Outcomes after curative or palliative surgery for locoregional recurrent breast cancer

Background

Locoregional recurrence (LRR) after breast cancer is an independent predictor for later systemic disease and poor long-term outcome. As the surgical treatment is complex and often leaves the patient with extensive defects, reconstructive procedures involving flaps, and thus plastic surgical assistance, are often required. The aim of the present study was to evaluate our institution’s approach to surgical treatment for locoregional recurrence of a breast cancer.

Methods

In the present retrospective, single-centre study, we evaluate our experience with 12 patients who underwent surgery for locally recurrent breast cancer at Aarhus University Hospital between 2006 and 2010. Nine patients underwent wide local excision. The remaining three patients underwent full thickness chest wall resection.

Results

There was no perioperative mortality and no major complications. Minor complications occurred in four (33 %) of the patients. Median overall survival was 22 months, regardless of the surgery being curative or palliative. A median disease-free survival of 18 months was achieved for patients having achieved radicality.

Conclusions

Both wide local excision and full thickness chest wall resection offer the opportunity of local control and palliation in patients with LRR. The plastic surgical reconstructive procedures are associated with a low complication rate, and thus not postponing further adjuvant therapy. However, a multidisciplinary approach with a highly careful patient selection is critical in order to ensure the best outcome for the patient. Level of Evidence: Level IV, therapeutic study.     

Effects of end-stage renal disease and aluminum hydroxide on temazepam kinetics

The kinetics of temazepam, 30 mg, were evaluated in 11 patients with end-stage renal disease. Age ranged from 18 to 65 years. On two occasions separated by 1 week, single oral 30 mg doses of temazepam were given once with water (TM) and once with 3600 mg aluminum hydroxide gel (TM + AHG). There were no significant differences in the maximum plasma concentration, the time to reach maximum concentration, or elimination rates between TM and TM + AHG dosing. In approximately half the subjects there were secondary temazepam peak concentrations. In the remaining subjects, temazepam elimination was biphasic, with the terminal t1/2 ranging from 11 to 77 hours. There was a lag time before absorption in all subjects. The percent free temazepam in plasma from dialysis subjects ranged from 4.4% to 8.8% (mean = 5.9%). Compared with literature reports of subjects with normal renal function, the maximum plasma concentration was lower and the percent free temazepam was higher in dialysis subjects. When sedation score was plotted against plasma temazepam concentration, there was clockwise hysteresis consistent with tolerance or adaptation to effects of the drug. Thus aluminum hydroxide gel does not affect temazepam absorption. The clinical significance of the low plasma concentrations and high free temazepam fraction in dialysis subjects is uncertain.     

Optimal antiproteinuric dose of aliskiren in type 2 diabetes mellitus: a randomised crossover trial

Aim  

The optimal antiproteinuric dose of aliskiren is unknown. This study compared the effect of placebo and increasing doses of aliskiren on urinary albumin excretion rate (UAER).     

Comparison of ultrasonographic findings in spontaneous abortions with normal and abnormal karyotypes

To determine whether ultrasonographic findings can predict the karyotype of spontaneous abortions, 137 pregnancies (54 spontaneous, 83 assisted ovulatory cycles) that subsequently aborted and had chromosome analysis performed on the products of conception were studied ultrasonographically. Transvaginal ultrasound was performed using an Acuson 128XP/10 with 7.5 MHz probe. The numbers of empty gestational sacs, small and normal for gestational size, embryonic poles and embryos with documented cardiac activity were calculated. The frequency of each of these findings in pregnancies with normal and abnormal karyotypes was compared. Of the 137 spontaneous abortions, 51 had normal chromosome analyses and 86 had abnormal karyotypes (68 aneuploidies and 18 polyploidies). Ultrasonographic findings in the 51 karyotypically normal pregnancies included 16 (31%) with empty gestational sacs, and 35 (69%) with embryonic poles, of which 24 (69%) were at least 1 week smaller than expected for gestational age and 11 (31%) were the expected size. Embryonic cardiac activity was documented in 22 (63%) of the 35 embryonic poles. Amongst 86 pregnancies with abnormal karyotypes, similar frequencies of ultrasound findings were found: 23 (27%) with empty gestational sacs, 42 (67%) with embryonic poles smaller than expected for gestational age, and 50 (79%) embryos lost after documentation of embryonic cardiac activity. No differences in the frequency of ultrasonographic findings of empty gestational sacs, small embryonic pole and embryonic cardiac activity were observed between karyotypically normal and abnormal spontaneous abortions. Ultrasonographic findings cannot predict the karyotype of spontaneous abortions.      

Comparison of two carbonated apatite ceramics in vivo

Carbonated apatite ceramics, with a composition similar to that of bone mineral, are potentially interesting synthetic bone graft substitutes. In the present study, two porous carbonated apatite ceramics were developed, characterized and tested for their bone repair capacity and osteoinductive potential in a goat model. Although the two ceramics were prepared from a similar starting powder, their physico-chemical and structural characteristics differed as a consequence of different preparation methods. Both ceramics had an open and interconnected porous structure with a porosity of about 80%. The morphology of the surface of CA-A and CA-B at the submicron level differed significantly: CA-A consisted of irregular grains with a size of 5–20 μm, with 1–10 μm large micropores among the grains, whereas CA-B surface consisted of much smaller and regular shaped grains (0.05–0.5 μm), with most micropores smaller than 1 μm. The specific surface area of CA-B was about 10 times larger than that of CA-A due to its significantly smaller grain size. CA-A and CA-B ceramics contained 3 and 5 wt.% of B-type carbonated apatite, respectively. Although neither ceramic succeeded in completely bridging the 17 mm iliac wing defect with new bone after 12 weeks of implantation, CA-A showed significantly more bone formation in the pores of the implant than CA-B. The total area percentage of new bone in the total defect area was 12.7 ± 1.81 and 5.51 ± 1.37 (mean ± SEM) for CA-A and CA-B, respectively. Intramuscular implantation of the ceramics led to ectopic bone formation by CA-A in all three implanted specimens, in contrast to CA-B, where no new bone was observed in any of the 11 animals. CA-A showed a more pronounced degradation than CA-B both in vitro and in vivo at both implantation sites, which was unexpected based on the physico-chemical and structural properties of the two ceramics. Both physico-chemical and structural properties of the ceramics could, dependently or independently, have affected their in vivo behaviour, emphasizing the importance to control individual parameters for successful bone repair.     

Fluorinated gels for gel permeation chromatography

The aim of these investigations was the development of stationary phases for GPC compatible with fluorinated solvents. The properties of crosslinked copolymers of 4-(2-heptafluoropropoxy-1, 2,2-trifluoroethoxy)styrene ( 1 ) were investigated in dependence of the mode of synthesis. Divinylbenzene (DVB) was used as crosslinking agent. In the case of homogeneously crosslinked gels, 1 mol-% of DVB results in a gel with an exclusion molecular weight of 2000. Heterogeneous crosslinking copolymerization of 1 with DVB in presence of inert diluents results in gels with exclusion limits from 5000 to 4000000 in dependence of the diluent composition. Characterization of the gels in GPC experiments was carried out with 2-(1,2-dibromotrifluoroethoxy)-1,1,2,3,3,3-hexafluoro-1-(perfluoropropoxy)propane (PPVE₂Br₂), hexafluorobenzene, 1,1,2-trichlorotrifluoroethane (Frigen^R113) and trifluoromethylbenzene as eluents.