ABSTRACT
BACKGROUND: Single-session intraoperative radiation therapy (IORT) minimizes treatment demands associated with traditional whole breast radiation therapy (WBRT) but outcomes on local disease control and morbidity among the elderly is limited. METHODS: A multi-institutional retrospective registry was established from 19 centers utilizing IORT from 2007 to 2013. Patient, tumor, and treatment variables were analyzed for ages <70 and ≥70. RESULTS: We evaluated 686 patients (<70 = 424; ≥70 = 262) who were margin and lymph node negative. Patients <70 were more likely to have longer operative time, oncoplastic closure, higher rates of IORT used as planned boost, and receive chemotherapy and post-operative WBRT. Wound complication rates were low and not significantly different between age groups. Median follow-up was 1.06 (range 0.51-1.9) years for < 70 and 1.01 (range 0.5-1.68) years for ≥ 70. There were 5 (0.73%) breast recurrences (4 in <70 and 1 ≥ 70, p = 0.65) and no axillary recurrences during follow-up. CONCLUSIONS: IORT was associated with a low rate of wound complication and local recurrence on short-term follow-up in this cohort.
Subject(s)
Breast Neoplasms/radiotherapy , Intraoperative Care , Age Factors , Aged , Aged, 80 and over , Breast Neoplasms/pathology , Breast Neoplasms/surgery , Combined Modality Therapy , Female , Humans , Mastectomy, Segmental , Middle Aged , North America , Operative Time , Postoperative Complications/epidemiology , Retrospective Studies , Treatment OutcomeABSTRACT
PURPOSE: To assess complications and cosmesis in patients with breast cancer who underwent lumpectomy and radiation therapy and who previously underwent uncomplicated bilateral augmentation mammoplasty. MATERIALS AND METHODS: Twenty-one patients (aged 36-70 years; median age, 50 years) with breast cancer who had previously undergone bilateral breast augmentation without complications underwent ipsilateral lumpectomy and radiation therapy. Radiation therapy was delivered to the augmented breast in opposed tangential fields with a 4- or 6-MV linear accelerator. The tangential fields received an average radiation dose of 5,021 cGy (range, 4,500-5,600 cGy), with an average fraction of 187 cGy (range, 180- 200 cGy). Sixteen patients received an additional 1,000-2,000-cGy boost to the surgical bed with a 9-18-MeV electron beam. Follow-up was 4-48 months (median, 22 months). RESULTS: At the last follow-up examination, 18 (86%) of the 21 patients were free of disease. Twelve patients had capsular contracture (57%). Seven patients underwent attempted surgical repair of capsular contracture. Twelve patients (57%) reported fair to poor cosmesis. The radiation dose, the location of the implant, the type of implant, and systemic therapy were not correlated with poor cosmesis. CONCLUSION: Lumpectomy and radiation therapy in patients with breast cancer who have previously undergone augmentation mammoplasty result in a high prevalence of capsular contracture and suboptimal cosmesis.
Subject(s)
Breast Neoplasms/complications , Contracture/etiology , Mammaplasty , Mastectomy, Segmental , Postoperative Complications/etiology , Adult , Aged , Breast Neoplasms/radiotherapy , Breast Neoplasms/surgery , Contracture/epidemiology , Esthetics , Female , Follow-Up Studies , Humans , Mammaplasty/statistics & numerical data , Mastectomy, Segmental/statistics & numerical data , Middle Aged , Postoperative Complications/epidemiology , Prevalence , Radiotherapy Dosage , Radiotherapy, Adjuvant , Retrospective Studies , Time FactorsABSTRACT
Isotonic, isosmotic lavage is a safe and effective means of mechanical preparation of the large bowel for left colon surgery. In this prospective, randomized trial comparing lavage with a more traditional three-day bowel preparation, the lavage was well tolerated, led to decreased preoperative hospital days, and produced no higher incidence of infectious complications when compared to the traditional three-day technique.
Subject(s)
Colon/surgery , Isotonic Solutions/administration & dosage , Peritoneal Lavage , Preoperative Care , Anti-Bacterial Agents/administration & dosage , Clinical Trials as Topic , Humans , Infection Control , Length of Stay , Postoperative Complications/prevention & control , Premedication , Prospective Studies , Random Allocation , Time FactorsABSTRACT
A retrospective review of 1353 cases of acute perforated sigmoid diverticulitis treated surgically demonstrates that those operations that resect or exteriorize the perforated segment at the first operation are associated with a lower operative mortality rate than procedures that fail to remove the perforated segment at the initial operation. These results are true for both diffuse peritonitis and localized abscess.
Subject(s)
Colostomy , Diverticulitis, Colonic/surgery , Emergencies , Intestinal Perforation/surgery , Sigmoid Diseases/surgery , Acute Disease , Colostomy/mortality , Humans , Methods , Postoperative Complications , Retrospective StudiesSubject(s)
General Surgery/education , Hospital Departments/organization & administration , Hospitals, Teaching/statistics & numerical data , Internship and Residency , Surgery Department, Hospital/organization & administration , Surgical Procedures, Operative/standards , Hospital Bed Capacity, 500 and over , Humans , Medical Staff, Hospital/standards , New York City , Private Practice/standards , Quality of Health Care , Surgical Procedures, Operative/statistics & numerical dataABSTRACT
A 43-year old man with CRST syndrome (calcinosis, Raynaud's phenomenon, sclerodactyly and telangiectasia) and progressive systemic sclerosis presented with a four-year history of relapsing abdominal pain, the result of chronic pancreatitis, not associated with alcoholism, biliary disease, or any of the known causes of pancreatitis. He had a good response to retrograde pancreatic duct drainage but exhibited management problems and complications that may be peculiar to the systemic sclerosis patient with pancreatitis. A cause and effect relationship between progressive systemic sclerosis and pancreatic disease is not proven but we believe there is evidence to suggest such a relationship.
