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Frontiers in Endocrinology 2022Studies have shown that carbon dioxide (CO2) insufflation during endoscopic thyroidectomy is associated with many risks. Recently, we have designed a simple lifting tool... (Randomized Controlled Trial)
Randomized Controlled Trial
OBJECTIVE
Studies have shown that carbon dioxide (CO2) insufflation during endoscopic thyroidectomy is associated with many risks. Recently, we have designed a simple lifting tool using Kirschner wire. We aimed to use this tool for flap-lifting in modified areola approach endoscopic thyroidectomy and compare it with conventional CO2 insufflation.
METHODS
In a prospective study, patients who underwent endoscopic thyroidectomy modified areola approach were randomly assigned into gasless (n = 20) or CO2 groups (n = 22). Pre-operative variables included age, gender, tumor diameter, and clinical diagnosis. Intra-operative hemodynamic monitoring included mean arterial pressure, heart rate, pulse oximetry, end-tidal carbon dioxide (ET-CO2) and arterial pH. Other intra-operative details included total operative time, operative blood loss, conversion from endoscopic surgery to open surgery, intra-operative events, and endoscope video score. Postoperatively, the hospital stay, drainage volume, and complications were recoded.
RESULTS
Patient characteristics were not different between the two groups. During the operation, ET-CO2 levels were significantly higher in the CO2 group ( < 0.05), whereas arterial pH levels were significantly lower ( < 0.05). The CO2 group had longer operation time and higher endoscope clarity VAS score than gasless group. Hospital stay, drainage volume, and postoperative complications did not differ significantly between the two groups ( > 0.05).
CONCLUSIONS
The gasless endoscopic thyroidectomy we performed our Kirschner wire hook was safe, feasible, and yielded good results.
Topics: Humans; Carbon Dioxide; Nipples; Prospective Studies; Thyroidectomy
PubMed: 36619584
DOI: 10.3389/fendo.2022.1028805 -
Surgery Today Jun 2021Advances in multi-modality treatments incorporating systemic chemotherapy, endocrine therapy, and radiotherapy for the management of breast cancer have resulted in a... (Comparative Study)
Comparative Study Review
Advances in multi-modality treatments incorporating systemic chemotherapy, endocrine therapy, and radiotherapy for the management of breast cancer have resulted in a surgical-management paradigm change toward less-aggressive surgery that combines the use of breast-conserving or -reconstruction therapy as a new standard of care with a higher emphasis on cosmesis. The implementation of skin-sparing and nipple-sparing mastectomies (SSM, NSM) has been shown to be oncologically safe, and breast reconstructive surgery is being performed increasingly for patients with breast cancer. NSM and breast reconstruction can also be performed as prophylactic or risk-reduction surgery for women with BRCA gene mutations. Compared with conventional breast construction followed by total mastectomy (TM), NSM preserving the nipple-areolar complex (NAC) with breast reconstruction provides psychosocial and aesthetic benefits, thereby improving patients' cosmetic appearance and body image. Implant-based breast reconstruction (IBBR) has been used worldwide following mastectomy as a safe and cost-effective method of breast reconstruction. We review the clinical evidence about immediate (one-stage) and delayed (two-stage) IBBR after NSM. Our results suggest that the postoperative complication rate may be higher after NSM followed by IBBR than after TM or SSM followed by IBBR.
Topics: Adult; Aged; Breast Implantation; Breast Implants; Breast Neoplasms; Combined Modality Therapy; Cost-Benefit Analysis; Female; Humans; Mammaplasty; Mastectomy, Segmental; Middle Aged; Mutation; Nipples; Organ Sparing Treatments; Prophylactic Mastectomy; Safety; Treatment Outcome; Ubiquitin-Protein Ligases
PubMed: 33185799
DOI: 10.1007/s00595-020-02175-4 -
Canadian Journal of Surgery. Journal... 2023Documenting negative margins at the nipple-areolar complex (NAC) during nipple-sparing mastectomy (NSM) remains the standard, but how to achieve this and how to manage a...
BACKGROUND
Documenting negative margins at the nipple-areolar complex (NAC) during nipple-sparing mastectomy (NSM) remains the standard, but how to achieve this and how to manage a positive margin is debated. We sought to review nipple margin assessments at our institution and to analyze the risk factors of a positive margin and rate of local recurrence.
METHODS
Patients who underwent NSM between 2012 and 2018 were reviewed and divided into 3 groups based on indication - cancer, contralateral prophylactic mastectomy (CPM) and bilateral prophylactic mastectomy (BPM).
RESULTS
Nipple-sparing mastectomies were performed on 337 patients; 72% for cancer, 20% for CPMs and 8% for BPMs. Nipple margin assessments were performed in 87.8% of patients; 10 patients (3.4%) had a positive margin, 7 of whom underwent NAC excision and 3 were managed with observation.
CONCLUSION
As indications for NSM increase, assessment of nipple margin provides valuable information to manage the NAC in patients with cancer. The routine use of nipple margin biopsies in patients undergoing CPM and BPM may no longer be required, as rates of occult malignant disease are low with no positive biopsies. Further studies with larger sample sizes are needed.
Topics: Humans; Female; Mastectomy; Breast Neoplasms; Nipples; Biopsy; Risk Factors
PubMed: 37225245
DOI: 10.1503/cjs.001922 -
Actas Dermo-sifiliograficas 2023
Topics: Humans; Female; Nipples; Breast Neoplasms; Mammaplasty
PubMed: 37302476
DOI: 10.1016/j.ad.2023.06.006 -
Actas Dermo-sifiliograficas 2023
Topics: Humans; Female; Nipples; Breast Neoplasms; Mammaplasty
PubMed: 36435480
DOI: 10.1016/j.ad.2022.01.053 -
Revista Da Escola de Enfermagem Da U S P Oct 2018To analyze the association between the surgical characteristics of breast implants, time elapsed since surgery, access route, implant placement and implanted volume and...
OBJECTIVE
To analyze the association between the surgical characteristics of breast implants, time elapsed since surgery, access route, implant placement and implanted volume and variables related to breastfeeding, type, first 'milk let-down', breast engorgement, pain, lesion, milk production and use of galactagogues.
METHOD
A prospective cohort carried out during the hospital stay (12 to 72 hours after delivery), home care (5thto 7thday after delivery) and telephone contact (between the 30thand 32ndday postpartum) of 115 postpartum women with breast implants between 2015 and 2017.
RESULTS
The first evaluation identified more frequent use of oral galactagogues (p=0.029) by puerperal women with prepectoral implants, and of oxytocin spray by those with implants up to 270 ml (p=0.040). The second evaluation showed a higher pain score among those with prepectoral implants (p=0.046). Around the 30thday postpartum, the presence of nipple lesion (p=0.021), pain (p=0.025) and a higher pain score (p=0.039) was more frequent among those with mammoplasty performed less than 10 years ago.
CONCLUSION
The presence of pain and a higher pain score, the occurrence of lesion and the use of oral and nasal galactagogues were associated with implant placement, implant size and time elapsed since surgery.
Topics: Adult; Breast Feeding; Breast Implantation; Breast Implants; Cohort Studies; Female; Galactogogues; Humans; Nipples; Pain; Pain Measurement; Postpartum Period; Prospective Studies; Time Factors
PubMed: 30328982
DOI: 10.1590/S1980-220X2017037803363 -
The British Journal of Radiology Apr 2021Pathologic nipple discharge (PND) is typically unilateral, spontaneous, involves a single duct, and is serous or bloody in appearance. In patients with PND, breast MRI... (Review)
Review
Pathologic nipple discharge (PND) is typically unilateral, spontaneous, involves a single duct, and is serous or bloody in appearance. In patients with PND, breast MRI can be helpful as an additional diagnostic tool when conventional imaging with mammogram and ultrasound are negative. MRI is able to detect the etiology of nipple discharge in 56-61% of cases when initial imaging with mammogram and ultrasound are negative. Advantages to using MRI in evaluation of PND include good visualization of the retroareolar breast and better evaluation of posterior lesions which may not be well evaluated on mammograms and galactograms. It is also less invasive compared to central duct excision. Papillomas and nipple adenomas are benign breast masses that can cause PND and are well visualized on MRI. Ductal ectasia, and infectious etiologies such as mastitis, abscess, and fistulas are additional benign causes of PND that are well evaluated with MRI. MRI is also excellent for evaluation of malignant causes of PND including Paget's disease, ductal carcinoma and invasive carcinoma. MRI's high negative predictive value of 87-98.2% is helpful in excluding malignant etiologies of PND.
Topics: Breast Diseases; Female; Humans; Magnetic Resonance Imaging; Nipple Discharge; Nipples
PubMed: 33544650
DOI: 10.1259/bjr.20201013 -
Genes Feb 2021Growing numbers of asymptomatic women who become aware of carrying a breast cancer gene mutation (BRCA) mutation are choosing to undergo risk-reducing bilateral... (Review)
Review
Growing numbers of asymptomatic women who become aware of carrying a breast cancer gene mutation (BRCA) mutation are choosing to undergo risk-reducing bilateral mastectomies with immediate breast reconstruction. We reviewed the literature with the aim of assessing the oncological safety of nipple-sparing mastectomy (NSM) as a risk-reduction procedure in BRCA-mutated patients. Nine studies reporting on the incidence of primary breast cancer post NSM in asymptomatic BRCA mutated patients undergoing risk-reducing bilateral procedures met the inclusion criteria. NSM appears to be a safe option for BRCA mutation carriers from an oncological point of view, with low reported rates of new breast cancers, low rates of postoperative complications, and high levels of satisfaction and postoperative quality of life. However, larger multi-institutional studies with longer follow-up are needed to establish this procedure as the best surgical option in this setting.
Topics: Adult; Asymptomatic Diseases; BRCA1 Protein; BRCA2 Protein; Breast Neoplasms; Clinical Decision-Making; Female; Follow-Up Studies; Gene Expression; Humans; Mammaplasty; Mastectomy; Middle Aged; Mutation; Nipples; Quality of Life; Risk Assessment
PubMed: 33578759
DOI: 10.3390/genes12020253 -
Hong Kong Medical Journal = Xianggang... Aug 2016The number of new mothers who breastfeed has increased dramatically over the last three decades. There is a concern that the present related medical service may be...
INTRODUCTION
The number of new mothers who breastfeed has increased dramatically over the last three decades. There is a concern that the present related medical service may be inadequate. Breast pain is the most common complaint among lactating mothers who seek medical help. This study aimed to investigate this problem.
METHODS
Medical records of women who presented with breast pain to a private clinic run by a doctor who was trained as an International Lactation Consultant were reviewed over a period of 6 months in 2015. Most patients were self-referred after chatting online. Assessment included characteristics and duration of pain, treatment prior to consultation, feeding practices, mother's diet, and breast examination. Any site of blockage was identified and relieved. Those with persistent pain were given antibiotics. When there were signs of abscess or abscess that could not be drained, they were referred to a breast surgeon.
RESULTS
A total of 69 patients were seen of whom 45 had been breastfeeding for more than 1 month. Pain was experienced for longer than 7 days in 22 women. Antifungal or antibacterial treatment had been unsuccessful in 31 women prior to consultation. The diagnoses were engorgement in five women, blocked duct in 35, mastitis in 13, breast abscess in six, poor positioning and latch in seven, nipple cracks in two, and skin infection in one. Oral antibiotics were prescribed to 21 patients and local antifungal treatment was given to one patient only.
CONCLUSION
Blocked duct was the most common cause of breast pain in lactating mothers. Without prompt relief it is possible that it will progress to mastitis/breast abscess or the mother may discontinue breastfeeding. This may be a suitable time for Hong Kong to set up one or more public full-time breastfeeding clinics to provide a better service to lactating mothers and to facilitate professional training and research.
Topics: Breast Diseases; Breast Feeding; Female; Humans; Infant; Infant, Newborn; Lactation; Mastitis; Maternal Nutritional Physiological Phenomena; Nipples; Pain; Referral and Consultation
PubMed: 27313273
DOI: 10.12809/hkmj154762 -
Actas Dermo-sifiliograficas Nov 2016
Review
Topics: Acanthoma; Aged; Betamethasone; Breast Neoplasms; Female; Gentamicins; Humans; Nipples; Skin Neoplasms
PubMed: 27206609
DOI: 10.1016/j.ad.2016.04.008