[DIFFERENT APPROACHES TO MAMMOGRAPHY AS A SCREENING TOOL FOR BREAST CANCER].

INTRODUCTION: Mammography as a screening tool can reduce mortality from breast cancer. Nevertheless, it has disadvantages such as false positive results, false negative, impaired sensitivity in women with dense breast over-diagnosis and radiation. Due to the different weight given to the advantages versus the disadvantages of mammography, different approaches to screening have developed. These range from annual screening starting at the age of 40 years, to biannual screening starting at the age of 50. The official screening program in Israel is biannual screening between the ages of 50 and 74.

Intraoperative radiation therapy for breast cancer-Immediate and 30-month oncological outcomes.

There is growing evidence that intraoperative radiation therapy (IORT) may be a viable option in selected patients with early breast cancer. This study reports our 4-year experience with IORT. The perioperative outcome and imaging data of all patients who underwent IORT for early breast cancer at a tertiary medical center in 2014-2018 were retrospectively retrieved. The cohort included 158 patients aged 52-84 years (mean 68) with stage I (n = 137) or II (n = 21) breast cancer. Mean applicator size was 4.13 cm; IORT added a mean of 29 minutes to the operative time. Minor wound infections (n = 18, 11.4%) requiring antibiotics and drainage were the only postoperative complication. In 25 patients (15%), postoperative mammography demonstrated a seroma (n = 22) or fat necrosis (n = 3). The risk of wound infection or a new postoperative imaging finding was unrelated to patient age, operative time, tumor size, or comorbid diabetes or obesity. After a mean of 30 months' follow-up, none of the patients who met the institutional criteria for IORT had local recurrence, regardless of age, histology, tumor grade, KI67 proliferation index, pathologic stage, Recurrence Score, or additional whole-breast irradiation or adjuvant treatment. Patients for whom a Recurrence Score was determined (n = 55, 35%) had a significantly higher tumor grade, pathologic stage, and whole-breast irradiation/adjuvant chemotherapy rate than the remaining patients. IORT may be a safe alternative to traditional external beam radiation in well-selected patients with early breast cancer, with few minor complications and good 30-month outcome.

[SINGLE-INCISION TECHNIQUE FOR RIGHT HEMICOLECTOMY].

AIMS: The single incision laparoscopic technique is an emerging modality. The aim of our study was to compare the intra-operative and short term post-operative outcomes of single incision versus multi-incision laparoscopy for right hemicolectomy. METHODS: We retrospectively reviewed the charts of all patients who underwent right hemicolectomy from October 2010 till December 2012. RESULTS: Thirty six patients underwent laparoscopic right hemicolectomy, of which, twenty five were performed with the traditional multi-incision technique and eleven were conducted with a single incision. From the parameters that were evaluated, we found that in the single incision technique there was a statistical trend [p=0.08] of better oncological results with a higher mean lymph node extraction. In addition, there was a statistically significant [p=0.05] advantage of decreased length of hospitalization. CONCLUSIONS: The single incision technique is feasible and safe for right hemicolectomy. Given our findings, we believe that it can be an effective alternative to the traditional multi-port technique.

Use of a porcine dermal collagen implant for contaminated abdominal wall reconstruction in a 105-year-old woman: a case report and review of the literature.

INTRODUCTION: Repair of contaminated abdominal wall defect in a geriatric patient is a challenge for the surgeon. We present the case of the oldest patient (105-years old) to successfully undergo a single-stage repair of a contaminated abdominal wall defect with a Permacol™ implant. CASE PRESENTATION: A 105-year-old Caucasian woman presented to our emergency room with a clinical and radiological diagnosis of small bowel obstruction due to prior operative adhesions. She underwent laparotomy with small bowel resection and primary closure of her abdomen. There was total eventration of her bowel through the suture line 9 days after surgery. She underwent a second laparotomy that revealed no signs of peritonitis or turbid fluid. Her abdomen was closed with a 15 × 10 cm Permacol™ implant sutured sublay with prolene sutures. Her postoperative period was unremarkable. After a follow-up period of 3 years and 2 months, there was no sign of recurrent hernia or wound contamination. CONCLUSION: We suggest that Permacol™ mesh can be considered an efficient alternative to primary closure or synthetic mesh in geriatric patients with contaminated abdominal wall defects.

Evaluation of a porcine dermal collagen (permacol) implant for abdominal wall reconstruction in a pediatric multitrauma patient.

The presence of a contaminated surgical field in abdominal wall defects caused by trauma presents a challenge for surgeons. Both primary suture and synthetic meshes are strongly discouraged as surgical treatments in such cases. We describe the use of a porcine dermal collagen (Permacol) implant in an eight-year-old patient with multiple injuries. Three months after discharge, the child remains well with good cosmetic results. He is free of pain and has returned to full activity levels with complete wound closure and without any evidence of residual hernia. In conclusion, our experience indicates that the use of Permacol can be considered an efficient technique for reconstructing an infected abdominal wall defect of a pediatric multitrauma patient.

[Intraoperative margin evaluation in breast-conservation surgery using margin probe technique].

BACKGROUND: The most important prognostic factor after breast conservation surgery is surgical margin involvement. In cases where surgical margins are involved, the patient must return to the OR for a second operation. Therefore, there is a need for an intra-operative tool to assess the surgical margins. The Margin Probe technique was developed for this need. In this article we present our experience at the "Barzilai" Medical Center using the Margin Probe during breast conservation surgery. METHODS: The Margin Probe technique is added to routine standard of care at "Barzilai" Medical Center. The device sends radiofrequency signals to the resected tissue and spectroscopy analysis provides data to the surgeon about the involvement of the surgical margins. In cases where the device signals for positive margins, the surgeon expands the resection, in order to avoid a second surgery in the future. RESULTS: From sixty four patients who underwent breast conservative surgery, twenty four (37.5%) underwent intraoperative additional re-excision due to positive margin signals from the Margin Probe device. From those patients, nine patients (37.5%) indeed had surgical margins involvement in the pathology analysis. From all patients, four (6.25%) underwent a second surgery, while only one patient had a false negative measurement from the device. CONCLUSIONS: According to our experience, using the Margin Probe technique is feasible, safe and reduces the rate of repeated operation.

A new role of vemurafenib as a neoadjuvant treatment of axillary and brain melanoma metastases.

Vemurafenib is approved by the FDA for the management of unresectable or metastatic melanoma. However, its role as a neoadjuvant therapy has not been determined. We present the first documented case in which vemurafenib induced complete tumor necrosis of both lymph node and brain metastases within one month or less, an outcome that indicated that the patient was a good candidate for excisional surgery.