Mastectomy margins for ductal carcinoma-in-situ (DCIS): 18 Years of follow-up.

BACKGROUND: In patients undergoing mastectomy for ductal carcinoma in situ (DCIS), the significance of a positive or close (<2 mm) margin and associated recurrence risk is unclear. The study sought to evaluate risk of recurrence in relation to the mastectomy surgical margin. METHODS: A single institution retrospective review of patients with DCIS who underwent mastectomy between 2000 and 2010 was performed. Patient demographics, tumor biology, margin status and adjuvant therapy were recorded. The incidence of local recurrence (LR), distant metastasis were analyzed. RESULTS: A total of 282 patients with DCIS were identified. Overall, 12.3% of patients had a pathological positive/close margin (n = 9 tumor on ink and n = 36 <2 mm). Adjuvant radiation was administered to 11 patients with a positive or close margin. At a median follow-up of 12 years, LR was 3.4% (n = 10). None of the patients with LR had a positive or close margin. Additionally, none of the patients who received radiation developed LR. CONCLUSION: Risk of recurrence after mastectomy for DCIS is low and appears to be unrelated to margin status or the use of radiation therapy.

Kinetics of Eosinophils during Development of the Cellular Infiltrate Surrounding the Nurse Cell of Trichinella spiralis in Experimentally Infected Mice.

We study the kinetics of eosinophils during the development of the cellular infiltrate surrounding the nurse cell of Trichinella spiralis (T. spiralis) in experimentally infected mice. Male CD1 mice were experimentally infected with 50 viable muscle larvae of the MSUS/MEX/91/CM-91 T. spiralis strain. Tongues and diaphragms were obtained daily from days 13 to 39 post infection. Diaphragms were compressed and subjected to Giemsa stain. Tongues were histologically sectioned and stained with erythrosine B or hematoxylin and eosin. The cellular infiltrate and the nurse cell-larva complex were detected by optical microscopy since day 16 post infection. The size of the larva increased exponentially during the course of the infection. The kinetics of eosinophils showed a multimodal trend, with a bimodal predominance. The maximum peaks were reached on days 21 and 27 post infection. The results of this study demonstrate that eosinophils occur abundantly in two transcendent moments of the T. spiralis life cycle: first, when the stage 1 larva invades the myocyte and second when the nurse cell-larva complex has been fully developed. These results help one to understand the immunobiology of T. spiralis, highlighting the importance of eosinophils in the survival of the larva in skeletal muscle. Further studies are needed to characterize the cell populations that comprise the cellular infiltrate during the development of the mother cell.

Lessons Learned: Management of Breast Cancer Patients throughout the COVID-19 Pandemic.

Purpose of Review: The COVID-19 pandemic of 2020 presented a multitude of challenges for physicians nationwide. Standard of care treatment was tailored to protect patients from virus exposure, while delivering safe and adequate care. This article reviews the steps taken to treat and protect breast cancer patients during the pandemic and reentry approaches to resume care. Recent Findings: Breast cancer experts rapidly convened to develop treatment guidelines during the pandemic. These recommendations encompass screening approach, prioritization of breast cancer patients, educational modifications, research and data considerations, and a re-entry treatment approach as the pandemic evolved. Without prior experience with a pandemic of this magnitude, these guidelines were based on expert knowledge and previously established data. Summary: This emergency forced physicians to operate in a more efficient and effective manner to deliver value-based patient care, and future evaluation of these adjustments will determine if overall patient outcomes were compromised.

Noncollagen Dermal Fillers: A Summary of the Clinical Trials Used for Their FDA Approval.

BACKGROUND: Many noncollagen dermal fillers (NCDFs) have been approved by the FDA and are currently the second-most performed noninvasive cosmetic procedure. OBJECTIVE: To summarize and compare the clinical trials reviewed by the United States FDA in the approval of NCDFs. METHODS: The FDA Premarket Approval (PMA) site was queried, and the year of approval, indication, design, primary end points, touch-ups, retreatments, and study duration were extracted and tabulated. RESULTS: Twenty-one FDA-approved NCDFs from 2003 to 2018 and 24 Summary of Safety and Effectiveness documents were reviewed. Differences in the trial design and in reporting of data make comparisons difficult. This article provides comparative tables to make interpreting the various trial results more straightforward. LIMITATIONS: Primary efficacy end points and the way that filler volumes were reported varied by company. This article does not focus on secondary end points or safety data. CONCLUSION: A comprehensive and comparative review of clinical trials of NCDFs by the FDA demonstrates that differences in data reporting, especially for touch-ups and retreatments, make filler duration difficult to compare and interpret. Understanding of the trial design will allow the clinician to become more astute and allow for better management of patient expectations in clinical practice.

Inflammatory linear verrucous epidermal nevus treated successfully with crisaborole ointment in a 5-year-old boy.

Inflammatory linear verrucous epidermal nevus (ILVEN) is a chronic, a linear, or whorled array of inflammatory, following the lines of Blaschko. Treatment of ILVEN is challenging with numerous therapies of varying degrees of success reported. We present a case of ILVEN in a 5-year-old-boy, treated successfully with crisaborole 2% ointment. This brief report suggests that there may be additional cellular immunologic pathways responsible for the presentation of ILVEN that may be explained by management with crisaborole use.

Synthesis of Polysubstituted Benzoic Esters from 1,2-Dihydropyridines and Its Application to the Synthesis of Fluorenones.

A convenient, instrumentally simple, and efficient methodology to transform 1,2-dihydropyridines into benzoic esters is described. The generated multisubstituted benzoic esters feature different topologies spanning from simple aromatic rings to fused benzocycloalkane systems. As an extension of this methodology, these benzoic esters are efficiently transformed into an array of fluorenone frameworks featuring interesting and novel topological patterns.

Adrenal myelolipoma: To operate or not? A case report and review of the literature.

INTRODUCTION: Myelolipoma is a rare, benign neoplasm that predominantly occurs in the adrenal gland and is composed of mature adipose tissue and scattered islands of hematopoietic elements. Although usually small and asymptomatic, there are some cases of adrenal myelolipoma that cause symptoms such as chronic pain. Elective surgery can prevent a more severe symptom presentation and life threatening progression while also allowing accurate diagnosis in patients with tumors larger than 6cm. PRESENTATION OF CASE: This report presents an unusual case of a 28-year-old female who suffered with chronic pain from a growing left-sided adrenal myelolipoma. Without the financial means for additional testing along with many symptoms warranting a high suspicion for malignancy, this patient decided to have the mass surgically excised, which was both diagnostic and curative. DISCUSSION: For this specific patient, surgery was the most cost effective option, as well as both diagnostic and curative. Surgery can also prevent complications such as spontaneous rupture and hemorrhage of the mass, which can lead to subsequent cardiovascular shock. CONCLUSION: Management of adrenal myelolipoma should be considered on an individual basis. Although it is a benign tumor, surgery plays an important role for symptomatic cases and those lesions that cannot be distinguished reliably from malignancy.

Epalrestat: an aldose reductase inhibitor for the treatment of diabetic neuropathy.

Diabetic neuropathy is one of the most common long-term complications in patients with diabetes mellitus, with a prevalence of 60-70% in the United States. Treatment options include antidepressants, anticonvulsants, tramadol, and capsaicin. These agents are modestly effective for symptomatic relief, but they do not affect the underlying pathology nor do they slow progression of the disease. Epalrestat is an aldose reductase inhibitor that is approved in Japan for the improvement of subjective neuropathy symptoms, abnormality of vibration sense, and abnormal changes in heart beat associated with diabetic peripheral neuropathy. Unlike the current treatment options for diabetic neuropathy, epalrestat may affect or delay progression of the underlying disease process. Data from experimental studies indicate that epalrestat reduces sorbitol accumulation in the sciatic nerve, erythrocytes, and ocular tissues in animals, and in erythrocytes in humans. Data from six clinical trials were evaluated, and it was determined that epalrestat 50 mg 3 times/day may improve motor and sensory nerve conduction velocity and subjective neuropathy symptoms as compared with baseline and placebo. Epalrestat is well tolerated, and the most frequently reported adverse effects include elevations in liver enzyme levels and gastrointestinal-related events such as nausea and vomiting. Epalrestat may serve as a new therapeutic option to prevent or slow the progression of diabetic neuropathy. Long-term, comparative studies in diverse patient populations are needed for clinical application.