Risk of Local Recurrence of Benign and Borderline Phyllodes Tumors: A Danish Population-Based Retrospective Study.

PURPOSE: To determine the recurrence rate of benign and borderline phyllodes tumors (PTs) of the breast, the association between the size of resection margin and risk of recurrence and the risk of progression of histological grading at recurrence. METHODS: Nationwide retrospective study on Danish women aged 18 years or older, operated from 1999 to 2014, with resected benign or borderline PTs. Information on age, size of primary tumor and recurrence, histological grade, surgical treatment, margin size, and local recurrence were collected from the national Danish Pathology Register. RESULTS: A total of 479 cases were identified; 354 benign (74 %), 89 borderline (19 %), 6 uncertain histological grading (1.2 %), and 30 possibly PT (6 %). The mean age at presentation was 45.6 years (range 18-85), the mean tumor size was 3.5 cm (range 0.5-21), and the mean follow-up time was 98 months (range 1.1-192). We identified 30 local recurrences, i.e., a recurrence rate of 6.3 %. Twenty-three recurrences had similar or lower histological grading than the primary tumor, one primary benign PT recurred as a tumor with unclear diagnosis, and one primary borderline PT recurred as malignant. The number of recurrences was too low, and the information on the size of the closest resection margin was too sparse to estimate an adequate margin size for excision of nonmalignant PTs. CONCLUSIONS: The recurrence rate of PTs was considerably lower than previously stated in literature. No apparent pattern of progression in histological grading was found. The results do not justify wide excision margins of nonmalignant phyllodes tumors of the breast.

Self-reported systemic symptoms among women with breast implants.

Around 2,500 women receive a breast augmentation with silicone-based implants yearly in Denmark. A number of these women report various uncharacteristic systemic symptoms, which they attribute to the breast implants, including impaired cognition, joint pain, etc. This condition has been termed "breast implant illness" and is currently not a recognised diagnosis. The correlation between the patient's self-reported symptoms and breast implants has not been established and there is limited evidence that surgery has any effect. In this review, the current literature on the topic has been reviewed.

Routine X-ray of the chest is not justified in staging of patients with primary breast cancer.

INTRODUCTION: Chest X-rays (CXRs) are performed routinely as part of staging of primary breast cancer patients in most breast units in Denmark. However, several international studies have found exceedingly low detection rates for occult pulmonary metastatic disease among breast cancer patients. Even so, no data have previously been published on Danish patients. METHODS: A retrospective study was conducted of all breast cancer patients undergoing CXRs at the Department of Breast Surgery, Herlev Hospital, from April 2016 to December 2017. The primary outcome was detection of pulmonary metastases on CXRs at the time of the patient's breast cancer diagnosis. The follow-up period was 12 months. RESULTS: A total of 1,014 patients were included in this study. Among these, 11 (1%) had a positive CXR and 1,003 (99%) had a negative CXR. Three (0.3%) patients were diagnosed with lung metastases but had false negative CXRs. The sensitivity was 0%, the specificity was 98.9%, the positive predictive value was 0% and the negative predictive value was 99.6%. CONCLUSION: Routine preoperative CXR did not impact staging or lead to changes in the treatment of breast cancer patients. Therefore, routine CXR cannot be justified and should be omitted. FUNDING: none. TRIAL REGISTRATION: The study was approved by the local hospital legal department (Herlev and Gentofte Hospital) as quality assurance research (workzone number: 19000557).

[Goldilocks mastectomy].

The Goldilocks mastectomy was first described in 2012 as a third option for patients who are not eligible for or want traditional modes of breast reconstruction. The technique involves performing a skin-sparing mastectomy using Wise pattern incisions and creating a breast mound from the residual lower mastectomy flap. In this case report, we present a 58-year old woman with breast cancer who was not eligible for traditional breast reconstruction, and instead an uncomplicated Goldilocks mastectomy was performed.

[New Nordic guidelines on management of burn injuries].

Denmark has recently entered a collaboration with other Nordic countries to ensure a common strategy in the management of burn mass casualties. The collaboration is based upon the guideline Emergency Management of Severe Burns originating from the Australian and New Zealand Burn Association. The desire to establish a common Nordic strategy has led to a number of changes in the national guidelines for the treatment of burn injuries. The new guidelines recently implemented at the national university hospital of Denmark, Rigshospitalet, are presented in this review.

[Keraunoparalysis after lightning injury with transient ischaemia and paralysis of an extremity].

Keraunoparalysis is a transient paralysis of the extremities, which results from close contact with lightning. In this case report, a 58-year-old man came in close contact with a bolt of lightning. His left foot was pulseless, pale, cold and with absence of capillary refill. His symptoms were initially interpreted as arterial occlusion, and therefore bypass surgery and even amputation were considered. However, his symptoms resolved within hours. Therefore, clinicians must consider keranoparalysis as a differential diagnosis in patients struck by lightning.

[Treatmentof rhinophyma with laser and surgery].

Rhinophyma is a disfiguring skin condition characterised by progressive hyperplasia of the nasal sebaceous glands and proliferation of blood vessels and connective tissue. It is considered the end stage of rosacea and affects primarily older males of Northern European descent. Several surgical and laser treatment options are available. None of these has been compared in randomised, controlled prospective trials. In this review, we provide an overview of the different treatment modalities and account for their respective strengths and limitations.

[Handling of hypermetabolism in major burn injuries].

Multitrauma, critical illness and major burn injuries give rise to a stress response with a consequential increase in resting energy expenditure. Especially for burn trauma patients, this stress response is severe and prolonged and may cause a reduced lean muscle mass, loss of peripheral fatty tissue, hyperglycaemia and stress-induced diabetes. This review provides an overview of current strategies to attenuate the hypermetabolic stress response in order to improve the clinical outcome for these patients.

[Chemoprevention of photocarcinogenesis using antioxidants].

The skin is constantly exposed to reactive oxygen species (ROS) from both endogenous and exogenous sources. Ultraviolet irradiation is a well-known contributor of photocarcinogenesis and photoaging, as it - among other things - promotes the production of ROS which damage nucleic acids, proteins and lipids. Topical or oral administration of antioxidants is presumed to counteract the damaging effects of ROS to the skin, thus potentially lowering the risk of skin cancers and skin aging. We review the current literature on chemoprevention of photocarcinogenesis using antioxidants.

Assessment of burn size in obese adults; a literature review.

PURPOSE: Obesity causes changes in the total body surface area as well as the distribution of skin surfaces. In burn management, three methods are commonly used to determine the surface area burned: the patient's palm, the rule of nines, and the Lund-Browder chart. These methods rely on the distribution of skin surface, although none of these methods consider differences in body mass. This study investigates the relationship between body surfaces and body mass in the assessment of burn size to determine the validity of the conventional methods when applied to obese individuals. METHODS: The current literature was reviewed using relevant electronic databases. The initial search yielded 247 results. Relevant articles were then reviewed. A total of seven publications fulfilled the inclusion criteria. RESULTS: The palmar surface area ranged between 0.59%-1.22%, depending on BMI, gender, and ethnicity, compared to 1% according to conventional methods. The palmar surface area of obese individuals approximated 0.7% of the total body surface area in Caucasians. The surface areas comprised 5%-7.5% of the total body surface area for each arm, 15%-20% for each leg, and 40%-52% for the trunk in obese or morbidly obese individuals, compared to 9%, 18%, and 36%, respectively, for normal-weight adults. CONCLUSIONS: The commonly used methods for assessment of burns should be used with caution when applied to obese burn patients, and the clinical parameters observed even more systematically.