Anthracycline and trastuzumab-induced cardiotoxicity in breast cancer.

OBJECTIVE: Breast cancer is the most common cancer among women. In the last twenty years early diagnosis, neoadjuvant and adjuvant systemic treatment that targeted to specific molecular targets have significantly reduced the mortality from breast cancer. However, the increase in survival has allowed to observe the cardiotoxic effects of anticancer therapy and increased mortality from cardiovascular causes, resulting in a large literature where experts try to identify the correct management of this critical problem. Even thought the increased attention in this field, many questions have not yet answers and new studies are needed. MATERIALS AND METHODS: We conducted a broad search of the English-language literature in Medline using the following search terms: cardiotoxicity, anthracyclines, trastuzumab, breast cancer, left ventricular dysfunction, heart failure. A manual examination of the articles found has been performed. RESULTS: We provide a comprehensive assessment of the current knowledge about cardiotoxicity induced by anthracycline plus trastuzumab in women affected by breast cancer. CONCLUSIONS: Early identification and prompt treatment of subclinical cardiotoxicity may improve cardiologic prognosis of these patients and may allow oncologists to avoid withdrawal of chemotherapy. That is why it becomes always more important the creation of multidisciplinary teams where cardiologists and oncologists work together to ensure optimal care to oncologic patients treated with cardiotoxic agents.

Update on oncoplastic breast surgery.

Oncoplastic surgery of the breast (OPS) has generated great excitement over the past years and has become an integrated component of the surgical treatment of breast cancer. Oncoplastic surgical procedures associate the best surgical oncologic principles to achieve wide tumor-free margins with the best principles of plastic surgery to optimize cosmetic outcomes. Thanks to oncoplastic techniques, the role of breast conserving surgery (BCS) has been extended to include a group of patients who would otherwise require mastectomy to achieve adequate tumor clearance. As OPS continues to gain acceptance and diffusion, an optimal and systematic approach to these techniques is becoming increasingly necessary. This article has the aim to review the essential principles and techniques associated with oncoplastic surgery, based on the data acquired through an extensive search of the PUBMED and MEDLINE database for articles published using the key words "breast cancer oncoplastic surgery". This review analyzes possible the advantages", classifications, indications, and the criteria for a proper selection of oncoplastic techniques to facilitate one's ability to master these procedures and make OPS a safe and an effective procedure.

[Percutaneous endoscopic gastrostomy (PEG) in pediatric patients: our experience and proposal of follow-up methodology]. / Gastrostomia endoscopica percutanea (PEG) nei pazienti pediatrici: nostra esperienza e proposta operativa di metodologia osservazionale.

OBJECTIVE: To evaluate effectiveness and acceptability of percutaneous endoscopic gastrostomy (PEG) in pediatric patients and to propose a data collection and follow-up methodology. MATERIALS AND METHODS: Observational retrospective and prospective study on 33 pediatric patients and 5 adults with PEG, placed using Gauderer "push" technique, between 2000 and 2007. By means of an appropriate questionnaire, the following parameters were evaluated: complications, factors of further risk, nutritional status, management and acceptability of PEG. RESULTS: No problems occurred during placement. Complications were few and easy to resolve. In 3 patients a stomal dehiscence occurred, strongly related to the tube gauge. During replacement, in 4 patients, bumper was not taken away because of difficult removal. 8 patients had pre-PEG Gastroesophageal reflux: In 2 of them, during the PEG placement, fundoplication was realized. Subsequently PEG procedure, only 1 patient needed fundoplication for worsening of GER. All of them continued gastroprotective treatment. Respiratory tract infections decreased in our 13 patients carries of tracheostomy. CONCLUSIONS: To prefer smaller gauge reduces risk of dehiscence. If the bumper's removal is hard, to leave it inside is acceptable and quite safe, on condition of a careful surveillance of gastrointestinal obstruction signs. GER is not a contraindication of PEG. A careful follow-up is important, by recording all the evaluated parameters and by questionnaire to the family, during every hospital admission. This study, even if on few patients, confi rms PEG as the technique of choice for long-term enteral feeding, also in children. Training of family and caregivers is important to care.

Conservative and radical oncoplastic approches in the surgical treatment of breast cancer.

In the attempt to optimise the balance between the risk of local recurrence and the cosmetic outcomes in breast surgery, new surgical procedures, so-called oncoplastic techniques, have been introduced in recent years. The term oncoplastic surgery refers to surgery on the basis of oncological principles during which the techniques of plastic surgery are used, mostly for reconstructive and cosmetic reasons. The advantage of the oncoplastic surgery for breast cancer is the possibility of performing a wider excision of the tumour with a good cosmetic result. Oncoplastic surgery is a broad concept that can be used for several different combinations of oncological surgery and plastic surgery: excision of the tumour by reduction mammoplasty, tumour excision followed by remodelling mammoplasty, mastectomy with immediate reconstruction of the breast and partial mastectomy with reconstruction. Careful patient selection and preoperative planning are key components for the success of any oncoplastic operation for breast cancer. Accurate preoperative evaluation of the clinical and biological features of the tumour as well as of the morphological aspects of the breast allow the surgeon to make a decision if a conservative or radical approach is preferable and select the most effective oncoplastic surgical technique. In this review we summarise the indications, advantages and limitations of several oncoplastic procedures.