling. Data gathering tools were the Body Esteem Scale (BES), Herth Hope Index (HHI), and Symptom Checklist 25 (SCL-25) mental health questionnaire. Data analysis was performed using SPSS software. Results: Most of the patients had low body esteem. There was a significant direct linear relationship between body esteem and hope and mental health. This relationship was stronger between valuing the body and hope. Conclusion: Body esteem has a significant linear relationship with hope and mental health. PMID:26009674

Implementasi Automatic Packet Reporting System (APRS) Untuk Paket Data Pemantauan dan PengukuranUntuk Paket Data Pemantauan dan Pengukuran

OpenAIRE

Arief Goeritno

2016-01-01

Telah dilakukan implementasi Automatic Packet Reporting System (APRS) untuk paket data pemantauan dan pengukuran melalui tujuan penelitian, berupa: a) penyetelan program aplikasi pada jaringan APRS dan b) pengukuran terhadap penerimaan data berdasarkan kinerja sensor-sensor. Penyetelan program aplikasi APRS merupakan konfigurasi perangkat lunak untuk APRS yang akan digunakan pada stasiun penerimaan data APRS dengan program aplikasi yang biasa digunakan, yaitu hyperterminal dan UI-View 32. Pen...

Comparison of Reconstructive Outcomes in Breast Cancer Patients With Preexisting Subpectoral Implants: Implant-Sparing Mastectomy With Delayed Implant Exchange Versus Immediate Tissue Expander Reconstruction.

Science.gov (United States)

Parabkaharan, Sangeetha; Melody, Megan; Trotta, Rose; Lleshi, Amina; Sun, Weihong; Smith, Paul D; Khakpour, Nazanin; Dayicioglu, Deniz

2016-06-01

Women who have undergone prior augmentation mammoplasty represent a unique subset of breast cancer patients with several options available for breast reconstruction. We performed a single institution review of surgical outcomes of breast reconstruction performed in patients with breast cancer with prior history of subpectoral breast augmentation. Institutional review board-approved retrospective review was conducted among patients with previously mentioned criteria treated at our institution between 2000 and 2014. Reconstructions were grouped into 2 categories as follows: (1) removal of preexisting subpectoral implant during mastectomy with immediate tissue expander placement and (2) implant-sparing mastectomy followed by delayed exchange to a larger implant. We reviewed demographics, tumor features, and reconstruction outcomes of these groups. Fifty-three patients had preexisting subpectoral implants. Of the 63 breast reconstructions performed, 18 (28.6%) had immediate tissue expander placed and 45 (71.4%) had implant-sparing mastectomy followed by delayed implant exchange. The groups were comparable based on age, body mass index, cancer type, tumor grade, TNM stage at presentation, and hormonal receptor status. No significant difference was noted between tumor margins or subsequent recurrence, mastectomy specimen weight, removed implant volume, volume of implant placed during reconstruction, or time from mastectomy to final implant placement. Rates of complications were significantly higher in the tissue expander group compared to the implant-sparing mastectomy group 7 (38.9%) versus 4 (8.9%) (P = 0.005). Implant-sparing mastectomy with delayed implant exchange in patients with preexisting subpectoral implants is safe and has fewer complications compared to tissue expander placement. There was no difference noted in the final volume of implant placed, time interval for final implant placement, or tumor margins.

Risk-reducing mastectomy for the prevention of primary breast cancer.

Science.gov (United States)

Carbine, Nora E; Lostumbo, Liz; Wallace, Judi; Ko, Henry

2018-04-05

Recent progress in understanding the genetic basis of breast cancer and widely publicized reports of celebrities undergoing risk-reducing mastectomy (RRM) have increased interest in RRM as a method of preventing breast cancer. This is an update of a Cochrane Review first published in 2004 and previously updated in 2006 and 2010. (i) To determine whether risk-reducing mastectomy reduces death rates from any cause in women who have never had breast cancer and in women who have a history of breast cancer in one breast, and (ii) to examine the effect of risk-reducing mastectomy on other endpoints, including breast cancer incidence, breast cancer mortality, disease-free survival, physical morbidity, and psychosocial outcomes. For this Review update, we searched Cochrane Breast Cancer's Specialized Register, MEDLINE, Embase and the WHO International Clinical Trials Registry Platform (ICTRP) on 9 July 2016. We included studies in English. Participants included women at risk for breast cancer in at least one breast. Interventions included all types of mastectomy performed for the purpose of preventing breast cancer. At least two review authors independently abstracted data from each report. We summarized data descriptively; quantitative meta-analysis was not feasible due to heterogeneity of study designs and insufficient reporting. We analyzed data separately for bilateral risk-reducing mastectomy (BRRM) and contralateral risk-reducing mastectomy (CRRM). Four review authors assessed the methodological quality to determine whether or not the methods used sufficiently minimized selection bias, performance bias, detection bias, and attrition bias. All 61 included studies were observational studies with some methodological limitations; randomized trials were absent. The studies presented data on 15,077 women with a wide range of risk factors for breast cancer, who underwent RRM.Twenty-one BRRM studies looking at the incidence of breast cancer or disease-specific mortality, or

Age-dependent Characteristics in Women with Breast Cancer: Mastectomy and Reconstructive Trends at an Urban Academic Institution.

Science.gov (United States)

Rodby, Katherine A; Robinson, Emilie; Danielson, Kirstie K; Quinn, Karina P; Antony, Anuja K

2016-03-01

Breast reconstruction is an important aspect of treatment after breast cancer. Postmastectomy reconstruction bears a significant impact on a woman's postsurgical confidence, sexuality, and overall well-being. Previous studies have inferred that women under age 40 years have unique characteristics that distinguish them from an older cohort. Identifying age-dependent trends will assist with counseling women on mastectomy and reconstruction. To identify age-dependent trends, 100 consecutive women were sampled from a prospectively maintained breast reconstruction database at an urban academic institution from June 2010 through June 2013. Women were placed into two cohorts mastectomy, reconstructive and symmetry procedures were evaluated. Statistical analysis was performed using SAS software. In 100 patients of the sample study cohort, 151 reconstructions were performed. Increasing age was associated with one or more comorbidities [odds ratio (OR) = 1.07, P = 0.005], whereas younger age was associated with metastatic disease (OR = 0.88, P = 0.006), chemotherapy (OR = 0.94, P = 0.01), and radiation (OR = 0.94, P = 0.006); split cohorts demonstrated similar trends (P Mastectomy and reconstructive characteristics associated with younger age included bilateral mastectomy (OR = 0.94, P = 0.004), tissue expander (versus autologous flap) (OR = 0.94, P = 0.009), extra high implant type (OR = 0.94, P = 0.049), whereas increasing use of autologous flaps and contralateral mastopexy symmetry procedures (OR = 1.09, P = 0.02) were associated with an aging cohort. Increasing age was not associated with an increasing likelihood of complications (P = 0.75). Age-related factors play a role in the treatment of patients with breast cancer. Younger women typically present with more aggressive features requiring oncologic treatment including chemotherapy and radiation. Mastectomy and reconstructive choices also demonstrate age-dependent characteristics. Women in younger age groups are more

Bilateral DCIS following gynecomastia surgery. Role of nipple sparing mastectomy. A case report and review of literature☆

Science.gov (United States)

Noor, L.; McGovern, P.; Bhaskar, P.; Lowe, J.W.

2011-01-01

Bilateral ductal carcinoma in situ of breast is a very rare disease in men. Ductal carcinoma in situ (DCIS) is an abnormal proliferation that involves the ductal epithelium and it has the potential of evolving into an invasive tumour. Gynaecomastia (female like breast in men) is a benign condition though it is associated with a reported 3% incidence of unilateral invasive breast cancer.2 Synchronous bilateral breast cancer in association with gynaecomastia is exceptionally rare. The recommended treatment for DCIS in male is mastectomy. So far only 2 cases of bilateral DCIS in male patients has been reported in the literature treated with skin and nipple sparing mastectomies. We report another case of synchronous bilateral DCIS in a male treated with skin and nipple sparing mastectomies. A 44 year-old man with history of long-standing gynecomastia. He had no identifiable risk factor for the development of cancer. His pre operative assessment of breast including mammograms was normal. He underwent bilateral subcutaneous mastectomies, with subsequent incidental diagnosis of synchronous bilateral ductal carcinoma in situ. The case was discussed in multidisciplinary team meeting and the need for further surgery was felt including excision of nipple areola complex. However considering patient wishes, cosmetic outcome and recent literature it was decided to preserve nipple areola complex (NAC) with regular follow up evaluation. Our patient at completion of 18 months of treatment is doing well with no signs of local recurrence. PMID:22096697

Mixed Psychological Changes Following Mastectomy: Unique Predictors and Heterogeneity of Post-traumatic Growth and Post-traumatic Depreciation.

Science.gov (United States)

Kroemeke, Aleksandra; Bargiel-Matusiewicz, Kamilla; Kalamarz, Magdalena

2017-01-01

Objectives: Post-traumatic growth (PTG) and its opposite-post-traumatic depreciation (PTD)-may be treated as important indicators of the patient quality of life. In the absence of studies on both, PTG and PTD in cancer patients, we investigated (1) coping strategies and support effectiveness as predictors of PTG and PTD in post-mastectomy women, (2) homogeneous classes with different intensity of PTG and PTD symptoms, and (3) correlates of class membership. Methods: Coping strategies (Brief COPE), support effectiveness (SSE-Q), PTG (PTGI), and PTD (negatively reworded items of PTGI) were measured in 84 post-mastectomy women (mean age = 62.27, SD = 8.38). Multiple regression, two-step cluster, and multinomial logistic regression were applied. Results: PTG and PTD had unique predictors: time since diagnosis and positive emotion-focused coping predicted PTG ( R 2 = 0.24), while negative emotion-focused and avoidance-focused coping and low support effectiveness were linked to PTD ( R 2 = 0.14). Four groups of PTG × PTD symptoms were identified: high PTG low PTD group (52.4%), low PTG low PTD group (17.9%), high PTG high PTD group (15.5%), and low PTG high PTD group (14.3%). Higher emotion- and avoidance-focused coping was characteristic for the high PTD low PTG group ( R 2 = 0.41). Conclusion: Our findings shed light on the coexistence and unique predictors of PTG and PTD after mastectomy, indicating heterogeneity in PTG and PTD levels among post-mastectomy women.

Radiation therapy for chest wall recurrence of breast cancer after mastectomy in a favorable subgroup of patients

International Nuclear Information System (INIS)

Hsi, R. Alex; Antell, Andrew; Schultz, Delray J.; Solin, Lawrence J.

1998-01-01

Purpose: Long-term outcome after radiation therapy for local-regional recurrence of breast cancer after mastectomy is generally poor. This study was performed to evaluate the long-term outcome for a potentially favorable subgroup of patients with chest wall recurrence. Methods and Materials: Of 71 patients with an isolated local-regional recurrence of breast cancer after mastectomy, 18 were identified who met the following favorable selection criteria: 1) a disease-free interval after mastectomy of 2 years or more, 2) an isolated chest wall recurrence, and 3) tumor size < 3 cm or complete excision of the recurrent disease. All 18 patients were treated with local-regional irradiation between 1967 and 1988. Radiotherapy (RT) was delivered to the chest wall to a median total dose of 60 Gy (range 30-66 Gy). Four patients received adjuvant chemotherapy and six patients received adjuvant hormonal therapy. Results: With a median follow-up of 8.4 years, nine of 18 patients were alive and free of disease. The 10-year actuarial overall and cause-specific survivals were 72% and 77%, respectively. The 10-year actuarial relapse-free survival and local control were 42% and 86%, respectively. Conclusion: Treatment for a local-regional recurrence of breast cancer after mastectomy in a favorable subgroup of patients results in a high rate of long-term survival as well as excellent local control. Aggressive treatment is warranted in this favorable subgroup of patients. 1998 Elsevier Science Inc

48 CFR 1552.235-75 - Access to Toxic Substances Control Act Confidential Business Information (APR 1996).

Science.gov (United States)

2010-10-01

... Control Act Confidential Business Information (APR 1996). 1552.235-75 Section 1552.235-75 Federal... Confidential Business Information (APR 1996). As prescribed in 1535.007(b), insert the following provision: Access to Toxic Substances Control Act Confidential Business Information (APR 1996) In order to perform...

Prophylactic Nipple-Sparing Mastectomy and Direct-to-Implant Reconstruction of the Large and Ptotic Breast: Is Preshaping of the Challenging Breast a Key to Success?

Science.gov (United States)

Gunnarsson, Gudjon L; Bille, Camilla; Reitsma, Laurens C; Wamberg, Peter; Thomsen, Jørn Bo

2017-09-01

Nipple-sparing mastectomy with simultaneous hammock technique direct-to-implant reconstruction is increasingly offered to patients opting for risk-reducing mastectomy. Despite this promising method, patients with macromastia and ptotic breasts remain a challenging group to treat satisfactorily and more often end up undergoing a difficult corrective procedure and experience an unacceptably high rate of failed reconstruction. The authors examined whether targeted preshaping mastopexy/reduction could prepare these patients for a successful nipple-sparing mastectomy/direct-to-implant reconstruction. Patients seeking risk-reducing nipple-sparing mastectomy/direct-to-implant reconstruction at the authors' institutions deemed unfit for a one-stage procedure based on their previous experience were offered a targeted two-stage, risk-reducing mastopexy/reduction followed by a delayed secondary nipple-sparing mastectomy and direct-to-implant reconstruction. Patients were followed up at 3 weeks and 6 or 12 months. Forty-four reconstructions were performed in 22 patients aged 43 years (range, 26 to 57 years). All 44 procedures were completed successfully without any failure or nipple-areola complex losses. Patients' median body mass index was 30 kg/m (range, 22 to 44 kg/m). Six patients were smokers and one had hypertension. Two patients underwent reoperation because of hematoma and fat necrosis. The authors' results demonstrate that a targeted preshaping mastopexy/reduction followed by nipple-sparing mastectomy/direct-to-implant reconstruction can be safely planned in women who opt for a risk-reducing mastectomy and can be performed successfully with a 3- to 4-month time span between operations. On the basis of these results and the superior cosmetic outcome, the two-stage approach has become the authors' standard of care in all such settings. Therapeutic, IV.

[Implementation of a post-discharge surgical site infection system in herniorrhaphy and mastectomy procedures].

Science.gov (United States)

San Juan Sanz, Isabel; Díaz-Agero-Pérez, Cristina; Robustillo-Rodela, Ana; Pita López, María José; Oliva Iñiguez, Lourdes; Monge-Jodrá, Vicente

2014-10-01

Monitoring surgical site infection (SSI) performed during hospitalization can underestimate its rates due to the shortening in hospital stay. The aim of this study was to determine the actual rates of SSI using a post-discharge monitoring system. All patients who underwent herniorraphy or mastectomy in the Hospital Universitario Ramón y Cajal from 1 January 2011 to 31 December 2011 were included. SSI data were collected prospectively according to the continuous quality improvement indicators (Indicadores Clinicos de Mejora Continua de la Calidad [INCLIMECC]) monitoring system. Post-discharge follow-up was conducted by telephone survey. A total of 409patients were included in the study, of whom 299 underwent a herniorraphy procedure, and 110 underwent a mastectomy procedure. For herniorrhaphy, the SSI rate increased from 6.02% to 7.6% (the post-discharge survey detected 21.7% of SSI). For mastectomy, the SSI rate increased from 1.8% to 3.6% (the post-discharge survey detected 50% of SSI). Post-discharge monitoring showed an increased detection of SSI incidence. Post-discharge monitoring is useful to analyze the real trend of SSI, and evaluate improvement actions. Post-discharge follow-up methods need to standardised. Copyright © 2013 Elsevier España, S.L.U. y Sociedad Española de Enfermedades Infecciosas y Microbiología Clínica. All rights reserved.

Neoadjuvant radiotherapy followed by mastectomy and immediate breast reconstruction. An alternative treatment option for locally advanced breast cancer

Energy Technology Data Exchange (ETDEWEB)

Pazos, Montserrat; Corradini, Stefanie; Schoenecker, Stephan; Scheithauer, Heike; Belka, Claus [LMU Munich, Department of Radiation Oncology, Munich (Germany); Dian, Darius [Mednord Munich Clinic, Munich (Germany); Bodungen, Vera von; Ditsch, Nina; Wuerstlein, Rachel; Harbeck, Nadia [LMU Munich, Breast Center, Department of Obstetrics and Gynecology, Munich (Germany)

2017-04-15

The optimal sequence of mastectomy with immediate breast reconstruction (IBR) and radiotherapy (RT) for the treatment of locally advanced breast cancer (LABC) is still under debate. Increased rates of postoperative complications are described following postmastectomy RT. Neoadjuvant RT aims to improve the aesthetic results and simplify the reconstructive pathway. A total of 22 patients diagnosed with LABC and treated with neoadjuvant RT followed by mastectomy and IBR between 04/2012 and 03/2015 were retrospectively analyzed. RT consisted of external beam RT to the breast and the regional lymphatics, if indicated. Both implant-based and autologous tissue-transfer reconstruction techniques were used. At the time of RT, 10 patients had no prior surgery and 12 patients had previously undergone breast-conserving surgery (BCS) with positive resection margins without the possibility to perform a second BCS. Additional neoadjuvant chemotherapy was administered in 18 patients prior to RT. A complete pathological response was achieved in 55.0% of patients. The 2-year overall survival rate was 89.3%, the 2-year disease-free-survival 79.8% and the local-recurrence-free survival was 95.2%. The cosmetic result was excellent or good in 66% of the patients treated with upfront mastectomy and 37% of the patients who had previously undergone BCS. Among patients who received implant-based IBR, 4 patients developed serious wound-healing problems with implant loss. The most satisfactory results were achieved with autologous tissue reconstruction. A sequential neoadjuvant chemo-/radiotherapy to allow IBR following mastectomy in selected cases of LABC seems feasible and can be safely attempted. Careful patient selection, close monitoring, and continuous patient support is mandatory to ensure compliance in this treatment strategy. (orig.) [German] Die optimale Therapiesequenz von Mastektomie mit sofortiger Brustrekonstruktion (IBR) und Radiotherapie (RT) beim lokal fortgeschrittenen

Surgical Margins and the Risk of Local-Regional Recurrence After Mastectomy Without Radiation Therapy

International Nuclear Information System (INIS)

Childs, Stephanie K.; Chen Yuhui; Duggan, Margaret M.; Golshan, Mehra; Pochebit, Stephen; Wong, Julia S.; Bellon, Jennifer R.

2012-01-01

Purpose: Although positive surgical margins are generally associated with a higher risk of local-regional recurrence (LRR) for most solid tumors, their significance after mastectomy remains unclear. We sought to clarify the influence of the mastectomy margin on the risk of LRR. Methods and Materials: The retrospective cohort consisted of 397 women who underwent mastectomy and no radiation for newly diagnosed invasive breast cancer from 1998-2005. Time to isolated LRR and time to distant metastasis (DM) were evaluated by use of cumulative-incidence analysis and competing-risks regression analysis. DM was considered a competing event for analysis of isolated LRR. Results: The median follow-up was 6.7 years (range, 0.5-12.8 years). The superficial margin was positive in 41 patients (10%) and close (≤2 mm) in 56 (14%). The deep margin was positive in 23 patients (6%) and close in 34 (9%). The 5-year LRR and DM rates for all patients were 2.4% (95% confidence interval, 0.9-4.0) and 3.5% (95% confidence interval, 1.6-5.3) respectively. Fourteen patients had an LRR. Margin status was significantly associated with time to isolated LRR (P=.04); patients with positive margins had a 5-year LRR of 6.2%, whereas patients with close margins and negative margins had 5-year LRRs of 1.5% and 1.9%, respectively. On univariate analysis, positive margins, positive nodes, lymphovascular invasion, grade 3 histology, and triple-negative subtype were associated with significantly higher rates of LRR. When these factors were included in a multivariate analysis, only positive margins and triple-negative subtype were associated with the risk of LRR. Conclusions: Patients with positive mastectomy margins had a significantly higher rate of LRR than those with a close or negative margin. However, the absolute risk of LRR in patients with a positive surgical margin in this series was low, and therefore the benefit of postmastectomy radiation in this population with otherwise favorable features

The impact of mastectomy type on the Female Sexual Function Index (FSFI), satisfaction with appearance, and the reconstructed breast's role in intimacy.

Science.gov (United States)

Rojas, K; Onstad, M; Raker, C; Clark, M A; Stuckey, A; Gass, J

2017-06-01

As mastectomy rates increase and overall survival for early breast cancer improves, a better understanding of the long-term consequences of mastectomy is needed. We sought to explore the correlation of specific mastectomy type with the Female Sexual Function Index (FSFI), body image satisfaction, and the reconstructed breast's role in intimacy. This study is a secondary analysis of a cross-sectional survey including a retrospective chart review. Patients at least one year from primary surgery were invited to complete the survey between 2012 and 2014. Baseline characteristics and survey responses were compared between three mastectomy groups: total/modified radical (TMRM), skin-sparing (SSM), and nipple-sparing (NSM). All patients underwent reconstruction. Of 453 invited, 268 (59%) completed the survey. Sixty underwent mastectomy with reconstruction: 16 (27%) TMRM, 36 (60%) SSM, and 8 (13%) NSM. There were no significant differences in median total FSFI scores between groups, yet median FSFI scores for the NSM group indicated sexual dysfunction. After adjusting for receipt of chemotherapy and/or radiation, NSM had the lowest median desire score. There was a trend for the NSM group to be the least satisfied with postoperative appearance, but also more likely to report that the chest was "often" caressed during intimacy. However, nearly 40% of the NSM group reported that caress of the reconstructed breast was unpleasant. NSM offers patients the greatest opportunity for preservation of their native skin envelope and potentially enhanced cosmetic outcome, but our results did not demonstrate superior sexual function or body image outcomes in this group. By highlighting surgical consequences of mastectomy preoperatively, surgeons may better set realistic patient expectations regarding both aesthetic and functional outcomes after breast cancer surgery. With clearer expectations, patients will have a better opportunity for improved surgical decision-making.

Analysis of the motor behavior of a patient submitted to radical mastectomy - doi:10.5020/18061230.2009.p61

Directory of Open Access Journals (Sweden)

Lucas Flocke Hack

2012-01-01

Full Text Available Objective: To analyze the motor behavior of a patient in late postoperative of radical mastectomy during the accomplishment of some daily life activities, her gait and her body posture. Methods: This was an observational and descriptive case report study developed in an academic institution at Novo Hamburgo/RS, Brazil. By means of video recording, the accomplishment of daily life activities, the gait and body posture of a mastectomy patient were evaluated. Results: The most important alterations found were: increased base of support, torso swinging on gait, “S” shape scoliosis, accentuation of the spine physiologic curves and compensatory attitudes for reaching greater amplitudes of arm elevation at the same side of the surgery. Conclusion: We conclude that motor behavior alterations after surgery of radical mastectomy can be reasonably minimized, remaining a small reduction of movement amplitude and of muscular strength on upper limb and torso.

Skin Sparing Mastectomy and Immediate Breast Reconstruction (SSMIR for early breast cancer: Eight years single institution experience

Directory of Open Access Journals (Sweden)

Bobin Jean

2008-04-01

Full Text Available Abstract Background Skin Sparing Mastectomy (SSM and immediate breast reconstruction has become increasingly popular as an effective treatment for patients with breast carcinoma. The aim of this study was to evaluate the clinical outcome of skin sparing mastectomy in early breast cancer at a single population-based institution. Methods Records of ninety-five consecutive patients with operable breast cancer who had skin-sparing mastectomy and immediate breast reconstructions between 1995 and 2003 were reviewed. Patient and tumor characteristic, type of reconstruction, postoperative complications, aesthetic results and incidence of recurrence were analyzed. Results Mean age of the patients was 51.6(range 33–72 years. The AJCC pathologic stages were 0 (n = 51, 53.7%, I (n = 20, 21.1%, and II (n = 2, 2.1%. Twenty of the patients had recurrent disease (21.1%. The immediate breast reconstructions were performed with autologus tissue including latissimus dorsi musculocutaneous flap in 63 (66.3% patients and transverse rectus abdominis myocutaneous (TRAM flap in 4 (4.2% patients. Implants were used in 28 (29.4% patients. The average hospital stay was 7.7 days. Flap complication occurred in seven (10.4% patients resulting in four (6% re-operations and there were no delay in accomplishing postoperative adjuvant therapy. At a median follow-up of 69 months (range 48 to 144, local recurrence was seen in one patient (1.1% and systemic recurrence was seen in two patients (2.1%. Conclusion Skin sparing mastectomy and immediate breast reconstruction for early breast cancer is associated with low morbidity and low rate of local recurrence.

Quality of life in patients with recurrent breast cancer after second breast-conserving therapy in comparison with mastectomy: the German experience.

Science.gov (United States)

Jendrian, Svenja; Steffens, Katharina; Schmalfeldt, Barbara; Laakmann, Elena; Bergelt, Corinna; Witzel, Isabell

2017-06-01

Although some studies suggest that breast-conserving therapy (BCT) shows better psychosocial outcomes than mastectomy in patients with primary breast cancer, little is known about the outcomes of these surgical options in recurrent breast cancer. We investigated differences in overall survival and re-recurrence rates as well as psychosocial outcomes among patients who underwent BCT or mastectomy after the diagnosis of recurrent breast cancer in a single-center setting. 124 of 186 eligible patients who underwent surgical treatment for breast cancer recurrence completed the questionnaires on quality of life (EORTC QLQ-C30 and -BR23), fear of progression (PA-F-KF), anxiety and depression (HADS), and body image (BIS). Women after breast-conserving surgery (n = 46) showed significantly better outcomes than women after mastectomy (n = 61) with respect to body image (P quality of life were partnership (OR 2.46), higher monthly family income (OR 3.54), and higher professional qualification (OR 4.3) in our group of patients. Our results indicate that patients treated with breast-conserving therapy after recurrent breast cancer perceive lower impairments in body image and several aspects of quality of life than patients treated with mastectomy.

Insecticidal activity of the metalloprotease AprA occurs through suppression of host cellular and humoral immunity.

Science.gov (United States)

Lee, Seung Ah; Jang, Seong Han; Kim, Byung Hyun; Shibata, Toshio; Yoo, Jinwook; Jung, Yunjin; Kawabata, Shun-Ichiro; Lee, Bok Luel

2018-04-01

The biochemical characterization of virulence factors from entomopathogenic bacteria is important to understand entomopathogen-insect molecular interactions. Pseudomonas entomophila is a typical entomopathogenic bacterium that harbors virulence factors against several insects. However, the molecular actions of these factors against host innate immune responses are not clearly elucidated. In this study, we observed that bean bugs (Riptortus pedestris) that were injected with P. entomophila were highly susceptible to this bacterium. To determine how P. entomophila counteracts the host innate immunity to survive within the insect, we purified a highly enriched protein with potential host insect-killing activity from the culture supernatant of P. entomophila. Then, a 45-kDa protein was purified to homogeneity and identified as AprA which is an alkaline zinc metalloprotease of the genus Pseudomonas by liquid chromatography mass spectrometry (LC-MS). Purified AprA showed a pronounced killing effect against host insects and suppressed both host cellular and humoral innate immunity. Furthermore, to show that AprA is an important insecticidal protein of P. entomophila, we used an aprA-deficient P. entomophila mutant strain (ΔaprA). When ΔaprA mutant cells were injected to host insects, this mutant exhibited extremely attenuated virulence. In addition, the cytotoxicity against host hemocytes and the antimicrobial peptide-degrading ability of the ΔaprA mutant were greatly decreased. These findings suggest that AprA functions as an important insecticidal protein of P. entomophila via suppression of host cellular and humoral innate immune responses. Copyright © 2017 Elsevier Ltd. All rights reserved.

GOTHIC Simulation of APR1400 Auxiliary Charging Pump room heat up

Energy Technology Data Exchange (ETDEWEB)

Ha, Hui-Un; Heo, Sun [KHNP, Daejeon (Korea, Republic of)

2014-10-15

As a part of the Advanced Power Reactor 1400 (APR1400) U. S. Nuclear Regulatory Commission Design Certification (NRC DC) project, we have been investigating Auxiliary Charging Pump (ACP) room heat up. With reference to the design specification of the ACP room, we determined input information and developed a GOTHIC model of the APR1400 ACP room. This calculation model is described herein, and representative results from the calculation are presented as well. The results of the present paper are used to determine the integrity of ACP operating in the accident. APR 1400 GOTHIC model was developed for ACP room heat up calculation. Calculation results confirm that door opening is cooling the room properly. It is found that the difference due to the surface option of heat conductors is insignificant. Based on this result, further studies should be performed to confirm integrity of ACP.

Conceptual Designs for the Performance Improvement of APR1400 SIT and Preliminary Performance Evaluation

International Nuclear Information System (INIS)

Chu, In-Cheol; Kwon, Tae-Soon; Song, Chul-Hwa

2008-01-01

Some evolutionary type PWRs such as APR1400 and APWR adopt advanced safety injection tank (SIT). The SIT of APR1400 has a fluidic device (FD) which passively controls ECC water injection flow rate into reactor coolant system during refill and reflood phases of LB-LOCA (i.e., a high injection flow rate during the refill phase and a low injection flow rate during the reflood phase). The benefit of the FD is the elimination of the function of low pressure safety injection pump from the safety injection system. The flow controlling performance of the APR1400 FD was evaluated using a prototypical full-scale test facility, called VAPER (Valve Performance Evaluation Rig). Even though the performance of the APR1400 FD satisfied major design and licensing requirements, further improvement of the performance is expected such as the extension of total injection period, the delay of nitrogen gas discharge. Several conceptual designs have been being drawn out in order to improve the performance of the APR1400 SIT. The performance of some designs was evaluated using a small scale SIT test rig. The present paper introduces some of the conceptual designs and shows the performance evaluation experimental results

Development of LBB Piping Evaluation Diagram for APR 1000 Main Steam Line Piping

International Nuclear Information System (INIS)

Yang, J. S.; Jeong, I. L.; Park, C. Y.; Bai, S. Y.

2010-01-01

This paper presents the piping evaluation diagram (PED) to assess the applicability of Leak-Before- Break(LBB) for APR 1000 main steam line piping. LBB-PED of APR 1000 main steam line piping is independent of its piping geometry and has a function of the loads applied in piping system. Also, in order to evaluate LBB applicability during construction process with only the comparative evaluation of material properties between actually used and expected, the expected changes of material properties are considered in the LBB-PED. The LBB-PED, therefore, can be used for quick LBB evaluation of APR 1000 main steam line piping of both design and construction

Double Back Cut in Post-mastectomy Breast Skin (Fish-Shaped Skin Paddle) in Delayed Pedicled TRAM Flap Breast Reconstruction.

Science.gov (United States)

Berezovsky, Alexander Bogdanov; Pagkalos, Vasileios A; Shoham, Yaron; Krieger, Yuval; Silberstein, Eldad

2015-08-01

Breast reconstruction has become standard of care for female patients with breast cancer. The transverse rectus abdominis musculo-cutaneous flap (TRAMf) is the most common method of immediate or delayed autologous breast reconstruction following mastectomy. We share our experience with modified, double back cut of post-mastectomy skin in delayed pedicled TRAMf breast reconstruction, resulting in fish-shaped skin paddle. This sort of back cut is a simple, reliable way to obtain a natural, esthetically pleasant breast mound with inconspicuous hidden scars.

Review of APR+ Level 2 PSA

International Nuclear Information System (INIS)

Lehner, J.R.; Mubayi, V.; Pratt, W.T.

2012-01-01

Brookhaven National Laboratory (BNL) assisted the Korea Institute of Nuclear Safety (KINS) in reviewing the Level 2 Probabilistic Safety Assessment (PSA) of the APR+ Advanced Pressurized Water Reactor (PWR) prepared by the Korea Hydro and Nuclear Power Co., Ltd (KHNP) and KEPCO Engineering and Construction Co., Inc. (KEPCO-E and C). The work described in this report involves a review of the APR+ Level 2 PSA submittal (Ref. 1). The PSA and, therefore, the review is limited to consideration of accidents initiated by internal events. As part of the review process, the review team also developed three sets of Requests for Additional Information (RAIs). These RAIs were provided to KHNP and KEPCO-E and C for their evaluation and response. This final detailed report documents the review findings for each technical element of the PSA and includes consideration of all of the RAIs made by the reviewers as well as the associated responses. This final report was preceded by an interim report (Ref. 2) that focused on identifying important issues regarding the PSA. In addition, a final meeting on the project was held at BNL on November 21-22, 2011, where BNL and KINS reviewers discussed their preliminary review findings with KHNP and KEPCO-E and C staffs. Additional information obtained during this final meeting was also used to inform the review findings of this final report. The review focused not only on the robustness of the APR+ design to withstand severe accidents, but also on the capability and acceptability of the Level 2 PSA in terms of level of detail and completeness. The Korean nuclear regulatory authorities will decide whether the PSA is acceptable and the BNL review team is providing its comments for KINS consideration. Section 2.0 provides the basis for the BNL review. Section 3.0 presents the review of each technical element of the PSA. Conclusions and a summary are presented in Section 4.0. Section 5.0 contains the references.

Evaluation of the clinical and analgesic effects of subarachnoid ketamine-lidocaine administration in goats undergoing mastectomy

Directory of Open Access Journals (Sweden)

Daradka M

2014-05-01

Full Text Available Mousa Daradka, Zuhair Bani IsmailDepartment of Veterinary Clinical Sciences, Faculty of Veterinary Medicine, Jordan University of Science and Technology, Irbid, JordanAbstract: Twenty adult female goats affected with chronic mastitis were subjected to mastectomy or hemimastectomy under subarachnoid regional analgesia using a ketamine-lidocaine combination. Ketamine at 1.5 mg/kg and lidocaine hydrochloride at 1.25 mg/kg were administered intrathecally at the lumbosacral intervertebral space. Goats were then subjected to a 120-minute observation period for systemic or neurotoxic symptoms such as agitation, restlessness, hind limb paralysis, or seizures. In addition, analgesia of the caudal abdominal region and signs of systemic sedation were scored on a scale of 0–3. Heart rate, respiratory rate, and rectal temperature were also recorded prior to (baseline values and at 5, 15, 30, 60, 90, and 120 minutes after administration. Mastectomy or hemimastectomy operation was carried out after full assurance of the analgesic effect on the udder and caudal abdominal region. Time of onset of surgical analgesia (score 3 was achieved at 15 minutes and lasted for 60 minutes. Maximal sedation score was recorded at 15 minutes and lasted for 60 minutes, then decreased thereafter, with the lowest sedation score recorded at 120 minutes. There was a significant (P<0.05 rise in heart rate at some point between 5–90 minutes, while the respiratory rate and rectal temperature did not change significantly from baseline values. Postoperatively, animals did not show any signs of pain or discomfort. Follow-up on the operated goats showed that all wounds were fully healed without any significant complications. In goats, intrathecal administration of ketamine-lidocaine combination resulted in a safe and effective analgesia of the caudal abdominal and udder region sufficient to perform mastectomy or hemimastectomy.Keywords: analgesia, sedation, ruminants, mastectomy

Development of Nanosatellite Technology with APRS Module for Disaster Mitigation

Science.gov (United States)

Prahyang, S. Y.; Dhiya’Ulhaq, M. Z.; Golim, O. P.; Gunawan, R.; Suhandinata; Jahja, E.; Nelwan, E. R. G.; Ananta, C.; Chow, I. M.; Mali, N. D. F.

2018-05-01

Development of nanosatellite technology has enabled satellites to be developed with multiple capabilities for a specific mission in a short time with a low cost. Satellite communications are proved to be more effective in delivering information due to its large coverage area. Surya Satellite-1 will become the first Indonesian nanosatellite developed by undergraduate students. It is designed with low-cost commercial payloads, including an APRS module for communication and operated on VHF and UHF amateur radio frequencies. The mission of the satellites focused on disaster mitigation through APRS communication network with remote stations located on disaster-prone areas.

Probability Analysis of the Construction Cost of an APR1000 Single Unit

International Nuclear Information System (INIS)

Ha, Gak Hyeon; Suh, Yong Pyo; Kang, Yong Chul

2011-01-01

The nuclear power plant market is expected to grow rapidly in order to address issues of global warming, cutting CO 2 emissions and securing stable electricity supplies. Under these circumstances, the main primary goal of the APR1000 development is to ensure export competitiveness in the developing countries in the Middle East and Southeast Asia. To that end, APR1000 (1,000MWe, 3 rd generation) will be developed based on the OPR1000 (Korean standard nuclear power plant, 2.5 generation) by incorporating and improving the general requirements such as the 60 year design life time, comprehensive site requirement of 0.3g seismic design, stability improvement, operability improvement and provisions for severe accidents. The APR1000 adds 16 advanced design features to its predecessor, as outlined below in Table 1

Evaluation of the Main Steam Line Break Accident for the APR+ Standard Design using MARS-KS

Energy Technology Data Exchange (ETDEWEB)

Park, M. H.; Kim, Y. S.; Hwang, Min Jeong; Sim, S. K. [Environment Energy Technology, Daejeon (Korea, Republic of); Bang, Young Seok [Korea Institute of Nuclear Safety, Daejeon (Korea, Republic of)

2015-05-15

As a part of licensing evaluation of the APR+ (Advanced Power Reactor +) standard design, Korea Institute of Nuclear Safety(KINS) performed safety evaluation of the APR+ Standard Safety Analysis Report(SSAR). The results of the safety evaluation of the APR+ Main Steam Line Break(MSLB) accident is presented for the most limiting post-trip return-to-power case with the single failure assumption of the Loss Of Offsite Power(LOOP). MARS-KS regulatory safety analysis code has been used to evaluate safety as well as the system behavior during MSLB accident. The MARS-KS analysis results are compared with the results of the MSLB safety analysis presented in the SSAR of the APR+. Independent safety evaluation has been performed using MARS-KS regulatory safety analysis code for the APR+ MSLB accident inside containment for the limiting case of the full power post-trip return-to-power. The results of MARS-KS analysis were compared with the results of the MSLB safety analysis presented in the APR+ SSAR. Due to higher cooldown of the MARS-KS analysis, the MARS-KS analysis results in a higher positive reactivity insertion into the core by the negative moderator and fuel temperature reactivity coefficients than the APR+ SSAR analysis. Both results show no return-to-power during the limiting case of the MSLB inside containment. However, APR+ SSAR moderator temperature reactivity insertion should be evaluated against the MARS-KS moderator density reactivity insertion for is conservatism. This study also clearly shows asymmetric thermal hydraulic behavior during the MSLB accident at intact and affected sides of the downcomer and the core. These asymmetric phenomena should be further investigated for the effects on the system design.

Quality of Life of Post-Mastectomy Women Living in a Semi-Arid Region of Brazil.

Science.gov (United States)

Araújo Neto, Emídio A; Alves, Beatriz C A; Gehrke, Flávia de S; Azzalis, Ligia A; Junqueira, Virginia C B; Sousa, Luiz Vinicius de A; Adami, Fernando; Fonseca, Fernando L A

2017-06-05

Health is the major reference regarding quality of life; when it comes to breast cancer in particular, the loss of a breast traumatically affects a woman's life, reflecting on her quality of life. Recognizing this problem, our aim was to investigate the quality of life of women who live in a semi-arid region of Brazil after breast cancer mastectomy. In this exploratory, transversal and observational study, a Brazilian variantof the shorter version of the original instrument from the World Health Organization Quality of Life (WHOQOL-BREF), applied in the study population, was analyzed and their socio-demographic profile was obtained. The sample was composed of 50 mastectomized women. The 50 included patients comprised women at a mean age of 54 years. Most of them had finished elementary school, and their average income was one Brazilian minimum monthly wage. Regarding the data related to quality of life, the highest score was found in the social relationships domain (4.29) followed by the psychological (4.09) and environmental (3.88) domains. The lowest score observed was for the physical domain (3.48). With these findings we can say that social and psychological parameters are driving factors of the quality of life in post-mastectomy women. Therefore, these results are useful to establish strategies to improve the quality of life of breast cancer mastectomy patients.

[The effect of prophylactic mastectomy with recontruction on quality of life in BRCA positive women].

Science.gov (United States)

Spurná, Z; Dražan, L; Foretová, L; Dvorská, L

2012-01-01

It is presumed that bilateral mastectomy is so far the most efficient way how to prevent development of breast carcinoma among BRCA positive patients. This mutilating intervention might be unacceptable for cosmetic reasons for most women. The purpose of this study was to determine the influence of prophylactic mastectomy on the quality of life of BRCA positive patients by comparing results of psychodiagnostic questionnaire methods before surgical intervention and after it. Our data set consisted of 25 BRCA positive healthy women and 19 BRCA positive women in remission. All these patients underwent a reconstructive surgical intervention after mastectomy. Age of patients was 38-55 years. The following questionnaires were used: Life Satisfaction Questionnaire by J. Fahrenberg, M. Myrtek and E. Brähler, Clinical analysis questionnaire by S. E. Kruge and R. B. Cattel, Impact of Event Scale - Revised by D. S. Weiss and C. R. Marmar. Women in remission showed most significant decrease in Financial position category and minor decrease in Work and Employment category and Friends, Acquaintances and Relatives category. Improvement of quality of life was recorded especially in category of Health, Sexuality, Own person, Partnership and in Relationship with own children and there was also a significant improvement to overall life satisfaction. Among healthy patients, there was a significant improvement in category of Health and Own person. Most significant decrease was in dimension of Financial position and Work and employment. Prophylactic mastectomy with reconstruction might be the way of prevention of breast carcinoma because from psychological point of view there is the unambiguously significant fact that there was improvement of perception of own health and own person in both groups of women. These are the quality of life aspects that are considered to be basal and long term stabilizing from the perspective of dynamics of own self and they also systematically influence

Improvement of upper limb’s condition of women with post mastectomy syndrome with the help of problem-oriented program of physical rehabilitation

Directory of Open Access Journals (Sweden)

Y.A. Briskin

2015-11-01

Full Text Available Purpose: to determine effectiveness of problem-oriented program of women’s physical rehabilitation with post mastectomy syndrome in improvement of upper limb’s functional state. Material: 50 women with early symptoms of post mastectomy syndrome at stationary rehabilitation stage, who underwent radical mastectomy by Madden were involved in the research. Testing of movement amplitude in shoulder joint, swelling of upper limb and muscular strength of hand’s flexors was conducted on 2 nd day after surgery and at the end of stationary rehabilitation period (12-14 th day. Results: Main means of the authors’ program were: general and special physical exercises; static and dynamic breathing exercises; breathing through preloaded lips, controlled coughing, autogenic drainage, manual pressing, manual vibration; post-isometric relaxation; elements of labor therapy; lymphatic drainage massage and self massage; topical talks; consultations; auto training. The trainings were conducted individually 2-3 times a day; 20-30 minutes every session. The patients’ independent trainings included: fulfillment of therapeutic positions, self-massage, relaxation exercises and auto-training. Conclusions: application of problem-oriented physical rehabilitation program facilitates improvement of upper limb’s functional potentials of women with post mastectomy syndrome.

Pseudomonas syringae evades host immunity by degrading flagellin monomers with alkaline protease AprA

NARCIS (Netherlands)

Pel, Michiel J C; van Dijken, Anja J H; Bardoel, Bart W; Seidl, Michael F; van der Ent, Sjoerd; van Strijp, Jos A G; Pieterse, Corné M J

Bacterial flagellin molecules are strong inducers of innate immune responses in both mammals and plants. The opportunistic pathogen Pseudomonas aeruginosa secretes an alkaline protease called AprA that degrades flagellin monomers. Here, we show that AprA is widespread among a wide variety of

Pseudomonas syringae evades host Immunity by degrading flagellin monomers with alkaline protease AprA

NARCIS (Netherlands)

Pel, M.J.C.; Van Dijken, A.J.H.; Bardoel, B.W.; Seidl, M.F; Van der Ent, S.; Van Strijp, J.A.G.

2014-01-01

Bacterial flagellin molecules are strong inducers of innate immune responses in both mammals and plants. The opportunistic pathogen Pseudomonas aeruginosa secretes an alkaline protease called AprA that degrades flagellin monomers. Here, we show that AprA is widespread among a wide variety of

Quantitative Safety Impact of Severe Accident Management Systems for EU-APR during Low Power Shutdown Operation

International Nuclear Information System (INIS)

Lee, Keunsung; Hwang, Do Hun; Chang, Hyun-bin

2016-01-01

In order to enlarge and to diversify the export market of APR1400, the EU-APR design was developed based on the APR1400 design to comply with the latest version of the European Utility Requirements (EUR) revision D. The EU-APR design has the distinguished and advanced severe accident management systems taken from the APR1400 to obtain a containment integrity for the beyond design basis accident, such as the Passive Ex-vessel retaining and Cooling System (PECS), the Severe Accident Containment Spray System (SACSS) and the Containment Filtered Vent System (CFVS). The risk associated with the nuclear power plant can be identified through the Probabilistic Safety Assessment (PSA). In the EUR chapter 1 and 17 of volume 2, the Criteria for Limited Impact (CLI) should be applied to the Level 2 PSA as a risk metrics. The fraction of exceeding CLI for the EU-APR during LPSD operation was calculated as 4.52% of the CDF under the condition that all severe accident management systems are credited. The PECS, SACSS and CFVS are considered as the severe accident management system which is EU-APR dedicated system. The exemption of each system leads to increase the fraction of exceeding CLI to 54.18%, 89.74% and 21.32% respectively. In case if all these systems are unavailable, the fraction of exceeding CLI is increased to 100%. The most effective system is the SACSS that the system reduces containment pressure and temperature

Quantitative Safety Impact of Severe Accident Management Systems for EU-APR during Low Power Shutdown Operation

Energy Technology Data Exchange (ETDEWEB)

Lee, Keunsung; Hwang, Do Hun [KHNP CRI, Daejeon (Korea, Republic of); Chang, Hyun-bin [Future and Challenge Technology Co., Yongin (Korea, Republic of)

2016-10-15

In order to enlarge and to diversify the export market of APR1400, the EU-APR design was developed based on the APR1400 design to comply with the latest version of the European Utility Requirements (EUR) revision D. The EU-APR design has the distinguished and advanced severe accident management systems taken from the APR1400 to obtain a containment integrity for the beyond design basis accident, such as the Passive Ex-vessel retaining and Cooling System (PECS), the Severe Accident Containment Spray System (SACSS) and the Containment Filtered Vent System (CFVS). The risk associated with the nuclear power plant can be identified through the Probabilistic Safety Assessment (PSA). In the EUR chapter 1 and 17 of volume 2, the Criteria for Limited Impact (CLI) should be applied to the Level 2 PSA as a risk metrics. The fraction of exceeding CLI for the EU-APR during LPSD operation was calculated as 4.52% of the CDF under the condition that all severe accident management systems are credited. The PECS, SACSS and CFVS are considered as the severe accident management system which is EU-APR dedicated system. The exemption of each system leads to increase the fraction of exceeding CLI to 54.18%, 89.74% and 21.32% respectively. In case if all these systems are unavailable, the fraction of exceeding CLI is increased to 100%. The most effective system is the SACSS that the system reduces containment pressure and temperature.

Angelina Jolie's faulty gene: newspaper coverage of a celebrity's preventive bilateral mastectomy in Canada, the United States, and the United Kingdom.

Science.gov (United States)

Kamenova, Kalina; Reshef, Amir; Caulfield, Timothy

2014-07-01

This study investigates the portrayal of Angelina Jolie's preventive bilateral mastectomy in the news media. Content analysis of print news was conducted to identify major frames used in press coverage, the overall tone of discussions, how journalists report broader questions about BRCA1/2 testing and hereditary breast/ovarian cancer, and whether they raise concerns about the impact of celebrities on patients' choices and public opinion. The Factiva database was used to collect publications on Jolie's preventive mastectomy in elite newspapers in Canada, the United States, and the United Kingdom. The data set consisted of 103 newspaper articles published in the first month of media coverage. The results show that although the press discussed key issues surrounding predictive genetic testing and preventive options for women at high risk of hereditary breast/ovarian cancer, important medical information about the rarity of Jolie's condition was not communicated to the public. The results highlight the media's overwhelmingly positive slant toward Jolie's mastectomy, while overlooking the relative rarity of her situation, the challenges of "celebrity medicine," and how celebrities influence people's medical decisions. Future research is required to investigate whether the media hype has influenced demand and use of BRCA1/2 testing and preventive mastectomies.

Effectiveness of Cognitive Behavioral Group Intervention on Body Image Improving and Increasing Self-Esteem in Women with Breast Cancer after Mastectomy

Directory of Open Access Journals (Sweden)

Ahmad Izadi-Ajirlo

2013-01-01

Full Text Available Objective: This study was conducted to improve the body image and self-esteem among breast cancer patients after mastectomy. Materials & Methods: Our study comprised of 23 breast cancer patients in Imam Hossein Hospital, aged between 30-60 years, all of whom had undergone mastectomy and then radiotherapy. The study participants were selected through purposeful sampling and then randomly assigned to the case (10 and control (13 groups. The intervention program (cognitive behavioral group intervention consisted of 12 sessions of intervention (2 sessions per week each taking 90 minutes, in a 6 week process. Both group members completed the “body image and relationships scale” and the “Pope self- esteem questionnaire” before and after training. Analysis of covariance to eliminate the pretest effect on posttest results and ANOVA to determine the differences between the groups were used through SPSS 18 in this study. Results: This intervention was significantly effective on improving the mean score of body image and self- esteem in the breast cancer/mastectomy patients of the case group compared to that of the control group (P<0.01. Conclusion: Thus, cognitive behavioral group intervention can be effective in improving body image and increasing self-esteem among women with breast cancer after mastectomy.

Loss of attributes of femininity, anxiety and value crisis. Women with polycystic ovary syndrome compared to women after mastectomy and in menopause

Directory of Open Access Journals (Sweden)

Dorota Mącik

2016-01-01

Full Text Available Background Polycystic ovary syndrome (PCOS is a relatively widespread disease and a main cause of fertility problems. The disease diagnosis is frequently related to changes in the value hierarchy. However, it can be treated as a “loss of/threat to” femininity. Similar aspects of the loss of part of femininity are connected with menopause and mastectomy. Participants and procedure One hundred and forty-five women were examined in total: 42 with the PCOS diagnosis, 20 after mastectomy, 42 in menopause and 41 healthy women (reference group. Standard measurement methods were used: the Value Crisis Questionnaire by P. Oleś and the IPAT Anxiety Scale – Self Analysis Form by R. B. Cattell. Results Women suffering from PCOS obtained significantly higher indexes of both crisis and anxiety compared to other groups, whereas women after mastectomy and in menopause did not differ between one another in tested variables, and they did not differ from healthy women either. It was noted that the most relationships between variables were observed in the group of women in menopause (significant correlations between almost all dimensions, while there are few relationships in women after mastectomy. In women with PCOS (a relatively small number of correlations relationships of the greatest strength relate to the relationships of negative self-esteem and guilt proneness with all dimensions of the value crisis. Conclusions Polycystic ovary syndrome, despite having a relatively non-threatening course, is experienced much more strongly by women compared to mastectomy and menopause. It is associated with strong internal anxiety and degradation of the value hierarchy.

Patients' experience of breast reconstruction after mastectomy and its influence on postoperative satisfaction.

Science.gov (United States)

Schmidt, Jana L; Wetzel, Cordula M; Lange, Klaus W; Heine, Norbert; Ortmann, Olaf

2017-10-01

Breast cancer patients have the option to choose a breast reconstruction after mastectomy. A range of studies have postulated that patients' individually appraised significance of their breast is an important factor in the decision for or against breast reconstruction. This study explored the individually perceived significance of the breast among patients with and without breast reconstruction and its correlation with postoperative satisfaction. Ten patients without breast reconstruction, and ten patients with immediate breast reconstruction after mastectomy participated in the study. The perceived importance of the breast and the pre-and postoperative esthetic satisfaction of the patients were obtained using an 11-point Likert scale. Qualitative interviews explored patients' views on the meaning of their breast and their experience after surgery. Patients who had decided for breast reconstruction rated the importance of their breast for femininity (p = 0.004) and attractiveness (p = 0.037) significantly higher than patients without reconstruction. The qualitative data provide evidence that the breast of a woman fulfills a variety of intrapsychic and interactional functions. Difficulties in integrating the reconstructed breast into the body image were reported. A high importance of the breast correlated significantly with a decrease in satisfaction with the breast after reconstruction (rs = -0.652, p = 0.041). Patients who found their breast to be highly important were more likely to decide for a reconstruction. Mastectomy has an impact on various psychosocial variables but impairments may also occur after breast reconstruction. Patients reporting a high significance of their breast showed the greatest decrease in satisfaction with their breast after reconstruction.

Design features of Advanced Power Reactor (APR) 1400 steam generator

International Nuclear Information System (INIS)

Park, Tae-Jung; Park, Jun-Soo; Kim, Moo-Yong

2004-01-01

Advanced Power Reactor 1400 (APR 1400) which is to achieve the improvement of the safety and economical efficiency has been developed by Korea Hydro and Nuclear Power Co., Ltd. (KHNP) with the support from industries and research institutes. The steam generator for APR 1400 is an evolutionary type from System 80 + , which is the recirculating U-tube heat exchanger with integral economizer. Compared to the System 80 + steam generator, it is focused on the improved design features, operating and design conditions of APR 1400 steam generator. Especially, from the operation experience of Korean Standard Nuclear Power Plant (KSNP) steam generator, the lessons-learned measures are incorporated to prevent the tube wear caused by flow-induced vibration (FIV). The concepts for the preventive design features against FIV are categorized to two fields; flow distribution and dynamic response characteristics. From the standpoint of flow distribution characteristics, the egg-crate flow distribution plate (EFDP) is installed to prevent the local excessive flow loaded on the most susceptible tube to wear. The parametric study is performed to select the optimum design with the efficient mitigation of local excessive flow. ATHOS3 Mod-01 is used and partly modified to analyze the flow field of the APR 1400 steam generator. In addition, the upper tube bundle support is designed to eliminate the presence of tube with a low natural frequency. Based on the improved upper tube bundle support, the modal analysis is performed and compared with that of System 80 + . Using the results of flow distribution and modal analysis, the two mechanisms of flow-induced vibration are investigated; fluid-elastic instability (FEI) and random turbulence excitation (RTE). (authors)

Cancers du sein bilat?raux synchrones et grossesse a l'institut Joliot Curie de Dakar (S?n?gal)

OpenAIRE

Zongo, Nayi; Sawadogo, Yobi Alexis; Some, Some Ollo Roland; Bagre, Sidpawalmd? Carine; Ka, Sidy; Diouf, Doudou; Dieng, Mamadou Moustapha; Gaye, Papa Macoumba; Dem, Ahmadou

2016-01-01

D?crire notre strat?gie diagnostique et th?rapeutique dans les cancers du sein bilat?raux synchrones pendant la grossesse. L??ge gestationnel au moment du diagnostic du cancer ?tait respectivement de 7; 21 et 25 semaines. Il s'agissait de stade IV et IIIA respectivement dans deux et un cas. Elles ont toutes b?n?fici? d'une chimioth?rapie dans deux cas pendant la grossesse (6TEC et 3AC) et dans un cas apr?s l'accouchement. Une mastectomie bilat?rale a ?t? r?alis?e dans un cas. Une patiente est...

The psychological impact of breast reconstruction after prophylactic or therapeutic mastectomy for breast cancer

NARCIS (Netherlands)

Gopie, Jessica Premdee

2013-01-01

In this thesis the psychological impact of two types of breast reconstruction after prophylactic or therapeutic mastectomy for breast cancer was investigated with a prospective study including 202 patients from different hospitals in the South-West of the Netherlands between 2007-2012. With

External Volume Expansion in Irradiated Tissue: Effects on the Recipient Site.

Science.gov (United States)

Chin, Michael S; Lujan-Hernandez, Jorge; Babchenko, Oksana; Bannon, Elizabeth; Perry, Dylan J; Chappell, Ava G; Lo, Yuan-Chyuan; Fitzgerald, Thomas J; Lalikos, Janice F

2016-05-01

External volume expansion prepares recipient sites to improve outcomes of fat grafting. For patients receiving radiotherapy after mastectomy, results with external volume expansion vary, and the relationship between radiotherapy and expansion remains unexplored. Thus, the authors developed a new translational model to investigate the effects in chronic skin fibrosis after radiation exposure. Twenty-four SKH1-E mice received 50 Gy of β-radiation to each flank and were monitored until fibrosis developed (8 weeks). External volume expansion was then applied at -25 mmHg to one side for 6 hours for 5 days. The opposite side served as the control. Perfusion changes were assessed with hyperspectral imaging. Mice were euthanized at 5 (n = 12) and 15 days (n = 12) after the last expansion application. Tissue samples were analyzed with immunohistochemistry for CD31 and Ki67, Masson trichrome for skin thickness, and picrosirius red to analyze collagen composition. All animals developed skin fibrosis 8 weeks after radiotherapy and became hypoperfused based on hyperspectral imaging. Expansion induced edema on treated sides after stimulation. Perfusion was decreased by 13 percent on the expansion side (p External volume expansion temporarily reduces perfusion, likely because of transient ischemia or edema. Together with mechanotransduction, these effects encourage a proangiogenic and proliferative environment in fibrotic tissue after radiotherapy in the authors' mouse model. Further studies are needed to assess these changes in fat graft retention.

Non-Integrated Standalone Tests of APR1400 Simulator

International Nuclear Information System (INIS)

Hwang, Su Hyun; Lee, Jeong Ik; Hong, Soon Joon; Lee, Byung Chul; Seo, Jeong Gwan; Lee, Myung Soo

2007-01-01

APR1400 being developed for the construction of New Kori 3 and 4 Units has improved safety and more economical efficiency compared with previous PWR. The ESF(Engineered Safety Features) newly introduced to enhance safety are as follows: DVI (Direct Vessel Injection), Fluidic Device, IRWST (In-containment Refueling Water Storage Tank). So the transient pattern of anticipated accidents will show different characteristics from previous PWR. There are multidimensional flow phenomena like as emergency core cooling coolant bypass discharge in the downcomer, downcomer boiling, and different safety injection characteristics due to fluidic device during LBLOCA. Also there is the phenomenon of critical flow due to the open of pressurizer POSRV (Pilot Operated Safety Relief valve) connected to IRWST and safety depressurization system and the prediction of discharge flow is very important. KEPRI is developing APR1400 simulator using RELAP-RT . RELAP-RT was developed by DS and S (Data systems and Solutions) based on RELAP5/MOD3.2. The improved features of RELAP-RT to function as a simulator are as follows: Add simulator functionality - Control by simulator executive - IC snap and reset capability - Back-track snap and reset capability - Fast time capability. Fast time capability(examples) - The rate of condensation has been limited. - Fictional choking model has been developed for internal junctions. - Wall heat transfer coefficients and heat fluxes has been limited. In this study, various NISTs (Non-Integrated Standalone Tests) were performed to verify the capability of RELAP-RT as APR1400 simulator by the comparison with RELAP5/MOD3.3

[External workplace violence against doctors in hospital services in Lima Metropolitana, Peru 2014].

Science.gov (United States)

Tuya-Figueroa, Ximena; Mezones-Holguin, Edward; Monge, Eduardo; Arones, Ricardo; Mier, Milagros; Saravia, Mercedes; Torres, Jose; Mayta-Tristán, Percy

2016-01-01

. To calculate the frequency and factors associated with external workplace violence (EWV) against doctors in health inpatient services in the metropolitan area of Lima (Spanish: Lima Metropolitana), Peru. . A cross-sectional analytic study, which included doctors from the Ministry of Health (MINSA), Social Security (EsSalud), and the private subsector, was carried out. The frequency of EWV was measured throughout the entire professional practice during the previous 12 months and during the last month. Variables related to the doctor, assailant, and health service were measured. Raw and adjusted prevalence ratios (PR) were calculated by means of a Poisson-family generalized linear model with non-parametric bootstrapping. . A total of 406 doctors participated; 31.5% were victims of EWV at least once during their professional practice, with 19.9% over the past 12 months and 7.6% during the last month. The chances of being threatened in the last 12 months increased if the doctor was male (adjusted PR [aPR]: 1.7; 95% confidence interval [CI] = 1.1- 2.8), had graduated from a Peruvian university outside of the metropolitan area of Lima (aPR: 1.5; 95% CI = 1.1-2.4), worked at MINSA (aPR: 7.9; 95% CI = 2.24-50.73) or EsSalud (RR: 8.68; 95% CI = 2.26-56.17), and worked in the emergency (aPR: 1.9; 95% CI = 1.2-3.6) or operating room (aPR: 1.6; 95% CI = 1.1-2.3). Age, years of professional practice, or being a medical resident were not associated with EWV. . In the hospitals studied, a large number of doctors have been victims of EWV. Working in public services increases the possibility of violence. Implementation of support, identification, and primary prevention strategies in hospitals is recommended.

APR-246/PRIMA-1Met Inhibits and Reverses Squamous Metaplasia in Human Conjunctival Epithelium.

Science.gov (United States)

Li, Jing; Li, Cheng; Wang, Guoliang; Liu, Zhen; Chen, Pei; Yang, Qichen; Dong, Nuo; Wu, Huping; Liu, Zuguo; Li, Wei

2016-02-01

Squamous metaplasia is a common pathologic condition in ocular surface diseases for which there is no therapeutic medication in clinic. In this study, we investigated the effect of a small molecule, APR-246/PRIMA-1(Met), on squamous metaplasia in human conjunctival epithelium. Human conjunctival explants were cultured for up to 12 days under airlifting conditions. Epithelial cell differentiation and proliferation were assessed by Cytokeratin 10 (K10), K14, K19, Pax6, MUC5AC, and p63 immunostaining patterns. β-catenin and TCF-4 immunofluorescent staining and real-time PCR characterized Wnt signaling pathway involvement. Pterygium clinical samples were cultured under airlifting conditions with or without APR-246 for 4 days. p63, K10, β-catenin, and TCF-4 expression in pterygial epithelium was determined by immunofluorescent staining and real-time PCR. Airlift conjunctival explants resulted in increased stratification and intrastromal epithelial invagination. Such pathology was accompanied by increases in K10, K14, and p63 expression, whereas K19 and Pax6 levels declined when compared to those in freshly isolated tissue. On the other hand, APR-246 reversed all of these declines in K10, K14, and p63 expression. Furthermore, K19 and Pax6 increased along with rises in goblet cell density. These effects of APR-246 were accompanied by near restoration of normal conjunctival epithelial histology. APR-246 also reversed squamous metaplasia in pterygial epithelium that had developed after 4 days in ex vivo culture. Reductions in squamous metaplasia induced by APR-246 suggest it may provide a novel therapeutic approach in different squamous metaplasia-associated ocular surface diseases.

Does Smoking History Confer a Higher Risk for Reconstructive Complications in Nipple-Sparing Mastectomy?

Science.gov (United States)

Frey, Jordan D; Alperovich, Michael; Levine, Jamie P; Choi, Mihye; Karp, Nolan S

2017-07-01

History of smoking has been implicated as a risk factor for reconstructive complications in nipple-sparing mastectomy (NSM), however there have been no direct analyses of outcomes in smokers and nonsmokers. All patients undergoing NSM at New York University Langone Medical Center from 2006 to 2014 were identified. Outcomes were compared for those with and without a smoking history and stratified by pack-year smoking history and years-to-quitting (YTQ). A total of 543 nipple-sparing mastectomies were performed from 2006 to 2014 with a total of 49 in patients with a history of smoking. Reconstructive outcomes in NSM between those with and without a smoking history were equivalent. Those with a smoking history were not significantly more likely to have mastectomy flap necrosis (p = 0.6251), partial (p = 0.8564), or complete (p = 0.3365) nipple-areola complex (NAC) necrosis. Likewise, active smokers alone did not have a higher risk of complications compared to nonsmokers or those with smoking history. Comparing nonsmokers and those with a less or greater than 10 pack-year smoking history, those with a > 10 pack-year history had significantly more complete NAC necrosis (p = 0.0114, smoking history or >5 YTQ prior to NSM were equivalent to those without a smoking history. We demonstrate that NSM may be safely offered to those with a smoking history although a > 10 pack-year smoking history or <5 YTQ prior to NSM may impart a higher risk of reconstructive complications, including complete NAC necrosis. © 2017 Wiley Periodicals, Inc.

One-Stage Nipple and Breast Reconstruction Following Areola-Sparing Mastectomy

Directory of Open Access Journals (Sweden)

Hye Ri Kim

2013-09-01

Full Text Available Background Skin-sparing mastectomy with immediate breast reconstruction is increasinglybecoming a proven surgical option for early-stage breast cancer patients. Areola-sparingmastectomy (ASM has also recently become a popular procedure. The purpose of this articleis to investigate the reconstructive and aesthetic issues experienced with one-stage nippleand breast reconstruction using ASM.Methods Among the patients who underwent mastectomy between March 2008 and March2010, 5 women with a low probability of nipple-areolar complex malignant involvement underwentASM and immediate breast reconstruction with simultaneous nipple reconstructionusing the modified C-V flap. The cosmetic outcomes of this series were reviewed by plasticsurgeons and patient self-assessment and satisfaction were assessed via telephone interview.Results During the average 11-month follow-up period, there were no cases of cancer recurrence,the aesthetic outcomes were graded as excellent to very good, and all of the patientswere satisfied. Two patients developed a gutter-like depression around the reconstructednipple, and one patient developed skin erosion in a small area of the areola, which healedwith conservative dressing. The other complications, such as necrosis of the skin flap or areola,seroma, hematoma, or fat necrosis did not occur.Conclusions Since one-stage nipple and breast reconstruction following ASM is an oncologicallysafe, cost-effective, and aesthetically satisfactory procedure, it is a good surgical optionfor early breast cancer patients.

Do breast implants after a mastectomy affect subsequent prognosis and survival?

OpenAIRE

Brinton, Louise A

2005-01-01

In a large study, published in this issue of Breast Cancer Research, Le and colleagues report that women receiving implants after mastectomies for early-stage breast cancer experience lower breast cancer mortality than women not receiving implants. Assessment of survival patterns among women receiving reconstructive implants is complex given unique patient characteristics, disease attributes, and treatment patterns. The interpretation of reduced mortality from breast cancer must be assessed i...

Half versus full vacuum suction drainage after modified radical mastectomy for breast cancer- a prospective randomized clinical trial[ISRCTN24484328

Directory of Open Access Journals (Sweden)

Singh JP

2005-01-01

Full Text Available Abstract Background Suction drains are routinely used after modified radical mastectomy and are an important factor contributing to increased hospital stay as the patients are often discharged only after their removal. Amongst various factors that influence the amount of postoperative drainage, the negative suction pressure applied to the drain has been reported to be of great significance. While a high negative suction pressure is expected to drain the collection and reduce the dead space promptly, it may also prevent the leaking lymphatics from closing and lead to increased drainage from the wound. Against this background a prospective randomized clinical study was conducted to compare the amount and duration of drainage between a half negative suction and full vacuum suction drainage in patients following modified radical mastectomy. The associated postoperative morbidity was also compared between the two groups. Methods 85 FNAC (fine needle aspiration cytology proven cases of locally advanced breast cancer were randomized. (Using randomly ordered sealed envelops, which were opened immediately before the closure of the wound in to 50 patients with full vacuum suction (pressure = 700 g/m2 and 35 cases in to half vacuum suction drainage (pressure = 350 g/m2 groups. The two groups were comparable in respect of age, weight, and technique of operation and extent of axillary dissection. Surgery was performed by the same surgical team comprising of five surgeons (two senior and three resident surgeons using a standardized technique with electrocautery. External compression dressing was provided over the axilla for first 48 hrs and following that patients were encouraged to do active and passive shoulder exercises. The outcomes measured were postoperative morbidity and the length of hospital stay. Statistical methods used: Descriptive studies were performed with SPSS version 10 and group characteristics were compared using student t-test. Results

Preliminary Results Of LOCA Problem For APR1400 Reactor

International Nuclear Information System (INIS)

Le Dai Dien; Hoang Minh Giang; Le Thi Thu; Vo Thi Huong; Le Van Hong

2011-01-01

Several features of NPP with APR1400 nuclear reactor during a loss of coolant accident (LOCA) are investigated in this study. The report describes some main design characteristics of an engineering safety systems of APR1400 and the thermal hydraulic calculation results for steady-state using MARS and RELAP/SCDAPSIM codes. Large Break LOCA accident has been analyzed and evaluated based on acceptable criteria for ECCS given by US NRC. The results from cold leg break LOCA with broken area of 0.0465 m 2 in case of high pressure safety injection system (HPSI) failed to operate or 2 and 4 HPSI pumps are activated. The preliminary results of this work is a part of collaboration between INST researchers and KAERI experts in using RELAP tool for safety analysis of NPPs. (author)

Cannula-Assisted Flap Elevation (CAFE): a novel technique for developing flaps during skin-sparing mastectomies.

Science.gov (United States)

Grant, Michael D

2015-02-01

One of the most challenging procedures in breast surgery is the skin-sparing mastectomy (SSM). Various techniques and incisions have evolved that characterize this procedure; however, what is common in all of them is the smaller the incision, the more difficult it is to develop the skin flaps. A procedure was developed that incorporates the use of liposuction cannulas (without suction) to create the skin flaps. The technique and results are described in this manuscript. From October of 2012 to April 2014, 289 mastectomies (171 patients) were performed using the CAFE procedure on women of all shapes and sizes. Postoperatively, no problems were experienced with flap viability using this technique. The main difference in side effects between the CAFE technique and other standard techniques for developing flaps in SSMs was more bruising than normal, but this resolved rapidly. The results for use of this technique were consistently impressive. The learning curve for this procedure is very short, especially for those who perform SSMs using sharp technique (scissors). Residents and fellows became proficient with the CAFE technique in a relatively short amount of time. Plastic surgeons were pleased with the cosmetic outcomes of their reconstructions that follow this type of mastectomy. Patients were extremely satisfied with their reconstructions as well. Incorporating the use of liposuction cannulas (without suction) makes the creation of flaps for SSM a relatively simple and rapid method. It is especially useful to assist in developing skin flaps with even the smallest of skin incisions.

The burden of breast cancer in Italy: mastectomies and quadrantectomies performed between 2001 and 2008 based on nationwide hospital discharge records

Directory of Open Access Journals (Sweden)

Piscitelli Prisco

2012-11-01

Full Text Available Abstract Background Where population coverage is limited, the exclusive use of Cancer Registries might limit ascertainment of incident cancer cases. We explored the potentials of Nationwide hospital discharge records (NHDRs to capture incident breast cancer cases in Italy. Methods We analyzed NHDRs for mastectomies and quadrantectomies performed between 2001 and 2008. The average annual percentage change (AAPC and related 95% Confidence Interval (CI in the actual number of mastectomies and quadrantectomies performed during the study period were computed for the full sample and for subgroups defined by age, surgical procedure, macro-area and singular Region. Re-admissions of the same patients were separately presented. Results The overall number of mastectomies decreased, with an AAPC of −2.1% (−2.3 -1.8. This result was largely driven by the values observed for women in the 45 to 64 and 65 to 74 age subgroups (−3.0%, -3.4 -3.6 and −3.3%, -3.8 -2.8, respectively. We observed no significant reduction in mastectomies for women in the remaining age groups. Quadrantectomies showed an overall +4.7 AAPC (95%CI:4.5–4.9, with no substantial differences by age. Analyses by geographical area showed a remarkable decrease in mastectomies, with inter-regional discrepancies possibly depending upon variability in mammography screening coverage and adherence. Quadrantectomies significantly increased, with Southern Regions presenting the highest average rates. Data on repeat admissions within a year revealed a total number of 46,610 major breast surgeries between 2001 and 2008, with an overall +3.2% AAPC (95%CI:2.8-3.6. Conclusions In Italy, NHDRs might represent a valuable supplemental data source to integrate Cancer Registries in cancer surveillance.

Pre-expansion before risk reducing mastectomy combined with lipomodelling to enhance results from implant based reconstruction.

Science.gov (United States)

Katerinaki, E; Sircar, T; Fatah, F

2012-02-01

Implant based breast reconstruction after risk reducing mastectomy (RRM) is challenging as implants are inadequately covered in their lower pole. Also complication rates with one stage procedures are significant. We describe a novel method of pre-expansion by inserting subpectoral anatomical expandable implants to prepare the breast mound before RRM is carried out. Lipomodelling is later used to enhance the overall result of the reconstruction. Six patients who were BRCA 1 mutation carriers requested bilateral RRM. Median age was 31. All were non-smokers. Anatomical expandable implants were inserted via an inframammary incision and were expanded in the next two months. RRM was carried out 6-13 months later and was followed by lipomodelling seven months afterwards. Four patients had a nipple sparing mastectomy. In three cases access was via the previous inframammary scar. In all cases complete implant cover had been achieved. There were no early postoperative complications but one patient has developed grade III capsular contracture on the side of previous wide local tumour excision and radiotherapy. Five patients have so far undergone post-mastectomy lipomodelling to improve breast contour. In conclusion, we believe that our technique provides better aesthetic results with reduced complication rates for these patients. Copyright © 2011 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.

The role of tumor marker CA 15-3 in detection of breast cancer relapse after curative mastectomy

International Nuclear Information System (INIS)

Hyun, In Young; Kim, In Ho; Lee, Moon Hee; Kim, Chul Soo

2004-01-01

The purpose of this study was to determine the utility of tumor marker CA 15-3 in the following: the diagnosis of breast cancer relapse after curative mastectomy, and the differentiation of the value of tumor marker by site of metastases. Two hundred two patients (median age 48 years) with breast cancer included in the follow-up after curative mastectomy. The tumor marker CA 15-3 was determined by IRMA (CIS BIO INTERNATIONAl, France). Test values > 30 U/ml were considered elevated (positive). Among 202 patients, recurrent diseases were found in 16 patients. CA 15-3 was elevated in 5 of 16 patients with recurrences. There was no false-positive patients who had elevated CA 15-3. Sensitivity and specificity of CA 15-3 for detection of breast cancer recurrence were 31%, and 100%. CA 15-3 was elevated in all of the 4 patients with liver metastases. CA 15-3 was elevated in none of the patients who relapsed with metastasis to bone-only or contralateral breast-only. The tumor marker CA 15-3 in the detection of breast cancer relapse after curative mastectomy is specific, but not sensitive. However, it is useful to rule out liver metastases of breast cancer, which indicates bad prognosis

Review of nipple reconstruction techniques and introduction of v to y technique in a bilateral wise pattern mastectomy or reduction mammaplasty.

Science.gov (United States)

Riccio, Charles A; Zeiderman, Matthew R; Chowdhry, Saeed; Wilhelmi, Bradon J

2015-01-01

Nipple-areola complex reconstruction (NAR) is the final procedure in breast reconstruction after the majority of mastectomies. Many methods of NAR have been described, each with inherent advantages and disadvantages depending on local healthy tissue availability, previous scarring and procedures, and the operative morbidity of the NAR technique. Nipple reconstructions may be complicated by scars or previous nipple reconstruction, making the procedure more challenging. We propose the use of the V-Y advancement flap as a new method that is suitable for both novice and experienced surgeons wishing to broaden their range of techniques for difficult nipple reconstructions. A traditional V-Y advancement flap is lifted at the site of the future nipple. Mastectomy scars from prior mastectomy, mammoplasty, or nipple reconstruction can be incorporated into the flap. The flap is folded caudally upon itself and the secondary defect at the apex of the flap is linearly closed. At 6-month postoperative evaluation, adequate nipple projection and patient satisfaction were achieved with this method. The V-Y advancement flap is a suitable method for achieving satisfactory results when faced with challenging NAR. The method is easy to perform, reproducible, has low operative morbidity, and incorporates previous wise pattern mastectomy or mammaplasty scars into the newly reconstructed nipple, thereby decreasing new scar formation on the breast and leading to favorable cosmetic results.

The Ongoing Rediscovery of Après-Coup as a Central Freudian Concept.

Science.gov (United States)

House, Jonathan

2017-10-01

Après-coup, Freud's Nachträglichkeit, is an essential psychoanalytic concept structuring each of four concepts, four mental processes that lie at the foundation of Freud's thinking: psychic trauma, repression, the creation of the unconscious, and the creation of infantile sexuality. It is argued here that infantile sexual drives, in contrast to the self-preservative instincts, arise from a two-step process of translation and repression in which the residues of failed translation become source-objects of the drives. These residues of failed translation have an associative resonance with adult sexuality, and the child is driven to ongoing attempts to translate them, to make them meaningful après coup. Thus, après-coup is at the heart of the human subject as a sexual creature who requires, desires, and creates meaning.

Psychosocial effects of radiotherapy after mastectomy

International Nuclear Information System (INIS)

Hughson, A.V.M.; Cooper, A.F.; Smith, D.C.; McArdle, C.S.

1987-01-01

Psychosocial morbidity was measured in 47 patients who received postoperative radiotherapy and in 38 who received no further treatment after mastectomy. Roughly one third of all patients experienced depression or anxiety. One month after operation, before radiotherapy, there were no significant differences between the two groups in any of the measures of psychosocial morbidity. Knowledge of impending treatment did not seem to influence morbidity. At three months patients who had completed radiotherapy had significantly more somatic symptoms and social dysfunction than those not so treated. At six months the radiotherapy group continued to show more somatic symptoms, but a year after operation there were no significant differences between the groups. Although several patients who received radiotherapy were upset by their treatment, the study failed to confirm that depression and anxiety were commoner among those given radiotherapy than among patients given no further treatment. (author)

MRI evaluation of post-mastectomy irradiated breast implants: prevalence and analysis of complications.

Science.gov (United States)

Rella, L; Telegrafo, M; Nardone, A; Milella, A; Stabile Ianora, A A; Lioce, M; Angelelli, G; Moschetta, M

2015-09-01

To evaluate the effect of post-mastectomy radiation therapy (RT) on breast implants as detected by magnetic resonance imaging (MRI) searching for short-term complications. One hundred and forty patients (total of 144 implants) were evaluated by MRI; 80 (group 1) had undergone RT, whereas the remaining 60 patients (group 2) underwent mastectomy with implant reconstruction without RT. Two radiologists evaluated MRI images searching for implant rupture signs, sub-capsular seromas, capsular contracture, soft-tissue oedema, peri-implant fluid collections. Implant ruptures were classified as severe complications; seromas and capsular contractures as moderate complications; oedema and fluid collections as mild complications. The prevalence of MRI findings in the two groups was calculated and compared by unpaired t-test. Cohen's kappa statistics was used to assess interobserver agreement. Sixty-nine out of 144 (48%) implants presented pathological findings at MRI with complication rates of 47.5 and 48.4 for groups 1 and 2, respectively. Two (5%) severe complications, 10 (26%) moderate complications, and 26 (69%) mild complications occurred in group 1 and surgical treatment was performed in 10 cases. Two (6%) severe complications, seven (23%) moderate complications, and 22 (71%) mild complications occurred in group 2 and surgical treatment was performed in eight cases. No significant difference between the two groups was found (p>0.1). Almost perfect agreement between the two radiologists was found for MRI image detection (k=0.86). RT does not seem to cause a significant effect on breast implants in terms of complication rate in patients undergoing implant-based breast reconstruction. One-stage immediate implant-based breast reconstruction performed at the same time as mastectomy could be proposed. Copyright © 2015 The Royal College of Radiologists. Published by Elsevier Ltd. All rights reserved.

Perioperative music and its effects on anxiety, hemodynamics, and pain in women undergoing mastectomy.

Science.gov (United States)

Binns-Turner, Pamela G; Wilson, Lynda Law; Pryor, Erica R; Boyd, Gwendolyn L; Prickett, Carol A

2011-08-01

There is increasing interest in evaluating the use of nonpharmacologic interventions such as music to minimize potential adverse effects of anxiety-reducing medications. This study used a quasi-experimental design to evaluate the effects of a perioperative music intervention (provided continuously throughout the preoperative, intraoperative, and postoperative periods) on changes in mean arterial pressure (MAP), heart rate, anxiety, and pain in women with a diagnosis of breast cancer undergoing mastectomy. A total of 30 women were assigned randomly to a control group or to the music intervention group. Findings indicated that women in the intervention group had a greater decrease in MAP and anxiety with less pain from the preoperative period to the time of discharge from the recovery room compared with women in the control group. Music is a noninvasive and low-cost intervention that can be easily implemented in the perioperative setting, and these findings suggest that perioperative music can reduce MAP, anxiety, and pain among women undergoing mastectomy for breast cancer.

Incidence of breast cancer in Italy: mastectomies and quadrantectomies performed between 2000 and 2005

Directory of Open Access Journals (Sweden)

Artioli Fabrizio

2009-06-01

Full Text Available Abstract Objectives We aimed to determine the incidence of women's breast cancer in Italy without using statistical approximations. Methods We analyzed the national hospitalizations database at the Ministry of Health to calculate the number of major surgeries in Italian women (mastectomies and quadrantectomies due to breast cancer between 2000 and 2005, overall and by age groups ( Results Over the six years examined, an overall number of 100,745 mastectomies and 168,147 quadrantectomies were performed. A total of 41,608 major surgeries due to breast cancer were performed in the year 2000 and this number rose to 47,200 in 2005, with a 13.4% increase over six years. Conclusion by analyzing the hospitalizations database concerning major breast surgery, incidence of breast cancer in Italy was found to be 26.5% higher than the official estimations which have been computed using statistical models (namely 47,200 vs. 37,300 cases in year 2005.

Bilateral breast carcinoma: results with breast conservation therapy and a comparison with bilateral mastectomy

International Nuclear Information System (INIS)

Kim, David H.; Haffty, Bruce G.

1996-01-01

Purpose: To assess outcome of patients with bilateral breast carcinoma treated with bilateral breast conserving surgery with radiation therapy (CS+RT) and to compare their outcome to (1) patients with unilateral disease treated with CS+RT and (2) patients of comparable stage treated with bilateral mastectomy. Methods and Materials: The charts of all patients with the diagnosis of breast cancer treated with CS+RT at our facilities prior to 1993 were reviewed to identify patients with bilateral disease. A total of 50 patients identified as having bilateral breast cancer conservatively treated(BCT) served as the index population. Out of the 50 patients, 23 presented with synchronous bilateral breast cancer and 27 presented with metachronous bilateral breast cancer. A group of 984 patients with unilateral breast cancer (UCT) treated with CS+RT during the same time interval served as the first control group. A second control group was comprised of 42 patients with early stage bilateral breast cancer presenting during the same time interval treated with bilateral mastectomy (BMAST). Patients who had locally advanced disease in either breast or those patients treated exclusively for lobular carcinoma in situ in either breast were excluded from the analysis. Of the 42 BMAST patients, 33 presented with synchronous disease and nine presented with metachronous disease. Local-regional relapse rates were calculated from the date of treatment of each breast. Overall survival and distant relapse rates were calculated from the date of treatment of the second breast cancer diagnosed. Survival curves were calculated via the life table method and statistical comparisons between curves were performed using the log rank statistic. Chi square analysis was used to detect differences between categorical variables. Results: As of December 1995, the median follow-up of the bilateral conservatively treated patient population was 9.4 years. No statistically significant differences were noted

The 1998, 1999 patterns of care study for breast irradiation after mastectomy in Korea

International Nuclear Information System (INIS)

Keum, Ki Chang; Shim, Su Jung; Lee, Ik Jae

2007-01-01

To determine the patterns of evaluation and treatment in patients with breast cancer after mastectomy and treated with radiotherapy. A nationwide study was performed with the goal of improving radiotherapy treatment. A web-based database system for the Korean Patterns of Care Study (PCS) for 6 common cancers was developed. Randomly selected records of 286 eligible patients treated between 1998 and 1999 from 17 hospitals were reviewed. The ages of the study patients ranged from 20 to 80 years (median age 44 years). The pathologic T stage by the AJCC was T1 in 9.7% of the cases, T2 in 59.2% of the cases, T3 in 25.6% of the cases, and T4 in 5.3% of the cases. For analysis of nodal involvement, N0 was 7.3%, N1 was 14%, N2 was 38.8%, and N3 was 38.5% of the cases. The AJCC stage was stage I in 0.7% of the cases, stage IIa in 3.8% of the cases, stage IIb in 9.8% of the cases, stage IIIa in 43% of the cases, stage IIIb in 2.8% of the cases, and IIIc in 38.5% of the cases. There were various sequences of chemotherapy and radiotherapy after mastectomy. Mastectomy and chemotherapy followed by radiotherapy was the most commonly performed sequence in 47% of the cases. Mastectomy, chemotherapy, and radiotherapy followed by additional chemotherapy was performed in 35% of the cases, and neoadjuvant chemoradiotherapy was performed in 12.5% of the cases. The radiotherapy volume was chest wall only in 5.6% of the cases. The volume was chest wall and supraclavicular fossa (SCL) in 20.3% of the cases; chest wall, SCL and internal mammary lymph node (IMN) in 27.6% of the cases; chest wall, SCL and posterior axillary lymph node in 25.9% of the cases; chest wall, SCL, IMN, and posterior axillary lymph node in 19.9% of the cases. Two patients received IMN only. The method of chest wall irradiation was tangential field in 57.3% of the cases and electron beam in 42% of the cases. A bolus for the chest wall was used in 54.8% of the tangential field cases and 52.5% of the electron beam cases

Surgical treatment of gynecomastia: liposuction combined with subcutaneous mastectomy.

Science.gov (United States)

Boljanovic, S; Axelsson, C K; Elberg, J J

2003-01-01

The purpose of the present work has been to evaluate surgical treatment of gynecomastia performed by liposuction combined with subcutaneous mastectomy. It was designed as a prospective consecutive registration of 21 patients (28 breasts) operated in a four month period. Treatment was done in local anaesthesia in the out-patient clinic. Treatment was in one patient complicated with a haematoma. In 86% of cases the patients were satisfied with the postoperative result. Liposuction combined with surgical excision of the gland performed as an out-patient treatment in local anaesthesia is followed by few complications and good cosmetic results.

Deletion of aprA and nprA genes for alkaline protease A and neutral protease A from bacillus thuringiensis: effect on insecticidal crystal proteins.

Science.gov (United States)

Tan, Y; Donovan, W P

2001-11-17

The aprA gene encoding alkaline protease A (AprA) was cloned from Bacillus thuringiensis subsp. kurstaki, and the cloned gene was used to construct aprA-deleted (aprA1) strains of B. thuringiensis. An aprA1 strain of B. thuringiensis that contained the wild-type gene for neutral protease A (nprA(+)) displayed levels of extracellular proteolytic activity that were similar to those of an aprA(+)nprA(+) strain. However, when EDTA was included in the protease assay to inhibit NprA activity the aprA1nprA(+) strain displayed only 2% of the extracellular proteolytic activity of the aprA(+)nprA(+) strain. A strain that was deleted for both aprA and nprA (aprA1nprA3 strain) failed to produce detectable levels of proteolytic activity either in the presence or absence of EDTA in the assay. Compared with the aprA(+)nprA(+) strain the aprA1nprA(+) strain yielded 10% more full-length Cry1Bb crystal protein and the aprA1nprA3 strain yielded 25% more full-length Cry1Bb protein. No significant differences were seen in the 50% lethal dose of Cry1Bb protein from aprA(+)nprA(+) and aprA1nprA3 strains against three species of lepidopteran insects. These results suggest that enhanced yield of certain crystal proteins can be obtained by deletion of the genes aprA and nprA which are the major extracellular proteases of B. thuringiensis.

Development of the APR+ Auxiliary Building General Arrangement (GA)

International Nuclear Information System (INIS)

Moon, Hyung Keun; Park, Young Sheop; Kang, Yong Chul

2011-01-01

The general arrangement (GA) drawing of a nuclear power plant is the most basic drawing which contains all of the plant equipment, systems, and rooms. Therefore, it should be issued at an early design stage to provide the contours of the overall plant structure. This type of drawing is typically used widely throughout the design stages. The development project of APR+ (Advanced Power Reactor+), as a succeeding model of the APR1400 (Advanced Power Reactor 1400) design, has its own GA that encompasses all of its power buildings. This was developed starting in October of 2009. Among several of the buildings in this design, the Auxiliary Building (AB) is one of the most important buildings to produce electricity, and to protect against undesirable radiation emissions. This paper focuses on the design characteristics of the general arrangement of the AB

A Source Term Calculation for the APR1400 NSSS Auxiliary System Components Using the Modified SHIELD Code

International Nuclear Information System (INIS)

Park, Hong Sik; Kim, Min; Park, Seong Chan; Seo, Jong Tae; Kim, Eun Kee

2005-01-01

The SHIELD code has been used to calculate the source terms of NSSS Auxiliary System (comprising CVCS, SIS, and SCS) components of the OPR1000. Because the code had been developed based upon the SYSTEM80 design and the APR1400 NSSS Auxiliary System design is considerably changed from that of SYSTEM80 or OPR1000, the SHIELD code cannot be used directly for APR1400 radiation design. Thus the hand-calculation is needed for the portion of design changes using the results of the SHIELD code calculation. In this study, the SHIELD code is modified to incorporate the APR1400 design changes and the source term calculation is performed for the APR1400 NSSS Auxiliary System components

System Response Analysis of Rod Ejection Accident for APR1400 Using KNAP Hot Spot Model

International Nuclear Information System (INIS)

Kim, Yo-Han; Ha, Sang-Jun; Jun, Hwang-Yong

2006-01-01

Korea Electric Power Research Institute (KEPRI) has been developed the non-loss-of-coolant accident (non- LOCA) analysis methodology, called as the Korea Non- LOCA Analysis Package (KNAP), for the typical Optimized Power Reactor 1000 (OPR1000) plants. Considering current licensing methodology conducted by ABB-CE, however, the KNAP could be applied to Advanced Power Reactor 1400 (APR1400) also. In spite of some difference in design concepts of two plant types, there is a close resemblance between their nuclear steam supply systems (NSSS). So, in this study, the rod ejection accident (REA) event was analyzed using KNAP hot spot model (HSM) for APR1400 to estimate the feasibility of the application and the results were compared with those given in APR1400 Standard Safety Analysis Report (SSAR), which were calculated using the CESEC-III and STRIKIN-II code of ABB-CE. Through the study, it was concluded that the KNAP could be applicable to APR1400 on the view point of REA

Aesthetic outcome, patient satisfaction, and health-related quality of life in women at high risk undergoing prophylactic mastectomy and immediate breast reconstruction.

Science.gov (United States)

Isern, A E; Tengrup, I; Loman, N; Olsson, H; Ringberg, A

2008-10-01

Prophylactic mastectomy is an effective risk-reducing option in women with hereditary increased risk of breast cancer. It may be combined with immediate reconstruction, with the intention of improving aesthetic outcome and health-related quality of life. Sixty-one women underwent prophylactic mastectomy and immediate breast reconstruction in Malmö, Sweden, between 1995 and 2003. Forty women underwent bilateral prophylactic mastectomy and immediate reconstruction. Ten of these had a previous breast cancer diagnosis. Twenty-one women underwent contralateral prophylactic mastectomy and immediate reconstruction after a previous breast cancer. Fifty-four of the women (89%) were evaluated clinically for aesthetic results and complications. Patient satisfaction and quality of life were evaluated with one study-specific and two standardised health-related questionnaires administered at time of clinical follow-up. Median follow-up time was 42 months (range 7-99 months). The position of the reconstructed breasts was judged as satisfactory in 77% of breasts. Symmetry in relation to the midline was adequate in 89% of breasts. A capsular contracture grade III according to Baker and indentation tonometry was observed in 1% of breasts (1/104). The complication rate was 18% (7% early and 11% late). Secondary corrections were carried out in 11% of breasts. The study-specific questionnaire revealed a high degree of satisfaction. No woman regretted the procedure, and all women would have chosen the same type of surgery again. An age-stratified comparison of Swedish women using the Short Form 36 Health Survey Questionnaire (SF-36) questionnaire was carried out for this study. The study population scores were high, suggesting that prophylactic mastectomy and immediate reconstruction on both physical and psychological issues in this retrospective study had no negative effect. Also, the Hospital Anxiety and Depression Scale (HAD) questionnaire did not suggest any increased anxiety or

Homology modeling of dissimilatory APS reductases (AprBA of sulfur-oxidizing and sulfate-reducing prokaryotes.

Directory of Open Access Journals (Sweden)

Birte Meyer

Full Text Available BACKGROUND: The dissimilatory adenosine-5'-phosphosulfate (APS reductase (cofactors flavin adenine dinucleotide, FAD, and two [4Fe-4S] centers catalyzes the transformation of APS to sulfite and AMP in sulfate-reducing prokaryotes (SRP; in sulfur-oxidizing bacteria (SOB it has been suggested to operate in the reverse direction. Recently, the three-dimensional structure of the Archaeoglobus fulgidus enzyme has been determined in different catalytically relevant states providing insights into its reaction cycle. METHODOLOGY/PRINCIPAL FINDINGS: Full-length AprBA sequences from 20 phylogenetically distinct SRP and SOB species were used for homology modeling. In general, the average accuracy of the calculated models was sufficiently good to allow a structural and functional comparison between the beta- and alpha-subunit structures (78.8-99.3% and 89.5-96.8% of the AprB and AprA main chain atoms, respectively, had root mean square deviations below 1 A with respect to the template structures. Besides their overall conformity, the SRP- and SOB-derived models revealed the existence of individual adaptations at the electron-transferring AprB protein surface presumably resulting from docking to different electron donor/acceptor proteins. These structural alterations correlated with the protein phylogeny (three major phylogenetic lineages: (1 SRP including LGT-affected Archaeoglobi and SOB of Apr lineage II, (2 crenarchaeal SRP Caldivirga and Pyrobaculum, and (3 SOB of the distinct Apr lineage I and the presence of potential APS reductase-interacting redox complexes. The almost identical protein matrices surrounding both [4Fe-4S] clusters, the FAD cofactor, the active site channel and center within the AprB/A models of SRP and SOB point to a highly similar catalytic process of APS reduction/sulfite oxidation independent of the metabolism type the APS reductase is involved in and the species it has been originated from. CONCLUSIONS: Based on the comparative

Levels of Depression and Anxiety Post-Mastectomy in Breast Cancer Patients at a Public Sector Hospital in Karachi.

Science.gov (United States)

Khan, Sara; Khan, Naveed Ali; Rehman, Ata Ur; Khan, Iqra; Samo, Khursheed A; Memon, Amjad Siraj

2016-01-01

There is a noticeable change in the approach with which women nowadays seek help for diseases like breast cancer, primarily due to awareness campaigns, but what happens after surgical procedures is of great significance too. This study focused on the several psychological connotations attached to mastectomy and how the patients cope. To understand the pattern of anxiety and level of depression among Pakistani patients undergoing mastectomy. The sample size consisted of 88 patients who had undergone mastectomy at the different surgical units of the Civil Hospital, Karachi, from January 2012- December 2014; The questionnaire was administered before they were discharged i.e. within 3 days of surgical procedures. The patients were asked if they were willing to participate in this study, those who agreed signed the consent form and then we preceded by asking questions with a standardized tool. A self made questionnaire was constructed keeping in mind the nature and specification of the disease, which consisted of 20 questions related to anxiety and depression, focusing on a mixture of psychological and physiological symptoms. There were a total of 88 patients out of which 36 (41%) were aged 51 to 60 years, 24 (27.2%) of the patients were in the age category of 41 to 50 years, 17 aged 61 and above (19.3%) and only 11 (12.5%) 30-40 years of age, the youngest of all the age categories. The pattern of depression and anxiety was found to be similar among all age categories, severe depression and anxiety predominating over moderate level of such symptoms, with only relatively few patients sufering mild or no depression symptoms. It was concluded that going through mastectomy leads to moderate to severe levels of depression and anxiety, primarily because the females feel incomplete and insecure after losing a part of themselves.

Constrained model predictive control for load-following operation of APR reactors

International Nuclear Information System (INIS)

Kim, Jae Hwan; Lee, Sim Won; Kim, Ju Hyun; Na, Man Gyun; Yu, Keuk Jong; Kim, Han Gon

2012-01-01

The load-following operation of APR+ reactor is needed to control the power effectively using the control rods and to restrain the reactivity control from using the boric acid for flexibility of plant operation. Usually, the reason why the disproportion of axial flux distribution occurs during load-following operation is xenon-induced oscillation. The xenon has a very high absorption cross-section and makes the impact on the reactor delayed by the iodine precursor. The power maneuvering using automatically load-following operation has advantage in terms of safety and economic operation of the reactor, so the controller has to be designed efficiently. Therefore, an advanced control method that meets the conditions such as automatic control, flexibility, safety, and convenience is necessary to load-following operation of APR+ reactor. In this paper, the constrained model predictive control (MPC) method is applied to design APR reactor's automatic load-following controller for the integrated thermal power level and axial shape index (ASI) control. Some controllers use only the current tracking command, but MPC considers future commands in addition to the current tracking command. So, MPC can achieve better tracking performance than others. Furthermore, an MPC is to used in many industrial process control systems. The basic concept of the MPC is to solve an optimization problem for a finite future time interval at present time and to implement the first optimal control input as the current control input. The KISPAC-1D code, which models the APR+ nuclear power plants, is interfaced to the proposed controller to verify the tracking performance of the reactor power level and ASI. It is known that the proposed controller exhibits very fast tracking responses

Effect of Postmastectomy Radiotherapy in Patients <35 Years Old With Stage II-III Breast Cancer Treated With Doxorubicin-Based Neoadjuvant Chemotherapy and Mastectomy

International Nuclear Information System (INIS)

Garg, Amit K.; Oh, Julia L.; Oswald, Mary Jane; Huang, Eugene; Strom, Eric A.; Perkins, George H.; Woodward, Wendy A.; Yu, T. Kuan; Tereffe, Welela; Meric-Bernstam, Funda; Hahn, Karin; Buchholz, Thomas A.

2007-01-01

Purpose: Postmastectomy radiotherapy (PMRT) improves locoregional control (LRC) in patients with high-risk features after mastectomy. Young age continues to evolve as a potentially important risk factor. The objective of this study was to assess the benefits of PMRT in patients <35 years old treated with doxorubicin-based neoadjuvant chemotherapy for Stage II-III breast cancer. Patients and Methods: We retrospectively analyzed 107 consecutive breast cancer patients <35 years old with Stage IIA-IIIC disease treated at our institution with doxorubicin-based neoadjuvant chemotherapy and mastectomy, with or without PMRT. The treatment groups were compared in terms of LRC and overall survival. Results: Despite more advanced disease stages, the patients who received PMRT (n = 80) had greater rates of LRC (5-year rate, 88% vs. 63%, p = 0.001) and better overall survival (5-year rate, 67% vs. 48%, p = 0.03) than patients who did not receive PMRT (n = 27). Conclusion: Among breast cancer patients <35 years old at diagnosis, the use of PMRT after doxorubicin-based neoadjuvant chemotherapy and mastectomy led to a statistically greater rate of LRC and overall survival compared with patients without PMRT. The benefit seen for PMRT in young patients provides valuable data to better tailor adjuvant, age-specific treatment decisions after mastectomy

Cost-effectiveness analysis of levobupivacaine 0.5 %, a local anesthetic, infusion in the surgical wound after modified radical mastectomy.

Science.gov (United States)

Ferreira Laso, Lourdes; López Picado, Amanda; Antoñanzas Villar, Fernando; Lamata de la Orden, Laura; Ceballos Garcia, Mar; Ibañez López, Carolina; Pipaon Ruilope, Lorena; Lamata Hernandez, Felix; Valero Martinez, Cesar; Aizpuru, Felipe; Hernandez Chaves, Roberto

2015-09-01

Effective treatment of postoperative pain contributes to decreasing the rate of complications as well as the total cost of the operated patients. The aim of this study was to analyze the costs and the efficiency of use of continuous infusion of levobupivacaine 0.5 % with the help of an infusion pump in modified radical mastectomy. A cost calculation of the analgesic procedures (continuous infusion of levobupivacaine 0.5 % [levobupivacaine group (LG)] or saline [saline group (SG)] (2 ml/h 48 h) has been carried out based on the data of a previous clinical trial (double-blind randomized study) of patients who underwent modified radical mastectomy surgery. The measure of the effectiveness was the point reduction of pain derived from the verbal numeric rating scale (VNRS). The usual incremental cost-effectiveness ratio (ICER) was performed. Considering only the intravenous analgesia, overall costs were lower in LG, as less analgesia was used (EUR14.06 ± 7.89 vs. 27.47 ± 14.79; p mastectomy, therefore providing patients with a higher quality of care in the prevention of pain. clinicaltrials.gov: reference number NCT01389934. http://clinicaltrials.gov/show/NCT01389934

Hospital organizational factors affect the use of immediate breast reconstruction after mastectomy for breast cancer

NARCIS (Netherlands)

Schreuder, Kay; van Bommel, A.C.M.; De Ligt, K.M.; Maduro, J.H.; Vrancken Peeters, M.T.F.D.; Mureau, M.A.M.; Siesling, S.

2016-01-01

Background: Aims of the current study were to identify which hospital organizational factors determine the variation in the use of immediate breast reconstruction (IBR) after mastectomy for ductal carcinoma in situ (DCIS) or invasive breast cancer and to investigate whether these factors explain the

Decision making regarding prophylactic mastectomy: stability of preferences and the impact of anticipated feelings of regret.

Science.gov (United States)

van Dijk, Sandra; van Roosmalen, Mariëlle S; Otten, Wilma; Stalmeier, Peep F M

2008-05-10

Women who test positive for a BRCA1/2 mutation face difficult choices to manage their breast cancer risk; one of these choices is whether to opt for prophylactic mastectomy. Few data are available about this decision-making process. The current study provides data regarding the stability of risk-management preferences over time and the factors that are associated with these preferences. We analyzed data from 338 women who opted for breast cancer antigen (BRCA) testing. First, we prospectively assessed preferences of 80 BRCA mutation carriers at five different points in time ranging from 1 week after blood sampling up to 9 months after BRCA-test disclosure. Second, we applied univariate and multivariate regression analyses to examine which medical, sociodemographic, and psychological factors are related to a preference for prophylactic mastectomy. Ninety percent of the women already indicated a preference regarding risk management at baseline. Moreover, most women had stable preferences over time. Furthermore, anticipated feelings of regret in case of a hypothetical breast cancer diagnosis in the near future were strongly related to risk-management preference (odds ratio = 8.93; P preferences. Many of them may be sensitive to the possibility of regret in case of a bad outcome. We discuss whether possible regret in the future is a rational reason for opting for prophylactic mastectomy, or whether it signifies an emotional coping process or strategy in which the future costs are no longer fully considered.

Implementation and Analysis for APR1400 Soft Control System

International Nuclear Information System (INIS)

2015-01-01

Due to the rapid advancement of digital technology, the definite technical advantages of digital control system compared to analog control system are accelerating the implementation of advanced distributed digital control system in the nuclear power plant. One of the major advantages of digital control system is the capability of Soft Control System. The design of Soft Control System for Advanced Power Reactor 1400 (APR1400) plant of Man-Machine Interface System (MMIS) is based on full digital technologies to enhance reliability, operability and maintainability. Computer-based compact workstation has been adopted in the APR1400 Main Control Room (MCR) to provide convenient working environment. This paper introduces the approaches and methodologies of Soft Control System for the Advanced Control Room (ACR). This paper also explains major design features for operation and display of the Soft Control System and its implementation to cope with regulatory requirements. (authors)

Verbal Communication in the APR1400 Advanced Control Room

International Nuclear Information System (INIS)

Kim, Jong Hyun; Shin, Young Cheol

2007-01-01

This paper introduces the characteristics of communication in advanced main controlghd rooms (MCRs) and some observations from a case study performed for APR1400 MCR. In advanced MCRs, operators need not maintain the same communication patterns as they do in conventional ones. For example, a senior reactor operator (SRO) does not have to rely on board operators for information acquisition and can get any information from his/her own workstation. This situation may also bring about new problems in MCRs such as lack of shared situation awareness and collaboration between MCR operators. To cope with these problems, the APR1400 MCR adapts several approaches in design and training for encouraging operators to communicate with each other. This paper introduces the possible changes of communication patterns and the countermeasures in design and training. Some findings from an integrated system validation for Shin Kori Units 3 and 4 are also presented

Vingt ans après…

Directory of Open Access Journals (Sweden)

François Burgat

2002-05-01

Full Text Available Le dixième numéro des Chroniques Yéménites, publié vingt ans après la création du Centre Français d'Archéologie et de Sciences Sociales de Sanaa reflète des ambitions souvent exprimées: donner une chance aux jeunes chercheurs et couvrir un large éventail disciplinaire au service de l'affirmation de la vocation régionale du Centre. Depuis Sanaa ou Paris, chercheurs, doctorants ou stagiaires, de l'Ecole normale supérieure, de l'INALCO, de l'Université de Sanaa et de bon nombre d'institu...

The effect of peer-led education on the life quality of mastectomy patients referred to breast cancer-clinics in Shiraz, Iran 2009

OpenAIRE

Sharif, Farkhondeh; Abshorshori, Narjes; Tahmasebi, Sedigheh; Hazrati, Maryam; Zare, Najaf; Masoumi, Sarah

2010-01-01

Abstract Background Breast cancer among women is a relatively common with a more favorable expected survival rates than other forms of cancers. This study aimed to determine the improved quality of life for post-mastectomy women through peer education. Methods Using pre and post test follow up and control design approach, 99 women with stage I and II of breast cancer diagnosis were followed one year after modified radical mastectomy. To measure the quality of life an instrument designed by th...

Seismic analysis of APR1400 RCS for site envelope using big mass method

International Nuclear Information System (INIS)

Kim, J. Y.; Jeon, J. H.; Lee, D. H.; Park, S. H.

2002-01-01

One of design concepts of APR1400 is the site envelope considering various soil sites as well as rock site. The KSNP's are constructed on the rock site where only the translational excitations are directly transferred to the plant. On the other hand, the rotational motions affect the responses of the structures in the soil cases. In this study, a Big Mass Method is used to consider rotational motions as excitations at the foundation in addition to translational ones to obtain seismic responses of the APR1400 RCS main components. The seismic analyses for the APR1400 excited simultaneously by translation and rotational motions were performed. The results show that the effect of soil sites is not significant for the design of main components and supports of the RCS, but it may be considerable for the design of reactor vessel internals, piping, and nozzles which have lower natural frequencies

Preliminary Design of Optimized Reactor Insulator for Severe Accident Mitigation of APR1400

International Nuclear Information System (INIS)

Heo, Sun; Lee, Jae-Gon; Kang, Yong-Chul

2007-01-01

APR1400, a Korean evolutionary advance light water reactor, has many advanced safety feature to prevent and mitigate of design basis accident (DBA) and severe accident. When reactor cooling system (RCS) fails to cooling its core, the core melted down and the molten core gathers together on bottom of reactor vessel. The molten core hurts reactor vessel and is released to containment, which raises the release of radioactive isotopes and the heating of the containment atmosphere. Finally, the corium is accumulated in the bottom of reactor cavity and it also raises the Molten Core and Concrete Interaction (MCCI) and the heating of containment atmosphere. There are two strategies to cooling molten core. Those are in-vessel retention and ex-vessel cooling. At the early stage of APR1400 design, only ex-vessel cooling which is cooling of the molten core outside the vessel after vessel failure is considered based on EPRI Utility Requirement Document (URD) for Evolutionary LWR. However, a need has been arisen to reflect current research findings on severe accident phenomena and mitigation technologies to Korean URD and IVRERVC (In-Vessel corium Retention using Ex-Reactor Vessel Cooling) was adopted APR1400. The ERVC is not considered as a licensing design basis but based on the defense-in-depth principle and safety margin basis, which is the top-tier requirement of the severe accident mitigation design as stated in the KURD. The Severe Accident Management strategy for APR1400 is intended to aid the plant operating staff to secure reactor vessel integrity in the early stage of the severe accident. As a part of a design implementation of IVR-ERVC for APR1400, we developed the preliminary design requirement, design specification and conceptual design

ISSN 2073-9990 East Cent. Afr. J. 0 East Cent. Afr. J. 0 East Cent ...

African Journals Online (AJOL)

dell

2014-04-01

Apr 1, 2014 ... When ready to insert the wound drain following intracranial procedures, the blue tip of the drainage tube of ... squared (Fisher's exact) test, and the former with the student-t test. A p-value < 0.05 was .... 72(6):993-5. 6. Morris A. A controlled trial of closed wound suction drainage in radical mastectomy. British.

Influence of adjuvant irradiation on the development of late arm lymphedema and impaired shoulder mobility after mastectomy for carcinoma of the breast

International Nuclear Information System (INIS)

Ryttov, N.; Holm, N.V.; Qvist, N.; Blichert-Toft, M.; Odense Univ. Hospital

1988-01-01

The influence of postoperative radiation therapy on development of late arm lymphedema and shoulder joint disability following mastectomy was evaluated from a series of 57 women with operable carcinoma of the breast. The patients were divided into three groups. Common for all three groups was mastectomy and partial axillary dissection. In addition one group received postoperative irradiation plus systemic therapy and another group systemic therapy alone. The incidence of late arm lymphedema/impaired shoulder mobility was 11%/4% in the group of patients undergoing surgery alone, 46%/38% in the group of patients receiving adjuvant irradiation and 6%/12% in the group of patients receiving adjuvant systemic therapy. It is concluded that adjuvant irradiation to the axilla in patients with metastatic lymph nodes highly increases the risk of late physical sequelae following modified radical mastectomy. Adjuvant systemic therapy can be administered to high risk patients without increasing the risk of late arm lymphedema and shoulder disability. (orig.)

Single-tube condensation experiment in Passive Auxiliary Feedwater System of APR1400+

Energy Technology Data Exchange (ETDEWEB)

Shin, Chang Wook; No, Hee Cheon; Yun, Bong Yo; Jeon, Byong Guk [Korea Advanced Institute of Science and Technology, Daejeon (Korea, Republic of)

2012-05-15

Conventional Korean nuclear power plants, Advanced Power Reactors (APR), are characterized by an active cooling system. However, Active cooling system may not prevent significant damage without any AC power source available for its operation as vividly illustrated through the recent Fukushima incident. In the APR1400+ to be designed, an independent passive cooling system was added in order to overcome the aforementioned shortcomings. In the Passive Auxiliary Feedwater System (PAFS), gravity force and density difference between steam and water are used. The system comprises of 240 condensation tubes to efficiently remove decay heat. Before applying the PAFS to APR1400+, the system's safety and heat removal performance must be verified. The present study experimentally evaluates the heat removal performance of a single tube in the PAFS. The objectives of SCOP (Single-tube Condensation experiment facility of PAFS) are the evaluation of the heat removal performance in the tube of the PAFS and database construction under various tube designs and test conditions. Reaching these objectives, we developed advanced measurement techniques for the amount of moisture, heat flux, and water film thickness.

aprABC: A Mycobacterium tuberculosis complex-specific locus that modulates pH-driven adaptation to the macrophage phagosome

Science.gov (United States)

Abramovitch, Robert B.; Rohde, Kyle H.; Hsu, Fong-Fu; Russell, David G.

2011-01-01

Summary Following phagocytosis by macrophages, Mycobacterium tuberculosis (Mtb) senses the intracellular environment and remodels its gene expression for growth in the phagosome. We have identified an Acid and Phagosome Regulated (aprABC) locus that is unique to the Mtb complex and whose gene expression is induced during growth in acidic environments in vitro and in macrophages. Using the aprA promoter, we generated a strain that exhibits high levels of inducible fluorescence in response to growth in acidic medium in vitro and in macrophages. aprABC expression is dependent on the two-component regulator phoPR, linking phoPR signaling to pH sensing. Deletion of the aprABC locus causes defects in gene expression that impact aggregation, intracellular growth, and the relative levels of storage and cell wall lipids. We propose a model where phoPR senses the acidic pH of the phagosome and induces aprABC expression to fine-tune processes unique for intracellular adaptation of Mtb complex bacteria. PMID:21401735

Effect of Means of Problem-Oriented Physical Rehabilitation on Pain and Tactile Sensitivity and Pain Syndrome Intensity in Women with Post-Mastectomy Syndrome

Directory of Open Access Journals (Sweden)

Т. Є. Одинець

2015-03-01

Full Text Available The objective of the paper is to determine the effectiveness of problem-oriented physical rehabilitation of women with post-mastectomy syndrome in terms of normalization of their sensitivity and lessening of the pain syndrome. Materials and methods. The paper provides a review of the related literary sources and empirical data analyzed and summarized, offers definitions of pain by the Visual Analogue Scale, McGill Pain Questionnaire and the Verbal Rating Scale, evaluates tactile and pain sensitivity, and uses the methods of mathematical statistics. The participants in the study were 50 women with diagnosed with the post-mastectomy syndrome and at the stage of residential treatment. Results: The developed problem-oriented physical rehabilitation experimentally proved effective by showing improvements in tactile and pain sensitivity, and pain lessening by the sensory, affective and rating scales in women with post-mastectomy syndrome at the stage of residential treatment.

Structural assessments of plate type support system for APR1400 reactor

Energy Technology Data Exchange (ETDEWEB)

Nguyen, Anh Tung; Namgung, Ihn, E-mail: inamgung@kings.ac.kr

2017-04-01

Highlights: • This paper investigates plate-type support structure for the reactor vessel of the APR 1400. • The tall column supports of APR1400 reactor challenges in seismic and severe accident events. • A plate-type support of reactor vessel was proposed and evaluated based on ASME code. • The plate-type support was assessed to show its higher rigidity than column-type. - Abstract: This paper investigates an alternative form of support structure for the reactor vessel of the APR 1400. The current reactor vessel adopts a four-column support arrangement locating on the cold legs of the vessel. Although having been successfully designed, the tall column structure challenges in seismic events. In addition, for the mitigation of severe accident consequences, the columns inhibit ex-vessel coolant flow, hence the elimination of the support columns proposes extra safety advantages. A plate-type support was proposed and evaluated for the adequacy of meeting the structural stiffness by Finite Element Analysis (FEA) approach. ASME Boiler and Pressure Vessel Code was used to verify the design. The results, which cover thermal and static structural analysis, show stresses are within allowable limits in accordance with the design code. Even the heat conduction area is increased for the plate-type of support system, the results showed that the thermal stresses are within allowable limits. A comparison of natural frequencies and mode shapes for column support and plate-type support were presented as well which showed higher fundamental frequencies for the plate-type support system resulting in greater rigidity of the support system. From the outcome of this research, the plate-type support is proven to be an alternative to current APR column type support design.

Impact de la qualité de l'audit externe sur la liquidité des titres des entreprises tunisiennes cotées

OpenAIRE

Faten Hakim Ghorbel

2008-01-01

Cette recherche a pour objectif d'étudier l'impact de la qualité d'audit externe sur la liquidité. Nous appréhendons la qualité d'audit dans le cadre de notre étude par "la qualité de l'auditeur", et notamment de son indépendance et de ses compétences. Après avoir contrôlé l'effet d'autres variables censées, d'après la théorie, influencer la liquidité, les tests effectués ont permis de dégager une relation positive entre l'appartenance des auditeurs à un réseau international (Big 4), la spéci...

Outcomes of multiple wire localization for larger breast cancers: when can mastectomy be avoided?

Science.gov (United States)

Kirstein, Laurie J; Rafferty, Elizabeth; Specht, Michelle C; Moore, Richard H; Taghian, Alphonse G; Hughes, Kevin S; Gadd, Michele A; Smith, Barbara L

2008-09-01

Mastectomy is often recommended when mammography shows a breast cancer with extensive calcifications. We wished to determine whether the use of multiple localizing wires to guide lumpectomy in this setting was associated with increased rates of breast conservation. We also wanted to identify factors that predicted a poor chance of successful lumpectomy, to avoid multiple lumpectomy attempts in a patient who would ultimately require mastectomy. Records of 153 women with breast cancer who underwent lumpectomy for larger lesions that required multiple wire localization and 196 controls who required only single wire localization were reviewed retrospectively. The number of localizing wires, specimen volume, largest specimen dimension, number of surgical procedures, and rates of breast conservation were scored. Seventy-seven percent of patients requiring multiple wire localization had successful breast conservation, compared with 90% of those needing only single wire localization. Only 28% of multiple wire patients required more than 1 excision to achieve clear margins, compared with 36% of single wire patients (p localizing wires for excision. The use of multiple wires can decrease the number of procedures required to obtain clear lumpectomy margins.

Harmonic scalpel versus electrocautery dissection in modified radical mastectomy: a randomized controlled trial.

Science.gov (United States)

Khan, Salma; Khan, Shaista; Chawla, Tabish; Murtaza, Ghulam

2014-03-01

To test the hypothesis that the use of a harmonic scalpel increases operative time but results in less estimated blood loss, postoperative pain, drainage volume, and duration of surgery, as well as fewer complications, such as flap necrosis, seroma, and surgical site infection (SSI), than electrocautery. This parallel-group, single-institution blinded randomized controlled trial was conducted at the department of surgery of our institute between April 2010 and July 2011. Women undergoing modified radical mastectomy were randomly allocated to either harmonic dissection (n = 76) or electrocautery (n = 76). Both the groups were comparable for baseline variables with age of 50.5 ± 12.2 and 48.5 ± 14.5 years in the harmonic and electrocautery groups, respectively. Harmonic dissection yielded better outcomes compared to electrocautery with lower estimated blood loss (100 ± 62 vs. 182 ± 92, p electrocautery (r2 = 0.28, β = 11.8, p < 0.001). The harmonic scalpel significantly reduces postoperative discomfort and morbidity to the patient without increasing operating time. We thus recommend preferential use of harmonic dissection in modified radical mastectomy. (ClinicalTrials.gov NCT01587248).

Resultats visuels et complications apres chirurgie de la cataracte ...

African Journals Online (AJOL)

Resultats visuels et complications apres chirurgie de la cataracte: cas de l' Hopital Ophtalmologique Saint Andre de Tinre au nord-Benin. K.M. Amedome, C.R.A. Assavedo, M Aboudou, K Vonor, N Maneh, K Nonon Saa, K Dzidzinyo, K.D. Ayena, M Banla, K Balo ...

Containment Performance Analysis with Large Break LOCA for EU-APR1400

International Nuclear Information System (INIS)

Hwang, Do Hyun; Lee, Keun Sung; Kim, Yong Soo

2013-01-01

In this paper for containment performance analysis, the containment pressurization analysis is performed and thermo-hydraulic response analysis of containment structure is carried out to provide basic understanding of containment transient states under a severe accident sequence. Especially, in EU-APR1400 design, to reduce containment pressure and temperature, Severe Accident Containment Spray System (SACSS) is designed to be actuated automatically when Core Exit Temperature (CET) reaches 922 K (649 .deg. C). The containment performance analysis was carried on LBLOCA sequence for EU-APR1400 with SACSS through MAAP code. If SACSS is actuated when CET reaches 922 K (649 .deg. C) , the containment pressure and temperature decrease to a sufficient low level. The predicted atmospheric pressure of containment will not exceed the ultimate pressure capacity (UPC) and have a sufficient margin to it even though the UPC of the reference plant (Shin-Kori Units 3 and 4) is used instead because the UPC calculation for EU-APR1400 has not been completed. The largest load on the containment by LBLOCA is estimated at 306.1 kPa. Thus the margin to UPC is estimated to be 330 % in comparison with 1.329 MPa as UPC for the reference plant.

Review of Factors Influencing Women's Choice of Mastectomy Versus Breast Conserving Therapy in Early Stage Breast Cancer: A Systematic Review.

Science.gov (United States)

Gu, Jeffrey; Groot, Gary; Boden, Catherine; Busch, Angela; Holtslander, Lorraine; Lim, Hyun

2018-01-03

We have performed a narrative synthesis. A literature search was conducted between January 2000 and June 2014 in 7 databases. The initial search identified 2717 articles; 319 underwent abstract screening, 67 underwent full-text screening, and 25 final articles were included. This review looked at early stage breast cancer in women only, excluding ductal carcinoma in situ and advanced breast cancer. A conceptual framework was created to organize the central constructs underlying women's choices: clinicopathologic factors, physician factors, and individual factors with subgroups of sociodemographic, geographic, and personal beliefs and preferences. This framework guided our review's synthesis and analysis. We found that larger tumor size and increasing stage was associated with increased rates of mastectomy. The results for age varied, but suggested that old and young extremes of diagnostic age were associated with an increased likelihood of mastectomy. Higher socioeconomic status was associated with higher breast conservation therapy (BCT) rates. Resident rural location and increasing distance from radiation treatment facilities were associated with lower rates of BCT. Individual belief factors influencing women's choice of mastectomy (mastectomy being reassuring, avoiding radiation, an expedient treatment) differed from factors influencing choice of BCT (body image and femininity, physician recommendation, survival equivalence, less surgery). Surgeon factors, including female gender, higher case numbers, and individual surgeon practice, were associated with increased BCT rates. The decision-making process for women with early stage breast cancer is complicated and affected by multiple factors. Organizing these factors into central constructs of clinicopathologic, individual, and physician factors may aid health-care professionals to better understand this process. Copyright © 2017 The Authors. Published by Elsevier Inc. All rights reserved.

Invasive lobular carcinoma of the breast: MRI pathological correlation following bilateral total mastectomy

International Nuclear Information System (INIS)

Stivalet, Aude; Pigneur, Frederic; Luciani, Alain

2012-01-01

Background: Invasive lobular carcinoma (ILC) is more often multifocal and bilateral than invasive ductal carcinoma. MRI is usually recommended for detection of all ILC sites. The performance of known diagnostic breast MRI criteria for ILC characterization has not been evaluated to date using bilateral mastectomy specimens as gold standard. Purpose: To determine the value of BI-RADS 2006 MRI criteria for ILC detection and characterization, using pathological examination of bilateral mastectomy specimens as the reference standard. Material and Methods: Between 2004 and 2007, we retrospectively included all patients with pathologically documented ILC referred to our institution for bilateral mastectomy and preoperative bilateral breast MRI. The location, diameter, and characteristics (BI-RADS) of all lesions were compared with pathological findings. The sensitivity and positive predictive value of bilateral breast MRI for the diagnosis of ILC were calculated. Association of MRI BI-RADS categorical variables and characterization of ILC were assessed (Fisher exact test). Results: Among 360 patients treated for ILC in 2004-2007, 15 patients qualified for this study. Thirty-one ILC foci were found on pathological examination (30 ipsilateral and 1 contralateral tumor; mean diameter 23 mm; range 2-60 mm) and all were identified on MRI, with 90% of masses and 10% non-mass-like enhancements; MRI features significantly associated with ILC included absence of smooth margins (P = 0.02) and rim-shaped enhancement (P = 0.039). Enhancement kinetics of the 31 foci were evenly distributed among wash-out, plateau, and persistent profiles. Eleven additional lesions were seen on MRI, mainly corresponding to fibrocystic disease; 91% presented as masses and 9% had a wash-out profile. Conclusion: Based on the 2006 BI-RADS criteria, breast MRI shows a high sensitivity for ILC detection, at the expense of a 26% false-positive rate, suggesting that a pathological proof by US- or MR

Invasive lobular carcinoma of the breast: MRI pathological correlation following bilateral total mastectomy

Energy Technology Data Exchange (ETDEWEB)

Stivalet, Aude; Pigneur, Frederic (AP-HP, Groupe Henri Mondor Albert Chenevier, Imagerie Medicale, Creteil (France)); Luciani, Alain (AP-HP, Groupe Henri Mondor Albert Chenevier, Imagerie Medicale, Creteil (France); INSERM Unite U 955, Equipe 17, Univ. Paris Est Creteil, Creteil (France)), email: alain.luciani@hmn.aphp.fr (and others)

2012-05-15

Background: Invasive lobular carcinoma (ILC) is more often multifocal and bilateral than invasive ductal carcinoma. MRI is usually recommended for detection of all ILC sites. The performance of known diagnostic breast MRI criteria for ILC characterization has not been evaluated to date using bilateral mastectomy specimens as gold standard. Purpose: To determine the value of BI-RADS 2006 MRI criteria for ILC detection and characterization, using pathological examination of bilateral mastectomy specimens as the reference standard. Material and Methods: Between 2004 and 2007, we retrospectively included all patients with pathologically documented ILC referred to our institution for bilateral mastectomy and preoperative bilateral breast MRI. The location, diameter, and characteristics (BI-RADS) of all lesions were compared with pathological findings. The sensitivity and positive predictive value of bilateral breast MRI for the diagnosis of ILC were calculated. Association of MRI BI-RADS categorical variables and characterization of ILC were assessed (Fisher exact test). Results: Among 360 patients treated for ILC in 2004-2007, 15 patients qualified for this study. Thirty-one ILC foci were found on pathological examination (30 ipsilateral and 1 contralateral tumor; mean diameter 23 mm; range 2-60 mm) and all were identified on MRI, with 90% of masses and 10% non-mass-like enhancements; MRI features significantly associated with ILC included absence of smooth margins (P = 0.02) and rim-shaped enhancement (P = 0.039). Enhancement kinetics of the 31 foci were evenly distributed among wash-out, plateau, and persistent profiles. Eleven additional lesions were seen on MRI, mainly corresponding to fibrocystic disease; 91% presented as masses and 9% had a wash-out profile. Conclusion: Based on the 2006 BI-RADS criteria, breast MRI shows a high sensitivity for ILC detection, at the expense of a 26% false-positive rate, suggesting that a pathological proof by US- or MR

MRI evaluation of post-mastectomy irradiated breast implants: prevalence and analysis of complications

International Nuclear Information System (INIS)

Rella, L.; Telegrafo, M.; Nardone, A.; Milella, A.; Ianora, A.A. Stabile; Lioce, M.; Angelelli, G.; Moschetta, M.

2015-01-01

Aim: To evaluate the effect of post-mastectomy radiation therapy (RT) on breast implants as detected by magnetic resonance imaging (MRI) searching for short-term complications. Materials and methods: One hundred and forty patients (total of 144 implants) were evaluated by MRI; 80 (group 1) had undergone RT, whereas the remaining 60 patients (group 2) underwent mastectomy with implant reconstruction without RT. Two radiologists evaluated MRI images searching for implant rupture signs, sub-capsular seromas, capsular contracture, soft-tissue oedema, peri-implant fluid collections. Implant ruptures were classified as severe complications; seromas and capsular contractures as moderate complications; oedema and fluid collections as mild complications. The prevalence of MRI findings in the two groups was calculated and compared by unpaired t-test. Cohen's kappa statistics was used to assess interobserver agreement. Results: Sixty-nine out of 144 (48%) implants presented pathological findings at MRI with complication rates of 47.5 and 48.4 for groups 1 and 2, respectively. Two (5%) severe complications, 10 (26%) moderate complications, and 26 (69%) mild complications occurred in group 1 and surgical treatment was performed in 10 cases. Two (6%) severe complications, seven (23%) moderate complications, and 22 (71%) mild complications occurred in group 2 and surgical treatment was performed in eight cases. No significant difference between the two groups was found (p>0.1). Almost perfect agreement between the two radiologists was found for MRI image detection (k=0.86). Conclusion: RT does not seem to cause a significant effect on breast implants in terms of complication rate in patients undergoing implant-based breast reconstruction. One-stage immediate implant-based breast reconstruction performed at the same time as mastectomy could be proposed. -- Highlights: •RT could increase complication rates of implant-based breast reconstruction (IBR). •No general consensus

Uncertainty Evaluation of a Postulated LBLOCA for APR+ using KINS Realistic Evaluation Methodology and MARS-KS

Energy Technology Data Exchange (ETDEWEB)

Hwang, Min Jeong; Marigomena, Ralph; Yoo, Tae Ho; Kim, Y. S.; Sim, S. K. [Environment and Energy Technology, Inc., Daejeon (Korea, Republic of); Bang, Young Seok [KINS, Daejeon (Korea, Republic of)

2014-05-15

As a part of the regulatory safety research, Korea Institute of Nuclear Safety(KINS) also developed a best estimate safety analysis regulatory audit code, MARS-KS, to realistically predict and better understand the physical phenomena of the design basis accidents. KINS improved uncertainty propagation methodology using MARS-KS and applied the improved uncertainty evaluation method for the Shinkori Units 3 and 4 LBLOC. This study is to evaluate the uncertainty propagation of a postulated LBLOCA and quantify the safety margin using KINS-REM and MARS-KS code for the APR+ (Advanced Pressurizer Reactor Plus) Standard Safety Analysis Report(SSAR) which is under regulatory review by the KINS for its design approval. KINS-REM LBLOCA realistic evaluation methodology was used for the regulatory assessment of the APR+ LBLOCA using MARS-KS to evaluate the uncertainty propagation of the uncertainty variables as well as to assess the safety margin during the limiting case of the APR+ double ended guillotine cold leg LBLOCA. Uncertainty evaluation for the APR+ LBLOCA shows that the reflood PCT with upper limit of 95% probability at 95% confidence level is 1363.2 K and is higher than the blowdown PCT95/95 of 1275.3 K. The result shows that the current evaluation of APR+ LBLOCA PCT is within the acceptance criteria of 1477 K ECCS.

Breast reconstruction following mastectomy: current status in Australia.

Science.gov (United States)

Sandelin, Kerstin; King, Elizabeth; Redman, Sally

2003-09-01

Although breast reconstruction provides some advantages for women following mastectomy, few Australian breast cancer patients currently receive reconstruction. In Australia, the routine provision of breast reconstruction will require the development of specific health service delivery models. The present paper reports an analysis of the provision of breast reconstruction in eight sites in Australia. A semi-structured telephone interview was conducted with 10 surgeons offering breast reconstruction as part of their practice, including nine breast or general surgeons and one plastic surgeon. Surgeons reported offering breast reconstruction to all women facing mastectomy; the proportion of women deciding to have breast reconstruction varied between sites with up to 50% of women having a reconstruction at some sites. Most sites offered three types of reconstruction. Two pathways emerged: either the breast surgeon performed the breast surgery in a team with the plastic surgeon who undertook the breast reconstruction or the breast surgeon provided both the breast surgery and the reconstruction. Considerable waiting times for breast reconstruction were reported in the public sector particularly for delayed reconstruction. Surgeons reported receiving training in breast reconstruction from plastic surgeons or from a breast surgery team that performed reconstructions; a number had been trained overseas. No audits of breast reconstruction were being undertaken. Breast reconstruction can be offered on a routine basis in Australia in both the private and public sectors. Women may be more readily able to access breast reconstruction when it is provided by a breast surgeon alone, but the range of reconstruction options may be more limited. If access to breast reconstruction is to be increased, there will be a need to: (i) develop effective models for the rural sector taking account of the lack of plastic surgeons; (ii) address waiting times for reconstruction surgery in the

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...

Ultrasonographic features of traumatic neuromas in breast cancer patients after mastectomy

Energy Technology Data Exchange (ETDEWEB)

Sung, Hwa Sung; Kim, Young Seon [Dept. of Radiology, Yeungnam University College of Medicine, Daegu (Korea, Republic of)

2017-01-15

The purpose of this study was to evaluate the ultrasonographic (US) features of traumatic neuromas in breast cancer patients after mastectomy. This study was performed with approval from our Institutional Review Board, and the requirement for informed consent was waived. Six traumatic neuromas in five patients were included in this study. The US findings of traumatic neuromas were evaluated retrospectively by two radiologists according to the Breast Imaging-Reporting and Data System (BI-RADS) lexicon. The final assessment was also recorded. On US, all six lesions presented as a mass within the pectoralis muscle layer (mean size, 4.8 mm; range, 3.9 to 5.5 mm). Of the six masses, four had an oval shape with a circumscribed margin, and two had an irregular shape and an indistinct margin. They were all hypoechoic. Two lesions showed a non-parallel orientation. On color Doppler examinations, two lesions showed internal vascularity. Strain elastography was performed for four neuromas, resulting in scores of 1 (n=1), 4 (n=2), and 5 (n=1). The final assessment categories were BI-RADS 3 (n=2), 4A (n=2), and 4B (n=2). On US, an oval shape, circumscribed margin, parallel orientation, and hypoechogenicity were the most frequent features of traumatic neuromas in breast cancer patients after mastectomy. Neuromas may show increased vascularity on color Doppler imaging and present as a hard mass on elastography.

Reconstructive approach for patients with augmentation mammaplasty undergoing nipple-sparing mastectomy.

Science.gov (United States)

Alperovich, Michael; Choi, Mihye; Frey, Jordan D; Karp, Nolan S

2014-09-01

Nipple-sparing mastectomy (NSM) is a recent advance in the therapeutic and prophylactic management of breast cancer; however, the procedure is associated with increased reconstructive complications. Data on NSM after previous breast augmentation are limited. The authors compared reconstructive complications after NSM between patients with previously augmented breasts and a larger cohort that had not undergone prior augmentation. An approach to NSM that involves 2-stage reconstruction in augmented patients is also described. Medical records of NSMs performed at New York University Langone Medical Center from 2006 to 2013 were reviewed. Data points evaluated included patient characteristics, comorbidities, breast implant plane, and reconstructive complications. Fisher's exact and t tests were used for the comparisons. During the study period, NSMs were performed in 17 augmented breasts at this institution. After NSM, 15 of these breasts underwent implant-based reconstruction and 2 breasts underwent microvascular free flaps. Reconstructive complications included 1 hematoma managed nonoperatively (5.9%) and 1 partial necrosis of the nipple-areola complex (NAC) (5.9%). Compared with the larger nonaugmented cohort (n=332), patients with previously augmented breasts had fewer complications, and there were no statistically significant differences in the rates of mastectomy flap necrosis, partial NAC necrosis, complete NAC necrosis, hematoma, capsular contracture, explantation, implant displacement, seroma, or breast cellulitis. The results indicate that NSM reconstruction is associated with minimal complications in patients with previous augmentation mammaplasty. 4. © 2014 The American Society for Aesthetic Plastic Surgery, Inc.

Ultrasonographic features of traumatic neuromas in breast cancer patients after mastectomy

Directory of Open Access Journals (Sweden)

Hwa Sung Sung

2017-01-01

Full Text Available Purpose The purpose of this study was to evaluate the ultrasonographic (US features of traumatic neuromas in breast cancer patients after mastectomy. Methods This study was performed with approval from our Institutional Review Board, and the requirement for informed consent was waived. Six traumatic neuromas in five patients were included in this study. The US findings of traumatic neuromas were evaluated retrospectively by two radiologists according to the Breast Imaging-Reporting and Data System (BI-RADS lexicon. The final assessment was also recorded. Results On US, all six lesions presented as a mass within the pectoralis muscle layer (mean size, 4.8 mm; range, 3.9 to 5.5 mm. Of the six masses, four had an oval shape with a circumscribed margin, and two had an irregular shape and an indistinct margin. They were all hypoechoic. Two lesions showed a non-parallel orientation. On color Doppler examinations, two lesions showed internal vascularity. Strain elastography was performed for four neuromas, resulting in scores of 1 (n=1, 4 (n=2, and 5 (n=1. The final assessment categories were BI-RADS 3 (n=2, 4A (n=2, and 4B (n=2. Conclusion On US, an oval shape, circumscribed margin, parallel orientation, and hypoechogenicity were the most frequent features of traumatic neuromas in breast cancer patients after mastectomy. Neuromas may show increased vascularity on color Doppler imaging and present as a hard mass on elastography.

1-D Two-phase Flow Investigation for External Reactor Vessel Cooling

International Nuclear Information System (INIS)

Kim, Jae Cheol

2007-02-01

During a severe accident, when a molten corium is relocated in a reactor vessel lower head, the RCF(Reactor Cavity Flooding) system for ERVC (External Reactor Vessel Cooling) is actuated and coolants are supplied into a reactor cavity to remove a decay heat from the molten corium. This severe accident mitigation strategy for maintaining a integrity of reactor vessel was adopted in the nuclear power plants of APR1400, AP600, and AP1000. Under the ERVC condition, the upward two-phase flow is driven by the amount of the decay heat from the molten corium. To achieve the ERVC strategy, the two-phase natural circulation in the annular gap between the external reactor vessel and the insulation should be formed sufficiently by designing the coolant inlet/outlet area and gap size adequately on the insulation device. Also the natural circulation flow restriction has to be minimized. In this reason, it is needed to review the fundamental structure of insulation. In the existing power plants, the insulation design is aimed at minimizing heat losses under a normal operation. Under the ERVC condition, however, the ability to form the two-phase natural circulation is uncertain. Namely, some important factors, such as the coolant inlet/outlet areas, flow restriction, and steam vent etc. in the flow channel, should be considered for ERVC design. T-HEMES 1D study is launched to estimate the natural circulation flow under the ERVC condition of APR1400. The experimental facility is one-dimensional and scaled down as the half height and 1/238 channel area of the APR1400 reactor vessel. The air injection method was used to simulate the boiling at the external reactor vessel and generate the natural circulation two-phase flow. From the experimental results, the natural circulation flow rate highly depended on inlet/outlet areas and the circulation flow rate increased as the outlet height as well as the supplied water head increased. On the other hand, the simple analysis using the drift

[Evaluation of the capacity of the APR-DRG classification system to predict hospital mortality].

Science.gov (United States)

De Marco, Maria Francesca; Lorenzoni, Luca; Addari, Piero; Nante, Nicola

2002-01-01

Inpatient mortality has increasingly been used as an hospital outcome measure. Comparing mortality rates across hospitals requires adjustment for patient risks before making inferences about quality of care based on patient outcomes. Therefore it is essential to dispose of well performing severity measures. The aim of this study is to evaluate the ability of the All Patient Refined DRG system to predict inpatient mortality for congestive heart failure, myocardial infarction, pneumonia and ischemic stroke. Administrative records were used in this analysis. We used two statistics methods to assess the ability of the APR-DRG to predict mortality: the area under the receiver operating characteristics curve (referred to as the c-statistic) and the Hosmer-Lemeshow test. The database for the study included 19,212 discharges for stroke, pneumonia, myocardial infarction and congestive heart failure from fifteen hospital participating in the Italian APR-DRG Project. A multivariate analysis was performed to predict mortality for each condition in study using age, sex and APR-DRG risk mortality subclass as independent variables. Inpatient mortality rate ranges from 9.7% (pneumonia) to 16.7% (stroke). Model discrimination, calculated using the c-statistic, was 0.91 for myocardial infarction, 0.68 for stroke, 0.78 for pneumonia and 0.71 for congestive heart failure. The model calibration assessed using the Hosmer-Leme-show test was quite good. The performance of the APR-DRG scheme when used on Italian hospital activity records is similar to that reported in literature and it seems to improve by adding age and sex to the model. The APR-DRG system does not completely capture the effects of these variables. In some cases, the better performance might be due to the inclusion of specific complications in the risk-of-mortality subclass assignment.

Design of a Load Following Controller for APR+ Nuclear Plants

International Nuclear Information System (INIS)

Lee, Sim Won; Kim, Jae Hwan; Kim, Dong Su; Na, Man Gyun; Yu, Keuk Jong

2011-01-01

The load-following operation of an APR+ nuclear plants is required to restrain the adjustment of boric acid concentration and to efficiently control the control rods for the flexibility of the operation. Especially, axial flux distribution disproportion that is usually caused by load-following operation in a reactor core induces xenon oscillation because the absorption cross-section of xenon is extremely large and its effects in a reactor are delayed by the iodine precursor. Rapid and smooth power maneuvering has its benefits in view of the economical and safe operation of reactors, so it is required that the controller is efficiently designed. Therefore, the load-following operation of an APR+ nuclear plants needs the ultimate automatic control and the advanced control method that satisfies the conditions such as the flexibility, safety and convenience. A model predictive control (MPC) method is applied to design an automatic load-following controller for the integrated thermal power level and axial shape index (ASI) control for an APR+ nuclear plants. Some tracking controllers use only the current tracking command. On the other hand, since MPC considers future commands in addition to the current tracking command, the MPC can achieve better tracking performance. Therefore, the MPC has been applied very much to the control of industrial process systems. The basic concept of the MPC is to solve an optimization problem for generating finite future control inputs at current time and to implement as the current control input only the first control input among the solutions of the finite time steps. At the next time step, the second control input is not implemented and the procedure to solve the optimization problem is then repeated. The power level and the ASI are controlled by the regulating control banks and part-strength control banks together with the automatic adjustment of boric acid concentration. The 3-dimensional MASTER code, which models the APR+ nuclear

Design of a Load Following Controller for APR+ Nuclear Plants

Energy Technology Data Exchange (ETDEWEB)

Lee, Sim Won; Kim, Jae Hwan; Kim, Dong Su; Na, Man Gyun [Chosun University, Gwnagju (Korea, Republic of); Yu, Keuk Jong [Korea Hydro and Nuclear Power Co., Daejeon (Korea, Republic of)

2011-08-15

The load-following operation of an APR+ nuclear plants is required to restrain the adjustment of boric acid concentration and to efficiently control the control rods for the flexibility of the operation. Especially, axial flux distribution disproportion that is usually caused by load-following operation in a reactor core induces xenon oscillation because the absorption cross-section of xenon is extremely large and its effects in a reactor are delayed by the iodine precursor. Rapid and smooth power maneuvering has its benefits in view of the economical and safe operation of reactors, so it is required that the controller is efficiently designed. Therefore, the load-following operation of an APR+ nuclear plants needs the ultimate automatic control and the advanced control method that satisfies the conditions such as the flexibility, safety and convenience. A model predictive control (MPC) method is applied to design an automatic load-following controller for the integrated thermal power level and axial shape index (ASI) control for an APR+ nuclear plants. Some tracking controllers use only the current tracking command. On the other hand, since MPC considers future commands in addition to the current tracking command, the MPC can achieve better tracking performance. Therefore, the MPC has been applied very much to the control of industrial process systems. The basic concept of the MPC is to solve an optimization problem for generating finite future control inputs at current time and to implement as the current control input only the first control input among the solutions of the finite time steps. At the next time step, the second control input is not implemented and the procedure to solve the optimization problem is then repeated. The power level and the ASI are controlled by the regulating control banks and part-strength control banks together with the automatic adjustment of boric acid concentration. The 3-dimensional MASTER code, which models the APR+ nuclear

The Alberta Pregnancy Outcomes and Nutrition (APrON) cohort study: rationale and methods.

Science.gov (United States)

Kaplan, Bonnie J; Giesbrecht, Gerald F; Leung, Brenda M Y; Field, Catherine J; Dewey, Deborah; Bell, Rhonda C; Manca, Donna P; O'Beirne, Maeve; Johnston, David W; Pop, Victor J; Singhal, Nalini; Gagnon, Lisa; Bernier, Francois P; Eliasziw, Misha; McCargar, Linda J; Kooistra, Libbe; Farmer, Anna; Cantell, Marja; Goonewardene, Laki; Casey, Linda M; Letourneau, Nicole; Martin, Jonathan W

2014-01-01

The Alberta Pregnancy Outcomes and Nutrition (APrON) study is an ongoing prospective cohort study that recruits pregnant women early in pregnancy and, as of 2012, is following up their infants to 3 years of age. It has currently enrolled approximately 5000 Canadians (2000 pregnant women, their offspring and many of their partners). The primary aims of the APrON study were to determine the relationships between maternal nutrient intake and status, before, during and after gestation, and (1) maternal mood; (2) birth and obstetric outcomes; and (3) infant neurodevelopment. We have collected comprehensive maternal nutrition, anthropometric, biological and mental health data at multiple points in the pregnancy and the post-partum period, as well as obstetrical, birth, health and neurodevelopmental outcomes of these pregnancies. The study continues to follow the infants through to 36 months of age. The current report describes the study design and methods, and findings of some pilot work. The APrON study is a significant resource with opportunities for collaboration. © 2012 John Wiley & Sons Ltd.

Veselības aprūpes iemaņas pusaudžiem bērnu namā

OpenAIRE

Zūpe, Daira

2008-01-01

Pētniecības darbā „Veselības aprūpes iemaņas pusaudžiem bērnu namā” autore Daira Zūpe izpēta un analizē vienu no bērnu namu aktuālajām problēmām veselības profilakses veicināšanā – veselības aprūpes iemaņu attīstīšanu. Pētījumā uzmanība pievērsta māsas lomai bērnu nama pusaudžu veselības aprūpes procesā, kur akcentēta veselības aprūpes pamatiemaņu nozīme veselības vecināšanā - fiziskās aktivitātes, ēšanas paradumi, kaitīgie ieradumi un higiēnas iemaņas. Pētniecības darba zinātniskā vadītā...

Aprūpes īpatnības bērniem ar Dauna sindromu stacionārā

OpenAIRE

Lūse, Ērika

2015-01-01

Bakalaura darba tēma – Aprūpes īpatnības bērniem ar Dauna sindromu stacionārā. Tēmas aktualitāte pievērst uzmanību bērna ar Dauna sindroma aprūpei, kā arī mazināt stereotipus par šiem bērniem. Darba mērķis ir izpētīt Dauna sindromu un māsas lomu šo bērnu aprūpē, kā arī aprūpes īpatnības. Pētniecības uzdevumi ir veikt zinātniskās literatūras analīzi, pētījuma atbilstošas māszinību teorijas atlasi, izstrādāt anketu, veikt pilot pētījumu, iegūto datu apkopošanu, analīze un secinājumu veikšana. I...

Safety of long-term subcutaneous free flap skin banking after skin-sparing mastectomy.

Science.gov (United States)

Verstappen, Ralph; Djedovic, Gabriel; Morandi, Evi Maria; Heiser, Dietmar; Rieger, Ulrich Michael; Bauer, Thomas

2018-03-01

A persistent problem in autologous breast reconstruction in skin-sparing mastectomies is skin restoration after skin necrosis or secondary oncological resection. As a solution to facilitate reconstruction, skin banking of free-flap skin has been proposed in cases where the overlying skin envelope must be resected, as this technique spares the patient an additional donor site. Herein, we present the largest series to date in which this method was used. We investigated its safety and the possibility of skin banking for prolonged periods of time. All skin-sparing mastectomies and immediate autologous breast reconstructions from December 2009 until June 2013 at our institution were analysed. We identified 31 patients who underwent 33 free flap reconstructions in which skin banking was performed. Our median skin banking period was 7 days, with a maximum duration of 171 days. In 22.5% of cases, the banked skin was used to reconstruct overlying skin defects, and in 9.6% of cases to reconstruct the nipple-areolar complex. Microbiological and histological investigations of the banked skin revealed neither clinical infections nor malignancies. In situ skin banking, even for prolonged periods of time, is a safe and cost-effective method to ensure that skin defects due to necrosis or secondary oncological resection can be easily reconstructed.

Decision making regarding prophylactic mastectomy: stability of preferences and the impact of anticipated feelings of regret.

NARCIS (Netherlands)

Dijk, S. van; Roosmalen, M.S van; Otten, W.; Stalmeier, P.F.M.

2008-01-01

PURPOSE: Women who test positive for a BRCA1/2 mutation face difficult choices to manage their breast cancer risk; one of these choices is whether to opt for prophylactic mastectomy. Few data are available about this decision-making process. The current study provides data regarding the stability of

APR1400 Electrical Power System Conformance to SECY-91-078

Energy Technology Data Exchange (ETDEWEB)

Ha, Che-Wung; Kim, Yun-Ho [KHNP CRI, Daejeon (Korea, Republic of)

2016-10-15

In this paper, the APR1400 electric power system for NRC-DC was described. In addition, the conformance to SECY 91-078 was evaluated. Enclosure 1 of the SECY provides an overview of the issue and states that the staff concludes that feeding the safety buses from the offsite power sources through non-safety buses or from a common transformer winding with non-safety loads is not the most reliable configuration. Such an arrangement increases the difficulty in properly regulating voltage at the safety buses, subjects the safety loads to transients caused by the non-safety loads, and adds additional failure points between the offsite power sources and safety loads. Therefore, it is the staff’s position that at least one offsite circuit to each redundant safety division should be supplied directly from one of the offsite power sources with no intervening non-safety buses, in such a manner that the offsite source can power the safety buses upon a failure of any non-safety bus. The APR1400 does not have an intervening nonsafety bus in the current offsite to onsite electrical configuration; however, the design does include nonsafety and safety buses coming from the same secondary side 4.16 kV transformer winding. Nevertheless, the APR1400 has designed the electrical interface system between offsite and onsite power with enhanced reliability measures to ensure that the nonsafety system will not impact the safety loads. The design complies with GDC 17 and also conforms to SECY-91-078.

Complications After Mastectomy and Immediate Breast Reconstruction for Breast Cancer: A Claims-Based Analysis

Science.gov (United States)

Jagsi, Reshma; Jiang, Jing; Momoh, Adeyiza O.; Alderman, Amy; Giordano, Sharon H.; Buchholz, Thomas A.; Pierce, Lori J.; Kronowitz, Steven J.; Smith, Benjamin D.

2016-01-01

Objective To evaluate complications after post-mastectomy breast reconstruction, particularly in the setting of adjuvant radiotherapy. Summary-Background Data Most studies of complications after breast reconstruction have been conducted at centers of excellence; relatively little is known about complication rates in radiated patients treated in the broader community. This information is relevant for breast cancer patients' decision-making. Methods Using the claims-based MarketScan database, we described complications in 14,894 women undergoing mastectomy for breast cancer from 1998-2007 who received immediate autologous reconstruction (n=2637), immediate implant-based reconstruction (n=3007), or no reconstruction within the first two postoperative years (n=9250). We used a generalized estimating equation to evaluate associations between complications and radiotherapy over time. Results Wound complications were diagnosed within the first two postoperative years in 2.3% of patients without reconstruction, 4.4% with implants, and 9.5% with autologous reconstruction (pimplants, and 20.7% with autologous reconstruction (pimplant removal in patients with implant reconstruction (OR 1.48, pbreast reconstruction differ by approach. Radiation therapy appears to modestly increase certain risks, including infection and implant removal. PMID:25876011

Study on Applicability of 10 CFR Part 21 to APR1400 DC Project

International Nuclear Information System (INIS)

Shin, He Young; Lee, Do Hwan; Lim, Jae Yong

2014-01-01

The tools such as NCR (non conformance report), CAR (corrective action request) and CAP (corrective action program) are widely used for that purpose based upon the rule of 10 CFR Part 50 Appendix B and the ASME Code NQA-1 requirements. These are the tools for a utility, as a purchaser taking over related basic components and services, to ensure strong quality assurance. During the conduct of the project for the acquisition of the standard design certification for APR1400 nuclear power plants from the U. S. NRC (APR1400 DC Project), a new CAP procedure that is appropriate to conduct this unique project was developed. However, it was also recommended to comply with the requirements under 10 CFR Part 21 which enhances nuclear safety quality assurances. Consequently, a new QA procedure is developed in order to deal with the 10 CFR Part 21 issues and this is integrated to the CAP procedure In this paper, the current corrective action program for the APR1400 DC project is introduced and the result of the study on the applicability of 10 CFR Part 21 to the project is indicated. In addition, further improving aspects to be considered are identified. As a frontier project to obtain the standard design certification for APR 1400 model from the U. S. NRC, a modified CAP procedure is developed and enhanced to deal with safety concerning issues in accordance with 10 CFR Part 21. In addition, the newly established QA procedure to directly control the reportability on 10 CFR Part 21 is interfaced into the existing CAP procedure

Assistant Personal Robot (APR: Conception and Application of a Tele-Operated Assisted Living Robot

Directory of Open Access Journals (Sweden)

Eduard Clotet

2016-04-01

Full Text Available This paper presents the technical description, mechanical design, electronic components, software implementation and possible applications of a tele-operated mobile robot designed as an assisted living tool. This robotic concept has been named Assistant Personal Robot (or APR for short and has been designed as a remotely telecontrolled robotic platform built to provide social and assistive services to elderly people and those with impaired mobility. The APR features a fast high-mobility motion system adapted for tele-operation in plain indoor areas, which incorporates a high-priority collision avoidance procedure. This paper presents the mechanical architecture, electrical fundaments and software implementation required in order to develop the main functionalities of an assistive robot. The APR uses a tablet in order to implement the basic peer-to-peer videoconference and tele-operation control combined with a tactile graphic user interface. The paper also presents the development of some applications proposed in the framework of an assisted living robot.

Use of hypofractionated post-mastectomy radiotherapy reduces health costs by over $2000 per patient: An Australian perspective.

Science.gov (United States)

Mortimer, Joshua W; McLachlan, Craig S; Hansen, Carmen J; Assareh, Hassan; Last, Andrew; McKay, Michael J; Shakespeare, Thomas P

2016-02-01

The most recent clinical practice guidelines released by Cancer Australia draw attention to unanswered questions concerning the health economic considerations associated with hypofractionated radiotherapy. This study aimed to quantify and compare the healthcare costs at a regional Australian radiotherapy institute with respect to conventionally fractionated post-mastectomy radiotherapy (Cf-PMRT) versus hypofractionated post-mastectomy radiotherapy (Hf-PMRT) administration. Medical records of 196 patients treated with post-mastectomy radiotherapy at the NSW North Coast Cancer Institute from February 2008 to June 2014 were retrospectively reviewed. Australian Medicare item numbers billed for patients receiving either Cf-PMRT of 50 Gy in 25 daily fractions or Hf-PMRT of 40.05 Gy in 15 daily fractions were calculated. Decision tree analysis was used to model costs. Independent-samples t-tests and Mann-Whitney U-tests were used to compare crude average costs for Cf-PMRT and Hf-PMRT and determine which treatment components accounted for any differences. Hf-PMRT, with or without irradiation to the regional lymph nodes, was associated with significantly reduced Medicare costs ($5613 AUD per patient for Hf-PMRT vs $8272 AUD per patient for Cf-PMRT; P < 0.001). Savings associated with Hf-PMRT ranged from $1353 (22.1%) for patients receiving no regional irradiation to $2898 (32.0%) for patients receiving both axillary and supraclavicular therapy. Hf-PMRT results in a significant reduction in the financial costs associated with treating breast cancer patients in a regional Australian setting when compared with Cf-PMRT. © 2015 The Royal Australian and New Zealand College of Radiologists.

Apreçando Derivativos de Crédito no Brasil Credit Derivatives Pricing in Brazil

Directory of Open Access Journals (Sweden)

Jorge C. Kapotas

2004-12-01

Full Text Available Neste artigo apresentamos os principais modelos de apreçamento de instrumentos de crédito onde desenvolvem-se as equações de apreçamento de debêntures. Para tal, utilizam-se os modelos estruturais, de intensidade e, finalmente, de rating. A seguir, definimos o que são derivativos de crédito (CDS e derivamos fórmulas de apreçamento para estes instrumentos. Concluímos este artigo com uma aplicação ao mercado brasileiro. In this paper we present the main models used for pricing defaultable bonds and credit derivatives. The Merton structural model, the intensity framework and a Ratings based model are considered. We apply these techniques to the pricing of credit derivatives on Brazilian US$-indexed treasury bonds.

A rare case of silicone mammary implant infection by Streptomyces spp. in a patient with breast reconstruction after mastectomy: taxonomic characterization using molecular techniques

DEFF Research Database (Denmark)

Manteca, Angel; Pelaez, Ana Isabel; del Mar Garcia-Suarez, Maria

2009-01-01

A Streptomyces sp. isolated from a patient who had had breast reconstruction after a mastectomy was identified at the species level by comparative sequence analysis of 16S ribosomal DNA (rDNA) and the hypervariable alpha-region of the 16S rDNA.......A Streptomyces sp. isolated from a patient who had had breast reconstruction after a mastectomy was identified at the species level by comparative sequence analysis of 16S ribosomal DNA (rDNA) and the hypervariable alpha-region of the 16S rDNA....

Écrire (d’après

Directory of Open Access Journals (Sweden)

Denis Saint-Amand

2009-03-01

Full Text Available De l’allusion à la citation, de l’emprunt criard au plagiat déguisé, les jeux d’influences et d’aller-retour avec tel ou tel modèle, grand ou mineur, ont toujours participé de l’élaboration du texte littéraire. Si l’intertextualité est sans aucun doute née en même temps que l’écriture (ou quelques minutes après et que, comme ont pu le montrer notamment Jacques-Philippe Saint-Gérand et Daniel Sangsue, les facettes multiples qu’elle déploie ont toujours suscité l’attention des hommes de lettre...

Long-term outcome after mastectomy with immediate breast reconstruction

DEFF Research Database (Denmark)

Stralman, K.; Mollerup, C.L.; Kristoffersen, U.S.

2008-01-01

INTRODUCTION: The purpose of this study was to investigate long term outcome for women who had undergone mastectomy and immediate breast reconstruction. MATERIAL AND METHODS: Patient files of 167 immediately reconstructed breast cancer patients were reviewed for late surgical complications....... Furthermore, information of local recurrence rate, radiotherapy and death was obtained from the Danish Breast Cancer Cooperative Group register. Histopatological high and low risk patients were compared with respect to locoregional recurrence rate, recurrence free survival and death. Unpaired t...... found no increase in the occurrence of capsular contracture in our study group in patients who received radiotherapy. CONCLUSION: Immediate breast reconstruction seems to be oncologically safe. Breast reconstruction performed with implants was associated with a higher risk of late complications...

New tools for NTD vaccines: A case study of quality control assays for product development of the human hookworm vaccine Na-APR-1M74.

Science.gov (United States)

Pearson, Mark S; Jariwala, Amar R; Abbenante, Giovanni; Plieskatt, Jordan; Wilson, David; Bottazzi, Maria Elena; Hotez, Peter J; Keegan, Brian; Bethony, Jeffrey M; Loukas, Alex

2015-01-01

Na-APR-1(M74) is an aspartic protease that is rendered enzymatically inactive by site-directed mutagenesis and is a candidate antigen component in the Human Hookworm Vaccine. The mutant protease exerts vaccine efficacy by inducing antibodies that neutralize the enzymatic activity of wild type enzyme (Na-APR-1wt) in the gut of the hookworm, thereby depriving the worm of its ability to digest its blood meal. Previously, canines immunized with Na-APR-1(M74) and challenged with Ancylostoma caninum were partially protected against hookworm challenge infection, especially from the loss in hemoglobin observed in control canines and canine immunoglobulin (Ig) G raised against Na-APR-1 was shown to inhibit the enzymatic activity of Na-APR-1 wt in vitro, thereby providing proof of concept of Na-APR-1(M74) as a vaccine antigen. The mutated version, Na-APR-1(M74), was then expressed at the cGMP level using a Nicotiana benthamiana expression system (Fraunhofer, CMB, Delaware, MD), formulated with Alhydrogel®, and used to immunize mice in a dose-ranging study to explore the enzyme-neutralizing capacity of the resulting anti- Na-APR-1(M74) IgG. As little as 0.99 μg of recombinant Na-APR-1(M74) could induce anti Na-APR-1(M74) IgG in mice that were capable of inhibiting Na-APR-1w t-mediated digestion of a peptide substrate by 89%. In the absence of enzymatic activity of Na-APR-1(M74) as a surrogate marker of protein functionality, we developed an assay based on the binding of a quenched fluorescence-labeled inhibitor of aspartic proteases, BODIPY-FL pepstatin A (BDP). Binding of BDP in the active site of Na-APR-1 wt was demonstrated by inhibition of enzymatic activity, and competitive binding with unlabelled pepstatin A. BDP also bound to Na-APR-1(M74) which was assessed by fluorescence polarization, but with an ∼ 50-fold reduction in the dissociation constant. Taken together, these assays comprise a "toolbox" that could be useful for the analyses of Na-APR-1(M74) as it

Analytical Assessment of Environmental Impact for APR1400DC UHS Cooling Tower

Energy Technology Data Exchange (ETDEWEB)

Lee, Jaiho [KHNP-Central Research Institute, Daejeon (Korea, Republic of)

2015-05-15

Hot process water is pumped from the plant process to the cooling towers. Heat is rejected through evaporation of the process water, interacting with ambient air blown upward by fans.. Plumes generated from exit ports of the cooling tower may have adverse effects on the environment, such as deposition of cooling tower drift release, fogging, icing, shadowing, and ground-level temperature and humidity increase. These kinds of environmental impact of the cooling tower are linked closely with the dispersion of the cooling tower plumes. In this respect, predicting the behavior of the plumes has become one of the most important issues in the environmental assessments of the cooling towers. The SACTI (seasonal/annual cooling tower impact) model is an analytical tool to predict the environmental effect of cooling tower, which was developed by Argonne National Laboratory and University of Illinois with support from EPRI (electric power research institute). The initial version of SACTI has been widely used to assess the environmental effect of cooling towers in many industrial fields such as steam power plants and NPPs. Guo et. al. investigated impact of heat rejection and cooling tower height on plume dispersion using the SACTI model, for the purpose of the future construction of inland NPPs. They found that increasing cooling tower height decreases the plume length and height frequencies. Their simulation results showed that the increase in heat rejection increases the plum radius frequency. The APR1400DC is an advanced light water reactor developed for the purpose of NRC-DC (design certification). The cooling towers for APR1400DC UHS consist of two linear mechanical draft cooling towers (LMDCTs). The LMDCT for APR1400DC UHS is conceptually designed because the plant site has not been decided yet. In the present study, the dependency of plume dispersion on the number of cooling towers is investigated using SACTI-2-beta, for predicting annual environmental effect of APR

Psychosocial effects of mastectomy on married African women in Northwestern Nigeria.

Science.gov (United States)

Odigie, V I; Tanaka, Rika; Yusufu, L M D; Gomna, A; Odigie, E C; Dawotola, D A; Margaritoni, Marko

2010-08-01

Few studies have examined the psychosocial impact of breast cancer and its treatment on African women who come from a poverty-stricken, uneducated background in a developing country. The purpose of this study was to describe the specific psychosocial effects of breast cancer on married African women in order to help physicians educate and counsel future women and their families in Northwestern Nigeria. Two semi-structured, self-report questionnaires were given to 81 consenting married African women treated with unilateral total mastectomy secondary to operable breast cancer at the Ahmadu Bello University Teaching Hospital. Questionnaires were answered at the time of the diagnosis and treatment consultation and at 6 months postmastectomy and included questions about demographics, frequency of conjugal relations and how the woman's sense of femininity was affected. Marital status was also tracked up to 3 years. Six months after surgery, the survey responses revealed that 67.9% of women felt inadequate as a woman because of the mastectomy and that 79.0% experienced a decrease in frequency of conjugal relations. Three years after primary breast cancer treatment, 61.7% of the participants were still married while 38.3% reported being divorced/separated from their husbands. These results indicated that married African women face significant physical, emotional and social changes and difficulties following primary breast cancer treatment. Culturally sensitive therapeutic groups and interventions should be established to help Nigerian women with breast cancer and their spouses and families understand and cope with the disease and its long-term health and quality-of-life implications. (c) 2009 John Wiley & Sons, Ltd.

Modeling of melt retention in EU-APR1400 ex-vessel core catcher

Energy Technology Data Exchange (ETDEWEB)

Granovsky, V. S.; Sulatsky, A. A.; Khabensky, V. B.; Sulatskaya, M. B. [Alexandrov Research Inst. of Technology NITI, Sosnovy Bor (Russian Federation); Gusarov, V. V.; Almyashev, V. I.; Komlev, A. A. [Saint Petersburg State Technological Univ. SPbSTU, St.Petersburg (Russian Federation); Bechta, S. [KTH, Stockholm (Sweden); Kim, Y. S. [KHNP, 1312 Gil 70, Yuseongdaero, Yuseong-gu, Daejeon (Korea, Republic of); Park, R. J.; Kim, H. Y.; Song, J. H. [KAERI, 989 Gil 111, Daedeokdaero, Yuseong-gu, Daejeon (Korea, Republic of)

2012-07-01

A core catcher is adopted in the EU-APR1400 reactor design for management and mitigation of severe accidents with reactor core melting. The core catcher concept incorporates a number of engineering solutions used in the catcher designs of European EPR and Russian WER-1000 reactors, such as thin-layer corium spreading for better cooling, retention of the melt in a water-cooled steel vessel, and use of sacrificial material (SM) to control the melt properties. SM is one of the key elements of the catcher design and its performance is critical for melt retention efficiency. This SM consists of oxide components, but the core catcher also includes sacrificial steel which reacts with the metal melt of the molten corium to reduce its temperature. The paper describes the required properties of SM. The melt retention capability of the core catcher can be confirmed by modeling the heat fluxes to the catcher vessel to show that it will not fail. The fulfillment of this requirement is demonstrated on the example of LBLOCA severe accident. Thermal and physicochemical interactions between the oxide and metal melts, interactions of the melts with SM, sacrificial steel and vessel, core catcher external cooling by water and release of non-condensable gases are modeled. (authors)

Pre-operative and intra-operative detection of axillary lymph node metastases in 108 patients with invasive lobular breast cancer undergoing mastectomy.

Science.gov (United States)

Novak, Jerica; Besic, Nikola; Dzodic, Radan; Gazic, Barbara; Vogrin, Andrej

2018-02-05

Despite the recent changes in the treatment of the axilla in selected breast cancer patient, positive sentinel lymph node (SLN) in patients undergoing mastectomy still necessitates axillary lymph node dissection (ALND). In invasive lobular carcinoma (ILC), pre-operative detection of the lymph node metastasis may be demanding due to its unique morphology. The aim of this study was to examine the benefit of preoperative axillary ultrasound (AUS), ultrasound-guided fine-needle aspiration biopsy (US-FNAB), and intra-operative imprint cytology (IIC), in order to avoid two-stage axillary surgery in patients with ILC undergoing mastectomy. The object of this study were 102 patients (median age 52, range 34-73 years) with clinically non-suspicious axilla in whom 108 mastectomies were performed after a pre-operative AUS investigation. Whenever a metastasis was detected in a sentinel lymph node, ALND was done. Reports of the pre-operative AUS investigation, US-FNAB, and IIC were compared with definitive histopathological reports of surgical specimens. In 46 cases lymph node metastases were diagnosed. AUS suspicious lymph nodes were found in 29/108 cases and histopathology confirmed metastases in 22/30 cases. US-FNAB was performed in 29 cases with AUS suspicious lymph nodes. Cytology proved metastases in 11/29 cases. Histopathology confirmed metastases in 10/11 cases with only isolated tumor cells found in one case. IIC investigation was performed in 63 cases and in 10/27 cases metastases were confirmed by histopathology. Pre-operative AUS, US-FNAB, and/or IIC investigation enabled ALND during a single surgical procedure in 20/46 patients with metastases in lymph nodes. Pre-operative AUS, US-FNAB, and/or IIC are/is beneficial in patients with ILC planned for mastectomy in order to decrease the number of two stage axillary procedures.

The Effect of Adjuvant Trastuzumab on Locoregional Recurrence of Human Epidermal Growth Factor Receptor 2-Positive Breast Cancer Treated with Mastectomy.

Science.gov (United States)

Lanning, Ryan M; Morrow, Monica; Riaz, Nadeem; McArthur, Heather L; Dang, Chau; Moo, Tracy-Ann; El-Tamer, Mahmoud; Krause, Kate; Siu, Chun; Hsu, Meier; Zhang, Zhigang; Pei, Xin; McCormick, Beryl; Powell, Simon N; Ho, Alice

2015-08-01

Human epidermal growth factor receptor 2 (HER2) overexpression was associated with locoregional recurrence (LRR) in the preadjuvant trastuzumab era. This study aimed to examine the effect of trastuzumab on LRR in mastectomy patients and whether it varied with postmastectomy radiation (PMRT). From the authors' institutional database, 501 women with stages I-III HER2-positive breast cancer who underwent mastectomy from 1998 to 2007 were identified. A landmark analysis was performed to compare two cohorts: 170 women who received trastuzumab and 281 who did not. Kaplan-Meier methods were used to estimate locoregional recurrence-free survival (LRRFS). A propensity score analysis was used to balance the treatment groups with respect to multiple covariates. Analogous methods were used to study the effect of PMRT. The women in the trastuzumab group were more likely to be node positive and to receive systemic therapy or PMRT (p < 0.01). The 5-year LRRFS was 98 % in the trastuzumab troup versus 94 % in the no trastuzumab group [hazard ratio (HR) 0.31; 95 % confidence interval (CI) 0.09-1.09; p = 0.07]. After adjustment for multiple covariates, including receipt of chemotherapy and PMRT, trastuzumab decreased LRR rates (HR 0.21; 95 % CI 0.04-0.94; p = 0.04). Among the women who received PMRT, trastuzumab reduced the 5-year LRR rate (0 vs 5 %; p = 0.06). Among those who did not receive PMRT, trastuzumab did not significantly decrease LRR (3 vs 6 %; p = 0.26). High rates of locoregional control (5-year rate, 98 %) were observed among patients who received trastuzumab and mastectomy ± PMRT. Trastuzumab decreased LRR in HER2-positive women who received mastectomy and PMRT, suggesting that the largest benefit is seen in a higher-risk subset of patients.

Comparison of risk of local-regional recurrence after mastectomy or breast conservation therapy for patients treated with neoadjuvant chemotherapy and radiation stratified according to a prognostic index score

International Nuclear Information System (INIS)

Huang, Eugene H.; Strom, Eric A.; Perkins, George H.; Oh, Julia L.; Chen, Allen M.; Meric-Bernstam, Funda; Hunt, Kelly K.; Sahin, Aysegul A.; Hortobagyi, Gabriel N.; Buchholz, Thomas A.

2006-01-01

Purpose: We previously developed a prognostic index that stratified patients treated with breast conservation therapy (BCT) after neoadjuvant chemotherapy into groups with different risks for local-regional recurrence (LRR). The purpose of this study was to compare the rates of LRR as a function of prognostic index score for patients treated with BCT or mastectomy plus radiation after neoadjuvant chemotherapy. Methods and Materials: We retrospectively analyzed 815 patients treated with neoadjuvant chemotherapy, surgery, and radiation. Patients were assigned an index score from 0 to 4 and given 1 point for the presence of each factor: clinical N2 to N3 disease, lymphovascular invasion, pathologic size >2 cm, and multifocal residual disease. Results: The 10-year LRR rates were very low and similar between the mastectomy and BCT groups for patients with an index score of 0 or 1. For patients with a score of 2, LRR trended lower for those treated with mastectomy vs. BCT (12% vs. 28%, p = 0.28). For patients with a score of 3 to 4, LRR was significantly lower for those treated with mastectomy vs. BCT (19% vs. 61%, p = 0.009). Conclusions: This analysis suggests that BCT can provide excellent local-regional treatment for the vast majority of patients after neoadjuvant chemotherapy. For the few patients with a score of 3 to 4, LRR was >60% after BCT and was <20% with mastectomy. If these findings are confirmed in larger randomized studies, the prognostic index may be useful in helping to select the type of surgical treatment for patients treated with neoadjuvant chemotherapy, surgery, and radiation

897.pdf | apr102004 | currsci | Indian Academy of Sciences

Indian Academy of Sciences (India)

Home; currsci; apr102004; 897.pdf. 404! error. The page your are looking for can not be found! Please check the link or use the navigation bar at the top. YouTube; Twitter; Facebook; Blog. Academy News. IAS Logo. 29th Mid-year meeting. Posted on 19 January 2018. The 29th Mid-year meeting of the Academy will be held ...

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)

Implementasi Automatic Packet Reporting System (APRS Untuk Paket Data Pemantauan dan PengukuranUntuk Paket Data Pemantauan dan Pengukuran

Directory of Open Access Journals (Sweden)

Arief Goeritno

2016-03-01

Full Text Available Telah dilakukan implementasi Automatic Packet Reporting System (APRS untuk paket data pemantauan dan pengukuran melalui tujuan penelitian, berupa: a penyetelan program aplikasi pada jaringan APRS dan b pengukuran terhadap penerimaan data berdasarkan kinerja sensor-sensor. Penyetelan program aplikasi APRS merupakan konfigurasi perangkat lunak untuk APRS yang akan digunakan pada stasiun penerimaan data APRS dengan program aplikasi yang biasa digunakan, yaitu hyperterminal dan UI-View 32. Pengukuran penerimaan data berdasarkan kinerja sensor yang dilakukan melalui proses perekaman pada stasiun penerimaan data APRS. Kinerja sensor-sensor akan diamati pada stasiun pengiriman dan data hasil pengamatan akan dapat diterima pada stasiun penerimaan secara real time. Program aplikasi berbasis hyperterminal dan UI View 32 telah berhasil melakukan proses handshaking antara Terminal Node Controller (TNC dan komputer, sehingga data telemetri dari stasiun pengiriman paket data dapat diterima di stasiun penerimaan. Data telemetri dapat diamati pada stasiun penerimaan dan dapat diperoleh secara real time dengan format: YB0LRB-11>BEACON,WIDE2-1 [05/18/2014 04:03:49]: : T#010,008,093,004,122,075. Notifikasi YB0LRB-11 merupakan stasiun pengiriman paket data telemetri, kemudian data tersebut akan diterima pada stasiun penerima YD1PRY dengan format: YD1PRY-2>APLPN,ARISS [05/18/2014 04:03:07]: : !06.30.37S/106.48.26E#. Notifikasi tersebut merupakan pengiriman informasi data posisi oleh stasiun YD1PRY untuk inisialisasi pada jaringan APRS. Stasiun YB0LRB-11 ketika mengirim paket data telemetri dengan format: YB0LRB-11>BEACON,WIDE2-1 [05/18/2014 04:00:49]: : T#001,004,035,005,122,075. Paket data dari stasiun YB0LRB yang dipancar ulang atau digipeater dengan format: YB0LRB-11>BEACON,YD1PRY-2,WIDE2* [05/18/2014 04:00:50]: : T#001,004,035,005,122,075. Sensor pengukuran berkinerja relatif stabil, walaupun terdapat nilai simpangan pengukuran sebesar 1 cm atau

Breast implants following mastectomy in women with early-stage breast cancer: prevalence and impact on survival

International Nuclear Information System (INIS)

Le, Gem M; O'Malley, Cynthia D; Glaser, Sally L; Lynch, Charles F; Stanford, Janet L; Keegan, Theresa HM; West, Dee W

2005-01-01

Few studies have examined the effect of breast implants after mastectomy on long-term survival in breast cancer patients, despite growing public health concern over potential long-term adverse health effects. We analyzed data from the Surveillance, Epidemiology and End Results Breast Implant Surveillance Study conducted in San Francisco–Oakland, in Seattle–Puget Sound, and in Iowa. This population-based, retrospective cohort included women younger than 65 years when diagnosed with early or unstaged first primary breast cancer between 1983 and 1989, treated with mastectomy. The women were followed for a median of 12.4 years (n = 4968). Breast implant usage was validated by medical record review. Cox proportional hazards models were used to estimate hazard rate ratios for survival time until death due to breast cancer or other causes for women with and without breast implants, adjusted for relevant patient and tumor characteristics. Twenty percent of cases received postmastectomy breast implants, with silicone gel-filled implants comprising the most common type. Patients with implants were younger and more likely to have in situ disease than patients not receiving implants. Risks of breast cancer mortality (hazard ratio, 0.54; 95% confidence interval, 0.43–0.67) and nonbreast cancer mortality (hazard ratio, 0.59; 95% confidence interval, 0.41–0.85) were lower in patients with implants than in those patients without implants, following adjustment for age and year of diagnosis, race/ethnicity, stage, tumor grade, histology, and radiation therapy. Implant type did not appear to influence long-term survival. In a large, population-representative sample, breast implants following mastectomy do not appear to confer any survival disadvantage following early-stage breast cancer in women younger than 65 years old

"Does that Make Me a Woman?": Breast Cancer, Mastectomy, and Breast Reconstruction Decisions among Sexual Minority Women

Science.gov (United States)

Rubin, Lisa R.; Tanenbaum, Molly

2011-01-01

Feminist scholars and activists writing about breast cancer care among women have highlighted the sexist and heterosexist assumptions often embedded in the medical management of breast cancer, and of mastectomy in particular. Despite these contributions, and some speculation that sexual minority women may be less interested in breast…

75 FR 44847 - Proposed Collection; Comment Request for Forms 943, 943-PR, 943-A, and 943A-PR

Science.gov (United States)

2010-07-29

... 943, 943-PR, 943- A, and 943A-PR AGENCY: Internal Revenue Service (IRS), Treasury. ACTION: Notice and... comments concerning Forms 943, Employer's Annual Tax Return for Agricultural Employees, 943-PR, Planilla..., Agricultural Employer's Record of Federal Tax Liability, and 943A-PR, Registro De La Obligacion Contributiva...

A Danish randomized trial comparing breast-preserving therapy with mastectomy in mammary carcinoma

International Nuclear Information System (INIS)

Blichert-Toft, M.; Brincker, H.; Andersen, J.A.; Andersen, K.W.; Axelsson, C.K.; Mouridsen, H.T.; Dombernowsky, P.; Overgaard, M.; Gadeberg, C.; Knudsen, G.; Borgeskov, S.; Bertelsen, S.; Knudsen, J.B.; Hansen, J.B.; Poulsen, P.E.; Willumsen, H.; Schousen, P.; Froberg, D.; Oernsholt, J.; Andersen, M.; Olesen, S.; Skovgaard, S.; Oester, M.; Schumacher, H.; Lynderup, E.K.; Holm, C.N.

1988-01-01

The present study comprises 847 women operated upon for invasive breast carcinoma at 19 surgical departments and enrolled in protocol DBCG-82TM from January 1983 to November 1987. Among them 662 (78%) were allocated for breast-preserving therapy or mastectomy by randomization, while 185 patients (22%) did not accept randomization. Within the randomized group 6% could not be entered into adjuvant protocols, i.e. subsequent programmes of postoperative therapy and follow-up. This left 619 evaluable patients. In the non-randomized series 26% did not fulfil the demands for entrance into the adjuvant protocols, leaving 136 evaluable patients, 60 of whom had chosen a breast-preserving operation and 76 mastectomy. In the randomized series the patients in the two treatment arms were comparable in age, menopausal status, site of tumour, pathoanatomical diameter of the tumour, number of removed axillary lymph nodes, number of metastatic axillary lymph nodes, and distribution on adjuvant regimens. Ninety per cent of the patients in the randomized group accepted the method offered, whereas 10% declined and wanted the alternate form of operation. The median follow-up period was approximately 1.75 years. The cumulative recurrence rate in the randomized group was 13% and in the non-randomized group 7%. These results are preliminary. Life-table analyses have not so far demonstrated differences in recurrence-free survival either in the randomized or the non-randomized series. (orig.)

Safety of long-term subcutaneous free flap skin banking after skin-sparing mastectomy

Directory of Open Access Journals (Sweden)

Ralph Verstappen

2018-03-01

Full Text Available Background A persistent problem in autologous breast reconstruction in skin-sparing mastectomies is skin restoration after skin necrosis or secondary oncological resection. As a solution to facilitate reconstruction, skin banking of free-flap skin has been proposed in cases where the overlying skin envelope must be resected, as this technique spares the patient an additional donor site. Herein, we present the largest series to date in which this method was used. We investigated its safety and the possibility of skin banking for prolonged periods of time. Methods All skin-sparing mastectomies and immediate autologous breast reconstructions from December 2009 until June 2013 at our institution were analysed. Results We identified 31 patients who underwent 33 free flap reconstructions in which skin banking was performed. Our median skin banking period was 7 days, with a maximum duration of 171 days. In 22.5% of cases, the banked skin was used to reconstruct overlying skin defects, and in 9.6% of cases to reconstruct the nipple-areolar complex. Microbiological and histological investigations of the banked skin revealed neither clinical infections nor malignancies. Conclusions In situ skin banking, even for prolonged periods of time, is a safe and cost-effective method to ensure that skin defects due to necrosis or secondary oncological resection can be easily reconstructed.

[Application of serratus anterior muscle flap combined with breast implants for breast reconstruction after modified radical mastectomy].

Science.gov (United States)

Chai, Lijun; Zhang, Xuehui

2017-09-01

To investigate effectiveness of the combination of serratus anterior muscle flap and breast implants for breast reconstruction after modified radical mastectomy. Between January 2015 and December 2015, 25 female patients with breast cancer were enrolled, aged 24-62 years (mean, 40.6 years). The tumor located at left side in 9 cases and right side in 16 cases; 14 cases were in the left upper quadrant, 4 cases were in the left lower quadrant, 7 cases were on the top of the breast. All cases were invasive ductal carcinoma. According to TNM staging, 14 cases were at stageⅠand 11 cases were at stageⅡA. The diameter of lumps were all less than 3 cm. All those lumps were solitary and without distant metastasis. The sentinel nodes were all negative. After modified radical mastectomy, the breasts were reconstructed by serratus anterior muscle flap and breast implants. The nipples were spared in 22 cases. The operation time was 113-148 minutes (mean, 136 minutes). All breasts survived and incisions healed at stageⅠ. There was no complication such as hematoma, infection, etc . All patients were followed up 6-18 months (mean, 15 months). Except 1 case, the others were evaluated according to the criteria of the reconstructed breast at 12 months after operation. Among them, 23 cases were evaluated as good and 1 case as fair. There was no tumor recurrence during the follow-up period. The combination of serratus anterior muscle flap and breast implants after the modified radical mastectomy is a handy approach of breast reconstruction which is less harmful with few postoperative complications. It also gains a high degree of satisfaction from patients for good breast shape.

Numerical Analysis of Molten Corium Dispersion during Hypothetical High-Pressure Accidents in APR1400 Nuclear Power Plant

International Nuclear Information System (INIS)

Kim, Jong Tae; Ha, Kwang Soon; Kim, Sang Baik; Kim, Hee Dong; Jeong, Jae Sik

2010-01-01

During a hypothetical high-pressure accident in a nuclear power plant (NPP), molten corium can be ejected through a breach of a reactor pressure vessel (RPV) and dispersed by the following jet of a high pressure steam in the RPV. The dispersed corium is fragmented into smaller droplets in a reactor cavity of the NPP by the steam jet with very high velocity and is released into the upper compartment of the NPP by an overpressure in the cavity. The heat-carrying fragments of the corium transfer the thermal energy to the ambient air in the containment and react chemically with steam and generate hydrogen which may be burnt in the containment. The thermal loads from the ejected molten corium on the containment which is called direct containment heating (DCH) can threaten the integrity of the containment. New generation NPPs such as APR1400 and EPR have been designed in consideration of reducing the possibility of the containment failure from the DCH. In order for that, APR1400 has a convolute-type corium chamber connected to the reactor cavity. In the case of EPR, severe-accident dedicated depressurization valves are installed to preclude a high pressure melt ejection (HPME). DCH in a NPP containment is related to many physical phenomena such as multi-phase hydrodynamics, thermodynamics and chemical reaction. In the evaluation of the DCH load, the melt dispersion rates depending on the RPV pressure are the most important parameter. Mostly, DCH was evaluated by using lumped-analysis codes with some correlations obtained from experiments for the dispersion rates. The corium dispersion rates for many types of the NPP containments had been obtained by experiments in 90s. And some correlations from the experimental data were developed. As mentioned above, APR1400 has a corium chamber to reduce the corium dispersion rate. But there is no experimental data for the dispersion rate specific to the APR1400 cavity geometry. So its performance for capturing of the dispersed corium

Treatment choices in breast cancer: a comparative analysis of mastectomy patients and radiation patients

International Nuclear Information System (INIS)

Williams, J.

1985-01-01

This descriptive-exploratory study identified factors that distinguished women on the basis of the treatment they chose for breast cancer. A semi-structured interview and questionnaire was administered to 30 respondents who received mastectomy and 31 who received lumpectomy with radiation. The variables investigated as potential predictors of treatment choice were (1) participation in treatment planning, (2) knowledge of illness and treatment alternatives, (3) health locus of control, (4) sex-role identification, (5) body image, (6) social support and (7) age. As perceptions of the outcome of treatment influence attitudes about treatment choice, five variables relating to perceived treatment consequences were also examined. These were (1) social support, (2) body image, (3) satisfaction with medical care, (4) satisfaction with treatment and (5) general well-being. The major findings in regard to the predictor variables included a profile of the characteristics of each group. The radiation group had more knowledge, participated in planning to a greater extent, investigated treatment options more often and typically made their own decisions about treatment. The mastectomy group was older, attributed locus of control to chance and demonstrated nonsignificant trends toward locus of control in powerful others and toward a feminine sex-role identification; 50% cited Surgeon's Advice as the basis of their choice

78 FR 47051 - Proposed Collection; Comment Request for Forms 943, 943-PR, 943-A, and 943A-PR

Science.gov (United States)

2013-08-02

... 943, 943-PR, 943- A, and 943A-PR AGENCY: Internal Revenue Service (IRS), Treasury. ACTION: Notice and..., 943-PR, Planilla Para La Declarcion Anual De La Contribucion Federal Del Patrono De Empleados Agricolas, 943-A, Agricultural Employer's Record of Federal Tax Liability, and 943A-PR, Registro De La...

An Experimental Investigation on APR1400 Penetration Weld Failure by Metallic Melt

International Nuclear Information System (INIS)

An, Sang Mo; Ha, Kwang Soon; Kim, Hwan Yeol

2014-01-01

The penetrations are considered as the most vulnerable parts with respect to the reactor vessel failure when a core melt severe accident occurs and the corium reaches the lower head. Penetration tube failure modes can be divided into two categories; tube ejection out of the vessel lower head and rupture of the penetration tube outside the vessel. Tube ejection begins with degrading the penetration tube weld strength to zero as the weld is exposed to temperatures as high as the weld melting temperature, which is called weld failure, and then overcoming any binding force in the hole in the vessel wall that results from differential thermal expansion of the tube and vessel wall. Tube rupture assumes that the debris bed has melted the instrument tube inside the reactor and melt migrates down into the tube to a location outside the vessel wall where a pressure rupture can occur, thus breaching the pressure boundary. In the present paper, we have a focus on the tube ejection failure mode, specifically on the APR1400 weld failure by direct contact with a metallic melt. The objective is to investigate experimentally the ablation kinetics of an APR1400 penetration weld during the interactions with a metallic melt and to suggest the modification of the existing weld failure model. This paper involves the interaction experiments of two different metallic melts (metallic corium and stainless steel melts) with a weld specimen, and rough estimation of weld failure time. The interaction experiments between the metallic melts and an APR1400 penetration weld were performed to investigate the ablation kinetics of the penetration weld. Metallic corium and stainless steel melts were generated using an induction heating technique and interacted with a penetration weld specimen. The ablation rate of the weld specimen showed a range from 0.109 to 0..244 mm/s and thus the APR1400 penetration weld was estimated to be failed at hundreds of times after the interaction with the melt

Development of a Test Facility to Simulate the Reactor Flow Distribution of APR+

International Nuclear Information System (INIS)

Euh, D. J.; Cho, S.; Youn, Y. J.; Kim, J. T.; Kang, H. S.; Kwon, T. S.

2011-01-01

Recently a design of new reactor, APR+, is being developed, as an advanced type of APR1400. In order to analyze the thermal margin and hydraulic characteristics of APR+, quantification tests for flow and pressure distribution with a conservation of flow geometry are necessary. Hetsroni (1967) proposed four principal parameters for a hydraulic model representing a nuclear reactor prototype: geometry, relative roughness, Reynolds number, and Euler number. He concluded that the Euler number should be similar in the prototype and model under the preservation of the aspect ratio on the flow path. The effect of the Reynolds number at its higher values on the Euler number is rather small, since the dependency of the form and frictional loss coefficients on the Reynolds number is seen to be small. ABB-CE has carried out several reactor flow model test programs, mostly for its prototype reactors. A series of tests were conducted using a 3/16 scale reactor model. (see Lee et al., 2001). Lee et al (1991) performed experimental studies using a 1/5.03 scale reactor flow model of Yonggwang nuclear units 3 and 4. They showed that the measured data met the acceptance criteria and were suitable for their intended use in terms of performance and safety analyses. The design of current test facility was based on the conservation of Euler number which is a ratio of pressure drop to dynamic pressure with a sufficiently turbulent region having a high Reynolds number. By referring to the previous study, the APR+ design is linearly reduced to 1/5 ratio with a 1/2 of the velocity scale, which yields a 1/39.7 of Reynolds number scaling ratio. In the present study, the design feature of the facilities, named 'ACOP', in order to investigate flow and pressure distribution are described

Critical heat flux for APR1400 lower head vessel during a severe accident

International Nuclear Information System (INIS)

Noh, Sang W.; Suh, Kune Y.

2013-01-01

Highlights: ► Studied boiling on downward-facing hemispherical vessel with asymmetric thermal insulator. ► Scaled the APR1400 lower head linearly down by 1/10 including ICI tubes and shear keys. ► Performed thermal analysis using ANSYS V11.0 to determine the internal temperature and heat flux. ► Performed tests to obtain the CHF with saturated demineralized water at atmospheric pressure. ► Measured CHF accounting for 3D random flow effect expected in the APR1400 application. -- Abstract: Corium Ablation Stopper Apparatus (CASA) has a downward-facing hemispherical vessel and geometrically asymmetric thermal insulator of the Advanced Power Reactor 1400 MWe (APR1400) scaled linearly down by 1/10, as well as sixty-one in-core instrumentation (ICI) tubes and four shear keys. The heated vessel plays a pivotal role in CASA depending on the configuration of the oxide pool and metal layer to bring about the focusing effect expected of a molten pool in the lower head during a severe accident. The heated vessel was designed through a trial-and-error method and thermal analysis. Thermal analysis was performed using ANSYS V11.0 to investigate the effect of the internal temperature and heat flux on the integral hemispherical copper vessel. The CASA tests were carried out to obtain the critical heat flux (CHF) with saturated and demineralized water at the atmospheric pressure (0.1 MPa). The CHF in the metal layer through the hemispherical channel was found to be lower than that in the ULPU-2400 configuration V data through the streamlined thermal insulator. The experimental CHF was measured and obtained through the CASA hemispherical heated surface accounting for the three-dimensional random flow effect expected in the APR1400 application

Effectiveness of Mindfulness-Based Cognitive Therapy on Quality of Life and Body Image in Women With Breast Cancer Undergoing Mastectomy

Directory of Open Access Journals (Sweden)

Zahara Sharbaf Olyaie

2016-09-01

Discussion: Group mindfulness-based cognitive therapy can be considered as an effective and efficient approach to the quality of life and modification of body image in women with breast cancer who have undergone mastectomy.

Vibration Analysis for Steam Dryer of APR1400 Steam Generator

Energy Technology Data Exchange (ETDEWEB)

Han, Sung-heum; Ko, Doyoung [KHNP CRI, Daejeon (Korea, Republic of); Cho, Minki [Doosan Heavy Industry, Changwon (Korea, Republic of)

2016-10-15

This paper is related to comprehensive vibration assessment program for APR1400 steam generator internals. According to U.S. Nuclear Regulatory Commission, Regulatory Guide 1.20 (Rev.3, March 2007), we conducted vibration analysis for a steam dryer as the second steam separator of steam generator internals. The vibration analysis was performed at the 100 % power operating condition as the normal operation condition. The random hydraulic loads were calculated by the computational fluid dynamics and the structural responses were predicted by power spectral density analysis for the probabilistic method. In order to meet the recently revised U.S. NRC RG 1.20 Rev.3, the CVAP against the potential adverse flow effects in APR1400 SG internals should be performed. This study conducted the vibration response analysis for the SG steam dryer as the second moisture separator at the 100% power condition, and evaluated the structural integrity. The predicted alternating stress intensities were evaluated to have more than 17.78 times fatigue margin compared to the endurance limit.

Nipple-Sparing Mastectomy Improves Long-Term Nipple But Not Skin Sensation After Breast Reconstruction: Quantification of Long-Term Sensation in Nipple Sparing Versus Non-nipple Sparing Mastectomy.

Science.gov (United States)

Rodriguez-Unda, Nelson A; Bello, Ricardo J; Clarke-Pearson, Emily M; Sanyal, Abanti; Cooney, Carisa M; Manahan, Michele A; Rosson, Gedge D

2017-06-01

Changes in breast sensation after reconstruction are expected. Return of breast sensation after reconstruction and whether nipple-sparing mastectomy offers a substantial benefit in terms of sensation has been inconsistently documented in the literature. We conducted the current study using the pressure-specified sensory device to quantify postoperative breast sensation in patients undergoing nipple-sparing versus non-nipple-sparing mastectomy. Consecutive adult women who underwent nipple-sparing (NSM) and non-NSM (NNSM) and were at least 18 months postreconstruction were included. Breast measurements were taken in 4 quadrants (upper/lower lateral, upper/lower medial) and nipple. Averaged skin cutaneous thresholds [(UL+LL+UM+LM)/4] and nipple sensation between NSM and NNSM were compared as the primary outcome measure. A generalized estimating equations model was used; univariate and multivariate variable analyses were done when appropriate. Forty-four patients (74 breasts) were examined (53 NNSM vs 21 NSM). The groups were further subdivided into autologous versus implant-based reconstruction. Averaged cutaneous skin thresholds for quadrants were better for the NSM, 51.8(±24.5) g/mm versus NNSM, 56.5(±25.7) g/mm, although this difference was not statistically significant. However, NSM breasts measured higher nipple or nipple area sensitivity, 44.5(±30.8) g/mm versus NNSM, 83.8(±27.4) g/mm (P sensation was the number of revision surgeries, especially after third revision. Breast sensation is decreased after reconstruction in both NSM and NNSM, but nipple sensation or nipple area is better preserved in NSM breasts. Number of revision surgeries (>3) was a predictor of decreased sensation.

Psychological effects of breast conserving therapy in comparison with radical mastectomy

International Nuclear Information System (INIS)

Bartelink, H.; van Dam, F.; van Dongen, J.

1985-01-01

Psychosocial sequelae of breast conserving therapy (BCT) and radical mastectomy (RM) have been compared. Also, in the BCT group, the cosmetic results were judged by the patients themselves and two plastic surgeons. Body image in the BCT group (n = 114) was significantly more positive than in the RM group (n = 58). Patients treated with BCT had even less fear of recurrence of the cancer and would, if necessary, choose the same treatment again. Cosmetic results were good to excellent in 75% of the cases as judged by the two plastic surgeons. Most of the patients with a bad grading by the surgeons were happy with the results

GPM GROUND VALIDATION AIRBORNE SECOND GENERATION PRECIPITATION RADAR (APR-2) GCPEX V1

Data.gov (United States)

National Aeronautics and Space Administration — The GPM Ground Validation Airborne Second Generation Precipitation Radar (APR-2) GCPEx dataset was collected during the GPM Cold-season Precipitation Experiment...

1001.pdf | 25apr2010 | currsci | Indian Academy of Sciences

Indian Academy of Sciences (India)

2010-04-25

Apr 25, 2010 ... error. The page your are looking for can not be found! Please check the link or use the navigation bar at the top. YouTube · Twitter · Facebook · Blog. Academy News. IAS Logo. Summer Research Fellowship Programme 2018. Dates Extended To 7 December 2017. Register here · Focus Area Science ...

Feasibility of Performing Total Skin-Sparing Mastectomy in Patients With Prior Circumareolar Mastopexy or Reduction Mammoplasty Incisions.

Science.gov (United States)

Vaughn, Carolyn J; Peled, Anne Warren; Esserman, Laura J; Foster, Robert D

2013-06-19

Total skin-sparing mastectomy (TSSM) techniques with preservation of the nipple-areolar complex (NAC) skin are becoming increasingly popular due to improved cosmesis without compromise in oncologic safety. However, these techniques are not routinely offered to patients who have undergone previous breast surgery involving circumareolar incisions due to concern for NAC viability. We reviewed the outcomes of TSSM in 11 patients who underwent 21 TSSM procedures at our institution between 2008 and 2011. All patients had undergone previous breast surgery including reduction mammaplasty (7 breasts), mastopexy (4 breasts), augmentation (3 breasts), and combined mastopexy-augmentation (7 breasts). Incisions from previous breast surgery included circumareolar (11 cases) and Wise pattern (10 cases) incisions. All patients underwent TSSM through an inframammary incision followed by immediate tissue expander reconstruction and subsequent implant exchange. Patient demographics, previous breast surgery details, tumor and treatment characteristics, and postoperative complications were reviewed. Mean patient age was 43 years (range, 35-53 years) and mean body mass index was 24 kg/m (range, 19-32 kg/m). Mean follow-up was 10.2 months (range, 3-20 months).Indications for TSSM included prophylactic risk reduction in 10 cases, in situ cancer in 2 cases, and invasive cancer in 9 cases. Mean time from previous breast surgery to mastectomy was 6.9 years (range, 6 months-26 years). Major complications requiring operative reintervention included 1 (4.8%) case of cellulitis requiring expander removal and 2 (9.5%) cases of wound breakdown requiring operative closure. There were no complications involving the NAC. Total skin-sparing mastectomy with immediate reconstruction can safely be performed in patients who have undergone previous breast surgery involving circumareolar incisions. Our preferred technique in this group of patients is to perform TSSM through an inframammary incision with 2

Standard psychological consultations and follow up for women at increased risk of hereditary breast cancer considering prophylactic mastectomy

NARCIS (Netherlands)

M.B.M. Tan; E.M.A. Bleiker (Eveline); M.B.E. Menke-Pluymers (Marian); A.R. van Gool (Arthur); S. van Dooren (Silvia); B.N. van Geel (Bert); M.M.A. Tilanus-Linthorst (Madeleine); C.C.M. Bartels (Carina); J.G.M. Klijn (Jan); C.T. Brekelmans (Cecile); C.M. Seynaeve (Caroline)

2009-01-01

textabstractBackground: Women at increased (genetic) risk of breast cancer have to weigh the personal pros and cons of prophylactic mastectomy (PM) as an option to reduce their cancer risk. So far, no routine referral to a psychologist has been investigated for women considering PM. Aim of this

Breast reconstruction using a latissimus dorsi flap after mastectomy

DEFF Research Database (Denmark)

Højvig, Jens B; Bonde, Christian Torsten

2015-01-01

of 13 patients (10%) had local complications and were re-operated within the first 30 days. We observed one flap loss and only one systemic complication; a urinary tract infection. In all, 38 patients (28%) received antibiotic treatment after the operations and 27 (20%) developed a seroma at the donor...... of the clinical pathway and post-operative regimen could be future focus-points for this procedure. FUNDING: The review was performed as part of the pre-graduate research year project, "Donor-site morbidity after m. latissimus dorsi reconstruction", funded by Concordiafonden. TRIAL REGISTRATION: not relevant.......INTRODUCTION: The latissimus dorsi (LD) myocutaneous flap has long been regarded as the second choice flap for autologous breast reconstruction following a mastectomy in our department. Despite uncertainty about donor-site morbidity, it is regarded as a relatively safe procedure; moreover...

Self-perception of women after mastectomy as an ego defence mechanism. Comparison with a group of healthy women.

Science.gov (United States)

Mącik, Dorota; Ziółkowska, Patrycja; Kowalska, Monika

2012-01-01

Analysis of changes in self-perception in post-mastectomy patients and its comparison with self-perception of healthy women. The subjects of this study were 50 women. The main group was post-mastectomy patients involved in the meetings of the Amazons Club (25 women). The reference group consisted of 25 healthy women. The method used in the study was the ACL (Adjective Check List) test, identifying 37 dimensions of self-image. Oncological patients completed a test twice (for current and pre-cancer self-image), and healthy women once - for current self. Both groups were selected similarly in respect of education level for the purpose of ensuring a similar level of insight. Retrospective self-image and the current one in the Amazon women group were highly convergent. Existing differences include a reduced need for achievement and dominance, and a lower level of self-confidence. However, the comparison of current self-images in both groups showed a large discrepancy of the results. The Amazon women assess themselves in a much more negative way. Also, their self-image is self-contradictory in certain characteristics. Mastectomy is a difficult experience requiring one to re-adapt and to accept oneself thereafter. The way of thinking about oneself is a defence mechanism helping to cope. The work with patients programmes must, therefore, focus on identifying their emotions and thoughts, especially on those they do not want to accept because of the perceived pressure from the environment to effectively and quickly deal with this difficult situation. The increasing acceptance of personal limitations may help the affected women to adjust psychologically faster and easier.

Improved Design of Crew Operation in Computerized Procedure System of APR1400

Energy Technology Data Exchange (ETDEWEB)

Seong, No Kyu; Jung, Yeon Sub; Sung, Chan Ho [KHNP, Daejeon (Korea, Republic of)

2016-05-15

The operators perform the paper-based procedures in analog-based conventional main control room (MCR) depending on only communications between operators except a procedure controller such as a Shift Supervisor (SS), however in digital-based MCR the operators can confirm the procedures simultaneously in own console when the procedure controller of computerized procedure (CP) opens the CP. The synchronization and a synchronization function between procedure controller and other operators has to be considered to support the function of crew operation. This paper suggests the improved design of crew operation in computerized procedure system of APR1400. This paper suggests the improved design of APR1400 CPS. These improvements can help operators perform the crew procedures more efficiently. And they reduce a burden of communication and misunderstanding of computerized procedures. These improvements can be applied to CPS after human factors engineering verification and validation.

Greta Kaits 9. apr. 1928 - 29. aug. 1946 : [luuletused] / Mats Traat

Index Scriptorium Estoniae

Traat, Mats, 1936-

2008-01-01

Sisu : Greta Kaits 9. apr. 1928 - 29. aug. 1946 ; Villem Hänilane 1898 - 1952 ; Peeter Pedak 1897 - 1953 ; Max Äidse 1903 - 1959 ; Lavinia Laidam ; Buchard Pruus ; Sergei Krivokopõtov ; Allan Luht 5. VII 1962 - 17. V 2007 ; Karl Saarmets 9. III 1924 - 14. IX 1981 ; Raimo Ritsik

Modified radical mastectomy sparing one or both pectoral muscles in the treatment of breast cancer: intra and postoperative complications

Directory of Open Access Journals (Sweden)

Ruffo Freitas-Júnior

Full Text Available CONTEXT AND OBJECTIVE: Modified radical mastectomy is widely utilized in breast cancer treatment. However, no prospective comparison has yet been made between the Madden technique (preservation of the pectoralis minor muscle and the Patey technique (resection of this muscle. The aim of this work was to compare these two modified radical mastectomy techniques, by analyzing their degrees of difficulty and complications. DESIGN AND SETTING: Randomized trial at the Breast Unit of Hospital Araújo Jorge, Goiás; and Faculdade de Medicina da Universidade Federal de Goiás. METHODS: 430 patients with breast cancer with an indication for modified radical mastectomy were included in the program, of whom 426 patients were available for analysis (225 allocated to Patey and 201 to Madden. The chi-squared and Student t tests were used for analysis. RESULTS: The patients’ demographics were well balanced between the two groups. The mean duration of the surgical procedures was 105 (± 29.9 and 102 minutes (± 33, for the Patey and Madden groups, respectively (p = 0.6. Hospitalization duration was 2.3 days for both groups. The mean number of lymph nodes resected was 20.3 (± 7.6 for Patey and 19.8 (± 8.1 for Madden (p = 0.5. There were no differences in terms of vascular or nerve sections, hematomas or infections. The surgeons reported the same degree of difficulty for the two methods. CONCLUSION: The removal of the pectoralis minor muscle did not influence any of the variables studied. Therefore, either technique can be performed, at the surgeon’s discretion.

A Study on the Coupled FEM-Analysis for Reactor Vessel Lower Head of APR1400 under the Severe Accident Scenario

Energy Technology Data Exchange (ETDEWEB)

Kim, Hyonam; Namgung, Ihn [KEPCO International Nuclear Graduate School, Ulsan (Korea, Republic of)

2014-10-15

For the stabilization of the RPV the in-vessel retention strategy with external reactor vessel cooling (IVR-ERVC) is adopted in APR1400. Under this severe accident condition, a good understanding of the mechanical behavior of the reactor vessel lower head (RVLH) is necessary both for verification of structural integrity and for improving the design applying appropriate accident mitigation strategies. The purpose of this study is to develop the analysis method of the RVLH with thermo-mechanical analysis using FEM tool (ANSYS v.15) in case of core-melting severe accident condition, and then analyze the RVLH of APR1400 including creep behavior. The plastic strain can be the major cause of lower head failure on the reactor vessel, and the creep cannot be not negligible factor of the failure under the severe accident condition. In the study, we applied constant convection coefficient at assumed temperature on the outside wall of RPV and substitute creep data of SA-508. In addition, it was found that the steel ablation at the interface between corium and vessel steel is not only a thermal phenomenon in the METCOR experiments. Corrosion processes and the formation of eutectics lead to the erosion of the vessel steel at temperatures that are significantly lower than the melting temperature of steel. It called thermo-chemical attack of the corium (corrosion). Reduced wall thickness because of the thermo-chemical effect by corium increase the equivalent plastic strain, and decrease the minimum time to reach 20% creep strain.

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

Les pertes après récolte en Afrique : examen analytique et synthèse ...

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

Partout en Afrique, les pertes après récolte le long de la chaîne alimentaire, de la ferme à la table, mettent en péril la sécurité alimentaire des agriculteurs dépourvus de ressources. La réduction des pertes après récolte peut aider à accroître la disponibilité, la qualité nutritionnelle et la salubrité des aliments, et à améliorer ...

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.

Main steam line break accident simulation of APR1400 using the model of ATLAS facility

Science.gov (United States)

Ekariansyah, A. S.; Deswandri; Sunaryo, Geni R.

2018-02-01

A main steam line break simulation for APR1400 as an advanced design of PWR has been performed using the RELAP5 code. The simulation was conducted in a model of thermal-hydraulic test facility called as ATLAS, which represents a scaled down facility of the APR1400 design. The main steam line break event is described in a open-access safety report document, in which initial conditions and assumptionsfor the analysis were utilized in performing the simulation and analysis of the selected parameter. The objective of this work was to conduct a benchmark activities by comparing the simulation results of the CESEC-III code as a conservative approach code with the results of RELAP5 as a best-estimate code. Based on the simulation results, a general similarity in the behavior of selected parameters was observed between the two codes. However the degree of accuracy still needs further research an analysis by comparing with the other best-estimate code. Uncertainties arising from the ATLAS model should be minimized by taking into account much more specific data in developing the APR1400 model.

Operative outcomes of conventional specimen radiography versus in-operating room specimen radiography in radioactive seed-localized segmental mastectomies.

Science.gov (United States)

Rhee, Daniel; Pockaj, Barbara; Wasif, Nabil; Stucky, Chee-Chee; Pizzitola, Victor; Giurescu, Marina; Patel, Bhavika; McCarthy, Janice; Gray, Richard

2018-01-01

In-operating room specimen radiography (ORSR) has not been studied among women undergoing radioactive seed localization (RSL) for breast cancer surgery and had the potential to decrease operative time and perhaps improve intraoperative margin management. One hundred consecutive RSL segmental mastectomies among 98 patients using ORSR were compared to 100 consecutive segmental mastectomies among 98 patients utilizing conventional radiography (CSR) prior to the initiation of ORSR from December 2013 to January 2015 after radioactive seed localization. Final pathologic margins were considered to be 10 mm for all cases of no residual disease after biopsy or neoadjuvant therapy, but such patients were excluded from analyses involving tumor size. All patients' specimens were subjected to intraoperative pathologic consultation in addition to ORSR or CSR. The median age of the cohort was 65 years (range 36-97), and the median tumor size was 1 cm. There were no differences between the ORSR and CSR groups in age, tumor size, percentage of cases with only DCIS, and percentage of cases with microcalcifications. The ORSR group had a statistically significant lower BMI. Mean operative time from cut-to-close was not significantly different (ORSR 77 min, SD 24.8 vs CSR 76 min, SD 24.8, p = 0.75). There was no statistical difference in mean closest final pathologic margin (4.99 mm, SD 3.3 vs 4.88 mm, SD 3.5, p = 0.9). The percentage undergoing intraoperative margin re-excision (ORSR 40%, CR 47%, p = 0.31) and the mean total number of margins excised intraoperatively (ORSR 0.9, CR 1.0 p = 0.65) were similar. The rate of any margin CSR; this difference was not statistically significant (p = 0.25). The mean ratio of segmental mastectomy volume to maximum tumor diameter was less for ORSR (82.7cm2 vs 139.4cm2, p = 0.014). ORSR for RSL breast surgery, in the setting of routine intraoperative pathology consultation, does not significantly impact operative time, the rate or

Benefit of Adjuvant Brachytherapy Versus External Beam Radiation for Early Breast Cancer: Impact of Patient Stratification on Breast Preservation

International Nuclear Information System (INIS)

Smith, Grace L.; Jiang, Jing; Buchholz, Thomas A.; Xu, Ying; Hoffman, Karen E.; Giordano, Sharon H.; Hunt, Kelly K.; Smith, Benjamin D.

2014-01-01

Purpose: Brachytherapy after lumpectomy is an increasingly popular breast cancer treatment, but data concerning its effectiveness are conflicting. Recently proposed “suitability” criteria guiding patient selection for brachytherapy have never been empirically validated. Methods: Using the Surveillance, Epidemiology, and End Results–Medicare linked database, we compared women aged 66 years or older with invasive breast cancer (n=28,718) or ductal carcinoma in situ (n=7229) diagnosed from 2002 to 2007, treated with lumpectomy alone, brachytherapy, or external beam radiation therapy (EBRT). The likelihood of breast preservation, measured by subsequent mastectomy risk, was compared by use of multivariate proportional hazards, further stratified by American Society for Radiation Oncology (ASTRO) brachytherapy suitability groups. We compared 1-year postoperative complications using the χ 2 test and 5-year local toxicities using the log-rank test. Results: For patients with invasive cancer, the 5-year subsequent mastectomy risk was 4.7% after lumpectomy alone (95% confidence interval [CI], 4.1%-5.4%), 2.8% after brachytherapy (95% CI, 1.8%-4.3%), and 1.3% after EBRT (95% CI, 1.1%-1.5%) (P<.001). Compared with lumpectomy alone, brachytherapy achieved a more modest reduction in adjusted risk (hazard ratio [HR], 0.61; 95% CI, 0.40-0.94) than achieved with EBRT (HR, 0.22; 95% CI, 0.18-0.28). Relative risks did not differ when stratified by ASTRO suitability group (P=.84 for interaction), although ASTRO “suitable” patients did show a low absolute subsequent mastectomy risk, with a minimal absolute difference in risk after brachytherapy (1.6%; 95% CI, 0.7%-3.5%) versus EBRT (0.8%; 95% CI, 0.6%-1.1%). For patients with ductal carcinoma in situ, EBRT maintained a reduced risk of subsequent mastectomy (HR, 0.40; 95% CI, 0.28-0.55; P<.001), whereas the small number of patients treated with brachytherapy (n=179) precluded definitive comparison with lumpectomy alone. In

Effect of adding magnesium sulphate to bupivacaine on the clinical profile of ultrasound-guided thoracic paravertebral block in patients undergoing modified radical mastectomy

Directory of Open Access Journals (Sweden)

Mohamed Elsayed Hassan

2015-01-01

Conclusion: Adding magnesium sulphate to bupivacaine in ultrasound-guided paravertebral block resulted in more efficient analgesia and opioid-sparing in female patients undergoing modified radical mastectomy.

GPM GROUND VALIDATION AIRBORNE SECOND GENERATION PRECIPITATION RADAR (APR-2) GCPEX V1

Data.gov (United States)

National Aeronautics and Space Administration — The Second Generation Airborne Precipitation Radar (APR-2) is a dual-frequency (13 GHz and 35 GHz), Doppler, dual-polarization radar system. It has a downward...

Impact de la qualité de l'audit externe sur la liquidité des titres des entreprises tunisiennes cotées : Investigation théorique et évidence empirique

OpenAIRE

Hakim Ghorbel , Faten

2008-01-01

International audience; Cette recherche a pour objectif d'étudier l'impact de la qualité d'audit externe sur la liquidité. Nous appréhendons la qualité d'audit dans le cadre de notre étude par "la qualité de l'auditeur", et notamment de son indépendance et de ses compétences. Après avoir contrôlé l'effet d'autres variables censées, d'après la théorie, influencer la liquidité, les tests effectués ont permis de dégager une relation positive entre l'appartenance des auditeurs à un réseau interna...

Immediate breast reconstruction after skin- or nipple-sparing mastectomy for previously augmented patients: a personal technique.

Science.gov (United States)

Salgarello, Marzia; Rochira, Dario; Barone-Adesi, Liliana; Farallo, Eugenio

2012-04-01

Breast reconstruction for previously augmented patients differs from breast reconstruction for nonaugmented patients. Many surgeons regard conservation therapy as not feasible for these patients because of implant complications, whether radiotherapy-induced or not. Despite this, most authors agree that mastectomy with immediate breast reconstruction is the most suitable choice, ensuring both a good cosmetic result and a low complication rate. Implant retention or removal remains a controversial topic in addition to the best available surgical technique. This study reviewed the authors' experience with immediate breast reconstruction after skin-sparing mastectomy (SSM) and nipple-sparing mastectomy (NSM) with anatomically definitive implants. The retrospective records of 12 patients were examined (group A). These patients were among 254 patients who underwent SSM or NSM for breast carcinoma. The control group comprised 12 of the 254 patients submitted to SSM or NSM (group B) who best matched the 12 patients in the studied group. All of them underwent immediate breast reconstruction, with an anatomically definitive implant placed in a submuscular-subfascial pocket. The demographic, technical, and oncologic data of the two groups were compared as well as the aesthetic outcomes using the Breast Q score. The proportion of complications, the type of implant, the axillary lymph node procedure, and the histology were compared between the two groups using Fisher's exact test. Student's t test was used to compare the scores for the procedure-specific modules of the breast Q questionnaire in the two groups. A validated patient satisfaction score was obtained using the breast Q questionnaire after breast reconstruction. The demographic, technical, and oncologic characteristics were not significantly different between the two groups. The previously augmented patients reported a significantly higher level of satisfaction with their breast than the control patients. The scores

The Gravity Makeup on the LORHR Event during Mid-loop Operation for APR1400

Energy Technology Data Exchange (ETDEWEB)

Kim, Cheol Woo; Lee, Yong Hee; Lee, Gyu Cheon; Kim, Shin Whan [KEPCO, Daejeon (Korea, Republic of)

2015-05-15

This paper is to investigate means of the available gravity makeup after the event to prevent or sustain the core uncovery and fuel failure for the typical advanced power reactor nuclear power plants (APR1400). Unlike the OPR1000 (optimized power reactor 1000 nuclear power plants), the refueling water storage tank of APR1400 cannot be used for gravity makeup since it is located on the bottom of the containment with a lower elevation than the reactor vessel. So, the other means of gravity makeup and their effect on the core uncovery are accounted. The use of the water used for the cask loading pit (CLP) during refueling or the safety injection line filling tank (SIFT), which are not designed for gravity makeup during the event, and safety injection tanks (SITs) are considered as the alternative source of makeup feed. The results show that gravity makeup of a SIT provides a sufficient operator action time for the LORHR with the station black out (SBO) during the mid-loop operation for the APR1400. From the LORHR event analysis, the effective means of gravity makeup for APR1400 to cope with this event concurrent loss of all AC power is determined as the gravity feed using SITs. Other means for gravity makeup using CLP or SIFT, which are not designed to mitigate the LORHR event, are evaluated as not effective to the event due to the large flow resistances and the low elevation head to overcome the system pressure increase during the LORHR. The use of one SIT and two SITs for the LORHR provides the core uncovery times as 3 hr 8 min and 4 hr 32 min extending 1 hr 15 min and 2 hr 38 min from the base case, respectively.

MELCOR code modeling for APR1400

Energy Technology Data Exchange (ETDEWEB)

Choi, Young; Park, S. Y.; Kim, D. H.; Ahn, K. I.; Song, Y. M.; Kim, S. D.; Park, J. H

2001-11-01

The severe accident phenomena of nuclear power plant have large uncertainties. For the retention of the containment integrity and improvement of nuclear reactor safety against severe accident, it is essential to understand severe accident phenomena and be able to access the accident progression accurately using computer code. Furthermore, it is important to attain a capability for developing technique and assessment tools for an advanced nuclear reactor design as well as for the severe accident prevention and mitigation. The objective of this report is to establish technical bases for an application of the MELCOR code to the Korean Next Generation Reactor (APR1400) by modeling the plant and analyzing plant steady state. This report shows the data and the input preparation for MELCOR code as well as state-state assessment results using MELCOR code.

An investigation of major influences on the seismic response of APR1400 reactor vessel internals - 15145

International Nuclear Information System (INIS)

Byun, Y.J.; Kim, J.G.; Sung, K.K.; Lee, D.H.

2015-01-01

This paper deals with 3 topics concerning the APR1400 reactor vessel internals (RVI) seismic analysis: nonlinear problems, approaches to account for uncertainties of seismic model, and dynamic responses to various seismic excitations. First, the noticeable nonlinear characteristics of the RVI seismic model are discussed, and the modeling methods for properly simulating the nonlinear behaviors of RVI under seismic loads are presented. By applying these methods to the seismic model, the seismic analysis can correctly predict the dynamic response of RVI. Next, two approaches to account for the uncertainties of seismic model are evaluated: the time history broadening method, and the sensitivity analysis based on NUREG-0800, Section 4.2, Appendix A. From the evaluation results, it is confirmed that the time history broadening method employed in the seismic analysis of APR1400 RVI sufficiently accounts for the uncertainty of seismic model. Finally, the response characteristics of APR1400 RVI to various seismic excitations are investigated. The seismic excitations corresponding to various soil profiles, including the effects of cracked and un-cracked concrete stiffness on the reactor containment building structure, are used as forcing functions. From this study, the effects of various site conditions on the dynamic response of APR1400 RVI are identified. As a result, the enveloped seismic responses obtained from this study will contribute to the development of RVI seismic design that covers a wide range of potential site conditions. (authors)

The effect of peer-led education on the life quality of mastectomy patients referred to breast cancer-clinics in Shiraz, Iran 2009.

Science.gov (United States)

Sharif, Farkhondeh; Abshorshori, Narjes; Tahmasebi, Sedigheh; Hazrati, Maryam; Zare, Najaf; Masoumi, Sarah

2010-07-23

Breast cancer among women is a relatively common with a more favorable expected survival rates than other forms of cancers. This study aimed to determine the improved quality of life for post-mastectomy women through peer education. Using pre and post test follow up and control design approach, 99 women with stage I and II of breast cancer diagnosis were followed one year after modified radical mastectomy. To measure the quality of life an instrument designed by the European organization for research and treatment of cancer, known as the Quality of Life Question (QLQ-30) and its breast cancer supplementary measure (QLQ-BR23) at three points in time (before, immediately and two months after intervention) for both groups were used. The participant selection was a convenient sampling method and women were randomly assigned into two experimental and control groups. The experimental group was randomly assigned to five groups and peer educators conducted weekly educational programs for one month. Tabulated data were analyzed using chi square, t test, and repeated measurement multivariate to compare the quality of life differences over time. For the experimental group, the results showed statistically significant improvement in all performance aspects of life quality and symptom reduction (P life quality. The findings of this study suggest that peer led education is a useful intervention for post-mastectomy women to improve their quality of life.

967.pdf | 10apr2010 | currsci | Indian Academy of Sciences

Indian Academy of Sciences (India)

2010-04-10

Apr 10, 2010 ... error. The page your are looking for can not be found! Please check the link or use the navigation bar at the top. YouTube; Twitter; Facebook; Blog. Academy News. IAS Logo. 29th Mid-year meeting. Posted on 19 January 2018. The 29th Mid-year meeting of the Academy will be held from 29–30 June 2018 ...

Predictors of satisfaction and quality of life following post-mastectomy breast reconstruction.

Science.gov (United States)

Matthews, Hannah; Carroll, Natalie; Renshaw, Derek; Turner, Andrew; Park, Alan; Skillman, Jo; McCarthy, Kate; Grunfeld, Elizabeth A

2017-11-01

Breast reconstruction is associated with multiple psychological benefits. However, few studies have identified clinical and psychological factors associated with improved satisfaction and quality of life. This study examined factors, which predict satisfaction with breast appearance, outcome satisfaction and quality of life following post-mastectomy breast reconstruction. Women who underwent post-mastectomy breast reconstruction between 2010 and 2016 received a postal questionnaire consisting of The BREAST-Q Patient Reported Outcomes Instrument, The European Organisation for Research and Treatment of Cancer QLQ-30 Questionnaire, The Patient and Observer Scar Assessment Scale, and a series of Visual-Analogue Scales. One hundredforty-eight women completed the questionnaire, a 56% response rate. Hierarchical multiple regression analyses revealed psychosocial factors accounted for 75% of the variance in breast satisfaction, 68% for outcome satisfaction, and 46% forquality of life. Psychosocial well-being emerged as a significant predictor of satisfaction with breast appearance (β = .322) and outcome satisfaction (β = .406). Deep inferior epigastric perforator flap patients reported greater satisfaction with breast appearance (β = .120) and outcome satisfaction (β = .167). This study extends beyond the limited research by distinguishing between satisfaction with breast appearance and outcome satisfaction. The study provides evidence for the role of psychosocial factors predicting key patient reported outcomes and demonstrates the importance of psychosocial well-being and reconstruction type. The findings also highlight the need for healthcare providers to consider the psychosocial well-being of patients both preoperatively and post operatively and provide preliminary evidence for the use of deep inferior epigastric perforator reconstructions over other types of reconstructive procedures. Copyright © 2017 John Wiley & Sons, Ltd.

Phylogenetic Diversity of aprA Genes in Subseafloor Sediments on the Northwestern Pacific Margin off Japan.

Science.gov (United States)

Aoki, Masataka; Kakiuchi, Ryota; Yamaguchi, Takashi; Takai, Ken; Inagaki, Fumio; Imachi, Hiroyuki

2015-01-01

Markedly diverse sequences of the adenosine-5'-phosphosulfate reductase alpha subunit gene (aprA), which encodes a key enzyme in microbial sulfate reduction and sulfur oxidation, were detected in subseafloor sediments on the northwestern Pacific off Japan. The aprA gene sequences were grouped into 135 operational taxonomic units (90% sequence identity), including genes related to putative sulfur-oxidizing bacteria predominantly detected in sulfate-depleted deep sediments. Our results suggest that microbial ecosystems in the subseafloor biosphere have phylogenetically diverse genetic potentials to mediate cryptic sulfur cycles in sediments, even where sulfate is rarely present.

Effect of Pilates Exercise on Range of Motion and Edema of Upper Limb in Mastectomy Side

Directory of Open Access Journals (Sweden)

Maryam Ghorbani

2013-09-01

Full Text Available Background & objectives : The surgery of breast cancer like any other surgeries may bring about some problems and complications, which the knowledge of these problems may be an effective way for prevention or dealing with the complications. The motor and sensory impairments in the upper limb of the surgery side necessitate the utilization of the rehabilitation methods. The main purpose of this research was to show the effect of Pilates exercise on range of motion and edema of upper limb in females suffering from breast cancer after going through surgery.   Methods: This quasi- experimental study was conducted on 25 patients randomly chosen among the patients referring to Cancer Institute. The designed exercise included five "Mat Pilates" moves which were done for 15 sessions until the patient reached fatigue borderlines. Meantime, the control group was doing routine active exercises in physiotherapy center. The range of motion and edema of upper limb was measured before and after applying the designed exercise. For describing the data, the mean and standard deviation, and for inferential analysis, the correlated T-tests and one way analysis of variance were used in level of significance of 5%, to compare the variants before and after applying the designed exercise.   Results: The results showed a significant difference between the flexion, extension, and internal, external rotation of shoulder, flexion and extension of elbow, flexion, extension, supination deviation and pronation deviation of the wrist and forearm before and after experiment in Pilates group. While in the control group, flexion, extension, internal and external rotation of shoulder, flexion and extension of elbow, and flexion of wrist showed a significant difference before and after the experiment.   Conclusion: The use of Pilates exercise after mastectomy surgery can increase the range of motion of the upper limb in the involved side of the patients, and decrease the edema

Application of Nuclear Application Programs to APR1400 Simulator

International Nuclear Information System (INIS)

Hwang, Do Hyun; Lee, Myeong Soo; Hong, Jin Hyuk

2012-01-01

Advanced Power Reactor 1400MWe (APR1400) simulator has been developed and installed at Kori Training Center for operators of ShinKori no.3, 4 nuclear power plant by Korea Hydro and Nuclear Power,s Central Research Institute (KHNP CRI). NAPS (Nuclear Application Programs) is a computerbased system which provides operators with past and real-time information for monitoring and controlling NSSS (Nuclear Steam Supply System), BOP (Balance Of Plant) and Electric system. NAPS consists of several programs such as COLSS (Core Operating Limit Supervisory System), SPADES+ (Safety Parameter Display and Evaluation System), CEA (Control Element Assembly) Application Program, and so on. Each program makes calculations based on its own algorithm and provides information available for operation. In order to use NAPS programs with a simulator even though they are being used in a real plant, they should be modified to add several simulation functions such as reset, snap, run/freeze and backtrack required by ANSI/ANS-3.5 to the original NAPS functionality. On top of that, interfacing programs should be developed for the data communication between respective NAPS programs and simulator sever. The purpose of this paper is to provide the overall architecture of the communication system between NAPS and simulator model, and to describe the method to apply NAPS to APR1400 simulator

Cold-Leg Small Break LOCA Analysis of APR1400 Plant Using a SPACE/sEM Code

International Nuclear Information System (INIS)

Lim, Sang Gyu; Lee, Suk Ho; Yu, Keuk Jong; Kim, Han Gon; Lee, Jae Yong

2013-01-01

The Small Break Loss-of-Coolant Accident (SBLOCA) evaluation methodology (EM) for APR1400, called sEM, is now being developed using SPACE code. SPACE/sEM is to set up a conservative evaluation methodology in accordance with appendix K of 10 CFR 50. Major required and acceptable features of the evaluation models are described as below. - Fission product decay : 1.2 times of ANS97 decay curve - Critical flow model : Henry-Fauske Moody two phase critical flow model - Metal-Water reaction model : Baker-Just equation - Critical Heat Flux (CHF) : B and W, Barnett and Modified Barnett correlation - Post-CHF : Groeneveld 5.7 film boiling correlation A series of test matrix is established to validate SPACE/sEM code in terms of major SBLOCA phenomena, e.g. core level swelling and boiling, core heat transfer, critical flow, loop seal clearance and their integrated effects. The separated effect tests (SETs) and integrated effect tests (IETs) are successfully performed and these results shows that SPACE/sEM code has a conservatism comparing with experimental data. Finally, plant calculations of SBLOCA for APR1400 are conducted as described below. - Break location sensitivity : DVI line, hot-leg, cold-leg, pump suction leg. - Break size spectrum : 0.4ft 2 ∼0.02ft 2 (DVI) 0.5ft 2 ∼0.02ft 2 (hot-leg, cold-leg, pump suction leg) This paper deals with break size spectrum analysis of cold-leg break accidents. Based on the calculation results, emergency core cooling system (ECCS) performances of APR1400 and typical SBLOCA phenomena can be evaluated. Cold-leg SBLOCA analysis for APR1400 is performed using SPACE/sEM code under harsh environment condition. SPACE/sEM code shows the typical SBLOCA behaviors and it is reasonably predicted. Although SPACE/sEM code has conservative models and correlations based on appendix K of 10 CFR 50, PCT does not exceed the requirement (1477 K). It is concluded that ECCS in APR1400 has a sufficient performance in cold-leg SBLOCA

Cold-Leg Small Break LOCA Analysis of APR1400 Plant Using a SPACE/sEM Code

Energy Technology Data Exchange (ETDEWEB)

Lim, Sang Gyu; Lee, Suk Ho; Yu, Keuk Jong; Kim, Han Gon; Lee, Jae Yong [Central Research Institute, KHNP, Ltd., Daejeon (Korea, Republic of)

2013-10-15

The Small Break Loss-of-Coolant Accident (SBLOCA) evaluation methodology (EM) for APR1400, called sEM, is now being developed using SPACE code. SPACE/sEM is to set up a conservative evaluation methodology in accordance with appendix K of 10 CFR 50. Major required and acceptable features of the evaluation models are described as below. - Fission product decay : 1.2 times of ANS97 decay curve - Critical flow model : Henry-Fauske Moody two phase critical flow model - Metal-Water reaction model : Baker-Just equation - Critical Heat Flux (CHF) : B and W, Barnett and Modified Barnett correlation - Post-CHF : Groeneveld 5.7 film boiling correlation A series of test matrix is established to validate SPACE/sEM code in terms of major SBLOCA phenomena, e.g. core level swelling and boiling, core heat transfer, critical flow, loop seal clearance and their integrated effects. The separated effect tests (SETs) and integrated effect tests (IETs) are successfully performed and these results shows that SPACE/sEM code has a conservatism comparing with experimental data. Finally, plant calculations of SBLOCA for APR1400 are conducted as described below. - Break location sensitivity : DVI line, hot-leg, cold-leg, pump suction leg. - Break size spectrum : 0.4ft{sup 2}∼0.02ft{sup 2}(DVI) 0.5ft{sup 2}∼0.02ft{sup 2}(hot-leg, cold-leg, pump suction leg) This paper deals with break size spectrum analysis of cold-leg break accidents. Based on the calculation results, emergency core cooling system (ECCS) performances of APR1400 and typical SBLOCA phenomena can be evaluated. Cold-leg SBLOCA analysis for APR1400 is performed using SPACE/sEM code under harsh environment condition. SPACE/sEM code shows the typical SBLOCA behaviors and it is reasonably predicted. Although SPACE/sEM code has conservative models and correlations based on appendix K of 10 CFR 50, PCT does not exceed the requirement (1477 K). It is concluded that ECCS in APR1400 has a sufficient performance in cold-leg SBLOCA.

Survival benefit of post-mastectomy radiotherapy in breast carcinoma patients with T1-2 tumor and 1-3 axillary lymph node(s) metastasis

International Nuclear Information System (INIS)

Duraker, N.; Demir, D.; Bati, B.; Yilmaz, B.D.; Bati, Y.; Sobutay, E.; Caynak, Z.C.

2012-01-01

The objective of this study was to investigate the role of post-mastectomy radiotherapy in breast carcinoma patients with a tumor size of 5 cm or smaller (T1-2) and 1-3 axillary lymph node(s) metastasis (N1). We retrospectively reviewed the file records of 575 patients receiving radiotherapy (452 patients) and not receiving radiotherapy (123 patients). In the whole series, locoregional recurrence-free survival was significantly better in patients receiving radiotherapy compared with patients not receiving radiotherapy (P 0.25 and in T2N1 breast carcinoma patients with a lymph node ratio of >0.08. In patients with a lymph node ratio equal to or less than these ratios, post-mastectomy radiotherapy could be omitted to avoid radiotherapy-related risks. (author)

Prevalence of major depressive disorder in patients with modified radical mastectomy without reconstruction

Directory of Open Access Journals (Sweden)

Ana Celina Rueda López

2007-05-01

Full Text Available Antecedents: Major depressive disorder (MDD is a psychiatric dysfunction that appears with relative frequency in the women with breast cancer diagnosis or which they are in treatment forthe same one. Nevertheless, specific data don’t exist in Colombia about the prevalence of depression in the patients with cancer who suffer from subjected to modified radical mastectomy without reconstruction. Objective: To determine the prevalence of MDD in resident patients in the metropolitan area of Bucaramanga with modified radical mastectomy without reconstruction. Method: It is a descriptive transversal study; it included women older than 18 years. We applied the SCID I. A semi structured interview for MDD based on approaches of the DSM-IV. Results: 80 women were evaluated with ages among the 30-85 years, with a 58.1 year-old average, SD13.79; the prevalence was of 42.5%, (95%CI 31.68 – 53.30 for MDD. The MDD was lower than in those women who had social support in 41.2% (PR 2.41; 95%CI 1.56-3.73 and was higher than in women who had problems due to the surgery in 88.2% (PR 3.41;95%CI 1.35- 8.64, we didn’t find association with age, the grade ofstudy, the marital status, the socioeconomic level, pain scale, the occupation and the time of the surgery. Conclusion: In this study TDM prevalence was higher than similar ones with general population; TDM was related directly with the problems derived from surgery and inversely with the social support.

Neuchatel ne gardera pas le Palais de l'equilibre apres Expo.02

CERN Multimedia

2002-01-01

"La ville de Neuchatel ne souhaite pas conserver le Palais de l'equilibre apres Expo.02. Par 24 voix contre 7, le Conseil general a rejete le plan special du Conseil communal qui proposait de transformer l'edifice en un centre de congres" (1/2 page).

How to perform a NAC sparing mastectomy using an ADM and an implant

DEFF Research Database (Denmark)

Gunnarsson, Gudjon Leifur; Børsen-Koch, Mikkel; Wamberg, Peter

2014-01-01

experience performing NSM and IBR in a selected group of patients through the inframammary incision assisted by hydrodissection. MATERIAL AND METHODS: The study includes 20 healthy women, aged 23-53, and referred for bilateral risk-reducing mastectomy. NSM was carried out using inframammary crease incision...... the reconstructive goal for all 40 breasts (100%). There were no cases of NAC necrosis. Minor complications were registered in two reconstructions (5%), including one case of small partial necrosis and one case of wound dehiscence. The median follow-up was 13 months (range, 1-32 months). CONCLUSIONS: Bilateral risk-reducing...

COMPARATIVE STUDY OF MODIFIED RADICAL MASTECTOMY PERFORMED UNDER LOCAL ANAESTHESIA WITH DEXMEDETOMIDINE INFUSION VS. GENERAL ANAESTHESIA

Directory of Open Access Journals (Sweden)

Ramesan Chayampurath

2016-11-01

Full Text Available BACKGROUND The incidence of breast cancer is on the rise in developing countries. Though, there have been significant advances in general anaesthesia, surgery in elderly and those with comorbid illness still have an attendant morbidity and mortality. After the introduction of local anaesthesia by Kolher in 1884 and in spite of steady refinement, local anaesthesia is still not being widely used in major general surgical procedures. MATERIALS AND METHODS The study was conducted in Government Medical College, Calicut, a tertiary care centre in Kerala. The outcome of Modified Radical Mastectomy performed under Local Anaesthesia (LA and dexmedetomidine infusion was compared to similar cases done under General Anaesthesia (GA. RESULTS Rapid recovery from sedation leading to early restoration of normal physical activity was observed in the LA group when compared to GA group. Early initiation of oral feeds was possible in the former group as Postoperative Nausea and Vomiting (PONV was significantly less. Effective postoperative pain relief and significant reduction in respiratory complications was observed in the LA group compared to GA group. CONCLUSION Modified Radical Mastectomy under LA and procedural sedation with dexmedetomidine was significantly better in selected cases when compared to similar cases done under GA with respect to early recovery pain relief and decreased incidence of respiratory complications.

Clinical investigation: Regional nodal failure patterns in breast cancer patients treated with mastectomy without radiotherapy

International Nuclear Information System (INIS)

Strom, Eric A.; Woodward, Wendy A.; Katz, Angela; Buchholz, Thomas A.; Perkins, George H.; Jhingran, Anuja; Theriault, Richard; Singletary, Eva; Sahin, Aysegul; McNeese, Marsha D.

2005-01-01

Purpose: The purpose of this study was to describe regional nodal failure patterns in patients who had undergone mastectomy with axillary dissection to define subgroups of patients who might benefit from supplemental regional nodal radiation to the axilla or supraclavicular fossa/axillary apex. Methods and Materials: The cohort consisted of 1031 patients treated with mastectomy (including a level I-II axillary dissection) and doxorubicin-based systemic therapy without radiation on five clinical trials at M.D. Anderson Cancer Center. Patient records, including pathology reports, were retrospectively reviewed. All regional recurrences (with or without distant metastasis) were recorded. Median follow-up was 116 months (range, 6-262 months). Results: Twenty-one patients recurred within the low-mid axilla (10-year actuarial rate 3%). Of these, 16 were isolated regional failures (no chest wall failure). The risk of failure in the low-mid axilla was not significantly higher for patients with increasing numbers of involved nodes, increasing percentage of involved nodes, larger nodal size or gross extranodal extension. Only 3 of 100 patients with 20% involved axillary nodes, and the presence of gross extranodal extension (10-year actuarial rates 15%, 14%, and 19%, respectively, p 20% involved axillary nodes, or gross extranodal extension are at increased risk of failure in the supraclavicular fossa/axillary apex and should receive radiation to undissected regions in addition to the chest wall

Progress of Design Improvements for APR1400 Computerized Procedure System from HFE V and V results and Design Experience

International Nuclear Information System (INIS)

Lee, Sungjin; Seong, Nokyu

2015-01-01

This study shows major already improved design features from the above three processes and a design proposal for to-be-improving items. APR1400 CPS has been verified and validated by the HFE process, internal design review and site acceptance tests. APR1400 Computerized Procedure System (CPS) has been applied to Shin-Kori Nuclear Power Plant (SKN) 3 and 4 units, Shin-Hanul Nuclear Power Plant (SHN) 1 and 2 units and Baraka Nuclear Power Plant (BNPP) 1, 2, 3 and 4 units. Since APR1400 CPS is a first-of-a-kind (FOAK) human machine interface (HMI) for executing a computerized procedure in the nuclear power plant's main control room in South Korea, it has been continuously improved through a) the human factor engineering (HFE) verification and validation (V and V), b) the internal design review and c) prototype tests. Human engineering discrepancies (HEDs) can be identified by the HFE V and V activity. Some HEDs of APR1400 CPS for SKN 3 and 4 and SHN 1 and 2 have been adopted as a role of design improvement in the CPS system while others were regarded as an operator training requirement or part of task contents. Various requests for improving the CPS have been collected from those results. A HMI system should be improved continuously for removing potential defects. Some of introduced design features in this paper has been adopted for APR1400 nuclear power plants. Some of them are under the review in the CPS design team of KHNP

The effect of mastectomy and radiotherapy for breast carcinoma on soft tissues of the shoulder and join mobility among Egyptian patients

International Nuclear Information System (INIS)

Saied, G.M.; Kamel, R.M.; Dessouki, N.R.

2007-01-01

Patients with pos mastectomy soft tissue shoulder disorders usually benefit from various lines of physiotherapy treatment. However, the controversy about their efficacy persists. The aim of this work was to study and asses the efficacy of each, and to identify the best intervention. One hundred female patients with ipsilateral post mastectomy shoulder problems were enrolled in the stud, from September 2003 until December 2004. They were followed up for 32 weeks. Mastectomy, both radical and conservative and axillary lymph node clearance, was the standard surgery applied for operable breast carcinoma in this series. Clinical examination was followed by testing for the shoulder complaint by measuring maximal protrusion at the inferior scapular angle, scapular stabilization and the lift-off tests. Approved physiotherapy modalities were then applied, viz: no treatment (randomly chosen 12 patients), passive and active motion therapy (14 patients], oral diclofenac sodium (19 patients), local triamcinilone injection (40 patients] and manually applied low intensity laser therapy (15 patients). Assessment was by determining overall success rate for each intervention modality. Intervention outcome was assessed at 8, 16 and 32 weeks as shown by physical examination using the healthy shoulder as a reference, and by measuring restricted mobility during passive lateral rotation and glenohumeral abduction. Success rate was determined separately for each group at the end of the intervention period. The applied surgery was followed by radiotherapy in 90%, chemotherapy in 24% and both in 11%. The presenting post mastectomy symptoms at the shoulder were pain (100% shoulder weakness (88%), winging of the scapula (11%) and inability to perform everyday shoulder movements (23%). Evaluation was by overall improvement score. The results were: 14% for untreated patients, 43.3% for those treated by motion therapy 42% for diclofenac therapy, 80.7% for local triamcinolone, and lastly 68% for

Application of Standardized ITAAC to the APR1400 Design Certification

Energy Technology Data Exchange (ETDEWEB)

Kang, Deogji; Kim, Yunho [KHNP CRI, Daejeon (Korea, Republic of)

2016-10-15

Design certification applications (DCAs) submitted pursuant to 10 CFR Part 52 contain two tiers of information, Tier 1 and Tier 2. Tier 1 contains information that is to be certified through rulemaking, and includes the inspections, tests, analyses, and acceptance criteria (ITAAC). Tier 2 contains more detailed information and is the source for information included in Tier1. DC applicants have developed the ITAAC with their own format and contents. This has caused the ineffectiveness of the review process by Nuclear Regulatory Commission (NRC) at the design certification stage. Standardizing the format and content of Tier 1 and ITAAC will achieve greater efficiency and effectiveness for Tier 1 and ITAAC development and NRC review, and for ITAAC implementation and verification. NRC provided the proposed standardized ITAAC for APR1400, and KHNP is considering the application of the proposed ITAAC. The strategy for application of the NRC proposed standardized ITAAC to the APR1400 design certification is now under developing, and a meeting with NRC to review the NRC proposed standardized ITAAC is expected to be held in the near future. In this review process, establishment of industry position on the NRC proposed standardized ITAAC is very important. The support from NEI and US industry is expected to be gained.

Application of Standardized ITAAC to the APR1400 Design Certification

International Nuclear Information System (INIS)

Kang, Deogji; Kim, Yunho

2016-01-01

Design certification applications (DCAs) submitted pursuant to 10 CFR Part 52 contain two tiers of information, Tier 1 and Tier 2. Tier 1 contains information that is to be certified through rulemaking, and includes the inspections, tests, analyses, and acceptance criteria (ITAAC). Tier 2 contains more detailed information and is the source for information included in Tier1. DC applicants have developed the ITAAC with their own format and contents. This has caused the ineffectiveness of the review process by Nuclear Regulatory Commission (NRC) at the design certification stage. Standardizing the format and content of Tier 1 and ITAAC will achieve greater efficiency and effectiveness for Tier 1 and ITAAC development and NRC review, and for ITAAC implementation and verification. NRC provided the proposed standardized ITAAC for APR1400, and KHNP is considering the application of the proposed ITAAC. The strategy for application of the NRC proposed standardized ITAAC to the APR1400 design certification is now under developing, and a meeting with NRC to review the NRC proposed standardized ITAAC is expected to be held in the near future. In this review process, establishment of industry position on the NRC proposed standardized ITAAC is very important. The support from NEI and US industry is expected to be gained

Breast implants following mastectomy in women with early-stage breast cancer: prevalence and impact on survival

OpenAIRE

Le, Gem M; O'Malley, Cynthia D; Glaser, Sally L; Lynch, Charles F; Stanford, Janet L; Keegan, Theresa HM; West, Dee W

2004-01-01

Background Few studies have examined the effect of breast implants after mastectomy on long-term survival in breast cancer patients, despite growing public health concern over potential long-term adverse health effects. Methods We analyzed data from the Surveillance, Epidemiology and End Results Breast Implant Surveillance Study conducted in San Francisco?Oakland, in Seattle?Puget Sound, and in Iowa. This population-based, retrospective cohort included women younger than 65 years when diagnos...

The effect of peer-led education on the life quality of mastectomy patients referred to breast cancer-clinics in Shiraz, Iran 2009

Directory of Open Access Journals (Sweden)

Zare Najaf

2010-07-01

Full Text Available Abstract Background Breast cancer among women is a relatively common with a more favorable expected survival rates than other forms of cancers. This study aimed to determine the improved quality of life for post-mastectomy women through peer education. Methods Using pre and post test follow up and control design approach, 99 women with stage I and II of breast cancer diagnosis were followed one year after modified radical mastectomy. To measure the quality of life an instrument designed by the European organization for research and treatment of cancer, known as the Quality of Life Question (QLQ-30 and it's breast cancer supplementary measure (QLQ-BR23 at three points in time (before, immediately and two months after intervention for both groups were used. The participant selection was a convenient sampling method and women were randomly assigned into two experimental and control groups. The experimental group was randomly assigned to five groups and peer educators conducted weekly educational programs for one month. Tabulated data were analyzed using chi square, t test, and repeated measurement multivariate to compare the quality of life differences over time. Results For the experimental group, the results showed statistically significant improvement in all performance aspects of life quality and symptom reduction (P Conclusion The findings of this study suggest that peer led education is a useful intervention for post-mastectomy women to improves their quality of life.

Patient Information Needs and Breast Reconstruction After Mastectomy: A Qualitative Meta-Synthesis.

Science.gov (United States)

Carr, Tracey L; Groot, Gary; Cochran, David; Holtslander, Lorraine

2018-04-27

Although many women benefit from breast reconstruction after mastectomy, several studies report women's dissatisfaction with the level of information they were provided with before reconstruction. The present meta-synthesis examines the qualitative literature that explores women's experiences of breast reconstruction after mastectomy and highlights women's healthcare information needs. After a comprehensive search of 6 electronic databases (CINAHL, Cochrane Library, EMBASE, MEDLINE, PsycINFO, and Scopus), we followed the methodology for synthesizing qualitative research. The search produced 423 studies, which were assessed against 5 inclusion criteria. A meta-synthesis methodology was used to analyze the data through taxonomic classification and constant targeted comparison. Some 17 studies met the inclusion criteria, and findings from 16 studies were synthesized. The role of the healthcare practitioner is noted as a major influence on women's expectations, and in some instances, women did not feel adequately informed about the outcomes of surgery and the recovery process. In general, women's desire for normality and effective emotional coping shapes their information needs. The information needs of women are better understood after considering women's actual experiences with breast reconstruction. It is important to inform women of the immediate outcomes of reconstruction surgery and the recovery process. In an attempt to better address women's information needs, healthcare practitioners should discover women's initial expectations of reconstruction as a starting point in the consultation. In addition, the research revealed the importance of the nurse navigator in terms of assisting women through the recovery process.This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work

Secuelas de mastectomía subcutánea profiláctica: caso clínico Prophilactic subcutaneous mastectomy sequeal: case report

Directory of Open Access Journals (Sweden)

C. Gutiérrez Gómez

2008-12-01

Full Text Available La mastectomía subcutánea profiláctica es un procedimiento controvertido, sin embargo, es un hecho que disminuye la incidencia de cáncer mamario hasta en un 100% en pacientes con alto riesgo de padecerlo. Presentamos el caso de una paciente de 26 años de edad a quien se le realizó dicho procedimiento sin una indicación precisa y que presentó complicaciones (dehiscencia de heridas, infección y exposición de ambas prótesis mamarias que requirieron varios procedimientos reconstructivos, con un seguimiento de 8 años. La mastectomía subcutánea profiláctica es un procedimiento irreversible con implicaciones importantes para las pacientes, por lo que consideramos que debe estar plenamente justificada por estrictos criterios de prevención de cáncer mamario en pacientes con alto riesgo.Prophylactic subcutaneous mastectomy is controversial, in fact this procedure has proved its efficacy in decreasing mammary carcinoma in high risk patients up to 100 per cent. We report a case of 26 years old patient, in whom was performed a prophylactic bilateral subcutaneous mastectomy without a clear indication, and who presented several complications as suture dehiscence, infection and mammary implants exposition requiring several reconstructive procedures, with a follow up of 8 years. Prophylactic subcutaneous mastectomy is an irreversible procedure with important implications for the patient; we consider that it should be limited to patients with precise indications and at high risk for mammary carcinoma.

Outcomes of Post Mastectomy Radiation Therapy in Patients Receiving Axillary Lymph Node Dissection After Positive Sentinel Lymph Node Biopsy

International Nuclear Information System (INIS)

Stauder, Michael C.; Caudle, Abigail S.; Allen, Pamela K.; Shaitelman, Simona F.; Smith, Benjamin D.; Hoffman, Karen E.; Buchholz, Thomas A.; Chavez-Macgregor, Mariana; Hunt, Kelly K.; Meric-Bernstam, Funda; Woodward, Wendy A.

2016-01-01

Purpose: We sought to determine the rate of postmastectomy radiation therapy (PMRT) among women treated with axillary lymph node dissection (ALND) after positive sentinel lymph node (SLN) biopsy results and to establish the effect of negative ALND results and PMRT on locoregional recurrence (LRR) and overall survival (OS). Methods and Materials: All patients were treated with mastectomy and ALND after positive SLN biopsy results. All patients had clinical N0 or NX disease at the time of mastectomy and received no neoadjuvant therapy. The presence of lymphovascular space invasion, presence of multifocality, number of positive SLNs and non-SLNs, clinical and pathologic stage, extranodal extension, age, and use of PMRT were evaluated for significance regarding the rates of OS and LRR. Results: A total of 345 patients were analyzed. ALND after positive SLN biopsy results was negative in 235 patients (68.1%), and a total of 112 patients (32.5%) received radiation therapy. On multivariate analysis, only pathologic stage III predicted for lower OS (hazard ratio, 3.32; P<.001). The rate of 10-year freedom from LRR was 87.9% and 95.3% in patients with positive ALND results and patients with negative ALND results, respectively. In patients with negative ALND results with ≥3 positive SLNs, the rate of freedom from LRR was 74.7% compared with 96.7% in those with <3 positive SLNs (P=.009). In patients with negative ALND results, ≥3 positive SLNs predicted for an increase in LRR on multivariate analysis (hazard ratio, 10.10; P=.034). Conclusions: A low proportion of cT1-2, N0 patients with positive SLNs who undergo mastectomy receive PMRT after ALND. Even in this low-risk cohort, patients with ≥3 positive SLNs and negative ALND results are at increased risk of LRR and may benefit from PMRT.

Outcomes of Post Mastectomy Radiation Therapy in Patients Receiving Axillary Lymph Node Dissection After Positive Sentinel Lymph Node Biopsy

Energy Technology Data Exchange (ETDEWEB)

Stauder, Michael C., E-mail: mstauder@mdanderson.org [Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas (United States); Caudle, Abigail S. [Department of Breast Surgical Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas (United States); Allen, Pamela K.; Shaitelman, Simona F.; Smith, Benjamin D.; Hoffman, Karen E.; Buchholz, Thomas A. [Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas (United States); Chavez-Macgregor, Mariana [Department of Breast Medical Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas (United States); Hunt, Kelly K.; Meric-Bernstam, Funda [Department of Breast Surgical Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas (United States); Woodward, Wendy A. [Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas (United States)

2016-11-01

Purpose: We sought to determine the rate of postmastectomy radiation therapy (PMRT) among women treated with axillary lymph node dissection (ALND) after positive sentinel lymph node (SLN) biopsy results and to establish the effect of negative ALND results and PMRT on locoregional recurrence (LRR) and overall survival (OS). Methods and Materials: All patients were treated with mastectomy and ALND after positive SLN biopsy results. All patients had clinical N0 or NX disease at the time of mastectomy and received no neoadjuvant therapy. The presence of lymphovascular space invasion, presence of multifocality, number of positive SLNs and non-SLNs, clinical and pathologic stage, extranodal extension, age, and use of PMRT were evaluated for significance regarding the rates of OS and LRR. Results: A total of 345 patients were analyzed. ALND after positive SLN biopsy results was negative in 235 patients (68.1%), and a total of 112 patients (32.5%) received radiation therapy. On multivariate analysis, only pathologic stage III predicted for lower OS (hazard ratio, 3.32; P<.001). The rate of 10-year freedom from LRR was 87.9% and 95.3% in patients with positive ALND results and patients with negative ALND results, respectively. In patients with negative ALND results with ≥3 positive SLNs, the rate of freedom from LRR was 74.7% compared with 96.7% in those with <3 positive SLNs (P=.009). In patients with negative ALND results, ≥3 positive SLNs predicted for an increase in LRR on multivariate analysis (hazard ratio, 10.10; P=.034). Conclusions: A low proportion of cT1-2, N0 patients with positive SLNs who undergo mastectomy receive PMRT after ALND. Even in this low-risk cohort, patients with ≥3 positive SLNs and negative ALND results are at increased risk of LRR and may benefit from PMRT.

The comparison between layout and design of APR1400 MCR and EPRI requirement

International Nuclear Information System (INIS)

Suharyo Widagdo; Darlis; Sigit Santoso; T J Suryono

2013-01-01

A good man-machine interface system is needed by a nuclear power reactor because of its complexity and high safety factor. The man-machine interface system is centralized in the main control room (MCR). All of monitoring and controlling activity to keep the installation operation safety can be done from this place. In order to increase its ability in monitoring and controlling a hard effort to raise the interface system to the highest possible level is done not only by using the latest computer technology and instrumentation system but also using Human Engineering, as well. The paper aims to compare the lay out and design the APR1400 MCR and the requirement from EPRI about main control room lay out and design as response of TMI-2 accident. We can see from the discussion that the design of the MCR of APR1400 have been applied the request of EPRI. (author)

Effect of the design change of the LSSBP on core flow distribution of APR+ Reactor

International Nuclear Information System (INIS)

Kim, Kihwan; Euh, Dong-Jin; Choi, Hae-Seob; Kwon, Tae-Soon

2014-01-01

The uniform core inlet flow distribution of an Advanced Power Reactor Plus (APR+) is required to prevent the failure rate of the HIPER fuel assembly and improve the core thermal margin. KEPCO-E and C and KAERI proposed a design change of the Lower Support Structure Bottom Plate (LSSBP), since the core flow rates were intense near the outer region of the intact LSSBP in a previous study. In this study, an experiment was carried out to evaluate the effect of the design change of the LSSBP on the core flow distribution using the APR+ Core Flow and Pressure (ACOP) test facility. The results showed great improvement on the core flow distribution under a 4-pump balanced flow condition. Under the 4-pump balanced flow condition, fifteen tests were repeated using the ACOP test facility to verify the effect of the 50% blocked flow area at the outer region of the LSSBP on the core inlet flow distribution. The profiles of the core inlet mass flow rates were analyzed using ensemble averaged values, and compared with that of the intact LSSBP. The results showed great improvement for the overall core region. The change in design of the LSSBP is expected to improve the hydraulic performance of an APR+ reactor

Extended Station Blackout Analyses of an APR1400 with MARS-KS

International Nuclear Information System (INIS)

Kim, WoongBae; Jang, HyungWook; Oh, Seungjong; Lee, Sangyong

2016-01-01

The Fukushima Dai-ichi nuclear power plant accident shows that natural disasters such as earthquakes and the subsequent tsunamis can cause station blackout for several days. The electricity required for essential systems during a station blackout is provided from the emergency backup batteries installed at the nuclear power plant. In South Korea, in the event of an extended station blackout, the life of these emergency backup batteries has recently been extended from 8 hours to 24 hours at Shin-Kori 5, 6 and APR1400 for design certification. For a battery life of 24 hours, available safety means system, equipment and procedures are studied and analyzed in their ability to cope with an extended station blackout. A sensitivity study of reactor coolant pump seal leakage is performed to verify how different seal leakages could affect the system. For simulating of extended station blackout scenarios, the best estimate MARS-KS was used. In this paper, an APR1400 RELAP5 input deck was developed for station blackout scenario to analyze operation strategy by manually depressurizing the reactor coolant system through the steam generator's secondary side. Additionally, a sensitivity study was performed on reactor coolant pump seal leakage

Extended Station Blackout Analyses of an APR1400 with MARS-KS

Energy Technology Data Exchange (ETDEWEB)

Kim, WoongBae; Jang, HyungWook; Oh, Seungjong; Lee, Sangyong [KEPCO International Nuclear Graduate School, Ulsan (Korea, Republic of)

2016-10-15

The Fukushima Dai-ichi nuclear power plant accident shows that natural disasters such as earthquakes and the subsequent tsunamis can cause station blackout for several days. The electricity required for essential systems during a station blackout is provided from the emergency backup batteries installed at the nuclear power plant. In South Korea, in the event of an extended station blackout, the life of these emergency backup batteries has recently been extended from 8 hours to 24 hours at Shin-Kori 5, 6 and APR1400 for design certification. For a battery life of 24 hours, available safety means system, equipment and procedures are studied and analyzed in their ability to cope with an extended station blackout. A sensitivity study of reactor coolant pump seal leakage is performed to verify how different seal leakages could affect the system. For simulating of extended station blackout scenarios, the best estimate MARS-KS was used. In this paper, an APR1400 RELAP5 input deck was developed for station blackout scenario to analyze operation strategy by manually depressurizing the reactor coolant system through the steam generator's secondary side. Additionally, a sensitivity study was performed on reactor coolant pump seal leakage.

Evaluation of Ablation rate by the change of Sacrificial Material for PECS in EU-APR

International Nuclear Information System (INIS)

Hwang, Do Hyun; Kim, Yong Soo; Lee, Keun Sung

2015-01-01

EU-APR, modified and improved from its original design of APR1400, has been developed to comply with European Utility Requirements (EUR) and nuclear design requirements of the European countries. In EU-APR, Severe Accident Mitigation Systems are dedicated to providing an independent defense line from that of Engineered Safety Feature (ESF) and Diverse Safety Feature (DSF). They consist of Emergency Reactor Depressurization System (ERDS), Passive Ex-vessel corium retaining and Cooling System (PECS), Severe Accident Containment Spray System (SACSS), Hydrogen Mitigation System (HMS) and Containment Filtered Vent System (CFVS). The PECS, so called core catcher, was introduced to prevent the Molten Core Concrete Interaction (MCCI) after Reactor Vessel (RV) failure. The PECS has experienced a lot of changes from its original design. Recently, the most significant change was that as a SM, limestone concrete is installed on PECS's body wall instead of previous sacrificial material rich in Fe 2 O 3 . The main reason of this design change is to overcome the issue that the sacrificial material is ablated rather too fast when reacting with corium that contains a large fraction of Zr metal. Other changes in the geometry of PECS's wall and downcomer design are considered as minor ones. In this paper, the comparison of ablation rates between previous SM and limestone concrete is carried out using MAAP5 code with respective MCCI model according to the material. In this paper, major improvements of MAAP5 model for PECS in EU-APR are presented and the evaluation of ablation rate for the previous SM model and the new LC model is carried out by means of ablation depths with LBLOCA sequence. Two models have respective unique ablation process. The ablation of LC model proceeds at a constant rate regardless of water while the ablation of SM model proceeds at a faster rate before the arrival of cooling water for corium and SM mixture. The change of sacrificial material also

Locoregional first recurrence after mastectomy: prospective cohort studies with and without immediate chemotherapy

International Nuclear Information System (INIS)

Haylock, Brian J.; Coppin, Chris M.L.; Jackson, Jeremy; Basco, Vivien E.; Wilson, Kenneth S.

2000-01-01

Purpose: To evaluate prospectively the impact of combination chemotherapy in the combined modality treatment of isolated first locoregional recurrence (LRR) following mastectomy for breast cancer. Methods and Materials: Between 1979 and 1989, 120 chemotherapy-naive women with isolated LRR as first failure after mastectomy were prospectively identified, uniformly staged, and systematically followed. Treatment consisted of excision if feasible, radical locoregional radiotherapy, and a hormonal maneuver (unless estrogen receptor negative). The initial chemotherapy cohort also received 8 cycles of doxorubicin and cyclophosphamide. This was compared to a subsequent control cohort. Results: For all patients, the 10-year actuarial relapse-free survival ± 95% confidence interval was 42.1 ± 9.2%, and overall survival was 56.8 ± 9.1%. No difference was seen in locoregional control between cohorts. At 5 years, distant recurrence-free survival for chemotherapy and control cohort respectively was 75.4 ± 10.8% and 60.7 ±12.5% (p = 0.33) and overall survival was 81.9% ± 9.6 and 74.3% ± 11.2 (p = 0.24). Univariate analysis showed no prognostic importance for any imbalance between cohorts. Cox modeling confirmed that complete resection was strongly associated with fewer LRR (hazard ratio [HR] 0.32, p = 0.001) and also with better overall survival (HR 1.82, p = 0.019). Chemotherapy produced a substantial reduction in risk of death (HR 0.72 CI 0.421-1.235, p = 0.23). Conclusions: In this prospective but nonrandomized study of treatment for first LRR, the risk of death in the later control cohort was 1.39 times the risk in the chemotherapy cohort but failed to reach statistical significance. The results justify further study

Contralateral prophylactic mastectomy: current perspectives

Science.gov (United States)

Yao, Katharine; Sisco, Mark; Bedrosian, Isabelle

2016-01-01

There has been an increasing trend in the use of contralateral prophylactic mastectomy (CPM) in the United States among women diagnosed with unilateral breast cancer, particularly young women. Approximately one-third of women CPM in the US. Most studies have shown that the CPM trend is mainly patient-driven, which reflects a changing environment for newly diagnosed breast cancer patients. The most common reason that women choose CPM is based on misperceptions about CPM’s effect on survival and overestimation of their contralateral breast cancer (CBC) risk. No prospective studies have shown survival benefit to CPM, and the CBC rate for most women is low at 10 years. Fear of recurrence is also a big driver of CPM decisions. Nonetheless, studies have shown that women are mostly satisfied with undergoing CPM, but complications and subsequent surgeries with reconstruction have been associated with dissatisfaction with CPM. Studies on surgeon’s perspectives on CPM are sparse but show that the most common reasons surgeons discuss CPM with patients is because of a suspicious family history or for a patient who is a confirmed BRCA mutation carrier. Studies on the cost–effectiveness of CPM have been conflicting and are highly dependent on patient’s quality of life after CPM. Most recent guidelines for CPM are contradictory. Future areas of research include the development of interventions to better inform patients about CPM, modification of the guidelines to form a more consistent statement, longer term studies on CBC risk and CPM’s effect on survival, and prospective studies that track the psychosocial effects of CPM on body image and sexuality. PMID:27382334

Physical therapy after total mastectomy surgery in breast cancer

Directory of Open Access Journals (Sweden)

Andreia Cismaş

2011-12-01

Full Text Available Breast cancer is the most common type of cancer among women in the whole world. It is caused by the development of malignant cells in the breast. In cancer patients, physical therapy has resulted in improved physical functioning, cardiovascular fitness, sleep, quality of life, psychological and social well-being, and self esteem, and significant decreases in fatigue, anxiety and depression. Aim: The aim of this study is to underline the importance of physical therapy in the rehabilitation of patients after total mastectomy surgery in breast cancer. Material and methods: We investigated 14 women aged between 45 and 75 years old, diagnosed with breast cancer (stages I–III, having a total mastectomy surgery 6 months ago. At the beginning and after 2 weeks of intervention, the subject`s evaluations consisted in: each patient was evaluated in regard to shoulder flexibility (from Test 1 to Test 8; on the other hand, we measured the upper limb circumferences on the surgery side. The physical therapy programme consisted in 10 sessions of 20 minutes lymphatic drainage and 10 minutes individualized physical therapy programmes. Results: At the end of intervention, it was observed a score improvement at Test 2 (from 1.28±0.99 to 1.85±0.53, p=0.041, Test 3 (from 0.42±0.85 to 1.57±0.85, p=0.001, Test 7 (from 0.5±0.51 to 0.85±0.36, p=0.019 and Test 8 (from 1.28±0.99 to 1.85±0.53, p=0.041. In terms of total score (Total, the improvement was also significant increased (from 13.25±9.08 to 18.13±10.12, p=0.044. Circumference values significantly improved at arm (from 30.36±4.25 to 29.79±4.41, p=0.001, forearm (from 23±2.18 to 22.04±2.26, p=0.001 and wrist level (from 17.46±1.74 to 17.11±1.67, p=0.012. Despite the intervention, elbow circumference didn`t reached the statistical significance (p<0.05. Conclusions: After 2 weeks of intervention we noticed a significant improvement at most of the parameters which means a life quality increase in

The subtilisin-like protease AprV2 is required for virulence and uses a novel disulphide-tethered exosite to bind substrates.

Directory of Open Access Journals (Sweden)

Ruth M Kennan

Full Text Available Many bacterial pathogens produce extracellular proteases that degrade the extracellular matrix of the host and therefore are involved in disease pathogenesis. Dichelobacter nodosus is the causative agent of ovine footrot, a highly contagious disease that is characterized by the separation of the hoof from the underlying tissue. D. nodosus secretes three subtilisin-like proteases whose analysis forms the basis of diagnostic tests that differentiate between virulent and benign strains and have been postulated to play a role in virulence. We have constructed protease mutants of D. nodosus; their analysis in a sheep virulence model revealed that one of these enzymes, AprV2, was required for virulence. These studies challenge the previous hypothesis that the elastase activity of AprV2 is important for disease progression, since aprV2 mutants were virulent when complemented with aprB2, which encodes a variant that has impaired elastase activity. We have determined the crystal structures of both AprV2 and AprB2 and characterized the biological activity of these enzymes. These data reveal that an unusual extended disulphide-tethered loop functions as an exosite, mediating effective enzyme-substrate interactions. The disulphide bond and Tyr92, which was located at the exposed end of the loop, were functionally important. Bioinformatic analyses suggested that other pathogenic bacteria may have proteases that utilize a similar mechanism. In conclusion, we have used an integrated multidisciplinary combination of bacterial genetics, whole animal virulence trials in the original host, biochemical studies, and comprehensive analysis of crystal structures to provide the first definitive evidence that the extracellular secreted proteases produced by D. nodosus are required for virulence and to elucidate the molecular mechanism by which these proteases bind to their natural substrates. We postulate that this exosite mechanism may be used by proteases produced by

Investigation of the Condensation Effect at IRWST Pool Surface on Containment Back Pressure in APR1400 Containment

International Nuclear Information System (INIS)

Lee, Eui Jong; Lee, Jin Yong; Lee, Byung Chul

2006-01-01

The APR1400 has several new design concepts in order to improve the plant safety functions during a postulated accident. The In-Containment Refueling Water Storage Tank (IRWST) is one of the new design concepts of APR1400 and installed at the bottom of containment building to promote the plant safety functions by simplifying emergency core cooling water source and preventing release of the fission product during an accidents. This design feature, however, brings about uncertainty factors which may necessitate conventional prediction of temperature and pressure of containment building improved or revised under accident conditions. The hot steam which is released from RCS break enters into the IRWST through four Pressure Relief Dampers (PRDs). It is expected to be condensed with water stored in IRWST, colder than incoming steam. The purpose of this study is to examine closely the influence of the condensation effect at IRWST on containment back pressure in APR1400 containment building using the GOTHIC code which can predict the steam condensation on IRWST pool surface

Post-Mastectomy Radiation Therapy for Invasive Lobular Carcinoma: A Comparative Utilization and Outcomes Study.

Science.gov (United States)

Stecklein, Shane R; Shen, Xinglei; Mitchell, Melissa P

2016-08-01

To date, there have been no analyses to assess factors that influence post-mastectomy radiation therapy (PMRT) utilization in invasive lobular carcinoma (ILC) or to quantify the benefit of PMRT in ILC as compared with invasive ductal carcinoma (IDC). We compared histology-specific utilization of PMRT by tumor and patient characteristics and estimated the effect of PMRT on overall and breast cancer-specific survival in ILC and IDC patients meeting American College of Radiology (ACR) criteria for PMRT. We used the Surveillance, Epidemiology, and End Results database to identify women diagnosed with ILC or IDC from 2004 to 2009 who underwent mastectomy. We assessed utilization of PMRT by T and N stage, analyzed factors associated with PMRT use, and quantified the histology-specific survival benefit of PMRT using log-rank tests and multivariate Cox regression analysis. We identified 86,098 IDC and 12,703 ILC patients. Within this cohort, 18.7% of IDC patients and 26.1% of ILC met ACR criteria for PMRT. Among patients with a definite indication, PMRT was more commonly employed in ILC than in IDC (59.6% vs. 56.3%; P = .0004). Among patients with a definite indication for PMRT, radiation improved 5-year breast cancer-specific survival from 71.4% to 77.0% for IDC (P cancer-specific survival for ILC patients to a degree comparable with that seen in IDC. Moreover, among ILC and IDC patients who meet ACR criteria, PMRT appears to be significantly underutilized. Copyright © 2016 Elsevier Inc. All rights reserved.

The Alberta Pregnancy Outcomes and Nutrition (APrON) cohort study : rationale and methods

NARCIS (Netherlands)

Kaplan, Bonnie J.; Giesbrecht, Gerald F.; Leung, Brenda M. Y.; Field, Catherine J.; Dewey, Deborah; Bell, Rhonda C.; Manca, Donna P.; O'Beirne, Maeve; Johnston, David W.; Pop, Victor J.; Singhal, Nalini; Gagnon, Lisa; Bernier, Francois P.; Eliasziw, Misha; McCargar, Linda J.; Kooistra, Libbe; Farmer, Anna; Cantell, Marja; Goonewardene, Laki; Casey, Linda M.; Letourneau, Nicole; Martin, Jonathan W.

The Alberta Pregnancy Outcomes and Nutrition (APrON) study is an ongoing prospective cohort study that recruits pregnant women early in pregnancy and, as of 2012, is following up their infants to 3 years of age. It has currently enrolled approximately 5000 Canadians (2000 pregnant women, their

The Alberta Pregnancy Outcomes and Nutrition (APrON) cohort study : Rationale and methods

NARCIS (Netherlands)

Kaplan, B.J.; Giesbrecht, G.F.; Leung, B.M.; Field, C.J.; Dewey, D.; Bell, R.C.; Manca, D.P.; O'Beirne, M.; Johnston, D.W.; Pop, V.J.M.; Singhal, N.; Gagnon, L.; Bernier, F.P.; Eliasziw, M.; McCargar, L.J.; Kooistra, L.; Farmer, A.; Cantell, M.; Goonewardene, L.; Casey, L.M.; Letourneau, N.; Martin, J.W.

2014-01-01

The Alberta Pregnancy Outcomes and Nutrition (APrON) study is an ongoing prospective cohort study that recruits pregnant women early in pregnancy and, as of 2012, is following up their infants to 3 years of age. It has currently enrolled approximately 5000 Canadians (2000 pregnant women, their

Calculation of fuel and moderator temperature coefficients in APR1400 nuclear reactor by MVP code

International Nuclear Information System (INIS)

Pham Tuan Nam; Le Thi Thu; Nguyen Huu Tiep; Tran Viet Phu

2014-01-01

In this project, these fuel and moderator temperature coefficients were calculated in APR1400 nuclear reactor by MVP code. APR1400 is an advanced water pressurized reactor, that was researched and developed by Korea Experts, its electric power is 1400 MW. The neutronics calculations of full core is very important to analysis and assess a reactor. Results of these calculation is input data for thermal-hydraulics calculations, such as fuel and moderator temperature coefficients. These factors describe the self-safety characteristics of nuclear reactor. After obtaining these reactivity parameters, they were used to re-run the thermal hydraulics calculations in LOCA and RIA accidents. These thermal-hydraulics results were used to analysis effects of reactor physics parameters to thermal hydraulics situation in nuclear reactors. (author)

Risk-reducing mastectomy and salpingo-oophorectomy in unaffected BRCA mutation carriers: uptake and timing

DEFF Research Database (Denmark)

Skytte, A-B; Gerdes, Anne-Marie Axø; Andersen, M K

2010-01-01

from 306 healthy BRCA carriers with no personal history of ovarian or breast cancer. We found a 10-year uptake of 75% for risk-reducing salpingo-oophorectomy and 50% for risk-reducing mastectomy by time to event analysis. Age and childbirth influenced this decision. The uptake rate has not changed......Once female carriers of a BRCA mutation are identified they have to make decisions on risk management. The aim of this study is to outline the uptake of risk-reducing surgery in the Danish population of BRCA mutation positive women and to search for factors affecting this decision. We analysed data...

An analysis of the 'costs and effectiveness' of post-mastectomy local-regional radiation therapy

International Nuclear Information System (INIS)

Marks, L.B.; Prosnitz, L.R.; Hardenbergh, P.H.; Winer, E.T.

1997-01-01

Purpose: To estimate the 'cost/effectiveness' ratio for post-mastectomy local-regional radiation therapy (LR-XRT) for patients with breast cancer. As the risk of local-regional recurrence (LRR) is related to the number of positive axillary lymph nodes, the cost/effectiveness ratio of LR-XRT was assessed for a variable number of positive axillary nodes. For overall survival (OS), the cost per additional life-year is estimated as a function of follow-up duration. Methods/Assumptions: Literature data indicate that the risk of LRR is related to the number of positive axillary nodes (e.g. Fowble, Kuske). For example, the LRR rate is ∼10% for patients with negative nodes, increasing to ∼40% for patients with ≥4 positive nodes. Such data are used to linearly relate the number of positive nodes with the risk of LRR. Additional assumptions include: RT reduces the risk of LRR by 67%; local recurrences are treated with exision/biopsy, LR-XRT and systemic chemotherapy; half of the local recurrences are controlled locally and half will require additional salvage treatment with surgery or chemotherapy. The 5, 10 and 15 yr improvements in OS provided by LR-XRT are estimated to be 3, 7, and 10%, respectively, based on the literature (Overgaard, Ragaz, Klefstrom, Rutqvist). For each year following LR-XRT, the accrued life-years gained are estimated from the published survival curves. Professional and technical charges are used as a surrogate for costs, as follows (in thousands): LR-XRT-15; evaluation of recurrence-2; biopsy plus pathology-1; resection plus pathology-7, chemotherapy-10. Results: The cost per LRR prevented with the addition of routine post-mastectomy LR-XRT is shown, as a function of the number of positive axillary nodes. The cost per additional life-year gained with LR-XRT, as a function of follow-up duration, is shown. With increasing follow-up, the cost per life-year gained decreases as the additional life-years accrue. Conclusions: The cost per LRR

Effect of modified surgical method on subcutaneous hydrops of patients with breast cancer after modified radical mastectomy

OpenAIRE

Yan Li; Hua-Feng Pan; Gui-Lan Sun

2016-01-01

Objective: Through prospective randomized clinical study,to observe the preventive effect of improved surgical method to subcutaneous hydrops after modified radical mastec tomy. Method: A total of 80 cases of patients who have done modified radical mastectomy were selected, and randomly divided them into study group (40 cases) and control group (40 cases), then adopted different surgical methods as followed respectively, to observe the daily drainage volume at the first 3 d after ...

The effect of nodalization and temperature of reactor upper region: Sensitivity analysis for APR-1400 LBLOCA

International Nuclear Information System (INIS)

Kang, Dong Gu

2017-01-01

Highlights: • The nodalization of APR-1400 was modified to reflect the characteristic of upper region temperature. • The effect of nodalization and temperature of reactor upper region on LBLOCA consequence was evaluated. • The modification of nodalization is an essential prerequisite in APR-1400 LBLOCA analysis. - Abstract: In best estimate (BE) calculation, the definition of system nodalization is important step influencing the prediction accuracy for specific thermal-hydraulic phenomena. The upper region of reactor is defined as the region of the upper guide structure (UGS) and upper dome. It has been assumed that the temperature of upper region is close to average temperature in most large break loss of coolant accident (LBLOCA) analysis cases. However, it was recently found that the temperature of upper region of APR-1400 reactor might be little lower than or similar to hot leg temperature through the review of detailed design data. In this study, the nodalization of APR-1400 was modified to reflect the characteristic of upper region temperature, and the effect of nodalization and temperature of reactor upper region on LBLOCA consequence was evaluated by sensitivity analysis including best estimate plus uncertainty (BEPU) calculation. In basecase calculation, in case of modified version, the peak cladding temperature (PCT) in blowdown phase became higher and the blowdown quenching (or cooling) was significantly deteriorated as compared to original case, and as a result, the cladding temperature in reflood phase became higher and the final quenching was also delayed. In addition, thermal-hydraulic parameters were compared and analyzed to investigate the effect of change of upper region on cladding temperature. In BEPU analysis, the 95 percentile PCT used in current regulatory practice was increased due to the modification of upper region nodalization, and it occurred in the reflood phase unlike original case.

Nipple placement in simple mastectomy with free nipple grafting for severe gynecomastia.

Science.gov (United States)

Murphy, T P; Ehrlichman, R J; Seckel, B R

1994-11-01

Severe gynecomastia with excessive skin is difficult to treat by only periareolar excision or suction-assisted lipectomy or both. In these patients, total mastectomy and free nipple grafting may be the best option. Placement of the nipple, however, has been arbitrary. With use of 20 "aesthetically perfect" men as models, standard nipple distances were identified. The average sternal notch-to-nipple measurement was 21 cm. In addition, two consistent ratios were identified. The nipple plane was located 0.33 times the distance from the sternal notch to the pubis, and the internipple distance was 0.23 times the chest circumference. With use of preoperatively obtained measurements of the sternal notch to pubis and chest circumference, accurate nipple placement can be accomplished.

Characterisation of the thermostable protease AprX in strains of Pseudomonas fluorescens and impact on the shelf-life of dairy products: preliminary results

Directory of Open Access Journals (Sweden)

Nadia Andrea Andreani

2016-12-01

Full Text Available Bacterial proteases are involved in food spoilage and shelf-life reduction. Among the bacterial proteases, a predominant role in spoilage of dairy products seems to be played by the thermostable metallo-protease AprX, which is produced by various strains of Pseudomonas fluorescens. Differences in AprX enzyme activity among different strains were highlighted, but the most proteolytic strains were not identified. In this study, the presence of the aprX gene was evaluated in 69 strains isolated from food matrices and 18 reference strains belonging to the P. fluorescens group, which had been previously typed by the multi locus sequence typing method. Subsequently, a subset of reference strains was inoculated in ultra-high temperature milk, and the expression of the aprX gene was evaluated at 22 and 6°C. On the same milk samples, the proteolytic activity was then evaluated through Azocasein and trinitrobenzenesulfonic acid solution assays. Finally, to assess the applicability of the former assay directly on dairy products the proteolityc activity was tested on industrial ricotta samples using the Azocasein assay. These results demonstrate the spread of aprX gene in most strains tested and the applicability of Azocasein assay to monitor the proteolytic activity in dairy products.

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

A clinical randomized controlled trial of music therapy and progressive muscle relaxation training in female breast cancer patients after radical mastectomy: results on depression, anxiety and length of hospital stay.

Science.gov (United States)

Zhou, Kaina; Li, Xiaomei; Li, Jin; Liu, Miao; Dang, Shaonong; Wang, Duolao; Xin, Xia

2015-02-01

To examine effects of music therapy and progressive muscle relaxation training on depression, anxiety and length of hospital stay in Chinese female breast cancer patients after radical mastectomy. A total of 170 patients were randomly allocated to the intervention group (n = 85) receiving music therapy and progressive muscle relaxation training plus routine nursing care and the control group (n = 85) receiving routine nursing care. Music therapy and progressive muscle relaxation training were performed twice a day within 48 h after radical mastectomy, once in the early morning (6a.m.-8a.m.) and once in the evening (9p.m.-11p.m.), for 30 min per session until discharged from the hospital. A general linear model with univariate analysis showed that the intervention group patients had significant improvement in depression and anxiety in the effects of group (F = 20.31, P Music therapy and progressive muscle relaxation training can reduce depression, anxiety and length of hospital stay in female breast cancer patients after radical mastectomy. Copyright © 2014 Elsevier Ltd. All rights reserved.

Complex regulation of AprA metalloprotease in Pseudomonas fluorescens M114: evidence for the involvement of iron, the ECF sigma factor, PbrA and pseudobactin M114 siderophore.

Science.gov (United States)

Maunsell, Bláithín; Adams, Claire; O'Gara, Fergal

2006-01-01

In the soil bacterium Pseudomonas fluorescens M114, extracellular proteolytic activity and fluorescent siderophore (pseudobactin M114) production were previously shown to be co-ordinately negatively regulated in response to environmental iron levels. An iron-starvation extracytoplasmic function sigma factor, PbrA, required for the transcription of siderophore biosynthetic genes, was also implicated in M114 protease regulation. The current study centred on the characterization and genetic regulation of the gene(s) responsible for protease production in M114. A serralysin-type metalloprotease gene, aprA, was identified and found to encode the major, if not only, extracellular protease produced by this strain. The expression of aprA and its protein product were found to be subject to complex regulation. Transcription analysis confirmed that PbrA was required for full aprA transcription under low iron conditions, while the ferric uptake regulator, Fur, was implicated in aprA repression under high iron conditions. Interestingly, the iron regulation of AprA was dependent on culture conditions, with PbrA-independent AprA-mediated proteolytic activity observed on skim milk agar supplemented with yeast extract, when supplied with iron or purified pseudobactin M114. These effects were not observed on skim milk agar without yeast extract. PbrA-independent aprA expression was also observed from a truncated transcriptional fusion when grown in sucrose asparagine tryptone broth supplied with iron or purified pseudobactin M114. Thus, experimental evidence suggested that iron mediated its effects via transcriptional activation by PbrA under low iron conditions, while an as-yet-unidentified sigma factor(s) may be required for the PbrA-independent aprA expression and AprA proteolytic activity induced by siderophore and iron.

Expression, purification, and characterization of the Necator americanus aspartic protease-1 (Na-APR-1 (M74)) antigen, a component of the bivalent human hookworm vaccine.

Science.gov (United States)

Seid, Christopher A; Curti, Elena; Jones, R Mark; Hudspeth, Elissa; Rezende, Wanderson; Pollet, Jeroen; Center, Lori; Versteeg, Leroy; Pritchard, Sonya; Musiychuk, Konstantin; Yusibov, Vidadi; Hotez, Peter J; Bottazzi, Maria Elena

2015-01-01

Over 400 million people living in the world's poorest developing nations are infected with hookworms, mostly of the genus Necator americanus. A bivalent human hookworm vaccine composed of the Necator americanus Glutathione S-Transferase-1 (Na-GST-1) and the Necator americanus Aspartic Protease-1 (Na-APR-1 (M74)) is currently under development by the Sabin Vaccine Institute Product Development Partnership (Sabin PDP). Both monovalent vaccines are currently in Phase 1 trials. Both Na-GST-1 and Na-APR-1 antigens are expressed as recombinant proteins. While Na-GST-1 was found to express with high yields in Pichia pastoris, the level of expression of Na-APR-1 in this host was too low to be suitable for a manufacturing process. When the tobacco plant Nicotiana benthamiana was evaluated as an expression system, acceptable levels of solubility, yield, and stability were attained. Observed expression levels of Na-APR-1 (M74) using this system are ∼300 mg/kg. Here we describe the achievements and obstacles encountered during process development as well as characterization and stability of the purified Na-APR-1 (M74) protein and formulated vaccine. The expression, purification and analysis of purified Na-APR-1 (M74) protein obtained from representative 5 kg reproducibility runs performed to qualify the Na-APR-1 (M74) production process is also presented. This process has been successfully transferred to a pilot plant and a 50 kg scale manufacturing campaign under current Good Manufacturing Practice (cGMP) has been performed. The 50 kg run has provided a sufficient amount of protein to support the ongoing hookworm vaccine development program of the Sabin PDP.

Extended station blackout analyses of an APR1400 with MARS-KS

Directory of Open Access Journals (Sweden)

Kim Woongbae

2016-01-01

Full Text Available The Fukushima Daiichi nuclear power plant accident shows that natural disasters such as earthquakes and the subsequent tsunamis can cause station blackout for several days. The electric energy required for essential systems during a station blackout is provided from emergency backup batteries installed at the nuclear power plant. In South Korea, in the event of an extended station blackout, the life of these emergency backup batteries has recently been extended from 8 hours to 24 hours at Shin-Kori 5, 6, and APR1400 for design certification. For a battery life of 24 hours, available safety means system, equipment and procedures are studied and analyzed in their ability to cope with an extended station blackout. A sensitivity study of reactor coolant pump seal leakage is performed to verify how different seal leakages could affect the system. For simulating extended station blackout scenarios, the best estimate MARS-KS computer code was used. In this paper, an APR1400 RELAP5 input deck was developed for station blackout scenario to analyze operation strategy by manually depressurizing the reactor coolant system through the steam generator's secondary side. Additionally, a sensitivity study on reactor coolant pump seal leakage was carried out.

Evaluation of Ablation rate by the change of Sacrificial Material for PECS in EU-APR

Energy Technology Data Exchange (ETDEWEB)

Hwang, Do Hyun; Kim, Yong Soo; Lee, Keun Sung [KHNP-CRI, Daejeon (Korea, Republic of)

2015-05-15

EU-APR, modified and improved from its original design of APR1400, has been developed to comply with European Utility Requirements (EUR) and nuclear design requirements of the European countries. In EU-APR, Severe Accident Mitigation Systems are dedicated to providing an independent defense line from that of Engineered Safety Feature (ESF) and Diverse Safety Feature (DSF). They consist of Emergency Reactor Depressurization System (ERDS), Passive Ex-vessel corium retaining and Cooling System (PECS), Severe Accident Containment Spray System (SACSS), Hydrogen Mitigation System (HMS) and Containment Filtered Vent System (CFVS). The PECS, so called core catcher, was introduced to prevent the Molten Core Concrete Interaction (MCCI) after Reactor Vessel (RV) failure. The PECS has experienced a lot of changes from its original design. Recently, the most significant change was that as a SM, limestone concrete is installed on PECS's body wall instead of previous sacrificial material rich in Fe{sub 2}O{sub 3}. The main reason of this design change is to overcome the issue that the sacrificial material is ablated rather too fast when reacting with corium that contains a large fraction of Zr metal. Other changes in the geometry of PECS's wall and downcomer design are considered as minor ones. In this paper, the comparison of ablation rates between previous SM and limestone concrete is carried out using MAAP5 code with respective MCCI model according to the material. In this paper, major improvements of MAAP5 model for PECS in EU-APR are presented and the evaluation of ablation rate for the previous SM model and the new LC model is carried out by means of ablation depths with LBLOCA sequence. Two models have respective unique ablation process. The ablation of LC model proceeds at a constant rate regardless of water while the ablation of SM model proceeds at a faster rate before the arrival of cooling water for corium and SM mixture. The change of sacrificial material

The value of completion axillary treatment in sentinel node positive breast cancer patients undergoing a mastectomy: a Dutch randomized controlled multicentre trial (BOOG 2013-07)

International Nuclear Information System (INIS)

Roozendaal, L. M. van; Wilt, J. HW de; Dalen, T. van; Hage, J. A. van der; Strobbe, L. JA; Boersma, L. J.; Linn, S. C.; Lobbes, M. BI; Poortmans, P. MP; Tjan-Heijnen, V. CG; Van de Vijver, K. KBT; Vries, J. de; Westenberg, A. H.; Kessels, A. GH; Smidt, M. L.

2015-01-01

Trials failed to demonstrate additional value of completion axillary lymph node dissection in case of limited sentinel lymph node metastases in breast cancer patients undergoing breast conserving therapy. It has been suggested that the low regional recurrence rates in these trials might partially be ascribed to accidental irradiation of part of the axilla by whole breast radiation therapy, which precludes extrapolation of results to mastectomy patients. The aim of the randomized controlled BOOG 2013–07 trial is therefore to investigate whether completion axillary treatment can be safely omitted in sentinel lymph node positive breast cancer patients treated with mastectomy. This study is designed as a non-inferiority randomized controlled multicentre trial. Women aged 18 years or older diagnosed with unilateral invasive clinically T1-2 N0 breast cancer who are treated with mastectomy, and who have a maximum of three axillary sentinel lymph nodes containing micro- and/or macrometastases, will be randomized for completion axillary treatment versus no completion axillary treatment. Completion axillary treatment can consist of completion axillary lymph node dissection or axillary radiation therapy. Primary endpoint is regional recurrence rate at 5 years. Based on a 5-year regional recurrence free survival rate of 98 % among controls and 96 % for study subjects, the sample size amounts 439 per arm (including 10 % lost to follow-up), to be able to reject the null hypothesis that the rate for study and control subjects is inferior by at least 5 % with a probability of 0.8. Results will be reported after 5 and 10 years of follow-up. We hypothesize that completion axillary treatment can be safely omitted in sentinel node positive breast cancer patients undergoing mastectomy. If confirmed, this study will significantly decrease the number of breast cancer patients receiving extensive treatment of the axilla, thereby diminishing the risk of morbidity and improving quality of

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

A review of the literature and discussion: establishing a consensus for the definition of post-mastectomy pain syndrome to provide a standardized clinical and research approach.

Science.gov (United States)

Brackstone, Murial

2016-09-01

Chronic pain presents a management challenge for physicians and patients alike, and post-mastectomy pain is no exception. In this issue, Waltho and Rockwell present a review of post-mastectomy pain syndrome (PMPS) and propose a standard definition that should allow future studies to be comparable. The proposed definition of "post-breast surgery pain syndrome" includes pain after any type of breast surgery that is of at least moderate intensity and comprises neuropathic qualities, that is present in the ipsilateral breast/chest/arm, that lasts longer than 6 months and is present at least half the time. Further work is needed to clarify whether this pain syndrome is in fact driven by neuralgia resulting from the axillary dissection component of breast cancer surgery.

Outcomes of patients with abdominoperineal resection (APR) and low anterior resection (LAR) who had very low rectal cancer.

Science.gov (United States)

Yeom, Seung-Seop; Park, In Ja; Jung, Sung Woo; Oh, Se Heon; Lee, Jong Lyul; Yoon, Yong Sik; Kim, Chan Wook; Lim, Seok-Byung; Kim, Nayoung; Yu, Chang Sik; Kim, Jin Cheon

2017-10-01

We compared the oncological outcomes of sphincter-saving resection (SSR) and abdominoperineal resection (APR) in 409 consecutive patients with very low rectal cancer (i.e., tumors within 3 cm from the anal verge); 335 (81.9%) patients underwent APR and 74 (18.1%) underwent SSR. The APR group comprised higher proportions of men (67.5% vs 55.4%, P = .049) and advanced-stage patients (P cancer stages. RFS was associated with ypT and ypN stages in patients who received PCRT, while pN stage, lymphovascular invasion (LVI), and circumferential resection margin (CRM) involvement were risk factors for RFS in those who did not receive PCRT. Notably, SSR was not found to be a risk factor for RFS in either subgroup. Patients who were stratified according to cancer stage and PCRT also showed no differences in RFS according to the mode of surgery. Our results demonstrate that, regardless of PCRT administration, SSR is an effective treatment for very low rectal cancer, while CRM is an important prognostic factor for patients who did not receive PCRT.

Development of phenomena identification and ranking table for APR1400 main steam line break

International Nuclear Information System (INIS)

Song, J. H.; Chung, B. D.; Jeong, J. J.

2003-01-01

A Phenomena Identification and Ranking Table (PIRT) was developed for the Main Steam Line Break (MSLB) event of an APR-1400 (Advanced Power Reactor-1400). A team of experts from research institutes, industries, and regulatory bodies participated in the development. The selected event was a double-ended steam line break at full power with the reactor coolant pump running. The panel selected the fuel performance as the primary safety criterion for ranking. The plant design data, the results of APR-1400 safety analysis, and the results of additional best estimate analysis by MARS2.1 were utilized. Three phases of pre-trip, rapid cool-down, and safety injection phase were identified. Then, the ranking of a system, components, phenomenon/process based on the relative importance to the primary evaluation criterion were followed for each time phase. Finally, the knowledge-level for each important process in the component was ranked in terms of the existing knowledge. The highly ranked phenomena identified for APR-1400 MSLB are tube wall heat transfer at the steam generator shell, void distribution at the steam generator shell, liquid entrainment in the separators, mixture level in the separators, boron mixing in the upper down comer, boron transport and thermal mixing in the lower plenum, stored energy release in the upper head, and flow to and/from the upper head. The PIRT will be used as a guide in planning cost effective experimental programs and code development efforts, especially for the quantification of the process and/or phenomena, which have a high importance but low knowledge level

Preoperative paravertebral blocks for the management of acute pain following mastectomy: a cost-effectiveness analysis.

Science.gov (United States)

Offodile, Anaeze C; Sheckter, Clifford C; Tucker, Austin; Watzker, Anna; Ottino, Kevin; Zammert, Martin; Padula, William V

2017-10-01

Preoperative paravertebral blocks (PPVBs) are routinely used for treating post-mastectomy pain, yet uncertainties remain about the cost-effectiveness of this modality. We aim to evaluate the cost-effectiveness of PPVBs at common willingness-to-pay (WTP) thresholds. A decision analytic model compared two strategies: general anesthesia (GA) alone versus GA with multilevel PPVB. For the GA plus PPVB limb, patients were subjected to successful block placement versus varying severity of complications based on literature-derived probabilities. The need for rescue pain medication was the terminal node for all postoperative scenarios. Patient-reported pain scores sourced from published meta-analyses measured treatment effectiveness. Costing was derived from wholesale acquisition costs, the Medicare fee schedule, and publicly available hospital charge masters. Charges were converted to costs and adjusted for 2016 US dollars. A commercial payer perspective was adopted. Incremental cost-effectiveness ratios (ICERs) were evaluated against WTP thresholds of $500 and $50,000 for postoperative pain control. The ICER for preoperative paravertebral blocks was $154.49 per point reduction in pain score. 15% variation in inpatient costs resulted in ICER values ranging from $124.40-$180.66 per pain point score reduction. Altering the probability of block success by 5% generated ICER values of $144.71-$163.81 per pain score reduction. Probabilistic sensitivity analysis yielded cost-effective trials 69.43% of the time at $500 WTP thresholds. Over a broad range of probabilities, PPVB in mastectomy reduces postoperative pain at an acceptable incremental cost compared to GA. Commercial payers should be persuaded to reimburse this technique based on convincing evidence of cost-effectiveness.

Sequencing chemotherapy and radiotherapy in locoregional advanced breast cancer patients after mastectomy – a retrospective analysis

International Nuclear Information System (INIS)

Piroth, Marc D; Pinkawa, Michael; Gagel, Bernd; Stanzel, Sven; Asadpour, Branka; Eble, Michael J

2008-01-01

Combined chemo- and radiotherapy are established in breast cancer treatment. Chemotherapy is recommended prior to radiotherapy but decisive data on the optimal sequence are rare. This retrospective analysis aimed to assess the role of sequencing in patients after mastectomy because of advanced locoregional disease. A total of 212 eligible patients had a stage III breast cancer and had adjuvant chemotherapy and radiotherapy after mastectomy and axillary dissection between 1996 and 2004. According to concerted multi-modality treatment strategies 86 patients were treated sequentially (chemotherapy followed by radiotherapy) (SEQgroup), 70 patients had a sandwich treatment (SW-group) and 56 patients had simultaneous chemoradiation (SIM-group) during that time period. Radiotherapy comprised the thoracic wall and/or regional lymph nodes. The total dose was 45–50.4 Gray. As simultaneous chemoradiation CMF was given in 95.4% of patients while in sequential or sandwich application in 86% and 87.1% of patients an anthracycline-based chemotherapy was given. Concerning the parameters nodal involvement, lymphovascular invasion, extracapsular spread and extension of the irradiated region the three treatment groups were significantly imbalanced. The other parameters, e.g. age, pathological tumor stage, grading and receptor status were homogeneously distributed. Looking on those two groups with an equally effective chemotherapy (EC, FEC), the SEQ- and SW-group, the sole imbalance was the extension of LVI (57.1 vs. 25.6%, p < 0.0001). 5-year overall- and disease free survival were 53.2%/56%, 38.1%/32% and 64.2%/50%, for the sequential, sandwich and simultaneous regime, respectively, which differed significantly in the univariate analysis (p = 0.04 and p = 0.03, log-rank test). Also the 5-year locoregional or distant recurrence free survival showed no significant differences according to the sequence of chemo- and radiotherapy. In the multivariate analyses the sequence had no

Traumatic Neuroma in a Breast Cancer Patient After Modified Radical Mastectomy: A Case Report

International Nuclear Information System (INIS)

Kim, Eun Young; Kang, Doo Kyoung; Kim, Tae Hee; Kim, Ku Sang; Yim, Hyunee

2011-01-01

Traumatic neuromas are rare benign lesions that develop from non-neoplastic proliferation of axons, schwann cells, and fibroblasts at the proximal end of transected or injured nerves as a result of trauma or surgery. We present the case of a traumatic neuroma in a 47-year-old female who was treated with a right modified radical mastectomy for breast cancer 14 years ago. Ultrasound examination revealed an oval-shaped hypoechoic nodule at the 9-O'clock position in the right chest wall. Color Doppler imaging showed no increased blood flow and a positron emission tomography-computed tomography examination revealed no fluorodeoxyglucose uptake in this nodule. The typical histologic findings were present.

Complications following Nipple-Sparing Mastectomy and Immediate Acellular Dermal Matrix Implant-based Breast Reconstruction—A Systematic Review and Meta-analysis

Directory of Open Access Journals (Sweden)

Lene Nyhøj Heidemann, MD

2018-01-01

Conclusion:. The use of acellular dermal matrix in nipple-sparing mastectomy and implant-based breast reconstruction can be done with acceptable complication rates in selected patients. We recommend future studies to include specific definitions when reporting complication rates. Furthermore, future studies should elaborate on demographic characteristics of the included study samples and include predictor analysis to enhance knowledge of high risk patients.

Evaluation of Coolant Injection Procedure in the Severe Accident Management Strategy of APR1400

International Nuclear Information System (INIS)

Cho, Yongjin; Lim, Kukhee; Song, Sungchu; Lee, Sukho; Hwang, Taesuk

2013-01-01

A coolant injection strategy in the severe accident management guideline (SAMG) of APR1400 relates to immediate coolant injection into RCS (Reactor Coolant System) or injection following the recovery of secondary coolant inventory. This strategy could play important role in accident mitigation and radiological consequences. In this study, appropriateness of the strategy was evaluated using MELCOR1.8.6 and several sensitivity studies of the key parameters were performed. Analysis for APR1400 using MELCOR 1.8.6 was performed to evaluate the effectiveness of accident management strategies and the following conclusions were identified. Sequential operation of secondary and RCS injection may not be the best strategy and the simultaneous injection of secondary and RCS injection could be more preferable. At least, the RCS injection should start before complete drainage of water in the safety injection tank using mobile pumps. In this study, the effectiveness of timing of operator action has been examined and the amount of injection flowrate needs to be studied in the future

Body image and psychological distress after prophylactic mastectomy and breast reconstruction in genetically predisposed women: A prospective long-term follow-up study

NARCIS (Netherlands)

den Heijer, M.; Seynaeve, C.; Timman, R.; Duivenvoorden, H.J.; Vanheusden, K.; Tilanus-Linthorst, M.; Menke-Pluijmers, M.B.E.; Tibben, A.

2012-01-01

Purpose: To explore the course of psychological distress and body image at long-term follow-up (6-9 years) after prophylactic mastectomy and breast reconstruction (PM/BR) in women at risk for hereditary breast cancer, and to identify pre-PM risk factors for poor body image on the long-term. Methods:

Body image and psychological distress after prophylactic mastectomy and breast reconstruction in genetically predisposed women: a prospective long-term follow-up study.

NARCIS (Netherlands)

Heijer, M. den; Seynaeve, C.; Timman, R.; Duivenvoorden, H.J.; Vanheusden, K.; Tilanus-Linthorst, M.; Menke-Pluijmers, M.B.; Tibben, A.

2012-01-01

PURPOSE: To explore the course of psychological distress and body image at long-term follow-up (6-9 years) after prophylactic mastectomy and breast reconstruction (PM/BR) in women at risk for hereditary breast cancer, and to identify pre-PM risk factors for poor body image on the long-term. METHODS:

Simplified study for the proposed APR1400 condenser performance based on EL-DABAA SITE, EGYPT, with respect to BNPP and SHIN KORI NPP

Energy Technology Data Exchange (ETDEWEB)

Abdoelatef, M. Gomaa; Rezk, Osama; Lee, YonKwan [KEPCO International Nuclear Graduate School, Ulsan (Korea, Republic of)

2015-10-15

• Perception of nuclear power as a convenient, economically competitive and viable source of energy which, if introduced in the country, would not only complement the traditional energy sources, but would also promote technological development and serve as an incentive for social and economic progress. In this paper we will introduce APR-1400 as the most likely selected reactor type for 1st Egyptian Nuclear Power Plant. Then we will study the optimized APR-1400 condenser performance based on El-Dabaa site conditions. As the climate conditions, especially the seawater temperatures (intake for the cooling system) having a direct effects on the condenser performance and the overall NPP Efficiency, we studied the seawater temperature change based on EL-Dabaa site conditions and it's feedback on the proposed APR-1400 condenser performance and the NPP efficiency. All of the calculations and analysis had been executed by using KINGS NPA by applying EL-Dabaa seawater temperature variations for the 2 types of APR-1400 Condensers (Shinkori, south Korea and Barakah, UAE), and the main findings were as follow: For the APR-1400 condensers (Shinkori and Barakah) performance • The average difference all over the year for saturation temperature, cooling water outlet temperature, and condenser pressure are 0.135 .deg. C, .05785 .deg. C, and 0.3948 mHgA respectively. This shows that the Barakah condenser performance is not significantly better than the shinkori condenser performance based on EL-Dabaa Conditions, especially if we considered the cost difference between the two condensers designs. For APR-1400 NPPs (Shinkori and Barakah) net efficiency • The average difference all over the year for the power productions and net efficiency are 1.4791 MWe and .00037 %, respectively.

Trends in Local Therapy Utilization and Cost for Early-Stage Breast Cancer in Older Women: Implications for Payment and Policy Reform

International Nuclear Information System (INIS)

Shirvani, Shervin M.; Jiang, Jing; Likhacheva, Anna; Hoffman, Karen E.; Shaitelman, Simona F.; Caudle, Abigail; Buchholz, Thomas A.; Giordano, Sharon H.; Smith, Benjamin D.

2016-01-01

Purpose: Older women with early-stage disease constitute the most rapidly growing breast cancer demographic, yet it is not known which local therapy strategies are most favored by this population in the current era. Understanding utilization trends and cost of local therapy is important for informing the design of bundled payment models as payers migrate away from fee-for-service models. We therefore used the Surveillance, Epidemiology, and End Results Medicare database to determine patterns of care and costs for local therapy among older women with breast cancer. Methods and Materials: Treatment strategy and covariables were determined in 55,327 women age ≥66 with Tis-T2N0-1M0 breast cancer who underwent local therapy between 2000 and 2008. Trends in local therapy were characterized using Joinpoint. Polychotomous logistic regression determined predictors of local therapy. The median aggregate cost over the first 24 months after diagnosis was determined from Medicare claims through 2010 and reported in 2014 dollars. Results: The median age was 75. Local therapy distribution was as follows: 27,896 (50.3%) lumpectomy with external beam radiation, 18,356 (33.1%) mastectomy alone, 6159 (11.1%) lumpectomy alone, 1488 (2.7%) mastectomy with reconstruction, and 1455 (2.6%) lumpectomy with brachytherapy. Mastectomy alone declined from 39.0% in 2000 to 28.2% in 2008, and the use of breast conserving local therapies rose from 58.7% to 68.2%. Mastectomy with reconstruction was more common among the youngest, healthiest patients, whereas mastectomy alone was more common among patients living in rural low-income regions. By 2008, the costs were $36,749 for lumpectomy with brachytherapy, $35,030 for mastectomy with reconstruction, $31,388 for lumpectomy with external beam radiation, $21,993 for mastectomy alone, and $19,287 for lumpectomy alone. Conclusions: The use of mastectomy alone in older women declined in favor of breast conserving strategies between 2000 and 2008

Trends in Local Therapy Utilization and Cost for Early-Stage Breast Cancer in Older Women: Implications for Payment and Policy Reform

Energy Technology Data Exchange (ETDEWEB)

Shirvani, Shervin M. [Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas (United States); Department of Radiation Oncology, Banner MD Anderson Cancer Center, Gilbert, Arizona (United States); Jiang, Jing [Department of Health Services Research, University of Texas MD Anderson Cancer Center, Houston, Texas (United States); Likhacheva, Anna [Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas (United States); Department of Radiation Oncology, Banner MD Anderson Cancer Center, Gilbert, Arizona (United States); Hoffman, Karen E.; Shaitelman, Simona F. [Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas (United States); Caudle, Abigail [Department of Surgical Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas (United States); Buchholz, Thomas A. [Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas (United States); Giordano, Sharon H. [Department of Health Services Research, University of Texas MD Anderson Cancer Center, Houston, Texas (United States); Smith, Benjamin D., E-mail: bsmith3@mdanderson.org [Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas (United States); Department of Health Services Research, University of Texas MD Anderson Cancer Center, Houston, Texas (United States)

2016-06-01

Purpose: Older women with early-stage disease constitute the most rapidly growing breast cancer demographic, yet it is not known which local therapy strategies are most favored by this population in the current era. Understanding utilization trends and cost of local therapy is important for informing the design of bundled payment models as payers migrate away from fee-for-service models. We therefore used the Surveillance, Epidemiology, and End Results Medicare database to determine patterns of care and costs for local therapy among older women with breast cancer. Methods and Materials: Treatment strategy and covariables were determined in 55,327 women age ≥66 with Tis-T2N0-1M0 breast cancer who underwent local therapy between 2000 and 2008. Trends in local therapy were characterized using Joinpoint. Polychotomous logistic regression determined predictors of local therapy. The median aggregate cost over the first 24 months after diagnosis was determined from Medicare claims through 2010 and reported in 2014 dollars. Results: The median age was 75. Local therapy distribution was as follows: 27,896 (50.3%) lumpectomy with external beam radiation, 18,356 (33.1%) mastectomy alone, 6159 (11.1%) lumpectomy alone, 1488 (2.7%) mastectomy with reconstruction, and 1455 (2.6%) lumpectomy with brachytherapy. Mastectomy alone declined from 39.0% in 2000 to 28.2% in 2008, and the use of breast conserving local therapies rose from 58.7% to 68.2%. Mastectomy with reconstruction was more common among the youngest, healthiest patients, whereas mastectomy alone was more common among patients living in rural low-income regions. By 2008, the costs were $36,749 for lumpectomy with brachytherapy, $35,030 for mastectomy with reconstruction, $31,388 for lumpectomy with external beam radiation, $21,993 for mastectomy alone, and $19,287 for lumpectomy alone. Conclusions: The use of mastectomy alone in older women declined in favor of breast conserving strategies between 2000 and 2008

Skin-sparing mastectomy and immediate breast reconstruction by use of implants: an assessment of risk factors for complications and cancer control in 120 patients

NARCIS (Netherlands)

Woerdeman, Leonie A. E.; Hage, J. Joris; Smeulders, Mark J. C.; Rutgers, Emiel J. Th; van der Horst, Chantal M. A. M.

2006-01-01

BACKGROUND: Combined skin-sparing mastectomy and immediate reconstruction by use of an implant is increasingly accepted as a therapy for patients with breast cancer or a hereditary risk of breast cancer. Because little and contradictory evidence regarding possible risk factors for postoperative

Using a Classroom Response System to Improve Multiple-Choice Performance in AP[R] Physics

Science.gov (United States)

Bertrand, Peggy

2009-01-01

Participation in rigorous high school courses such as Advanced Placement (AP[R]) Physics increases the likelihood of college success, especially for students who are traditionally underserved. Tackling difficult multiple-choice exams should be part of any AP program because well-constructed multiple-choice questions, such as those on AP exams and…

Analysis of Turbine Load Rejection for APR1400 using SPACE

Energy Technology Data Exchange (ETDEWEB)

Kim, Sang Jin; Park, Chan Eok; Choi, Jong Ho; Lee, Gyu Cheon [KEPCO Engineering and Construction Co. Ltd., Deajeon (Korea, Republic of)

2016-10-15

Turbine Load Rejection event is one of the Performance Related Design Basis Event (PRDBE) that can be stabilized using plant control systems without any safety system actuation. The initiation of the event is turbine load rejection from 100% to 5% in 0.019 seconds. The NSSS control systems of APR1400 is composed of the Power Control System (PCS) and the Process-Component Control System (P-CCS). The PCS includes Reactor Regulating System (RRS), Reactor Power Cutback System (RPCS) and Digital Rod Control System (DRCS). The P-CCS includes the Pressurizer Pressure Control System (PPCS), the Pressurizer Level Control System (PLCS), the Feedwater Control System (FWCS) and the Steam Bypass Control System (SBCS). Turbine load rejection results in the increase of secondary pressure due to sudden blocking of steam flow to turbine. Then the Reactor Coolant System (RCS) cooling through steam generators is decreased rapidly and the RCS temperature will be increased. Turbine load rejection is a typical event to test NSSS control systems since it requires the automatic response of all major NSSS control systems. It is shown that the NSSS control systems of APR1400 have the capability to stabilize the plant without any safety system actuation for turbine load rejection event. This analysis results show that SPACE code has the capability to analyze the turbine load rejection event. However, further validation is necessary for other PRDBEs such as Two Main Feedwater Pumps Trip, Turbine Load Step Change and Turbine Load Ramp Down (5%/min) to verify the capability of SPACE for the full range of performance analyses.

Analysis of Turbine Load Rejection for APR1400 using SPACE

International Nuclear Information System (INIS)

Kim, Sang Jin; Park, Chan Eok; Choi, Jong Ho; Lee, Gyu Cheon

2016-01-01

Turbine Load Rejection event is one of the Performance Related Design Basis Event (PRDBE) that can be stabilized using plant control systems without any safety system actuation. The initiation of the event is turbine load rejection from 100% to 5% in 0.019 seconds. The NSSS control systems of APR1400 is composed of the Power Control System (PCS) and the Process-Component Control System (P-CCS). The PCS includes Reactor Regulating System (RRS), Reactor Power Cutback System (RPCS) and Digital Rod Control System (DRCS). The P-CCS includes the Pressurizer Pressure Control System (PPCS), the Pressurizer Level Control System (PLCS), the Feedwater Control System (FWCS) and the Steam Bypass Control System (SBCS). Turbine load rejection results in the increase of secondary pressure due to sudden blocking of steam flow to turbine. Then the Reactor Coolant System (RCS) cooling through steam generators is decreased rapidly and the RCS temperature will be increased. Turbine load rejection is a typical event to test NSSS control systems since it requires the automatic response of all major NSSS control systems. It is shown that the NSSS control systems of APR1400 have the capability to stabilize the plant without any safety system actuation for turbine load rejection event. This analysis results show that SPACE code has the capability to analyze the turbine load rejection event. However, further validation is necessary for other PRDBEs such as Two Main Feedwater Pumps Trip, Turbine Load Step Change and Turbine Load Ramp Down (5%/min) to verify the capability of SPACE for the full range of performance analyses

Local-Regional Recurrence With and Without Radiation Therapy After Neoadjuvant Chemotherapy and Mastectomy for Clinically Staged T3N0 Breast Cancer

International Nuclear Information System (INIS)

Nagar, Himanshu; Mittendorf, Elizabeth A.; Strom, Eric A.; Perkins, George H.; Oh, Julia L.; Tereffe, Welela; Woodward, Wendy A.; Gonzalez-Angulo, Ana M.; Hunt, Kelly K.; Buchholz, Thomas A.; Yu, Tse-Kuan

2011-01-01

Purpose: The purpose of this study was to determine local-regional recurrence (LRR) risk according to whether postmastectomy radiation therapy (PMRT) was used to treat breast cancer patients with clinical T3N0 disease who received neoadjuvant chemotherapy (NAC) and mastectomy. Methodsand Materials: Clinicopathology data from 162 patients with clinical T3N0 breast cancer who received NAC and underwent mastectomy were retrospectively reviewed. A total of 119 patients received PMRT, and 43 patients did not. The median number of axillary lymph nodes (LNs) dissected was 15. Actuarial rates were calculated using the Kaplan-Meier method and compared using the log-rank test. Results: At a median follow-up of 75 months, 15 of 162 patients developed LRR. For all patients, the 5-year LRR rate was 9% (95% confidence interval [CI], 4%-14%). The 5-year LRR rate for those who received PMRT was 4% (95% CI, 1%-9%) vs. 24% (95% CI, 10%-39%) for those who did not receive PMRT (p <0.001). A significantly higher proportion of irradiated patients had pathology involved LNs and were ≤40 years old. Among patients who had pathology involved LNs, the LRR rate was lower in those who received PMRT (p <0.001). A similar trend was observed for those who did not have pathology involved LN disease. Among nonirradiated patients, the appearance of pathologic LN disease after NAC was the only clinicopathologic factor examined that significantly correlated with the risk of LRR. Conclusions: Breast cancer patients with clinical T3N0 disease treated with NAC and mastectomy but without PMRT had a significant risk of LRR, even when there was no pathologic evidence of LN involvement present after NAC. PMRT was effective in reducing the LRR rate. We suggest PMRT should be considered for patients with clinical T3N0 disease.

A close or positive margin after mastectomy is not an indication for chest wall irradiation except in women aged fifty or younger

International Nuclear Information System (INIS)

Freedman, G.M.; Fowble, B.L.; Hanlon, A.L.; Myint, M.A.; Hoffman, J.P.; Sigurdson, E.R.; Eisenberg, B.L.; Goldstein, L.J.; Fein, D.A.

1997-01-01

Purpose: Indications for postmastectomy radiation include primary tumor size > 5 cm and ≥ 4 positive axillary nodes. In clinical practice, patients with a close or positive margin after mastectomy are also often treated with postmastectomy radiation. However, there is little data regarding the risk of a chest wall recurrence in patients with this pathologic feature who otherwise would be considered low risk (tumor size 25% at 8 years: Age ≤ 50 years was 28% vs. 0% for age > 50 (p=0.08). There was no correlation with chest wall failure and number of nodes, ER status, lymphovascular invasion, location of primary, grade, family history or type of tumor close to the margin. All four chest wall failures were in patients who had received adjuvant systemic chemotherapy ± Tamoxifen. Chest wall failures occurred in patients with margins within 1-2 mm in three patients and 5 mm in one patient. The cumulative chest wall recurrence at 8 years by margin proximity was 24% ≤ 2mm vs. 7% 2.1-6 mm (p=0.44), and by clinical size 24% for T2 tumors vs. 7% for T1 (p=0.55). Conclusions: A close or positive margin is uncommon (< 5%) after mastectomy in patients with tumor size < 5 cm and 0-3 positive axillary nodes, but when present it appears to be in a younger patient population. The subgroup of patients aged 50 or younger with clinical T1-T2 tumor size and 0-3 positive nodes who have a close (≤ 5 mm) or positive mastectomy margin are at high risk (28% at 8 years) for chest wall recurrence regardless of adjuvant systemic therapy, and therefore we recommend they be considered for postmastectomy radiation. This high risk of local failure was not observed in patients over age 50, suggesting this subgroup may not require adjuvant chest wall irradiation

A close or positive margin after mastectomy is not an indication for chest wall irradiation except in women aged fifty or younger

International Nuclear Information System (INIS)

Freedman, Gary M.; Fowble, Barbara L.; Hanlon, Alexandra L.; Myint, Maung A.; Hoffman, John P.; Sigurdson, Elin R.; Eisenberg, Burton L.; Goldstein, Lori J.; Fein, Douglas A.

1998-01-01

Introduction: Indications for postmastectomy radiation include primary tumor size ≥5 cm and/or ≥4 positive axillary nodes. In clinical practice, patients with a close or positive margin after mastectomy are also often treated with postmastectomy radiation. However, there is little data regarding the risk of a chest wall recurrence in patients with close or positive margins who otherwise would be considered low risk (tumor size 50 (p = 0.04). There was no correlation with chest wall failure and number of positive nodes, ER status, lymphovascular invasion, location of primary, grade, family history, or type of tumor close to the margin. Of 5 chest wall failures, 4 were in patients who had received adjuvant systemic chemotherapy ± tamoxifen. Chest wall failures occurred in 1 patient with a positive deep margin, 3 patients with margins within 2 mm, and 1 patient with a margin of 5 mm. The estimated cumulative incidence probability of chest wall recurrence at 8 years by margin proximity was 24% ≤ 2 mm vs. 7% 2.1-6 mm (p = 0.36), and by clinical size 24% for T2 tumors vs. 7% for T1 (p = 0.98). Conclusions: A close or positive margin is uncommon (≤5%) after mastectomy in patients with tumor size <5 cm and 0-3 positive axillary nodes but, when present, it appears to be in a younger patient population. The subgroup of patients aged 50 or younger with clinical T1-T2 tumor size and 0-3 positive nodes who have a close (≤5 mm) or positive mastectomy margin are at high risk (28% at 8 years) for chest wall recurrence regardless of adjuvant systemic therapy and, therefore, should be considered for postmastectomy radiation

Traumatic Neuroma in a Breast Cancer Patient After Modified Radical Mastectomy: A Case Report

Energy Technology Data Exchange (ETDEWEB)

Kim, Eun Young; Kang, Doo Kyoung; Kim, Tae Hee [Dept. of Radiology, Ajou University School of Medicine, Suwon (Korea, Republic of); Kim, Ku Sang [Dept. of Surgery, Ajou University School of Medicine, Suwon (Korea, Republic of); Yim, Hyunee [Dept. of Pathology, Ajou University School of Medicine, Suwon (Korea, Republic of)

2011-05-15

Traumatic neuromas are rare benign lesions that develop from non-neoplastic proliferation of axons, schwann cells, and fibroblasts at the proximal end of transected or injured nerves as a result of trauma or surgery. We present the case of a traumatic neuroma in a 47-year-old female who was treated with a right modified radical mastectomy for breast cancer 14 years ago. Ultrasound examination revealed an oval-shaped hypoechoic nodule at the 9-O'clock position in the right chest wall. Color Doppler imaging showed no increased blood flow and a positron emission tomography-computed tomography examination revealed no fluorodeoxyglucose uptake in this nodule. The typical histologic findings were present.

Survival analysis of female dogs with mammary tumors after mastectomy: epidemiological, clinical and morphological aspects

Directory of Open Access Journals (Sweden)

Maria Luíza de M. Dias

2016-03-01

Full Text Available Abstract: Mammary gland tumors are the most common type of tumors in bitches but research on survival time after diagnosis is scarce. The purpose of this study was to investigate the relationship between survival time after mastectomy and a number of clinical and morphological variables. Data was collected retrospectively on bitches with mammary tumors seen at the Small Animal Surgery Clinic Service at the University of Brasília. All subjects had undergone mastectomy. Survival analysis was conducted using Cox's proportional hazard method. Of the 139 subjects analyzed, 68 died and 71 survived until the end of the study (64 months. Mean age was 11.76 years (SD=2.71, 53.84% were small dogs. 76.92% of the tumors were malignant, and 65.73% had both thoracic and inguinal glands affected. Survival time in months was associated with age (hazard rate ratios [HRR] =1.23, p-value =1.4x10-4, animal size (HRR between giant and small animals =2.61, p-value =0.02, nodule size (HRR =1.09, p-value =0.03, histological type (HRR between solid carcinoma and carcinoma in a mixed tumor =2.40, p-value =0.02, time between diagnosis and surgery (TDS, with HRR =1.21, p-value =2.7x10-15, and the interaction TDS*follow-up time (HRR =0.98, p-value =1.6x10-11. The present study is one of the few on the subject matter. Several important covariates were evaluated and age, animal size, nodule size, histological type, TDS and TDS*follow up time were identified as significantly associated to survival time.

Endoscopic latissimus dorsi muscle flap for breast reconstruction after skin-sparing total mastectomy: report of 14 cases.

Science.gov (United States)

Iglesias, Martin; Gonzalez-Chapa, Diego R

2013-08-01

Some authors have mentioned that the endoscopic harvesting of the latissimus dorsi muscle flap for breast reconstruction is an uncommon technique that has been abandoned due to its technical complexity. Therefore, its use for immediate breast reconstruction after skin-sparing total mastectomies is reported for only a few patients, without clinical images of the reconstructed breast or of the donor site. This report describes 14 breast reconstructions using the aforementioned approach, with the latissimus dorsi muscle flap harvested by endoscopy plus the insertion of a breast implant in a single surgical procedure. The objective is to show images of the long-range clinical aesthetic results, both in the reconstructed breast and at the donor site as well as the complications so the reader can evaluate the advantages and disadvantages of the technique. From 2008 to 2011, 12 women who experienced skin-sparing total mastectomy and 2 women who underwent modified radical mastectomy were reconstructed using the aforementioned technique. The average age was 42 years (range 30-58 years), and the average body mass index was 29 kg/m(2) (range 22-34 kg/m(2)). Three patients were heavy smokers: one had undergone a previous abdominoplasty; one had hepatitis C; and one had undergone massive weight loss. Immediate reconstructions were performed for 11 patients, and 3 reconstructions were delayed. The implant volume ranged from 355 to 640 ml. The average endoscopic harvesting time was 163.5 min (range 120-240 min), and the average bleeding was 300 ml. Four patients experienced seromas at the donor site. Acceptance of the reconstructed breast was good in six cases, moderate in seven cases, and poor in one case. Acceptance of the donor site was good in 13 cases and moderate for 1 case. Endoscopic harvesting of the latissimus dorsi muscle has technical difficulties that have limited its acceptance. However, this technique offers the same quality of breast reconstruction as the

Gynecomastia: Simultaneous Subcutaneous Mastectomy and Areolar Reduction with Minimal Inconspicuous Scarring.

Science.gov (United States)

Atiyeh, Bishara S; Chahine, Fadel; El-Khatib, Arij; Janom, Hamed; Papazian, Nazareth

2015-12-01

Acceptable scar positioning on the anterior male chest is very limited. In Gynecomastia surgery, an obvious areolar incision is the most sensitive indicator of a previous operation; a less apparent scar is indispensable for the patient's psychological satisfaction. Whenever only areolar diameter reduction is required, the circumareolar incision must be performed in a position leaving the least conspicuous scar. Standard excision of an outer doughnut of areolar skin results in a visible and unnatural peri-areolar scar. The peri-nipple excision of areolar skin leaves the skin-areola junction undisturbed. When combined with a transverse areolar infra-nipple incision, access for subcutaneous mastectomy is facilitated. With this approach, risk of nipple vascular compromise is thought to be reduced, and necrosis of areolar pigmented skin virtually impossible. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.

PLUS 7TM advanced fuel assembly development program for KSNPs and APR1400

International Nuclear Information System (INIS)

Kim, Kyutae; Stucker, David L.

2002-01-01

KNFC and Westinghouse have recently completed the development of the PLUS 7 TM advanced 16 X 16 fuel assembly for the Korean Standard Nuclear Plants (KSNPs) and the Advanced Power Reactor 1400 (APR 1400). This fuel design utilized the proven advanced design features including mixing vane spacer grids to increase critical heat flux performance, ZIRLO TM advanced materials to enable high-duty, high burnup fuel management and an optimized fuel rod diameter which improves fuel cycle cost while resulting in significant standardization of Korean fuel manufacture. PLUS 7 TM , also includes a patented spacer grid design with conformal fuel rod support designed to provide superior fuel rod wear/fretting resistance while minimizing pressure drop. This paper will present an overview of the PLUS 7 TM fuel assembly development process including a summary of the three-year design and testing program from a mechanical, neutronic, and thermal/hydraulic perspective. The PLUS 7 TM fuel for the KSNPs and the APR1400 reactors results in multi-million dollar per cycle savings in imported enriched uranium product for the Korean nuclear power program with technology specifically developed for Korea by experienced Korean engineers

A Study on the Embedment Effect in the Soil-Structure Interaction Analysis of the APR1400

International Nuclear Information System (INIS)

Young-Sun Jang; Kwang-Ho Joo; Chong-Hak Kim

2002-01-01

The SSI (Soil-Structure Interaction) analyses are being performed for the APR1400 (Advanced Power Reactor 1400 MWe, Old name - KNGR; Korean Next Generation Reactor) design, because the APR1400 is developed as a Standard Nuclear Power Plant concept enveloping suitable soil conditions. For the SSI analyses, SASSI program which adopts the Flexible Volume Method is used. In the SSI analyses, there can be uncertainties by Bond and De-bond problem between the structure and lateral soil elements. According to ASCE Standard 4, one method to address this concern is to assume no connectivity between structure and lateral soil over the upper half of the embedment of 20 ft (6 m), whichever is less. This study is performed as a part of the parametric analyses for the APR1400 seismic analyses to address the concern of the potential embedment effect on the in-structure response spectra due to connectivity between structure and lateral soil. In this study, 4 model cases are analyzed to check the potential embedment effect - Full connection, 20 ft no connectivity which is defined as a minimum De-bond depth of the soil in ASCE Standard 4 and 26.5 ft no connectivity between structure and lateral soil over the upper half of the embedment. Last one is full no connection for only reference. The in-structure response spectra are compared with the response spectra without considering the embedment effect. (authors)

Evaluation Methodology for Void Swelling Susceptibility of APR1400 Reactor Vessel Internals for U.S. NRC Design Certification

Energy Technology Data Exchange (ETDEWEB)

Kweon, Hyeong Do; Lee, Do Hwan [KHNP CRI, Daejeon (Korea, Republic of)

2016-10-15

The APR1400 RVI (Reactor Vessel Internals) operates in harsh conditions, such as long term exposure to neutron irradiation, high temperatures, reactor coolant environment, and other operating loads. Therefore, even though the RVI components are mainly made of austenitic stainless steel which is well known to have good mechanical and corrosion-resistive properties, these operating conditions. The aging is characterized by a chromium depletion along grain boundaries of austenitic stainless steel, a decrease in ductility and fracture toughness of the steel, an increase in yield and ultimate strength of the steel, and a potential volume change due to void formation in the steel. For these reasons, under certain conditions of stress, temperature, and level of irradiation, the void swelling which is one of the challenging degradation mechanisms affecting the integrity of the RVI may appear at specific locations of the RVI, especially due to high neutron fluence and high temperature under localized gamma heating and low velocity of coolant flow. To assess the effects of operating neutron fluences, temperatures and stresses on the material properties changes and the susceptibility to the void swelling, the evaluation methodology of the APR1400 RVI components for U.S. NRC Design Certification was suggested in this paper. The approach to the evaluation is summarized as follows: 1. RVI component list of the APR1400 is collected. 2. Initial screening to determine the evaluation scope is completed using the design values of fluences. 3. Functionality assessments (radiation transport analysis, CFD analysis, structural analysis) are sequentially performed. 4. Susceptibility to the void swelling is identified through ANSYS/USERMAT module. KHNP believes that the proposed methodology which is based on the EPRI works for operating reactors is the best way to evaluate the void swelling for new reactors such as the APR1400.

Cloned Bacillus subtilis alkaline protease (aprA) gene showing high level of keratinolytic activity.

Science.gov (United States)

Zaghloul, T I

1998-01-01

The Bacillus subtilis alkaline protease(aprA) gene was previously cloned on a pUBHO-derivative plasmid. High levels of expression and gene stability were demonstrated when B. subtilis cells were grown on the laboratory medium 2XSG. B. subtilis cells harboring the multicopy aprA gene were grown on basal medium, supplemented with 1 % chicken feather as a source of energy, carbon, and nitrogen. Proteolytic and keratinolytic activities were monitored throughout the cultivation time. A high level of keratinolytic activity was obtained, and this indicates that alkaline protease is acting as a keratinase. Furthermore, considerable amounts of soluble proteins and free amino acids were obtained as a result of the enzymatic hydrolysis of feather. Biodegradation of feather waste using these cells represents an alternative way to improve the nutritional value of feather, since feather waste is currently utilized on a limited basis as a dietary protein supplement for animal feedstuffs. Moreover, the release of free amino acids from feather and the secreted keratinase enzyme would promote industries based on feather waste.

Constructibility assessment of APR1400

International Nuclear Information System (INIS)

Cho, Sung Jae; Kang, Yong Chul; Lee, Jae Gon; Lim, Woo Sang

2003-01-01

APR1400 (formerly KNGR) development is one of national G-7 projects sponsored by government and KHNP (Korea Hydro and Nuclear Power Co., LTD). It is an evolutionary standard reactor with the thermal output of 4000MWt and has been adopted for Shin-Kori Unit 3 and 4. The government organizations, research institutes, universities and industries have participated in the project since 1992 along with KHNP, and the standard design certification program was issued in May 2002. The project set up the top-tier requirements about the safety, economy, operability and maintainability, and constructibility in the early design stage. The requirements have been evaluated periodically during the design process, and the results were reflected to the design. This paper describes the methods for constructibility enhancement and the results of schedule analysis to assure meeting construction duration target, which is set to 48 months from the first concrete pouring to the commercial operation on the condition that learning effects are maximized at Nth plant. To meet the target schedule, the design characteristics and constructibility studies such as new construction methods and construction schedule analysis were performed. The new construction methods presented here are over the top method for NSSS components, deck plate and steel from for concrete wall and slab, automatic welding for large bore piping, and modularization of components and structure, etc. (author)

Analysis of Total Loss of Feedwater for APR1400 using SPACE

Energy Technology Data Exchange (ETDEWEB)

Hong, Seong Min; Park, Seok Jeong; Park, Chan Eok; Choi, Jong Ho; Lee, Gyu Cheon [KEPCO Engineering and Construction, Deajeon (Korea, Republic of)

2016-10-15

The Total Loss of FeedWater (TLOFW) event is an accident that main feedwater and auxiliary feedwater of secondary side are not supplied to steam generators. APR1400 uses the Safety Depressurization and Vent System (SDVS) for the F and B operation and SDVS is designed to perform the rapid depressurization function of Reactor Coolant System (RCS) through the remote manual operation when TLOFW is occurred. If RCS pressure falls below a Safety Injection Pump (SIP) working pressure, it can be possible to start the F and B operation which injects SIP flow to RCS and releases the RCS vapor and two-phase flow through Pilot Operated Safety Relief Valves (POSRVs) by opening the POSRVs, and then it can be possible to remove the decay heat. The design requirement of SDVS is that the core water level should be maintained at higher than 2 feet from the top of active core during the F and B operation. The TLOFW analysis was carried out to evaluate the capability of decay heat removal for APR1400 using newly developed SPACE code. The analysis results show that the F and B operation with 2 POSRVs and 2 SIPs and the F and B operation with 4 POSRVs and 4 SIPs meet the SDVS design requirement for the fuel cladding temperature. The comparison with RELAP5 shows good agreement and it validates the applicability of SPACE code for this type of accident analysis.

Single port-assisted fully laparoscopic abdominoperineal resection (APR) with immediate V-RAM flap reconstruction of the perineal defect.

LENUS (Irish Health Repository)

Ali, Sayid

2012-09-01

Abdominoperineal resection (APR) of anorectal cancers after neoadjuvant chemoradiotherapy may incur significant perineal morbidity. While vertical rectus abdominis muscle (V-RAM) flaps can fill the pelvic resection space with health tissue, their use has previously been described predominantly in association with laparotomy. Here, we describe a means of combination laparoscopic APR with V-RAM flap reconstruction that allows structural preservation of the entire abdominal wall throughout the oncological resection and of the deep parietal layers after V-RAM donation. Furthermore, a single port access device used at the end colostomy site allows a second senior surgeon assist with an additional two working instruments for the purpose of improved pelvic tissue retraction, especially useful in obese patients.

Reverse Abdominoplasty Flap in Reconstruction of Post-Bilateral Mastectomies Anterior Chest Wall Defect

Directory of Open Access Journals (Sweden)

William HC Tiong

2014-01-01

Full Text Available Reverse abdominoplasty was originally described for epigastric lift. Since the work by Baroudi and Huger in the 1970s, it has become clear that reverse abdominoplasty application can be extended beyond just aesthetic procedure. Through the knowledge of anterior abdominal wall vascularity, its application had included reconstructive prospect in the coverage of various chest wall defects. To date, reverse abdominoplasty flap has been used to reconstruct unilateral anterior chest wall defect or for larger defect but only in combination with other reconstructive techniques. Here, we presented a case where it is used as a standalone flap to reconstruct bilateral anterior chest wall soft tissue defect post-bilateral mastectomies in oncological resection. In conclusion, reverse abdominoplasty flap provided us with a simple, faster, and satisfactory reconstructive outcome.

Diversity of sulfur-cycle prokaryotes in freshwater lake sediments investigated using aprA as the functional marker gene.

Science.gov (United States)

Watanabe, Tomohiro; Kojima, Hisaya; Takano, Yoshinori; Fukui, Manabu

2013-09-01

The diversity of sulfate-reducing prokaryotes (SRPs) and sulfur-oxidizing prokaryotes (SOPs) in freshwater lake ecosystems was investigated by cloning and sequencing of the aprA gene, which encodes for a key enzyme in dissimilatory sulfate reduction and sulfur oxidation. To understand their diversity better, the spatial distribution of aprA genes was investigated in sediments collected from six geographically distant lakes in Antarctica and Japan, including a hypersaline lake for comparison. The microbial community compositions of freshwater sediments and a hypersaline sediment showed notable differences. The clones affiliated with Desulfobacteraceae and Desulfobulbaceae were frequently detected in all freshwater lake sediments. The SOP community was mainly composed of four major phylogenetic groups. One of them formed a monophyletic cluster with a sulfur-oxidizing betaproteobacterium, Sulfuricella denitrificans, but the others were not assigned to specific genera. In addition, the AprA sequences, which were not clearly affiliated to either SRP or SOP lineages, dominated the libraries from four freshwater lake sediments. The results showed the wide distribution of some sulfur-cycle prokaryotes across geographical distances and supported the idea that metabolic flexibility is an important feature for SRP survival in low-sulfate environments. Copyright © 2013 Elsevier GmbH. All rights reserved.

Precificação de consultoria empresarial com a contribuição das estratégias de apreçamento = Entrepreneurial Counseling Pricing with Pricing Strategy Contribution

Directory of Open Access Journals (Sweden)

Nivaldo João dos Santos

2008-11-01

Full Text Available A precificação de serviços de consultoria também pode se beneficiar dos conceitos e idéias das estratégias de apreçamento de bens de consumo de massa, especificamente na área de consultoria de gestão empresarial. Apesar deste campo ser dominado por grandes corporações multinacionais, ainda existe espaço para empresas e profissionais nacionais. Por se tratar de mercado que envolve valores de grande magnitude, imaginasse que as instituições de sucesso adotem estratégia de apreçamento. Neste trabalho, estratégias de apreçamento foram selecionadas para exame e verificação de aplicabilidade quando do estabelecimento valor pelos serviços da consultoria de gestão empresarial. O apreçamento de desnatação, apreçamento de penetração, apreçamento neutro e apreçamento baseado em valor tiveram seus conceitos sintetizados para fins de verificação. O apreçamento baseado em valor se revelou o mais propício para este tipo de produto (consultoria e o processo de comunicação é o elemento crítico para evidenciar valor, benefícios e, finalmente, justificar o preço do serviço. A sugestão de roteiro para apreçamento de serviço de consultoria empresarial é apresentada ao final, como resultado da análise das diversas estratégias de apreçamento.The pricing of counseling services may also benefit from strategy concepts and ideas ofmass consumption goods pricing, specifically within the entrepreneurial managementcounseling area. Even though this field has been taken over by big multinationalcorporations, there is still some space for national enterprisings and professionals. As itis a market that involves values of great magnitude, it is thought that successfulinstitutions adopt this pricing strategy. In this study, pricing strategies were selectedfor analysis and applicability checking by the time the price for entrepreneurialmanagement counseling service was established. The skimming pricing, penetratingpricing, neutral

Review of Nipple Reconstruction Techniques and Introduction of V to Y Technique in a Bilateral Wise Pattern Mastectomy or Reduction Mammaplasty

OpenAIRE

Riccio, Charles A.; Zeiderman, Matthew R.; Chowdhry, Saeed; Wilhelmi, Bradon J.

2015-01-01

Introduction: Nipple-areola complex reconstruction (NAR) is the final procedure in breast reconstruction after the majority of mastectomies. Many methods of NAR have been described, each with inherent advantages and disadvantages depending on local healthy tissue availability, previous scarring and procedures, and the operative morbidity of the NAR technique. Nipple reconstructions may be complicated by scars or previous nipple reconstruction, making the procedure more challenging. We propose...

Identification of Risk Factors for Locoregional Recurrence in Breast Cancer Patients with Nodal Stage N0 and N1: Who Could Benefit from Post-Mastectomy Radiotherapy?

Directory of Open Access Journals (Sweden)

Eunjin Jwa

Full Text Available The locoregional recurrence (LRR rate was reported as high as approximately 20% in stage I-II breast cancer following mastectomy. To investigate the risk factors for LRR in pT1-2N0-1 breast cancer patients treated with mastectomy but not radiation, and to define a subgroup of patients at high risk of LRR who may benefit from postmastectomy radiotherapy (PMRT.In total, 390 patients with pT1-2N0M0 (n = 307 and pT1-2N1M0 (n = 83 breast cancer who underwent total mastectomy without adjuvant radiotherapy from 2002 to 2011 were enrolled in the study.After a median follow-up period of 5.6 years (range, 0.6-11.3 years, 21 patients had 18 systemic relapses and 12 LRRs including six in the chest wall and eight in the regional nodal area. The 5-year LRR-free survival (LRRFS rates were 97.0% in pN0, 98.8% in pN1, and 97.4% in all patients. Multivariate analysis revealed that age < 50 years (Hazard Ratio, 11.4; p = 0.01 and no adjuvant chemotherapy (Hazard Ratio, 10.2; p = 0.04 were independent risk factors for LRR in pN0 patients. Using these factors, the 5-year LRRFS rates were 100% without any risk factors, 96.4% with one risk factor, and 86.7% with two risk factors. In pN1 patients, multivariate analysis revealed that having a hormone receptor negative tumor (Hazard Ratio, 18.3; p = 0.03 was the only independent risk factor for LRR. The 5-year LRRFS rates were 100.0% for luminal type, and 92.3% for non-luminal type cancer.Patients with pT1-2N0-1 breast cancer who underwent total mastectomy without PMRT could be stratified by nodal stage and risk factors for LRR. PMRT may have of value for node negative patients aged less than 50 years and who are not treated with adjuvant chemotherapy, and for non-luminal type patients with one to three positive nodes.

Isolated local-regional recurrence following mastectomy for adenocarcinoma of the breast treated with radiation therapy alone or combined with surgery and/or chemotherapy

International Nuclear Information System (INIS)

Mendenhall, N.P.; Devine, J.W.; Mendenhall, W.M.; Million, R.R.; Bland, K.I.; Copeland, E.M. III

1988-01-01

The results of radiation therapy alone or combined with surgery and/or chemotherapy are reported for 47 patients who presented with local and/or regional recurrence without evidence of distant metastases following initial management of adenocarcinoma of the breast with radical or modified radical mastectomy (43) or simple mastectomy (4). Patients were treated between October 1964 and March 1983 at the University of Florida; all have a 2-year minimum follow-up and 42/47 (89%) have had follow-up for ≥5 years. The overall actuarial local-regional control rates were 80% at 2 years, 68% at 5 years, and 61% at 10 years. The 5-year actuarial local-regional control rates by site and extent of disease were as follows: single chest wall nodule, 92%; multiple chest wall nodules, 49%; regional lymph nodes, 66%; and multiple sites, 64%. The 5- and 10-year actuarial determinate disease-free survival rates for all patients were 41 and 17%, respectively. The 5- and 10-year actuarial survival rates for all patients were 50 and 34%, respectively. 22 refs.; 5 figs.; 5 tabs

A Quantitative Feasibility Study on Potential Safety Improvement Effects of Advanced Safety Features in APR-1400 when Applied to OPR-1000

Energy Technology Data Exchange (ETDEWEB)

Ualikhan Zhiyenbayev [KAIST, Daejeon (Korea, Republic of); Chung, Dae Wook [Korea Institute of Nuclear Safety, Daejeon (Korea, Republic of)

2015-10-15

This study aims to test the feasibility of the applications using Probabilistic Safety Assessment (PSA). Particularly, three of those advanced safety features are selected as follows: 1. Providing an additional Emergency Diesel Generator (EDG); 2. Increasing the capacity of Class 1E batteries; 3. Placing a Refueling Water Storage Tank (RWST) inside containment, i.e., change from RWST to IRWST. The Advanced Power Reactor 1400 (APR-1400) adopts several advanced safety features compared to its predecessor, the Optimized Power Reactor 1000 (OPR-1000), which includes an additional Emergency Diesel Generator, increase in battery capacity, in-containment refueling water storage tank (IRWST), and so on. Considering the remarkable advantages of these safety features in safety improvement and the design similarities between APR-1400 and OPR-1000, it is feasible to apply key advanced safety features of APR-1400 to OPR-1000 to enhance the safety. The selected safety features are incorporated into OPR-1000 PSA model using the Advanced Information Management System (AIMS) for PSA and CDFs are re-evaluated for each application and combination of three applications. Based on current results, it is concluded that three of key advanced safety features of APR-1400 can be effectively applied to OPR-1000, resulting in considerable safety improvement. In aggregate, three advanced safety features, which are an additional EDG, increased battery capacity and IRWST, can reduce the CDF of OPR-1000 by more than 15% when applied altogether.

A Quantitative Feasibility Study on Potential Safety Improvement Effects of Advanced Safety Features in APR-1400 when Applied to OPR-1000

International Nuclear Information System (INIS)

Ualikhan Zhiyenbayev; Chung, Dae Wook

2015-01-01

This study aims to test the feasibility of the applications using Probabilistic Safety Assessment (PSA). Particularly, three of those advanced safety features are selected as follows: 1. Providing an additional Emergency Diesel Generator (EDG); 2. Increasing the capacity of Class 1E batteries; 3. Placing a Refueling Water Storage Tank (RWST) inside containment, i.e., change from RWST to IRWST. The Advanced Power Reactor 1400 (APR-1400) adopts several advanced safety features compared to its predecessor, the Optimized Power Reactor 1000 (OPR-1000), which includes an additional Emergency Diesel Generator, increase in battery capacity, in-containment refueling water storage tank (IRWST), and so on. Considering the remarkable advantages of these safety features in safety improvement and the design similarities between APR-1400 and OPR-1000, it is feasible to apply key advanced safety features of APR-1400 to OPR-1000 to enhance the safety. The selected safety features are incorporated into OPR-1000 PSA model using the Advanced Information Management System (AIMS) for PSA and CDFs are re-evaluated for each application and combination of three applications. Based on current results, it is concluded that three of key advanced safety features of APR-1400 can be effectively applied to OPR-1000, resulting in considerable safety improvement. In aggregate, three advanced safety features, which are an additional EDG, increased battery capacity and IRWST, can reduce the CDF of OPR-1000 by more than 15% when applied altogether

Cancer risk of incremental exposure to polycyclic aromatic hydrocarbons in electrocautery smoke for mastectomy personnel.

Science.gov (United States)

Tseng, Hsin-Shun; Liu, Shi-Ping; Uang, Shi-Nian; Yang, Li-Ru; Lee, Shien-Chih; Liu, Yao-Jen; Chen, Dar-Ren

2014-02-04

Electrocautery applications in surgical operations produce evasive odorous smoke in the cleanest operation rooms. Because of the incomplete combustion of electrical current in the tissues and blood vessels during electrocautery applications, electrocautery smoke (ES) containing significant unknown chemicals and biological forms is released. The potential hazards and cancer risk should be further investigated from the perspective of the occupational health of surgical staff. The particle number concentration and the concentration of polycyclic aromatic hydrocarbons (PAHs) in ES were thoroughly investigated in 10 mastectomies to estimate the cancer risk for surgical staff. The particle number concentration and gaseous/particle PAHs at the surgeons' and anesthetic technologists' (AT) breathing heights were measured with a particle counter and filter/adsorbent samplers. PAHs were soxhlet-extracted, cleaned, and analyzed by gas chromatography/mass spectrometry. Abundant submicron particles and high PAH concentrations were found in ES during regular surgical mastectomies. Most particles in ES were in the size range of 0.3 to 0.5 μm, which may potentially penetrate through the medical masks into human respiration. The average particle/gaseous phase PAH concentrations at the surgeon's breathing height were 131 and 1,415 ng/m³, respectively, which is 20 to 30 times higher than those in regular outdoor environments. By using a toxicity equivalency factor, the cancer risk for the surgeons and anesthetic technologists was calculated to be 117 × 10(-6) and 270 × 10(-6), respectively; the higher cancer risk for anesthetic technologists arises due to the longer working hours in operation rooms. The carcinogenic effects of PAHs in ES on the occupational health of surgical staff should not be neglected. The use of an effective ES evacuator or smoke removal apparatus is strongly suggested to diminish the ES hazards to surgical staff.

Postoperative nausea and vomiting prophylaxis: A comparative study of ondansetron, granisetron and granisetron and dexamethasone combination after modified radical mastectomy

OpenAIRE

Gupta, Pushplata; Jain, Shilpi

2014-01-01

Background: Post-operative nausea and vomiting (PONV) is commonly seen after modified radical mastectomy (MRM). In this randomized double-blind prospective study we compared the efficacy of ondansetron, granisetron and granisetron and dexamethasone combination for prevention of PONV following MRM in female patients. Materials and Methods: A total of 75 patients (20-60 years of age) undergoing elective MRM were randomly allocated to one of the three groups of 25 patients each. Group O received...

Probability of Neutralization Estimation for APR1400 Physical Protection System Design Effectiveness Evaluation

Energy Technology Data Exchange (ETDEWEB)

Kim, Myungsu; Lim, Heoksoon; Na, Janghwan; Chi, Moongoo [Korea Hydro and Nuclear Power Co. Ltd. Central Research Institute, Daejeon (Korea, Republic of)

2015-05-15

It is focusing on development of a new designing process which can be compatible to international standards such as IAEA1 and NRC2 suggest. Evaluation for the design effectiveness was found as one of the areas to improve. If a design doesn't meet a certain level of effectiveness, it should be re-designed accordingly. The effectiveness can be calculated with combination of probability of Interruption and probability of neutralization. System Analysis of Vulnerability to Intrusion (SAVI) has been developed by Sandia National Laboratories for that purpose. With SNL's timely detection methodology, SAVI has been used by U.S. nuclear utilities to meet the NRC requirements for PPS design effectiveness evaluation. For the SAVI calculation, probability of neutralization is a vital input element that must be supplied. This paper describes the elements to consider for neutralization, probability estimation methodology, and the estimation for APR1400 PPS design effectiveness evaluation process. Markov chain and Monte Carlo simulation are often used for simple numerical calculation to estimate P{sub N}. The results from both methods are not always identical even for the same situation. P{sub N} values for APR1400 evaluation were calculated based on Markov chain method and modified to be applicable for guards/adversaries ratio based analysis.

Pattern of External Breast Prosthesis Use by Post Mastectomy Breast Cancer Patients in India: Descriptive Study from Tertiary Care Centre

OpenAIRE

Ramu, D.; Ramesh, Rakesh S.; Manjunath, Suraj; Shivakumar; Goel, Vipin; Hemnath, G. N.; Alexander, Annie

2015-01-01

In India, Breast cancer is now the most common cancer in urban and 2nd most common in rural areas [1]. The incidence is rising, more younger women are getting affected and due to increase in survival rates there is an increase in the total number of women suffering from breast Cancer. So far there are no studies evaluating the pattern of breast prosthesis use in Indian scenario. The aim of this study is to address the patterns of external breast prosthesis used in India and view of Indian wom...

A randomised controlled study of the post-operative analgesic efficacy of ultrasound-guided pectoral nerve block in the first 24 h after modified radical mastectomy

Directory of Open Access Journals (Sweden)

Satish Kumar

2018-01-01

Full Text Available Background and Aims: Breast cancer has become the most common cancer in women worldwide. Acute post-operative pain following mastectomy remains a challenge for the anaesthesiologist despite a range of treatment options available. The present study aimed to compare the post-operative analgesic efficacy of pectoral nerve (Pecs block performed under ultrasound with our standard practice of opioids and non-steroidal anti-inflammatory drugs for mastectomy. Methods: This randomised controlled study was conducted at a tertiary care teaching hospital in India, after obtaining ethical clearance. Fifty adult female patients posted for elective unilateral modified radical mastectomy were divided into two groups as follows: Group I (general anaesthesia only and Group II (general anaesthesia plus ultrasound-guided Pecs block, each comprising 25 patients. Post-randomisation, patients in Group I received general anaesthesia, while Group II patients received ultrasound-guided Pecs block followed by general anaesthesia after 20 min. The primary outcome was measured as patient-reported pain intensity using Visual Analogue Scale (VAS at rest. Statistical analysis was performed using Student's t-test and Mann–Whitney U-test. Data were entered into MS Excel spreadsheet and analysis was performed using the Statistical Package for the Social Sciences version 23.0. Results: VAS score was significantly lower in Group II at rest and on abduction post-operatively at all time intervals (P < 0.001. The 24-h tramadol consumption was significantly less in Group II compared to Group I (114.4 ± 4.63 mg vs. 402.88 ± 74.22, P < 0.0001. Conclusion: Pecs block provided excellent post-operative analgesia in the first 24 h.

Real-time PCR quantification and diversity analysis of the functional genes aprA and dsrA of sulfate-reducing bacteria in marine sediments of the Peru continental margin and the Black Sea

Directory of Open Access Journals (Sweden)

Axel eSchippers

2011-12-01

Full Text Available A quantitative, real-time PCR (Q-PCR assay for the functional gene adenosine 5´-phosphosulfate reductase (aprA of sulfate-reducing bacteria (SRB was designed. This assay was applied together with described Q-PCR assays for dissimilatory sulfite reductase (dsrA and the 16S rRNA gene of total Bacteria to marine sediments from the Peru margin (0 – 121 meters below seafloor (mbsf and the Black Sea (0 – 6 mbsf. Clone libraries of aprA show that all isolated sequences originate from SRB showing a close relationship to aprA of characterised species or form a new cluster with only distant relation to aprA of isolated SRB. Below 40 mbsf no aprA genes could be amplified. This finding corresponds with results of the applied new Q-PCR assay for aprA. In contrast to the aprA the dsrA gene could be amplified up to sediment depths of 121 mbsf. Even in such an extreme environment a high diversity of this gene was detected. The 16S rRNA gene copy numbers of total Bacteria were much higher than those of the functional genes at all sediment depths and used to calculate the proportion of SRB to the total Bacteria. The aprA and dsrA copy numbers comprised in average 0.5 - 1 % of the 16S rRNA gene copy numbers of total Bacteria in the sediments up to a depth of ca. 40 mbsf. Depth profiles of the aprA and dsrA copy numbers were almost equal for all sites. Gene copy numbers decreased concomitantly with depth from around 108 / g sediment close to the sediment surface to less than 105 / g sediment at 5 mbsf. In the zone without detectable sulfate in the pore water from ca. 40 – 121 mbsf (Peru margin ODP site 1227, only dsrA (but not aprA was detected with copy numbers of less than 104 / g sediment, comprising ca. 14 % of the 16S rRNA gene copy numbers of total Bacteria. In this zone sulfate might be provided for SRB by anaerobic sulfide oxidation.

Domestic activity for technical development of the APR1400's RCP performance test

Energy Technology Data Exchange (ETDEWEB)

Cho, Seok; Kim, Seok; Bae, Byung-Uhn; Cho, Yun-Jae; Kim, Yeon-Sik; Jeon, Woo-Jin; Yun, Young-Jung [Korea Atomic Energy Research Institute, Daejeon (Korea, Republic of)

2015-10-15

The thermal hydraulic and electric capability of the RCP test facility (RCPTF) covers up to 18.5 MPa, 343 .deg. C, 11.7 m{sup 3}/s, and 14.0 MW in the design pressure, temperature, flow rate, and the maximum electric power, respectively. In 2013, commissioning test had been performed to verify its designed capability, followed by several modifications in the RCPTF including signal processing and control logic to enhance verification and evaluation capability of the RCP performance. After finishing the commissioning and modification of the RCPTF, type test for the new-type RCP had been performed successfully. In this paper, several technical issues developed in the 2013 and the type test's method and results will be described. In the present paper, the technical activities for the development of the verification test of APR1400's RCP are described. KAERI has completed the full set of technology development, prerequisite for the RCP verification test, and now on the way to perform a test for the sealing capacity of the seal assembly during the Station Block Out (SBO) condition of APR1400.

A novel technique of harmonic tissue dissection reduces seroma formation after modified radical mastectomy compared to conventional electrocautery: a single-blind randomized controlled trial.

Science.gov (United States)

Faisal, Mohammed; Fathy, Hamada; Shaban, Hamdy; Abuelela, Sameh T; Marie, Ahmed; Khaled, Islam

2018-01-01

Seroma is the most frequent postoperative complication following breast cancer surgery. Our aim was to evaluate the effect of the harmonic focus scalpel versus electrocautery in reducing seroma formation post-mastectomy and axillary clearance. A prospective randomized controlled trial study was conducted at the Department of Surgery of Suez Canal University Hospital from April 26th 2014 to 30th June 2016. Seventy-two women, in whom a mastectomy and axillary clearance for breast cancer were performed, were randomly allocated to either harmonic dissection ( n  = 36) or electrocautery ( n  = 36). The mean operative time was significantly longer for harmonic dissection compared with electrocautery (2.63 ± 0.41 vs. 1.75 ± 0.26 h; p  < 0.0001). In addition, a significantly smaller amount of intraoperative blood loss (69.4 ± 25.1 vs. 255.5 ± 41.6 ml; p  = 0.002) and total drainage volume (1277.8 ± 172.5 ml vs. 3300 ± 167.5 ml; p  = 0.002) were found in the harmonic group. Moreover, there was a significant reduction in the time of drain removal (10.9 ± 1.12 vs. 15.9 ± 1.44; p  = 0.001) and the incidence of seroma formation after drain removal [8.3% vs 33.3%; p  = 0.003] in the harmonic group compared with those in the electrocautery group. Harmonic dissection technique leads to significant decreases in intraoperative blood loss, total drainage volume and postoperative seroma in terms of shorter drain duration with a minimal increase in the operative time and better quality of life. Here, we recommend the use of the harmonic dissection technique in mastectomy and axillary clearance.

Paravertebral Block Plus Thoracic Wall Block versus Paravertebral Block Alone for Analgesia of Modified Radical Mastectomy: A Retrospective Cohort Study.

Directory of Open Access Journals (Sweden)

Nai-Liang Li

Full Text Available Paravertebral block placement was the main anesthetic technique for modified radical mastectomy in our hospital until February 2014, when its combination with blocks targeting the pectoral musculature was initiated. We compared the analgesic effects of paravertebral blocks with or without blocks targeting the pectoral musculature for modified radical mastectomy.We retrospectively collected data from a single surgeon and anesthesiologist from June 1, 2012, to May 31, 2015. Intraoperative sedatives and analgesic requirements, time to the first analgesic request, postoperative analgesic doses, patient satisfaction, and complications were compared.Fifty-four patients received a paravertebral block alone (PECS 0, and 46 received a paravertebral block combined with blocks targeting the pectoral musculature (PECS 1. The highest intraoperative effect-site concentration of propofol was significantly lower in the PECS 1 group than in the PECS 0 group [2.3 (1.5, 2.8 vs 2.5 (1.5, 4 μg/mL, p = 0.0014]. The intraoperative rescue analgesic dose was significantly lower in the PECS 1 group [0 (0, 25 vs 0 (0, 75 mg of ketamine, p = 0.0384]. Furthermore, the PECS 1 group had a significantly longer time to the first analgesic request [636.5 (15, 720 vs 182.5 (14, 720 min, p = 0.0001]. After further adjustment for age, body mass index, American Society of Anesthesiologists Physical Status classification, chronic pain history, incidence of a superficial cervical plexus block placement, and operation duration, blocks targeting the pectoral musculature were determined to be the only significant factor (hazard ratio, 0.36; 95% confidence interval, 0.23-0.58; p < 0.0001. Very few patients used potent analgesics including morphine and ketorolac; the cumulative use of morphine or ketorolac was similar in the study groups. However, the incidence of all analgesic use, namely morphine, ketorolac, acetaminophen, and celecoxib, was significantly lower in the PECS 1 group [3

Monitoring the impact of an aspartic protease (MpAPr1) on grape proteins and wine properties.

Science.gov (United States)

Theron, Louwrens Wiid; Bely, Marina; Divol, Benoit

2018-04-23

The perception of haze in wine is brought about when pathogenesis-related proteins become unstable and aggregate, subsequently resulting in crosslinking until it develops into light-dispersing particles. Elimination of these proteins is usually achieved via bentonite fining, which, although effective, suffers from several drawbacks. The utilization of proteases has been proposed as an ideal alternative. In a previous study, an aspartic protease (MpAPr1) from the yeast Metschnikowia pulcherrima was purified and shown to be partially active against grape proteins in synthetic medium. In this study, the effects of pure MpAPr1 supplemented to Sauvignon Blanc juice on subsequent fermentation were investigated. The juice was incubated for 48 h and thereafter inoculated with Saccharomyces cerevisiae. Results revealed that the enzyme had no observable effects on fermentation performance and retained activity throughout. Protein degradation could be detected and resulted in a significant modification of the wine composition and an increase in the presence of certain volatile compounds, especially those linked to amino acid metabolism.

Contralateral prophylactic mastectomy: A qualitative approach to exploring the decision making process.

Science.gov (United States)

Greener, Judith R; Bass, Sarah Bauerle; Lepore, Stephen J

2018-01-01

The proportion of women with unilateral breast cancer and no familial or genetic risk factors who elect contralateral prophylactic mastectomy (CPM) has grown dramatically, even in the absence of clear data demonstrating improved outcomes. To further extend the literature that addresses treatment decision-making, qualitative interviews were conducted with eleven women who considered CPM. A social ecological model of breast cancer treatment decision-making provided the conceptual framework, and grounded theory was used to identify the cognitive, psychosocial, and emotional influences motivating treatment choice. This research identified five themes that give context to women's decision-making experience: (1) variability in physician communication, (2) immediacy of the decision, (3) meaning of being proactive about treatment, (4) meaning of risk, and (5) women's relationship with their breasts. The results suggest that greater emphasis should be placed on a more nuanced understanding of patients' emotional reaction to breast cancer and managing the decision-making environment.

Numerical Investigation of APR1400 Loop Seal Reformation and Clearing Phenomena during Post-LOCA Long-term Cooling Period using RELAP5

Energy Technology Data Exchange (ETDEWEB)

Lee, S. I.; Jeon, J. H.; Park, J. H.; Sung, H. J.; Lee, J. I.; Choi, T. S. [KEPCO NF, Daejeon (Korea, Republic of)

2016-10-15

Hand calculations had been tried to show that the loop seal reformation does not degrade the LTC performance of the APR1400, but the result was unclear. Therefore, the code assessments of the phenomena for APR1400 are required to guarantee the performance of LTC. In the present study, RELAP5/MOD3.3 patch04 (3.3iy) is used for the assessments. The safety degradation, e.g., possible cladding temperature rise due to LSRC during LTC period would be stronger when the safety injection (SI) is larger, while the core uncovery is more probable when the SI is smaller. In other words, it is not easy to determine the limiting condition of safety injection as two or four safety injection pumps (SIPs) in APR1400. In the present study, both the minimum SI condition with two SIPs and the maximum SI condition with four SIPs are considered. The study focuses only on the top slot break condition due to its highest possibility of LSRC phenomena. The LSRC issues for APR1400 are discussed and investigated through numerical investigation using RELAP5MOD3.3 patch04 for top-slot cold leg (pump discharge line) breaks. The major items investigated are whether the simultaneous four loop seal reformation is possible and whether there is any possible violation of the long term coolability criteria in 10 CFR 50.46. Safety injection with two SIPs and four SIPs are investigated to find that the four loop seal reformation condition before the simultaneous injection may occur only with four SIPs.

Anatomical and radiographical studies on the arterial supply of the udder in goat and their surgical importance

Directory of Open Access Journals (Sweden)

Z.A. Adam

2016-09-01

Full Text Available The present study aimed to show the arterial blood supply of the udder of the Egyptian native breed of goat (Baladi goat to be used as a guide during mastectomy and other surgical interferences. The study was carried out on the udder of twelve apparently healthy adult female Egyptian Baladi goats. Four goats were used for mastectomy, one specimen was used for radiography and the other specimens were subjected to gum-milk latex injection to clarify the origin, course and distribution of the main arteries supplying the udder. The results revealed that the udder of goat was supplied by the external pudendal artery and dorsal labial and mammary branch of the ventral perineal artery. The course of the external pudendal artery through the inguinal canal before reaching the base of the udder, as well as that of the dorsal labial and mammary branch of the ventral perineal artery in the perineal region, were briefly described to determine the appropriate site for ligation of these vessels before mastectomy. Moreover, the arterial interconnection between the two halves of the udder was emphasized to be highlighted during unilateral mastectomy. Vascular ligation of the main blood vessels supplying the udder on the basis of the anatomical description provided less traumatic surgery and reduced the severity of the blood loss.

ExternE transport methodology for external cost evaluation of air pollution

DEFF Research Database (Denmark)

Jensen, S. S.; Berkowicz, R.; Brandt, J.

The report describes how the human exposure estimates based on NERI's human exposure modelling system (AirGIS) can improve the Danish data used for exposure factors in the ExternE Transport methodology. Initially, a brief description of the ExternE Tranport methodology is given and it is summarised...

The association between complications and quality of life after mastectomy and breast reconstruction for breast cancer.

Science.gov (United States)

Browne, John P; Jeevan, Ranjeet; Gulliver-Clarke, Carmel; Pereira, Jerome; Caddy, Christopher M; van der Meulen, Jan H P

2017-09-15

Medical treatment for breast cancer is associated with substantial toxicity and patient burden. There is less known about the impact of surgical complications. Understanding this impact could provide important information for patients when they are considering surgical options. Between 2008 and 2009, the UK National Mastectomy and Breast Reconstruction Audit recorded surgical complications for a prospective cohort of 17,844 women treated for breast cancer at 270 hospitals; 6405 of these women were surveyed about their quality of life 18 months after surgery. Breast appearance, emotional well-being, and physical well-being were quantified on 0- to 100-point scales. Linear multiple regression models, controlling for a range of baseline prognostic factors, were used to compare the scores of patients who had complications with the scores of those who did not. The overall complication rate was 10.2%. Complications were associated with little or no impairment in women undergoing mastectomy without reconstruction or with delayed reconstruction. The association was much larger for flap-related complications suffered during immediate reconstruction. The breast-appearance scores (adjusted mean difference, -23.8; 95% confidence interval [CI], -31.0 to -16.6) and emotional well-being scores (adjusted mean difference, -14.0; 95% CI, -22.0 to -6.0) of these patients were much lower than those of any other patient group. Implant-related complications were not associated with a lower quality of life in any surgical group. There is a strong case for prospectively collecting flap-complication rates at the surgeon and surgical unit level and for allowing patients to access these data when they make choices about their breast cancer surgery. Cancer 2017;123:3460-7. © 2017 American Cancer Society. © 2017 American Cancer Society.

Post-test analysis for the APR1400 LBLOCA DVI performance test using MARS

International Nuclear Information System (INIS)

Bae, Kyoo Hwan; Lee, Y. J.; Kim, H. C.; Bae, Y. Y.; Park, J. K.; Lee, W.

2002-03-01

Post-test analyses using a multi-dimensional best-estimate analysis code, MARS, are performed for the APR1400 LBLOCA DVI (Direct Vessel Injection) performance tests. This report describes the code evaluation results for the test data of various void height tests and direct bypass tests that have been performed at MIDAS test facility. MIDAS is a scaled test facility of APR1400 with the objective of identifying multi-dimensional thermal-hydraulic phenomena in the downcomer during the reflood conditions of a large break LOCA. A modified linear scale ratio was applied in its construction and test conditions. The major thermal-hydraulic parameters such as ECC bypass fraction, steam condensation fraction, and temperature distributions in downcomer are compared and evaluated. The evaluation results of MARS code for the various test cases show that: (a) MARS code has an advanced modeling capability of well predicting major multi-dimensional thermal-hydraulic phenomena occurring in the downcomer, (b) MARS code under-predicts the steam condensation rates, which in turn causes to over-predict the ECC bypass rates. However, the trend of decrease in steam condensation rate and increase in ECC bypass rate in accordance with the increase in steam flow rate, and the calculation results of the ECC bypass rates under the EM analysis conditions generally agree with the test data

Effect of distance to radiation treatment facility on use of radiation therapy after mastectomy in elderly women

International Nuclear Information System (INIS)

Punglia, Rinaa S.; Weeks, Jane C.; Neville, Bridget A.; Earle, Craig C.

2006-01-01

Purpose: We sought to study the effect of distance to the nearest radiation treatment facility on the use of postmastectomy radiation therapy (PMRT) in elderly women. Methods and Materials: Using data from the linked Surveillance, Epidemiology, and End Results-Medicare (SEER-Medicare) database, we analyzed 19,787 women with Stage I or II breast cancer who received mastectomy as definitive surgery during 1991 to 1999. Multivariable logistic regression was used to investigate the association of distance with receipt of PMRT after adjusting for clinical and sociodemographic factors. Results: Overall 2,075 patients (10.5%) treated with mastectomy received PMRT. In addition to cancer and patient characteristics, in our primary analysis, increasing distance to the nearest radiation treatment facility was independently associated with a decreased likelihood of receiving PMRT (OR 0.996 per additional mile, p = 0.01). Secondary analyses revealed that the decline in PMRT use appeared at distances of more than 25 miles and was statistically significant for those patients living more than 75 miles from the nearest radiation facility (odds of receiving PMRT of 0.58 [95% CI 0.34-0.99] vs. living within 25 miles of such a facility). The effect of distance on PMRT appeared to be more pronounced with increasing patient age (>75 years). Variation in the effect of distance on radiation use between regions of the country and nodal status was also identified. Conclusions: Oncologists must be cognizant of the potential barrier to quality care that is posed by travel distance, especially for elderly patients; and policy makers should consider this fact in resource allocation decisions about radiation treatment centers

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.

Benjamin Crémieux, Inquiétude et reconstruction. Essai sur la littérature d’après-guerre

OpenAIRE

Brangé, Mireille

2016-01-01

Après xxe siècle (1924) en 2010 reparaît ce recueil de 1931 où l’A. étudie ensemble «les faits littéraires, les concordances et les divergences qui caractérisent une époque, les formes spécifiques qu’y prennent les œuvres, […] leurs rapports avec le milieu historique et social, la vision de la vie qui s’y exprime» (p. 8). La même année que les Essais critiques d’Arland et que les articles de Drieu La Rochelle sur «la fin de l’après-guerre», il interroge l’inquiétude des années 1920 et envisag...

Migration d'une broche dans le canal médullaire cervical après une ...

African Journals Online (AJOL)

Migration d'une broche dans le canal médullaire cervical après une ostéosynthèse de l'articulation acromio-claviculaire. Bah Aliou, El Alaoui Adil. Abstract. We report the case of a 49 year-old right-handed chef with left shoulder trauma occurred during a football game. The diagnosis was fracture of the distal quarter of ...

Bilateral Mastectomy as Radical Treatment of Gynecomastia Secondary to Antiretroviral Therapy in a Low-Income Setting: A Case Report.

Science.gov (United States)

Antunes, Mario; Schiavone, Marcella; Pizzol, Damiano; Di Gennaro, Francesco; Ludovico, Rossana; De Palma, Angela

2018-05-11

Gynecomastia is a common finding in males, with an incidence that varies widely globally. In 10-25% of cases, it is caused by drugs. Its pathophysiologic mechanism includes exposure to exogenous estrogens and medications that cause hypogonadism, antiandrogenic effects and hyperprolactinemia. Gynecomastia is associated with exposure to antiretroviral therapy (ART), particularly efavirenz. Sometimes surgery may be required as treatment. We report a case of a 46-year-old man receiving ART presenting with a marked bilateral breast enlargement who underwent bilateral mastectomy as the only successful treatment in a low-income setting.

Measurement and assessment of doses from external radiations required for revised radiation protection regulations

Energy Technology Data Exchange (ETDEWEB)

Tsujimura, Norio; Kojima, Noboru; Hayashi, Naomi [Japan Nuclear Cycle Development Inst., Tokai, Ibaraki (Japan)

2001-06-01

Radiation protection regulations based on the 1990 recommendations of ICRP have been revised and will take effect from Apr., 2001. The major changes concerning on the measurement and assessment of doses from external radiations are as follows. (1) Personal dose equivalent and ambient dose equivalent stated in ICRP Publication 74 are introduced as quantities to be measured with personal dosimeters and survey instruments, respectively. (2) For multiple dosimetry for workers, the compartment weighting factors used for a realistic assessment of effective dose are markedly changed. In advance of the introduction of the new radiation protection regulations, the impacts on workplace and personal monitoring for external radiations by these revisions were investigated. The following results were obtained. (1) A new ambient dose equivalent to neutrons is higher with a factor of 1.2 than the old one for moderated fission neutron spectra. Therefore, neutron dose equivalent monitors for workplace monitoring at MOX fuel for facilities should be recalibrated for measurement of the new ambient dose equivalent. (2) Annual effective doses of workers were estimated by applying new calibration factors to readings of personal dosimeters, worn by workers. Differences between effective doses and effective dose equivalents are small for workers engaged in the fabrication process of MOX fuel. (author)

Measurement and assessment of doses from external radiations required for revised radiation protection regulations

International Nuclear Information System (INIS)

Tsujimura, Norio; Kojima, Noboru; Hayashi, Naomi

2001-01-01

Radiation protection regulations based on the 1990 recommendations of ICRP have been revised and will take effect from Apr., 2001. The major changes concerning on the measurement and assessment of doses from external radiations are as follows. (1) Personal dose equivalent and ambient dose equivalent stated in ICRP Publication 74 are introduced as quantities to be measured with personal dosimeters and survey instruments, respectively. (2) For multiple dosimetry for workers, the compartment weighting factors used for a realistic assessment of effective dose are markedly changed. In advance of the introduction of the new radiation protection regulations, the impacts on workplace and personal monitoring for external radiations by these revisions were investigated. The following results were obtained. (1) A new ambient dose equivalent to neutrons is higher with a factor of 1.2 than the old one for moderated fission neutron spectra. Therefore, neutron dose equivalent monitors for workplace monitoring at MOX fuel for facilities should be recalibrated for measurement of the new ambient dose equivalent. (2) Annual effective doses of workers were estimated by applying new calibration factors to readings of personal dosimeters, worn by workers. Differences between effective doses and effective dose equivalents are small for workers engaged in the fabrication process of MOX fuel. (author)

Influences on Satisfaction with Reconstructed Breasts and Intimacy in Younger Women Following Bilateral Prophylactic Mastectomy: a Qualitative Analysis.

Science.gov (United States)

Glassey, Rachael; O'Connor, Moira; Ives, Angela; Saunders, Christobel; Hardcastle, Sarah J

2018-04-30

The aim of this study was to explore the influences on satisfaction with reconstructed breasts and intimacy following bilateral prophylactic mastectomy (BPM) in younger women (influence satisfaction. Communication with partners prior to BPM appeared to improve satisfaction with intimacy post-BPM. The findings suggest that satisfaction with reconstructed breasts for younger women post-BPM appeared to be influenced by realistic outcome expectations and communication with others concerning reconstructed breast appearance and intimacy post-BPM. Implications for practice include discussion of realistic reconstructed breast appearance, referral to a psychologist to discuss sensitive issues, and accurate communication of surgical risks and consequences.

L’Allemagne : un non – lieu pour les exiles judéo-allemands après 1945 ?

OpenAIRE

Bohnekamp, Dorothea

2017-01-01

L’omniprésence de l’Allemagne dans les productions littéraires des exilés judéo-allemands en France après 1945 pose tout d’abord la question des différentes représentations de ce pays chez les rescapés. Le nombre important de métaphores spatiales interroge plus particulièrement le rôle de l’espace, matériel/urbain ou symbolique, dans la mémoire des émigrants et dans la reconstruction d’une Heimat souvent imaginaire. Après la guerre, cet attachement souvent ambivalent à l’Allemagne comme patri...

Analysis of MSGTR events for APR1400 by means of best estimate thermal-hydraulic system code

International Nuclear Information System (INIS)

Jeong, Ji Hwan; Kim, Sang Jae; Chang, Keun Sun; Lee, Jae Hun

2001-01-01

A multiple steam generator tube rupture (MSGTR) event has never occurred in the history of commercial nuclear reactor operation while single steam generator tube rupture (SGTR) event is reported to occur every two years. As there is no history of MSGTR event, the understandings of transients and consequences of this event are not so much. In this study, a postulated MSGTR event in advanced power reactor 1400 (APR1400) is analyzed using thermal-hydraulic system code. The APR 1400 is a two-loop, 1000 MWe, PWR supposed to be built in 2009. MARS1.4 is used in this study. The present study aims to understand the effects of rupture location in heat transfer tubes and selection of affected steam generator following a MSGTR event. The effects of five tube rupture locations are compared with each other. The comparison shows that the response of APR1400 is to allow shortest time for operator action following a tubes rupture in the vicinity of hot-leg side tube sheet and to allow longest time following a tube ruptures at the tube top. The MSSV lift time for rupture at tube-top is evaluated as 24.5% larger than that for rupture at hot-leg side tube sheet. Also, the MSSV lift time for four cases are compared in order to examine how long operator response time is allowed depending on which steam generator is affected. The comparison shows that the cases for both of two steam generators are affected allow longer time for operator action compared with the cases that a single steam generator is affected. Further more, the tube ruptures in the steam generator where a pressurizer is linked leads to the shortest operator response time

Real-Time PCR Quantification and Diversity Analysis of the Functional Genes aprA and dsrA of Sulfate-Reducing Prokaryotes in Marine Sediments of the Peru Continental Margin and the Black Sea.

Science.gov (United States)

Blazejak, Anna; Schippers, Axel

2011-01-01

Sulfate-reducing prokaryotes (SRP) are ubiquitous and quantitatively important members in many ecosystems, especially in marine sediments. However their abundance and diversity in subsurface marine sediments is poorly understood. In this study, the abundance and diversity of the functional genes for the enzymes adenosine 5'-phosphosulfate reductase (aprA) and dissimilatory sulfite reductase (dsrA) of SRP in marine sediments of the Peru continental margin and the Black Sea were analyzed, including samples from the deep biosphere (ODP site 1227). For aprA quantification a Q-PCR assay was designed and evaluated. Depth profiles of the aprA and dsrA copy numbers were almost equal for all sites. Gene copy numbers decreased concomitantly with depth from around 10(8)/g sediment close to the sediment surface to less than 10(5)/g sediment at 5 mbsf. The 16S rRNA gene copy numbers of total bacteria were much higher than those of the functional genes at all sediment depths and used to calculate the proportion of SRP to the total Bacteria. The aprA and dsrA copy numbers comprised in average 0.5-1% of the 16S rRNA gene copy numbers of total bacteria in the sediments up to a depth of ca. 40 mbsf. In the zone without detectable sulfate in the pore water from about 40-121 mbsf (Peru margin ODP site 1227), only dsrA (but not aprA) was detected with copy numbers of less than 10(4)/g sediment, comprising ca. 14% of the 16S rRNA gene copy numbers of total bacteria. In this zone, sulfate might be provided for SRP by anaerobic sulfide oxidation. Clone libraries of aprA showed that all isolated sequences originate from SRP showing a close relationship to aprA of characterized species or form a new cluster with only distant relation to aprA of isolated SRP. For dsrA a high diversity was detected, even up to 121 m sediment depth in the deep biosphere.

SU-F-T-87: Comparison of Advanced Radiotherapy Techniques for Post- Mastectomy Breast Cancer Patients

Energy Technology Data Exchange (ETDEWEB)

Heins, D; Zhang, R [Louisiana State University, Baton Rouge, LA (United States); Hogstrom, K; Sanders, M [Mary Bird Perkins Cancer Center, Baton Rouge, LA (United States)

2016-06-15

Purpose: To determine if bolus electron conformal therapy (Bolus-ECT) combined with intensity modulated x-ray therapy (IMXT) and flattening filter free volumetric modulated arc therapy (FFF-VMAT (6x and 10x)) can maintain equal or better dose coverage than standard volumetric modulated arc therapy (Std-VMAT) while reducing doses to organs at risk (OARs). Methods: Bolus-ECT with IMXT, FFF-VMAT, and Std-VMAT treatment plans were produced for ten post-mastectomy radiotherapy (PMRT) patients previously treated at our clinic. The treatment plans were created on commercially available treatment planning system (TPS) and all completed treatment plans were reviewed and approved by a radiation oncologist. The plans were evaluated based on planning target volume (PTV) coverage, tumor control probability (TCP), dose homogeneity index (DHI), conformity index (CI), and dose to organs at risk (OAR). Results: All techniques produced clinically acceptable PMRT plans. Overall, Bolus-ECT with IMXT exhibited higher maximum dose compared to all VMAT techniques. Bolus-ECT with IMXT and FFF-VMAT10x had slightly improved TCP over FFF-VMAT6x and Std-VMAT. However, all VMAT techniques showed improved CI and DHI over Bolus-ECT with IMXT. All techniques showed very similar mean lung dose. Bolus-ECT with IMXT exhibited a reduced mean heart dose over Std-VMAT. Both FFF-VMAT techniques had higher mean heart dose compared to Std-VMAT. In addition, Bolus-ECT with IMXT was able to reduce mean dose to the contralateral breast compared to Std-VMAT and both FFF-VMAT techniques had comparable but slightly reduced dose compared to Std-VMAT. Conclusion: This work has shown that Bolus-ECT with IMXT produces clinically acceptable plans while reducing OAR doses. Both FFF-VMAT techniques are comparable to Std-VMAT with slight improvements. Even though all VMAT techniques produce more homogenous and conformal dose distributions, Bolus-ECT with IMXT is a viable option for treating post-mastectomy patients

Radiation Therapy Versus No Radiation Therapy to the Neo-breast Following Skin-Sparing Mastectomy and Immediate Autologous Free Flap Reconstruction for Breast Cancer: Patient-Reported and Surgical Outcomes at 1 Year-A Mastectomy Reconstruction Outcomes Consortium (MROC) Substudy.

Science.gov (United States)

Cooke, Andrew L; Diaz-Abele, Julian; Hayakawa, Tom; Buchel, Ed; Dalke, Kimberly; Lambert, Pascal

2017-09-01

To determine whether adjuvant radiation therapy (RT) is associated with adverse patient-reported outcomes and surgical complications 1 year after skin-sparing mastectomy and immediate autologous free flap reconstruction for breast cancer. We compared 24 domains of patient-reported outcome measures 1 year after autologous reconstruction between patients who received adjuvant RT and those who did not. A total of 125 patients who underwent surgery between 2012 and 2015 at our institution were included from the Mastectomy Reconstruction Outcomes Consortium study database. Adjusted multivariate models were created incorporating RT technical data, age, cancer stage, estrogen receptor, chemotherapy, breast size, body mass index, and income to determine whether RT was associated with outcomes. At 1 year after surgery, European Organisation for Research and Treatment of Cancer (EORTC) Breast Cancer-Specific Quality of Life Questionnaire breast symptoms were significantly greater in 64 patients who received RT (8-point difference on 100-point ordinal scale, PBREAST-Q (Post-operative Reconstruction Module), Patient-Report Outcomes Measurement Information System Profile 29, McGill Pain Questionnaire-Short Form (MPQ-SF) score, Generalized Anxiety Disorder Scale, and Patient Health Questionnaire-were not statistically different between groups. Surgical complications were uncommon and did not differ by treatment. RT to the neo-breast compared with no RT following immediate autologous free flap reconstruction for breast cancer is well tolerated at 1 year following surgery despite patients undergoing RT also having a higher cancer stage and more intensive surgical and systemic treatment. Neo-breast symptoms are more common in patients receiving RT by the EORTC Breast Cancer-Specific Quality of Life Questionnaire but not by the BREAST-Q. Patient-reported results at 1 year after surgery suggest RT following immediate autologous free flap breast reconstruction is well tolerated

Impact of preoperative information on anxiety and disease-related knowledge in women undergoing mastectomy for breast cancer: a randomized clinical trial.

Science.gov (United States)

Wysocki, W M; Mituś, J; Komorowski, A L; Karolewski, K

2012-01-01

Despite the large number of clinical trials on breast cancer, patient-related factors such as perioperative anxiety and level of knowledge about the disease and treatment have not been included in mainstream research efforts. This randomized trial was performed to evaluate the impact of information, provided preoperatively, on anxiety and knowledge of women undergoing mastectomy for breast cancer. Sixty consecutive patients with breast cancer, admitted for a mastectomy, as primary treatment for breast cancer, with no previous cancer history, were randomized to receive structured information (short video about practical aspects of the hospital stay, surgical and adjuvant treatment) in addition to the routine informed consent procedure for surgery or the routine informed consent only. Anxiety and subjective knowledge levels were measured with the visual analogue scales; in addition, knowledge was assessed with a questionnaire. There was no significant effect of the additional information on perioperative anxiety or knowledge (subjective). Significantly more patients in the additional information group correctly listed all major available treatment options compared to the patients that received routine information (preoperatively 54% vs. 19%; p = 0.0101; 7 days postoperatively 50% vs.19%; p = 0.0367). Use of an informational video, preoperatively, did not significantly affect perioperative anxiety or subjective knowledge. Additional research is needed on effective delivery of disease- and treatment-specific information perioperatively.

Externalities of energy. Swedish implementation of the ExternE methodology

International Nuclear Information System (INIS)

Nilsson, Maans; Gullberg, M.

1998-01-01

The growing interest for developing economic instruments for efficient environmental policies has opened up a large area of multi-disciplinary research. ExternE is an example of this research, combining disciplines such as engineering, ecology, immunology and economics expertise to create new knowledge about how environmental pressures from energy production affect our nature and society. The ExternE Project aims to identify and, as far as possible quantify the externalities of energy production in Europe. The Stockholm Environment Institute has carried out a preliminary aggregation: -Coal Fuel Cycle: centred around Vaesteraas Kraftvaermeverk, Vaesteraas. This is the largest co-generation plant in Sweden, with four blocks and a maximum co-generation output of 520 MW electricity and 950 MW heat. The analysis is carried out on boiler B4. -Biomass Fuel Cycle: centred around Haendeloeverket, Norrkoeping. This plant predominately burns forestry residues, but a variety of fuels are combusted. Haendeloeverket has an installed capacity of 100 MW electricity and 375 MW heat, in a total of three boilers and two back-pressure turbines. The analysis is carried out on boiler P13. -Hydro Fuel Cycle: Klippens Kraftstation, Storuman. Built in 1990-1994, it is the youngest hydro power station in Sweden. It has been designed and built with significant efforts to account for and protect environmental values. Installed capacity is 28 MW. The environmental impact assessment from the construction of this plant is carried out, but the evaluation is still not finalized. The preliminary aggregation aimed to test whether ExternE results could be used to make estimates for the entire Swedish electricity production system. Hence, national results as well as results from other partner countries in ExternE has been applied

Evaluation for In-Vessel Retention Capabilities with In-Vessel Injection and External Reactor Vessel Cooling

International Nuclear Information System (INIS)

Lee, Jeong Seong; Ryu, In Chul; Moon, Young Tae

2016-01-01

If the accident has not progressed to the point of substantial changes in the core geometry, establishing adequate cooling is as straightforward as re-establishing flow through the reactor core. However, if the accident has progressed to the point where the core geometry is substantially altered as a result of material melting and relocation, as was the case in the TMI-2 accident, the means of cooling the debris are not as straightforward. From this time on, the reactor core was either completely or nearly covered by water, with high pressure injection flow initiated shortly after three hours into the accident. However, the core debris was not coolable in this configuration and a substantial quantity of molten core material drained into the bypass region, with approximately twenty metric tons of molten debris draining into the reactor pressure vessel (RPV) lower head. Hence, the core configuration developed at approximately three hours into the accident was not coolable, even submerged in water. The purpose of this paper is to evaluate in-vessel retention capabilities with in-vessel injection (IVI) and external reactor vessel cooling (ERVC) available in a reactor application by using the integrated severe accident analysis code. The MAAP5 models were improved to facilitate evaluation of the in-vessel retention capability of APR1400. In-vessel retention capabilities have been analyzed for the APR1400 using the MAAP5.03 code. The results show that in-vessel retention is feasible when in-vessel injection is initiated within a relatively short time frame under the simulation condition used in the present study

Evaluation for In-Vessel Retention Capabilities with In-Vessel Injection and External Reactor Vessel Cooling

Energy Technology Data Exchange (ETDEWEB)

Lee, Jeong Seong; Ryu, In Chul; Moon, Young Tae [KEPCO Engineering and Construction Co. Ltd., Deajeon (Korea, Republic of)

2016-10-15

If the accident has not progressed to the point of substantial changes in the core geometry, establishing adequate cooling is as straightforward as re-establishing flow through the reactor core. However, if the accident has progressed to the point where the core geometry is substantially altered as a result of material melting and relocation, as was the case in the TMI-2 accident, the means of cooling the debris are not as straightforward. From this time on, the reactor core was either completely or nearly covered by water, with high pressure injection flow initiated shortly after three hours into the accident. However, the core debris was not coolable in this configuration and a substantial quantity of molten core material drained into the bypass region, with approximately twenty metric tons of molten debris draining into the reactor pressure vessel (RPV) lower head. Hence, the core configuration developed at approximately three hours into the accident was not coolable, even submerged in water. The purpose of this paper is to evaluate in-vessel retention capabilities with in-vessel injection (IVI) and external reactor vessel cooling (ERVC) available in a reactor application by using the integrated severe accident analysis code. The MAAP5 models were improved to facilitate evaluation of the in-vessel retention capability of APR1400. In-vessel retention capabilities have been analyzed for the APR1400 using the MAAP5.03 code. The results show that in-vessel retention is feasible when in-vessel injection is initiated within a relatively short time frame under the simulation condition used in the present study.

The Experience of Staging Nijinsky's "L'Apres-Midi d'un Faune" in a Higher Education Dance Program

Science.gov (United States)

Curran, Tina

2010-01-01

This study documented the experiences of staging Vaslav Nijinsky's "L'Apres-midi d'un Faune" in a higher education dance program. The ballet was staged from Labanotation. Research questions focused on teaching and learning pedagogy, characterization of the process over time, experiences of the participants and teaching approaches. The project…

Verification of SAMG entry condition for APR1400

Energy Technology Data Exchange (ETDEWEB)

Yun, Junghyun; Kim, Taewan; Kim, Jonghyun [KEPCO International Nuclear Graduate School, Ulsan (Korea, Republic of)

2013-10-15

In the wake of the Fukushima accident, severe accident management has become important more than ever. While Emergency Operating Procedures (EOPs) focuses on cooling down the core during a design basis accident, the prime objective of severe accident management guideline (SAMG) is to prevent the release of radioactive material into the environment during a severe accident. Only one fixed value of core exit temperature (CET) has been applied for several decades to different types of nuclear power plants (NPPs) in Korea. Although the different types of NPPs have different cladding materials and system designs, the identical CET, i. e., 650 .deg. C, is applied as the entry condition to the SAMG of all the NPPs (except CANDU plants), i. e., Westinghouse type, OPR1000, and APR1400. In this paper, the transition point is re-evaluated for dominant severe accident sequences; station black-out (SBO), small break loss of coolant accident (SBLOCA), and me dium break loss of coolant accident (MBLOCA). In cases of SBO and SBLOCA, the current SAMG entry condition seems proper, while it needs to be reconsidered for MBLOCA case.

Analysis Of Feedwater Line Break Of APR1400 By MARS Code

International Nuclear Information System (INIS)

Nguyen Thi Thanh Thuy; Le Dai Dien, Hoang Minh Giang

2011-01-01

This paper will deal with analysis of Feed water Line Break problem (FWLB) of the APR 1400 NPP with initial conditions: operation at 100% of power, double-ended break area of 0.058 m 2 and the break location of the feedwater line between the check valve and the steam generator. The analysis was simulated by MARS code through two step: calculation for steady state and calculation for transient state with initial condition mentioned. Some output result were presented with explanation: sequence of events corresponding to the time of the accident, the system behavior as temperature, pressure, steam generator water levels as well as DNBR, etc. before and after the accident. (author)

Analysis Of Control Rod Ejection Of APR1400 By RELAP5

International Nuclear Information System (INIS)

Le Thi Thu; Hoang Minh Giang; Vo Thi Huong; Le Dai Dien

2011-01-01

This paper presents the analysis of Reactivity Induced Accident caused by ejection of a Control Element Assembly (CEA) from APR 1400 reactor vessel within 0.05 second. The initial condition were assumed as following: power level at 102%, delayed neutron fraction β = 412 pcm and CEA worth = 110 pcm. The analysis was simulated by RELAP5 code through two step: calculation of steady state and calculation of transient with initial condition mentioned as above. Some output results were presented with explanation: sequence of events corresponding to the time of the accident, the system behavior as power, reactivity feedback from fuel temperature changes (Doppler) as well as temperature, pressure, DNBR within 6 second of the accident. (author)

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

No serious late cardiac effects after adjuvant radiotherapy following mastectomy in premenopausal women with early breast cancer

International Nuclear Information System (INIS)

Gustavsson, Anita; Bendahl, Pear-Ola; Cwikiel, Magdalena; Eskilsson, Jan; Thapper, Kerstin Leofvander; Pahlm, Olle

1999-01-01

Purpose: To assess cardiac mortality, coronary artery disease, myocardial dysfunction, and valvular heart disease in women younger than 65 years of age, at least 10 years after adjuvant radiotherapy following mastectomy in early breast cancer. Methods and Materials: Ninety women (45-64 years old) with Stage II breast cancer without relapse, included in the South Sweden Breast Cancer Trial (premenopausal arm), with or without adjuvant postoperative radiotherapy ± cyclophosphamide were examined with myocardial scintigraphy and echocardiography/Doppler, 10-17 years after radiotherapy. Thirty-four patients had been irradiated for left-sided tumors, 33 for right-sided tumors, and 23 patients had not been treated with radiotherapy. The radiotherapy (conventional roentgen, electron beams, and high-energy photon beams combined, in each patient) included the chest wall and the regional lymph nodes, with a specified target dose of 38-48 Gy, administered in daily fractions of 1.9-2.4 Gy, 5 days/week. Results: No cardiac deaths were found among the original 275 patients randomized to adjuvant therapy. In the 90 patients examined, abnormal findings were recorded for ECG (14 patients), exercise test (5 patients), myocardial scintigraphy (6 patients), thickening of valve cusps (14 patients), and mild valvular regurgitation (20 patients). All patients had normal systolic function. Diastolic dysfunction was observed in 6 patients (abnormal relaxation in 4 patients and restrictive filling abnormality in 2 patients). Although no significant differences were found between the 3 study groups, there was a tendency to more abnormal findings after radiotherapy. Conclusion: Women younger than 50 years of age at the time of adjuvant radiotherapy following mastectomy in early breast cancer, had no serious cardiac sequelae 13 years (median) later, despite partly old-fashioned radiation techniques

The effect of post-mastectomy radiation therapy on breast implants: Unveiling biomaterial alterations with potential implications on capsular contracture

Energy Technology Data Exchange (ETDEWEB)

Ribuffo, Diego; Lo Torto, Federico [Department of Plastic Surgery, “Sapienza” University of Rome, Viale del Policlinico 155, 00166 Rome (Italy); Giannitelli, Sara M. [Tissue Engineering Unit, Department of Engineering, Università Campus Bio-Medico di Roma, Via Álvaro del Portillo 21, 00128 Rome (Italy); Urbini, Marco; Tortora, Luca [Surface Analysis Laboratory, Department of Mathematics and Physics, University “Roma Tre”, Via della Vasca Navale 84, 00146 Rome (Italy); INFN — National Institute of Nuclear Physics, Section of Roma Tre, Via della Vasca Navale 84, 00146 Rome (Italy); Mozetic, Pamela; Trombetta, Marcella [Tissue Engineering Unit, Department of Engineering, Università Campus Bio-Medico di Roma, Via Álvaro del Portillo 21, 00128 Rome (Italy); Basoli, Francesco; Licoccia, Silvia [Department of Chemical Science and Technologies, University of Rome “Tor Vergata”, Via della Ricerca Scientifica 1, 00173 Rome (Italy); Tombolini, Vincenzo [Department of Radiation Oncology, “Sapienza” University of Rome, Viale del Policlinico 155, 00166 Rome (Italy); Spencer-Lorillard Foundation, Viale Regina Elena 291, 00161 Rome (Italy); Cassese, Raffaele [Department of Radiation Oncology, “Sapienza” University of Rome, Viale del Policlinico 155, 00166 Rome (Italy); Scuderi, Nicolò [Department of Plastic Surgery, “Sapienza” University of Rome, Viale del Policlinico 155, 00166 Rome (Italy); and others

2015-12-01

Post-mastectomy breast reconstruction with expanders and implants is recognized as an integral part of breast cancer treatment. Its main complication is represented by capsular contracture, which leads to poor expansion, breast deformation, and pain, often requiring additional surgery. In such a scenario, the debate continues as to whether the second stage of breast reconstruction should be performed before or after post-mastectomy radiation therapy, in light of potential alterations induced by irradiation to silicone biomaterial. This work provides a novel, multi-technique approach to unveil the role of radiotherapy in biomaterial alterations, with potential involvement in capsular contracture. Following irradiation, implant shells underwent mechanical, chemical, and microstructural evaluation by means of tensile testing, Attenuated Total Reflectance Fourier Transform InfraRed spectroscopy (ATR/FTIR), Scanning Electron Microscopy (SEM), high resolution stylus profilometry, and Time of Flight Secondary Ion Mass Spectrometry (ToF-SIMS). Our findings are consistent with radiation-induced modifications of silicone that, although not detectable at the microscale, can be evidenced by more sophisticated nanoscale surface analyses. In light of these results, biomaterial irradiation cannot be ruled out as one of the possible co-factors underlying capsular contracture. - Highlights: • The debate continues whether to perform breast reconstruction before or after PMRT. • Radiation therapy may alter implant material, concurring to capsular contracture. • In this work, irradiated implants were investigated by a multi-technique approach. • Radiation-induced alterations could be evidenced by ATR/FTIR and ToF-SIMS. • Reported alteration might represent a co-factor underlying capsular contracture.

Environmental external effects from wind power based on the EU ExternE methodology

DEFF Research Database (Denmark)

Ibsen, Liselotte Schleisner; Nielsen, Per Sieverts

1998-01-01

of the Danish part of the project is to implement the framework for externality evaluation, for three different power plants located in Denmark. The paper will focus on the assessment of the impacts of the whole fuel cycles for wind, natural gas and biogas. Priority areas for environmental impact assessment......The European Commission has launched a major study project, ExternE, to develop a methodology to quantify externalities. A “National Implementation Phase”, was started under the Joule II programme with the purpose of implementing the ExternE methodology in all member states. The main objective...

ExternE National Implementation Finland

Energy Technology Data Exchange (ETDEWEB)

Pingoud, K; Maelkki, H; Wihersaari, M; Pirilae, P [VTT Energy, Espoo (Finland); Hongisto, M [Imatran Voima Oy, Vantaa (Finland); Siitonen, S [Ekono Energy Ltd, Espoo (Finland); Johansson, M [Finnish Environment Institute, Helsinki (Finland)

1999-07-01

ExternE National Implementation is a continuation of the ExternE Project, funded in part by the European Commission's Joule III Programme. This study is the result of the ExternE National Implementation Project for Finland. Three fuel cycles were selected for the Finnish study: coal, peat and wood-derived biomass, which together are responsible for about 40% of total electricity generation in Finland and about 75% of the non-nuclear fuel based generation. The estimated external costs or damages were dominated by the global warming (GW) impacts in the coal and peat fuel cycles, but knowledge of the true GW impacts is still uncertain. From among other impacts that were valued in monetary terms the human health damages due to airborne emissions dominated in all the three fuel cycles. Monetary valuation for ecosystem impacts is not possible using the ExternE methodology at present. The Meri-Pori power station representing the coal fuel cycle is one of the world's cleanest and most efficient coal-fired power plants with a condensing turbine. The coal is imported mainly from Poland. The estimated health damages were about 4 mECU/kWh, crop damages an order of magnitude lower and damages caused to building materials two orders of magnitude lower. The power stations of the peat and biomass fuel cycles are of CHP type, generating electricity and heat for the district heating systems of two cities. Their fuels are of domestic origin. The estimated health damages allocated to electricity generation were about 5 and 6 mECU/kWh, respectively. The estimates were case-specific and thus an generalisation of the results to the whole electricity generation in Finland is unrealistic. Despite the uncertainties and limitations of the methodology, it is a promising tool in the comparison of similar kinds of fuel cycles, new power plants and pollution abatement technologies and different plant locations with each other. (orig.)

ExternE National Implementation Finland

Energy Technology Data Exchange (ETDEWEB)

Pingoud, K.; Maelkki, H.; Wihersaari, M.; Pirilae, P. [VTT Energy, Espoo (Finland); Hongisto, M. [Imatran Voima Oy, Vantaa (Finland); Siitonen, S. [Ekono Energy Ltd, Espoo (Finland); Johansson, M. [Finnish Environment Institute, Helsinki (Finland)

1999-07-01

ExternE National Implementation is a continuation of the ExternE Project, funded in part by the European Commission's Joule III Programme. This study is the result of the ExternE National Implementation Project for Finland. Three fuel cycles were selected for the Finnish study: coal, peat and wood-derived biomass, which together are responsible for about 40% of total electricity generation in Finland and about 75% of the non-nuclear fuel based generation. The estimated external costs or damages were dominated by the global warming (GW) impacts in the coal and peat fuel cycles, but knowledge of the true GW impacts is still uncertain. From among other impacts that were valued in monetary terms the human health damages due to airborne emissions dominated in all the three fuel cycles. Monetary valuation for ecosystem impacts is not possible using the ExternE methodology at present. The Meri-Pori power station representing the coal fuel cycle is one of the world's cleanest and most efficient coal-fired power plants with a condensing turbine. The coal is imported mainly from Poland. The estimated health damages were about 4 mECU/kWh, crop damages an order of magnitude lower and damages caused to building materials two orders of magnitude lower. The power stations of the peat and biomass fuel cycles are of CHP type, generating electricity and heat for the district heating systems of two cities. Their fuels are of domestic origin. The estimated health damages allocated to electricity generation were about 5 and 6 mECU/kWh, respectively. The estimates were case-specific and thus an generalisation of the results to the whole electricity generation in Finland is unrealistic. Despite the uncertainties and limitations of the methodology, it is a promising tool in the comparison of similar kinds of fuel cycles, new power plants and pollution abatement technologies and different plant locations with each other. (orig.)

ExternE National Implementation Finland

International Nuclear Information System (INIS)

Pingoud, K.; Maelkki, H.; Wihersaari, M.; Pirilae, P.; Hongisto, M.; Siitonen, S.; Johansson, M.

1999-01-01

ExternE National Implementation is a continuation of the ExternE Project, funded in part by the European Commission's Joule III Programme. This study is the result of the ExternE National Implementation Project for Finland. Three fuel cycles were selected for the Finnish study: coal, peat and wood-derived biomass, which together are responsible for about 40% of total electricity generation in Finland and about 75% of the non-nuclear fuel based generation. The estimated external costs or damages were dominated by the global warming (GW) impacts in the coal and peat fuel cycles, but knowledge of the true GW impacts is still uncertain. From among other impacts that were valued in monetary terms the human health damages due to airborne emissions dominated in all the three fuel cycles. Monetary valuation for ecosystem impacts is not possible using the ExternE methodology at present. The Meri-Pori power station representing the coal fuel cycle is one of the world's cleanest and most efficient coal-fired power plants with a condensing turbine. The coal is imported mainly from Poland. The estimated health damages were about 4 mECU/kWh, crop damages an order of magnitude lower and damages caused to building materials two orders of magnitude lower. The power stations of the peat and biomass fuel cycles are of CHP type, generating electricity and heat for the district heating systems of two cities. Their fuels are of domestic origin. The estimated health damages allocated to electricity generation were about 5 and 6 mECU/kWh, respectively. The estimates were case-specific and thus an generalisation of the results to the whole electricity generation in Finland is unrealistic. Despite the uncertainties and limitations of the methodology, it is a promising tool in the comparison of similar kinds of fuel cycles, new power plants and pollution abatement technologies and different plant locations with each other. (orig.)

Cervical Epidural Anaesthesia for Radical Mastectomy and Chronic Regional Pain Syndrome of Upper Limb - A Case Report

Directory of Open Access Journals (Sweden)

Ashok Jadon

2009-01-01

Full Text Available A 47-yrs-female patient presented with carcinoma right breast, swelling and allodynia of right upper limb. radical mastectomy with axillary clearance and skin grafting was done under cervical epidural anaesthesia through 18G epidural catheter placed at C6/C7 level. Postoperative analgesia and rehabilitation of affected right upper limb was managed by continuous epidural infusion of 0.125% bupivacaine and 2.5 µg/ml -1 clonidine solution through epidu-ral catheter for 5 days and physiotherapy. This case report highlights the usefulness of cervical epidural analgesia in managing a complex situation of carcinoma breast with associated periarthitis of shoulder joint and chronic regional pain syndrome (CRPS of right upper limb.

Regional Externalities

NARCIS (Netherlands)

Heijman, W.J.M.

2007-01-01

The book offers practical and theoretical insights in regional externalities. Regional externalities are a specific subset of externalities that can be defined as externalities where space plays a dominant role. This class of externalities can be divided into three categories: (1) externalities

Unit Risk Quotient (RQ) and Relative Significance of Radionuclide on Flora and Fauna to the EU-APR Optimization

Energy Technology Data Exchange (ETDEWEB)

Lee, Keunsung [KHNP-CRI, Daejeon (Korea, Republic of); Kim, Sukhoon [FNC Technology Co., Ltd., Yongin (Korea, Republic of); Lee, Chonghui [KEPCO E and C, Yongin (Korea, Republic of)

2015-05-15

As part of the project for acquiring the certification from EUR organization, in accordance with Articles 4.8 and 5.5 specified in Section 2.20 of EUR Volume 2, the effects of ionizing radiation from the standard design of EU-APR on biota and ecosystems during operation and decommissioning phases shall be assessed. This assessment must be carried out according to the ERICA (i.e. Environmental Risk from Ionizing Contaminants: Assessment and management) integrated approach. This paper describes the evaluation results for unit risk quotient and relative significance by radionuclide derived from performing Tier 1 assessment on flora and fauna for the EU-APR design using ERICA Tool. As specified previously, Pa-231 and Th-228 are the most significant for the terrestrial and for the marine/freshwater ecosystems, respectively. And, in terms of environmental risk, those radionuclides having the most impact on flora and fauna are relatively more significant than isotope having the least impact by about 7 to 10 orders of magnitude.

Unit Risk Quotient (RQ) and Relative Significance of Radionuclide on Flora and Fauna to the EU-APR Optimization

International Nuclear Information System (INIS)

Lee, Keunsung; Kim, Sukhoon; Lee, Chonghui

2015-01-01

As part of the project for acquiring the certification from EUR organization, in accordance with Articles 4.8 and 5.5 specified in Section 2.20 of EUR Volume 2, the effects of ionizing radiation from the standard design of EU-APR on biota and ecosystems during operation and decommissioning phases shall be assessed. This assessment must be carried out according to the ERICA (i.e. Environmental Risk from Ionizing Contaminants: Assessment and management) integrated approach. This paper describes the evaluation results for unit risk quotient and relative significance by radionuclide derived from performing Tier 1 assessment on flora and fauna for the EU-APR design using ERICA Tool. As specified previously, Pa-231 and Th-228 are the most significant for the terrestrial and for the marine/freshwater ecosystems, respectively. And, in terms of environmental risk, those radionuclides having the most impact on flora and fauna are relatively more significant than isotope having the least impact by about 7 to 10 orders of magnitude