-
International Journal of Women's... Oct 2024Hidradenitis suppurativa (HS) is a chronic skin disease characterized by recurrent nodules that affect areas with a high density of apocrine sweat glands, such as the...
BACKGROUND
Hidradenitis suppurativa (HS) is a chronic skin disease characterized by recurrent nodules that affect areas with a high density of apocrine sweat glands, such as the axillae and groin. Androgens are implicated in the pathophysiology of HS. Therefore, spironolactone, an antiandrogen therapy, is recommended. However, data on its use in women of childbearing age are limited, especially since its antiandrogenic effects may affect menstruation, fertility, and pubertal development.
OBJECTIVE
To evaluate the efficacy and safety of spironolactone in the treatment of hidradenitis suppurativa in women of childbearing age and to identify factors associated with treatment response.
METHODS
A retrospective analysis was conducted on female patients aged 12 to 50 with HS treated with spironolactone at Michigan Medicine dermatology clinics from 2000 to 2021. The patients' demographic data, HS characteristics, and spironolactone responses were examined. Statistical assessments were performed to determine the efficacy indicators.
RESULTS
Of the 157 patients reviewed, 31 showed an improvement in treatment. Variables such as axillary involvement, previous treatment failures, and use of intralesional steroids were linked to a lack of improvement in spironolactone. Through adjusted multiple logistic regression analysis, a significant association was observed between improvement status and Hurley stage 3 (odds ratio = 0.15 [95% CI: 0.02-0.79], = .036), suggesting that patients with Hurley stage 3 were 85% less likely to exhibit improvement in spironolactone therapy.
LIMITATIONS
The study's retrospective nature and reliance on single-center data can limit generalizability. The sample size is limited and therefore affects the study's statistical power.
CONCLUSION
Thus, spironolactone may offer therapeutic benefits for HS in women of childbearing age. However, patients with severe disease (Hurley stage 3) had reduced response rates. Further prospective studies are recommended to validate these findings and determine the most suitable patient profile for spironolactone therapy for HS.
PubMed: 38957411
DOI: 10.1097/JW9.0000000000000159 -
Plastic and Reconstructive Surgery Feb 2024Breast cancer-related lymphedema (BCRL) is a debilitating sequela affecting up to one in three breast cancer survivors. Current treatments are palliative and does not...
BACKGROUND
Breast cancer-related lymphedema (BCRL) is a debilitating sequela affecting up to one in three breast cancer survivors. Current treatments are palliative and does not address the underlying lymphatic injury. Recently, preclinical and non-randomized studies have shown promising results using Adipose-Derived Regenerative Cells (ADRCs) and lipotransfer in alleviating BCRL through regeneration of lymphatic tissue. However no randomized controlled trial has been performed in an attempt to eliminate a placebo effect.
METHODS
This randomized, double-blinded, placebo-controlled trial included patients with no-option, persistent disabling unilateral BCRL. Patients were randomly assigned in a 1:1 ratio to receive either autologous ADRCs (4.20x10 7±1.75x10 7 cells) and 30cc lipotransfer or placebo (saline) to the axilla. The primary outcome was a change in BCRL volume one year after treatment. Secondary outcomes included changes in the quality of life, indocyanine green lymphangiography stage, bioimpedance, and safety.
RESULTS
Eighty patients were included, of which 39 were allocated to ADRCs and lipotransfer treatment and 41 to placebo treatment. Baseline characteristics were similar in both groups. One year after treatment, no objective improvements were observed in the treatment or placebo groups. In contrast, significant subjective improvements were noted for both the treatment and placebo groups.
CONCLUSION
This trial failed to confirm a benefit of ADRCs and lipotransfer in the treatment of BCRL. These non-confirmatory results suggest that ADRC and lipotransfer should not be recommended for alleviating BCRL at this time. However, we cannot exclude that repeated treatments or higher doses of ADRCs or lipotransfer could yield a clinical effect.
PubMed: 38954656
DOI: 10.1097/PRS.0000000000011343 -
The British Journal of Surgery Jul 2024
Topics: Humans; Breast Neoplasms; Female; Axilla; Lymph Node Excision; Lymphatic Metastasis; Lymph Nodes
PubMed: 38953507
DOI: 10.1093/bjs/znae141 -
The British Journal of Surgery Jul 2024
Topics: Humans; Breast Neoplasms; Axilla; Female; Lymph Node Excision; Lymphatic Metastasis; Systematic Reviews as Topic
PubMed: 38953506
DOI: 10.1093/bjs/znae142 -
JAAD Case Reports Jul 2024
PubMed: 38952858
DOI: 10.1016/j.jdcr.2024.05.005 -
Cancer Innovation Aug 2024Clinical studies have shown that atherosclerotic cardiovascular disease and cancer often co-exist in the same individual. The present study aimed to investigate the role...
BACKGROUND
Clinical studies have shown that atherosclerotic cardiovascular disease and cancer often co-exist in the same individual. The present study aimed to investigate the role of high-fat-diet (HFD)-induced obesity in the coexistence of the two diseases and the underlying mechanism in apolipoprotein E-knockout (ApoE) mice.
METHODS
Male ApoE mice were fed with a HFD or a normal diet (ND) for 15 weeks. On the first day of Week 13, the mice were inoculated subcutaneously in the right axilla with Lewis lung cancer cells. At Weeks 12 and 15, serum lectin-like oxidized low-density lipoprotein receptor-1 (LOX-1) and vascular endothelial growth factor levels were measured by enzyme-linked immunosorbent assay, and blood monocytes and macrophages were measured by fluorescence-activated cell sorting. At Week 15, the volume and weight of the local subcutaneous lung cancer and metastatic lung cancer and the amount of aortic atherosclerosis were measured.
RESULTS
At Week 15, compared with mice in the ND group, those in the HFD group had a larger volume of local subcutaneous cancer ( = 0.0004), heavier tumors ( = 0.0235), more metastatic cancer in the lungs ( < 0.0001), a larger area of lung involved in metastatic cancer ( = 0.0031), and larger areas of atherosclerosis in the aorta ( < 0.0001). At Week 12, serum LOX-1, serum vascular endothelial growth factor, and proportions of blood monocytes and macrophages were significantly higher in the HFD group than those in the ND group ( = 0.0002, = 0.0029, = 0.0480, and = 0.0106, respectively); this trend persisted until Week 15 ( = 0.0014, = 0.0012, = 0.0001, and = 0.0204).
CONCLUSIONS
In this study, HFD-induced obesity could simultaneously promote progression of lung cancer and atherosclerosis in the same mouse. HFD-induced upregulation of LOX-1 may play an important role in the simultaneous progression of these two conditions via the inflammatory response and VEGF.
PubMed: 38948249
DOI: 10.1002/cai2.127 -
Academic Radiology Jun 2024RATIONALE AND OBJECTIVES: Detection of tumor marker location in the breast and axilla using a less commonly utilized color Doppler ultrasound (CDUS) artifact.
UNLABELLED
RATIONALE AND OBJECTIVES: Detection of tumor marker location in the breast and axilla using a less commonly utilized color Doppler ultrasound (CDUS) artifact.
MATERIALS AND METHODS
This prospective study was conducted between August and December 2023 and included consecutive patients with markers placed in the breast and axilla, both before and after neoadjuvant chemotherapy (NACT). Examinations were conducted using a 14 to 5 MHz linear array transducer with B-mode and Doppler capability. By reducing the velocity scale and increasing the color gain values, adjustments were made to create a bloom-like artifact. CDUS was performed with the ultrasound transmit frequency set between 14-5 MHz, color frequency between 6 and 7, color gain ranging from 58 to 80, and velocity scale within the range of 4.6-6.1 cm/s.
RESULTS
Twenty patients, with a mean age of 55.50 years ± 12.04 SD (range, 31-72), were included in the study. 14 (70%) were pre-NACT, and six (30%) were post-NACT patients. A total of 20 breast lesions and six axillary lymph nodes were marked. The breast lesions and axillary lymph nodes where the biopsy marker was placed (14 breast lesions and five axillary lymph nodes before NACT, six breast lesions and one axillary lymph node after NACT) were localized with blooming-like artifact. The average size of breast lesions was 20.95 mm ± 6.56 SD (range, 15-40). For axillary lymph nodes, the average size was 20.63 mm ± 5.01 SD (range: 31-14).
CONCLUSION
The blooming-like CDUS artifact is a novel and easily applicable method determining the location of metallic markers in the breast and axilla on diagnostic examinations.
PubMed: 38942644
DOI: 10.1016/j.acra.2024.05.036 -
Annals of Surgical Oncology Jun 2024Many patients who have undergone surgery experience persistent pain after breast cancer treatment (PPBCT). These symptoms often remain unnoticed by treating...
BACKGROUND
Many patients who have undergone surgery experience persistent pain after breast cancer treatment (PPBCT). These symptoms often remain unnoticed by treating physician(s), and the pathophysiology of PPBCT remains poorly understood. The purpose of this study was to determine prevalence of PPBCT and examine the association between PPBCT and various patient, tumor, and treatment characteristics.
PATIENTS AND METHODS
We conducted a questionnaire-based cross-sectional study enrolling patients with breast cancer treated at Máxima Medical Center between 2005 and 2016. PPBCT was defined as pain in the breast, anterior thorax, axilla, and/or medial upper arm that persists for at least 3 months after surgery. Tumor and treatment characteristics were derived from the Dutch Cancer Registry and electronic patient files.
RESULTS
Between February and March 2019, a questionnaire was sent to 2022 women, of whom 56.5% responded. Prevalence of PPBCT among the responders was 37.9%, with 50.8% reporting moderate to severe pain. Multivariable analyses showed that women with signs of anxiety, depression or a history of smoking had a higher risk of experiencing PPBCT. Women aged 70 years or older at diagnosis were significantly less likely to report PPBCT compared with younger women. No significant association was found between PPBCT and treatment characteristics, including type of axillary surgery and radiotherapy.
CONCLUSIONS
A considerable percentage of patients with breast cancer experience PPBCT. Women with signs of anxiety or depression and women with a history of smoking are more likely to report PPBCT. Further research is required to understand the underlying etiology and to improve prevention and treatment strategies for PPBCT.
PubMed: 38940899
DOI: 10.1245/s10434-024-15682-2 -
Cureus May 2024Ganglion cysts represent a small group of lesions that can arise from almost any joint in the body. Demonstrating a predilection for the joints in the hand and wrist,...
Ganglion cysts represent a small group of lesions that can arise from almost any joint in the body. Demonstrating a predilection for the joints in the hand and wrist, ganglion cysts in the glenohumeral joint are extremely rare. Due to the vivid array of masses that can be found in the axillary fossa, forming a free-from-error work-up to the correct diagnosis can be quite confounding. In this paper, we present a case of a paralabral cyst of the shoulder joint, located in the axilla. With there being only eight other such cases published in clinical literature, we believe this case report to be of unique importance in gaining further insight into the genesis and treatment of this pathology.
PubMed: 38939263
DOI: 10.7759/cureus.61200 -
World Journal of Surgical Oncology Jun 2024To evaluate sanitary techniques for radical thyroid cancer surgery via the transaxillary approach without inflation single-port endoscopic surgery (TAWISES) and the... (Comparative Study)
Comparative Study
A controlled study of the hygienic technical evaluation of the transaxillary approach for inflation-free single-port lumpectomy versus conventional transcervical anterior open surgery in radical thyroid cancer resection.
OBJECTIVE
To evaluate sanitary techniques for radical thyroid cancer surgery via the transaxillary approach without inflation single-port endoscopic surgery (TAWISES) and the conventional open anterior cervical approach (COACAS) in a controlled manner.
METHODS
This work was a retrospective analysis of the clinical data of 60 patients admitted to our hospital for unilateral radical thyroid cancer surgery between 01/2021 and 12/2022. The control group underwent COACAS (30 patients), and the experimental group underwent TAWISES (30 patients). The patients' operative time, intraoperative bleeding volume, 24-h postoperative pain index, drainage tube carrying time, hospitalization duration and complication rate were compared and analyzed. The patients were followed up for 3, 6 and 12 months postoperatively and evaluated based on numbness, muscular tightness, pain and other discomfort in the neck, as well as satisfaction with social adaptation and cosmetic incisions. The recurrence status was assessed for 1 year in both groups of patients. A questionnaire survey was conducted to assess patient acceptance of the two surgical approaches. The economic characteristics (cost-effectiveness and cost-utility) of the different approaches in our region were evaluated comprehensively.
RESULTS
The length of the incision, drainage tube carrying time and hospitalization duration were greater in the experimental group than in the control group (P < 0.05). The differences in complication rate, intraoperative bleeding volume, 24-h postoperative pain index and recurrence rate were not statistically significant between the two groups (P > 0.05). Neck discomfort was greater in the control group, and the difference was statistically significant at the 3-month postoperative follow-up (P < 0.05). The differences at the 6- and 12-month postoperative follow-ups were not statistically significant (P > 0.05). However, mild discomfort was significantly more common in the experimental group (63.33% > 36.67%, 80% > 53.33%, P < 0.05). The experimental group had better social adaptability, greater total medical costs, and better overall patient medical satisfaction than did the control group (P < 0.05). The acceptance of TAWISL was greater than that of COACAS (P < 0.05).
CONCLUSION
Compared with COACLAS, TAWISES is safe and effective and better meets the cosmetic, psychological and social adaptation needs of patients. TAWISES is also more cost effective and can be better utilized for the population in our region, filling the gap in surgical modalities for thyroid cancer in in our region.
Topics: Humans; Female; Thyroid Neoplasms; Male; Retrospective Studies; Middle Aged; Follow-Up Studies; Adult; Thyroidectomy; Mastectomy, Segmental; Postoperative Complications; Prognosis; Axilla; Case-Control Studies; Length of Stay; Operative Time; Endoscopy; Cost-Benefit Analysis; Pain, Postoperative
PubMed: 38937770
DOI: 10.1186/s12957-024-03445-y