Intraoperative ultrasound guidance in breast-conserving surgery shows superiority in oncological outcome, long-term cosmetic and patient-reported outcomes: Final outcomes of a randomized controlled trial (COBALT).

BACKGROUND: The multicenter randomized controlled COBALT trial demonstrated that ultrasound-guided breast-conserving surgery (USS) results in a significant reduction of margin involvement (3.1% vs. 13%) and excision volumes compared to palpation-guided surgery (PGS). The aim of the present study was to determine long term oncological and patient-reported outcomes including quality of life (QoL), together with their progress over time. METHODS: 134 patients with T1-T2 breast cancer were randomized to USS (N = 65) or PGS (N = 69). Cosmetic outcomes were assessed with the Breast Cancer Conservative Treatment cosmetic results (BCCT.core) software, panel-evaluation and patient self-evaluation on a 4-point Likert-scale. QoL was measured using the EORTC QLQ-C30/-BR23 questionnaire. RESULTS: No locoregional recurrences were reported after mean follow-up of 41 months. Seven patients (5%) developed distant metastatic disease (USS 6.3%, PGS 4.4%, p = 0.466), of whom six died of disease (95.5% overall survival). USS achieved better cosmetic outcomes compared to PGS, with poor outcomes of 11% and 21% respectively, a result mainly attributable to mastectomies due to involved margins following PGS. There was no difference after 1 and 3 years in cosmetic outcome. Dissatisfied patients included those with larger excision volumes, additional local therapies and worse QoL. Patients with poor/fair cosmetic outcomes scored significantly lower on aspects of QoL, including breast-symptoms, body image and sexual enjoyment. CONCLUSION: By significantly reducing positive margin status and lowering resection volumes, USS improves the rate of good cosmetic outcomes and increases patient-satisfaction. Considering the large impact of cosmetic outcome on QoL, USS has great potential to improve QoL following breast-conserving therapy.

Autocapture compatibility in patients with the MembraneEX lead and Affinity pulse generators.

The first Autocapture generation worked well with all recommended leads. The newer Autocapture generation provides a more sensitive resolution for evoked response testing and its implementation in a dual-chamber device. The purpose of the study was to evaluate the performance of the Affinity SR/DR pacemaker with the new Autocapture algorithm in combination with the small surface area pacing lead MembraneEX in 129 patients. Autocapture ventricular threshold, sensing threshold, lead impedance, evoked response (ER) and polarization signals were determined at implantation and discharge, as well as after 1 and 3 months. Autocapture recommendation rate was based on the ER sensitivity test. The median pacing threshold was 0.38, 0.50, 0.75, 0.75 V at implant, discharge, 1 and 3 months post-implant, respectively. The respective data for median lead impedance were 744, 605, 649 and 691 ohms; median sensing threshold was 12.5 mV at all visits. The median ER amplitude was 9.0, 10.1, 9.9 and 10.1 mV and the median polarization signal 0.39 mV at all visits. The frequency of recommended Autocapture activation was 98.3%, 99.2%, 98.3% and 96.2% of all patients at implant, at discharge, 1 and 3 months post-implant respectively. In conclusion, the studied pulse generator enabled, in combination with this pacing lead, in >95% of all patients activation of Autocapture.

Atrial versus ventricular pacing in sick sinus syndrome: the role of retrograde ventriculoatrial conduction.

This study compares the acute haemodynamic effect of atrial versus ventricular pacing, and ventricular pacing in the presence versus absence of retrograde ventriculoatrial conduction. Twenty-two patients with symptomatic sick sinus syndrome were tested: 12 with ventriculoatrial conduction (Group 1) and 10 without it (Group 2). Cardiac haemodynamics were measured by thermodilution technique at spontaneous rhythm as baseline and during atrial versus ventricular pacing at two different pacing rates. Atrial pacing offered an average augmentation for 20% in cardiac index from spontaneous rhythm in both groups (P < 0.05). The presence of ventriculoatrial conduction was the crucial determinant of cardiac performance during ventricular pacing. The change in cardiac index from the baseline was towards decrease in Group 1 and towards increase in Group 2. The difference between the groups was significant (P < 0.05). We conclude that atrial pacing is superior to ventricular and should be preferred in symptomatic sick sinus syndrome patients without atrioventricular conduction defects. However, ventricular pacing can be considered for preventing clinical symptoms associated with attacks of severe bradycardia or temporary cardiac arrest in patients without ventriculoatrial conduction.

[Organization of systematic after-care of cancer patients in a general hospital]. / Organisation einer systematischen Nachsorge für Karzinom-Patienten an einem Allgemeinkrankenhaus.

For better care and control of our cancer-patients we have built up an organization for systematic follow-up. Two years' experiences are reported. After some difficulties in the beginning we now are able to follow-up and record the further course of the disease in all cancer-patients. Systematic oncologic follow-up contributes to greater living quality of the patients and leads the physician always to compare the treatment with that of other clinics and hospitals; it also enhances interdisciplinary exchange and -last not least-scientific evaluation of the therapeutic results.