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Frontiers in Surgery 2022Skin-reducing mastectomy has been applied to several surgical techniques in which subcutaneous mastectomy is associated with various types of skin reduction, with...
Superomedial pedicle skin-reducing mastectomy in ptotic and large-sized breasts with two-stage reconstruction through transaxillary video-assisted technique: An effective surgical and anesthetic approach.
INTRODUCTION
Skin-reducing mastectomy has been applied to several surgical techniques in which subcutaneous mastectomy is associated with various types of skin reduction, with preservation of a lower dermal flap to reinforce the inferior lateral seat of an implant. The aim of the study is to present a case series of patients with pendulous/ptotic and/or large-sized breasts treated for breast cancer at the Breast Surgery Unit of Istituto Nazionale Tumori IRCCS Fondazione "G. Pascale", Naples, Italy, with the superomedial pedicle skin-reducing mastectomy technique, two-stage reconstruction, and transaxillary video-assisted technique, when a postoperative radiotherapy was indicated. We verified its effectiveness by discussing its results, especially in patients who are candidates for postmastectomy radiotherapy.
MATERIALS AND METHODS
A single-center retrospective study was performed between January 2020 and March 2021 on a prospectively filled database of conservative mastectomies. Of the 64 patients who underwent nipple/skin-sparing mastectomies in the mentioned period, 17 (mean age 46 years, range 30-62 years) were treated with superomedial pedicle skin-reducing mastectomy, with two-stage breast reconstruction through transaxillary video-assisted replacement expander with definitive prosthesis and contralateral symmetrization, selected for postmastectomy radiotherapy.
RESULTS
We had only three minor complications. No flap necrosis, no infections, no breast seromas, and no reconstructive failures were observed. During follow-up of the patients treated with video-assisted reconstruction, there were no cases of infection, hematoma, implant rupture, or suture dehiscence in the reconstructed breast.
DISCUSSION
Skin-reducing mastectomy with superomedial pedicle is a safe and reliable procedure to treat breast cancer in selected patients, i.e., those with pendulous/ptotic and or large-sized breasts. Particularly, in patients who undergo postmastectomy radiotherapy, the two-stage reconstruction with video-assisted transaxillary endoscopic approach can find its main indication, using incisions positioned far from the mammary region, offering numerous advantages.
PubMed: 36684343
DOI: 10.3389/fsurg.2022.1040602 -
PloS One 2018Zuojiangia jingxiensis, both a new genus and species, is described from the Pearl River in China. It is distinguished from all other genera and species of Labeonini by...
Zuojiangia jingxiensis, both a new genus and species, is described from the Pearl River in China. It is distinguished from all other genera and species of Labeonini by the unique combination of modified oromandibular structures and head skeleton: a well-developed, pendulous, and conspicuously arched rostral fold, with an entirely crenulated margin; prominent papillae densely covering the margin of the rostral fold and anterior part of the lower lip; long postlabial grooves, partitioning the lower lip into three parts; transverse branch of dentary longer than half the length of the longitudinal branch; stubby lateral process present at the anterolateral margin of the longitudinal branch of the dentary, close to the corner; in the upper jaw, the premaxilla bears a triangular ascending process tapering to a point; maxilla exhibits a pair of articular heads at the anterodorsal margin, and a distinct fingerlike descending process posterior to the medial articular head embracing the ascending process of the premaxilla.
Topics: Animal Distribution; Animals; China; Cyprinidae; Ecosystem; Pigmentation; Rivers
PubMed: 29979725
DOI: 10.1371/journal.pone.0199973 -
Sensors (Basel, Switzerland) Feb 2023Nonlinear error has become the most critical factor restricting the measurement accuracy of pendulous integrating gyroscopic accelerometers (PIGA) during their...
Nonlinear error has become the most critical factor restricting the measurement accuracy of pendulous integrating gyroscopic accelerometers (PIGA) during their improvement. The key to nonlinear error suppression for PIGA is the precise measurement and compensation of the micro product of inertia (MPOI) of the float assembly. However, the existing equipment and procedure for product of inertia (POI) measurement and compensation do not meet the accuracy requirements for MPOI. To solve this problem, novel equipment and procedures are proposed for the measurement and compensation of MPOI. The principle of the proposed measurement method is to simulate the error produced by MPOI in PIGA by using a single-axis turntable to rotate the float assembly along the eccentric axis to generate a centrifugal moment due to MPOI. The principle of the proposed compensation method is to remove the asymmetric mass to reduce the MPOI to zero. Through experimental validation, it is concluded that: (1) the measurement and compensation accuracy of the proposed method are better than 1 × 10 kg·m and 3 × 10 kg·m, respectively; (2) the proposed method is validated as the MPOI is reduced from 7.3 × 10 kg·m to 3 × 10 kg·m for a real float assembly in PIGA, and the quadratic error of PIGA is reduced from 10/g to 3 × 10/g.
PubMed: 36772606
DOI: 10.3390/s23031564 -
PloS One 2019Heat stress-induced sperm DNA damage has recently been demonstrated in boars during tropical summer; which could negatively impact early embryo survival and litter size...
Heat stress-induced sperm DNA damage has recently been demonstrated in boars during tropical summer; which could negatively impact early embryo survival and litter size in sows. Given the boar's inefficient capacity to sweat, non-pendulous scrotum and low antioxidant activity in seminal plasma, elevated endogenous levels of antioxidants are needed to combat reactive oxygen species induced during periods of heat stress. This should prevent the build-up of pathological levels of DNA damage in boar spermatozoa. Our aim was to investigate whether a combined antioxidant supplement could mitigate sperm DNA damage in boars exposed to tropical summer conditions. Terminal deoxynucleotidyl transferase dUTP nick end labelling and flow cytometry of 20,000 spermatozoa/boar/treatment revealed that boar diets supplemented with 100 g/day custom-mixed antioxidant during peak wet summer effectively reduced sperm DNA damage by as much as 55% after 42 and 84 days treatment respectively (16.1 ± 4.9 peak wet control vs. 9.9 ± 4.5 42 day vs. 7.2 ± 1.6% 84 day treatments; P ≤ 0.05). Supplementation did not improve sperm concentration beyond control levels for either season (P > 0.05); nor alter total motility, progressive motility or several other motion parameters measured by computer assisted sperm analysis of 20 x 106 sperm/mL at 38°C (P > 0.05). Antioxidant supplementation during tropical summer appears to mitigate the negative impact of heat stress on DNA integrity but not concentration nor motility of boar spermatozoa; which may provide one solution to the problem of summer infertility in the pig.
Topics: Animals; Antioxidants; DNA Damage; Dietary Supplements; Humidity; Male; Queensland; Seasons; Sperm Motility; Spermatozoa; Sus scrofa; Temperature; Tropical Climate
PubMed: 31039205
DOI: 10.1371/journal.pone.0216143 -
PhytoKeys 2019, which was previously not validly published, is here validated. The species is described along with illustration and photos. Morphologically, the long and pendulous...
, which was previously not validly published, is here validated. The species is described along with illustration and photos. Morphologically, the long and pendulous stem and distichous leaves of this new species indicate that it belongs to the sect. Microphyllae. It is unique in having thick fleshy leaves and margin significantly serrate, small flowers, reniform epichile and margin with dentations, thickened cushion on the central epichile and subconic hypochile. Meanwhile, a preliminary conservation status assessment according to IUCN Red List categories and criteria is given to the new species.
PubMed: 31534404
DOI: 10.3897/phytokeys.130.34555 -
Practical Radiation Oncology 2021This pilot study (ClinicalTrials.gov NCT04543851) investigates a novel breast positioning device using a low density, high tensile carbon-fiber cradle to support the...
PURPOSE
This pilot study (ClinicalTrials.gov NCT04543851) investigates a novel breast positioning device using a low density, high tensile carbon-fiber cradle to support the breast, remove the inframammary fold, and reduce dose to organs at risk for whole breast radiation therapy in the supine position.
METHODS AND MATERIALS
Thirty patients with inframammary folds ≥1 cm or lateral ptosis in supine treatment position were planned with standard positioning and with a carbon-fiber Adjustable Reusable Accessory (CARA) breast support. Twenty patients received whole breast with or without regional nodal irradiation with 42.5 Gy in 16 fractions or 50 Gy in 25 fractions using CARA. Median body mass index was 32 in this study.
RESULTS
CARA removed all inframammary folds and reduced V20Gy V105%, and V50% , without compromising target coverage. Median (range) V20Gy for whole breast radiation therapy was 12.3% (1.4%-28.7%) with standard of care versus 10.9% (1.2%-17.3%) with CARA (Wilcoxon P = .005). Median V105% was 8.0% (0.0%-29%) with standard of care versus 4.0% (0.0%-23%) with CARA (P = .006) and median V50% was 3056 mL (1476-5285 mL) versus 2780 mL (1415-5123 mL) with CARA (P = .001). CARA was compatible with deep inspiration breath hold and achieved median V25Gy = 0.1% (range 0%-1.9%) for all patients with left breast cancer. Skin reactions with CARA were consistent with historical data and daily variation in treatment setup was consistent with standard supine positioning.
CONCLUSIONS
CARA can reduce V105%, lung and normal tissue dose, and remove the inframammary fold for breast patients with large or pendulous breasts and high body mass index treated in the supine position, without compromising target coverage. CARA will undergo further study in a randomized controlled trial.
Topics: Breast Neoplasms; Carbon Fiber; Female; Heart; Humans; Organs at Risk; Pilot Projects; Radiotherapy Dosage; Radiotherapy Planning, Computer-Assisted
PubMed: 34303034
DOI: 10.1016/j.prro.2021.06.012 -
Asian Pacific Journal of Cancer... 2015To investigate the impact of the breast size, shape, maximum heart depth (MDH), and chest wall hypotenuse (the distance connecting middle point of the sternum and the...
BACKGROUND
To investigate the impact of the breast size, shape, maximum heart depth (MDH), and chest wall hypotenuse (the distance connecting middle point of the sternum and the length of lung draw on the selected transverse CT slice) on the volumetric dose to heart with whole breast irradiation (WBI) of left-sided breast cancer patients.
MATERIALS AND METHODS
Fifty-three patients with left-sided breast cancer undergoing adjuvant intensity-modulated radiotherapy (IMRT) were enrolled in the study. The primary breast size and shape, MHD and DCWH (chest wall hypotenuse) were contoured on radiotherapy (RT) planning CT slices. The dose data of hearts were obtained from the dose-volume histograms (DVHs). Data were analyzed by one-way analysis of variance (ANOVA), Student's t-test and linear regression analysis.
RESULTS
Breast size was independent of heart dose, whereas breast shape, MHD and DCWH were correlated with heart dose. The shapes of breasts were divided into four types, as the flap type, hemisphere type, cone type and pendulous type with heart mean dose being 491.8±234.6 cGy, 752.7±219.0 cGy, 620.2±275.7 cGy, and 666.1±238.0 cGy, respectively. The flap type of breasts shows a strong statistically reduction in heart dose, compared to others (p=0.008 for V30 of heart). DCWH and MHD were found to be the most important parameters correlating with heart dose in WBI.
CONCLUSIONS
More attention should be paid to the heart dose of non-flap type patients. The MHD was found to be the most important parameter to correlate with heart dose in tangential WBI, closely followed by the DCWH, which could help radiation oncologists and physicsts evaluate heart dose and design RT plan in advance.
Topics: Adult; Aged; Breast; Female; Heart; Humans; Middle Aged; Radiation; Radiotherapy Dosage; Radiotherapy, Intensity-Modulated; Thorax; Unilateral Breast Neoplasms
PubMed: 25854378
DOI: 10.7314/apjcp.2015.16.7.2889 -
American Journal of Men's Health Sep 2018Penoscrotal transposition and pendulous-prostatic anastomotic urethroplasty for the treatment of long-segment bulbar and membranous urethral stenosis is rarely reported....
Penoscrotal transposition and pendulous-prostatic anastomotic urethroplasty for the treatment of long-segment bulbar and membranous urethral stenosis is rarely reported. This study reports the case of a 43-year-old man with dysuria resulting from pelvic fracture. The patient had a long-term history of multiple urethral reconstructions and presented a long-segment bulbar and membranous urethral stenosis at imaging. Penoscrotal transposition and pendulous-prostatic anastomotic urethroplasty was performed and completed in 170 min (blood loss: 400 ml). Postoperative treatment was uneventful with favorable short-term outcomes and high patient satisfaction without recurrence at 12-month follow-up. This surgical technique should be attempted in carefully selected patients with long-segment bulbar and membranous urethral stenosis and performed by an experienced urethral reconstruction specialist.
Topics: Abnormalities, Multiple; Adult; Cystography; Dysuria; Follow-Up Studies; Fractures, Bone; Humans; Male; Pelvic Bones; Penis; Postoperative Care; Recovery of Function; Scrotum; Treatment Outcome; Urethral Diseases; Urethral Stricture; Urination; Urography
PubMed: 29737937
DOI: 10.1177/1557988318774230 -
Journal of Clinical Medicine May 2021Presence of severe tricuspid regurgitation (TR) has a significant impact on assessment of right ventricular function (RVF) in transthoracic echocardiography (TTE). High...
BACKGROUND
Presence of severe tricuspid regurgitation (TR) has a significant impact on assessment of right ventricular function (RVF) in transthoracic echocardiography (TTE). High trans-valvular pendulous volume leads to backward-unloading of the right ventricle. Consequently, established cut-offs for normal systolic performance may overestimate true systolic RVF.
METHODS
A retrospective analysis was performed entailing all patients who underwent TTE at our institution between 1 January 2013 and 31 December 2016. Only patients with normal left ventricular systolic function and with no other valvular lesion were included. All recorded loops were re-read by one experienced examiner. Patients without severe TR (defined as vena contracta width ≥7 mm) were excluded. All-cause 2-year mortality was chosen as the end-point. The prognostic value of several RVF parameters was tested.
RESULTS
The final cohort consisted of 220 patients, 88/220 (40%) were male. Median age was 69 years (IQR 52-79), all-cause two-year mortality was 29%, median TAPSE was 19 mm (15-22) and median FAC was 42% (30-52). In multivariate analysis, TAPSE with the cutoff 17 mm and FAC with the cutoff 35% revealed non-significant hazard ratios (HR) of 0.75 (95%CI 0.396-1.421, = 0.38) and 0.845 (95%CI 0.383-1.867, = 0.68), respectively. TAPSE with the cutoff 19 mm and visual eyeballing significantly predicted survival with HRs of 0.512 (95%CI 0.296-0.886, = 0.017) and 1.631 (95%CI 1.101-2.416, = 0.015), respectively.
CONCLUSIONS
This large-scale all-comer study confirms that RVF is one of the main drivers of mortality in patients with severe isolated TR. However, the current cut-offs for established echocardiographic parameters did not predict survival. Further studies should investigate the prognostic value of higher thresholds for RVF parameters in these patients.
PubMed: 34073744
DOI: 10.3390/jcm10112266 -
Advanced Biomedical Research 2023The surgery for a breast imaging-reporting and data system (BIRADS) IV lesions needs imaging or pathology supporting data. The roll of breast scintigraphy for this...
BACKGROUND
The surgery for a breast imaging-reporting and data system (BIRADS) IV lesions needs imaging or pathology supporting data. The roll of breast scintigraphy for this purpose is unclear.
MATERIALS AND METHODS
In a prospective design, 16 patients with 25 BIRADS IV lesions who were scheduled for surgery were included. Before the surgery, breast scintigraphy was done using a nondedicated dual head gamma camera in the prone position employing a shaped foam pad providing imaging at breast pendulous position. Twenty mCi Tc methoxy-isobutyl-isonitrile was injected and two 15 and 60-min delayed imaging were done (anterior, bilateral, and single photon emission computed tomography [SPECT] projections). Pathology reports were collected and tumor to nontumor uptake ratio (T/NT) was analyzed, accordingly.
RESULTS
Out of all lesions, 12 were malignant (invasive ductal and lobular carcinoma ductal carcinoma ). At 15 min, T/NT was insignificantly higher in the malignant compared to benign lesions (22.8 ± 23.9 vs. 10.1 ± 10.1; = 0.109). The optimal T/NT cutoff for discrimination of malignant and benign lesions was 20. Only 1 out of 13 benign lesions presented uptake >20 (7.7%; false-positive rate; = 0.047). The diagnostic accuracy, sensitivity, and specificity for T/NT calculated at 0.68, 0.42, and 0.92, respectively. The T/NT at 60 min remained unchanged for either benign or malignant lesions (22.3 ± 30.2 vs. 11.7 ± 17.1; = 0.296).
CONCLUSIONS
Breast scintigraphy with general purpose gamma camera employing SPECT imaging may assist the selection of BIRADS IV lesions in need for surgery. All uptake positive cases should undergo surgery and decision for uptake negative cases should be made based on other data.
PubMed: 37288015
DOI: 10.4103/abr.abr_347_21