ABSTRACT
The effectiveness of breast-conserving surgery for patients with locally advanced breast cancer (LABC) after neoadjuvant chemotherapy (NACT) is still a controversial issue, and variable incidences of locoregional failures have been reported. The present study was conducted to pathologically assess the response of LABC to NACT, and also to evaluate the efficacy of preoperative clinical examination and mammography in detecting these pathological changes. A total of 38 patients with LABC received NACT in the form of three cycles of fluorouracil/adriamycin/cyclophosphamide and were then subjected to a mastectomy. The residual tumors in the mastectomy specimens were measured, mapped, and compared to the pretreatment and preoperative clinical and mammographic findings for evaluation. An objective response to NACT was observed in 70.4% of the patients; however, only 26.7% of them were suitable candidates for conservative surgery. The rest of the responders showed an increased incidence of multifocality and in situ lesions localized within the original tumor-bearing area. Both clinical examinations and mammography were inadequate for the selection of candidates for breast conservation. Tumor regression by NACT is probably induced by a process of tumor segmentation. It is also associated with an increased incidence of multifocality and in situ lesions.
Subject(s)
Antineoplastic Combined Chemotherapy Protocols/therapeutic use , Breast Neoplasms/drug therapy , Breast Neoplasms/surgery , Mastectomy, Segmental , Adult , Antineoplastic Combined Chemotherapy Protocols/administration & dosage , Breast Neoplasms/pathology , Cyclophosphamide/administration & dosage , Doxorubicin/administration & dosage , Female , Fluorouracil/administration & dosage , Humans , Middle Aged , Neoadjuvant Therapy , Neoplasm Staging , Patient Care Planning , Prognosis , Treatment OutcomeABSTRACT
Extending a McBurney's muscle-splitting incision, to achieve a better exposure when performing a difficult appendectomy, by muscle cutting may be associated with an increase in patient morbidity. In a retrospective study we Verified two actual indications that call for wound extension. The first is to correct a malpositioned first incision that does not match an existing anatomical variation in the region of the appendix. The second is to achieve a wide surgical space to deal with complicated cases. For each of these two indications, we thus introduced a new technique that fulfills the real requirement without muscle cutting. For the first indication we used a double muscle-splitting incision, while for the second indication we combined the original muscle-splitting incision with a vertical incision of the posterior lamina of the anterior rectus sheath. The two techniques are herein presented and the results of their application in 126 cases are discussed.
Subject(s)
Appendectomy/methods , Muscle, Skeletal/surgery , Adolescent , Adult , Child , Female , Humans , Male , Middle Aged , Prospective Studies , Retrospective StudiesABSTRACT
This study consists of a preliminary report of 94 cases with various types of inguinal hernias. All cases were repaired by a new technique, in which the herniotomy is performed via a preperitoneal approach and the repair is achieved by using a bipedicled flap from the external oblique aponeurosis, which is transpositioned into the preperitoneal space and sutured to the iliopubic tract. The details of this technique are herein described. After a follow-up ranging from 15 to 48 months, both the early and late complications are presented. They were minimal and of minor significance, apart from a hernial recurrence in one case.
