RESUMEN
The moment magnitude (Mw) 5.5 earthquake that struck South Korea in November 2017 was one of the largest and most damaging events in that country over the past century. Its proximity to an enhanced geothermal system site, where high-pressure hydraulic injection had been performed during the previous 2 years, raises the possibility that this earthquake was anthropogenic. We have combined seismological and geodetic analyses to characterize the mainshock and its largest aftershocks, constrain the geometry of this seismic sequence, and shed light on its causal factors. According to our analysis, it seems plausible that the occurrence of this earthquake was influenced by the aforementioned industrial activities. Finally, we found that the earthquake transferred static stress to larger nearby faults, potentially increasing the seismic hazard in the area.
RESUMEN
OBJECTIVES: The latissimus dorsi (LD) flap is well-known in breast reconstruction especially in previously-irradiated patients, in order to have a low capsular contraction rate whenever an implant is associated. The aim of this study is to closely evaluate the effect of LD flap harvesting on shoulder function as well as specific movements related to the LD, both objectively and subjectively. MATERIALS AND METHODS: We retrospectively collected data on 86 patients who underwent pedicled LD muscle flap for breast reconstruction at the European Institute of Oncology between September 1995 until March 2011. RESULTS: The majority of patients showed a joint recovery superior to 80% in all joint movements examined. Disabilities of the Arm, Shoulder and Hand questionnaire revealed minimal disability similar to normal range and furthermore it appears to decrease in all sports and in particular in those who practice with LD involvement. CONCLUSION: Focusing this data, a growing, "disability-free" percentage changes depending on whether or not the patients have practiced sport could be appreciate.
Asunto(s)
Artropatías/fisiopatología , Mamoplastia/efectos adversos , Complicaciones Posoperatorias , Articulación del Hombro/fisiopatología , Colgajos Quirúrgicos/efectos adversos , Adulto , Anciano , Neoplasias de la Mama/fisiopatología , Neoplasias de la Mama/cirugía , Evaluación de la Discapacidad , Femenino , Humanos , Artropatías/etiología , Mamoplastia/métodos , Persona de Mediana Edad , Estudios Prospectivos , Rango del Movimiento Articular , Estudios Retrospectivos , Músculos Superficiales de la Espalda/trasplanteRESUMEN
OBJECTIVE: Vulvar cancer is a relatively rare tumour accounting for just 5% of all gynaecological malignancies. Radical excision can sometimes involve the distal one-third to one-half of the urethra leading to postoperative problems with micturition, asymmetries and psychosexual distress. Although this topic has been largely addressed, no specific method for distal urethra reconstruction has been described. The aim of this paper is to assess the safety and reliability of our reconstructive technique. METHODS: We conducted a retrospective study of 47 consecutive patients who underwent neourethral meatus reconstruction with vaginal mucosa flap. The surgical technique is described step-by-step. We reviewed the patients' demographics, operative characteristics, as well as immediate complications and long-term outcomes. RESULTS: Neo-meatal reconstruction was combined to direct vulvar closure in 2 patients, rhomboid flaps in 3 cases, 1 bilateral lotus flap and 36 V-Y fasciocutaneous flaps, 4 rectus abdominis and 1 gracilis flap. Wound dehiscence at the site of the neourethral reconstruction occurred in only 4.3%, partial necrosis of the vaginal mucosa flap in 2.1%. Totally post-operative early complication rate including the whole procedures was 29.8% with a re-operation rate of 4.3%. Long-term outcomes were evaluated in 68.1% patients, including 18.7% of urinary incontinence, no urethral stenosis and 25% of narrowed vaginal introitus. CONCLUSION: Neourethral meatus reconstruction using the vaginal mucosa flap is a simple, safe and reliable technique with a very low early complication rate. We suggest that this flap could be a good option to preserve and restore urinary function in case of distal urethral amputation.
Asunto(s)
Procedimientos de Cirugía Plástica/métodos , Recto del Abdomen/trasplante , Colgajos Quirúrgicos , Uretra/cirugía , Vulva/cirugía , Neoplasias de la Vulva/cirugía , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Persona de Mediana Edad , Estudios RetrospectivosRESUMEN
BACKGROUND: Fat grafting is widely carried out in breast cancer patients to improve quality in breast reconstruction. Recently, in vitro and animal studies have questioned the role of adipose tissues in cancer development. DESIGNS: Matched-cohort study. We analysed: (i) 59 intraepithelial neoplasia patients who had undergone lipofilling, with no recurrence between primary surgery and lipofilling. (ii) A control group of 118 matched patients (two controls per lipofilling patient) with the corresponding recurrence-free intervals. Both groups were also matched for main cancer criteria. A local event (LE) was the primary end point, with follow-up starting from the baseline. RESULTS: Median follow-up was 63 and 66 months from surgery, and 38 and 42 from baseline, for the lipofilling and control groups, respectively; the 5-year cumulative incidence of LE was 18% and 3% (P = 0.02). Ki-67 was the significant factor in univariate survival analysis. A subgroup analysis showed that lipofilling increased the risk of LE in women <50 years, with high grade neoplasia, Ki-67 ≥ 14 or who had undergone quadrantectomy. CONCLUSION: Higher risk of LE was observed in intraepithelial neoplasia patients following lipofilling. Although further studies are required to validate our conclusions, patients belonging to this subgroup should be informed of these results and the potential risks.
Asunto(s)
Neoplasias de la Mama/cirugía , Carcinoma in Situ/cirugía , Seguridad del Paciente , Grasa Subcutánea/trasplante , Adulto , Anciano , Neoplasias de la Mama/diagnóstico , Carcinoma in Situ/diagnóstico , Estudios de Casos y Controles , Estudios de Cohortes , Femenino , Estudios de Seguimiento , Humanos , Lipectomía/efectos adversos , Lipectomía/métodos , Persona de Mediana Edad , Estudios Retrospectivos , Trasplante de Tejidos/efectos adversos , Trasplante de Tejidos/métodosRESUMEN
BACKGROUND: A small but significant proportion of patients with breast cancer (BC) will develop loco-regional recurrence (LRR) after immediate breast reconstruction (IBR). The LRR also varies according to breast cancer subtypes and clinicopathological features. METHODS: We studied 1742 consecutive BC patients with IBR between 1997 and 2006. According to St Gallen conference consensus 2011, its BC approximations were applied to classify BC into five subtypes: estrogen receptor (ER) and/or progesterone receptor (PgR) positive, HER2 negative, and low Ki67 (<14%) [luminal A]; ER and/or PgR positive, HER2 negative and high Ki67(≥ 14%) [luminal B/HER2 negative]; ER and/or PgR positive, any Ki67 and HER2 positive [luminal B/HER2 positive]; ER negative, PgR negative and HER2 positive [HER2 positive/nonluminal]; and ER negative, PgR negative and HER2 negative [triple negative]. Cumulative incidences of LRR were compared across different subgroups by means of the Gray test. Multivariable Cox regression models were applied. RESULTS: Median follow up time was 74 months (range 3-165). The cumulative incidence of LRR was 5.5% (121 events). The 5-year cumulative incidence of LRR was 2.5% for luminal A; 5.0% for luminal B/HER2 negative; 9.8% for luminal B/HER2 positive; 3.8% for HER2 non luminal; and 10.9% for triple negative. On multivariable analysis, tumor size (pT) >2 cm, body mass index (BMI) ≥ 25, triple negative and luminal B/HER2 positive subtypes were associated with increased risk of LRR. CONCLUSION: Luminal B/HER2 positive, triple negative subtypes and BMI ≥ 25 are independent prognostic factors for risk of LRR after IBR.
Asunto(s)
Biomarcadores de Tumor/análisis , Neoplasias de la Mama/patología , Neoplasias de la Mama/cirugía , Mamoplastia , Recurrencia Local de Neoplasia/etiología , Obesidad/complicaciones , Adulto , Anciano , Índice de Masa Corporal , Neoplasias de la Mama/química , Neoplasias de la Mama/etiología , Neoplasias de la Mama/terapia , Quimioterapia Adyuvante , Femenino , Estudios de Seguimiento , Humanos , Incidencia , Italia/epidemiología , Antígeno Ki-67/análisis , Metástasis Linfática , Persona de Mediana Edad , Análisis Multivariante , Clasificación del Tumor , Recurrencia Local de Neoplasia/epidemiología , Estadificación de Neoplasias , Obesidad/metabolismo , Modelos de Riesgos Proporcionales , Radioterapia Adyuvante , Receptor ErbB-2/análisis , Receptores de Estrógenos/análisis , Receptores de Progesterona/análisis , Estudios Retrospectivos , Factores de Riesgo , Factores de TiempoRESUMEN
BACKGROUND: Lipofilling has been indicated for postmastectomy and postlumpectomy breast reconstruction. The clinical literatures underline its technical efficacy but experimental studies raise important questions about the potential detrimental effect of adipocytes on the stimulation of cancer growth and reappearance. DESIGN: We collected 321 consecutive patients operated for a primary breast cancer between 1997 and 2008 who subsequently underwent lipofilling for reconstructive purpose. For each patient, we selected two matched patients with similar characteristics who did not undergo a lipofilling. RESULTS: Eighty-nine percent of the tumors were invasive. Median follow-up was 56 months from the primary surgery and 26 months from the lipofilling. Eight and 19 patients had a local event in the lipofilling and control group, respectively, leading to comparable cumulative incidence curves [P = 0.792; Hazard Ratio(Lipo vs No lipo) = 1.11 (95% confidence interval 0.47-2.64)]. These results were confirmed when patients undergoing quadrantectomy and mastectomy were analyzed separately and when the analysis was limited to invasive tumors. Based on 37 cases, the lipofilling group resulted at higher risk of local events when the analysis was limited to intraepithelial neoplasia. CONCLUSIONS: Lipofilling seems to be a safe procedure in breast cancer patients. Longer follow-up and further experiences from oncological series are urgently required to confirm these findings.
Asunto(s)
Adipocitos/trasplante , Neoplasias de la Mama/cirugía , Mamoplastia/efectos adversos , Mamoplastia/métodos , Recurrencia Local de Neoplasia/epidemiología , Adulto , Anciano , Femenino , Humanos , Persona de Mediana Edad , Modelos de Riesgos Proporcionales , Factores de Riesgo , Adulto JovenRESUMEN
BACKGROUND: Fat grafting is largely used to correct soft-tissue defects in any region of the human body. This study analysed its safety when the technique is used to correct defects after breast-cancer reconstruction. METHODS: A total of 158 patients who underwent 194 breast fat grafting procedures were analysed. Almost all patients (98%) had a personal history of breast cancer: conservative surgery or mastectomy with breast reconstruction. In all cases, fat grafting was performed according to the Coleman's technique by a single surgeon. RESULTS: Immediate complications included liponecrosis and infection in seven cases (3.6%) that required only daily dressings and oral antibiotics administration. In cases of fat grafting after conservative surgery, only four patients (5.9%) showed minor alterations in the postoperative mammograms, consisting of the appearance of benign images. CONCLUSION: Breast fat grafting can be a good solution to repair defects after breast-cancer treatment and reconstruction, and can reduce the indication for more extensive surgeries such as myocutaneous flaps. Postoperative complication rates are very low and there is little alteration in follow-up mammograms. Two points remain unclear--how much of the fat is absorbed after grafting and the potential risk of local 'dormant' tumour cells being stimulated to induce a local recurrence.
Asunto(s)
Tejido Adiposo/trasplante , Neoplasias de la Mama/cirugía , Mamoplastia , Adulto , Anciano , Anestesia General , Anestesia Local , Femenino , Humanos , Mamografía , Persona de Mediana Edad , Complicaciones Posoperatorias , Estudios Prospectivos , Adulto JovenRESUMEN
Small bowel perforation occurs in 3% to 5% of cases of blunt abdominal trauma. The initial clinical exam can be unremarkable because signs of hollow viscus injury (HVI) may take time to develop. Conventional radiograms are often unable to diagnosis of this subset of trauma. Three cases of jejunal perforation after a blunt abdominal trauma are described. One of these showed at laparotomy small sero muscular diastasis of the jejunum and multiple ecchymosis of the small bowel without peritonitis. The detection of this subset of trauma patients has improved markedly with CT, which has led to a decrease in the number of negative laparotomies performed. In our report CT imaging showed a increased thickness of bowel loop wall in left ipocondrium in the first and second case. In our small experience this sign suggest us a jejunal contusion in which an isolated perforating is always possible.
Asunto(s)
Perforación Intestinal/etiología , Enfermedades del Yeyuno/etiología , Heridas no Penetrantes/complicaciones , Adulto , Femenino , Humanos , Masculino , Persona de Mediana Edad , Adulto JovenRESUMEN
In order to reduce mutilation, nipple-areola complex (NAC) conservation can be proposed for the treatment of breast cancer when mastectomy is indicated. To reduce the risk of retro areolar recurrence, a novel radiosurgical treatment combining subcutaneous mastectomy with intraoperative radiotherapy (ELIOT) is proposed. One thousand and one nipple sparing mastectomies (NSM) were performed from March 2002 to November 2007 at the European institute of oncology (EIO), for invasive carcinoma in 82% of the patients and in situ carcinoma in 18%. Clinical complications, aesthetic results, oncological and psychological results were recorded. A comparison was performed between the 800 patients who received ELIOT and the 201 who underwent delayed one-shot radiotherapy on the days following the operation. The median follow up time was 20 months (range 1-69) for a follow up performed in 83% of the patients. The NAC necrosed totally in 35 cases (3.5%) and partially in 55 (5.5%) and was removed in 50 (5%). Twenty infections (2%) were observed and 43 (4.3%) prostheses removed. The median rate of the patients for global cosmetic result on a scale ranging from 0 (worst) to 10 (excellent) was 8. Evaluation by the surgeon in charge of the follow-up gave a similar result. Only 15% of the patients reported a partial sensitivity of the NAC. Of the fourteen (1.4%) local recurrences, ten occurred close to the tumour site, all far from the NAC corresponding to the field of radiation. No recurrences were observed in the NAC. In a group of patients characterized by a very close free margin under the areola, no local recurrence was observed. Overall, 36 cases of metastases and 4 deaths were observed. No significant outcome difference was observed between the 800 patients receiving intraoperative radiotherapy (ELIOT) and the 201 patients receiving delayed irradiation.
Asunto(s)
Neoplasias de la Mama/radioterapia , Neoplasias de la Mama/cirugía , Mastectomía Subcutánea/métodos , Pezones/efectos de la radiación , Pezones/cirugía , Adulto , Anciano , Femenino , Humanos , Periodo Intraoperatorio/métodos , Italia , Mastectomía Subcutánea/efectos adversos , Persona de Mediana Edad , Recurrencia Local de Neoplasia/epidemiología , Pezones/patología , Radioterapia Adyuvante/efectos adversos , Radioterapia Adyuvante/métodosRESUMEN
BACKGROUND: When the conservative treatment is not recommended, Nipple Sparing Mastectomy (NSM) is proposed more and more frequently for the surgical treatment of breast cancer. The risk of local recurrence behind the nipple areolar complex (NAC) is the main limiting factor of the NSM procedure. To minimize such risk, we proposed in 2002 a intraoperative radiotherapy of the preserved NAC. PATIENTS AND METHODS: From March 2002 to November 2006, 579 cases (in 570 patients) of NSM were performed for carcinoma. The median follow up time was 19 months (Range: 1-60). The subcutaneous mastectomy was performed through an incision removing a portion of the skin overlying the tumour. An extemporaneous histological examination was performed on the retroareolar glandular tissue. If the histology was positive the patient was not considered eligible. Then an intraoperative radiotherapy with electrons (ELIOT) of 16 Gy in one shot was delivered on the NAC area. An immediate breast reconstruction was done using implants in most cases and in several cases a musculocutaneous flaps, usually in large breast. The number of local recurrences was recorded and the correlation between their occurrence and the clinical and histological criteria were analysed using the Gray test statistical method in a competing framework. RESULTS: In 516 cases the negative retroareolar frozen section biopsy was confirmed by the final histology, while in 63 cases, the final histology showed foci of carcinoma. Seven out of these 63 cases underwent a secondary NAC removal. In the 56 cases which preserved areolas we did not observe any local recurrence after 19 months follow up. The probability of retro areola positive histology increases with the tumour size. and was not related to the nodal status. The rate of local relapses was 0.9% per year. We didn't find any significant difference in the local relapse rate according to different patient's and tumour's features. Most relapses were located close to the tumour bed but never in the NAC area. CONCLUSION: Our study confirms that the local recurrence rate in the NSM completed with local radiotherapy on the NAC is not higher than the usual rate observed in the literature and the preservation of the NAC does not increase the risk. The absence of local recurrence in the region where a portion of glandular tissue has been purposely preserved is a good argument in favour of ELIOT.
Asunto(s)
Neoplasias de la Mama/patología , Neoplasias de la Mama/cirugía , Mastectomía Subcutánea , Recurrencia Local de Neoplasia/patología , Pezones/patología , Adulto , Femenino , Humanos , Periodo Intraoperatorio , Mamoplastia , Persona de Mediana Edad , Pezones/cirugía , Radioterapia AdyuvanteRESUMEN
BACKGROUND: Acute Mesenteric Insufficiency (AMI) is a surgical emergency with a difficult methodological approach. Its high mortality is mainly due to delay in the correct diagnosis. In turn this is due to the lack of specificity of the clinical presentation and of the laboratory data and abdominal radiographic findings, especially in the early-middle phase. PURPOSE: To evaluate the positive predictive value (PPV) and negative predictive value (NPV) of Duplex Ultrasound (DU) of mesenteric vessels in the diagnosis of acute mesenteric ischaemia. PATIENTS AND METHODS: 325 patients were prospective analyzed with Duplex US (Aloka ssd 1700); 120 with acute abdomen (group A); 120 healthy subjects without abdomen preparation (group B); 85 healthy subjects with abdomen preparation (group C). We considered the B mode visualization, the vessel extension and diameter, the colour signal capture (enhancement), the velocitograms with systolic peak velocity and medium diastolic velocity. RESULTS: In 32 patients with high suspect of AMI we founded 21 really negative results, 3 wrong positive results, 5 really positive results, 3 false negative results. The PPV and NPV were respectively 0.62 and 0.87. CONCLUSIONS: The Duplex Us is more useful rather exclude than confirm AMI.
Asunto(s)
Abdomen Agudo/diagnóstico por imagen , Arterias Mesentéricas/diagnóstico por imagen , Ultrasonografía Doppler Dúplex , Abdomen Agudo/diagnóstico , Diagnóstico Diferencial , Humanos , Valor Predictivo de las Pruebas , Estudios Prospectivos , Sensibilidad y EspecificidadRESUMEN
In 26 patients (65-80 yr) with low risk of sudden death, the circadian rhythm of spontaneous ventricular arrhythmias was analyzed, throughout 72 h, by the Holter monitoring method. The prolonged ECG monitoring is indispensable to evaluate the real necessity of an antiarrhythmic therapy and to establish the therapeutic approach. Premature ventricular complexes (PVC): isolated, couplets and runs of ventricular tachycardia have been considered. The isolated PVC showed uniform distribution throughout 24h, with higher frequency/hour ratio (f/h) in females. Couplets and runs showed circadian diurnal distribution with higher f/h ratio in smokers and males. After analysis of the results, the patients were additionally subdivided into smokers and non-smokers. Since smokers showed a diurnal distribution of all kinds of arrhythmias, antiarrhythmic drugs whose pharmacological peak corresponds to the distribution peaks of arrhythmias were proposed. Non-smokers could be divided into two groups: a) patients with isolated extrasystoles which did not show a circadian rhythm of arrhythmias and who must be treated with retard-drugs, which give protection throughout 24h; b) patients with runs or couplets of PVC showing a circadian rhythm of arrhythmias and who must be treated with drugs whose pharmacological peak corresponds to the distribution peaks of arrhythmias.