Becker Expander-Based Breast Reconstruction Following Wise Pattern Skin-Reducing Mastectomy: Complication Rates and Risk Factors.

Our aim is to analyze the results of immediate breast reconstruction in women with macromastia after skin-reducing mastectomy (SRM), with an emphasis on complications and risk factors. Between 2008 and 2013, fifty women with hypertrophic breasts, aged 21-74 years, underwent immediate expander-based breast reconstruction after Wise pattern SRM. An inferiorly based de-epithelialized skin flap was sutured to the inferolateral border of the pectoralis major muscle and covered the expander. Thirty-five women had a unilateral and fifteen a bilateral procedure (total 65 breasts). In all cases, Becker-35 expanders of volume ranging from 365 to 685 cc were used. Risk factors (BMI, smoking, expander's size, preoperative irradiation, chemotherapy) and complications were recorded. Follow-up up to 60 months was compiled. In all cases, the myodermal pouch provided safe coverage and support of the expander. Postoperative complications occurred in 18 out of 65 breasts (27.6%) and included skin ischemia in 11 breasts (16.9%), late infection in two (3%), seroma and expander rotation in four and one, respectively (6.1 and 1.5%), and severe peri-prosthetical contraction in five breasts (7.6%). Statistical analysis showed that complications were significantly related to preoperative radiotherapy and smoking; no significant correlation was documented between complication rates and chemotherapy, BMI, age or expander's size. We suggest that the inverted-T SRM, creating a combined "myodermal" flap for the coverage of a Becker expander, is a useful single-stage reconstructive option for patients with macromastia. Preoperative radiotherapy is significantly related to higher postoperative complication rates, and may result in a less optimal reconstructive outcome. Level of Evidence V This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.

The role of P53 and Bcl-2 proteins in 7, 12-dimethylbenz-(a)-anthracene-induced tumor growth.

7, 12- Dimethylbenz-(a)-anthracene (DMBA) has been used for a long time to induce rat mammary gland carcinogenesis. In a previous paper we described the effects of diet, of non-steroidal anti-inflammatory drugs and the combination of these two factors on breast cancer. We also pointed out that DMBA tumor generating process is still poorly understood. The present study attempts to explore whether P53 or the pro-apoptotic protein Bcl-2 are potential targets of DMBA in its induction of breast tumors in the Sprague-Dawley rat breast tumorigenesis model. Our results indicate that the DBMA-induced tumors are apparently the result of P53 inactivation. This inactivation results in tumorigenesis, probably aided by the absence of Bcl-2 in the tumor cells of the Sprague-Dawley rat animal model. We discuss the potential mechanisms by which P53 inactivation results in tumorigenesis.

Effects of rich-in-fat diets and highly selective COX-2 inhibitors on 7,12-dimethylbenz-(A)-anthracene-induced tumor growth.

The effects of diet, of non-steroidal anti-inflammatory drugs, or of their combination on carcinogenesis continue to be a case for controversy. Diets that are high in fat have been linked to increased risk of various tumors. At the same time there is substantial, but not conclusive, evidence that the risk of breast and colon cancer correlates with total fat intake rather than a specific type of fat. On the other hand, non-steroidal anti-inflammatory drugs (NSAIDs) have been studied extensively because they appear to delay or inhibit the development of malignant and pre-malignant lesions. 7,12-Dimethylbenz-(a)-anthracene (DMBA) has been used for a long time to induce carcinogenesis in a number of rat animal models. The present study attempts to identify the effects on DMBA-induced tumor growth (a) of diets rich in fat and (b) of the highly selective COX-2 inhibitor Celecoxib, which has been claimed to offer substantial protection against carcinogenesis.

Mesenteric cyst of the descending colon: report of a case.

Mesenteric cysts are rare benign, lesions that are discovered accidentally or during the management of one of their complications (torsion, rupture, haemorrhage, obstruction of nearby organs). We present the case of a 56-year old female patient, with a mesenteric cyst of the descending colon, discovered accidentally during a routine gynaecological examination. Preoperative evaluation included U/S scan, IVP, CT scan and MRI scan. She underwent exploratory laparotomy and the cyst was enucleated intact. Postoperative period was uneventful and pathological examination showed a benign mesenteric lymphangioma. The patient is free of symptoms on 1-year follow-up. We also review the literature.

The effect of aspirin and high fibre diet on colorectal carcinoma: a comparative experimental study.

BACKGROUND: The aim of this study is to assess the role of high fibre diet and aspirin on dimethylhydrazine (DMH)-induced colorectal cancer in rats. MATERIALS AND METHODS: Colorectal tumours were induced with DMH. The animals were randomly divided into five groups (15 rats each): I, controls; II, rats receiving only the carcinogen; III, rats receiving the carcinogen and high fibre diet; IVA, rats receiving the carcinogen plus low dose aspirin; IVB, rats receiving the carcinogen plus high dose aspirin. RESULTS: Adenocarcinomas were detected in 100% of the rats in group II, 47% of the rats in group III (chi2, p<0.05), 100% of the rats in group IVA, but the incidence was reduced to 50% in the rats of group IVB (p<0.05). CONCLUSIONS: These data indicate that high fibre diet and aspirin suppress experimental colon carcinogenesis and the protective effect of aspirin is dose related.

Management of colorectal cancer: 20 years' experience.

Colorectal cancer is the second most common cause of cancer death in westernised countries. Its treatment is the subject of active, ongoing investigation within all treatment modalities, including surgery, chemotherapy and radiotherapy. We reviewed the charts of all patients treated in this university general surgical department for colorectal carcinoma, between January 1983 and December 2002. A total number of 494 patients with colorectal cancer were operated on, on an elective or emergency basis. Patients' demographics, clinical presentation, location of tumour, type of surgery, operative staging, pathology of tumour, outcome and follow-up were recorded and analysed.

Fluid collections detected by ultrasound following uncomplicated colorectal surgery.

The aim of the study was to assess the incidence and site of intraperitoneal fluid collections following uncomplicated colorectal surgery and to identify factors relating to the presence of such collections. 38 patients (22 males) with a mean age of 67 years (range 38-85 years) undergoing uncomplicated colorectal procedures were studied prospectively. Patients underwent abdominal and pelvic ultrasound on Day 3 and Day 7 following surgery. The number, site and volume of collections were recorded. Ultrasound-detected fluid collections were present in 26% on Day 3 and 25% on Day 7 following laparotomy. The presence of a collection was not related to the amount of residual volume after peritoneal lavage with normal saline prior to operative closure, to intraoperative blood loss or to the presence of drains. The right upper quadrant was the commonest site of intraperitoneal collections. In the absence of additional clinical signs, the presence of such collections is not an indication for intervention.

Paratubal cysts in young females as an incidental finding in laparotomies performed for right lower quadrant abdominal pain.

Paratubal cysts represent remnants of the paramesonephric or mesonephric duct, the former being more common. Most of them are asymptomatic, but they may rarely give rise to clinical problems due to enlargement or torsion. In this study, we looked for paratubal cysts or other pathological lesions of the right uterine adnexa in young females operated upon for right lower quadrant (RLQ) abdominal pain. Our material consisted of 338 white female patients aged 4-14 years. Laparotomy revealed only acute appendicitis in 283 cases, while 44 had acute appendicitis plus a coincidental paratubal cyst. Most of these cysts were smaller than 1 cm in diameter. However, 2 additional cases had torsion of a large paratubal cyst, while 5 had a ruptured corpus luteum. We suggest that a thorough search of the right adnexa for the presence of paratubal cysts during laparotomies performed for RLQ pain is a useful procedure. This approach also allows detection of other pathological lesions of the right adnexa that often produce symptoms similar to acute appendicitis.

Gross morphologic variations and histologic changes in cryptorchid testes

Cryptorchid testes are frequently accompanied by gross morphologic changes with regard to the size and shape of the testis, various degrees of detachment between the epididymis and testis, elongation of the caudal epididymis and vas deferens, as well as histologic changes. This study examined the gross and microscopic testicular, epididymal, and vas changes in relation to various parameters in 824 patients operated upon in our clinic during the last decade. The major findings were the following: (1) most patients (78.8%) were older than 4 years, and many older than 8 years (39.8%); (2) the frequency of abdominal undescended testes decreased with increasing age (P <0.1), while the frequency of suprascrotal testes increased with increasing age (P <0.001); (3) most of the undescended testes in a suprascrotal position were normal or had mild atrophy (78.7%), while those in intracanalicular, internal ring, and abdominal positions frequently presented moderate or severe atrophy (71,38%; (P <0.0001); and (4) most suprascrotal testes were either normal or had mild extension and looping of the epididymis (63.8%), while most of the intracanalicular, internal ring, and abdominal testes showed moderate or profound epididymal anomalies (63.4%; P <0.0001). We conclude that even though the necessity for early surgical correction of cryptorchidism is well established, these patients at least in our region, still tend to come very late to surgery, with consequent increased risks of infertility and malignant transformation.

Gross morphologic variations and histologic changes in cryptorchid testes.

Cryptorchid testes are frequently accompanied by gross morphologic changes with regard to the size and shape of the testis, various degrees of detachment between the epididymis and testis, elongation of the caudal epididymis and vas deferens, as well as histologic changes. This study examined the gross and microscopic testicular, epididymal, and vas changes in relation to various parameters in 824 patients operated upon in our clinic during the last decade. The major findings were the following: (1) most patients (78.8%) were older than 4 years, and many older than 8 years (39.8%); (2) the frequency of abdominal undescended testes decreased with increasing age (P <0.1), while the frequency of suprascrotal testes increased with increasing age (P <0.001); (3) most of the undescended testes in a suprascrotal position were normal or had mild atrophy (78.7%), while those in intracanalicular, internal ring, and abdominal positions frequently presented moderate or severe atrophy (71,38%; (P <0.0001); and (4) most suprascrotal testes were either normal or had mild extension and looping of the epididymis (63.8%), while most of the intracanalicular, internal ring, and abdominal testes showed moderate or profound epididymal anomalies (63.4%; P <0.0001). We conclude that even though the necessity for early surgical correction of cryptorchidism is well established, these patients at least in our region, still tend to come very late to surgery, with consequent increased risks of infertility and malignant transformation.