Bilateral Cancer of the Breast

1982 ◽  
Vol 68 (2) ◽  
pp. 155-160 ◽  
Author(s):  
Marco Rosselli Del Turco ◽  
Stefano Ciatto ◽  
Giuliano Perigli ◽  
Domenico Borrelli ◽  
Maria Luisa Carcangiu ◽  
...  
Keyword(s):  
Lobular Carcinoma ◽  
Radical Mastectomy ◽  
Breast Cancers ◽  
Course Of Action ◽  
Younger Age ◽  
Average Annual Incidence ◽  
Contralateral Mastectomy ◽  
Second Breast Cancer

The authors reviewed a series of 2311 primary breast cancers followed-up from 1 to 11 years after radical mastectomy. Twenty-eight simultaneous and 40 metachronous contralateral breast cancers were observed in the study period with an average annual incidence rate of 4.5%. Younger age and histologic evidence of lobular carcinoma at first cancer diagnosis was significantly associated with contralateral cancer, whereas first cancer stage did not seem to be a risk factor. Contralateral metachronous cancer significantly worsened the expected prognosis, which was not true for simultaneous bilateral cancers. The possible reasons for this negative prognostic influence of a second breast cancer and the role of preventive measures such as contralateral mastectomy are discussed. At the present time, an accurate annual clinicomammographic follow-up seems to be the most advisable course of action.

scholarly journals Pulmonary embolism in patients with COVID-19: characteristics and outcomes in the Cardio-COVID Italy multicenter study

2020 ◽  
Author(s):  
Pietro Ameri ◽  
Riccardo M. Inciardi ◽  
Mattia Di Pasquale ◽  
Piergiuseppe Agostoni ◽  
Antonio Bellasi ◽  
...  
Keyword(s):  
Pulmonary Embolism ◽  
Pulmonary Involvement ◽  
Hospital Death ◽  
Bleeding Events ◽  
Younger Age ◽  
Sizable Proportion ◽  
Bleeding Episodes ◽  
Restricted Cubic Splines

Abstract Background Pulmonary embolism (PE) has been described in coronavirus disease 2019 (COVID-19) critically ill patients, but the evidence from more heterogeneous cohorts is limited. Methods Data were retrospectively obtained from consecutive COVID-19 patients admitted to 13 Cardiology Units in Italy, from March 1st to April 9th, 2020, and followed until in-hospital death, discharge, or April 23rd, 2020. The association of baseline variables with computed tomography-confirmed PE was investigated by Cox hazards regression analysis. The relationship between d-dimer levels and PE incidence was evaluated using restricted cubic splines models. Results The study included 689 patients (67.3 ± 13.2 year-old, 69.4% males), of whom 43.6% were non-invasively ventilated and 15.8% invasively. 52 (7.5%) had PE over 15 (9–24) days of follow-up. Compared with those without PE, these subjects had younger age, higher BMI, less often heart failure and chronic kidney disease, more severe cardio-pulmonary involvement, and higher admission d-dimer [4344 (1099–15,118) vs. 818.5 (417–1460) ng/mL, p < 0.001]. They also received more frequently darunavir/ritonavir, tocilizumab and ventilation support. Furthermore, they faced more bleeding episodes requiring transfusion (15.6% vs. 5.1%, p < 0.001) and non-significantly higher in-hospital mortality (34.6% vs. 22.9%, p = 0.06). In multivariate regression, only d-dimer was associated with PE (HR 1.72, 95% CI 1.13–2.62; p = 0.01). The relation between d-dimer concentrations and PE incidence was linear, without inflection point. Only two subjects had a baseline d-dimer < 500 ng/mL. Conclusions PE occurs in a sizable proportion of hospitalized COVID-19 patients. The implications of bleeding events and the role of d-dimer in this population need to be clarified. Graphic abstract

Early breast cancer: evaluation of the prognostic role of the site of the primary tumor.

1998 ◽  
Vol 16 (4) ◽  
pp. 1363-1366 ◽  
Author(s):  
R Zucali ◽  
L Mariani ◽  
E Marubini ◽  
R Kenda ◽  
L Lozza ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Early Breast Cancer ◽  
Distant Metastases ◽  
Breast Cancers ◽  
Prognostic Role ◽  
Long Term Follow Up ◽  
Internal Mammary

PURPOSE The prognostic role of the site of the primary breast cancer has not been clarified. This study aimed to gather more information about this issue from a large series of patients with long-term follow-up data. PATIENTS AND METHODS Data from 2,396 patients treated for early breast cancer with a conservative approach were reviewed (1973 to 1989). In 1,619 patients, the tumor had a lateral site, while in 777 cases, it was situated in the internal/central quadrants. The characteristics of the two groups were well balanced, apart from axillary nodal metastases, which were more frequent for lateral tumors (38.1% v 26.3%). RESULTS Analysis of distant metastases indicated that the regression coefficient associated with tumor site was significant and the hazards ratio estimate was 1.291, which indicates the risk of distant metastases was increased by approximately 30% for internal/central tumors. The analysis of overall survival yielded a significant coefficient and a hazards ratio of 1.192, which indicates an approximately 20% increase of mortality for internal/central tumors. CONCLUSION Early breast cancers situated in central/ internal quadrants have a worse prognosis compared with those in lateral quadrants, in terms of distant metastases and survival. Irradiation of the internal mammary chain for internal/medial tumors could be suggested, but, to date, the therapeutic strategy is still controversial.

scholarly journals What Are the Results and the Prognostic Factors of Motor Cortex Stimulation in Patients with Facial Pain? A Systematic Review of the Literature

2021 ◽  
pp. 1-6
Author(s):  
Alessandro Rapisarda ◽  
Eleonora Ioannoni ◽  
Alessandro Izzo ◽  
Nicola Montano
Keyword(s):  
Motor Cortex ◽  
Facial Pain ◽  
Univariate Analysis ◽  
Implantation Rate ◽  
Long Term Results ◽  
Motor Cortex Stimulation ◽  
Younger Age

<b><i>Introduction:</i></b> Facial pain (FP) is a type of neuropathic pain which recognizes both central and peripheral causes. It can be difficult to treat because it can often become resistant to pharmacological treatments. Motor Cortex Stimulation (MCS) has been used in selected cases, but the correct indications of MCS in FP have not been fully established. Here we systematically reviewed the literature regarding MCS in FP analysing the results of this technique and studying the possible role of different factors in the prognosis of these patients. <b><i>Methods:</i></b> A literature search was performed through different databases (PubMed, Scopus, and Embase) according to PRISMA guidelines using the following terms in any possible combination: “facial pain” or “trigeminal” or “anaesthesia dolorosa” and “motor cortex stimulation.” <b><i>Results:</i></b> 111 articles were reviewed, and 12 studies were included in the present analysis for a total of 108 patients. Overall, at latest follow-up (FU), 70.83% of patients responded to MCS. The preoperative VAS significantly decreased at the latest FU (8.83 ± 1.17 and 4.31 ± 2.05, respectively; <i>p</i> &#x3c; 0.0001). Younger age (<i>p</i> = 0.0478) and a peripheral FP syndrome (<i>p</i> = 0.0006) positively affected the definitive implantation rate on univariate analysis. Younger age emerged as a factor strongly associated to a higher probability to go to a definitive MCS implant on multivariate analysis (<i>p</i> = 0.0415). <b><i>Conclusion:</i></b> Our results evidenced the effectiveness of MCS in treating FP. Moreover, the younger age emerged as a positive prognostic factor for definitive implantation. Further studies with longer FU are needed to better evaluate the long-term results of MCS.

scholarly journals Cohort profile: The Australian Parkinson's Genetics Study (APGS)

2021 ◽  
Author(s):  
Svetlana Bivol ◽  
George D. Mellick ◽  
Jacob Gratten ◽  
Richard Parker ◽  
Aiobhe Mulcahy ◽  
...  
Keyword(s):  
Neurodegenerative Disorder ◽  
Study Patient ◽  
Individual Risk ◽  
Younger Age ◽  
Patient Reported ◽  
Genetic And Environmental Factors ◽  
Reported Data ◽  
Future Work

Purpose: Parkinson's disease (PD) is a neurodegenerative disorder associated with progressive disability. While the precise aetiology is unknown, there is evidence of significant genetic and environmental influences on individual risk. The Australian Parkinson's Genetics Study (APGS) seeks to study patient-reported data from a large cohort of individuals with PD in Australia to understand the sociodemographic, genetic, and environmental basis of PD susceptibility, symptoms and progression. Participants: In the pilot phase reported here, 1,819 participants were recruited through assisted mailouts facilitated by Services Australia (formerly known as the Australian Government Department of Human Services), based on having three or more prescriptions for anti-PD medications in their Pharmaceutical Benefits Scheme (PBS) records. The average age at the time of the questionnaire was 64 +/- 6 years. We collected patient-reported PD information and socio-demographic variables via an online (93% of the cohort) or paper-based (7%) questionnaire. 1,532 participants (84.2%) had a current PD diagnosis and consented to provide a DNA sample via a saliva sampling kit sent by traditional post. Of these, 1435 (94%) returned the saliva samples for genotyping. Findings to date: 65% of participants were male, and 92% identified as being of European descent. A previous traumatic brain injury was reported by 16% of participants and was associated with a younger age of symptom onset. At the time of the questionnaire, constipation (36% of participants), depression (34%), anxiety (17%), melanoma (16%) and diabetes (10%) were the most commonly reported comorbid conditions. Future plans: We are actively seeking funding to expand the project's scope and reach, including recruiting unaffected controls, and a follow-up questionnaire focused on non-motor symptoms and cognitive function assessment. Future work will explore the role of genetic and environmental factors in the aetiology of PD susceptibility, onset, symptoms and progression, including as part of international PD research consortia.

Effect of cannabis consumption on characteristics and evolution of thromboangitis obliterans

VASA ◽  
2021 ◽  
pp. 1-5
Author(s):  
Guillaume Bergère ◽  
Claire Toquet ◽  
Clément Hoffmann ◽  
Luc Bressollette ◽  
Alizée Raimbeau ◽  
...  
Keyword(s):  
Clinical Characteristics ◽  
Clinical Presentation ◽  
Thromboangiitis Obliterans ◽  
Tobacco Exposure ◽  
Free Survival ◽  
Younger Age ◽  
Arterial Involvement ◽  
Cannabis Consumption

Summary: Background: Thromboangiitis obliterans (TAO) is a distal non atherosclerotic thrombotic vasculitis affecting tobacco smokers. The role of cannabis co-exposure remains controversial. The study aims to assess how cannabis consumption influences clinical presentation and outcome of TAO in tobacco smokers. Patients and methods: TAO patients, according to Papa’s criteria, were included in a retrospective bicentric study between the 1st January 2003 and the 1st march 2020. Clinical characteristics, arterial involvement at TAO diagnosis, vascular event and amputations during follow-up were analyzed according to cannabis consumption. Results: Seventy-three patients with TAO patients were included. Forty-five patients were in Tobacco group (T) and 28 in Tobacco and cannabis group (T&C). Tobacco exposure was less important in T&C group than in T group (19.4±11.3 vs 31.6±16.6 pack-years) (p=0.005) and patients in T&C group were younger at TAO diagnosis than in T group (p=0.008). Patients in T&C group presented more claudication (33.3% vs 8.9%, p=0.01) and less upper limbs resting ischemia (25.9% vs 51.1%, p=0.04) than patients in the T group. No differences were found between groups with regard to arterial distribution. Amputation rate for patients who had at least one major or minor amputation did not differ between T and T&C group (25% vs 14.8%, p=0.38). Conclusions: Cannabis consumption was associated with a younger age of TAO onset. However, it does not affect amputation-free survival, Tobacco exposure is less important in T&C patients; data of this bicentric study suggest that cannabis could be a cofactor of tobacco which accelerates TAO onset.

Constituting and maintaining activities across sequences: And-prefacing as a feature of question design

1994 ◽  
Vol 23 (1) ◽  
pp. 1-29 ◽  
Author(s):  
John Heritage ◽  
Marja-Leena Sorjonen
Keyword(s):  
Conversation Analysis ◽  
Institutional Interaction ◽  
Course Of Action ◽  
Using Data ◽  
Spoken Interaction ◽  
Preceding Question

ABSTRACTThe role of the connective and is here considered as a preface to questions in spoken interaction. Using data from informal medical encounters, it is argued that and-prefacing is used to link a question to a preceding question/answer pair or pairs. In such contexts, and-prefacing indicates that the questions it prefaces have a routine or agenda-based character. This in turn can be a resource which invokes and sustains an orientation to an activity or course of action that is implemented through a series of question/answer pairs, but transcends any individual pair. The general characteristics of and-prefaced questions are contrasted with “contingent” or “follow-up” questions, which are not normally and-prefaced. Some strategic uses of and-prefaced questions are described, and the role of the device within the more general sociolinguistic context of the data is discussed. (Connectives, conversation analysis, discourse, institutional interaction, medical encounters, turn design)

scholarly journals Survival Outcomes in Male Breast Cancer – A Single Institution Experience

2018 ◽  
Vol 3 (4) ◽  
pp. 71
Author(s):  
Nisha Hariharan
Keyword(s):  
Breast Cancer ◽  
Male Breast Cancer ◽  
Treatment Guidelines ◽  
Ductal Carcinoma ◽  
Radical Mastectomy ◽  
Male Breast ◽  
Survival Outcomes ◽  
Breast Cancers ◽  
Breast Cancer Patients

Introduction: Male breast cancer is an uncommon entity. Due to the scarce numbers, treatment protocolshave largely been extrapolated from available evidence for female breast cancers.Methods: We analysed the clinicopathological features and survival outcomes for male breast cancer patients treated at our institute between January 2010 and June 2016.Results: Of the 5534 women treated at our institute, we screened 40 male breast cancers of whom 33 had available follow up data and were included in the present analysis. Male breast cancer constituted 0.7% of all breast cancers. The median age was 60 years and the median tumor size was 3cm with 66% of patients having nodal disease at presentation. Invasive ductal carcinoma was the most common histology and 97% were hormone receptor positive. Most of the patients (87.8%) underwent an upfront modified radical mastectomy. With a median follow up of 36 months, 10 patients experienced recurrences all of which were distant metastasis (3 to the bone, 1 to the brain, and 6 had visceral metastasis). Of these, 7 patients succumbed to the disease. The 3-year overall survival was 78.7 %.Conclusion: Male breast cancer is a rare clinical entity and current treatment guidelines follow those for women. Due to the lack of awareness, men often present to clinics at an advanced stage. Social support targeted at improving awareness and access to treatment could improve outcomes in this cohort.  

scholarly journals Breast Cancer Systemic Treatments and Upper Limb Lymphedema: A Risk-Assessment Platform Encompassing Tumor-Specific Pathological Features Reveals the Potential Role of Trastuzumab

2019 ◽  
Vol 8 (2) ◽  
pp. 138 ◽  
Author(s):  
Marco Invernizzi ◽  
Anna Michelotti ◽  
Marianna Noale ◽  
Gianluca Lopez ◽  
Letterio Runza ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Risk Assessment ◽  
Proportional Hazards ◽  
Growth Factor Receptor ◽  
Cox Proportional Hazards ◽  
Breast Cancers ◽  
Pathological Features ◽  
Systemic Treatments

Breast cancer related lymphedema (BCRL) is frequent but strategies for an individualized risk assessment are lacking. We aimed to define whether tumor-specific pathological features, coupled with clinical and therapeutic data, could help identify patients at risk. Data from 368 patients with node-positive breast cancers were retrospectively collected, including 75 patients with BCRL (0.4–25.6 years follow-up). BCRL was assessed during the standard follow-up oncology visits using the circumferential measurement. Clinicopathologic and therapeutic factors associated with BCRL were integrated into a Cox proportional hazards regression model. Lymphovascular invasion (LVI) was more common in BCRL patients (n = 33, 44% vs. n = 85, 29%, p = 0.01), akin extra nodal extension (ENE) of the metastasis (n = 57, 76% vs. n = 180, 61%, p = 0.02). Sentinel lymph node excision without axillary dissection and extra-axillary radiotherapy were BCRL-unrelated. A higher number of BCRL-positive patients were treated with taxane-based chemotherapy with or without trastuzumab, compared to BCRL-negative patients (p < 0.01). Treatment with trastuzumab and/or taxanes, adjusted for systemic infections, laterality, therapy, and pathological features (i.e., LVI and ENE), had a significant impact in BCRL-free survival (p < 0.01). This work offers new insights on BCRL risk stratification, where the integration of clinical, therapeutic, and tumor-specific pathological data suggests a possible role of anti-human epidermal growth factor receptor 2 (HER2) therapy in BCRL pathogenesis.

scholarly journals Association of CNR1 and INSIG2 polymorphisms with antipsychotics-induced weight gain: a prospective nested case–control study

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Natalia Jimeno ◽  
Veronica Velasco-Gonzalez ◽  
Inmaculada Fierro ◽  
Mercedes Duran ◽  
Alfonso Carvajal
Keyword(s):  
Weight Gain ◽  
Case Control ◽  
Natural Setting ◽  
Control Approach ◽  
Younger Age ◽  
Increased Risk ◽  
Clinically Significant ◽  
Nested Case Control

AbstractWeight gain is a frequent and severe adverse reaction in patients taking antipsychotics. The objective was to further investigate in a natural setting influential risk factors associated with clinically significant weight gain. An observational follow-up study was conducted. Patients when initiating treatment with whatever antipsychotic were included; a structured questionnaire was applied at baseline, 3 and 6 months later; a blood sample was obtained. In a nested case–control approach, patients with an increase ≥ 7% of their initial weight were considered as cases, the remaining, as controls. The results showed that, out of 185 patients, 137 completed the 6-month follow-up (cases, 38; controls, 99). Weight gain gradually and significantly increased in cases (baseline, 65.0 kg; 6 months, 74.0 kg) but not in controls (65.6 kg and 65.8 kg, respectively). Age (adjusted OR = 0.97, 95% CI = 0.96–0.99, p = 0.004), olanzapine (adjusted OR = 2.98, 95% CI = 1.13–7.80, p = 0.027) and quetiapine (adjusted OR = 0.25, 95% = 0.07–0.92, p = 0.037) significantly associated with weight gain. An association was also found for the CNR1 (rs1049353) and INSIG2 (rs7566605) polymorphisms. In conclusion, an increased risk of antipsychotics-induced weight gain was observed for younger age and olanzapine, and a relative lower risk for quetiapine. A potential role of CNR1 rs1049353 and INSIG2 rs7566605 polymorphisms is suggested.

Role of Sentinel Lymphadenectomy in Thin Invasive Cutaneous Melanomas

2003 ◽  
Vol 21 (7) ◽  
pp. 1326-1331 ◽  
Author(s):  
Richard J. Bleicher ◽  
Richard Essner ◽  
Leland J. Foshag ◽  
Leslie A. Wanek ◽  
Donald L. Morton
Keyword(s):  
Early Stage ◽  
Regional Lymph Node ◽  
Metastatic Potential ◽  
Nodal Metastasis ◽  
Lymph Node Status ◽  
Sentinel Nodes ◽  
Sentinel Lymphadenectomy ◽  
Younger Age

Purpose: Regional lymph node status is the strongest prognostic determinant in early-stage melanoma. Lymphatic mapping and sentinel lymphadenectomy (LM/SL) is standard to stage regional nodes because it is accurate and minimally morbid, yet its role for thin (≤ 1.5 mm) primary melanomas is unknown. Patients and Methods: Our melanoma database of more than 10,000 patients was reviewed for patients with melanomas ≤ 1.50 mm thick who underwent LM/SL. All had lymphoscintigrams and LM/SL via dye alone or with radiopharmaceutical. Patients with tumor-positive sentinel nodes (SNs) underwent completion dissections. Results: Five hundred twelve patients underwent LM/SL. Most were men (57%), and median age was 49 years. Most primary melanomas were on the torso (44%). Twenty-five patients (4.9%) had tumor-positive SNs. The thinnest lesion with a nodal metastasis was 0.35 mm. The SN-negative and SN-positive cohorts were equivalent by sex, but SN+ patients tended to be younger (P = .053), with significantly more SN metastases in those younger than 44 years (P = .005). No consistent pathology among SN-positive primary melanomas was found. Among those with 1.01- to 1.05-mm primaries, 7.1% were SN-positive. Among 272 patients with lesions ≤ 1.00 mm, 2.9% had positive SNs and 1.7% with lesions ≤ 0.75 mm had SN metastases. All 13 deaths were in SN-negative patients. Median follow-up durations in SN-positive and SN-negative patients were 25 and 45 months, respectively. Conclusion: The high nodal positivity rate associated with primary melanomas 1.01 to 1.50 mm thick suggests that LM/SL is indicated in this group. Younger age may be correlated with nodal metastases in patients with lesions ≤ 1.00 mm. Lesions ≤ 0.75 mm have minimal metastatic potential, and therefore LM/SL is rarely indicated.

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