Postexcision mammography is indicated after resection of ductal carcinoma-in-situ of the breast.

BACKGROUND: The adequacy of excision of ductal carcinoma-in-situ (DCIS) usually is confirmed with specimen mammography and histopathological assessment of specimen margins. Postexcision mammography of the involved breast is used at some centers. The objective of this study was to evaluate the impact of postexcision mammography in DCIS. METHODS: We conducted a retrospective chart review of all patients treated for DCIS at our institution from 1995 to 1998. RESULTS: Sixty-seven patients had postexcision mammography performed. Residual microcalcifications were identified in 16 patients (24%). Further surgery was precluded by precise mammographic-pathological correlation by using sliced-specimen mammography in two patients. Twelve patients had repeat wide excision, and two patients underwent mastectomy. Residual DCIS was identified at re-excision in 9 of 14 patients (64%). The margin status of the initial resection was negative in three of nine patients (33%) and positive or unknown in six of nine patients (67%). CONCLUSIONS: Postexcision mammography is a valuable technique that complements specimen mammography and histopathological margin assessment in confirming that an adequate excision of DCIS has been performed. Postexcision mammography should be performed in all patients with DCIS associated with mammographic calcifications who are treated with breast-conserving therapy.

Absorbable mesh sling prevents radiation-induced bowel injury during "sandwich" chemoradiation for rectal cancer.

HYPOTHESIS: Absorbable mesh slings can prevent radiation-induced bowel injury when adjuvant pelvic radiotherapy is given in the early postoperative period. We hypothesized that the mesh sling technique is similarly effective during "sandwich" sequence adjuvant chemoradiation. DESIGN: Retrospective review. SETTING: Tertiary care comprehensive cancer center. PATIENTS: Nonrandomized series of 19 consecutive patients who underwent abdominoperineal resection and received postoperative sandwich sequence chemoradiation at Roswell Park Cancer Institute, Buffalo, NY, between January 1994 and September 1999. INTERVENTIONS: Twelve patients had an absorbable mesh sling placed at the completion of abdominoperineal resection. Seven patients did not have an absorbable mesh sling placed. MAIN OUTCOME MEASURES: Radiotherapy dose and gastrointestinal toxic effects. RESULTS: All 12 patients in the "mesh" group were able to receive full-dose radiotherapy with tumor bed boost (total dose, 54 Gy, 11 patients; 59.4 Gy, 1 patient). Only 3 of 7 patients in the "no mesh" group were able to receive a tumor bed boost (total dose, 46.8 Gy, 1 patient; 50.4 Gy, 3 patients; 54 Gy, 3 patients). Acute gastrointestinal toxic effects were minimal in the mesh group (grade 1, 10 patients; grade 2, 2 patients) compared with the no mesh group (grade 2, 6 patients; grade 3, 1 patients). None of the patients in the mesh group have shown evidence of late gastrointestinal toxic effects. One patient in the no mesh group required surgery for complications of chronic radiation enteritis. CONCLUSIONS: The protective effects of an absorbable mesh sling extend beyond the life expectancy of the mesh itself. Sandwich sequence chemoradiation should not preclude the use of the mesh sling technique.

Repeat administration of DNA/liposomes to the nasal epithelium of patients with cystic fibrosis.

The major cause of mortality in patients with cystic fibrosis (CF) is lung disease. Expression of the cystic fibrosis transmembrane conductance regulator (CFTR) gene product in the airways is a potential treatment. Clinical studies in which the CFTR cDNA was delivered to the respiratory epithelia of CF patients have resulted in modest, transient gene expression. It seems likely that repeated administration of the gene transfer vector will be required for long-term gene expression. We have undertaken a double-blinded study in which multiple doses of a DNA/liposome formulation were delivered to the nasal epithelium of CF patients. Ten subjects received plasmid DNA expressing the CFTR cDNA complexed with DC-Chol/DOPE cationic liposomes, whilst two subjects received placebo. Each subject received three doses, administered 4 weeks apart. There was no evidence of inflammation, toxicity or an immune response towards the DNA/liposomes or the expressed CFTR. Nasal epithelial cells were collected 4 days after each dose for a series of efficacy assays including quantitation of vector-specific DNA and mRNA, immunohistochemistry of CFTR protein, bacterial adherence, and detection of halide efflux ex vivo. Airway ion transport was also assessed in vivo by repeated nasal potential difference (PD) measurements. On average, six of the treated subjects were positive for CFTR gene transfer after each dose. All subjects positive for CFTR function were also positive for plasmid DNA, plasmid-derived mRNA and CFTR protein. The efficacy measures suggest that unlike high doses of recombinant adenoviral vectors, DNA/liposomes can be successfully re-administered without apparent loss of efficacy.

The adverse effects of octreotide on wound healing in rats.

Octreotide acetate is a long-acting somatostatin analogue with protean physiologic effects. It is used primarily as an inhibitory paracrine hormone to treat a variety of medical and surgical disorders, including endocrine tumors and several gastrointestinal hypersecretory states. Because of octreotide's known inhibition of multiple trophic and anabolic hormones, we suspected that it may have deleterious effects on wound healing. Twenty-four rats were randomized to one of three groups: control, steroid (a negative control), or octreotide. Dorsal midline incisions were made and closed primarily. Wound-breaking strength measurements were performed 7 days later. The mean peak load (+/- standard error of the mean) for each group was calculated: control = 754 +/- 89 g; steroid = 378 +/- 32 g; and octreotide = 427 +/- 41 g. The difference between the control group and each of the other groups was statistically significant with P < 0.030. We conclude that octreotide has significant adverse effects on wound healing in the rat model and that these effects are comparable in magnitude to those caused by steroids.

The crochet hook method of stab avulsion phlebectomy for varicose veins.

Excision of varicose veins through ministab incisions is currently the choice for the removal of varicose vein clusters. The crochet hook technique of stab avulsion phlebectomy is described in this paper. This surgical method for the treatment of varicose veins has been widely utilized in a residency training environment during the last twelve years and has been used by the senior author for more than 20 years. The technique is easily mastered, cost effective, and has excellent therapeutic and cosmetic results.

The uterine sound as a convenient, cost-effective method for creating the subcutaneous tunnel for long-term venous catheters.

Long-term central venous access catheters generally require creating a subcutaneous tunnel to minimize infectious complications and secure the catheter to the chest wall. Many techniques for this procedure have been reported. We describe the use of a uterine sound to create the subcutaneous tunnel.