Breast conserving oncoplastic surgery in the treatment of centrally located malignant breast tumors

Central breast neoplasms account for 5 to 20% of breast cancer cases. For decades, they have been traditionally treated with mastectomy. The high incidence of involvement associated with these tumors necessitates nipple and areola resection. Oncoplastic surgical techniques, in well selected cases, enable the achievement of adequate cosmetic results following a radical central quadrantectomy along with the Nipple-Areola Complex. The present paper summarizes the indications, techniques and results of breast conserving surgeries of central breast tumors.     

Lymphocyte transformation in competent and in immunodepressed individuals. 3 ways of results presentation

Lymphocytes from 107 healthy individuals and 34 patients with lung cancer were cultured and stimulated with PHA. Wide variation in lymphocyte transformation reactivity was observed, ranging from significantly low responses to high blastogenesis. Low spontaneous blastogenic responses were not always associated with a simultaneous decrease in PHA-induced lymphocyte transformation in the same individuals. The results are presented by the (disintegrations per minute) values of the stimulated and nonstimulated cultures and by the stimulation index. A new index termed the Blastogenic Cumulative Index is proposed. It is defined as the sum of the logarithms of the values of the spontaneous and the PHA-induced lymphocyte transformation. A better relationship was observed in immunocompetent and in immunodepressed individuals between the dpm values and Cumulative Indices than between the dpm and the Stimulation Indices.     

The midwives ordinance of Palestine, 1929: historical perspectives and current lessons

KATVAN E and BARTAL N. Nursing Inquiry 2010; 17 : 165–172
The midwives ordinance of Palestine, 1929: historical perspectives and current lessons Until 1929, midwifery in Palestine was relatively open to anyone and only partially regulated by the 1918 Public Health Ordinance, legislated shortly after the beginning of British rule. This article describes the factors that guided the shaping of midwifery and suggests possible sources of inspiration for the British legislator in crafting the Midwives Ordinance in 1929, including American, local (Jews and Arabs), and British ones. The Midwives Ordinance reflects the adjustment of midwifery to changes in the society that evolved under the British Mandate. The ordinance shows how the modern midwife’s role contracted relative to the traditional one, in the context of social processes in other countries, east and west. This historical research project is based on interviews, archive documents and research literature. It analyzes the British interests in regulating midwifery, including the rationale of preserving public health and reducing infant mortality, against a background of political power struggles as well as cultural, social and professional diversity in Palestine (the tensions between the powers of doctors, nurses, and pharmacists).     

Immune perturbations in patients along the perioperative period: Alterations in cell surface markers and leukocyte subtypes before and after surgery

BackgroundSurgery renders patients susceptible to life-threatening complications, including infections, multiple organ failure, and presumably cancer metastases. Surgery-induced immune perturbations were suggested to contribute to such deleterious effects, but also to facilitate post-injury healing. Preoperative psychological and physiological stress responses may contribute to these immune perturbations, and could thus jeopardize patients even before surgery. The current study assessed the effects of various operations on an array of immune indices during the perioperative period. To qualify immune changes before surgery, patients’ immune status was also compared to that of healthy controls.MethodsA total of 81 subjects (operated patients and healthy controls) provided up to five daily blood samples during the perioperative period, for assessment of leukocyte subtypes (granulocytes, monocytes, Tc, Th, NK, NKT, CD4⁺CD25⁺, CD8^brightCD4^dim, and B cells) and their surface markers (HLA-DR and LFA-1).ResultsEven before surgery patients displayed immune perturbations, including reduced lymphocyte HLA-DR expression and increased monocyte LFA-1 expression. Following surgery, we recorded a reduction in lymphocyte numbers that was subtype specific, increased granulocyte numbers, and reduced expression of HLA-DR by lymphocytes and monocytes. Finally, no significant associations were found between alteration in leukocyte numbers and cell surface markers (although these indices showed high correlations with other variables), implying differential mediating mechanisms.ConclusionSeveral immune alterations are manifested prior to surgery, and contribute to the marked postoperative changes, which are commonly interpreted as immune suppression. We discuss the possible adaptive and maladaptive nature of these perturbations in the context of natural injury, stress, and surgery.     

A preliminary study of intravenous methanol extraction residue of BCG in treatment of advanced cancer.

Twenty-four patients with advanced cancer not reacting to conventional therapy were treated with 97 courses of i.v. MER (methanol extraction residue of BCG). MER was administered by i.v. infusion over a 4-h period, twice a week, in dosages varying from 0.05 mg to 1.25 mg. The skin reactivity to 5 recall antigens was evaluated in the patients. All patients except 4 were anergic. Twelve patients had no side-effects. Anergic patients had less side-effects than ergic patients. The side-effects recorded in the others were fever, chills, vomiting and tachycardia. The reaction subsided within 24 h after treatment and was tolerable for most patients. In 2 patients an objective improvement was observed. No changes in cutaneous reactivity, renal and hepatic functions were found. A significant increase in peripheral leucocyte count was noted in two patients and slight a increase in the remainder.     

A successful case of basilar bifurcation aneurysm surgery

Summary After a short review of the related literature, the authors present a personal case of an aneurysm at the bifurcation of the basilar artery. The patient was operated upon after a second coma-producing haemorrhage. The aneurysm was largely excluded from the circulation by clipping of the basilar trunk distal to the superior cerebellar arteries and of the right posterior cerebral artery, proximal to the posterior communicating artery. Four days after the operation he developed severe cardiovascular and neurological disturbances and diabetes insipidus. After some weeks he made a remarkable recovery and was eventually able to return to work. The possibility of circulatory disturbances in the posterior perforating vessels as an explanation of the unusual postoperative course is discussed.

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Zusammenfassung Nach kurzer Literaturübersicht berichten die Autoren über einen eigenen Fall mit einem Aneurysma der Bifurkation der A. basilaris. Der Patient wurde nach einer zweiten, komaverursachenden Blutung operiert. Das Aneurysma wurde weitgehend aus der Zirkulation ausgeschaltet durch Klippen des Basilaris-Stammes distal der oberen zerebellaren Arterien sowie der rechten A. cerebri posterior proximal der A. communicans posterior. 4 Tage nach der Operation entwickelten sich schwere kardio-vaskuläre und neurologische Störungen sowie ein Diabetes insipidus. Nach einigen Wochen kam es zu einer bemerkenswerten Besserung mit Wiederherstellung der Arbeitsfähigkeit. Als Ursache des ungewöhnlichen postoperativen Verlaufes wird die Möglichkeit von Zirkulationsstörungen in den hinteren perforierenden Gefäßen diskutiert.

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Resumen Después de una breve revisión de la literatura sobre este tema los autores presentan, a su vez, un caso de aneurisma de la bifurcación del tronco basilar.La intervencion quirúrgica tuvo lugar a continuación de una recidiva de hemorragia y con el enfermo en coma.La circulación pudo ser excluida en gran parte por el pinzamiento de la porción distal del tronco basilar, tomando como referencia la arteria cerebelosa superior y por pinzamiento de la arteria cerebral posterior derecha, y de la parte proximal del tronco basilar guiados por la arteria comunicante posterior.El enfermo presentó a los 4 días de la intervención trastornos cardiovasculares graves, así como neurológicos y una diabetes insípida. Sin embargo, algunas semanas más tarde se recupera de una manera asombrosa y finalmente ha podido reanudar su trabajo.Los autores discuten la posibilidad de que los trastornos circulatorios en los vasos perforantes posteriores pudieran ser la causa de este curso postoperatorio poco habitual.

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Résumé Après une revue rapide de la littérature correspondante, les auteurs présentent, à leur tour, un cas d'aneurisme de la bifurcation du tronc basilaire.L'intervention chirurgicale a eu lieu à la suite d'une récidive d'hémorragies avec coma.L'aneurisme a été exclu en grande partie de la circulation par le pincement de la partie distale du tronc basilaire, par rapport à l'artère cérébelleuse supérieure et par pincement de l'artère cérébrale postérieure droite; et de la partie proximale du tronc basilaire par rapport à l'artère communicante postérieure.Le malade a présenté, 4 jours après l'intervention, de graves troubles cardio-vasculaires et neurologiques ainsi qu'un diabète insipide. Toutefois, quelques semaines plus tard, le malade s'est remis d'une façon remarquable et a pu finalement reprendre son travail.Les auteurs ont enfin discuté la possibilité de troubles circulatoires dans les vaisseaux perforants postérieurs pour expliquer les suites postopératoires inhabituelles.

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Riassunto Dopo una breve scorsa della letteratura su questo argomento, gli AA. presentano un caso personale di un aneurisma della biforcazione dell'arteria basilare. Il paziente venne operato dopo una seconda emorragia che lo mise in coma. L'aneurisma fu isolato dalla circolazione mediante il clippaggio del tronco della basilare distalmente alle arterie cerebellari superiori e all'arteria cerebrale posteriore destra, prossimalmente all'arteria comunicante posteriore.Quattro giorni dopo l'operazione il paziente accusò gravi disturbi cardiovascolari e neurologici, nonchè diabete insipido, ma dopo alcune settimane ebbe una notevole ripresa ed alla fine potè riprendere il suo lavoro. Gli AA. esprimono poi l'ipotesi che il non comune decorso postoperatorio possa stare in connessione con disturbi circolatori nei vasi posteriori perforanti.

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Presented at the congress of the Israel Neurological, Neurosurgical and Psychiatric Society, 12th–17th May 1966.