Management of the axilla with sentinel lymph node biopsy after neoadjuvant chemotherapy for breast cancer: A single-center study

The neoadjuvant chemotherapy (NAC) is the gold standard initial treatment of the locally advanced breast cancer (LABC). However, the reliability of methods that used to assess response the NAC is still controversial. In this study, patients with LABC who underwent NAC were evaluated retrospectively. The assessment of response to NAC and the effect of axillary approach were investigated on LABC course.The study comprised 94 patients who received NAC with an LABC diagnosis between 2008 and 2020. In our center, magnetic resonance imaging, ultrasonography, and ¹⁸ F-flouro deoxyglucose positron emission tomography/computed tomography, and, for some patients, fine-needle aspiration biopsy of suspicious axillary lymph nodes have been performed to assess the effects of NAC. Patients with positive hormone receptor status received adjuvant hormonotherapy, and those with human epidermal growth factor receptor 2 gene expression were treated with trastuzumab. Adjuvant radiotherapy was applied to all patients undergoing breast conserving surgery. Radiotherapy was applied to the peripheral lymphatic areas in the clinical N1 to N3 cases regardless of the response to NAC.The clinical response to the NAC was found that partial in 59% and complete in 19% of the patients. However, 21.2% of the patients were unresponsive. The mean of lymph nodes that excised with the procedure of sentinel lymph node biopsy (SLNB) was 2.4 (range 1–7). In 22 of the 56 patients who underwent SLNB, axillary dissection (AD) was added to the procedure upon detection of metastasis in frozen section examinations. There was no difference between the SLNB and AD groups regarding overall survival (OS; P = .472) or disease-free survival (DFS) rates (P = .439). However, there were differences in the OS (P < .05) and DFS (P = .05) rates on the basis of the LABC histopathological subtypes.The study found that a relationship between molecular subtypes and LABC survival. However, the post-NAC axillary approach had no effect on OS or DFS. Therefore, multiple imaging and interventional methods are needed for the evaluation of NAC response. In addition, morbidity can be avoided after AD by the use of SLNB in cN0 patients.     

A new microvascular anastomosis technique using muscle graft

A novel microvascular anastomosis technique is described. Forty-five male Sprague-Dawley rats were divided equally into three groups before undergoing femoral artery anastomosis. The first group received standard eight-suture anastomotic repair. Group 2 (muscle group) received three sutures plus autogenous muscle graft wrapped around the anastomosis. In group 3 (fascial surface group), a muscle graft was wrapped around the anastomosis with the fascial side of the graft facing the anastomosis. Significantly less time and suture usage were noted using both fascial surface and muscle groups compared with controls (p??0.05). Additionally, grade 2 anastomotic leakage was less frequent in the study groups compared with the control group (p?相似文献   

Management of Delayed Presentation of a Right-Side Traumatic Diaphragmatic Rupture

Background  

Right-side diaphragmatic rupture is an unusual condition after blunt trauma. The diagnosis may be missed during the early period of trauma and may lead to progressive herniation of intraabdominal contents into the thorax. In this study, we aimed to evaluate the diagnosis and treatment options for the late diagnosis of cases of right-side traumatic diaphragmatic rupture.     

The relation between superior phacoemulsification incision and steep axis on astigmatic outcomes

To evaluate the relation between superior phacoemulsification incision and different steep axis on astigmatism outcomes. This prospective, randomized study comprised three groups each with 24 eyes with age-related cataracts and underwent 3.0?mm superior clear corneal incision (CCI). The three groups of the patients were divided by the location of the steep axis. The steep axis was between 0 and 30° in group 1, 31–60° in group 2, 61–90° in group 3. The degree was accepted as the distance from the steep axis to the distal aspect of the wound. Outcome measures were including the changes in mean total astigmatism, surgically-induced astigmatism (SIA), axis deviation, uncorrected visual acuity (UCVA), and best corrected visual acuity (BCVA). Astigmatism was measured by manuel keratometry readings before surgery and day-1, week-1, week-2, week-4 and week-8 postoperatively. The surgically-induced astigmatism was calculated by the vector analysis using the Holladay–Cravy–Koch method. The magnitude of mean total astigmatism was lowest in group 1 and highest in group 3 at 8th week. Surgically-induced astigmatism was 0.52 diopter (D), 0.88?D, 1.03?D in group 1, group 2, and group 3 respectively. The change in SIA was significant in group 1 (P?<?0.05). The change in the astigmatic axis deviation was highest in group 1 (31.5?±?31.3, P?<?0.05). The mean UCVA and BCVA were not significant pre and postoperatively between groups (P?>?0.05). Axis deviation and SIA were stable after the week-1 and week-2 examinations respectively. Cataract surgery with CCI on or near the steep axis is resulted in decreased SIA and increased axis deviation.     

Obstructive jaundice due to a textiloma mimicking a common bile duct stone

A foreign body is a rare cause of obstructive jaundice. We report a 19-year-old woman with jaundice caused by a surgical gauze in the common bile duct (CBD). Four yours earlier, she had undergone a cholecystectomy and drainage for hydatid disease of the liver. Her postoperative course was complicated by a biliary fistula that healed after 50 days. She now presented with obstructive jaundice of 2 weeks' duration. Magnetic resonance cholangiopancreatography (MRCP) showed a signal-void mass, consistent with a CBD stone. Surgical exploration of the CBD revealed a surgical gauze as the cause of the obstruction. To the best of our knowledge, this is the first case of a surgical gauze obstructing the CBD requiring surgical removal.     

Seroprevalence of varicella, measles and hepatitis B among female health care workers of childbearing age

To evaluate the relation between infectious agents and reproductive health hazards for health care workers (HCWs), a cross-sectional study consisting of 73 HCWs and 65 bureau workers was conducted. The reproductive health problems of both groups were compared using a questionnaire, and serologic examinations for measles, varicella and hepatitis B were performed. There were no differences between the two groups according to the rate of seropositivity of measles and varicella (P > 0.05). The prevalence of anti-HBc seropositivity was significantly higher among HCWs than controls (31.5 versus 16.9%). There were no differences between seropositive and seronegative subgroups of measles, varicella and hepatitis B regarding the rates of normal delivery time, preterm and postterm delivery and stillbirth. Subjects seropositive for anti-HBc showed a higher spontaneous abortion rate than those who were seronegative (38.2 versus 16.3, P = 0.009). Although these data showed that HCWs had a high rate of anti-HBc seropositivity and that the rate of spontaneous abortion was associated with past hepatitis B virus infection, further studies including larger populations are needed. We considered that it should be strongly recommended that all HCWs be vaccinated against this virus, and future studies should be focused on the relationship between infectious diseases and reproductive health problems in HCWs.