Radiation induced angiosarcoma a sequela of radiotherapy for breast cancer following conservative surgery

Radiation induced angiosarcomas (RIA) can affect breast cancer patients who had radiotherapy following conservative breast surgery. They are very rare tumors and often their diagnosis is delayed due to their benign appearance and difficulty in differentiation from radiation induced skin changes. Therefore it is very important that clinicians are aware of their existence. We report here a case of RIA followed by discussion and review of literature.     

Closed degloving injuries: results following conservative surgery.

Closed degloving wounds are uncommon but important injuries because they may be overlooked in the multiply injured patient and, if not treated correctly, may give rise to significant morbidity. This prospective study reports the results of a conservative surgical management policy in 16 patients with closed degloving wounds treated during a 1-year period in a tertiary referral center. Motor vehicle accidents caused most of the injuries, 69 percent of which occurred on the lower limb. The extent of injury ranged from 2 to 12 percent (mean 4.9 percent) of the total body surface area. The diagnosis of closed degloving wound was missed at initial assessment in one-third of patients. A uniform management policy with drainage of the degloved area through a small incision followed by compression bandaging was applied. The volume of blood and necrotic fat evacuated ranged from 15 to 800 ml (mean 120 ml). One patient with necrotic skin initially had excision and primary wound closure performed. Delayed necrosis occurred in one patient in whom extensive degloving occurred and effective compression could not be applied. Ultimate flap viability using this technique was excellent, since only 1 of 16 patents required skin grafting.     

Blepharo-canthal deformities in patients following craniofacial surgery

Functional problems and deformities of the eyes have become a major concern in the surgical treatment of ortital hypertelorism and craniofacial dysostosis, as experience with skeletal relocation for these disorders has been gained. Comprehensive preoperative and postoperative study and measurements of the bony orbits, the globes, the lids, the canthi, and the nose are necessary for the evaluation of present techniques and the design of alternative procedures. Some of the deformities of the blepharo-canthal complex are part of the congenital malformation. Other distortions, seen only postoperatively, are secondary to specific surgical maneuvers. Awareness of these primary and secondary factors has led to better soft tissue reconstruction at the time of the bony orbital translocations or the craniofacial disjunction. We describe the techniques which we have found especially useful in avoiding and correcting these postoperative blepharocanthal deformities.     

Breast cancer following breast reduction surgery in Sweden

Women undergoing breast reduction surgery have been reported to be at low subsequent risk of breast cancer, especially when the surgery is performed after age 40. To evaluate the age and time-related patterns of cancer risk following surgical removal of breast tissue, we identified 31,910 women who underwent breast reduction surgery from 1965 to 1993 in Sweden using hospital discharge register data. There were 19,975 women (63 percent) under age 40 at surgery. Linkages with Swedish registries for cancer, death, and emigration were based on unique national registration numbers assigned to each Swedish resident. Cancer incidence was contrasted with that expected in the general population based on age- and calendar year-specific data from the nationwide cancer registry. Overall, 161 incident breast cancers were identified during 238,765 person-years of observation (mean, 7.5 years) compared with 223.9 expected (standardized incidence ratio = 0.72; 95 percent confidence interval = 0.61 to 0.84). The reduction in risk of breast cancer was most pronounced for women whose operations were performed after age 50 (SIR = 0.57) and for those followed for more than 5 years (SIR = 0.68). Among women operated on before age 40, risk was nonsignificantly elevated within the first 5 years after surgery (SIR = 1.47; 95 percent CI = 0.89 to 2.30) but tended to be reduced thereafter (SIR = 0.80; 95 percent CI = 0.55 to 1.13). The magnitude of the reduction in risk thus appears directly related to age at surgery. Women followed for an average of 7.5 years after bilateral breast reduction surgery, were at a statistically significant 28 percent decreased risk of breast cancer. The current study is thus consistent with a protective effect following partial removal of breast glandular tissue.     

Recurrent deformities following reduction mammaplasty and correction of breast asymmetry

In order to properly evaluate results after reduction mammaplasty and correction of breast asymmetry, it is necessary to follow patients for several years. Cases are presented in which unusual deformities occurred after an initial satisfactory result. Pregnancy, aging, and fluctuations in weight contributed to these deformities. A case of recurrent hypertrophy 4 years following a reduction mammaplasty is presented. Several cases of asymmetry corrected by a combination of reduction and augmentation had early satisfactory results but several years later again showed asymmetry due to recurrent ptosis or atrophy. In one case, a 10-year follow-up showed considerable deformity after an initial good result following asymmetrical augmentation. It is important to point out to patients that changes do occur and that occasionally additional surgery is necessary.     

Etiology of breast cancer. II. Epidemiologic aspects

The epidemiology of breast cancer is reviewed with particular emphasis on its etiology. A number of studies suggest that differences in breast cancer incidence are associated with differences in marital status, number of pregnancies, age at menarche, age at menopause, height and weight, socioeconomic status, geographic location and residence. However, in no case is the evidence adequate to establish a “cause and effect” relationship. The genetic component of these associations may be of primary importance, while other conditions such as marital status are probably indirect reflections of the operation of more fundamental factors.There is a general consensus that endocrine factors play an important part in mammary cancer occurrence. At present, the association between breast cancer and the presence of the virus-like (type B) particles in human milk is not established.     

Correction of secondary cleft lip deformities

Learning Objectives: After studying this article, the practitioner should be able to (1) describe the common secondary deformities of the cleft lip, (2) determine the appropriate timing for surgical intervention to correct the deformities, and (3) determine the best method of addressing each of the individual secondary deformities of the cleft lip. Secondary deformities are common in children born with a cleft lip and palate. Patients with cleft lip deformity will undergo multiple surgical procedures early in life, so it is imperative to prioritize treatment of their secondary deformities and minimize the number of interventions needed. Of the many approaches used to correct these problems, surprisingly few work well consistently. As with all plastic surgery, the timing and procedure should be predicated on the severity of the deformity.     

Musculoskeletal deformities following treatment of Wilms' tumour.

Wilms'' tumour is one of the most common neoplasms of infancy and childhood. Current treatment regimens result in a cure rate of about 80% for localized tumours but may also cause musculoskeletal deformities. Assessment of 21 patients previously treated for Wilms'' tumour showed that all had flank atrophy on the treated side. Radiologic abnormalities included asymmetry of vertebral bodies, vertebral end-plate irregularities, scoliosis, kyphosis, platyspondyly and hypoplasia of the ilium. Although the vertebral changes following radiotherapy for Wilms'' tumour are present from an early age and the potential is great for an increase in spinal deformity with growth, few spinal curves progress past 20 degree. Since one cannot predict which curves will progress, all such patients need careful orthopedic follow-up until skeletal maturity is achieved.     

Variation in breast cancer surgery in Ontario.

OBJECTIVES: To analyse the extent of variation by county and hospital in the use of breast-conserving surgery in the initial management of breast cancer and to assess some factors that might explain the observed variation. DESIGN: Population-based retrospective cohort study. SETTING: Ontario. PATIENTS: All women with breast cancer newly diagnosed from Jan. 1, 1989, to Dec. 31, 1991. MAIN OUTCOME MEASURE: Proportion of women undergoing unilateral breast cancer surgery who had breast-conserving surgery in each hospital and county. RESULTS: Of the 14,570 women with newly diagnosed breast cancer 12,815 (88.0%) underwent unilateral breast cancer surgery. The mean proportion of breast-conserving procedures by county was 52% and ranged from 11% to 84%. The proportion of breast-conserving procedures in individual hospitals with one or more cases of breast cancer per month ranged from 6% to 84%. The variations in the rates between hospitals was greater than that expected by chance alone (p < 0.0001). CONCLUSIONS: There was marked variation at the hospital and county level in the use of breast-conserving surgery in the initial management of breast cancer. This variation was strongly associated with the hospital where the surgery was performed.     

Occupied and unoccupied type II estrogen binding sites in human breast cancer

Using a saturation analysis over a wide range of [3H]estradiol at two temperatures 4 and 22 degrees C we have determined unoccupied (4 degrees C) and total (22 degrees C) type II estrogen binding site (EBS) levels in individual cytosols of 100 patients with breast cancer (50 post and 50 premenopausal). Exchange was found to be complete after 18 h at 22 degrees C and receptor degradation was negligible during this treatment. Steroid specificity and affinity determined by Scatchard and Rosenthal plot analysis were not altered at 22 degrees C. Carcinomas presented a higher total type II REBS level as compared unfilled type II binding sites or the classical ER, independently of menopausal status, phase of the menstrual cycle or positivity of ER. On the other hand, unoccupied type II EBS level was strongly correlated to the concentration of type I ER, being higher on the post-menopausal group and older patients.     

Reduction mammaplasty following radiation therapy for breast cancer.

This report describes an unusual case in which reduction mammaplasty was performed following radiation therapy for breast cancer. While healing was significantly prolonged (compared with the nonirradiated contralateral breast), the final result was satisfactory from both the functional and the aesthetic standpoint. Women with prior radiation therapy may be considered candidates for reduction mammaplasty. Patients should be warned of the increased risks of wound complications, the likelihood of delayed healing, and the possibility of pigmentation changes in the grafted nipple-areola complex. We elected to transpose the nipple as a full-thickness graft, but consideration also might be given to use of an inferiorly based pedicle flap.     

Toxic shock syndrome following breast and nasal surgery

Toxic shock syndrome is a rapidly developing disease which may be lethal if not recognized and treated early. While this disease is usually associated with menstruating females, it is being seen in both male and female patients following clean, elective surgery. Toxic shock syndrome has been reported following surgical procedures which normally have a very low incidence of postoperative wound infections. Toxic shock syndrome is associated with Staphylococcus aureus bacteria which produce the toxic shock syndrome toxin 1. Three patients with postoperative toxic shock syndrome, of varying degrees of severity, are presented. Prompt institution of resuscitative and therapeutic measures can prevent the potentially fatal outcome of this postoperative complication.