Impact of chemotherapy followed by aromatase inhibitors on bone health of women with ER-positive early breast cancer in real world clinical settings in Greece: Results of the POCHARBI trial conducted by the Hellenic Society of Breast Surgeons.

INTRODUCTION: The aim of this observational study was to assess the combined impact of chemotherapy (CT) and aromatase inhibitors (AI) therapy on bone mineral density (BMD) in postmenopausal women with estrogen receptor (ER)-positive early breast cancer. METHODS: Patients were treated with a third generation AI, either as adjuvant therapy (HT cohort, n = 166) or as subsequent endocrine therapy after initial treatment with chemotherapy (CT cohort, n = 124), and were followed up for a 12-month period. BMD was evaluated at lumbar spine (LS) and total hip (HP) before CT, before AI therapy and after 12 months of AI therapy. The primary study objective was changes in LS BMD between pre CT treatment and post 12 months AI therapy in the CT cohort. RESULTS: There were no statistically significant changes in LS BMD, either within CT or HT cohort. In the CT cohort, the mean LS BMD change was -0.72% (95% CI: -2.97%, +1.53%, p = 0.5526) between CT start and month 12 of AI therapy, while it was -0.19% (95% CI: -2.12%, +1.74%, p = 0.8309) and -0.59% (95% CI: -3.18%, +2.00%, p = 0.4759) between CT start and AI start and AI start and month 12 of AI therapy respectively. The mean change in LS BMD in the HT cohort (i.e. after 12 months of AI treatment) was +1.51% (95% CI: -0.96%, +3.98%, p = 0.7420). CONCLUSIONS: The results of this study indicate that, under routine clinical practice, most postmenopausal patients who receive CT before AI therapy do not experience debilitating BMD consequences during the first year of AI treatment. TRIAL REGISTRATION: ClinicalTrials.gov Identifier NCT01298362.

Sentinel node biopsy in male breast carcinoma: is the "female" approach justified?

PURPOSE: Mastectomy with axillary lymph node dissection (ALND) represents the gold standard in the treatment of male breast carcinoma. Recently, data have emerged supporting that sentinel lymph node biopsy (SNB) may be feasible in selected patients. The aim of this study was to analyze the safety and prognostic reliability of SNB in male patients with breast carcinoma and clinically negative axilla. METHODS: During a 10-year period (2000-2010), 11 men with mean age 66.1 years (range 34-84) diagnosed with breast carcinoma were retrospectively included to our study. All patients underwent SNB. Regardless of the SNB results, completion axillary clearance was conducted in all cases. RESULTS: SNB detection rate was 100%, while the mean number of sentinel nodes removed was 1.5 +/- 0.7 (range 1-2). Frozen section analysis revealed a negative sentinel node in four out of 11 patients (36.4%). Independently of these results, all patients underwent completion ALND. The overall false-negative rate, defined as the percentage of all node-positive tumors in which the SNB was negative, was 0%. CONCLUSION: The current study indicates that SNB may be feasible in selected male individuals with breast carcinoma. The technique may reduce the morbidity related to dissection of the axilla; prospective multicenter trials are needed in order to define the exact criteria for wider application of this technique.

Duration of tamoxifen effect on lipidemic profile of postmenopausal breast cancer patients following deprivation of treatment.

OBJECTIVE: It was the aim of this study to investigate the effect of tamoxifen withdrawal on markers of lipid metabolism in postmenopausal women with breast cancer who completed tamoxifen therapy and received no further treatment. METHODS: Lipidemic profile changes were studied in 190 postmenopausal patients with operable breast cancer, following cessation of 5-7 years of tamoxifen treatment. Assessments of total cholesterol, high-density lipoprotein, low-density lipoprotein and total serum triglycerides were performed at baseline, 6 months and 12 months. RESULTS: By 6 months, both total cholesterol and low-density lipoprotein levels were significantly increased, and total triglyceride levels were significantly reduced compared with baseline values and maintained to 12 months. There was no significant alteration observed for high-density lipoprotein levels over the study period. CONCLUSION: The beneficial effect of tamoxifen on the lipidemic profile of postmenopausal breast cancer patients seems to be lost in less than 12 months time following cessation of 5-7 years of tamoxifen treatment. A 'rebound effect' on the lipidemic parameters should be expected and those patients should be monitored carefully.

Effect of exemestane on the lipidemic profile of post-menopausal operable breast cancer patients following 5-7 years of adjuvant tamoxifen: preliminary results of the ATENA substudy.

Long-term endocrine therapy for breast cancer may have clinical implications as drugs that potentially alter the lipid profile may increase the risk of developing cardiovascular disease. In this study, a companion subprotocol to the ATENA (Adjuvant post-Tamoxifen Exemestane versus Nothing Applied) trial, we compared the effect of the steroidal aromatase inactivator exemestane on the lipid profile of post-menopausal women with operable breast cancer in the adjuvant setting to that of observation alone following deprivation of 5-7 years primary treatment with tamoxifen. In this open-label, randomized, parallel group study, 340 post-menopausal patients with operable breast cancer who had been treated with tamoxifen for 5-7 years were randomized to either 5 additional years of exemestane (25 mg/day; n=172) or observation alone (n=168). Assessments of total cholesterol, high-density lipoprotein (HDL), low-density lipoprotein (LDL) and total serum triglycerides (TRG) were performed at baseline, and at 6 and 12 months. Total TRG levels were significantly reduced compared with baseline for the exemestane and the observational arm. Both total cholesterol and LDL levels were significantly increased above that of baseline values by 6 months, maintained through to 12 months, with no significant difference between the two treatment arms. There was no significant alteration observed for HDL over time or between the two arms. We conclude that sequential adjuvant treatment with exemestane in post-menopausal operable breast cancer patients following cessation of 5-7 years of tamoxifen does not appear to significantly alter the lipidemic profile for at least 12 months compared with an observational arm.

The role of nasogastric tube after elective abdominal surgery.

PURPOSE: Nasogastric tube (NGT) is routine employed after abdominal surgery still in our country and abroad too, but the patients' discomfort is severe and several serious complications were referred as related to its use. The aim of this study was to evaluate the pros and cons of routine use of NGT in elective uncomplicated abdominal surgery. PATIENTS AND METHODS: In order to evaluate the routine use of NGT we performed a prospective randomized trial on 100 patients who had elective uncomplicated abdominal surgery: 50 subjects had the early removal of NGT and in 50 patients it was maintained until passage of flatus/feces. RESULTS: The relevant differences between the two groups were the earlier passage of flatus and feces and the lower incidence of postoperative gastrectasy in the group where NGT was early removed. No statistical difference was recorded concerning the occurrence of postoperative nausea, vomiting, abdominal distension, complications and day of clinical release. CONCLUSIONS: The routine application of NGT in elective abdominal surgery could be omitted if the surgeon and nursing team are willing to renounce a useful tool in providing informations about the resolution of postoperative intestinal atony to the patient's benefit: in fact a severe discomfort due to the NGT was recorded in the 70% of our series.

Papillary serous adenocarcinoma of the endocervix: A rare neoplasm. Immunohistochemical profile.

Serous adenocarcinoma of the endocervix is a rare carcinoma similar to the serous carcinoma of the ovary and the endometrium. We report a case of a 63-year-old woman with papillary serous adenocarcinoma arising within the endocervix, describing the clinical presentation and the morphologic characteristics of this rare neoplasm. A detailed immunohistochemical analysis on the expression of low- and high-molecular weight cytokeratins (AE1 and AE3), EMA, CEA, vimentin, B72.3, nm23, estrogen and progesterone receptors, LeuM1 (CD15), p53, Ki-67 antigen, and PCNA by tumor cells has also been carried out, which to our knowledge has not been previously reported.

Intra-arterial versus systemic chemotherapy for non-operable hepatocellular carcinoma.

BACKGROUND/AIMS: To compare intra-arterial (regional) hepatic chemotherapy with doxorubicin, to the systemic (intravenous) one in patients with non-resectable (Stage IVA) hepatocellular carcinoma. METHODOLOGY: Seventy-two patients with inoperable hepatocellular carcinoma were randomized to receive doxorubicin 50 mg/m2 as a bolus infusion either via an implantable intra-arterial catheter (Group A) or as systemic chemotherapy (Group B) every 21-28 days. RESULTS: Patients of Group A had a higher rate of objective and subjective remissions and Karnofsky performance status improvement in comparison to Group B. The mean survival was 7 months (range: 2-16) for Group A and 6.5 months (range: 1-13) for Group B, but this difference was not statistically significant. The quality of life remained at an acceptable level until death in both groups. CONCLUSIONS: A slight but not statistically significant superiority of intra-arterial chemotherapy against the systemic one is concluded.

Improved determination of breast cancer size in mammography.

Breast cancer size determination in a preoperative stage is of great importance, as it is taking into account the classification of the tumour. In this paper a simple method of the improved determination of the actual tumour size is presented. The method is based on the calculation of correction factors taking into account the magnification of the tumour image during the mammographic examination. The method was applied for evaluation on forty cases of breast cancer. In all cases the final approximation of tumour maximum diameter with the presented method is almost equal to this obtained from the pathologists' reports. The possibility of wrong stage characterisation of a tumour, which is a problem arising from the measurement of the maximum diameter directly from the mammogram, is also minimised, especially in case that tumour size is between two stages.

Comparison of fine needle aspiration and Tru-Cut biopsy of palpable mammary lesions.

To assess the accuracy and predictive value of fine-needle aspiration (FNA) cytology and Tru-Cut needle biopsy of palpable breast lesions, we studied 215 aspirates obtained from 209 patients and 120 tissue-core biopsies taken from 109 patients. The FNA and Tru-Cut findings have been grouped as benign, malignant, suspicious, and nondiagnostic. Histologic confirmation was obtained in 103 aspirated and 102 biopsied cases. Considering only cases with a definitive benign or malignant diagnosis, the accuracy of FNA was 94%, while the sensitivity and specificity were 90 and 100%, respectively. The predictive value of a positive diagnosis (PV+) was 100% and the predictive value of a negative diagnosis (PV-) was 86%. Likewise, the accuracy of Tru-Cut needle biopsy was 90% while the sensitivity and specificity were 89 and 100%, respectively. The PV+ was 100%, and the PV- was 58%. Our study suggests that FNA cytology of the breast is a reliable diagnostic procedure and it should always be included in the preoperative diagnosis of breast tumors.

Herniography with methylene blue for the detection of recurrent inguinal hernia.

OBJECTIVE: To validate a new technique for the confirmation of the diagnosis of recurrent inguinal hernia. DESIGN: Open study. SETTING: University hospital. SUBJECTS: 14 Patients with gorin pain who had previously had hernias repaired. INTERVENTIONS: Herniography in all 14, which showed recurrent hernias in 6. The 6 then had 20 ml methylene blue infused intraperitoneally, and 12-18 hours later 4 of the 6 were operated on. RESULTS: At operation 3 of the 4 hernial sacs were stained with methylene blue. There was no histological evidence of acute inflammatory reaction, but only of chronic inflammation which was probably caused by the hernia itself. CONCLUSION: Methylene blue injected into the peritoneal cavity makes it easier to repair recurrent inguinal hernias safely.

Portosystemic shunt for the treatment of portal vein thrombosis following orthotopic liver transplantation.

The efficacy of the portosystemic shunt operation for the treatment of portal vein thrombosis following orthotopic liver transplantation was demonstrated. From 1 July 1988 to 31 December 1991 42 portosystemic shunt operations were performed at our centre. In six of these cases portal vein thrombosis after orthotopic liver transplantation (OLT) was the indication for the procedure. All the patients retained adequate liver function but they demonstrated manifestations of significant portal hypertension, mainly variceal rebleeding. Two of the patients were children. Three patients underwent distal splenorenal shunt (DSRS), one mesocaval and one side-to-side splenorenal shunt and the last one side-to-side splenorenal shunt which was converted to DSRS 2 weeks later. All these patients were doing well after 30 months mean follow-up time without rebleeding or other signs of portal hypertension and none had so far required retransplantation.

Smooth muscle tumors of the gastrointestinal tract. A 10-year experience.

Benign or malignant smooth muscle tumors of the gastrointestinal tract are uncommon. The diagnostic and therapeutic approaches vary depending on the histological behavior of these neoplasms. Between 1981 and 1991, 32 patients with gastrointestinal tumors were treated at the Department of Surgery of the University of Patras. There were 16 females and 16 males. The mean age at the time of diagnosis was 61.9 years (range 22-83 years). Eighty-one per cent of the tumors were discovered in asymptomatic patients by a variety of diagnostic studies. Fifty-six per cent of tumors were located in the stomach, 38% in the small intestine and 6% in the colon. Leiomyomas made up 71.8% of these tumors and were treated by conservative excision. The malignant smooth muscle tumors were treated by radical excision in four cases and conservative excision in one case. The 5-year survival rate was 85% for leiomyomas and 0% for malignant smooth muscle tumors. There is widespread agreement that wide resection of the lesion is the appropriate treatment for these tumors. The size and mitotic activity of these tumors remain the most important diagnostic parameters and prognostic factors.

Hepatic artery pseudoaneurysm ligation after orthotopic liver transplantation--a report of 7 cases.

Pseudoaneurysm (PA) is a rare but life-threatening complication of liver transplantation. The authors present their experience on 7 patients treated by ligation of a post-OLT PA. Hepatic artery ligation or embolization was performed from 10 to 70 days after liver transplantation. Of the seven patients, four survived, one developed a biliary stricture, treated by percutaneous balloon dilatation, two died of a complication not related to treatment, and one died of multiple organ failure.

Radical consequence in the sexuality of male patients operated for colorectal carcinoma.

Sixty sexually-active male patients affected by colorectal cancer and surgically treated at the Department of Surgery at University of Patras between 1981 and 1987 were interviewed by structured questionnaire to evaluate the etiology of sexual dysfunction. Patients were divided into three groups: (1) 20 patients, mean age 60.5 years (range 39-70), subjected to high anterior resection for carcinoma of the sigmoid colon (not lower than 18 cm from the anal margins, 1.2% Dukes' A, 31% Dukes' B, 67.8% Dukes' C); (2) 20 patients, mean age 62.4 years (range 43-70), subjected to low anterior resection (not more than 8 cm from the anal margins, 3% Dukes' A, 36% Dukes' B, 61% Dukes' C); and (3) 20 patients, mean age 59.75 years (range 27-70), subjected to abdominoperineal surgery (Miles' technique) in whom the malignancy was in the distal rectum (8% Dukes' A, 32% Dukes' B, 60% Dukes' C). The first group served as the control. All the anastomoses in the low anterior resection group were performed by manual suture. Statistical evaluation of the three groups was by the chi 2-test. The form of sexual dysfunction, (1) cessation of sexual relationship, (2) absence of erection, (3) impossible penetration or (4) absence of ejaculation, varied according to the type of operation, the frequency of each form being 5%, 5%, 30%, 20% for the high anterior resection, 65%, 45%, 60%, 50% for Miles' operation and 20%, 25%, 45%, 5% for the low anterior resection respectively.

Complications of splenic tissue reimplantation.

Splenic tissue reimplantation employing the omental implantation technique was applied in 23 patients undergoing splenectomy for traumatic or iatrogenic splenic injury. Four complications were encountered after autotransplantation (17.4%). Two of these consisted of small bowel obstruction due to postoperative adhesions and were successfully managed by lysis of the adhesions. The other two complications were aseptic necrosis of the splenic transplants and were treated with ablation of the autolysed transplants. A case of abnormal splenic tissue reimplantation in a male patient with unsuspected myelofibrosis is also discussed. He underwent an emergency laparotomy for rupture of a subcapsular splenic haematoma. It is concluded that splenic tissue implantation in the greater omentum is associated with important early morbidity and this should be taken into account whenever application of the method is considered.