Minimizing re-excision after breast conserving surgery - a review of radiofrequency spectroscopy for real-time, intraoperative margin assessment.

Introduction: For early-stage breast cancer, breast-conserving surgery (BCS) plus radiation is standard-of-care. Nationwide, >20% of BCS patients require re-excision for positive margins, resulting in delayed adjuvant therapy, increased complications, emotional and financial stress for patients, and additional cost to the healthcare system. Although several methods may be employed to mitigate positive margins, no technique can fully address the need.

Identifying determinants of noise in a medical intensive care unit.

Continuous and intermittent exposure to noise elevates stress, increases blood pressure, and disrupts sleep among patients in hospital intensive care units. The purpose of this study was to determine the effectiveness of a behavior-based intervention to reduce noise and to identify determinants of noise in a medical intensive care unit. Staff were trained for 6 weeks to reduce noise during their activities in an effort to keep noise levels below 55 dBA during the day and below 50 dBA at night.

A novel modality for intraoperative margin assessment and its impact on re-excision rates in breast conserving surgery.

Background: A single center retrospective chart review was performed examining the ability of a novel radiofrequency probe (Margin Probe; Dune Medical Devices, Caesarea, Israel) for intraoperative margin assessment to reduce the number of reexcisions in breast-conserving surgery.

Methods: Reexcision rates were evaluated in one-hundred and twenty consecutive patients before and after the institution of the device. Utility of the device was evaluated by comparing intraoperative feedback with postoperative pathology reports.

Community airborne particulate matter from mining for sand used as hydraulic fracturing proppant.

Field and laboratory studies were conducted to evaluate the impact of proppant sand mining and processing activities on community particulate matter (PM) concentrations. In field studies outside 17 homes within 800m of sand mining activities (mining, processing, and transport), respirable (PM) crystalline silica concentrations were low (<0.4μg/m) with crystalline silica detected on 7 samples (2% to 4% of mass).

Radiation and depression associated with complications of tissue expander reconstruction.

Purpose: Rates of implant failure, wound healing delay, and infection are higher in patients having radiation therapy (RT) after tissue expander (TE) and permanent implant reconstruction. We investigated pretreatment risk factors for TE implant complications.

Patients And Methods: 127 breast cancer patients had TE reconstruction and radiation.

Paravertebral blocks in breast cancer surgery: is there a difference in postoperative pain, nausea, and vomiting?

Background: The purpose of this study was to evaluate postoperative pain and postoperative nausea and vomiting (PONV) in patients with paravertebral blocks (PVB) undergoing breast cancer surgery with or without axillary staging.

Methods: An Institutional Review Board approved, retrospective chart review from January 2007 to December 2009 was performed at a single institution. Charts were reviewed for type of breast cancer surgery, axillary staging, PVB, PONV, postoperative pain score, dosages of pain medication and antiemetic medication given in the Post Anesthesia Care Unit (PACU), and during the postoperative days (POD).

Using ChIP-based technologies to identify epigenetic modifications in disease-relevant cells.

The effect of epigenetic modifications on the regulation of gene expression and the concomitant relationship to human diseases has become a key area of biological research in recent years. Studies have suggested that there is direct correlation between epigenetic modifications, such as histone methylation, histone acetylation and DNA methylation, and gene expression in disease-relevant cells, including cancer cells. The development of chromatin immunoprecipitation (ChIP)-based technologies, such as ChIP-chip and ChIP-Seq, has facilitated the high-throughput genome-wide mapping of epigenetic modifications that enable researchers to define the epigenome in disease-relevant cells and use comparative ChIP-based epigenetic mapping to correlate changes in epigenetic modifications with key physiological changes in disease-relevant tissues, including cancer cells, stem cells and T-cells.

MammoSite accelerated partial breast irradiation: a single-institution outcomes analysis with 2 years of followup.

Purpose: To provide longitudinal follow-up and assess the intermediate outcomes in breast cancer patients treated with the MammoSite radiation therapy system.

Methods And Material: Ninety-two patients with histologically proven stage 0-II breast cancer were treated with MammoSite accelerated partial breast irradiation after breast-conserving surgery. The catheter was placed at the time of surgery or postoperatively.

Does failure to visualize a sentinel node on preoperative lymphoscintigraphy predict a greater likelihood of axillary lymph node positivity?

Background: Sentinel lymph node (SLN) mapping has become the standard of care for axillary staging in women with early-stage breast cancer. The purpose of the study was to investigate the hypothesis that nonvisualization of SLN on lymphoscintigraphy (LSG) predicts a subset of patients at risk of having a substantial burden of axillary tumor as evidenced by higher rate of lymph node involvement.

Study Design: We retrospectively reviewed the records of 1,500 patients who underwent dual-tracer SLN mapping for breast cancer between 1999 and 2004.

Predictors of residual invasive disease after core needle biopsy diagnosis of ductal carcinoma in situ.

Core needle biopsy (CNB) is used to sample both mammographically and ultrasound detected breast lesions. A diagnosis of ductal carcinoma in situ (DCIS) by CNB does not ensure the absence of invasive cancer upon surgical excision and as a result an upstaged patient may need to undergo additional surgery for axillary nodal evaluation. This study evaluates the accuracy of CNB in excluding invasive disease and the preoperative features that predict upstaging of DCIS to invasive breast cancer.

Placement technique and the early complications of balloon breast brachytherapy: Magee-Womens Hospital experience.

Backgrounds And Objectives: Open (OT) and percutaneous closed (PCT) techniques have been described for placement of the MammoSite catheter to deliver accelerated partial breast brachytherapy. We report early complications of both techniques.

Methods: A total of 125 patients underwent catheter placement for MammoSite high-dose rate brachytherapy, with 108 patients successfully completing treatment.

Is routine sentinel lymph node biopsy indicated in women undergoing contralateral prophylactic mastectomy? Magee-Womens Hospital experience.

Introduction: The routine use of sentinel node biopsy (SLNB) at the time of prophylactic mastectomy remains controversial. This retrospective study was undertaken to determine if SLNB is justified in patients undergoing CPM.

Methods: Between 1999 and 2004, 155 patients underwent contralateral prophylactic mastectomy (CPM) at the Magee-Womens Hospital of University of Pittsburgh Medical Center.

Preemptive analgesia with bupivacaine for segmental mastectomy.

Background And Objectives: Preemptive analgesia is the concept of providing analgesia before surgical incision, resulting in less postoperative pain. The purpose of this study is to determine if preemptive and/or postoperative local anesthetic infiltration of bupivacaine in patients undergoing segmental mastectomy results in less postoperative pain compared with patients receiving placebo.

Methods: In this prospective, double-blinded study, 120 patients were randomized into 4 groups: group 1, preincisional (10 mL) and postoperative (10 mL) wound infiltration of 0.

Selective intraoperative consultation for the evaluation of sentinel lymph nodes in breast cancer.

Background: Routine intraoperative evaluation of sentinel lymph nodes (SLNs) in breast cancer suffers from lack of sensitivity and consumes both time and resources. Failure to perform immediate consultation requires node-positive patients to return for delayed dissection.

Methods: We sought to determine whether selective use of intraoperative pathology consultation (IOC), based on the surgeon's clinical suspicion for metastases, would be accurate, avoid unnecessary consultations, and have a similar rate of delayed axillary dissection.