The effects of breast augmentation surgery on future ability to lactate

The majority of women receiving breast augmentation surgery do so at a time in their lives when both reproduction and lactation are common. It does not occur to most women to consider the possible effects breast augmentation surgery may have on their future ability to exclusively breast-feed their baby. Most women raise concerns about their inability to exclusively breast-feed years after surgery when they have a child. It is therefore important that women considering breast augmentation surgery be fully informed of the possible effects surgery may have on their future ability to lactate. The possible direct effects of surgery on the breast tissue and the complications of breast surgery on future ability to lactate are discussed. Surgical technique, i.e., implant type and placement, are also discussed. The types of incisions made into the breast tissue and the positioning of the implants once inside the breast parenchyma are analyzed and their possible effects on future ability to lactate are explored. Women who undergo breast augmentation surgery have a greater incidence of lactation insufficiency. Factors directly related to the surgical procedure as well as short- and long-term complications of surgery compromise future ability to exclusively breast-feed a baby. Factors directly related to surgery include severing of the lateral and medial branches of the fourth intercostal nerve or the nerve endings of the nipple-areolar complex, which, lead to reduced sensation and loss of the suckling reflex resulting in decreased milk production. Hematoma formation increases the risk of developing capsular contracture therefore necessitating the need for further surgical intervention. Infection also requires further intervention and as a result, further risk to the breast tissue. Long-term breast pain, capsular contracture, and pressure effects on the breast from the implant are all possible long-term complications that compromise a woman's future ability to lactate and exclusively breast-feed her baby. With good surgical technique and proper postoperative management, most of the complications associated with surgery that may result in insufficient milk production can be minimized but not always avoided. Compared with nonaugmented women, women who have had augmentation surgery have a higher incidence of lactation insufficiency.     

A polyepitope DNA vaccine targeted to Her-2/ErbB-2 elicits a broad range of human and murine CTL effectors to protect against tumor challenge

A cDNA vaccine (pVax1/pet-neu) was designed to encode 12 different Her-2/ErbB-2-derived, HLA-A*0201-restricted dominant and high-affinity heteroclitic cryptic epitopes. Vaccination with pVax1/pet-neu triggered multiple and ErbB-2-specific CTL responses in HLA-A*0201 transgenic HHD mice and in HLA-A*0201 healthy donors in vitro. Human and murine CTL specific for each one of the 12 ErbB-2 peptides recognized in vitro both human and murine tumor cells overexpressing endogenous ErbB-2. Furthermore, vaccination of HHD mice with pVax1/pet-neu significantly delayed the in vivo growth of challenged ErbB-2-expressing tumor (EL4/HHD/neu murine thymoma) more actively when compared with vaccination with the empty vector (pVax1) or vehicle alone. These data indicate that the pVax1/pet-neu cDNA vaccine coding for a poly-ErbB-2 epitope is able to generate simultaneous ErbB-2-specific antitumor responses against dominant and cryptic multiple epitopes.     

EphA2 as target of anticancer immunotherapy: identification of HLA-A*0201-restricted epitopes

EphA2 (Eck) is a tyrosine kinase receptor that is overexpressed in several human cancers such as breast, colon, lung, prostate, gastric carcinoma, and metastatic melanoma but not in nonmalignant counterparts. To validate EphA2 as a tumor antigen recognized by CD8+ T lymphocytes, we used reverse immunology approach to identify HLA-A*0201-restricted epitopes. Peptides bearing the HLA-A*0201-specific anchor motifs were analyzed for their capacity to bind and stabilize the HLA-A*0201 molecules. Two peptides, EphA2(58) and EphA2(550), with a high affinity for HLA-A*0201 were selected. Both peptides were immunogenic in the HLA-A*0201-transgenic HHD mice. Interestingly, peptide-specific murine CTLs cell lines responded to COS-7 cells coexpressing HLA-A*0201 and EphA2 and to EphA2-positive human tumor cells of various origin (renal cell, lung, and colon carcinoma and sarcoma). This demonstrates that EphA2(58) and EphA2(550) are naturally processed from endogenous EphA2. In addition, EphA2(58) and EphA2(550) stimulated specific CD8(+) T cells from healthy donor peripheral blood mononuclear cells. These T cells recognized EphA2-positive human tumor cells in an HLA-A*0201-restricted manner. Interestingly, EphA2-specific CD8+ T cells were detected in the peripheral blood mononuclear cells of prostate cancer patients. These results show for the first time that EphA2 is a tumor rejection antigen and lead us to propose EphA2(58) and EphA2(550) peptides for a broad-spectrum-tumor immunotherapy.     

Inhibition of factor VIIa generation and prothrombin activation by treatment with enoxaparin in patients with unstable angina

Factor VIIa (FVIIa) and thrombin generation occur in patients suffering an acute coronary event. We studied the effect of treatment with enoxaparin on FVIIa and prothrombin activation in patients with unstable angina. Anti-Xa activity, FVIIa, FVII coagulant activity (FVII:C) and FVII antigen (FVII:Ag), free tissue factor pathway inhibitor (TFPI), and prothrombin fragments 1 + 2 (F1+2) were measured in patients' plasma, over a 24-h treatment period with enoxaparin. All 14 patients recruited in the study (mean age 68 years) were treated with a subcutaneous injection of enoxaparin, 1 mg/kg twice daily. Blood was drawn just before, and at different time intervals after, the first injection. Before enoxaparin administration, the levels of FVIIa (4.02 +/- 0.8 ng/ml) and F1+2 (2.68 +/- 0.2 nmol/l) were significantly increased as compared with control subjects (2.3 +/- 0.3 ng/ml and 0.9 +/- 0.1 nmol/l respectively, P < 0.05). Free TFPI, FVII:C and FVII:Ag were within normal ranges. One hour after the first injection of enoxaparin, FVIIa and F1+2 levels decreased by 65% and 50%, respectively, and no significant fluctuations were noted throughout the observation period. The concentrations of FVII:C and FVII:Ag were not modified as compared with baseline values. After each injection, the peak concentrations of free TFPI and anti-Xa activity were observed at 2 and 4 h respectively. The kinetics of FVIIa and F1+2 inhibition did not follow those of anti-Xa activity and TFPI release.     

Analysis of SAA1 gene polymorphisms in the Greek population: rheumatoid arthritis and FMF patients relative to normal controls. Homogeneous distribution and low incidence of AA amyloidosis.

OBJECTIVE: To address whether or not the rarity of amyloidosis in Greek patients with rheumatoid arthritis (RA) is related to specific alleles of single nucleotide polymorphisms (SNPs) in the 5'-flanking region and the exon 3 of the SSA1 gene. METHODS: The genotypes of the -13T/C SNP in the 5'-flanking region of the SAA1 gene and the two SNPs within exon 3 of SAA1 (2995C/T and 3010C/T polymorphisms) were determined in 88 Greek patients with RA, 14 patients with familial Mediterranean fever (FMF) and 110 healthy controls. Linkage disequilibrium and haplotype frequencies involving -13T/C, 2995C/T and 3010C/T in these populations were tested and estimated, respectively. RESULTS: The genotypic distribution and allelic frequencies were similar in all groups tested. SNPs 2995 and 3010 were in linkage disequilibrium for all study populations (p < 0.05), whereas SNP -13 was not in linkage disequilibrium with either 2995 or 3010 (p > or = 0.05). Two major haplotypes presented in all patients with RA and FMF and controls: -13C; 2995T; 3010C (-13C; alpha) and -13C; 2995C; 3010T (-13C; beta). The -13T allele was linked with the gamma haplotype in Greek patients with RA and controls. The frequency of the -13T allele was found to be very rare in all groups tested. CONCLUSIONS: In conclusion, the rarity of the putative amyloidogenic -13T allele in Greek populations may be related to low prevalence of AA amyloidosis development in Greek RA patients.     

Hemispherotomy: description of surgical technique

INTRODUCTION: Hemispherectomy constitutes an established surgical method in the management of patients with medically intractable epilepsy, secondary to severe unilateral hemisphere damage. The well-established association of the anatomical hemispherectomy initially described with severe complications such as late hydrocephalus has led to the development of less resective and more disconnecting procedures. All these technical variations of hemispherotomy carry less favorable outcomes compared with anatomic hemispherectomy, but significantly fewer complications. METHODS: In our current communication, we outline the indications and the surgical technique of hemispherotomy and report our experience of the clinical application of this surgical procedure. RESULTS: In our clinical series, the 5-year follow-up shows that 66.6% of our patients (6 out of 9) had class I outcome according to Engel's classification system, 22.2% (2 out of 9) class II outcome, while 11.1% (1 out of 9) had class III outcome. No mortality occurred in the current series and operative blood loss was significantly lowered. CONCLUSION: Hemispherotomy represents a less efficacious technique compared with anatomic hemispherectomy, but is a safe and technically simple surgical alternative for the management of patients with medically intractable seizures.     

Response to radiotherapy in brain metastases and survival of patients with non-small cell lung cancer

The present study involves non-small cell lung (NSCLC) cancer patients with brain metastases, who were treated with radiation therapy, and our aim was to determine response rate and survival. A total of 167 patients were recruited, 155 (125 male, 30 female) of whom were evaluable. Performance status was 0-2 and histology or cytology included 66 (42.58%) adenocarcinomas, 62 (40.00%) undifferentiated and 27 (17.42%) squamous cell carcinomas. The stage of disease at diagnosis was IIIA-B in 92 (59.35%) patients and IV in 63 (40.65%). All patients had whole brain irradiation (3 Gy x 5 days/week for 2 weeks to a total dose of 30 Gy), which was performed by a linear accelerator and a 6-MV photon beam. Objective response was observed in 59/155 (38.06%) patients with 17 (10.97%) complete and 42 (27.09%) partial responses, and median survival of 5 months for all patients [95% confidence interval (CI) 3.9-6.1]. Responders had statistically significant longer survival than non-responders. Although responders represented less than half of our patients with NSCLC and brain metastases, they had significantly longer survival.     

Is Preservation of the Adrenal Vein Mandatory in Laparoscopic Adrenal-Sparing Surgery?

BACKGROUND AND OBJECTIVE: Adrenal tissue-sparing or partial adrenalectomy evolved initially for patients with bilateral synchronous adrenal surgical pathology to preserve vital adrenal volume. In the laparoscopic era, the exact criteria for performing such procedures laparoscopically have yet to be defined. Controversy exists regarding the importance of preserving the adrenal vein, main or accessory. The aim of this retrospective study was to present our short series of laparoscopic tissue-sparing adrenalectomies with vein preservation. Our main goal is not to support partial adrenalectomy as an alternative to total (this is already advocated by many surgeons) but to emphasize the vein-preserving technique. METHODS: Seven patients with peripherally located either aldosterone-producing adenomas (4 cases) or myelolipomas (4 cases) underwent laparoscopic lateral partial adrenalectomy. One patient harbored an aldosterone-producing adenoma and a myelolipoma as well. The main adrenal vein was identified and preserved in 6 patients and the accessory vein in one. RESULTS: No conversion to open adrenalectomy was necessary, and no perioperative morbidity or mortality occurred. Three adenoma patients are normotensive 44, 23, and 20 months postoperatively, while the fourth one's pressure is refractory. CONCLUSIONS: Surprisingly, total adrenalectomies preceded the partial ones, which is controversial compared with other procedures. Laparoscopic lateral partial adrenalectomy is a technically challenging tissue-sparing operation. Meticulous dissection allows preservation of the middle artery and main or accessory vein resulting in a functioning adrenal stump.