Clinical characteristics and management of a Greek female patient cohort with breast conserving treatment.

PURPOSE: The purpose of this retrospective single-center study was to examine histopathological characteristics and treatment options in a cohort of Greek female patients treated with breast conserving surgery (BCS) and to evaluate potential predictive factors of breast cancer (BC) local recurrence. METHODS: The clinic's medical records from 1995 up to the end of July 2016 were scanned in order to identify female patients treated with BCS. We recognized 1175 patients who underwent BCS, representing 35.8% of the entire sample (3281 patients). RESULTS: The mean age of the patients enrolled in this study was 54.7 years, with a median follow-up period of 58.5 months. Nine deaths (0.8%) were registered with 5-year overall survival (OS) rate being 100%. Regarding adjuvant therapies, radiotherapy (RT) was assigned to 94.4% of the patients, endocrine therapy to 86.0%, chemotherapy to 51.3%, while all therapies were given simultaneously to 38.3% of the sample patients. Herceptin was administered to 14.1% of the patients. Twenty-eight recurrences (2.4%) with 3 deaths (10.7%) were confirmed. Over all traditional parameters studied, only lymph node status appeared to be statistically correlated with local recurrence (p=0.005). T3 stage can be considered as a hint that this tumor size might be a risk factor of local recurrence. Age at diagnosis seems to be an independent factor of BC local recurrence. CONCLUSIONS: A very low rate of local recurrence (2.4%) was validated which can be attributed to patients being appropriately selected for BCS, who were then enrolled in this study, and to the uniformity of the RT plan.

Diagnosing congenital syphilis using Hutchinson's method: Differentiating between syphilitic, mercurial, and syphilitic-mercurial dental defects.

OBJECTIVES: This study focuses on the dental abnormalities observed by Sir Jonathan Hutchinson, Henry Moon and Alfred Fournier in patients with congenital syphilis and in those treated with mercury, in order to define alterations in dental morphology attributable to each of these causes. These definitions are applied to reported paleopathological cases, exploring various etiologies behind the defects, in order to aid in the diagnosis of congenital syphilis. METHODS: Original works were examined for descriptions of dental abnormalities in congenital syphilis and in mercurial treatments. These descriptions were compared with dentitions of paleopathological cases (n = 4) demonstrating abnormalities attributed to congenital syphilis. RESULTS: Distinct morphological differences were recognized between congenital syphilitic teeth and teeth affected by mercury. Mercury produces a pronounced deficiency in enamel of incisors, canines and first permanent molars that become rugged and pitted, and of dirty grey honeycombed appearance. Mercury-induced dental changes are evident in three out of four cases studied here. In one case, only syphilitic changes were present. DISCUSSION: Dental changes in congenital syphilis range from no visible signs to those beyond the classical models of Hutchinson, Moon and Fournier. Treatment of neonates and infants with mercury produces additional changes. Signs of disease and treatment with mercury on teeth may occur together; permanent incisors, first molars and canines, are typically affected, premolars and second/third molars are usually spared. Signs of treatment with mercury might be the only evidence of the occurrence of the disease as mercury was rarely used to treat other diseases.

Health effects of European colonization: An investigation of skeletal remains from 19th to early 20th century migrant settlers in South Australia.

The British colony of South Australia, established in 1836, offered a fresh start to migrants hoping for a better life. A cohort of settlers buried in a section of St Mary's Anglican Church Cemetery (1847-1927) allocated for government funded burials was investigated to determine their health, with a focus on skeletal manifestations associated with metabolic deficiencies. Findings of St Mary's sample were compared with those published for contemporary skeletal samples from two British cemeteries, St Martin's, Birmingham, and St Peter's, Wolverhampton, to explore similarities and differences. To investigate the changing economic background of the St Mary's cohort, which may have influenced the location of their burial within the cemetery, the number and demographic profile of government funded burials and those in privately funded leased plots were compared. The study sample consisted of the skeletal remains of 65 individuals (20 adults, 45 subadults) from St Mary's Cemetery 'free ground' section. The bones and teeth of individuals in this cohort showed evidence of pathological manifestations, including areas of abnormal porosity in bone cortices in 9 adults and 12 subadults and flaring of metaphyses (one subadult) and costochondral junctions of the ribs (one subadult). Porous lesions of orbital roof bones (Types 3 to 4) were seen on three subadults. Macroscopic examination of teeth identified enamel hypoplastic defects and micro-CT scans showed areas of interglobular dentine. Comparison of St Mary's findings with the British samples revealed that prevalences of manifestations associated with vitamin C deficiency were higher at St Mary's and manifestations associated with vitamin D deficiency were lower respectively. The location of burial pattern at St Mary's Cemetery, from the mid-1840s to1860s, showed differences in the economic status of migrants. This pattern changed from the 1870s, which reflected improvements in the local economy and the economic recovery of the colony.

Presence of dental signs of congenital syphilis in pre-modern specimens.

OBJECTIVE: Tooth morphology can vary due to genetic factors, infectious diseases and other environmental stresses. Congenital syphilis is known to interrupt tooth formation i.e. odontogenesis and amelogenesis, producing specific dental characteristics. Variation of those characteristics can occur, resulting in dental signs "not typical" of the disease, however, they are described in the 19th century literature. Past treatments of congenital syphilis with mercury also interrupted dental processes resulting in significantly different dental signs. The aim of this study is to examine the dentition of the oldest (pre 15th century) cases attributed to congenital syphilis to determine whether their dental processes have been affected by either congenital syphilis itself, its treatments (mercury) or a combination of both (syphilitic-mercurial). DESIGN: Comparisons of dental signs of congenital syphilis and its mercuric treatments as described by Hutchinson, Moon and Fournier in the 1800s and in standardised methods as established by modern studies, are made with the dentition of specimens found in archaeological sites in Mexico, Italy, Turkey and Austria dating back to the Terminal Formative Period, Classical Antiquity, Byzantine times and Middle Ages. RESULTS: The dentitions of a child from Oaxaca, Mexico, St. Pölten, Austria, and two juveniles from Classical Antiquity site Metaponto, Italy, show signs attributed to syphilis only. One adolescent from Byzantine site Nicaea, Turkey, shows dental signs characterised as syphilitic-mercurial. CONCLUSIONS: Dental abnormalities observed in Mediterranean individuals match a range of signs attributable to congenital syphilis and its treatments, more so than the New World case. Therefore, it is likely that these individuals suffered from congenital syphilis.

Scar endometriosis, a tricky diagnosis. A case series report and a short review of the literature.

BACKROUND: Abdominal wall endometrioma is a rare condition, which usually develops in surgical scar of a Cesarean section (C-section) or of a hysterectomy. Scar endometriosis is a misdiagnosed condition in general surgery, since it mimics other surgical conditions. Diagnosis is mainly based upon a high index of suspicion. AIM: The purpose of this study is to highlight the characteristics of this rare pathology and assess the diagnostic algorithm and therapeutic options. METHODS: The article is a case series and therefore no specific methods have been applicable. RESULTS: In the current study, we present a case series of seven cases with abdominal pain on the Pfannenstiel incision, treated in our department during a two years period, between 2014 and 2016, followed by a brief review of the literature. CONCLUSION: Scar endometriosis may be difficult to diagnose as it is an unfamiliar entity to general surgeons. This condition can be confused with other surgical conditions. Imaging methods, such as ultrasound or CT-scan should be used for differential diagnosis. The prevention of scar endometriosis may also be important. Surgical excision is the treatment of choice for scar endometriosis. KEY WORDS: Abdominal wall, Caesarian, Endometriosis, Scar.