[Great moments in renal transplantation]

A selective review of some great moments in renal transplantation experienced or witnessed with some of the great architects of this epic. The path was strewn with hazards, sometimes halts or changes of attitude that harmed or helped some patients

Predictors of inflammatory local recurrence after breast-conserving therapy for breast cancer: matched case-control study

Inflammatory local recurrence [ILR] after breast-conserving surgery for noninflammatory breast cancer [BC] is associated with dismal prognosis. Risk factors for ILR are not well defined

Methods: Between 2001 and 2010, twelve patients at our hospital developed ILR after breast-conserving surgery, adjuvant chemotherapy, and radiotherapy for BC. We compared their clinico-pathological characteristics to those of 24 patients with noninflammatory local recurrence [non-ILR], 24 patients with distant metastases, and 48 disease-free controls, matched for age and observation period

Results: The median time to ILR was 10 months. In univariate analysis, extent of lymph node involvement [p < 0.05], multifocality [p < 0.05], c-erbB2 overexpression [p < 0.05], and lymphovascular invasion [LVI] [p < 0.001] affected the risk of ILR. Conditional logistic regression analysis showed a significant association between ILR and combined LVI and high histopathological grade. The odds ratio [OR] for ILR versus non-ILR was 6.14 [95% confidence interval [CI] 1.48-25.38] and for ILR versus distant metastases it was 3.05 [95% CI 0.09-97.83] when both LVI and high histopathological grade were present. Patients with family history of BC were more likely to present with ILR than non-ILR [OR 5.47; 95% CI 1.55-19.31] or distant relapse [OR 5.62; 95% CI 0.26-119.95]

Conclusions: Pre- and postmenopausal women with high-grade BC and LVI are at increased risk to develop ILR, especially in the presence of family history of BC. Identification of risk factors for this lethal form of recurrent BC may lead to more effective preventive treatment strategies in properly selected patients

[History of mastectomy before and after halsted]

The operation described by Halsted, in 1894 and called radical mastectomy, represents a milestone in the treatment of breast cancer. It consisted of removal of the breast, muscles and axillary lymph nodes. The pre-Halsted era saw attitudes ranging from the willful abstention to brutal treatments by cauterization or amputation. The introduction of anesthesia and asepsis enabled more advanced surgical attempts. The stratification of patients into operable and non-operable categories has improved surgical outcome. After attempts to extend Halsted procedure [by extended or super-radical mastectomies] proved to be of little benefit, a minimally-invasive trend emerged gradually. It started with modified radical mastectomy that spares the muscles and was then followed by breast conservative surgery that leaves breast tissue behind. Then sentinel lymph node mapping was introduced with the hope of reducing the extent of axillary dissection. Finally, skin sparing mastectomy appeared in order to conserve skin and facilitate breast reconstruction

Subtotal or total colectomy as surgical treatment of left-sided occlusive colon cancer

The treatment of acutely obstructed carcinoma of the left colon and sigmoid still represents a matter of controversy. The aim of this study was to assess retrospectively the results of its management by emergency subtotal or total colectomy with primary anastomosis. Sixty-seven patients were reviewed. There were 42 males and 25 females. The mean age was 70.5 years [range: 26-87 years]. Mean operative time was 210 minutes. There were five synchronous colon carcinomas [75%] and 23 [343%] synchronous tubulous and tubulovillous adenomas. No death was noted in the series. Ten postoperative complications [15%] occurred in nine patients including one postoperative peritonitis without evidence of anastomotic leak, one alithiasic cholecystitis, one evisceration and two intra-abdominal abscesses. The mean hospital stay was 11.4 days. Fifty-eight patients were assessed at three and twelve months for functional results. No fecal incontinence was encountered. The mean number of bowel movements per 24 hours was 3.2 at three months and 2 at twelve months. All patients were satisfied with their quality of life. Twelve patients [20.7%] occasionally needed anti-diarrheic medications. Urgent subtotal or total colectomy with primary anastomosis is a safe and efficient procedure in the management of acutely obstructed neoplasm of the left colon. It allows to treat in one stage the cancer and the obstruction, bearing no mortality, acceptable morbidity and satisfactory postoperative functional results