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81.
Elizabeth FitzSullivan MD Sara A. Lari BS Benjamin Smith MD Abigail S. Caudle MD Savitri Krishnamurthy MD Anthony Lucci MD Elizabeth A. Mittendorf MD PhD Gildy V. Babiera MD Dalliah M. Black MD Jamie L. Wagner DO Isabelle Bedrosian MD Wendy Woodward MD Sarah M. Gainer MD Rosa Hwang MD Funda Meric-Bernstam MD Kelly K. Hunt MD Henry M. Kuerer MD PhD 《Annals of surgical oncology》2013,20(13):4103-4112
Background
The impact of close margins in patients with ductal carcinoma-in situ (DCIS) treated with mastectomy is unclear; however, this finding may lead to a recommendation for postmastectomy radiotherapy (PMRT). We sought to determine the incidence and consequences of close margins in patients with DCIS treated with mastectomy.Methods
The records of 810 patients with DCIS treated with mastectomy from 1996 through 2009 were reviewed. Clinical and pathologic factors were analyzed with respect to final margin status. Median follow-up was 6.3 years.Results
Overall, 94 patients (11.7 %) had close margins (positive, n = 5; negative but ≤1 mm, n = 54; 1.1–2.9 mm, n = 35). Independent risk factors for close margins included multicentricity, pathologic lesion size ≥1.5 cm, and necrosis, but not age, use of skin-sparing mastectomy, or immediate reconstruction (p > 0.05). Seven patients received PMRT, and none had a locoregional recurrence (LRR). Among the remaining 803 patients, the 10-year LRR rate was 1 % (5.0 % for margins ≤1 mm, 3.6 % for margins 1.1–2.9 mm, and 0.7 % for margins ≥3 mm [p < 0.001]). The 10-year rate of contralateral breast cancer was 6.4 %. On multivariate analysis, close margins was the only independent predictor of LRR (p = 0.005).Conclusions
Close margins occur in a minority of patients undergoing mastectomy for DCIS and is the only independent risk factor for LRR. As the LRR rate in patients with close margins is low and less than the rate of contralateral breast cancer, PMRT is not warranted except for patients with multiple close/positive margins that cannot be surgically excised. 相似文献82.
83.
Edmond M. Cronin MB Jennifer Gray DO Bernard Abi-Saleh MD Bruce L. Wilkoff MD Kerry H. Levin MD 《Muscle & nerve》2013,47(6):840-844
Introduction: Pacemakers and implantable cardioverter-defibrillators (ICDs) are vulnerable to inappropriate sensing of electromagnetic interference (EMI), such as from nerve conduction studies. We conducted a prospective study to assess the safety of repetitive nerve stimulation (RNS). Methods: Fourteen patients undergoing insertion of 10 ICDs and 4 pacemakers under general anesthesia received RNS of the median, axillary, and spinal accessory nerves at 2 HZ and 50 HZ . We recorded detection of EMI and whether or not this resulted in an arrhythmia diagnosis or change in pacing output. Results: EMI was visible in 2 ICDs, without spurious tachyarrhythmia detection. EMI was observed in 3 of the 4 pacemakers, which led to pacing inhibition and a pause in 2, both of which were programmed to a unipolar sensing configuration. Conclusions: RNS is safe in patients with ICDs. In pacemaker patients, RNS appears safe during bipolar sensing, but caution is recommended in pacemaker patients with unipolar sensing. Muscle Nerve 47: 840–844, 2013 相似文献
84.
85.
Chester A. Mathis PhD Lewis H. Kuller MD DrPH William E. Klunk MD PhD Beth E. Snitz PhD Julie C. Price PhD Lisa A. Weissfeld PhD Bedda L. Rosario PhD Brian J. Lopresti BS Judith A. Saxton PhD Howard J. Aizenstein MD PhD Eric M. McDade DO M. Ilyas Kamboh PhD Steven T. DeKosky MD Oscar L. Lopez MD 《Annals of neurology》2013,73(6):751-761
86.
87.
Rhian E. Davies DO Ian C. Gilchrist MD FSCAI 《Catheterization and cardiovascular interventions》2016,87(5):875-876
- Radial artery catheterization results in local vascular injury to the artery and at times subsequent arterial occlusion, yet even in patients with abnormal collateral testing ischemic hand injury remains essentially unseen.
- Careful serial examinations of neuro‐muscular function of the hand in patients undergoing transradial catheterization demonstrate that even in the case of radial occlusion and an abnormal collateral test, hand function is not altered after the procedure.
- While radial artery occlusion may not result in functional ischemic findings, the occlusion itself results in lost future opportunity for vascular access or conduit use and further understanding on how to prevent this sequalae continues to be a priority.
88.
89.
Defining a new diagnostic assessment parameter for wound care: Elevated protease activity,an indicator of nonhealing,for targeted protease‐modulating treatment 下载免费PDF全文
Thomas E. Serena MD Breda M. Cullen PhD Simon W. Bayliff BSc Molly C. Gibson BSc Marissa J. Carter PhD Lingyun Chen PhD Raphael A. Yaakov MS John Samies MD Matthew Sabo DPM Daniel DeMarco DO Namchi Le MD James Galbraith MD 《Wound repair and regeneration》2016,24(3):589-595
It is widely accepted that elevated protease activity (EPA) in chronic wounds impedes healing. However, little progress has occurred in quantifying the level of protease activity that is detrimental for healing. The aim of this study was to determine the relationship between inflammatory protease activity and wound healing status, and to establish the level of EPA above which human neutrophil‐derived elastase (HNE) and matrix metalloproteases (MMP) activities correlate with nonhealing wounds. Chronic wound swab samples (n = 290) were collected from four wound centers across the USA to measure HNE and MMP activity. Healing status was determined according to percentage reduction in wound area over the previous 2–4 weeks; this was available for 211 wounds. Association between protease activity and nonhealing wounds was determined by receiver operating characteristic analysis (ROC), a statistical technique used for visualizing and analyzing the performance of diagnostic tests. ROC analysis showed that area under the curve (AUC) for HNE were 0.69 for all wounds and 0.78 for wounds with the most reliable wound trajectory information, respectively. For MMP, the corresponding AUC values were 0.70 and 0.82. Analysis suggested that chronic wounds having values of HNE >5 and/or MMP ≥13, should be considered wound healing impaired. EPA is indicative of nonhealing wounds. Use of a diagnostic test to detect EPA in clinical practice could enable clinicians to identify wounds that are nonhealing, thus enabling targeted treatment with protease modulating therapies. 相似文献
90.
Shilpa A. Padia MD Mary Freyvogel DO Jill Dietz MD Stephanie Valente DO Colin O'Rourke MS Stephen R. Grobmyer MD 《The breast journal》2016,22(1):90-95
Breast magnetic resonance imaging (MRI) has been repeatedly shown to have a high false‐positive rate for additional findings in the breast resulting in additional breast imaging and biopsies. We hypothesize that breast MRI is also associated with a high rate of false‐positive findings outside of the breast requiring additional evaluation, interventions, and delays in treatment. We performed a retrospective review of all breast MRIs performed on breast cancer patients in 2010 at a single institution. MRI reports were analyzed for extra‐mammary findings. The timing and yield of the additional procedures was also analyzed. Three hundred and twenty‐seven breast cancer patients (average age = 53.53 ± 11.08 years) had a breast MRI. Incidental, extra‐mammary findings were reported in 35/327 patients (10.7%) with a total of 38 incidental findings. The extra‐mammary findings were located in the liver (n = 21, 60.0%), thoracic cavity (n = 12, 34.3%), kidneys (n = 1, 2.9%), musculoskeletal system (n = 3, 8.6%), and neck (n = 1, 2.9%). Eighteen of the 35 patients (51.4%) received additional radiographic imaging, 3 (8.6%) received additional laboratory testing, 2 (5.7%) received additional physician referrals and 2 (5.7%) received a biopsy of the finding. The average time to additional procedures in these patients was 14.5 days. None of the incidental, extra‐mammary findings were associated with breast cancer or other malignancy. Breast MRI was associated with a high rate (10.7%) of extra‐mammary findings, which led to costly additional imaging studies, referrals, and tests. These findings were not associated with breast cancer or other malignancies. Extra‐mammary findings highlight an unrecognized adverse consequence of breast MRI. 相似文献