Avoiding axillary dissection in breast cancer surgery: a randomized trial to assess the role of axillary radiotherapy.

BACKGROUND: The need to dissect axillary nodes in patients with early breast cancer and clinically negative axilla remains controversial. The aim of the study was to assess the role of axillary radiotherapy (RT) in reducing axillary metastases in patients with early breast cancer who did not receive axillary dissection. PATIENTS AND METHODS: From 1995 to 1998, 435 patients over 45 years old with breast cancer up to 1.2 cm and no palpable axillary nodes were randomized 214 to breast conservation without axillary treatment and 221 to breast conservation plus axillary RT. RESULTS: After a median follow-up of 63 months, overt axillary metastases were fewer than expected: three cases in the no axillary treatment group (1.5%) and one in the RT group (0.5%). Expected cases were 43 in the no axillary treatment group and 10 in the RT group. Rates of distant metastases and local failures were low, and 5-year disease free survival was 96.0% (95% confidence interval, 94.1%-97.9%) without significant differences between the two arms. CONCLUSIONS: This study suggests that occult axillary metastases might never become clinically overt and axillary dissection might be avoided in patients with small carcinomas and a clinically negative axilla. Axillary RT seems to protect the patients from axillary recurrence almost completely.

Management of true splenic artery aneurysms. Two case reports and review of the literature.

Few series of splenic artery aneurysms (SAA) have been reported, but today asymptomatic SAA are detected with increasing frequency. Their importance lies from their potentially fatal consequences as life-threatening hemorrhage. SAA management still remains controversial as reported in this review. Our 2 patients treated with resection of the aneurysms, both located in the middle third of the splenic artery. Some authors demonstrated that when splenic artery has been ligated (or embolized) and the patients remain anatomically splenic, they may not retain any splenic function. Laparoscopic SAA ligation repair appears to be optimal and useful for aneurysms protruding from the pancreas and it is gaining interest because clinical recovery is rapid with a poor morbidity and economic and cosmetic advantages. Transcatheter embolization too offers a temporary control in urgency to stop hemorrhage and go back at later date to make much better elective operation. Endovascular interventions as percutaneous embolization has recently gained popularity: it offers a safe alternative or adjunctive therapy to traditional surgery. We hope in the future instrumentation will likely improve so that this procedure can be done percutaneously by development of prosthetic devices in the 21th century.

[Streptococcus pneumoniae: evolution of antibiotic resistance in a pediatric hospital in Córdoba, Argentina]. / Streptococcus pneumoniae: evolución de la resistencia a los antimicrobianos en un hospital de niños de Córdoba, Argentina.

The wide variety of prevalence of antimicrobial resistant Streptococcus pneumoniae in different countries confirms the importance of determining local patterns of resistance. From 1992 to 2000, we studied the pattern of antimicrobial resistance in S. pneumoniae and its evolution along the years, using 468 strains isolated in the Hospital de Niños de Córdoba. A total of 177 isolates (37.8%) were not susceptible to penicillin, with 19% intermediate and 18.8% resistant strains. High and intermediate resistance levels to cefotaxime were 4.9% and 10.9%, respectively. Decreased susceptibility to trimethoprim/sulfamethoxazole (TMS), erythromycin, chloramphenicol, and rifampin was found in 194 isolates (41.5%), 32 (6.8%), 13 (2.8%) and 3 (0.6%), respectively. No isolates resistant to vancomycin were detected. The most commonly combined resistance patterns were: penicillin/TMS (35.6%) and penicillin/TMS/cefotaxime (11.8%). This study highlights the increased rate of drug resistant S. pneumoniae during the last years, and the importance of antimicrobial resistance surveillance of adequate empirical therapy involving local and regional susceptibility patterns.

Streptococcus pneumoniae: evolución de la resistencia a los antimicrobianos en un hospital de niños de Córdoba, Argentina / Streptococcus pneumoniae: evolution of antibiotic resistance in a pediatric hospital in Córdoba, Argentina

The wide variety of prevalence of antimicrobial resistant Streptococcus pneumoniae in different countries confirms the importance of determining local patterns of resistance. From 1992 to 2000, we studied the pattern of antimicrobial resistance in S. pneumoniae and its evolution along the years, using 468 strains isolated in the Hospital de Niños de Córdoba. A total of 177 isolates (37.8) were not susceptible to penicillin, with 19 intermediate and 18.8 resistant strains. High and intermediate resistance levels to cefotaxime were 4.9 and 10.9, respectively. Decreased susceptibility to trimethoprim/sulfamethoxazole (TMS), erythromycin, chloramphenicol, and rifampin was found in 194 isolates (41.5), 32 (6.8), 13 (2.8) and 3 (0.6), respectively. No isolates resistant to vancomycin were detected. The most commonly combined resistance patterns were: penicillin/TMS (35.6) and penicillin/TMS/cefotaxime (11.8). This study highlights the increased rate of drug resistant S. pneumoniae during the last years, and the importance of antimicrobial resistance surveillance of adequate empirical therapy involving local and regional susceptibility patterns.

[An angiogenesis study of Dukes' B colonic tumors]. / Studio sull'angiogenesi nei tumori colici Dukes' B.

PURPOSE: To evaluate the angiogenesis in Dukes' B colon cancer. PATIENTS AND METHODS: In 60 patients (age, 39-75 years), the microvessel density and the relationship between the angiogenesis and other histologic features were retrospectively evaluated. In an ongoing prospective study, 25 patients have been enrolled to determine the possible therapeutic implications of VEGF quantitative analysis. RESULTS: The retrospective portion of this study confirms the prognostic value of the angiogenesis in terms of recurrences and survival. At present, no conclusions can be drawn from the prospective portion of the study.

[Stereotactic fine-needle aspiration biopsy (FNAB) of nonpalpable breast lesions: cyto-histological correlations]. / Agoaspirazione (FNAB) mediante centratura stereotassica di lesioni mammarie non palpabili: correlazioni cito-istologiche.

There are not complete consensus if mammographically guided FNABs of nonpalpable breast lesions can replace open biopsy. To elucidate this problem, we have reviewed the efficacy of stereotactic FNAB in a series of 502 cases of nonpalpable lesions observed in a period from 1990 to 1994, with a immediate cytologic control of adequacy of material. In 144 patients of the lesion is achieved with 4% sterile coal localisation and an open biopsy of the area performed. In each case cytologic findings, with a brief description of probable histotype of the lesion, are correlate with surgical pathologic diagnosis, with a comparison between two time period (1990-92; 1993-94). In our study particularly ductal and lobular hyperplasia (with or without atypia) restrict the efficiency of the FNAB. In fact the specificity varies from 83.3% to 90.3%, the sensitivity from 78.7% to 77.8%, positive predictive value from 86.0% to 90.3%, negative predictive value from 75.6% to 70% and diagnostic accuracy from 80.0 to 82.4%, considering ductal and lobular hyperplasias as true negatives or true suspects. Cytologically we have 2 false positive in the first period of time, 3 false suspects in the second period of time and 7 false negatives. However benign/malign biopsy ratio is well (0.97). Moreover histopathologic informations of cytological diagnosis is variable according the histotype of the lesion. In conclusion our study confirm that FNAB is an reliable method that avoid unnecessary biopsy but is insufficiently sensitive to replace open biopsy of nonpalpable breast lesions, also with an immediate cytological control of adequacy of aspirate.

[Proposal of a surgical technique to avoid deformities after conservative treatment of T1 tumors of centroinferior quadrants of the breast]. / Proposta di tecnica chirurgica per evitare deformità dopo trattamento conservativo dei tumori T1 dei quadranti centro-inferiori della mammella.

An important aim of breast surgery is to perform a conservative treatment in which both oncological and cosmetic purposes are fulfilled. This is achieved for the T1 tumors of the upper quadrants by means of the elliptical radial quadrantectomy. In the central or inferior quadrants the cosmetic results performing the same technique are poor. We have recently published a new technique called Centroinferior Hemimastectomy for the treatment of T1 breast cancer with which both the aims are respected. We report the data obtained from thirty-three consecutive Centroinferior Hemimastectomies performed from January 1989 until June 1993. The tumors were removed as described and for those centrally located also the nipple areola complex was removed. The reconstruction was carried out by immediate reimplantation of the nipple (10 cases) or later by tattooing (16 cases). For the tumors located in the inferior quadrants, the nipple-areola complex was made to emerge through the circular skin incision and sutured separately (7 cases). The oncological follow-up (range 3-42 months, mean 16 months) did not show local or systemic relapses. The cosmetic evaluation of the patients was subjectively and objectively very good. Thus the technique can be considered a research progress offering a better quality and quantity of life.

Contralateral spontaneous pneumothorax after single lung transplantation for fibrosis.

The authors report the treatment of a case of contralateral spontaneous pneumothorax during single lung transplantation. This is a unusual complication that must be treated to avoid life-threatening problems. There is no consensus of opinion on therapeutic procedures. This work underline the success obtained with a simple thoracostomic drainage.

[Use of propofol and buprenorphine for total intravenous anesthesia]. / L'impiego del propofol e della buprenorfina per una anestesia totalmente endovenosa.

A study was carried out in 47 patients undergoing general surgery and elective gynecological surgery under totally endovenous general anesthesia. For this purpose, propofol and buprenorphine were used in controlled ventilation with oxygen and air, totally excluding the use of nitrous oxide and halogenate vapours. The following parameters were measured to evaluate the state and depth of anesthesia: arterial pressure (systolic, mean, diastolic), heart rate, sweating, lacrimation (Evan's PRST). The awakening from anesthesia was evaluated using Steward's test. The results of monitoring show that the method represents a valid alternative to anesthesia using inhalatory techniques. Nonetheless, the Authors underline the need for further research on the subject.

[Use of prostheses made of ePTFE in anastomoses of the rat uterine horn]. / Impiego di protesi in ePTFE nell'anastomosi di corno uterino di ratto.

ePTFE prostheses were used in the microsurgical anastomosis of the rat uterine horn. Handling characteristics of this synthetic material during the performance of anastomosis were tested. Patency rates, infections and local tissue reaction were evaluated after thirty and sixty days. Connective tissue infiltration and incomplete endothelialization by normal endometrial elements were observed on the luminal surface of the prosthesis.