Background
Surgeons have increasingly performed breast-conserving surgery (BCS) utilizing oncoplastic techniques in place of standard lumpectomy for early-stage breast cancer. We assess oncologic outcomes after oncoplastic BCS for T1–T2 breast cancer.

Outcomes After Oncoplastic Breast-Conserving Surgery in Breast Cancer Patients: A Systematic Literature Review

If memory serves and I am not deceived by 20/20 hindsight, this prediction seemed far-fetched to me even in 1979, and it has, of course, been thoroughly disproved by the event. We now have a chess program that can beat almost anyone — soon, perhaps, with a little more speed, some more fine-tuning, one or two more clever search heuristics, a program that can beat absolutely anyone — built on the narrowest possible principles. Deep Blue not only has no idea of talking about poetry; it not only has no capacity for learning or abstraction; but indeed it knows astonishingly little about chess. The program has no idea of strategies, tactics, gambits, or forks; it cannot answer elementary questions about chess such as “If a bishop is now on a black square, will it ever be on a white square?” or “Is there a position in which white can mate black, if it is white’s move, and black can mate white, if it is white’s move?” or even “What is checkmate?” All that it can do is to generate a next move of extraordinary quality.

The Retrospective Review

Antimicrobial resistance (AMR) is a high priority across countries as it increases morbidity, mortality and costs. Concerns with AMR have resulted in multiple initiatives internationally, nationally and regionally to enhance appropriate antibiotic utilization across sectors to reduce AMR, with the overuse of antibiotics exacerbated by the COVID-19 pandemic. Effectively tackling AMR is crucial for all countries. Principally a narrative review of ongoing activities across sectors was undertaken to improve antimicrobial use and address issues with vaccines including COVID-19. Point prevalence surveys have been successful in hospitals to identify areas for quality improvement programs, principally centering on antimicrobial stewardship programs. These include reducing prolonged antibiotic use to prevent surgical site infections. Multiple activities centering on education have been successful in reducing inappropriate prescribing and dispensing of antimicrobials in ambulatory care for essentially viral infections such as acute respiratory infections. It is imperative to develop new quality indicators for ambulatory care given current concerns, and instigate programs with clear public health messaging to reduce misinformation, essential for pandemics. Regular access to effective treatments is needed to reduce resistance to treatments for HIV, malaria and tuberculosis. Key stakeholder groups can instigate multiple initiatives to reduce AMR. These need to be followed up.

Strategies to improve antimicrobial utilization with a special focus on developing countries

Objective:The aim of this study was to evaluate the long-term oncologic outcome after oncoplastic surgery (OPS).Background:OPS combines wide tumor excision with reduction mammoplasty techniques thus extending breast conserving surgery to large tumors that might else be proposed a mastectomy. Little

Long-term Results After Oncoplastic Surgery for Breast Cancer: A 10-year Follow-up.

Background:Reduction mammaplasty at the time of lumpectomy is a good option in women with breast cancer and macromastia. We critically evaluated refinements and outcomes of this technique.Methods:A prospectively maintained database was reviewed of all women with breast cancer who received lumpectomy

Oncoplastic Breast Reduction Technique and Outcomes: An Evolution over 20 Years.

The literature indicates various approaches regarding the properties of phenol, the target patient group, and the complication and recurrence rates. Although phenol is most frequently used to treat the fistulated form of the disease, it can also be applied for other types. The overall success and complication rates of the application is reported as 62-95% and 0%-2%, respectively. Phenol treatment in pilonidal disease can be used more frequently as an alternative method with acceptable success, complication, and recurrence rates.

/pdf/treatment-of-pilonidal-disease-by-phenol-application-4gfyag3ssl.pdf

Treatment of pilonidal disease by phenol application.

Oncological outcomes of the oncoplastic breast surgery in patients with locally advanced breast cancer (LABC) are not well defined. This study examined the effects of oncoplastic techniques for LABC in terms of localized control and survival. We also evaluated the esthetic results of patients who had undergone oncoplastic breast conservation surgery (OBCS) and their satisfaction with the outcome.
 The files and Medula (Probel Co.) database records of the patients were studied retrospectively. The esthetic evaluation was conducted by a panel. A validated satisfaction study was also performed.
 In total, 42 LABC cases (median age 48 years; range 33–69 years) were included. The median observation period was 61 months (range 26–151 months). Neoadjuvant chemotherapy (NACT) was administered in 32 (76 %) cases, and a pathologic complete response was observed in 7 (16.7 %) cases. The median T size during the post-NACT pathological study was 27 mm (range 0–44 mm). Oncoplastic reduction surgery was performed in 13 cases, a glandular flap in 7, Grisotti flap in 5, and latissimus dorsi flap in 3 cases. The median specimen weight was 198 g (range 103–812 g), and the mean surgical margin length was 8.7 mm (range 5–17 mm). The margin was positive in 7.1 % of cases, and the local repetition rate was 14.6 %. The total survival rate was 86.6 %, and disease-free survival was 59.6 %. The rate of excellent and good ratings by the esthetic assessment panel was 79.4 %. The satisfaction rate was 88.2 %. The early and delayed complication rate was 16.7 %. Oncoplastic techniques are suitable and safe for patients undergoing OBCS. These techniques do not pose a risk to oncological local control. No survival or follow-up problems were detected during the 5-year follow-up period, the esthetic results were acceptable, and the satisfaction rate was high.

The effectiveness of simultaneous oncoplastic breast surgery in patients with locally advanced breast cancer.

INTRODUCTION This study aims to evaluate the efficacy of a new antimicrobial stewardship program (ASP) on surgical antibiotic prophylaxis (SP) and antibiotics in discharge prescriptions used as a continuation of SP. METHODOLOGY The study included elective patients with clean and clean-contaminated wounds. The accuracy of the assigned SP was evaluated according to international guidelines. Primary outcome measures comprised appropriateness of prophylactic antibiotic indication, correct timing of initial dose, discontinuation of SP within 24 hours, and antibiotic prescription at discharge. A secondary outcome measure was to determine whether the effect of ASP was sustained long-term. RESULTS The total compliance rate for all stages of SP increased from 8% to 52.1% after the intervention (p < 0.05). When analyzed according to individual SP components, it was found that although ASP did not change first dose timing rates, it did affect the rates of prophylactic antibiotic indication, discontinuation of SP within 24 hours and antibiotic prescription at discharge, with statistical significance (p < 0.05). In addition, ASP continued to increase its effectiveness throughout the 3rd year. CONCLUSIONS Based on the findings of our study, it seems clear that the modified ASP introduced in our general surgery clinic can be used effectively and simply; in addition, this ASP increases its efficacy with time.

/pdf/a-new-antibiotic-stewardship-program-approach-is-effective-1n6m0hzmos.pdf

A new antibiotic stewardship program approach is effective on inappropriate surgical prophylaxis and discharge prescription.

Objective: Our purpose was to evaluate and compare the results of minimally invasive parathyroidectomy (MIP) with intraoperative parathormone (IOPTH) monitoring and conventional bilateral neck exploration (BNE) without IOPTH monitoring in patients with primary hyperparathyroidism (pHPT). Methods: Of the 68 patients in the study, 33 patients (48.5%) underwent MIP with IOPTH monitoring, and 35 patients (51.5%) bilateral neck exploration without IOPTH monitoring. Data regarding imaging, localization site, surgery performed, incision size, operative time, adenoma size, postoperative complication, and calcium/PTH measurements obtained at postoperative 6th and 12th months were collected from the patient charts. Results: A statistically significant difference was not seen between MIP, and BNE groups as for the amount of changes in PTH blood levels according to these two time points of the follow-up period (p>0.05). When compared with MIP group, in BNE group, blood Ca levels increased to a greater extent also at postoperative 12. month relative to postoperative 6. month (p=0.005). As for the comparison of the groups with successful, and failed outcomes, negative effects of male gender, and possession of at least one comorbidity on success rates were detected (p=0.007, and p=0.002, respectively). Statistically significant effects of type of surgery, and median size of the adenoma on success rates were not seen (p=0.314, and p=0.615, respectively ). Conclusion: Minimally invasive parathyroidectomy performed with IOPTH analysis, and parathyroidectomy using BNE method have similar, and acceptable success rates.

Minimally invasive parathyroidectomy versus bilateral neck exploration for primary hyperparathyroidism

Objective Metaplastic breast cancer (MBC) is a rare type of breast cancer that is considered to be clinically aggressive. The clinical significance and prognostic risk factors of MBC are limited. This study comprises a retrospective analysis of the clinical and pathologic findings of a series of patients treated for MBC. Materials and methods The files of 657 patients who underwent surgery because of breast cancer at our clinic were examined and the data found on 11 patients who were diagnosed as having MBC were analyzed. Results With a median age of 56 years, all patients were postmenopausal and presented with a palpable mass on physical examination. Symptoms of ulceration and skin involvement were seen in only one patient. Eight patients were diagnosed as having squamous cell carcinoma (SCC), and 3 had both SCC and osseous differentiation. The median diameter was 3.8 cm (max. 14 cm; min. 1.5 cm). Lymph node metastasis was detected in 5 (45%) patients. Progesterone (PR) and estrogen (ER) were both negative in 11 (100%) patients and 10 (90.9%) patients, respectively, and CerbB2 was negative in 7 (63.6%) patients. Patients were followed up for a median period of 15 months (range, 6-40 months); at the end of which, 10 patients survived and one died of cardiac arrest at 7 months post-operatively. No instances of local recurrence or distant organ metastasis were found in any patients. The overall patient survival rate was 90%. Conclusion There is no consensus on the clinical significance or best treatment approach for metaplastic carcinoma. In our study, patients with MBC were of advanced age, had tumors with large margins, high negativity for hormone receptors, and moderate- to well-differentiated histology.

/pdf/metaplastic-breast-carcinoma-analysis-of-clinical-and-2m2gakdlrj.pdf

Metaplastic Breast Carcinoma: Analysis of Clinical and Pathologic Characteristics - A Case Series.

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