Malignant phylliodes tumours: Results of breast conserving surgery and immediate reconstruction

Malignant phylliodes tumour [MPT] is a rare breast tumor. Surgery is the mainstay in treatment but varies from local resection to modified radical mastectomy. In this study, we present our experience using wide local excision or subcutaneous mastectomy and immediate breast reconstruction in the management of MPT. Twenty-three recurrent MPT and ten patients with histological evidence of MPT were included. All patients with recurrent MPT [n=23] had subcutaneous mastectomy, two centimeter wide excision of the scar and immediate breast reconstruction with either Latissimus Dorsi [LD] myocutaneous flap [n= 10] or Latissimus Dorsi muscle flap [n=13]. Seven of the newly diagnosed patients had wide local excision of the tumor, reconstruction with LD muscle flap, two had wide local excision and reduction of contra lateral breast, and one had subcutaneous mastectomy and silicon implant. The margin resection varied between five and fifteen centimeter in wide local resection group and subcutaneous mastectomy group respectively and the size of tumors varied between five and fifteen centimeters in diameter. During the follow up period, which ranged between twenty-four and eighty-four months one local recurrence, was recorded [3.03%] and none of the patients had distant metastasis or regional lymph nodes involvement. This approach has secured wider excision of MPT, offered breast reconstruction, and has reduced the chances of recurrence in our patients

Non-linear correlation between nerve terminal parameters and muscle fibre diameter of exercised mice during aging

The effect of exercise on morphological age changes in endplate parameters and their relation to muscle fibre diameter was studied in male [C57B1/6J] mice. Animals [N = 60; half of them served as controls] aged 12, 18 and 24 months at sacrifice, were treadmill exercised for two months for 1 h/day at velocities up to 30 m/min. The area [A], perimeter [P], nerve longitudinal extent length [E] and fibre diameter [FD] from camera lucida drawings of extensor digitorum longus zinc iodide osmium-stained nerve terminals were measured. Non-linear regression and multivariate analysis were used to study the inter-relationships among these parameters under aging and exercise conditions. At 12 months E was strongly correlated with FD, but the correlation badly deteriorated with aging, and exercise did not improve it. At all ages A was not correlated with FD during aging alone, but with exercise the correlation improved, especially at 18 months [r2 = 0.73]. The ratio E/FD was not correlated with the other endplate parameters except in exercised animals, in whom E/FD showed a high correlation with A, especially at age 12 months [r2 = 0.72]. FD showed a high correlation with P/A at 12 months of age, but exercise decreased this correlation at all ages. Multivariate analysis showed no significant relationship between FD and nerve terminal parameters at any age in control animals, but in exercised animals a close relationship appeared, given by the equation: FD = 18.75 + 0.025A - 0.08E + 0.01P with P < 0.01 and r2 = 0.34. The discovery of a non-linear relationship between FD and nerve terminal parameters makes possible a further analysis of the effects of exercise on morphological age changes at the neuromuscular junction