Width of margins in phyllodes tumors of the breast: the controversy drags on?-a systematic review and meta-analysis.

PURPOSE: Phyllodes tumors (PT) of the breast are rare fibroepithelial neoplasms. Information is controversial in the literature regarding to the optimal surgical management. Most studies suggested margins of at least 10 mm while some recent studies suggested narrower margins without an increased risk of local recurrences (LR) and distant metastases (DM). The objective of this systematic review was to identify and compare studies that assessed these different practices. METHODS: A systematic review was performed through five databases up to April 2019. Studies exploring the association between the width of margins, subtypes of PT, and the LR and DM rates were considered for inclusion. A statistical model for analyzing sparse data and rare events was used. RESULTS: Thirteen studies met eligibility criteria and were selected. Considering a threshold of 10 mm (margins < 10 vs margins ≥ 10 mm), the 5-year incidence rate of LR was estimated to be 5.22 vs. 3.63 (diff. -1.59) per 100 person-years for benign PT, 9.60 vs. 7.33 (diff. -2.27) for borderline PT, and 28.58 vs. 21.84 (diff. -6.74) for malignant PT. For DM, it was estimated to be 0.88 vs. 0.86 (diff. -0.02) for benign PT, 1.61 vs. 1.74 (diff. 0.13) for borderline PT, and 4.80 vs 5.18 (diff. 0.38) for malignant PT. The data for a threshold of 1 mm were not sufficient to draw any conclusions. CONCLUSION: Irrespective of tumor grade, we found that DM was a rarer event than LR. Malignant PT had the highest incidence rate of LR and DM. This meta-analysis found a clear association between width of margins and LR rates. Whatever the tumor grade, surgical margins ≥ 10 mm guaranteed a lower risk of LR than margins < 10 mm. On the other hand, the width of margin did not influence the apparition of DM.

Anatomically based classification of medial clavicle fractures.

Medial clavicle fractures represent less than 5% of all clavicle injuries. The purpose of this study was to evaluate reliability of a new anatomically based (AB) classification system compared to other classification systems and to evaluate the clinical outcome of nonoperative treated fractures. 55 acute medial clavicle fractures (55 patients) were 3D reconstructed and evaluated using the Edinburgh (ED), Throckmorton (TR) and new AB classification. The AB classification classified the fracture as medial (Type 1) or lateral (Type 2) to the costoclavicular ligament and no or minimal displaced (Type A) or displaced (Type B). Next, a consecutive retrospective clinical evaluation of 38 of these patients was performed using the Oxford Shoulder and Constant Score. An anatomically based classification shows the highest inter- and intra-observer reliability. In case the fracture line originate medial to the costoclavicular ligament and is displaced the Constant and Oxford scores are significantly less.

Dehiscencia uterina diagnosticada un mes postparto: presentación de un caso y revisión bibliográfica / Uterine dehiscence discovered one month after delivery: case report and literature review

La rotura uterina es una complicación obstétrica cuyas consecuencias pueden ser graves. Se diagnostica principalmente antes o durante el trabajo de parto en mujeres con antecedente de cesárea y una extracción rápida del feto es necesaria. Sin embargo, pocos casos de dehiscencia uterina son diagnosticados a distancia del parto. Presentamos el caso de una paciente con útero cicatrizado, que consulta por metrorragia 27 días después de parto por vía vaginal, en la que se diagnosticó una dehiscencia uterina con consecuente histerectomía abdominal a través de una incisión de Pfannenstiel. Por medio de este caso se evaluarán los signos y síntomas para el diagnóstico temprano de una dehiscencia, permitiendo así proporcionar el tratamiento más conservador posible (AU)

Uterine rupture is an uncommon but potentially devastating maternal and obstetric complication that is usually diagnosed in women with a prior caesarean delivery before or during labour, leading to an emergency foetal extraction. However, there are very few reports of uterine rupture diagnosed in the postpartum period. We report the case of a patient with a scarred uterus who presenting with metrorrhagia 27 days after a vaginal delivery. A diagnosis of uterine dehiscence was made, requiring an abdominal hysterectomy through Pfannenstiel incision. Through this case we highlight the symptoms and signs to establish an early diagnosis, which allow provision of the most conservative treatment possible (AU)

Herpes Mastitis: Diagnosis and Management.

Herpetic lesions most frequently occur on oral and genital areas. However, herpes simplex virus (HSV) can be a rare cause of breast infection. In few published articles, the route of transmission is predominantly from infant to mother. We report two cases about simultaneous mammary and extramammary (oral and genital) herpetic infection in nonlactating women. In both cases, HSV breast lesions were acquired by sexual contacts with partners who were asymptomatic HSV carriers. Through a review of literature, we highlight clinical signs for an early diagnosis. We also emphasize the advantage of the valacyclovir for treating this uncommon pathology.

Axillary recurrence rate in breast cancer patients with negative sentinel lymph node biopsy or containing micrometastases and without further lymphadenectomy: a monocentric review of 8 years and 481 cases.

Sentinel lymph node biopsy (SLNB) has almost completely replaced complete axillary lymph node dissection (CALND) as the first-line axillary procedure for clinically node-negative early stage breast cancer. We assessed the incidence of axillary relapse in patients with negative SLNB who had no additional CALND (group 1, n = 481) and in patients whose SLNB contained micrometastases and had no further CALND (group 2, n = 45). All patients were operated on between November 1997 and December 2005 and followed at the Jules Bordet Institute. The median follow-up was 48 months. A mean of 2.2 sentinel lymph nodes was removed per patient. Axillary relapse was observed in only one patient (0.2%) in group 1 and in none of the patients in group 2. This study confirms that the axillary recurrence rate after long-term follow-up of patients with a negative sentinel lymph node is very rare, provided that the selection criteria are judicious.