The impact of surgical excision on pterygium induced astigmatism

Objective: The aim of this meta-analysis was to discuss evidence supporting the efficacy of adjuvant human papillomavirus (HPV) vaccination in reducing the risk of recurrent cervical intraepithelial neoplasia (CIN) 2 or greater after surgical treatment. Methods: A systematic literature search was performed for studies reporting the impact of HPV vaccination on reducing the risk of recurrence of CIN 2+ after surgical excision. Results were reported as mean differences or pooled odds ratios (OR) with 95% confidence intervals (95% CI). Results: Eleven studies met the inclusion criteria and were selected for analysis. In total, 21,310 patients were included: 4039 (19%) received peri-operational adjuvant HPV vaccination while 17,271 (81%) received surgery alone. The recurrence of CIN 2+ after treatment was significantly lower in the vaccinated compared with the unvaccinated group (OR 0.35; 95% CI 0.21–0.56; p < 0.0001). The recurrence of CIN 1+ after treatment was significantly lower in the vaccinated compared with the unvaccinated group (OR 0.51; 95% CI 0.31–0.83; p = 0.006). A non-significant trend of reduction rate of HPV persistence was observed in the vaccinated compared with the unvaccinated cohorts (OR was 0.84; 95% CI 0.61–1.15; p = 0.28). Conclusions: HPV vaccination, in adjuvant setting, is associated with a reduced risk of recurrent CIN 1+ and CIN 2+ after surgical treatment.

Download Full-text

Accuracy and Upgrade Rates of Percutaneous Breast Biopsy: The Surgeon's Role

The American Surgeon ◽

10.1177/000313481007601013 ◽

2010 ◽

Vol 76 (10) ◽

pp. 1084-1087 ◽

Cited By ~ 3

Author(s):

Windy Olaya ◽

Won Bae ◽

Jan Wong ◽

Jasmine Wong ◽

Sharmila Roy-Chowdhury ◽

...

Keyword(s):

Needle Biopsy ◽

Breast Imaging ◽

Breast Biopsy ◽

Imaging Study ◽

Surgical Excision ◽

Core Size ◽

Image Guided ◽

Core Samples ◽

Limited Sampling ◽

The Impact

We sought to evaluate the impact of needle core size and number of core samples on diagnostic accuracy and upgrade rates for image-guided core needle biopsies of the breast. A total of 234 patients underwent image-guided percutaneous needle biopsies and subsequent surgical excision. Large-core needles (9 gauge or less) were used in 14.5 per cent of cases and the remainder were performed with smaller core needles. More than four core samples were taken in 78.9 per cent of patients. In 71.8 per cent of cases, needle biopsy pathology matched surgical excision pathology. After surgical excision, upgraded pathology was revealed in 10.7 per cent of cases. Of 11 patients (52.4%) with benign needle core pathology who had upgraded final pathology on surgical excision, 10 had a Breast Imaging Recording and Data System score 4 or 5 imaging study. Lesions smaller than 10 mm were more likely to be misdiagnosed ( P = 0.01) or have upgraded pathology ( P = 0.009). Other predictors of upgraded pathology were patient age 50 years or older ( P = 0.03) and taking four or fewer core samples ( P = 0.003). Needle core size did not impact accuracy or upgrade rates. Surgeons should exercise caution when interpreting needle biopsy results with older patients, smaller lesions, and limited sampling. Discordant pathology and imaging still mandate surgical confirmation.

Download Full-text

Posterior Corneal Asphericity Effect on Postoperative Astigmatism after EDOF Intraocular Lens Implantation in Cataract Patients

Journal of Ophthalmology ◽

10.1155/2021/1877516 ◽

2021 ◽

Vol 2021 ◽

pp. 1-5

Author(s):

Mark Rabinovich ◽

Ivo Guber ◽

Laëtitia Jessy Niegowski ◽

Ana Maria Aramburu del Boz ◽

Danial Al Khatib ◽

...

Keyword(s):

Anterior Chamber Depth ◽

Q Value ◽

Corneal Surface ◽

Surgically Induced Astigmatism ◽

Postoperative Astigmatism ◽

Corneal Asphericity ◽

Induced Astigmatism ◽

The Impact ◽

Surgically Induced ◽

Cataract Patients

Aim. To assess the impact of posterior corneal asphericity on postoperative astigmatism. Methods. We included retrospectively 70 eyes of 70 patients that underwent cataract surgery. We included data of the Q value, Kmax, K1, K2, astigmatism AL, and ACD. We performed a vectorial analysis to calculate the astigmatic vectors. Results. Seventy eyes were evaluated. 40 eyes were of females (58%) and 30 of males (42%). The average cohort age was 73 ± 8.9 years. Axial length (AL) was 23.5 ± 0.9, anterior chamber depth (ACD) was 3.13 ± 0.3, and the average posterior Q value was −0.35 ± 0.2. The only significant predictive variable for the correction index (CI) was the posterior Q value (r = 0.24, p < 0.05) and for the surgically induced astigmatism (SIA) (β = 0.34, r = 0.58, p < 0.05). Conclusion. Posterior corneal surface asphericity significantly influences the surgically induced astigmatism and the overcorrection for cataract patients after Lucidis EDOF IOL implantation.

Download Full-text

A giant juvenile fibroadenoma in a 12-year-old girl: Case report and brief literature review

Journal of Clinical Images and Medical Case Reports ◽

10.52768/2766-7820/1235 ◽

2021 ◽

Vol 2 (4) ◽

Author(s):

Ekhlas S Bardisi ◽

◽

Ann Smeets ◽

Giuseppe Floris ◽

Chantal Van Ongeval ◽

...

Keyword(s):

Rare Variants ◽

Treatment Options ◽

Young Patients ◽

Surgical Excision ◽

Left Breast ◽

Normal Breast ◽

Breast Mass ◽

Breast Development ◽

Areolar Complex ◽

The Impact

Juvenile fibroadenoma is the most common breast mass in adolescents accounting for 0.5–4% of all cases of fibroadenomas. Giant fibroadenomas are rare variants and represent only 0.5% of all fibroadenomas, usually occurring in girls between the ages of 10 and 18. They are characterized by massive and rapid enlargement of a rubbery, mobile, and non-tender mass and defined as being larger than 5 cm or weighing more than 500 g. The aetiology is not well understood and is believed to be an increased sensitivity to normal oestrogen level. We present a 12-year-old Asian girl treated at the age of 8 for idiopathic precocious puberty, without known family history of breast masses or cancers, who developed spontaneous giant fibro-adenoma measuring 15cm X 17 cm. The patient was further evaluated via ultrasonography showing a sole large lesion of 15 X 17 cm in the left breast. Surgical excision with conservation of the developing breast parenchyma and nipple-areolar complex under general anaesthesia was performed. Histopathological findings after the surgical excision were suggestive of juvenile fibroadenoma. The patient has a normal breast development throughout 4 years follow-up. The rapid growth of a breast mass in such young patients can be of great concern causing a considerable impact on these patients’ psychological and emotional condition. One of the most important concerns is the impact on potential future mammary gland development. Therefore, it is crucial to promptly rule out malignant processes or phyllodes tumors and educate young patients and their families on treatment options that fit their concerns. In addition, the final cosmetic result is essential after the surgical excision; although the primary cause of asymmetrical breast enlargement is a benign mass, early surgical excision is efficient concerning the best possible cosmetic outcome. Keywords: Breast mass; juvenile fibroadenoma; giant fibroadenoma.

Download Full-text

The impact of surgical excision of the primary tumor in stage IV breast cancer on survival: a meta-analysis

Oncotarget ◽

10.18632/oncotarget.23189 ◽

2017 ◽

Vol 9 (14) ◽

pp. 11816-11823 ◽

Cited By ~ 1

Author(s):

Shuangshuang Lu ◽

Jiayi Wu ◽

Yan Fang ◽

Wei Wang ◽

Yu Zong ◽

...

Keyword(s):

Breast Cancer ◽

Primary Tumor ◽

Meta Analysis ◽

Stage Iv ◽

Surgical Excision ◽

Stage Iv Breast Cancer ◽

The Impact

Download Full-text

Synovial Sarcoma: Current Concepts and Future Perspectives

Journal of Clinical Oncology ◽

10.1200/jco.2017.75.1941 ◽

2018 ◽

Vol 36 (2) ◽

pp. 180-187 ◽

Cited By ~ 35

Author(s):

Silvia Stacchiotti ◽

Brian Andrew Van Tine

Keyword(s):

Synovial Sarcoma ◽

Tumor Biology ◽

Soft Tissue Sarcomas ◽

Predictive Biomarkers ◽

Surgical Excision ◽

The United States ◽

Future Research ◽

Global Methylation ◽

Neo Adjuvant Chemotherapy ◽

The Impact

Synovial sarcoma (SS) is a rare sarcoma driven by a translocation between SS18 and SSX 1, 2, or 4. With approximately 800 to 1,000 cases a year in the United States, it most commonly affects young adults between the ages of 15 and 30 years. The resultant tumors are either monophasic (pure sarcomas), biphasic (a combination or epithelioid and sarcomatous components), or poorly differentiated. The hybrid transcription factor SS18:SSX alters SWItch/Sucrose Non-Fermentable (SWI/SNF) chromatin remodeling and global methylation patterns that may allow for future therapeutic opportunities. In this review, we focus on the pharmacologic management of SS, both in the curative setting, where the standard approach is wide surgical excision combined with radiotherapy and/or (neo)adjuvant chemotherapy as appropriate, and in the palliative setting. In advanced disease, chemotherapy with anthracyclines and/or ifosfamide, trabectedin, or pazopanib has been demonstrated to be more active compared with other soft tissue sarcomas. In addition, a better understanding of the molecular and immunologic characteristics of SS has allowed for the identification of new potential targets and the development of novel biology-driven therapies that are all at different stages of testing. There include targeted agents, immunotherapy, and metabolic therapies. Because the impact of these strategies for improving SS outcome is still limited, current and future research is strongly needed to better understand the tumor biology, to identify predictive biomarkers, and to improve the outcomes for patients with SS.

Download Full-text

Risk of Preterm Delivery Associated with Prior Treatment of Cervical Precancerous Lesion according to the Depth of the Cone

Disease Markers ◽

10.1155/2013/686027 ◽

2013 ◽

Vol 35 ◽

pp. 721-726 ◽

Cited By ~ 18

Author(s):

Roberto Berretta ◽

Salvatore Gizzo ◽

Andrea Dall’Asta ◽

Eleonora Mazzone ◽

Michela Monica ◽

...

Keyword(s):

Preterm Delivery ◽

Precancerous Lesion ◽

Inverse Correlation ◽

Intraepithelial Neoplasia ◽

Surgical Excision ◽

Cervical Stenosis ◽

Spontaneous Preterm Delivery ◽

Complication Risk ◽

Subsequent Fertility ◽

The Impact

The aim of this study was to evaluate the impact of the surgical excisional procedures for cervical intraepithelial neoplasia (CIN) treatment both on subsequent fertility (cervical factor) and pregnancy complication (risk of spontaneous preterm delivery). We retrospectively analyzed 236 fertile women who underwent conization for CIN. We included in the study 47 patients who carried on pregnancy and delivered a viable fetus. Patients were asked about postconization pregnancies, obstetrical outcomes, and a possible diagnosis of secondary infertility caused by cervical stenosis. We evaluated the depth of surgical excision, the timing between cervical conization and subsequent pregnancies, surgical technique, and maternal age at delivery. We recorded 47 deliveries, 10 cases of preterm delivery; 8 of them were spontaneous. The depth of surgical excision showed a statistically significant inverse correlation with gestational age at birth. The risk of spontaneous preterm delivery increased when conization depth exceeded a cut-off value of 1.5 cm. Our data do not demonstrated a relation between conization and infertility due to cervical stenosis.

Download Full-text

Estimate of false-positive breast cancer diagnoses from accuracy studies: a systematic review

Journal of Clinical Pathology ◽

10.1136/jclinpath-2016-204184 ◽

2017 ◽

Vol 70 (4) ◽

pp. 282-294 ◽

Cited By ~ 2

Author(s):

Nereo Segnan ◽

Silvia Minozzi ◽

Antonio Ponti ◽

Cristina Bellisario ◽

Sara Balduzzi ◽

...

Keyword(s):

Breast Cancer ◽

Systematic Review ◽

False Positive ◽

Surgical Excision ◽

Cochrane Library ◽

Needle Core Biopsy ◽

Eligibility Criteria ◽

Cross Sectional ◽

The Impact ◽

Positive Breast Cancer

BackgroundFalse-positive histological diagnoses have the same consequences of overdiagnosis in terms of unnecessary treatment. The aim of this systematic review is to assess their frequency at needle core biopsy (CB) and/or surgical excision of the breast.MethodsPubMed, Embase, Cochrane Library were systematically searched up to 30 October 2015. Eligibility criteria: cross-sectional studies assessing diagnostic accuracy of CB compared with surgical excision; studies assessing reproducibility of pathologists reading the same slides. Outcomes: false-positive rates; Misclassification of Benign as Malignant (MBM) histological diagnosis; K statistic. Independent reviewers extracted data and assessed quality using an adapted QUADAS-2 tool.ResultsSixteen studies assessed CB false-positive rates. In 10 studies (41 989 screen-detected lesions), the range of false-positive rates was 0%–7.1%. Twenty-seven studies assessed pathologists' reproducibility. Studies with consecutive, random or stratified samples of all the specimens: at CB the MBM range was 0.25%–2.4% (K values 0.83–0.98); at surgical excision, it was 0.67%–1.2% (K values 0.86–0.94). Studies with enriched samples: the MBM range was 1.4%–6.2% (K values 0.57–0.86). Studies of cases selected for second opinion: the MBM range was 0.29%–12.2% (K values 0.48 and 0.50).ConclusionsHigh heterogeneity of the included studies precluded formal pooling estimates. When considering studies of higher sample size or methodological quality, false-positive rates and MBM are around 1%. The impact of false-positive histological diagnoses of breast cancer on unnecessary treatment, as well as that of overdiagnosis, is not negligible and is of importance in clinical practice.

Download Full-text

Maximising Refractive Outcomes with an Extended Depth of Focus IOL

The Open Ophthalmology Journal ◽

10.2174/1874364101812010273 ◽

2018 ◽

Vol 12 (1) ◽

pp. 273-280 ◽

Cited By ~ 2

Author(s):

Barry Power ◽

Rory Murphy ◽

Antonio Leccisotti ◽

Tara Moore ◽

William Power ◽

...

Keyword(s):

Cohort Analysis ◽

Visual Outcome ◽

Corneal Astigmatism ◽

Depth Of Focus ◽

Extended Depth Of Focus ◽

Refractive Outcomes ◽

Department Of Ophthalmology ◽

Induced Astigmatism ◽

The Impact ◽

Corneal Incisions

Objective: To assess the impact of the magnitude of preoperative and postoperative corneal astigmatism on refractive outcomes in patients undergoing cataract surgery or lens exchange with an extended depth of focus intraocular lens. To compare visual outcomes of steep and temporal on-axis corneal incisions. Setting: Department of Ophthalmology, Blackrock Clinic, Dublin, Ireland. Design: Prospective cohort analysis. Methods: Fifty-three consecutive adult patients (94 eyes) undergoing routine phacoemulsification with Symfony IOL implantation were analysed. Exclusion criteria: targets for mini-monovision, incomplete data, other ocular pathology. Data were prospectively collected on pre- and postoperative refraction, keratometry, distance vision, near vision, surgical wound site and Surgically Induced Astigmatism (SIA). Results: The average postoperative monocular Uncorrected Distance and Near visual acuities (UDVA and UNVA) were 0.12 LogMAR (± 0.1) (6/7.5+1) and 0.34 LogMAR (± 0.09) respectively. The average binocular UDVA and UNVA were 0.05 (± 0.07) and 0.29 LogMAR (± 0.06) respectively. Low levels of preoperative corneal astigmatism (0-0.99 D) were associated with better LogMAR UDVA and UNVA when compared with higher levels (> 0.99 D): 0.11 (CI 0.103-0.107) vs. 0.206 (CI 0.122-0.290) (p =0.015, CI 95%) and 0.33 (CI 0.316 - 0.356) vs. 0.39 (CI 0.34-0.43) (p =0.034, CI 95%) respectively. When patients with steep on-axis corneal incisions were compared with temporal on-axis corneal incisions, no difference was detected in visual outcome or SIA. Conclusion: The Symfony IOL is an effective surgical means of addressing presbyopia and reducing postoperative spectacle dependence. We stress caution when offering potential spectacle independence for patients with over 1D of preoperative corneal astigmatism as these patients achieve statistically significantly inferior and less predictable visual results.

Download Full-text

High-Risk Nonmelanoma Skin Cancers: Identification, Management, and Reconstruction

Facial Plastic Surgery ◽

10.1055/s-0040-1709132 ◽

2020 ◽

Vol 36 (02) ◽

pp. 141-147

Author(s):

Emily S. Misch ◽

Adam M. Terella

Keyword(s):

High Risk ◽

Surgical Excision ◽

Depth Of Invasion ◽

Perineural Spread ◽

Skin Cancers ◽

Immunocompromised Status ◽

High Risk Cancer ◽

The Impact ◽

Nonmelanoma Skin Cancers

AbstractHigh-risk nonmelanoma skin cancers of the head and neck may be identified through a variety of tumor risk factors, including location on the lips or ears, size > 2 cm, recurrence, patient immunocompromised status, poor tumor differentiation, > 6 mm thickness, Clark level V depth of invasion, and presence of perineural spread. Surgical excision is the mainstay of treatment, with Mohs' micrographic surgery typically preferred to standard surgical excision. When reconstructing these defects, ensuring negative margins is of utmost importance and delaying reconstruction until confirmation of margins is recommended. Attention to the impact of immunosuppression and adjunct radiation therapy on wound healing is important for an optimal cosmetic outcome. As with all high-risk cancer patients, close follow-up and surveillance of these patients is imperative.

Download Full-text