Flank hernia secondary to phenol nerve block

Background  

The management of patients with chronic pain is challenging. The aim of treatment is alleviation of symptoms in an attempt to increase functional capacity. Interventional procedures, such as chemical neurolysis are adopted when other techniques fail to provide adequate pain control.     

The pathological expressions of Brunners gland hyperplasia into adenoma and hamartoma

The terms Brunners gland adenoma and hamartoma are 2 pathological expressions of hyperplasia of these glands. We report 3 patients and review the recent literature to support our hypothesis of common pathology. Awareness of the existence and character of Brunners gland lesions will increase the possibility of their accurate diagnosis.     

The effects of changes in the environmental temperature on the growth of bone in the mouse. Radiological and morphological study.

Groups of 25-day-old mice were kept at 33 degrees, 21 degrees and 8 degrees for up to 195 days. Measurements and observations on length, width, gross and microscopic structure using radiological and histological techniques were made on central and peripheral bones. Tail bones of animals kept at 33 degrees grew longer and faster than those in the cold but also closed their epiphyses earlier. The diaphyses of "hot" vertebrae were cylindrical but "cold" and "control" vertebrae were of narrower diameter in their mid-diaphyses compared to their distal ends producing a "waisted" appearance. The "cold" vertebrae in addition showed thickened cortical bone and more woven bone in the marrow cavity. These changes were interpreted as indicating a disproportionate sensitivity of external apposition of cortical bone to cold. The internal remodelling of bone as the vertebrae grew was only affected by the coldest conditions and accounted for the thickened cortex and denser woven bone in the marrow cavity.     

Management Strategies for Locally Recurrent Breast Cancer: Redo-Lumpectomy,Redo-Sentinel Node Biopsy,Redo-Radiation

Annals of Surgical Oncology - A multidisciplinary approach to the management of locally recurrent breast cancer is essential. The complexities of the management of patients in this setting include...     

Breast cancer—The catalyst of contemporary trials design

Surgical trials in breast cancer have catalyzed contemporary trial design for solid organ cancers and are a prime example of surgeons taking the lead in clinical trial design. Surgeons have lead trials that have improved patient outcomes and quality of life without sacrificing oncologic safety. We have evolved from radical mastectomy to breast conservation and sentinel node biopsy. Contemporary trial design in breast cancer now focus on personalizing care based on tumor genomics     

Extrapolation of ACOSOG Z0011 trial results—A survey of breast cancer providers

We surveyed breast providers from a national oncology cooperative group to evaluate axillary management recommendations for patients with 1–2 positive sentinel lymph nodes (+SLNs) with scenarios not explicitly included in the Z0011 trial. These scenarios included patients underrepresented (premenopausal, HER2+/triple-negative tumors, and invasive lobular carcinoma) or excluded (treated with mastectomy or neo-adjuvant chemotherapy [NAC]) from the ACOSOG Z0011 trial. Survey response rate was 94/149 (64%). For patients in underrepresented groups, 45–63% of providers recommended no further axillary treatment. For mastectomy patients, 45–55% recommended multi-disciplinary discussion. 83% felt more data are needed to change practice, but 41% believed there would be significant accrual challenges to a clinical trial. For patients treated with NAC, recommendations varied widely. 85% felt more data are needed to change practice, but 26% felt there would be significant accrual challenges. For all scenarios, 86–100% of radiation oncologists recommended axillary radiation, while surgeons more often recommended no further axillary treatment. Traditional randomized trials are likely not feasible to provide answers to these critical management questions, so more pragmatic or big data studies may be needed.