Surgical margins of resection for breast cancer: current evidence.

Breast cancer is the most common form of cancer and second main cause of death in women in western countries. Breast-conserving therapy, consisting of lumpectomy and radiation therapy, has become the standard local treatment for T1-T2 breast tumors. There is general agreement that successful breast conservation requires complete tumor excision with a "tumor-free" or "negative" margin of resection, but the definition of a negative margin is controversial. A commonly accepted definition of adequate margins requires a 2-mm distance between ink and tumor but opinions range from the original National Surgical Adjuvant Breast and Bowel Project definition of "no ink on tumor", to a recommended width of 10 mm or more. The ability to perform real-time molecular imaging analysis of margins during surgery would clearly be a significant advance; several groups have engaged in this effort, with encouraging reports of preliminary data. Further development of such techniques promises to lead to a point at which accurate intraoperative margin evaluation may be possible and may even be combined with therapeutic interventions, using techniques such as photodynamic therapy.

Anorectal avulsion: Management of a rare rectal trauma.

INTRODUCTION: Traumatic injuries of the rectum are unusual even though their treatment is challenging and often lead to high morbidity and mortality rate. PRESENTATION OF CASE: This paper reports a rare case of complete rectal avulsion with multiple fracture and hemoperitoneum treated with a multistep approach in our department. DISCUSSION: The anorectal avulsion is a rare rectal trauma; only few reports are available. Treatment key points of rectal trauma are: direct repair, diverting stoma and sacral drainage. CONCLUSION: We reported a case of anorectal avulsion with complete detachment of external sphincter muscle. A multidisciplinary approach was mandatory in this kind of lesions.

Mastication in the oral myofunctional disorders.

The aim of this article is to show two ways of clinical work with mastication in Oral Myofunctional Disorders. Consideration is given to limitations that make direct treatment impossible: symptoms/signs of temporo-mandibular joint, occlusions alterations, types of orthodontics or orthopedics appliances and loosing teeth. The procedures suggested are named procedures WITH and WITHOUT LIMITATIONS.

Myofunctional therapy: brief intervention.

This study addresses speech-language therapy in orofacial myology utilizing a Brief Intervention (in Portuguese: IntervenAão Fonoaudiológica Breve) (IFB). IFB is applied to patient groups between the ages of 8 and 15 years with orthodontic/orthopedic appliances in 1997. Results are presented indicating the advantages of using IFB for breathing, feeding, oral-facial habits, buccal hygiene and corporal posture/physical activity. It concludes that Brief Intervention can be accomplished in 8 sessions, is economically advantageous for use in group therapy, and may be used before or in conjunction with Myofunctional Therapy/Myotherapy.

[Benign insulinoma. Efficacy of preoperative treatment for persistent hyperinsulinemia using a synthetic somatostatin analog]. / Insulinoma benigno. Efficacia del trattamento preoperatorio sulla persistente iperinsulinemia con l'analogo sintetico della somatostatina.

We investigated the 24-hour mean blood glucose and serum insulin (IRI), C peptide (C pep) and glucagon concentrations before (pre) and after (post) continued treatment with octreotide (100 mcg three time daily by s.c. injection) in a woman, 68 years old, affected by a nine years long benign insulinoma. The blood pool to dose 24-hour mean glucose and all hormone concentrations was obtained by equal quantities of blood samples taken every 2-hour over 24-hour. The IRI, C pep, glucagon, glucose circadian pattern and IRI/glucose ratio were determined on remaining blood portions. After continued treatment with octreotide was significantly reduced the exaggerated and inappropriate insulin (pre = 77.08 +/- 23.6 microUI/ml; post = 15.19 +/- 2.3 microUI/ml; p < 0.001) and C pep secretion (pre = 4.17 +/- 0.4 ng/ml; post--1.64 +/- 0.04; p < 0.001), while the blood glucose levels were significantly elevated (pre = 40.46 +/- 3.1 mg/dl; post = 132.46 +/- 6.9 mg/dl; p < 0.001). Also glucagon levels were significantly inhibited (pre = 73.53 +/- 12.19 pg/ml; post = 46.80 +/- 9.1 pg/ml; p < 0.05). The long-acting somatostatin analogue has improved a lot IRI/glucose ratio (pre = 1.9 +/- 0.4; post = 0.12 +/- 0.04; p < 0.001). A significant positive correlation was found between IRI and C pep before (r = 0.93; p < 0.001) as well after octreotide treatment (r = 0.85; p < 0.001). A significant positive correlation (r = 0.69; p < 0.008) between IRI and glucose was observed only after octreotide treatment.(ABSTRACT TRUNCATED AT 250 WORDS)

[Correlation between hormonal and metabolic profiles in women with polycystic ovary syndrome]. / Correlazioni tra assetto ormonale e metabolico in donne con sindrome dell'ovaio policistico.

To investigate the sex hormone status of women with polycystic ovary syndrome (PCO) and to relate this to serum levels of glucose, insulin, lipids and lipoproteins, 90 women with PCO (30 obese: BMI greater than 30 kg/m2; 30 overweight: BMI greater than 25- less than 30 kg/m2; 30 non obese: BMI less than 25 kg/m2) and 60 normal ovulatory women (20 obese; 20 overweight; 20 non obese) were studied. The women with PCO had significantly increased LH, FSH and androgen levels and significantly decreased SHBG levels compared to the normal women. Obese women with PCO had higher concentrations of fasting glucose, fasting insulin, incremental glucose area, incremental insulin area and lipid than overweight and non obese women with PCO and overweight and non obese control subjects, but were similar in obese normal women. There were decreases in high-density lipoproteins levels in both the obese groups (obese PCO and obese control women). Lipid and lipoprotein concentrations did not differ in the obese, overweight and non obese PCO women compared to the normal groups while HDL cholesterol were decreased in obese PCO and obese control women. The correlations between hormone, glucose, insulin, lipid and lipoprotein levels were different among the six groups. Non obese PCO women had: inverse correlations between free testosterone and incremental glucose area (r = -0.5128, P = 0.03); positive correlations between SHBG and alpha-lipoproteins (r = 0.9159, P = 0.001). Non obese normal women had: positive correlations between fasting insulin and total testosterone (r = 0.5272, P = 0.043) and between SHBG and beta-lipoproteins (r = 0.7445, P = 0.014) and LDL cholesterol (r = 0.7360, P = 0.010).(ABSTRACT TRUNCATED AT 250 WORDS)

A New Non-Glycosidic Iridoid and a New Bisiridoid from Argylia radiata1.

From ARGYLIA RADIATA a non-glycosidic iridoid, the (4a S, 7 S, 7a S)-7-hydroxy-7-methyl-1,4a,5,6,7,7a-heptahydrocyclopenta[ C]pyran-3(4 H)-one, and a bisiridoid, derived from the junction of catalpol and 7-deoxyloganic acid, were isolated.

Hypopituitarism following a direct bullet injury to the pituitary. A case report.

A 29-year old man was referred for hypogonadism. At 14 years of age he was struck by a gun bullet in the head, receiving a frontomedial open fracture with leakage of cerebral tissue. The bullet could not be extracted at the operation. At 16 years of age he noticed a stop of pubertal development, weight gain and a fall in visus on the left eye. The clinical examination and the endocrinological data (low F-T4 and F-T3; low plasma cortisol and testosterone; normal plasma prolactin; sub-normal pituitary response to intravenous administration of insulin, GnRH, TRH and GRF) demonstrated that the patient was hypopituitaric. A radiological skull X-ray showed that the bullet was lodged in the sellar and parasellar region. This seems to be the seventh case of hypopituitarism following a direct injury to the pituitary region described in the literature so far.