Current controversies in the treatment of ductal carcinoma in situ of the breast.

The incidence of ductal carcinoma in situ (DCIS), a noninvasive form of breast cancer, has increased markedly in recent decades, and DCIS now accounts for approximately 20% of breast cancers diagnosed by mammography. Laboratory and patient data suggest that DCIS is a precursor lesion for invasive cancer. Controversy exists with regard to the optimal management of DCIS patients.

[Progresses in the treatment of early breast cancer. A mini-review].

The treatment of breast cancer has undergone continuous and profound changes over the last three decades; breast conservation therapy has been progressively validated as a safe alternative to radical mastectomy for patients with early stage breast cancer. Several large trials have shown that overall survival time of patients treated with conservative surgery and axillary dissection followed by radiation therapy is equivalent to that of patients treated with modified radical mastectomy, with better cosmetic outcomes and acceptable rates of local recurrence. Improvements in diagnostic work-up and the wider diffusion of screening programs have allowed the detection of smaller, often non palpable tumours, furtherly facilitating the widespread use of tumour localization and breast conserving techniques.

Conservative treatment of the central breast cancer with nipple-areolar resection: an alternative oncoplastic technique.

Conservative surgery with radiation therapy is the standard treatment for early-stage breast cancer. Nevertheless, the patients with subareolar breast cancer have been often excluded from breast-conserving surgery and treated with mastectomy because of the unacceptable cosmetic effect associated with the resection of the nipple-areola complex (NAC), as well as oncologic concerns about multicentricity or multifocality associated with these tumours. We show a conservative "oncoplastic technique" in which the resection of the central portion of the breast, including the NAC, can allow a wide excision of the tumour with uninvolved margins of resection and good cosmetic results.

Update in the treatment of locally advanced breast cancer: a multidisciplinary approach.

Locally advanced breast cancer represents a wide variety of neoplasms and constitutes approximately 10%-20% of the newly diagnosed breast cancers. These cancers may have widely different clinical and biological characteristics. According to the American Joint Committee on Cancer (AJCC) staging system, all of stage III disease is considered locally advanced.

Management of locally advanced breast cancer. Mini-review.

The term locally advanced breast cancer (LABC) encompasses a heterogeneous group of breast neoplasms; in the last revision of the American Joint Committee on Cancer (AJCC) staging system, all of stage III disease is considered locally advanced. LABC constitutes up to 20% of breast cancer in medically underserved populations in the United States and up to 75% of breast cancers in developing countries. The prognosis depends on tumor size, extent of lymph node involvement, and the presence or absence of an inflammatory component.

Gastro-intestinal symptoms as clinical manifestation of peritoneal and retroperitoneal spread of an invasive lobular breast cancer: report of a case and review of the literature.

Background: Distant spread from breast cancer is commonly found in bones, lungs, liver and central nervous system. Metastatic involvement of peritoneum and retroperitoneum is unusual and unexpected.

Case Presentation: We report the case of a 67 year-old-woman who presented with gastrointestinal symptoms which revealed to be the clinical manifestations of peritoneal and retroperitoneal metastatic spread of an invasive lobular breast cancer diagnosed 15 years before.

Synchronous bilateral breast carcinoma in a 50-year-old man with 45,X/46,XY mosaic karyotype: report of a case.

We report a case of synchronous bilateral breast cancer in a patient with ambiguous external genitalia attributed to a 45,X/46,XY mosaicism. To our knowledge, this represents the first such case ever to be reported. Mammography, ultrasonography, computed tomography, and magnetic resonance imaging all showed bilateral suspicious breast masses with microcalcifications.

Surgical treatment and MRI in phyllodes tumors of the breast: our experience and review of the literature.

Aims: To reassess the relationship between magnetic resonance imaging (MRI) findings and surgical resection margins in an attempt to address the issue of appropriate surgical management of phyllodes tumors (PT).

Methods: Three female patients with a large palpable mass suspicious for phyllodes tumors were studied by mammography (MX), ultrasound (US) and dynamic MRI and then underwent surgery.

Results: MRI demonstrated a rapidly and markedly enhancing multi-lobulated lesion.

Metastatic tumors of the umbilicus: report of two cases and review of the literature.

An umbilical nodule may be an early or late sign of metastatic spread from an internal malignancy. Usually it appears when the internal malignancy is widely disseminated and has been previously diagnosed. More rarely, such a nodule is the first sign of disease and eventually results in the diagnosis of the primary tumor.

Use of a new type of PTFE mesh in laparoscopic incisional hernia repair: the continuing evolution of technique and surgical expertise.

We present the results of our first 44 laparoscopic incisional hernia repairs. This study examines the effectiveness of this technique in patients presenting with a first-time or recurrent incisional hernia. From October 2001 to November 2002, a total of 45 consecutive patients underwent laparoscopic incisional hernia repair with a new form of expanded polytetrafluoroethylene (ePTFE) mesh.

[Surgical treatment of carcinoma of the left colon and rectum as an emergency. A new method for assessing operative risk].

Background/aims: The surgical treatment of the left colon and rectal cancer emergencies is still controversial. In our opinion the choices to be based on the general health status of the patient.

Methodology: The authors analysed a series of 63 patients submitted to immediate resection and anastomosis.

41-month follow-up of risk factors correlated with new coronary events in 708 elderly patients.

A prospective study correlated coronary risk factors with new coronary events in 192 elderly men and 516 elderly women, mean age 82 +/- 8 years. Follow-up was 41 +/- 6 months (range 24-44). Coronary events (myocardial infarction, primary ventricular fibrillation, and sudden cardiac death) occurred in 64 of 192 men (33%) and in 149 of 516 women (29%), P not significant.

Risk factors for atherothrombotic brain infarction in persons over 62 years of age in a long-term health care facility.

A history of systolic (greater than or equal to 160 mm Hg) or diastolic (greater than or equal to 90 mm Hg) hypertension, diabetes mellitus (fasting venous plasma glucose greater than or equal to 140 mg/dl), a history of cigarette smoking, fasting serum total cholesterol greater than or equal to 200 mg/dl and greater than or equal to 250 mg/dl, and obesity (greater than or equal to 20% above ideal body weight) were examined as risk factors for atherothrombotic brain infarction (ABI) in 144 men, mean age 81 +/- 8 years, and 391 women, mean age 82 +/- 8 years, in a long-term health care facility. ABI occurred in 33 of 144 men (23%) and in 68 of 391 women (17%), P not significant. A history of systolic or diastolic hypertension correlated with ABI in both men and women (P less than 0.

Risk factors for coronary artery disease in persons older than 62 years in a long-term health care facility.

A history of smoking 5 to 60 cigarettes per day, hypercholesterolemia (fasting total serum cholesterol 200 mg/dl or more), history of systolic (160 mm Hg or more) or diastolic (90 mm Hg or more) hypertension, diabetes mellitus (fasting venous plasma glucose 140 mg/dl or more) and obesity (at least 20% above ideal body weight) were correlated with coronary artery disease (CAD) in 138 men (mean age 82 +/- 8 years) and 380 women (mean age 82 +/- 8 years) in a long-term health care facility. CAD occurred in 43 of 138 men (31%) and in 103 of 380 women (27%), difference not significant. A history of smoking 5 to 60 cigarettes per day significantly correlated with CAD in men (p less than 0.