Obtaining a tailored breast resection is challenging in microcalcifications detected on screening mammography, and an accurate localization is required. The aim of this study was to compare the efficacy of radio‐guided localization (ROLL) versus ultrasound localization of a titanium clip with collagen (TCC) in terms of clear margins, re‐intervention rates, excess of resected breast tissue, and operative times in pure malignant microcalcifications detected on screening mammography. Two hundred and twenty‐one consecutive patients with malignant microcalcifications detected on screening mammography from a tertiary breast unit were reviewed: 177 patients were localized by TCC and 44 patients by stereotactic ROLL. A propensity score‐matched analysis was performed, followed by a logistic regression model, to avoid selection bias. Adequacy of resection was expressed as the calculated resection ratio considering lesion size. No differences were found in clear margins with ROLL versus TCC (77.3% vs 81.8%, adjusted OR 2, P = 0.27). Re‐operation rates were similar, being 11.3% with ROLL and 7.4% with TCC (P = 0.627). Mean resection volume was 46.2 cm3 with ROLL versus 54.2 cm3 with TCC (P = 0.222). Adjusted mean calculated resection ratio was 1.8 with ROLL and 2.1 with TCC (P = 0.38). Surgery time was longer with TCC compared to ROLL (69.6 vs 52.7 minutes, P < 0.0001). ROLL and TCC are equally effective to excise malignant microcalcifications with clear margins, providing similar re‐intervention rates and resection volumes.
Background: The oncologic benefit of upfront re-excision of involved margins after breastconserving surgery in the context of current multimodal clinical management of breast cancer is unclear. The aim of the present study was to assess the 5-years locoregional recurrence (LRR)-free and distant metastases (DM)-free survival probabilities in patients not undergoing re-excision of positive margins after lumpectomy for breast cancer. Methods: A cohort of 104 patients with positive margins not undergoing re-excision was matched by propensity score with a cohort of 2,006 control patients with clear margins after breastconserving surgery, treated between 2008 and 2018. A multivariate survival analysis was performed accounting for all variables related to LRR and DM, including adjuvant treatments. Results: After adjusting for potential confounders, avoiding to re-excise a positive margin after lumpectomy had no effect on 5-years LRR-free survival probability (HR 0.98, 95%CI 0.36-2.67, p=0.96) or 5-years DM-free survival probability (HR 0.37, 95%CI 0.08-1.61, p=0.18). No correlation was found between occurrence of LRR and number of involved margins (HR 1.28, 95%CI 0.10-12.4, Log-rank p=0.83), or extension of infiltrating disease (HR 1.21, 95%CI 0.20-7.40, Log-rank p=0.83), but a trend toward higher LRR probability was found for invasive ductal (HR 6.92, 95%CI 0.7-68.8, Log-rank p=0.10) and invasive lobular cancer (HR 12.95, 95%CI 0.79-213.6, Log-rank p=0.07) on positive margins. Conclusions: In the era of multimodal treatment of breast cancer and accurate strategies to reduce the probability of residual disease in the post-lumpectomy cavity, re-excision of positive margins might be omitted in selected patients with low-risk breast cancers.
Background and Objectives An accurate localization is mandatory to tailor breast lumpectomy in nonpalpable cancers. The aim of this study was to compare radio‐guided localization (ROLL) vs ultrasound localization of a titanium clip with collagen (TCC) in nonpalpable mass‐like breast cancers. Methods Two hundred seventy‐three consecutive patients were reviewed: 64 patients were localized by TCC and 209 patients by ROLL. Propensity score‐matched analysis was performed. Margin status and reintervention rates were compared. Adequacy of resection was expressed as the calculated resection ratio (CRR) considering lesion size. Loco‐regional and distant recurrence rates were assessed with ROLL vs TCC. Results No differences were found with ROLL vs TCC in clear margins (90.6% vs 89.1%; odds ratio, 0.74; P = 0.64) or reoperations (6.7% vs 1.6%; P = 0.529). ROLL allowed more tailored resections compared with TCC (adjusted CRR, 1.7 vs 2.7; P = 0.0008), particularly in lesions with associated extensive intraductal component (CRR, 3.0 vs 4.5; P = 0.017). Loco‐regional recurrence occurred in 1.9% of ROLL patients vs 3.2% of TCC cases (P = 0.628). Conclusions ROLL and TCC are equally effective to excise nonpalpable mass‐like breast cancers with clear margins, providing similar loco‐regional control. However, ROLL allows more tailored breast resections, particularly in lesions with the associated extensive intraductal component.
Introduction: Gastroesophageal reflux (GER) is defined as the reflux of gastric and/or intestinal contents into the esophagus. It is a common phenomenon, seen in 40-65% of infants and is due to transient relaxations of the lower esophageal sphincter.Many infants have daily episodes of GER, of short duration after meals, during sleepeven while awake. Its early diagnosis helps towards early intervention and successful treatment of complications. Furthermore, it contributes to improving the infant’s and the family’s quality of life. Physiotherapy as an adjunctive therapeutic intervention seems to be able to contribute significantly to the improvement of GER in infants. The goal is to improve movement, body posture, cardiorespiratory function and coordination in order to limit the phenomenon. Aim:The main purpose of this study was to investigate whether infants with GER, in addition to dietary and other instructions and any pharmaceutical intervention, also undergo physical therapy treatment to improve their symptoms. Additional objectives were to record the infant’s and the family’s quality of life, and to explore parents’ expectations of a physical therapy program. Patients and methods:Thirty infants with GER participated in the study. The research was conducted in Thessaloniki, Greece, in a regular pediatric gastroenterology clinic. The questionnaire was given to the parents and completed under the supervision of the researcher in case of need for clarification. Results:None of the 30 infants studied was following a physical therapy program. In addition, GER was found to have a great impact on parents’ quality of life, since 80% answered that they were significantly affected, not knowing how to manage the condition. Regarding the need for physical therapy intervention and informing parents, 70% answered that they would like to have information and help from a physical therapist. A percentage of 80% of parents were in favor of a physical therapy program that could contribute to the reductioneven the elimination of their children’s medication. Conclusions:Gastroesophageal reflux affects a large percentage of infants. In severe cases, if not treated in time, it can affect the health of young infants and the families’ quality of life. Most parents seem to trust a physical therapy program to improve their children’s health for the fastest recovery from GER. This research can be a pilot for further studies, in the context of a more holistic intervention by doctors and physical therapists in infants with GER symptoms.
Psychological harassment in the workplace is a silent epidemic nowadays and verbal abuse is the most common form of harassment in the health professions. The apparentdeeper causes of the phenomenon vary, making it difficult to investigate but at the same time necessary because of its serious impact on the individual, the organization and society. Given the characteristics of pediatric physiotherapy, as a specialized profession requiring interdisciplinary collaboration and direct contact with the pain and dysfunction of the delicate group of pediatric patients and their families, we can assume the existence of verbal abuse in this job. In this case, there are negative consequences for the dynamics of the treatment team and the quality of medical care. Purpose: This study aims to investigate the verbal abuse against physiotherapists in pediatrics, in Greece
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