Nipple discharge after nipple-sparing mastectomy: should the areola complex always be removed?

Nipple discharge (ND) is a common symptom with a reported incidence of 2% to 5% of patients referred to breast cancer clinics. Approximately 90% of ND is of benign etiology. An underlying carcinoma is present with a rate of 6% to 21%. This is more frequent if it is associated with clinical or radiologic abnormality. ND after nipple-sparing mastectomy (NSM) is a rare event as the whole retroareolar glandular tissue is usually completely removed with mastectomy. ND is otherwise possible if a small amount of tissue is accidentally left by the surgeon or with the aim of reducing the risk of the nipple-areola complex (NAC) necrosis. This condition can be of concern as it may imply a local recurrence and therefore implicate NAC removal. Herein we report a case of a ND in an NSM in which only a selective duct excision allowed NAC preservation.     

Shrinkage in oral squamous cell carcinoma: An analysis of tumor and margin measurements in vivo,post-resection,and post-formalin fixation

Purpose

To quantify changes in tumor size and tumor-free margins following surgical resection and formalin fixation of oral cavity squamous cell carcinoma.

Mohs micrographic surgery technique

This article provides a protocol for the systematic approach to the technique of Mohs micrographic surgery. Each step, from tumor excision and tissue mapping, to specimen processing and histologic interpretation, through wound closure and postoperative management, is covered. The advantages of Mohs surgery over other treatment modalities are observed histologic margin control, superior cure rates, and maximal tissue-sparing potential. The increased preservation of normal tissue leads to smaller surgical defects, optimal reconstructive results, and diminished risk of poor surgical outcomes. Overall, the risks of the procedure are few, the benefits numerous, and the outcomes worth the time and effort spent in learning the technique.     

Rapid noninvasive optical imaging of tissue composition in breast tumor margins

Background

In women undergoing breast conserving surgery (BCS), up to 60% can require re-excision. Our objective is to develop an optically based technology which can differentiate benign from malignant breast tissues intraoperatively through differences in tissue composition factors.

Methods

A prospective study of optical imaging of BCS margins is being performed. Optical images are transformed into tissue composition maps with parameters of total hemoglobin concentration, b-carotene concentration and scattering. The predicted outcome is then compared to the margin-level pathology.

Results

Fifty-five margins from 48 patients have undergone assessment. Within 34 specimens with pathologically confirmed positive margins, the ratio map of b-carotene/scattering showed the most significant difference reflecting a decrease in adipose and an increase in cell density within malignant margins (p=.002). These differences were notable in both in-situ and invasive disease.

Conclusions

We present a novel optical spectral imaging device that provides a rapid, non-destructive assay of the tissue composition of breast tumor margins.     

不同材料的全冠边缘对Beagle犬牙周环境的影响

目的:探讨不同材料的全冠边缘对Beagle犬牙周环境的影响。方法:用手用洁治器对4只Beagle犬行全口龈上洁治、龈下刮治。3周后,对49颗犬牙行瓷熔附金属(porcelain fused m etal,PFM)冠修复术。于牙体预备前和PFM粘固后4周,分别记录实验牙菌斑指数(p laque index,PLI)、牙周探诊深度(prob ing depth,PD)、龈沟出血指数(su lcus b leed ing index,SB I),测量龈沟液量(gingival crevicu lar flu id,GCF),并检测龈沟液中天冬氨酸转氨酶(as-partate am inotransferase,AST)的水平。整个实验过程中每周给予旋转刷牙法刷牙1次。结果:结果表明,PFM冠粘固后第4周,舌侧牙龈的PD、PLI≥1的频率、GCF量、SB I≥2频率、AST活性明显增加(P<0.01);颊侧牙龈的PD、PLI≥1的频率、GCF量均无明显变化,SB I≥2的频率、AST活性明显增加(P<0.05);两组GCF量、SB I≥2频率、AST活性有明显的差异(P<0.05)。结论:每周给Beagle犬刷牙1次,PFM冠粘固后第4周,烤瓷边缘和金属边缘对应的牙周组织炎症均明显加重,金属边缘对应的牙周组织尤为明显。可能是由于金属表面和烤瓷表面容易形成菌斑。     

弱光启动固化对后牙树脂聚合收缩和表面硬度的影响

目的探讨弱光启动固化对三种临床常用的光同化后牙树脂（EcuSphere—Carat，EC；Fihek P60，P60；Tetric Ceram HB．HB）聚合收缩和表面硬度的影响。方法将树脂充填入直径0．7cm、高0．4cm的圆柱状容器中．每种树脂实验组和对照组各10个样本．采用扫描电镜测量树脂样本与充填容器的边缘裂隙宽度，评价弱光启动对聚合体积收缩的影响；同法制备样本，每种树脂实验组和对照组各7个样本．采用显微硬度计测量两种固化方式处理的样本表面的维氏硬度．探讨弱光启动固化对树脂表面硬度的影响．结果EC、P60、HB三种树脂传统光固化后边缘裂隙宽度分别为（15．32±1．78）μm、（15．72±1．97）μm和（16．14±1．74）μm，差异无统计学意义（P〉0．05）；弱光启动固化后的边缘裂隙宽度分别（14．83±3．34）μm、（13．64±1．92）μm、（14．18±2．01）μm，弱光启动固化后的边缘裂隙宽度减小＋差异有统计学意义（P〈0．05）。树脂表面硬度传统光固化后分别为（116．76±12．00）MPa、（159．14±5．90）MPa、（119．59±5．00）MPa：弱光启动固化后分别为（109．74±5．77）MPa、（154．81±3．99）MPa、（114．11±6．42）MPa，表面硬度较传统光固化低，差异有统计学意义（P〈0．05）。结论弱光启动固化模式能有效降低后牙树脂的聚合收缩．但树脂的表面硬度有所下降．三种树脂中P60的表面硬度最高。     

Mode of action based risk assessment of the botanical food-borne alkenylbenzene apiol from parsley using physiologically based kinetic (PBK) modelling and read-across from safrole

The present study developed physiologically-based kinetic (PBK) models for the alkenylbenzene apiol in order to facilitate risk assessment based on read-across from the related alkenylbenzene safrole. Model predictions indicate that in rat liver the formation of the 1′-sulfoxy metabolite is about 3 times lower for apiol than for safrole. These data support that the lower confidence limit of the benchmark dose resulting in a 10% extra cancer incidence (BMDL₁₀) that would be obtained in a rodent carcinogenicity study with apiol may be 3-fold higher for apiol than for safrole. These results enable a preliminary risk assessment for apiol, for which tumor data are not available, using a BMDL₁₀ value of 3 times the BMDL₁₀ for safrole. Based on an estimated BMDL₁₀ for apiol of 5.7–15.3 mg/kg body wt per day and an estimated daily intake of 4 × 10⁻⁵ mg/kg body wt per day, the margin of exposure (MOE) would amount to 140,000–385,000. This indicates a low priority for risk management. The present study shows how PBK modelling can contribute to the development of alternatives for animal testing, facilitating read-across from compounds for which in vivo toxicity studies on tumor formation are available to compounds for which these data are unavailable.