Invasive local recurrence increased after radiation therapy for ductal carcinoma in situ.

BACKGROUND: It is thought that equal numbers of invasive and noninvasive recurrences develop after conservative treatment for ductal carcinoma in situ. We analyzed our data to see if this was true. METHODS: A prospective database of 878 conservatively treated patients with ductal carcinoma in situ was analyzed. RESULTS: Among 551 excision patients, there were 88 recurrences. Thirty-five percent were invasive. Among 327 excision plus radiotherapy patients, there were 59 recurrences. Fifty-three percent were invasive. In an attempt to predict which patients develop invasive recurrences, prolonged time to recurrence was the only statistically significant factor. CONCLUSIONS: The median time to local recurrence for irradiated patients was more than twice as long when compared with nonirradiated patients, during which there is more time for local recurrence to progress to invasion. Irradiated patients had more breast scarring, making diagnosis by palpation and mammography harder. Irradiated patients develop invasive recurrences at a statistically higher rate than nonirradiated patients. Follow-up evaluation with magnetic resonance imaging should be considered.

The effect of systemic anticoagulation in patients undergoing angioaccess surgery.

The benefit of intravenous heparin as an anticoagulant to avoid thrombotic complications during angioaccess surgery for hemodialysis is unknown. We prospectively randomized 115 consecutive patients referred to our institution for permanent hemodialysis access to receive systemic anticoagulation or no anticoagulation during angioaccess surgery. Patient demographics, comorbid conditions, procedure time, complications, and patency were recorded in accordance with standards recommended by the Society for Vascular Surgery. Of the 115 patients randomized, 58 received no anticoagulation and 57 received systemic anticoagulation with intravenous heparin. Arteriovenous fistulas were created in 84 patients and 31 arteriovenous grafts were inserted. Operative times were longer for grafts compared to fistulas, but there were no significant differences in operative times between patients receiving anticoagulation and those not (p = 0.31). Perioperative bleeding complications were more common in patients receiving heparin (p = 0.008). The primary 30-day patency was 84% for patients receiving heparin and 86% for those not (p = 0.79). The 3-month functional patency was 68% for both groups (p = 0.99). Age, gender, operative time, and incidence of bleeding complications had no impact on patency. In our experience, systemic anticoagulation for angioaccess surgery is associated with an increased incidence of bleeding complications and offers no advantage in terms of early patency.