New concept for immediate breast reconstruction for invasive cancers: feasibility, oncological safety and esthetic outcome of post-neoadjuvant therapy immediate breast reconstruction versus delayed breast reconstruction: a prospective pilot study.

Feasibility and oncological safety of post-adjuvant skin-sparing mastectomy (SSM) plus immediate breast reconstruction (IBR) cannot be evaluated by randomized trials. However, comparative study could modify guidelines for the oncosurgical treatment of invasive breast cancer. Our study compared the feasibility, oncological safety and esthetic outcome of SSM plus latissimus dorsi (LD) flap IBR after chemotherapy (CT) and radiotherapy (RT) with the standard management for invasive breast cancer: mastectomy as primary treatment, adjuvant CT and RT, and LD flap delayed breast reconstruction (DBR). Twenty-six selected patients with stages IIA-IIIA breast cancer were offered post-neoadjuvant SSM plus IBR with LD flap plus implant (IBR group). Seventy-eight other patients had primary mastectomy, adjuvant CT and RT, and LD-assisted DBR (DBR group). After 4.1 years (range 1-8) of follow-up, feasibility, oncological safety, and esthetic outcome were compared. Sixteen (61%) early complications were reported for the IBR group versus 44 (56%) for the DBR group (P = 0.645). Early implant loss was 0% in IBR versus 12% in DBR. IBR had 8 (30%) late complications versus 17 (21%) for DBR (P = 0.362). Capsular contracture and reconstruction failure rates were similar. Local recurrence was 7.7% (2/26) in IBR and 6.4% (5/78) in DBR (P = 0.823). Cosmetic evaluation by independent physicians and by the patients themselves was identical in the two groups. Our concept provides a basis for offering more women the opportunity to elect for immediate reconstruction, even in the setting of radiation therapy.

First report of a necrotising fasciitis of the breast following a core needle biopsy.

Necrotising fasciitis (NF) is the most aggressive form of soft tissue infection. We report the first case of NF of the breast following a core needle biopsy. Aggressive management including surgical debridement and vacuum therapy allowed wound healing and breast conservation.

Estrogen induction and overexpression of fibulin-1C mRNA in ovarian cancer cells.

Fibulin-1 is an extracellular matrix protein induced by estradiol in estrogen receptor (ER) positive ovarian cancer cell lines. Alternative splicing of fibulin-1 mRNA results in four different variants named A, B, C and D that may have distinct biological functions. We studied the relative expression of fibulin-1 mRNA variants and their estrogen regulation in human ovarian cancer cells. In ovarian tissues and cancer cell lines, fibulin-1C and -1D are the predominant forms, whereas fibulin-1A and -1B are weakly expressed. We developed a competitive PCR assay based on coamplification of fibulin-1C and -1D to study the relative expression of these fibulin-1 variants in human ovarian samples. In ovarian cancer cell lines and ovarian cancer samples, there was a marked increase in the fibulin-1C:1D and fibulin-1C:HPRT mRNA ratios as compared to normal ovaries. In the BG1 estrogen receptor positive ovarian cancer cell line, fibulin-1C mRNA was induced by estradiol in a dose- and time-dependent manner. Since others and we have previously shown an increased expression of ERalpha as compared to ERbeta in ovarian cancer cells, we investigated whether ERalpha or ERbeta is involved in this induction. For this aim, MDA-MB-231 breast cancer cell line, which expresses both low basal levels of ERs and fibulin-1, was infected with recombinant ERalpha or ERbeta encoding adenovirus and treated with estradiol. Fibulin-1C was induced by estradiol in ERalpha- but not ERbeta-infected cells, suggesting that fibulin-1C induction is mediated through ERalpha. In ovarian tumors, a trend towards a correlation between fibulin-1C and ERalpha expression levels was noted. In conclusion, this study showed an increased fibulin-1C:-1D mRNA ratio in ovarian cancer cells as compared to normal ovaries. This finding suggests that the C variant may be involved in ovarian carcinogenesis. Fibulin-1C overexpression may thus be a clue for the understanding of a putative role of estrogens in ERalpha promoted ovarian tumor progression.

Pfannenstiel versus Maylard incision for cesarean delivery: A randomized controlled trial.

OBJECTIVE: To compare the Pfannenstiel incision with transverse muscle-cutting Maylard incision in women who had cesarean delivery. METHODS: Patients were assigned randomly to a Pfannenstiel or Maylard incision. Postoperative treatment was similar for each group. Surgical characteristics, complications, postoperative pain (visual analog scale, analgesic use), and related quality of life (1- and 3-month self-administered questionnaires) were analyzed. Abdominal wall muscle recovery was compared objectively by dynamometer. RESULTS: Fifty-four women had a Pfannenstiel incision and 43 had the Maylard incision. There were no differences in intraoperative characteristics, postoperative morbidity, or pain. Women's responses to the Nottingham Health Profile questionnaire at 1 and 3 months postoperatively and clinical and isokinetic testing for abdominal wall strength were similar between the two groups. CONCLUSION: Transecting the rectus muscle was no more deleterious than the Pfannenstiel incision. There was no difference in objectively measured abdominal wall strength.

Expression of adrenomedullin in human ovaries, ovarian cysts and cancers. Correlation with estrogens receptor status.

OBJECTIVE: To investigate the expression of adrenomedullin (AM) in benign and malignant ovarian tissues and its correlation with estrogen receptors (ERs) mRNA status. STUDY DESIGN: Ovarian carcinoma cell lines, normal ovaries, serous cysts and cancers were analyzed using real-time polymerase chain reaction (PCR) in order to quantify adrenomedullin and ERs mRNAs expression. Some ovarian samples were submitted to laser-capture microdissection to determine the differential expression of target genes in epithelium and stroma. RESULTS: Ovarian cancer cells express adrenomedullin mRNA for both the ligand and receptor and produce the peptide. In tumors, the ER alpha/beta ratio was higher than in other tissues. Correlations were found between ER alpha and ER beta mRNA and adrenomedullin mRNA expression in tumors. CONCLUSION: Adrenomedullin may be involved in both normal and malignant tissue growth through both vascular and growth factor effects. Because of the correlations with ERs status, there is emerging evidence that ovarian cancer is endocrine-related.

Synechia after uterine compression sutures.

We present a study of 37 women who underwent uterine compression suture for postpartum hemorrhage, with 13 postoperative assessments by hysteroscopy. Synechia occurred in seven patients, of whom three had Asherman syndrome (23% of women who desired pregnancy and had hysteroscopic evaluation) that could not be corrected.

Comparative study of the accuracy of breast resection in oncoplastic surgery and quadrantectomy in breast cancer.

BACKGROUND: The aim of this study was to determine whether oncoplastic surgery ensures accurate tumor resection and reduces the need for further surgery in comparison with standard quadrantectomies. METHODS: This was a prospective comparative study of 74 patients with breast tumor diameter >or=15 mm. The principal criterion for case selection was breast size that allowed either quadrantectomy or oncoplastic surgery to be scheduled. The following were recorded and compared between groups: the size of the glandular resection, the width of the nearest margins, the ratio of clear margins, and the need for further surgery. RESULTS: The patients who underwent oncoplastic surgery were younger than those who had quadrantectomy. All other demographic and oncological preoperative data were comparable. The median volume of the excised specimen in the oncoplastic group was higher than in the quadrantectomy group. The nearest lateral margin widths were larger in the oncoplastic group than in the quadrantectomy group. Free surgical margins >or=5 mm and >or=10 mm were obtained more frequently using oncoplastic surgery than standard quadrantectomy. However, the need for fewer secondary surgeries was not demonstrated in our study. CONCLUSIONS: Oncoplastic surgery achieves more accurate tumor resection than standard quadrantectomy. This approach might be useful in extending the indications for conservative therapy.

Transverse rectus abdominis myocutaneous flap wound-healing complications in breast reconstruction: assisted closure using foam suction dressing.

Transverse rectus abdominis myocutaneous (TRAM) flap necrosis is a difficult reconstructive problem which historically has entailed protracted management with poor aesthetic outcome. The use of a foam suction dressing achieves effective delayed primary closure of the flap wound with an acceptable aesthetic result. The results of using a vacuum-assisted closure (VAC) system were examined in three patients. The VAC system was found to be safe and effective in facilitating the closure of large and complex wounds without skin grafting. This option should thus be given serious consideration in some difficult wound healing situations.

Achieving symmetry in unilateral breast reconstruction: 17 years experience with 683 patients.

Breast symmetry is one of the most important parameters of patient satisfaction in breast reconstruction. We undertook this retrospective study to determine whether autologous reconstruction requires opposite-breast procedures less often to achieve symmetry than do non-autologous techniques. The records of 683 patients who underwent delayed breast reconstruction between March 1983 and March 2000 were reviewed. Two hundred and twelve patients (31%) received a TRAM flap, 167 (24%) received a latissimus dorsi myocutaneous flap plus implant (LD), and 304 patients (45%) underwent saline-filled implant (I) reconstruction. The type of opposite surgery was analyzed and compared among groups. An inverted-T breast reduction or mastopexy was performed with equal frequency in the three groups (respectively, 33.5%, 37.8%, and 27.6%). Mastopexy using a circumareolar technique was less frequently performed in the TRAM group (1.9%) than in the other two groups (5.3% and 8.2%, respectively; p = 0.012). Breast augmentation was essentially performed in the LD (30.5%) and I (21.7%) groups, and the difference was statistically significant (p = 0.03). Only one patient of the TRAM group underwent augmentation mammaplasty. The total prevalence of opposite breast procedures was different between the TRAM group (35.5%) and the other two groups (67% in the LD group and 54.6% in the I group; p = 0.001). Our study clearly demonstrates that TRAM flap breast reconstruction more frequently matches the opposite breast, thus avoiding additional surgery to achieve symmetry, in comparison with implant-based techniques.

Steroids and adrenomedullin growth patterns in human ovarian cancer cells: estrogenic-regulation assay.

OBJECTIVE: Adrenomedullin is a multifunctional regulatory peptide with mitogenic and angiogenic capabilities. Objectives in this study were: (1) to describe the effects of adrenomedullin and anti-adrenomedullin antibodies on ovarian carcinoma cell proliferation, and (2) to assess the estradiol regulation of adrenomedullin metabolism. METHODS: We assessed the effects of estradiol, adrenomedullin, and anti-adrenomedullin antibodies on cell growth in three human ovarian cell lines. RT-PCR was used to assess mRNA expression and Western blots to determine protein levels. RESULTS: Estradiol stimulates BG-1 and PEO4 cells growth but not PEO14 cells. Adrenomedullin mRNA expression and secretion were not under estrogen control. Adrenomedullin and anti-adrenomedullin antibodies had no growth effects in vitro. Adjunction of anti-adrenomedullin antibodies to estradiol-stimulated cells significantly inhibited their growth. CONCLUSION: Adrenomedullin metabolism is not under estradiol control. Anti-adrenomedullin antibodies display inhibitory effects on cells having high mitogenic activity. This opens the need for additional search toward in vivo specific immunotherapy.

Cuadrantectomía con mastopexia tipo "donut" versus cuadrantectomía estándar en cáncer de seno: un estudio comparativo prospectivo / Doughnut type quadrantectomy with mastopexy versus standard quadrantectomy in breast cancer: a prospective comparative study

Este fue un estudio comparativo prospectivo de 104 pacientes con cáncer de seno, a quienes se ofreció la elección entre dos tratamientos quirúrgicos conservadores: cuadrantectomía con mastopexia tipo donut (Grupo CMD, n=39) o cuadrantectomía estándar (Grupo CE, n=75). Los grupos fueron similares en tamaño radiológico del tumor, localización del tumor en el seno, tamaño histológico, y la distribución por estadios pT. En el grupo CMD, la incisión de piel fue tres veces más grande que en el grupo CE, pero con ella se obtuvo al final, una cicatriz alrededor del complejo areola-pezón, sin complicaciones posoperatorias posteriores. El volumen promedio del espécimen quirúrgico y los márgenes de sección, fueron mayores en el grupo CMD comparados comparados con el grupo CE. Se obtuvieron márgenes libres de tumor con mayor frecuencia en el grupo CMD que en el grupo CE, pero la diferencia no fue significativa. Estos datos indican fuertemente que la técnica CMD puede ser más eficiente que la técnica CE, en términos de precisión en la resección del tejido mamario.